Loading...
HomeMy WebLinkAbout040-1303-00-010 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561023 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town of 040-1303-00-010 CST BM Elev: Inspl~ BM Elev: BM Description: Section/Town/Range/Map No: w qg T - B2 > 22.28.19.1745 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark w Z_ O r Qa y iooa l Dosing Al BM / F 4 1-4 Z S p? Aeration Bldg. Sewer .7, I g t/ t Inlet $ S.p Holding ' b 95~ ~S TANK SETBACK INFORMATION St t Outlet TANK TO rP,/,L ELL BLDG. Vent to Air Intake ROAD Dt Inlet l^ Septic Dt Bottom / s~jt Dosing ► Header/ an. Aeration A Dist. Pipe Holding Bot. System -0 r Final Grade r PUMP/SIPHON INFORMATION C-7A' l &,jj a~ 14-1, " I Manufacturer GP Rand St Cover am/ CD J 8 7 7cJ Model Number - C~ /10/14 TDH Lift Friction Loss TDH Ft Forcemain Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Lengtp f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~J~( ' DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE LAKE/STREA LEACHING anufacturer: INFORMATION CHAMBER OR Ty Of System: UNIT Model Number 5G N D IBUTION SYSTEM lof-) 9,D-41 eader T_1` d Distribution x ole Size x Hole Spacing ent Air Inta e N Pi e s LengtDia Length Dia Spacing rD SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / e Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes D No J C, yi,,~l•~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ?J 1)2--113 nspection #2: Z0/3 Location: 662 Tradition Trail Hudson, WI 54016 (NW 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Trl ute Lot I Parcel No: 22.28.19.1745 ~J / 1.) Alt BM Description = F C o J e,` Gin 4; a ~ 20 ~3 ` 4-) A ah -R_.-•~ 56 2A) ` 0.}- 2.) Bldg sewer length = 54 63 - amount of cover = 0 00 3, Plan revision Required? ❑ Yes o - - L Use other side for additional information. L✓ 71 Cert. No. Date Insepctor's S-i4t.- SBD-6710 (R.3/97) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3/4/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 BENCHMARK V.R.P. Top of 1" cond ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 94.6/94.3'4.4' below qrade 133' Property Line Well is to meet all setbacks required by WDNR 4% 85' Slope 32' Vents y F~DB-2 5~ b 6.~. _ 1 10 ° 40' 92' 10' UY` ST _ 2-3' X 94' 'cells with >3' spacing All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. ro 3 Bedroom House Vent >6„ Quick4 Standard Scale is 1" = 40' of Cover Leaching Chamber with 20.0 ft2 of Area unless otherwise 12~~ 5.6ft^2/pair of end caps noted 4' Long Grade at System Elevation 34" Town Road carneres.wl gaw¢ 4;° , - Safety dnd Buildings 5-i W I County _ r111 W, Washington Ave. I>.O. Box 7162 tharummyd consi1 ~ Madison, W1 5"> - f1T ' ~;p" of Camniem Suuilevy f u[ cant Nua[L.:r (1u bu fI11uU iu by 'late 11"r111851G11UA NlmnlbC[ - Sanitary Pe,radt Application y i M ....a In acr:orda/toe with s. Comm. 83.2!(2), 1Vis A1~11a. Code, submission of this ti>rm to the appropriate gnventmtsntal unit is mquired prim to obtaining a sanitary permit. Note: Application torus for state-owned POWTS are Project Address (if ditterent than muiling address) submitted to the Department of Commerce. Personal infbrmation you provide muy be used for secondary purposes in accordance with the PrivacyLr1i•1, s. 15.04(l)(rn Stair. / f. Application Information - Please Print All luformatiou - tc~ Property Owner's Narrne - - - I Parcel 9l t.<<-__-- ,-?I- ~n 0-'Ie) /363 - co 6/0 Property Owner's Mai ' drtss-'--n--- ` Property l.uuatiar l 7 _ City, State Gip Code Phone Nurnl>er Govt. Lot / ^ - ~ Section 0/7 N; It 1 IlL Type of Building (check all that apply) ~ Lo 11 - r 2 Family Dwelling - Number of Bed. oonm Subdivision Nan - - - n - Public/Cununemial - Describe Use e_: U City ai',---- L.) State Owned --Describe Use CSM Number U Village of y z A-- "n, W, r CektS w ~3 =r Z- III. Type of Permit: (Check my one ibox on line A. Complete tine B if applicable) - - A` ew System 11 Replacatnunt System ❑ TreatmenUHolding'Fank Replacement Only U Other Modification to Existing System (explain) 1g. 0 Permit Renewal Revision Change of Plumber 171>c,rlnit'frausfer to New List Previous Permit Number aril Dale Issued - - )ermit Before Expiration Owner i I'W. T e of PO TS S stem/Com ouavnt/Device: (Check all that appiv)__-_- n-Pressurized In-Ground ❑ Pressw ized In-Ground ❑ A(-Grade L_I Mound ? 24 in. af'suilable soil U Mound < 24 in. of suitable soil C~ 1IolJing 'fardc' ❑ Other Dispersal Component (explain) - - j Pretreabneat Devicx (expla' - V. Dispersairfreatment Area Information: - _ = Desi 1 Flow (gpd)~ Design Soil Appiicac.ion (gpdsf) Dis ersal Area _ _ Design p Required (sl) ]dispersal Area Nropcrsi System Elev ion VI.'fankInfo Caaacityin Total bof Manufacturer ( iallons Gallons Units o , New Tanks - Existing ruuics Raq v a. U vi u, sn w Cy M. Septic or Holding Tank - - - Dosing haulbnr - - V.li_ Responsibility Statement- 1, the undersigned, assu esponsnbility Tor installation of the POW'TS shown on the attached plans. Pburttbe 'F Name (Print) Plumber' atone MP/MPR/S'Number Business Phone Numlwr a- 03 Plumber's Address (Street, city, State, Zip ( ode) , _1Y 3 -L 1 L ,,4J2-, 54_._ 0 ~ ~ZApproved [ Count /1De lartinent Use Only Duel Permit Fee Date Issued Issuing t Signature even I QuaiLlOrDonial -5 6k f . Cond*#tgWM /Reasons ibr Disapproval - m o...1;.r<~ 1. Septic tank effttibntflt®rand 3~ ~~~.I~+t~ 1 dispersal cell must all be services I main tat~led as .per management plan provided by plumbs 2. An se6ack requirements must. be maiotalrAd per ePPi:*tile Dole / wrdinanbes: _ Attach to complete plans for' the system and submit to the county only on paler not less titan 8 Vz x t 1 inches in site SI0-6398 (R. 02/09) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4s 22 /T 28 N 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/4/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUN ~AESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 66 BENCHMARK V.R.P. Top of 1" conduit ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.6/94.3'4.4' below qrade 133' Property Well is to meet all setbacks required by WDNR B-3 4% 85' Slope 32' Vents .M. 20' B-2 10' 40 92' 10' B-1 ST 2-3' X 94' ' cells with >3' spacing All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 50' Pro 3 Bedroom House 2L- Quick4 Standard Scale is 1" = 40' eaching Chamber ith 20.0 ft2 of Area unless otherwise .6ft^2/pair of end caps noted Grade at System Elevation 34Town Road f Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. G _ 2 00 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d Please print all information. Revi ed by Date _ c Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1 /4 7 1/4 2 T Z N R E (o e, Z Property Owners Maili d r ss Lot # Block # Subd. Nafne or CSM# n City State Zip Code Phone Number ❑ City ❑ Village own Nearest Road New Construction Use: Residential / Number of bedrooms- Code derived design flow rate J1~ GPD ❑ Replacement d ❑ Public or commercial - Describe: - - Parent material Flood Plain elevation if applicable ft. General comments and recommendations: System Type A-s System Elevation Ilz of- ❑ Bonng Boring # , 0 ft. Depth to limiting in. M W-Pit Ground surface elev.- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Z - Bori i ~ C] Boring Q ® ~ # ® pit Ground surface elell z ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 2 L I C U Effluent #1 = BOD > 30 < 220 mg(L and T >30 1150 ` Effluent #2 = BOD < 30 mg/L and TSS 130 mg/L CST Kariv (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 t Property Owner _ Parcel ID # Page of Boring # ❑ Boring F3-1 f'°t' Pit Ground surface elev. Y, / ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary. Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 7 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seD-9330 (e.6,oo) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4s 22 /T 28 N 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3/4/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUN~~A ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 BENCHMARK V.R.P. Top of 1" conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.6/94.3' 4.4' below qrade 133' Property Well is to meet all setbacks required by WDNR B-3 4% 85' Slope 32' Vents .M.* 20' B-2 10' 40' 92' 10' B-1 ST 2-3' X 94' ' cells with >3' spacing All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 50' Pro 3 Bedroom House Vent Quick4 Standard Scale is 1 = 40 ' Leaching Chamber with 20.0 ft2 of Area unless otherwise 5.6ft^2/pair of end caps j4'Long noted " t System Elevation 3 4" Grade a Town Road - cortlimerce.W1.90v Safety and Buildings Division CountyC + 201 W. Washington Ave., P.O Box 7162. v Ff - Msr@i srun, WI 5.3 07-1"-'! ti„n.ou v ~•,.,,.r ni ,t,. tw 1 t ood by . . ~s+cons~r' t pepartniew of con"imir: e 5 ~ 0 l` ' Sanitary Permit Application Number In acoordnnce with s. Comm. 83.21(2), Wis Adrn. Code, subouission of this liorrn to the. appropriate governmental unit is squired prior to obtaining a salutary permit. Note: Application tb ms for stale-owned. POWTS ate Project: A tfress (if dititrent than mailing address) submitted to the Department of Commeree. Personal information you proviclc^ ,fy U. used for secondary ru oses in accordance with the Privacy Lm i, s 15.041 (lm), - - - - / / j'~ (G ttt~~~++/ r~ *61 lieation Information PleasePrint All Infor on / /.n 1 i /~A~ l_ A r r - _ - _ - _ - Property Owner's Ntulte - Part el # propel ty Owner's Mailing Address Propr ly Location 0754-5) 3 3 r . 2 /4, Section _ City, State 'Lip Codc Phone Number 2 -7 '1IGtC Olle 1-------- - - 1 G_ N> 1tor~ II. Type of Building (check all that apply) Lot • ~ Subdivision Marne _ t or -2 Family Dwelling-- Number of Bedrooms U Public/Commercial - Describe Usk _ O City of CSMNumbcr - Vitlagcof State Owned -Describe M. Type of Permit (Check my one box on line A Complete line, B if applicable) New System 0 Replaucownt System ❑ Treatment/Holding Lank Replacement Only 0 Olhc r Modification to Existing System (explain List Ptti viols 1?eltnit Nnnrber and hate Issued - - - U. ❑ Peimit Renewal ❑ Ptamil Revision C.I Change oil,Mulober (I Permit Tiansfer to New ~ Beforc Expnitlion Owner t _ XV._Typc of PUW 1rS SystendCom +~~+ngnt/Devtce: (C:he~k all tLat a I on-Pressurized In-Ground H Pressui ized In-Ground At-Grade C_I Mound > 24 in. ol'suttable soil LE Mound ' 24 in. of suitable sail s I.j Pretreatment Device (rxplain)._ - -,I l loldint; Tank Other Dispersal (;ontponent (explain) - % y_~ •V Dispersay'!y at t Area Information, - - - ° - Proposed De-' f low (gpd)- Design Soil AppliQuion Rate(gp Utspeysat A ea Requrrecl (sl) DtspySal Area (s .levalion sip) - - - C,a~acity in Total 0 of Manufacturer VI. Tank Into C gallons Gallons Units N P Ww't'auks Existing"Parks ri U to y cn u. rte Scpuc or Holding Tank _ t - - - _ - - L'L- - - -_ti.._ - Dosing - - - - - VII. Responsibility Stntemerrt_X the l.ttrtersigncrl, assurn •pnastltlllty for installation of the P(JW'I'S shown 010. the allac le -p um• - Plumber's attire MYlMPRS Numhei- Business Phone Number Plat Zinc (Print) .~l~✓_- Plumbers Address (Street, (Stair zip (o L . Permit Fee ----____--D_-ate Iss-u--ed -_Issuing nt Signature. VApprovud bunt /De eminen-t U - - se oral - - - $ C.l Citven Reason , enlal IX. C'tlre irl o Jim- Disapproval-_- - ~t(n / RIG+~elo ~o pfd✓' - ivv~- 1.S p c etian , "fflu~lt dispersal cell must be s"rYl d 1 maintained T re>~ as per management plan provided by plumber. 2. All setback ica le codelordinances• maintained as per appl Atlelt:h to comptele plans for the system and submit to the Coaniy only on paper not 1"s than 9 tr7 x 1 i hrches rn size SBD-6398 (R. 02109) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1/17/13 Owner: Oevering Homes LLC Location: SE1/4 SE1/4 S22 T28 N,R19W Lot 10 Walnut Hill Farm Troy System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #226900 i PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 1/17/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1 /2' conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.6/94.3'4.4' below qrade All piping shall be SDR 30/34, within 10' Well is to meet all of tank, piping shall be Schedule 40. setbacks required by WDNR 327' Property Line Please note: soils are to be rechecked prior to installation and dug deeper B-3 to possibly lower 42' 4% Slope system elevation B.M.* Vents 2-3' X 66' cells with >3' spacing 12' 10' -2 -1 40' 92' 10' B-1 ST Pro 3 Bedroom 107' House I Vent >6„ Quick4 Standard Scale is 1 = 40' of Cover Leaching Chamber with 20.0 ft2 of Area unless otherwise 12" 10.2ft^2/pair of end caps noted 4' Long 34' Grade at System Elevation Town Road Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft 2 pair of end plates Finish grade elevation Typical Installation 99.0' Vent Al Grade Vent 3' 4" AT X30/34 Septic Tank 5' Long 1 5' 5' Long 1 3691 Grade at System Elevation Grade at System Elevation Spacing 5 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A 94.6' B 94.3' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of-...._. ILE INFORMATION SYSTEM SPECIFICATIONS Owner _ Septic Tank Capacity / al O NA Pcsrmii # Septic Tank Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer r2T ❑I NA Number of Bedrooms ❑NA Effluent Filter Model ❑ NA _ gal _ Number of Public Facility Units -A Pump Tank Capacity D NA j Estimated flow (average) -_Y 3ola1/day Pump Tank Manufacturer NA I Design flow (peak), (Estimated x 1.5) J L~ _ gal/da Pump Manufacturer _ - NA _ ~T. Soil Application Rate Pump Model NA ~ Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L L1 Sand/Gravel Filter d Peat Filter Biochemical Oxygen Demand (BOD,) x220 mg/L NA 0 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ~ 0 Disinfection L] Other: Pretreated Effluent Quality r Monthly average Dispersal Cell(s) D NA Biochemical Oxygen Demand (B+JDs) 530 mg/L -<[p-Ground (gravity) l] In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/t. -?94A ❑ At-Grade ❑ Mound - Fecal Coliform (geometric mean) X104 cfu/100ml © Drip-Line ❑ Other: iMaximum Effluent Particle Size Y in dia. d NA Other: CJ NA NA Other: ❑ NA ~Oilher: v-_ - - Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency 4- q month(s) (Maximum 3 years) ❑ NA linspect condition of tank(s) At least once every: - .year(s) (Pump out contents of tank(s) When combined sludge and scum equals one-third ('h) of tank volume 0 NA CJ onth(s) (Maximum 3 years) ❑ NA At least once eve linspect dispersal cell(s) every _ear(s) _ D NA I.-;lean effluent filter At least once every: ar s _ - - - 0 month(s) CI NA I aspect pump, pump controls & alan'r At least once every: d year(s) v month(s) ❑ NA Hush laterals and pressure test At least once every: p year(s) - C1 month(s) 1'.'ither: At least once every; d NA _ d year(s) )ther: U1 NA hMLAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master PPlumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must !include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i;;ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface, The dispersal cell(s) shall be oisually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. the ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 14!1 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION painting rproducts or other chemicals thElt: may impede POWTS check treatment tment tan cell(s), s} if high concentrations are detected have the contents of tht'• For new construction, prior to use of the the treatment process and/or damage the dispersal tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. may result in the backup olr se excess urface discharge ofrefFlulenp During power outages pump tanks may fib above normal levels. When power is restored discharged is the dispersal cell(s) in one large dose, overloading (s) and operating rvi the pump controls to restore normal levels To avoid this situation have the contents of the pump tank to sdtnym u PYg Servrcrny Operator prior to restoring power of a to the effluent pump or contact a Plumber or POWTS Maintainer t within the pump tank. or compact, the area within Do not drive or park vehicles over tanks and dispersal cells. Da not drive or park over, or otherwise disturb 15 feet down slope of any mound or at-grade soil absorption area. fat foundation of the O d alin Deduction or elimination of the following from the wastewater stream marodventh fper o diapers and prolong the antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; ; disinfectants; (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT propel. When the POWTS fails and/or is permanently taken out of g3.e vice the fold Aing steps shall) be taken to insure that the system is ProP y and safely abandoned in compliance with chapter Comm a Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. -The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliilrn abso replacement system: lacement ion A suitable replacement area has brottevaluated disturbance and co mpaction and sho` ldenot be 'infringed upontby egsuii ed and may be utilized for" The replacement area should b be protected ll result Failure to Replacetmthe ent systems mustecomiply with theh ule; en in t setbacks from existing evaluation to establish lot lines nd wells. for a new soil and site Z effect at that time. A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology/ a --holding tank may be installed as a last resort to replace the failed POWTS. WTS soil and ble aOha d ng tank may beeinstalled"as sit d The site has not been evaluated able replacement area. If no replacement rea ilure of the must be performed to locate a suitable P a last resort to replace the failed POWTS. 17 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNI NG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO (ENTER A SEPTIC, PUMP OR OTHER TREATMENT B TANK DIFFICULT NDE ANY CIRCUM TANCES. DEATH MAY RESULT. RESCUE Oi A PERSON FROM THE INTERIOR OF A TANK MA ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER FName Name ~c:2 Phone J Phone i J = k_ - 1 Vf SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Namh<~r` NamePhone Phon4/ ~Zy This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f1 and 383.54(1), (2) & (3), Vftconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK. MANTEN-ANCE AGREEMENT AND OWNERSHIP CERTWICA 'ION FORM Owner/Bu yar 14 A M ailing .Address C>° Al _ (Verification required front Planning & Zoning Del7artmeat ['or new constnictiou.) o 0 l 303 -W-0/v Ciity/State Eaarcel. Identificai:iotl Number ~ - - LEGAL DESCRIPTION l'ixiperty Locatior 2 -3N .R~ l 'V'~, Town of 1 _ _ ` Iloi: # _~~.7. Volume (:'.ertrtied Survey Map Volume Page Warranty Deed # _ - - _ - y Spec house 6e Ito Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every throe years or sooner, if needed, by a. licensed purr►pez. What YOU put into aie system call affect the - itnotion of the septic tank as a treatment stage ill the waste disposal system. Owner rnarllterrance responsibilities are specified in Wolf'". 83.52(1) and in Chapter 1:2 - St. Croix County Sanitary Ordinance. The property owner agrees to subunit to St. Croix County planning & zoning I)eparttueut a certification form, signed by the owner and by a master plumber, journeyman. Plumber, restricted plumber or a licensed Pumper verifying that (l) tln these ttic tank is wastewater disposal system is it, proper operating condition arid/of (Z) after inspection and pumping (if necessary), p less than 1 /3 full of sludge. system W'tit I/we, the undersigned have r le Deartment of Cic y u erce and fhelDepar tme t of Nt; pr atural Resources,bStatelof W iscU b ll' standards set tbrtL, lnereiri, as set by tt p (.ertilfication stating that your septic system has been maintained lutist be, completed and returned to the St,. (;roix. (.%ounty Planning Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this f:orrn are true to the best of my/our knowledge. I/we anl/are the owner(s) of the property described above, by virtue of a warranty deed recorded in ltegister of Deeds Office. rl~ V~ 'i` umber of bedrooms- . v bl~ - DATE IC r ATUj of `r l'PLICA:NI(S) it information that is misrepresented may resrxlt in the sanitary permit 11eing revoked. by the Planning & zoning .Department. with this application a recorded warranty deed from file Itegister of Deeds Office and it copy o1, the certified survey map if Include reference is rrlade in the warranty deed. (Rl!.V. (18!05) OAr :Zr~ { il„' Installation ST P I Dry fit the fester arse. into the and at thg centered under the aceeens opening. +ther Ipipe more ensure it it tank through the outlet or eivetrt waM not, than dither Insert onto pips unto the pipe (glue) additional pipe onto the outlet u Ft7 Z! While the rase is still dry fitted on the outlet pipa, measure the length of =w-inch pion needed to bracts the filter to the tank and wall if utillzing the optional supplemental side support. If side support mathod Is nut utilized, proceed to stop lour yrVi" :i Fur installattahs utilizing the vptimmi suppiernefttal side support: scluebt wild the %-inch pipe into Chit We case. If side support Method is not utilized, proceed to step four. Solvent wbid the Sltel case onto the nutlet Oilie. cartridge into the case, preilbini down anti! the filter r locks into 1nto t the litter c}f M the case. the battorn of If a VAS switch is utiiiaA:d_ insert limo the filter y g r*s x t:krckwlSE Spe and buck b turnip r fo :i;;'!c' a k Maintenance 1. I'he effluent filter should be cleaned every tune the raptlc tank Is serviced. 2. Open the outlet access opering to Inspect the tank and kitr r, + 8. Pump the septic tank aorriplertely, making sure to remove the siudga layer on the bottom of the talnk and not just the scum and effluent. :x: 4. once the efikrent level has bean lowered below the invert of thu outlet pipe, firmly pull up on the fitter handle to dislodge the ct cartridge from the case. 5. slide the cartridge up and el it of the case for cleaning, 6. I( a VRs switch connected to an alarrn Is present, the switch should be removed by turning counterclockwise 9(r, and deatied with water only. 7. While holding the cartridge; on Its bide (large flat surface facing tt down) over the actress upenigy, 1`111610 all the cartridge with water ei only, making sure all septage awtodai Is rhisad back Into tha tank- r a. if VRS switch is utilised, replace: by loserting into filter and turning dockwise 90o hg 9, Insert the filter cartridge bark into the cote, pressing down antic the filter locks into the bottoun of the case. IU.Rapiate and secure the Wit t e: i opening on the tank. 1:• ..on?. r. It "y1`; : 4~1 :'i!.'.luvt*, ~ k. u,- 'l tf.f : lrit k.1- SY.:S! wllvlw.beamawtexom. 877-.1 LRLTERS (653-4583) • N 1~ 4 ~ 1 1 t o 1 ~ " ca-s~ IMI ~ w r V~ FR% RR3 p,nrtr N' A - - - - - - - - - - - - - - - - - - ~a~y 1 0 1 i~ A~ A In 0 N ~ so UNPLATTE LANG OWN Q / o F- z sET WITNESS IROII Z00 s 000725•-E - - - / O Id L kA7N Qc PHYLLIS Aj$~ yp _ / / W 0 ►t CORNER FALLS M 36' OAK TREE ` S o<Z i N EAST LINE OF THE EAST LINE OF THE NW 1/4-SE 1/4 O n SW 1/4-NE 1/4 u7.66' S 00.1437' E 890.71' S or. _ 32.54 67. 1 3.1 37579.. w S 00nr2E - y - - - - <N 169.49 1 dC~ W- q'• 25. In , tt III ~i ~Q Ir ~ 1 ~ 12 ~ 1 f / / z I r 111 d 1` ° p~~ Qg J iV/ 6 5 -CL- LLJ it, z C7 1 I ~ V+~ nl 1 N11 CT ~_l'~ ~ : Y yf I O W j 1 r N 12'0 00 w 1 ' a~ 1,0 H _ N < 3 r 1 c 1 - _ L ` o -1 1 -.I4& - eR, \p Q~ T'3 9•? E W W ' 1~ ~'Niaot'7° 3''~! 1 IF Ipa' 1 if w 35.12' ' ~IC~+W I n 1- 0606 ' Mix IV 'It 0 i 1 1 ~ ~yya2 ~ ~ .21 1 ~H 1 \ 1 ' _cv I I- zz as m Q 292 oQ 0 !2 ca -1 OD 02/11/20 PM 3 04:59 Parcel 040-1303-00-010 P PAGE E 1 1 OF 1 Alt. Parcel 22.28.19.1745 040 - TOWN OF TROY Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - CITIZENS STATE BANK CITIZENS STATE BANK 375 STAGELINE RD PO BOX 247 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 662 TRADITION TRL SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.060 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T28N R19W PT NW SE WALNUT HILL Block/Condo Bldg: LOT 010 FARM LOT 10 (1.060AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-19W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 12/10/2003 748766 2471/591 WD 11/19/2003 747018 9/92 PLAT I i 2012 SUMMARY Bill Fair Market Value: Assessed with: 187904 24,100 Valuations: Last Changed: 08/20/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.060 27,500 0 27,500 NO 10 Totals for 2012: General Property 1.060 27,500 0 27,500 Woodland 0.000 0 0 Totals for 2011: General Property 1.060 35,800 0 35,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 8 1 3 3 7 1 8 Tx:4108037 STATE BAR OF WISCONSIN FORM 3 - 2000 973570 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX I THIS DEED, made between Citizens State Bank, Grantor, and Oevering 0ST CR IX CO., O., Homes, LLC, Grantee. Grantor quit claims to Grantee the following described real estate in St. EXERECMPT MPT#:NA NA FEE: 30.00 Croix County, State of Wisconsin (the "Property"): TRANS FEE: 177.90 Lots 10 and 29 of Walnut Hill Farm, All in the Town of Troy, St. Croix PAGES: 1 County, Wisconsin. Lots are sold `as is' with all faults. Recording Area Name and Return Address: Title One File 19148 Together with all appurtenant rights, title and interests. 040-1303-00-009 & 040-1303-0-029 Parcel Identification Number (PIN) This is not homestead property. Dated this 12th day of February, 2013. Citizens State Bank * Tom Van Pelt, President/CEO * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN Signature(s) . ST CROIX COUNTY. ) ss. authenticated this 12th day of February, 2013 Personally came before me this 12th day of February, 2013 the above named Tom Van Pelt, President/CEO of Citizens State Bank to me known to be the person(s) who * executed the foregoing instrument and acknowledged the TITLE: MEMBER STATE BAR OF WISCONSIN same. ([f not, authorized by § 706.06, Wis. Slats.) I THIS INSTRUMENT WAS DRAFTED BY *Evelyn Jaeger Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: Michael H Forecki, Attorney 12/11/201 ) (Signatures may be authenticated or acknowledged. Both are not necese=y 'Names of persons signing in any capacity must be typed or printed below 1 of 1 QUITCLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 scorisirt Department of Commerce SOIL EVALUATION REPORT Page of 3 W Division of Safety and BuMings in acoordancewith Comm 85. Wis. Adm. Code County sT Gl' el f 'V Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. L V T percent slope. scale or dimensions. north am m. and location and distance to nearest road. Cr-- Please print all Information. R by Date Personai kvkwn dm you provide may be used for secondary purposes (Privacy Law. s.15.04 (1) (m)). Ar~ V Property Owner ToDO Property Location T-O PP B3 ERS Te"f3 T- e/r A/lam IVM Govt. Lot All 04 5 S 1/4S 7-L T 2.8 N R / f (r) Property Owner's Mailing Address Lot # Block # Subd. Name or CSkW }i l f fl lei'( & O t 5 CA Wi LL AV-R- • /0 WA Nearest Road City NM2 state zip code Phone Number ❑ city ❑ Village (A Town bPPOE HTT MAJ SSOWe ( &5t) l'/8• t09-Roy SD. 6-100eR 0 New Construction Use. IA Residential I Number of bedrooms Code derived design flow rate r D D GPD ❑ Replacement ❑ Public or commercial - Describe: 4 Parent material /D &5 S OVA, SgNOY 00 6v~'+ Flood Plain elevation if applicable ft General comments and recommendations: ' fl'k~A- T~ S TAD St,~' T~9~(3/.e. - /fry i~y'~E'OtJ,csD ~1 Sys Jim Gl/lP1~ r n wring all-o~~ ❑ L/ p o B°' 'g # ® Pit Ground space elev. / ft. Depth to limiting factor / in. Rate Sol Application HMimn Depth Oomrttnt Color Redox Description Texture Structure Consistence Boundary Roots GPQff b in. Munsel Qu. Sz- Cont. Color Gr. Sz. Sh. 'Etf#1 'Etf#2 \ i O"Z 10023 G 2-Fshk ~f W 3 . s •,P % c . s 3 s S/✓ Shy d A ~ o . - Z ® Pit Grorxd surface elev. ft Depth to limiting fads in. Soft Application Rate t„ Horizon Depth Dominant Redgx Description Texture Sbucxure Consistence Boundary Roots GPD/fF Munsell Qu. Sz. Cont. Colt Gr. Sz. Sh. 'Eff#1 'Eff#2 n In. / D • /D 3 1. 2-fSdk W s' Eu SiL cs f- . z N z 17 o V1? z/A ,0 yA -41 Si L ' Effluent #1 = BM 5:o 30 1220 mg& and TSS >30 1150 mg& ' Effluent #2 = BOD < 30 mg& and TSS 130 Trot CST Name (Please Prim Signature i ' 22 •R • Zt~B R i Gl.`f"r" Address Ulbricht & Ass9ciates Date Evaluation Con dUCled Telephone Number Private SST- `1 20.03 715. 77a. • 3Yy 2-- 2812 10th Ave. Spring Valley, WI 54767 2~10 4&e,5 D 1/0. lp 0Y1. X09( 20. ovv 01/0•/096- ©yo• 1096. 70 - oar o yD . lo~'C~ ~'d • Dfi~ Gv~Lti ~ 7- ?bDV T.31E ~25TEDT- Property Owner Parcel ID # L ° r / o Z Boof F31 ' p t Ground surface elev 97. 7ft. Depth to l'nn" factor ~F in Hotlzon Depth Dominant Color Redox Description Texture Structtxe Corusisterrce sal Ratee Boundary Roots Wulf k~ MunseN Qu. Sz Cont. Color Gr. Sz. Sh. `E1 'F# ~ /0Y/Z 33 L ~~ShK 3 z 9•/ a SiL zfsG~ /f •S . 3 7•5 S/~ 2 ~h ~P v - • s 4 ° s s his { Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sol Rate i Horizon Deptfr Dominam Redox Description Texture StrurcNre Consistence Boundary Roots Gpf1R#= in Mu nsell CQu. Sz Cont. Color Gr. Sz Sh. •Efl#1 'E ! t~ LS pit Ground surface elev. ft.pth fo t~miting factor in. Sub Rate Horizon Depth Dor tnarrt Redox Description_ Texhfie Structure CanststOM Boundary Roots In. MurrceA Qu. Sz Cont Color Car, SZ. Sh. `E#lfE1 'Eff#2 t F Sorlng# 3 Weir Ground surface elev. i#. Depth to WrOV factor In. p's# -a Avpkefion Rate Horizon Depth Batt inan€ Redox Desalpt - Texture Structure C rebtence Boundary Roars OPOff in. Munsell OIL Sz. Cori. Color Gr. SZ. Sh. `Eff#1 *E f#2 t Effluent #1 = 8OD5 > 30:s 220 ntg& and TSS >30 < 150 mgil. ° Effluent #2 = BOD, 130 mg& and TSS < 30 mgfL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or treed material in an alternate format, please contact the department at 608-266-3153 or TTY 608-264-8777. sea a3a tRr~1 Gt1~G,v v l' h111 ,Cr~iPM • -wP S l e k S Te~DT- Proper€y Owner O z or 3 Parcel ID # L I - / page 1:1 17.71/ P t Ground surface elev. fl. Depth to !ir»itirig factor ? irz Soil icafion Ra ~ te f3omr; C 4wtxon Depth olor Redax Des tiara Texture Stn,~cture Consistence Boundary Roots GP(Nt~ In. Munsed Ou. Sz. Cunt. Color Gr. Sz. Sh. 'Eif#1 'Etf#2 o- ~o Y/z 313 /1cShK 3 3 7•S R S/G 2 n~ ~SLJ v ~rc - • s • o S S OS . 7 F-1 Bonng # El Oldng El pit Ground surface elev. Depth to lbilting factor in. Soll ica6 on Rate Horizon Deptfs f)ominant Col Redox Description Texture Structure Consistence Boundary Moots GPDff in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. •Elf#'t 'Eta Botirv ipit Ground surface elev. ft. `Ikpth to limiting factor in. El E] Std 'r~tiors Raie Horizon Depth Dominant Color RedDx Oesaiptras- Texttf a Structure Consistence Boundary Roots GPi) In. Munseif Ou. Sz. Curt. Color Gf. Sz. Sh. `Eti1#1 'E11#2 i i' 1 pit Ground surface elev. f#. Depth to limiting factor in. t-~ Ong F]' 50~ Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence aoundes Roots 43PON ! In. Munsell Qu. Viz. Cont. Color Gr. Sz. Sts. 'EW1 "Etf##2 Effluent #1 = SODS > 30 < 220 rngli_ and TSS >30 < 150 rngfl ° Effluent #2 = BOD5 < 30 mglt and TSS < 30 rnWL The Department of Commerce is an equal opportunity service provider and employer. If you creed assistance to access services or need material in an alternate forma(, please contact the department at 608-266-3151 or TTY 608 -264-9777. saua~wnzamol . PLOT PLAN WALNUT HILLS FARM. LOT # /D Pg. 3 of 3 Contour elevation lines. 49 = Backhoe Soil pits. Q = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE: 1 30 G-oT _ 0 ~i i t y 2,( y90 0 o o~ '2 '32- '7 y. so ' j3M ~ , zo 00,0 1,0 107 7- 40 r Ord& fo"w s~ ~a r 1-33 -