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040-1303-00-029
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 561026 0 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 040-1303-00-029 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 3 ~1 ( CST 22.28.19.1764 TANK INFORMATION ELEVATION DATA 3. / A)3 An 6) TYPE MANUFACTURER CAPACITY STATION ~S HI FS ELEV. ^-1 , `1• / 0 y Ages Septic Z Benchmark ~6 ~d d Dosing Alt. BM J~- Aeration Bldg. Sewer e /,3.5 s~. (P Holding St/Ht Inlet lt/ Q St/Ht Outlet TANK SETBACK INFORMATION TANK TO E P/L WELL BLDG. ntto take ROAD DtInlet Septic 3d 7 _ Dt Bottom 95, 1 Dosing 7 5d 7 zD Header/Man. 3•~ 77, 61 Aeration Dist. Pipe 2 L1.5 7?. Holding Bot. System 1,2- PUMP/SIPHON INFORMATION Final Grade z ~66 • fl Manufacturer I Demand St Coverer ~a ✓l. l GPM t'; i~... g•Y `7T• 5 Model Number S d Co z. 5 7' 7. TDH Lift) 5 riction Loss System Head TDH t 3 • 3 • °1 21 • ~ • l~ Forcemain Len h IDia. 7y Dist. to Well 1 66 /i z '7 sa SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 ve SETBACK SYSTEM TO L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION N CHAMBER OR UNIT Model Number: Type f 0 J ~b /6a ! 2 /66 / I DISTRIBUTION SYSTEM Header/Manifol~ Distribution L f x Hole Size x Hole Spacing! Ven Air Int i/ Z Pipe(s) K -IL Z 4 Z U Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seede /Sodded xx Mulched Bed/Trench Center J 75 Bed/Trench Edges Topsoil No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / ✓5/ 13 Inspection #2: Location: 248 Walnut Hill Way River Falls, WI 54022 (SE 1/4 SE 1/4 22 T29N R19W) Walnut Hill Farm aka The Tribute Parcel o: 22.28.19.1764 1.) Alt BM Description 1 G ana Ul M Li Bldg sewer length = Z t t Li b - amount of cover = J f ' D s#nature Plan revision R equired? Yes No L 75 13 ~ ~J? ~ Use other side for additional information. SBD-6710 (R.3/97) Date InsepctorCert. No. PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 114 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 99.8' 1.8' sand lift! BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P. same as benchmark Grading i s to be done to Pro Torn Road / divert run-off away fro ' 2<,. B.M.* Property Line 325 s cale 1/4' 1 01 B-3 98.5' 1 acre lot 98' Huffcutt Combo Tank 96.5' B-1 B- 5% Slope ,6 .n A rea 15' be I ow syste m Pro 3 is to remain (v Bedroom House undisturbed Tank is to be properly To S. Glover Road ` bedded and provided with I oc kdow n covers with approved warning el I is to meet all labels WDNR setbacks Propert 33~ County _ Industry Services Division ~'rv '1400 E Washington Ave Sanitary Permit Number ([o be fiVted m by Co.) ('.1 on, Box 77162 07 2 4Z^-, -61024 c, 'A $ Madison, WI 53707-7162 CC 4 J,~r Transaction Number anitary Permit Application nn 2 5 -741 In accord i PS 3.21Wis. Adm. Code, submission of this form to the appropria~ overnm~fSt~ Jt a PrQlect Address (if different than mailing address) is required o o ming a si.nitary permit. Nofe: Application forms for state-owned POW submittc t the Dc t of afety and Professional Servies. Personal information you provide may be used O~dary u se co ante with the Privacy Law, s. 15.04(1 )(m), Slats. _ 1. A li tion -Information - Please 1'rint Ali Information - Parcel # Property Owner's Name O" (O r,/3o3 o6 -o 2- el ),1 Property Location -7 t, Property owner's Mailing ress r 7 AerA- Govt. Lot s S 1! Section G~ Zip Code Phone Number /1, City, State trcle on I - T ~ N , k ~ ` G W 5, V 0 -7 ~cC~~i L~J I ~ H. T pe of Building (check ail that apply) LotN CCC Subdivision Narne or 2FamilyDwelling-Number ofBedrooms v y Bloc ❑ City of ❑ Public/Commercial - Describe Use CSM Number-- ❑ Village of - ❑ State Owned - Describe Use wn of III. Type of Permit: (Check only one box online A. Complete line B if applicable) A. New System I.7 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) _ List Previous Permit Number and Date lssued ❑ Change of Plumber El Permit Transfer to New B. ❑ Permit Renewal Permit Revision Owner Before Expiration ITL+~n - Irr 7 oi'NOWTS S stemlComptlnent/Devlce: (Check all that appiy}_ nd < 24 in of suitable s ip I p p D Ype ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ~'ZL/1i / o ❑ Pretreaiment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component V. Dis ersal/Treatment Area Information: sal Area Propo d (sf~ 5 ste levtuion Dispersn~e~uire ~ f~ S Pc ' ' Design Flow (gPd) Desig oil Applic• lion Rate(gpdsf) Dis rTJ (C// ~ - Manufactures J~ U D' C Capacity to Total # of b V °3 VI. Tank Info - Gallons Gallons Units _ - _ vC Newl'anks EaistingTanks w U rn a. 0 a Septic or Holding Tank - - Dosing Chamber 0 - the PO'NTS shown on the attached pans. VII. Responsibility Statentient- T, the undersigned, assume a onsibiiity for installation of ber Business Phone Number t Plumber's ame (Print) Plumber's are MP/MFRS No,, c ~17~ fry) 7iJ Plumber's Address (Street, City, State, Zip Code) Vol/ L,q~ Vill oil it /Depar : Use Onlle permit0ee Date Issued 2 I " •,ng Agei Signal e Approved ❑ DisapPrcved~/Z~ ~l 00 - - . Y ❑ Owner Given Reaso=L).'., IX, Conditions of ApproNal/Reasons for Disapproval CST~~ J/ Z9,,13 64 Attach to complete phrnsfor the system and submit to the County only nn paper no; less th- an a 02 x t t inches io size SBD-6398 (80313) Soil Test Plot Plan, Project Name Oevering Homes Shade ird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 #226900 Lot 29 Subdivision Walnut Hill Farm Date 5/25/13 SE 1/4 SE 1/4S 22 T 28 N/R19 W Township Troy Boring Q Well PL Property Line County ST. CROIX , BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 99.8' *HRPSame as Benchmark Pro Town Road 2~ 1 -ZC B.M.* Property Line Scale = 1/4 " = 1 Of B-3 98.5' 1 acre lot 97.5' 96.5' e B-1 B-2 A` 5% Slope To S. Glover Road Property Line 1 68.3' kU z ' r 140.15" tj - 000or ~ A~ , S 89'1J + *01 M w 22M 50* r 5 • y ~ S 891 rOi'm W 228-50 i No" aw ~ F -@7 w ~.w •w ~ ~1w i~ ~ r'► CIO" I 30 M i 47722 S.F. 1 S.1 45273 1.10 Ac./ 7 . w 11.04 Ac. 29' 54475 S.F. 1.25 A.C. 31 45409 1.04 s JJ~ 141.98" 202.5 U PLA TTEID LANDS , ~t~• VDU LINE OF THE Sl 3W I, QTHERS t 5~ 2~~~vARrMro~ DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH o WAUKESHA WI 53188-3789 K Contact Through Relay 9 www.dsps.wi.gov/sb/ ~stiv www.wisconsin.gov ossroNScott Walker, Governor Dave Ross, Secretary June 14, 2013 CUST ID No. 226900 ATTN. POWTS.Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/14/2015 Identification Numbers Transaction ID No. 2257408 SITE: Site ID No. 788210 Oevering Homes Please refer to both identification numbers, Hillary Farm Rd Lot 29 above, in all correspondence with the Town of Troy agency. St Croix County SE1/4, SE1/4, S22, T28N, R19W Lot: 29, Subdivision: Walnut Hill Farm FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1432628 Maintenance required; 450 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved ans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-106 40 and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatmant Syst ~Vo" SBD-10706-P (N.01/01). eOr OVFr p~~IIP OFESS$O~~~~S11AFg The building sewer and distribution network piping shall be of material IC*1 1~~[3g60-3 and 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts fun sVasto eate a he alth hazard, the property owner must follow the contingency plan as described in the ddition, the owner must comply with the operation, maintenance and monitoring duties as descryi~ VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 6/14/2013 I Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 85.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Pavment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page RECEIVED MAY 292013 Shaun Bird 1N~u'S rRy SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/ 25/13 Owner: Oevering Homes Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 29 Walnut Hill Farm Troy System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-)4. Soil test Filter Specifications a oss section Shaun Bird Signature License numbe O 6900 '~~jz ja II 1 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 SYSTEM ELEVATION 99.8' 1.8' sand lift! BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 MOUND HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE WELL *H.R.P. sameasbenchmark O Grading is to be done to Pro Town Road divert run-off away from system Property Line 7-A L Scale = 1 /4" = 10' B-3 98.5' 1 acre lot 98' Huffcutt Combo Tank 96.5' B-1 B-2 5% Slope Pro 3 A rea 15' be I ow syste m Bedroom is to remain House undisturbed Tank is to be properly To S. Glover Road bedded and provided with Iockdown covers with approved warning el I is to meet al I labels WDNR setbacks Property Line Mound System Cross euion :c,.nd Plan View -T ~)irrrerdsic►rr -I+ysei ' y tl - 1 tl vrr.rrrrr }.✓w rw irrwrrr.r}'' "'''rororo`roro "t +rot t /J y~(y, .F:'iroaZ •r i=rw rort { ro S w fi.'."'M1'rox a tl A Y '=~:r}i}}~T.~~S~'~~{rw'}FM1VM1%:r`i%F}u:i} ''r^iroiro'i}i:,'r}F .}r r. `TrS,'r'T2.,r ✓ro~roi i'~r.✓''✓}r.r S : Tr'. Y • .r}'}~f ~rtin?ro" i:L{{4a '~}ro'i} }ro:t {3T%:iSTr:3}i:siw} i.{Tr:3°r s5i:rrM15}r }TiLa}i~F. r iYr. ✓ ✓ ro i 1 tl :.,.M1S}r % r.rw .F rw.r}r.r w%.r •r.✓. ror}` %ros.;{..~t.yr tl ,L- -y ~q / 9.r-.x„T-ti ro w ro... r,~.F✓. ✓:.r:F'rti.r:r.i:i:r. t.ro.i { ~S.~t{ L. uro. ro ro ro"~y-}-1-'S-S'y-S-'Y Y-r^ ~ St-~-T~}r . tl F tl r G tl Y - tl J. tl K r ; _ y 1. - - - l r Slope tl -i •l'opsoil ASTM C..3 i . M1 5 tl t Cap [,"z•. t_,lc,~r r aggregate = 4 in. sc;h. x-10 Material sand fill r~rySw pvc Material to % in. clia. observation pi ~e l Geotextile Fabric r troy 5.y2 "f /',(/mow.--~'•..;.~::~:::~ L}} l., al roK rot - l 4 '~r4✓L~L 1 L ;'rLr lt 7 r / awed Surf. irc e C) U Ft Contour Slope Directio r GENERAL INSTALLA'T'ION: The rnourid area is staked cow along the design contour. 1"'Xis,irrh; vegetation is mowed and raked off tie site. The mound basal area (h x W) is plowed with a moldboard o3- chisel plow. Plowing may not proceed if the, soil is wet enough at t i plow depth io form a '/4 inch soil wire when a sample is rolled between the palms of the hands. AST M C'-33 quality sand is placed imrrrediate.iy alter plowing. Sand is placed with a tracked machine keeping 12 or more inches of' sand. under the trercks or is placed overhead by a backhoe. Special care must be used rvlr-n placing; satin of' less than onc; loot thickness to minimize corrrpaction of the plowed surface. After thd; topsoil cap is placed, the entire rrrourrd is seeded and mulched to promote vegetative growth, limit e:rwion and protect from Freezing, The observation pipes are slotted in the lower 6 inches and secured in pl:wee with r•ebar or a closet flange. 10/07 lgi Page of Pr°essmr e Lateral. gut t__, leaflou t IVialritirYcl Lateral Tura-.crlr up, it. M x Force lWain Long, tl 'Sweep t 90 IIe,IId isirrt~►rrtru~y Network S yeci cr~titr>trs .S.._stem "oxistruction Lateral Diameter . ~ YrL Matuiold Diameter 47 lrl, Laterals err; cvrrstructcd oC ` clredtrt( 40 i'Vt'. Orifice Diameter ' Yrr. plpc;_ Oji ices are drilled perperrdicolar to t (t)rrfic,c S acir~ tti.- lire, pipe with a sharp drilt bit and ia(,( down. Y Q.,ateral Leil rtlr~ FL Lateral ti"MAIPS terminatc; with a threaded M Ovlarr bold 1 !n q9 - Ft. clear►out plug and arc, miclosod in a 6-S itrc,li l;crrce Main Diameter - - - Irl. diarrreter limn sprinkler valve; bon ~rcc~~ ~silrlc; 1-'once Main Length Y t_ ti (rnr Yinisl7 eEl grade- 0 6-8 inch Lawn r BOX 03/05I9) i w c~~,Aic-Dose f an Cross ection And Ptan P erfbrmance Specifications laa~xxls 1►✓tatu~~fac Curet _ t t Pump 1Yla ufacturelx t . rJ -1'~i1 Tank ~W- Model 'Number Pump Model Number Total Tank, Capacity r > e ~ A.larzrx Manufa~ctuxa~x ~ ,r ~ ~ 114ax [ my l7ieptl>t Alami Model Number ~ L vVitcb ~1 to t',c t r c ilter anufhc F turex X otal Dynamic Head (TDII) Feet I-Filtm Model Number ' l~i~t t~re~rxre < , W Nerkmak Loss Mtxxirnuurrt i'um _ ~rli~~n_ n_ ,nc_~ ~teat.t~aeri ~ l once .Main. foss l'o1,al ..,,~W, F) `1,DJ4 Outlet Manhole On. 4" Above Gt*lc WiOA flouking Dv? ice. inlet M:anlz o Manhole Mira. 4"Above Gracie 6" Below laude Sealed Watei;tight ~..w....~ Securekv Mounted With Locking Deroice , c. Weather -proof Juttodou BOX • , r..# P~YI Finished Grade Vent Mitt„ 12" Disconnect Abova Cn°ade Means Witt, vont cap ~ Y 4>,OVY M1 v~Y-~96 d b{ D,D Y 1 Y Y / Y b 1 6 b/ 1 1 ~''p Y Y P O~Y*Y p 1 ' >'i°a VY aY I Y a PVYAIa9 Y{I•DV/ IaYVi e 1 Y a J YV>{ Ve{YJ~'~l,/J V a•ibA f 1 tl1 JP V J y+, x 4 ~J i J Outlet: Filter ` - 4JY Haf ~(nlell fie baY • Ib > e°Y aba° YJy, " IIr1 / V V bL ,0a1 xf~l. Switclx Sat4ugs and Reserve Capacity , a r P P W eets Tan Volume L)ixxiexxsiax<: Inches °'V'oliane (ral., k& Hole 1'Y :>tl ,,a.,, (reserve) A' ;X j- _ ;:.;J (alarm l3 , f Elevv d C l3ottaxrx Oem) dam- _ O +r P'Y rlf'VA 1oXA Total r 5 .t.>, Y-i--T`t'7'Y'i"G i'L'fi_ ib_b..•f-5_.f-li..i" i. s._I..TI-~6-~ T••Y'6r->`s"G i 4~Y d i:p ~6xi~C a F~E'•L`i•t ° ~i~ -'H---_ ."___....r..e-v aT1 { i A 1 f V tl d d V V J i J•Y Va { J 1 api Y Jb4 i J d V tl J V V J J V a i a •1 J J I I J d V R A J Y Y V VYV la V4 YIa `Y'1 Y> Y P I a Y,b Y> D/ Y'Y b y 4 Y >V! D P DaP Y I+4AP Y Y> b Y Irb~M1 is V/fib P I P 1 Y b Y Y b! p PVI IV> uap'1 PVYV IV P'b Pa1 VYVl IVI + J JJ i JaJ•f,!i^.yJVVi JYA> : { aJa iiJ..Li.JJ"~JA/~{y{s!Z ei.Jj i~ i c laiya~Y~da PyV aaa~0ya,4/J J J,;1 J~JYd J~Y~V %aia ~Jyla f.lui A i 1 i i iGENERM, INSTALl.aA:l'ION9 "iC"!he septic/dose, tank is beddw4 and back. filled in accordance with the mantitacturer's product aliproval specif -Gations> Maximum depth at b Y as, spacifaod by the manufacturer may not be exceeded without pirior 4pprovalw Manhole covers exposed to grades !lave an emotive looking device (padlock) installed. Piping at Ow inlet and oudel. is of approved mste.rial, conuet,ted to the tnmk: with watertight fittings, and laid on stable soil to prevent willing oy riaggiixig;, ' 'lie fc)rc a main is sit %•ed with 4?"Sch. 40 PVC; to bridge the tank. oxcavation and the 964ve is sealed wit"Utight.. Bleclrical service, eomplxesm with NEC 300 and Comus 16 .2-11 02/05 Lf ~ v SI 1r.cl WwCal _4 • Ste SlErd-40 Sermes 4/10 hP Submersible Effluerit Purrwpp,3/4" Soli 'ons,tructiion 1'iow - t,iterNlViinllte ll 50 100 150 200 250 300 t:4)Vf3r 35 . F 1i t boxy-c0atud Gast ir'0n Q n~ r 1# r pct y 0~ bd:q ~t il'Or, 10 su - - w IMPOIr-n IUlarelii,l 7u rnroralastG t_lasfurner 25 _ x ~10~~'ilC ti ICftH 1 pox. , u 41er1 , atit Iron q " 3~ ~OIIcAi ,I1fUV f 111 clr ~illut4l :;haft M4110 With Larbon tlnri ~ ~e~i c4lramk: fr~~;e>a 'i - Il fFI{1t6rNR ~.l1 qui, u Itcjol 20 011 till ~ , s Flow Uallons/Ml"ute l h'=iril ~ 1 ~1~~81 ~l3ltlfe~ell ~y~ eHR L i 1r~. T SFN -4D-Ar SIEN. 4O Specifications • MUMMA $kN 40 508211' 4!111 T15 Y 1/2" FiVPI W9211 81 70 ati ( (10 45 l5 1 14 24 26 5 1 T5(1 'mvg,,,o imos, v /9RO C$ 7(f' ' 60 fk r'4 Q IM°.,; X715.",` '1 ~ ! N RO AF If09213 4110 115 1 1 rMPT 9/926 00 !i) 60 45 :?!i , 19 0 ~~'N 4tlr ~~82 'q Fpq ~r+ h,~ 1~Y 27 ~ 1I60 k /11~► r1, I/ p1JI~T' It/~~0 `ir Ntt;~:v:' JR + _511 k,: a . ' ~a in. Franklin Electric 400 East Spring Streel, Bluffto►Ir IN 467'i4 Tel: 260.024.2900 11 Vax: 260.824.2909 Fong 0061997-1'1 wwuv.#rarnklin-electric.c">m WE INPUfim Ayit'7N POW TS CJ'VtlNEWS MANUAL & Ii1ANAGIEMEIVT PLAN Pago..._.. r,r Owner P ~ sYt~'rtV!Cl1~ 59ptrr. Tank Carper#ty ~'~"""'----•'.~""~'7.`I.'"`. _ p~ _ __i1cr1 rk7~IVN Sblytrc 1',arrk IVlanufacturyr AwErErs ~--•~r itlucrYt f-fitter Nranufar;turer LL Number of Badroixnb 0 r. ._U NA~ NA I.fllttelrt I filter Mo(jel Number of Public I-acNity units _ IV61 ~IVN f urrrKr ,Yr,fr Capacity Fstirrrated flaw (average) 1--t NA allda pump Ir rrlr 1VJarrutacturrjr I D61091-1 flaw (peak), (Estimated),l.,>} - I afkla I'Clrnt~ II%trr utacturr3r' Soil Application Rate g __.._Y_. l :l iVar1 - 1, I/d~ry/ft? lyClp Moc et c nl Standard Influent!! ffluent Quality -.Monthly average" t"retreatrrment Unit Fats, Oil & Grease f°OCi( ) X30 trig/- t..l SaridAiiavol HItur ~ ~ Nochernical Oxygen t)errrand (f300,j) s,22p mg/l. C7 t tl of (-filter' t:l NA 1:7 IVIec;Frarr r;al Nerattarr (--'J VVr~tFand Total brrspended Solidb 0'85) "5.1,90 raretreated Efflumt LfuaN IA I)isJrrit+ iurr n other, Monthly avert#.tr e l7rsllerm~el roc rernical Oxygen Fernand (8()D ~ s) 53U rrrg/L L'I lwc)rest rid ravit I_:1 IVN [..1 Irr C',rrrurrrl {prebsurired) Total Suspended Solids (`l'S5) Sgt) rrr /1_ (g y) I .11P Pe►ral Coliform VA IA /(t Gr'trr u uurrd -__T - (geometric: rrrearr) 51t) ufuJlt)Orrtl I i 11}('11 r i if ra t it ()the(; lvlaximurtr Effluent Particle Site in dial Gt1rwa. JTJ NA - -J NA 1_°1 WAJ . "Values typical for dorrrasilo wastewater ands 17) IVN et►tir;terrlr efflusut. i tas,tlN'f iVIbNGE SCIiEUUt [J NA Service( lverrf b1,11,vice Frequency IInspect condition of tank(s) At least o(rr ra every. r ~rint -1 s) _rrr(e;) (Itliar~rtrntrrrr r4 years) L- I [),::lump cut contents of tank(s) _ VUiterI U)rrIbined sludge arrrd s(An) 5luals one third (fi) of tart!( voltitne (inspect dispersal call(s) I") NN At Idast (artaa every rrrcrnth(s) - - - m (MaXIMILIm 1 yeah) l i NA dal s can effluent filter - At least eant,a every l°7 rnonth(b} u76pect pump, pump cattrols t~ alarllr I 1 NN At least once cruet} r L`-l,~~flneyr7tlr(s) - - - l ) 1.1 NA lush laterals and pressure test At teirSt on(,r revery, r Cl month(s) - - 1-year(s) 11 NA At mast unlue avary. Ca M- 1-1til(s) f_1 NA _ 1_J NA MAINTENANCE INSTRUCTIONS fJrrspetticans of tanks and dispersal cells shall be made try an individual carrying orrt: r►f the 110110 t 111 IluoritSHb crtrtlficatirls Ir~lumt rr; Master Plumber fiestrioted Sewer; P()VV'f`S Jrrspa(;tol; Powr5 iVlaintainer; ,ji)0(age Servicing (7per'attrr tt(a linclude a visual inspection of tfre tank (s) to Identify any Inissin(d or break(((( hardware, irl(rYrti ns Master e; rambirreid , or Gulfl ina nns a t.rsr sludge and scum andto check f'or arty back up or panding cif effluent round Surtkv, lea , ffla (usure sal celf(r;) shah be visually inspected to check the affluent levels in the Observation pi on Ilia ground I~ apt ""d to r;hc~c ,,11. ay un Crac pundiiiU ks of or ea►ke} oftille~t rrl orr o the rsa- 1 ~Itherourrd su)(;halltftlcu, '''he ponying of c~filuenf on the gnxrrrd surfatla aray indicate r, far peili"q uondltiun anal ro(tuire~s (tie irrrrriedlate rr(atifiration rat t1le lorai ogulatary authority. iNherr the colnbined accurnulatiorl of sldge and (;GUI-l in tarry tank equals 0110-Qhird (f;) or more of the tank vciurno, the antlte crarrtants of i'he tank shall be removed by p a 5e togO Servicing Cperatnr and (1116 (abler! of 10 aocordance with chaptar' NR 119, vvfscorr,Ydrrilnlatrative God(). K .,lr r All other services, including but trot lirnlt(ad to tile servicing of eflHaarrt filter'n, rrleratranic rrt or Pressurized rrrrnpC7nttnts, pl'6treetmr~rlt Urrtts, fend any servicingg at Intervals of ;5-la n'mriths, ahall be faenforrned by a vartiti(ad p(.)VVT'f' Maintainer. 11'1 service report shall be provided to the local regulatory authority within 10 delay„ of oolrrratation of airy service event. Page,___ cf---._. , STARTUP AND OPERATION For new construction, prior to use of the POWT,1; tthack treatment tank(s) lot the presence of painting products or other chernicals thy:lt may impede the treatment process and/or damt,ge the dispersal f;e11(s). if high C;orrrentratkxas are detected have the contents of thja tank(s) removed by a septage servicing operator Nior to use. `yystern start up shall not occur when sail coridltlens are frozen At the Infiltrative surface, Oaring power outages. pump tanks may fill abevfr normal ldghwater lovels. Whon power Is festored the excess wastewater will ble dischargers to the dispersal cell(ti) In one large do.", ovearloadIng the of 11(s) and wn a~, result in the backup or Surface discharge of effluerilk. Vo avoid this situation have the contents of the paurnp tank removed by a t3fepterge Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist ire rrranually Operating the Frump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, Do riot drive or park over, or othanulse disturb or compact, the area wits o l ti feet down slope of ally mound or at-grade seal! Pabsoiptlon area. Reduction or elimination of the foilowkny from the wastewater' !stream may Improva the performance and prolong the iife of the POW I l' antibiotics; baby wipes; cigarette butte; condarris.; cotton swabs; degreasers; dentat floss; diapers; disinfectants; fat; foundation droaNn (surrip pump) water; fruit and vegetable peelings; gatioline; grease; he:rtricidecs; most scraps; medications; olf; painting products; pesticides; sariltary riapkins; tampons; and water softener brine. ABANDONMENT When the PCIWTS fails and/Gtr Is permanently token out of service the following tstaos shell be taken to Insure that the system is propeily and safely abandoned in r ompiianue~ with chaptot Gomm 8 3,33, Wisc n.aln Adminisirative Code, 0 ,ill piping to tanks lira! pits shall be discatinec.ted and the abandoned pipe openings sealed, 0 ]-he contents of all tanks and pits shalt bo removed and property disposed ~)f by a Septtage Servicing Operator. m After ptirriping, all tanks and pits shall lie excavated and re:rnoved car their covers removed and the uold space filled with f'0l, gravel or another inert solid material. CONTINGENCY PLAN If the POW"('S falls and cannot be repaired the following measures have been, rir must too:, taken, to provide a code cornpliiirnt replacement system: n i\ suitable replacement area has been ev'altiEated and may be utilized for tho location c:,f a replacement soil absorption systejm. The replacement area Should be prolfected trout disturbance: and r,oml:ination and should root Foe infringed upon by requiijed setbark% from existing and proposed !+tCLICturd, lot lines and woalis• Failure t0 protect the teplac:eament area will result In the ncled for a raew soil and alle evaluation to ei.tabiish a suitable replacement area. lteplacemeant systems must comply with the MICA in affect at that time, IA A sultahle reapiacernent area Is not rauaiiable due to setback and/or Boll Ilinitations. Barring advances in POWTS technoiotiy a Iloldilly tank rnay bo Installed as a lasl iesort to replace the failed POWT8, ° the site has not been evraluated to Idgrrfify €s suitable reipiacA-Fnent area, 01jort failure of the POWN9 a soil and site evalusitlion must be perfortned to Iodate a suitablt! replavotilent area. If no rQplfloenierit area is avalWble a holding tank may be installed) as a last resort to replace the failed POW k':.>. ' ,1kV1o lnd and at-grade; soil absurptiun ;)stems may be rec.onstructe:d in plaoo following removal of the blomat at the infiltrative tsurface. Reconstructlons ref such sys PM& mast c,ornply with the rimes in otfect at that time, <<WARNiNG>> SEPTIC, PUMP ANri OTHER 'mewrmwr iANKS MAY CONTAIN LETHAL GASSES ANCr/f:)R INSLIFFIGl1*NT oxYGm no NJO, FNTER ASEPTIC, PUMP OR OTHER TREATMENT -IAN K UNDPX ANY C-IRCUNISTANCSS. UEATHi MAY RESVI.T. RESCUE(*, A PLRSON FROM `rHF INTERIOR OF A TANK Il1AY• BE DIFF1C UL-r oR 1M1 08SIBLE . ADDITIONAL COMMENTS POWTS INSTALLER P( WTS MAIAITAINER - Name j <c ¢r,, • ~ a 7 Nanre ~ car )o e Phony - , - ,L S.~ L2 8FNTAQr- SIERVICINa C:IPFRAM~r'C,iII~ PtIMPSIB' I .OCA1 rdIwr3 ULA"rgRY A1,1't"WtaRt Noarne ,'s y, k~7 r. Phone Phone 11118 docwnent was drafteo in cornpllraricr: with Ghapte P:; 7N,1.;?~!(:Zy(b)(`I)(d}&(f) and 381,!i4(•1). (2) 8, (3),11Uisconski Administrative Code, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings actor with Comm 85, Wis. Adm. Code /J Attach complete site plan A6~fa r no s than 8 1/2 x 11 inches in size. Plan must County jn5 include, but not limited to: v l horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road.! Vpr, 0 yo- / 3 0? - 2~ Please print all information. lwiewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f 1 r ? 1 3 / 3 Property Owner Property Location ST CR ~JP Govt. Lot 1/4 ,CfAU,iq T Z e N R E (o W Property Owner's Mailing Addr L Block # Subd. Na or CSM# / City late Zip Code Phone Number ❑ Village 'Jiglown Nearest Road 23 6-7 1 New Construction Usejt3.B'esidential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement p~ Public or commercial - Describe: Parent material Flood Plain elevation if applicable _ - - ft. General comments cO 2 endaendations: (/J and recommendations: System Type "-9 Z-" Z' tY h;?' ''stem Elevation / 0 F 1-1 V1 Boring # E] Boring Pit Ground surface elev. , J ft. Depth to limiting factor _,All? 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 •Effff#2 Boring ❑ # Boring 911, ® 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 Z /7--/ Ali Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST t4ans (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 I 715-246-4516 Property Owner _ Parcel ID # Page of © Boring # ❑ Boring / Pit Ground surface elev. -91-Ift• Depth to limiting factor - in. Soil Application 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 3/Z s f 0-7 Z 7-1'5- a 6/3 3 p S " ern - f' All ❑ 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 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Applicati on Rate Boundary Roots GPD/ff Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/- 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 alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB"310 (R.6I00) f Soil Test Plot Plan, Project Name Oevering Homes Sharird Address 1433 Cernohous Ave Suite A " New Richmond Wi 54017 #226900 Lot 29 Subdivision Walnut Hill Farm Date n5l13 SE 1/4 SE 1/4S 22 T 28 N/R19 W Township Troy F-I Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 99.8' *HRPSame as Benchmark Pro Town Road B M * Property Line N~-4- Scale = 1/4" = 10' B-3 98.5' 1 acre lot 97.5' 96.5' E3 E9 B-1 B-2 5% Slope To S. Glover Road Property Line lwgrRucir I i7W a P:Yr fl' timlrlPYYY•daYl rkl ~ 1 YfYaC WfYrYh Y..anttr ~aYPt1Y ~irr u1rrP itll'l:~rrA YwfP;{w~l; lYiYlrr lda d: Punk IIYYwU I ItIYJvf ru alua aY~k A'YiraiYrdYr~d xPYktP er{ekJlY !P Y kia& Yw vaw Ydl'PrrAl hr~ Yr al: lu Moll ilYa+aMYk WgryyJki r;IIIILYIIy NdralilNkhtrf rPWt AY YaIIYIYYivw IAIYIuir alY~gy . J 8 IPA~+ fMrkn P,IrAYA ulrl'PY,Y: Yfnu A A'r;kt ! tWhllvu aue 17wjj" feu rSCiP!I tPh y , elf % illt1Y P'rY vwa AIIWKI tWt PrruYra., Ai Yy Y P YIMamA' A rra rAUP;InI: rl'Yrg BYP►flltYgyl 4" ~6 1 ~IYrr r A , rmurasa,tn Ylriu bYYIYyPAH iklYlb!rrPYYrlwll V~rIYr I7kxtrPrraYt:..LI' w"Nla ask PnfrtYiY rAYrri uurr~l it YICillalutY J(rvt I►I'ur Yrµ~ RYA S PrrllY. YYbr►YFl: IYYIg1;PYUY) IYs" r11rI Ilkilotovi n~uMehtlrl; Woolf oolf Il'. Y•'i"yr;,ya iWpprYYrYYruFYll'1P18;rtY i9rep GIlYl~4YPrirltsPgylYlhkr'Yerrxltad; rv 4i•-itaeef• J aY.t vi4iEhdtUrl ~ I Ythitt Yd9ro Nl'i?N!Y a,4,rLt9,. +krJaa tirarrluaYrd: Y fP8'IYJ''tkUVI tb ~i~rp IIlekl~ Yi' 4. ' > raiA• 5MY(IIPNYW' Ir/YVkPtviui i6 turiJ E:HAY.yfrfUYr nret~r 1 1Y11~,•*tSEV~IAYYw,~a;dAHr~~~HrY tYIPtxA YriY~ rrerklvrf: m P v'iYrt t:Gra.ar, I [~D1flb11 11YAPyP P'IYW Pi E IMYe, Ikat:vyrP Had, J v`•„0 it ~P4u dYrt;kri PorlxY tivm lae Y'tnbrYO r Yat~ . ,.F tl` Pi VPL:i adtlPlf rllM is rrllla "eYi:al:. iYenrwnE eralRa 4.1•r r1ul;Yruulzer rltJva, . +iYlkru :arFatY lYrrlit IEY ro ~ 1,r1Y'YYiYrii ' 'i .l 1 far I'. •}7r.Yrtr.•ti.r P. Pilo tAYi'iUaank liill'tlr nli~raaYYid tier "•:taa;rrYgaJ YarteYly tflYYtg tiP1iY rnpl ACIY: :utYl'vYll'iUUI . 1^ v"dilWjra C1Pa4 erlallrkk Yar_e:tYSd aY4ralYFrd i pulpit is ~I•. JYlikre 1:1 rv Wi Iw IPkf«1t+akdlC I:fyt;;;~I~' la • warrtlc rkvrulr awYYrlppiF!'rtl Y v»itel IIIPYPA, t ItIWY,r' krrk PYIW l+nMlarrY vkf Irfrw ~a'rk arm ►~k~yy~ ~t ~i~ •1r . ' ~ J . lk~ar:ay fv,r, vdWtrarrY Pr,YrYaBPYxrra Pitraari AYwkYYawi tiinrerY t , IoY"rx, t. tabw khm ulurttMr+ t Yrlktlwl IYiI•e" YYrrr PWrd Y!PtMlYvurrP. Jrlall YsAa xdrr P-Ynra YYrYur' fa WOW J:iYY[ yyrt✓{yYt' a:al yyf t'PYa.r 'r~ MEwMV0 #M401 ~t1lF IL,06 wwrilri YIiWPYPYJPyYr 0141 " Sllrldv the r::aA'Ifikim" aria atkarJ 1.000: err`A:YyA9 11"AANly 400' Y' . tat re tY VAG switilr Y»rlalrar.J'rrrl I:ar ltrrv i lltillllrYil„ 111*40101 tnY YY4kreYrved by Yrr• wHteP etuYwrYxar IdY 3tv~vybtdi YB', EJka" with willow. arYty wJP:Yrh~ kli iY1rrJ 1:PHVPUYJrf i'• WlYlp! irtnidlaq tine vJniwAr,) IrVryl f~rir 'ibtv1dYYYuw Kilo 1#1 i It1:u9 ~Ptliy I1~tYMYYr WY7f trlrs"cgr f da.frrYJ t uFwlyy" araYrltler avuYn till idtrYallAraYr pVagU WYYI ' tilt, Alriflfr dull UJtYbau' r.'' Yvy la., ll' VPtka swlltr.h J vrYilixwrl st art. IlY1Jk llYfY Ip I:arr'aii, Y•,lw a N`FMwr:Qr toy I.W,0P: llPtirlYL""lielPP 1rYiaJ l7Y,,' ,P. •''v N ~iYWdevtr r~rk"•• a4dFF' imYti ~ / p~lltln. • sF, Jlgmeef•J; tMPYCr ifltaYr Y:aYlrirlllrr fa . ••,t the YPll;mt' ltr(&O iiAtt *410 lrtYkl uaY eP,{ UAW cw k J IPPiIkI~AnIYY1~j IIIAYhlrt-tIAYYfP l „•••1r. vhw v I. U.I~IrrfAlut:kr anA eAkra:uru t•'has kY+i.;r,;wk'A~ Yru~lrPlrkll tPlr IPPYw P:WYYit. 1 ~J'r~ a:.. ,.r r r~ 6 YtWY Y•Ll :•V.BJ rtl ~t,.r, . ' wPrwowwr~iwPJ~IP~P+r~PwP~,w:~IrxrW ~'rid'~"~Y~r~~r~`Y~~°ryI~Y',-~+'~r~arf3~•~"r • t ommerce,ypl.gov Safety and Bu'Win s Division County { ■ 201 W. Washingto Ave:, P.O. Box-7-162- C J o j soon s i n Madison, 4IA707-`-162 Sanitary Permit Number (to be filled in by Co.) Department of Commeme 501 02-G Sanitary Permit Application State Transaction Number in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriateovgnmental 6 pw_ ned are Project Addr s (if different than a'liug addr ss) unit is required prior to obtaining a sanitary permit. Note: Application forms for staolp submitted to the Department of Commerce. Personal information you proviu y may be` d for se u Z A y . ; oses in accordance with the Privacy Law, a. 15.0 1 m , Stats. c 1. Application Information - Please Print All Information Property Owner's Name Parcel# 'V Property Owner's Mailing Address Property Location / r l Govt. Lot City, State VZip Code Phone Number O~t2`J~ y,y,, section - ~~r-~-~ LCD ,l Cf - T- N, R lE o r W II. Type of Building (check all that apply) -2 Lot # or 2 Family Dwelling - Number of Bedrooms Subdivision Name 61W rbt.~~ ~n 7 P Block # i ' ~L L?'• ❑ Public/Co_mlm~ercial -Describe Use a ilo a (.1 ~f J(1 r 2 _ ❑ City of El State Owned - scribe UscZ CSM Number ❑ iilage of PV_ O U W• t Gown of ype P rmit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) nsfer to Ncw List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of PlumbeTop...7-ItTI, Before Expiration IV. Type of POWTS System/Component/Device: Check all that a ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound > 24 in. of suitable soil ❑ ound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) evice (explain} V. Dispersal/Treatment Area Information: J Design Flow (gpd) Design Soil Applic lion Ra pdsf) Dispersal Area Re aired (sf) Di``spJJersal A/rea P posed (sf) System Elevation '%~J~J SOU Y/J lv z 2- VI. Tank Info Capacity in Tota # of Manufactu er Gallons Gallons Units l7`e r - 84 V New Tanks Existing Tanks U ,L ~ U rn ~n v~ W C7 P.. v Septic or Holding Tunk cl Dosing Chamber G > Z7r VII. Responsibility Statement- 1, the undersigned, ass esponsibility for installation of the POWTS shown on the attached plans. Plumber's Name Print) Plumb gnature MP/MFRS Number Business Phone Number cam, '7) Plumber's Add ss (Street, City, State, Zip Cod VII ount /De artment Use Onl Permit Fee Date Iss Issuing ant Signature Approved ❑ Disapproved $ 3 ~ Zb~3 11 Owner Given Reason for Qenial J IX Conditions of A roval/Reasons for Disapproval 9& SYSTEM OWNE~ 1. Septic tank, effluent filter and All dispersal cell must be serviced / maintained 4~~ as per management plan provided by plumber. ' 2. All setback requirements must be maintained Aivl r a2%t!GU/t a~- as per app Ica le Cpli;{gttbpdk4g @thft uns for the system an ubmit to the County only on paper not less than 8 I/2 x I I Inches i site 3- N DI" aft cam ~"p 1 SBD-6398 07 ValidthruOt/09 {R. 0 / ) pnaxN Safety and Buildings 4 To 141 NW BARSTOW ST FL 4TH oWAUKESHA WI 53188-3789 Contact Through Relay 3 .c www.dsps.vA.gov/sb/ 9 ; www.wisconsin.gov OFESSIONPyS~ Scott Walker, Governor Dave Ross, Secretary February 22, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIItES: 02/22/2015 Transaction ID No. 2211569 Site ID No. 788210 SITE: Please refer to both identification numbers, Oevering Homes a low f411 above, in all correspondence with the Lot 29 agency. Town of Troy St Croix County SE1/4, SE1/4, S22, T28N, R19W Lot: 29, Subdivision: Walnut Hill Farm FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1414098 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). t~ The building sewer and distribution network piping shall be of material listed in Ta~ 4'-3 and 384.30-5, Wis. Adm. Code. C~ In the event this soil absorption system or any of its component parts malfunctions so as to ciliate a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 2/22/2013 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sinc I Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer 11, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. s Cover Page RECEIVED FEB 19 2013 Shaun Bird INDUSTRY SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/ 10/13 Owner: Oevering Homes LLC Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 29 Walnut Hill Farm Troy System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications an r s section Shaun Bird Signature License number 2 00 <c F>L ~~n C~~ ` PLOT PLAN PROJECT Oeverina Homes LLC 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 SYSTEM ELEVATION 101.2' 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none 66 BENCHMARK V.R.P. Top of 1/2" steel conduit ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark Hillary Farm Road Property Line Scale = 1 /4" = 10' 1 Acre Lot B.M.* 100.2' B-1 ❑ Tank is to be properly bedded and provided with Iockdown covers with approved warning labels B-3 6% Slope Wei l is to meet al I WDNR setbacks Pro 3 Bedroom Ho us ►m t26- U S° S,~r Hu ffc'utt J Combo Tank 98.5' 100.5' Grading is to be done to divert run-off away from system Area 15' below system is to remai in undisturbed i pg .2- Mound System Cross Section and Plan View r' Trt ..y 'r" y,K r ~ +TT ;IRw .r ~ r n.rr+.. r ..ws, ~ Dimension Feet A r. 1 r - - B N - D ~r ~s # r F T7r ~ .s re r~• r•~ ~'r~ li 1' ~ G r Z, H r I r t I I I r: - 1 - K t' l L r W r r. YV J n r..r...~ r r• r 1~..~r.. r r ~ r r r r r it it ww-r' in..' V 'r r r .r' ~ ' ~ ,l( K B Z L Sloe % J8Ad4 &V-1(1- 60 -q- < ' '"'I = Topsoil = ASTM C-33 ;t = Clean aggregate = 4 in. sch. 40 pvc U ` Cap Material sand fill '/2 to 2 % in. dia. 0 L..: observation pipe Geotextile Fabric I D Plowed Surface Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately afl;er plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page of Pressure Lateral Layout Two Laterals - End Manifold r! -'t'hreaded Cleanout Manifold 1_,ateral Turn-up Plug M :Irv, _4 - l:l Lon Force Main b 1- J C Sweep d 90 Bend Distribution Network S ecifications Pressure System Construction Lateral Diameter Manifold Diameter ;;I- In. Laterals are constructed o:l' Schedule 40 PVC Orifice Diameter & In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) _ 02 ln. the pipe with a sharp drill bit and face down. L (Lateral Length) Ft. Lateral tutu-ups terminate with a threaded M (:Manifold Length) Ft, cleanout plug and are enclosed in a 6-8 inch Force Main Diameter _ In. diameter lawn sprinkler valve box accessible Force Main T,en th Cj Ft. iiom finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box Page of 031U5 lgj Septic-Dose 'Fate Cross Section And Pump Perfo alnce Specifications facto rer_ ~2 _ird Lank Manufacturer . _ _ LurYT .1._ anu Tank Model Number 6C) U_ Puurrt Model Number Total Tanis Capacity 3 A1arnt Manufacturex--- _ Max. Bury Dc9th Alarm Model Number. ~ Switch Type Total Dynamic Head (TDR) a- Feet l~"iltc;r Model 'KTurrnfser Elevation Head - - Distal Pressure c 7 Network Loss Minirnt,un Pump .Petionnance f*uired horses Main floss / GPI ' .r`t TDH 'row . > Outlet Manhole MIn. 4" Above Grade With Looking lJerfice. Inlet Manhole Manhole Min. 4" Above c~rrnde ~l With Locking Device ~ 6"' Below GrWe Sealed'Watertighi: Sectrvuly Mounted Weather-proof Junction Bois. Finished Grade .LW Now r.+ ow 4Yw Ywll ..11 WY 8rf 'r► Vent Min. 12" Disconnect Above Grade Means With Vent Cap 41<1 1111 1,r~ +1~ ,Y r l 1, Y,Y / i/ i 1 L! r I Y Yom/ ~L~a~1 0 1 t i • Y Y Y L Y Y Y Y r 1 / 1 t/ l i / 1 I t I k J Vr I t {Ik t 1 i 1 t 1 IrY 1/ . ,I,Y, I r b b 1 Y+ISIII Y Ill/ki IYI L L,r r r l r 11 Y T r r Y I Y r r .fir 1 111 I Y+i .~1 Outlet Filter Inlet wet Hafer •~i----------" - - - - _ _:~_~.1 1/ - I1 1 + +L Ilt1 Switch 8e ~ i?aaserw+e Capacity f~Y7 Tank Voluxrr~e = S-- 'G_ weep <II+ ! r Uimensiori' Inches Volume Gal. Hale B r _ (reserve) A. 2 •1k (alarm) B : 2 , i Off" Elevation ; T {dose] la, 1, 111,: ; 1 (dead) D / - Bottom If/;f - / 1• D I1/ evatlran WTotal 't f ,f rC'tiT'i Y',`I-'T~i->~Y+1-T-f-4 i 1 1 r t t. 1 1 1. 1 Ila 1 11 / 1 1 1 . 1 trr k 1~~ j lY~f'l-f~Y; yr VY~YTftf~(~jt II+'a~ J< S l t f 1. 1 t< t. V t i c k t i i 1 r /'1 a 1 1 1 a k, all If 111'+f 1Yk~11If it SI1VV 11LIr1f Iff III iY111 k1{11'<f{+elkrslf Fl ki, 1~1 Y Y I /,r I Y I Y Y 11~ Y11f YIf l Y 1 1/ Y! I t Y/ 1 1 Y! i t i Y r I 1 Y I 1 L Y1r 1 Y'1 1 r 1'Y ~I I, IYI ' '~1~ I I I S I t 1 1 1 V V I t t S I/ S t 1 a r{++ k t 1 (1 1 1 1 1 1 1{{{ t i l I f l /,1 I/ Y 1 1 L kYlll t GEN1E;RAL 1N8TA{LL,4'I'`f()l'q: The saptlcldose tank its bedded and hack filled in accordowe with the rrranutacturer's product approrral apecsi c atiant3. w Mal MUM depth of bury as spooified by the manufacturer may not be exceeded without prior 4pproval. Manhole covers exposed to grade have an efteutive lockirr device installed. Piping at the inlet and outiet is of approved material, connected to the tank with watertight t (padlock) and laid on stable soil to prevent settling or sagging. The fame main is sldeved with 41' Sch. 40 PVC to bridge the tank . excavatiam and the sleeve is sealed waatvWghti Electrical service complies with NEC 300 and Comm 16.24. 02105U Wage n I AP LaserJet 3100; 1 71b bbL' Utid► ; rvi14y-a~~d a.v+urw~, ,.y„ 9 E H SERIES ' UM P/lEFFL.QUENT PUMP sp" Mile WL 11► on 118Y811tl8 AIAAwfi M Cf W1Ml~ 1 RFF 1 u MAL CIR 111101 100110110 M0. a 194-801 ANidINNIi 0 10 IV it IN IR1 "a1 WXKNIg VIN41M =NO NO 41;0 115 314 4.0 10 70 54 65 41 82 12,8 20' 24 111 01.64x890 014.010 WIND W04 keg 180 IN 6.5 1000 76 64 55 41 82 18.8 23' ;1a 811 111.64%&94 89"WOB 608859 um 4011 1115 9M 184 1000 70 64 55 41 82 18.8 20 27 8.11 x 11,64 K 11.84 Am 51019 am ED no 61 in a 0 56 4 7 71 31,111 4 C9109000batY9lrtad-"Ei41111tilurtlNaate11at4ap9np:atrta11edra93nne89dut911118►tlp11116111ll ena~wllMeUsYtrLNfA80n1 {101a18~ec99um9s" _ FLOW- urER$fi k Construction----. 0 1000 2000 ;cane Motor Hn4>::it~_ y_` $goxy Coatsni Cast Iron Impeller Material _ Poly Carbotlat,e is Crrspetlmr c _ _ closed Vane ti r.s Power Cord SJT W A _ en Medt4tOk-21 Sk2111 Seal Nibile with carbon and cet7tBtic facer, a Y'aBletUBYS .....ia11114H4F Nice! 10 F.9 Shaft t&iltle ti Steel _ Heariictgs Upper Sleeve and L.nwer Rail Hearings: 9 FO 1J 60 80 FLOW- GALLOKSM8NUTE PUMP PERFORMANCE CURVE Little Want Pump CO. 115v GVHZ 1041 Box 17818.OkMoma CYtls, 0913157 n um. 445.047.7911 • Foul 465.229.450 • &u49#I= ¢a111gm4Hranwlue~g111tt1e~iwtala4o Www.I f19t1e i1nmti%mp-cOm c~# FW" "6238-•-07J03 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -7 of PILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA !DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA INumber of Bedrooms ❑ NA Effluent Filter Model ❑ NA !Number of Public Facility Units - OMA Pump Tank Capacity ❑ NA !Estimated flow (average) _ gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5)T t J-0 gal/day Pump Manufacturer ` ❑ NA -Soil Application Rate /1 al/da /ft2 Pump Model Q NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit - ANA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/t_ Ci NA ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average rDispersal Cell(s) - Ll NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 rng/L ><NA ❑ At-Grade wound _ Fecal Coliform (geometric mean) 5104 du/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size... )A in die. p NA other: 0 NA Other: Ci NA Other: ~ 0 NA *Values typical for domestic wastewater and septic tank effluent. Other: - ~ 0 NA MAINTENANCE SCHEDULE _ Service Event Service Frequency ❑ month i's) Inspect condition of tank(s) At least once every: year s) (Maximum 3 years) ❑ NA -lump out contents of tank(s) When combined sludge and scum equals one-third of tank volume O NA Inspect dispersal cell(s) At least once every: ~nthi s) (Maximum 3 years) ❑ NA year s- _ Clean effluent filter - - At least once every: ❑ mdnthi s) 0 NA Inspect pump, pump controls & alarm At least once every: „3,nonth,ls) L3 NA earls _ F=lush laterals and pressure test At least once every: ❑ month(s) LI NA Other: At least once every: ❑ month(s) ❑ NA - - Q year(s) - - ()ther: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master .Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servif ing Operator. Tank inspections must nclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the efflr.rent 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. When the combined accumulation of sludge and scum in any tank equals one-third (4) or more of the tank volume, the entire contents of ithe tank shall be removed by a Septage Servicing Operator and disposed of in accordanc-ra with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 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 1=or now construction, prior to use of the POWTS" check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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, During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within IS feet down slope of any mound or at-grade soil absorption area. Reduction or efrminatlon of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrapE ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. A, BANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code, • All 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. e 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 compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing anti proposed structure, lot lines and wells, Failure to protect the replacement area will resuft in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in 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. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area, If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following rumoval of the biomat at the infiltrative urface, Reconstructions of such systems must comply with the rules in effect at that time. <4WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/Oft INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. Dp ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIF=FICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name C` Name Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name ~,5 / ~ Phone 7/J - r t _ j Phone 4j gz/-zd~ This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. • V . 0 FILTER.:00 Installation h1 Etc- x Pry flt the raer ca- onto the and of centered under the occesx khe outlek pipe to ensure it is tank through the outlet or sn~lvent weldnpjite en either insert more pipe into flee pl e. (g ) additional P pipe onto the nutlet t i While the case is still dry fitted an the outlet pipe, of Inch pipe needed measure the length optional to brace the filter to the tank end wa"Piemantal side support. If side s g If Utilizing the Proceed to step four, upport method. is not l utilized, zing t 6`' ; For tinstallations h,e W,-Inch utlll2ing solvent the optional supplemental side support. utRi7ed, weld the proceed W to step inch pipe onto the filter rase, if side support method is not to four: ra Solvent weld the flitrr case onto the outlet cartridge into the rase, pressing down until the filter Locks iInse the filter the case. n orthe bottom of k!r`.,;SP;e If a AS switch is utilized: insert into by the filter and cork clockwise 90°, h •'?F•r~" ,turning . 2rr •E I l1 Main _ tenance L The effluent filter should be cleaned every time the septic tank Is serviced, 2. Open the outlet access opening to Inspect the tank and filter. 3. Pump the septic tank campletei , layer on the bottom of the tank making ott justsure ttheo SCUM the uent, 4. Once the effluent level has b and effluent, Outlet et t e en been lowered beioW the invert of the pre: cartridge fro firmly pull up On the filter handle to dislodge the cartridge m the case. G. slide the cartridge up and Out of th ~ x, 6. If a VAS switch the case for cleaning. connected to an alarm is present, the switch ! should be removed by turning counterclockwise 90° and cleaned with water only, "l. While holding the cartridge an Its side (large fiat surface facing down) over the - : ' only, making access apenkr9, rinse off the cartridge with water sure an septage material is rinsed back into the tank. 8• If VRS switch is utilized, replace by inserting into filter and 7 ' turning clockwise go 1 ''•x~ r".- 'i 9- Insert the filter cartridge back into the case ! - M.. ~r 31 r"jr , pressing dawn until the filter locks Into the bottom of the case. 10- Replace and secure the access opening on the tank, 44 µ + •y/r ~,''.'d)4Yf: ilr'Y;,, „f I'.~ L irk 4. ':.Ih i+J:. S:>•I.t:•l... WWw bearons1tex0M 877-ML-FILTIRP.S [653-4583 ST. CROIX COUNTY SEPTIC TANK. :MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer v._~2SZ~' ~''`c~ - - - - _ - - f Mailing Address _ ~f ~~y u~ Property dress 2~I V V a! 4 a~ Y l l(_ W A r ~i~ (Verification required from Planning & Zoning Dep rtment for new construction.) City/State Parcel Identification Number LEtGAL DESCRIPTION Property Location N R f 7W, Town of _ -7) Subdivision Certified Survey Map Volume Page # Volume :Page # - Warranty Deed # Spec house yes rw lot lines identifiable (259:1 no S'YSTENI MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper into maintenance consists of pumping out the septic tank every three years or sooner, if needed, by'a. licensed pumper. What you put the system can affect the function of the septic tank as a treatment stage to the waste disposal system. owner' maintenance responsibilities are specified in §Comm. 133.52(1) and in Chapter :12 - St. Croix county Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the on-site owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying hat (1) the the septic flank is wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if less than 113 full of sludge, ystem With the ivate ain of C requirements nardid agree the to mAin n of Natural Resources, pore of Wisco sin. l1we, the undersigned have read he above standards set forth., herein, as set by the Department Depart Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning Zoning Department within 30 days of the tinee year expiration date. lmowtodg 1/we certify that all statements on this form are rue t he, Rbeat egisf mYl Deeds Offi ee I/we am/are the owner(s) of the ter of property described above, by virtue o warranty de d o C~~""'' " - ` Plumber of bedrooms DATE U> Ir---~-- - ~~~IGNA'3. OF APPLICANTS) formation that is misrepresented may result in the sanitary Peru being revoked by the planning 8c 'Coning Department. -r Any in lncliide with this application a recorded warranty deed from the l~gister of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) 8133718 Tx:4108037 STATE BAR OF WISCONSIN FORM 3 - 2000 973570 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Oevering ST. CROIX CO., WI Homes, LLC, Grantee. 02/19/2013 3:15 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT*: NA Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 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 Retum Address: Title One File # 19148 Together with all appurtenant rights, title and interests. 040-1303-00-009 =040-1303-0-0_29::) Parcel Identification Num 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 TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) c. 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 necessary.) *Names of persons signing in any capacity must be typed or printed below ei0tigwN MNotapublic. t2 o1 of 1 QUITCLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 04:01 Parcel 040-1303-00-029 P oz/za/zo 3 PM PAGE 1 OF 1 F 1 Alt. Parcel M 22.28.19.1764 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Current X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - 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 " 248 WALNUT HILL WAY SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.250 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T28N R19W PT SE SE WALNUT HILL Block/Condo Bldg: LOT 029 FARM LOT 29 (1.250AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 03/28/2006 821622 WD 12/10/2003 748768 2471/594 WD 11/19/2003 747018 9/92 PLAT 2012 SUMMARY Bill M Fair Market Value: Assessed with: 187923 30,700 Valuations: Last Changed: 08/20/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.250 35,000 0 35,000 NO 10 Totals for 2012: General Property 1.250 35,000 0 35,000 Woodland 0.000 0 0 Totals for 2011: General Property 1.250 45,500 0 45,500 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 88.38' Lt 140.18` ZI N~f 4MOMP ur VENOM --m mm IL 'S 89'17'01" w ZZ& 50 _ (b lb S 891 7`O1 " W 228.50' Opp 'h t 2 r IW1 30 .1 gl 47722 S.F. ~ 5273 S.F. s ~ 1.10 Ac. #1.04 Ac.1 .29 54475 S.F. 1.25 Ac. 1 xa 31 .6 454N 1.04 141.98' 202.5' UNPLA TTED 1 VO5 , ~~ill TH LINE THE Sf ~QWNED BY .QTHERS S r o z z w O F°~~ea9 ~ N p z a;"ga C Q Q z €g > ° > J g a;1 A ~w> cjwJ NZW mj0 III ^itt~ ~ I j C NQ ' J 1 7M > r LLOuj r k p i y !1 1_ ~LLm II ,I del I' ~ ~I ~~li ~ ELI A-~ ~T I +E 8~ d -11 I I u ,{I. il~ IJ J. t ? ?ip ~ { r }i. ~ `z_ ' IL 4 L6 4 rc- m i H ?i [[ff ~C '1 ~ Ls a II i ` a ~I p { a "a o O M Si CC6 ISp~ca n lj Zap x Y° 'C 7 ) } ! 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I I I I i I I B Wb ffo 5;@ 8 l y J a e s of E > Hot ~Llj p W z~ J F 5 LL o.~, 30 ~ aJ Ito" u n[ .o J J 3~3 W I I UZ °ia m I I I I I I ~ _ R I k .r .s[ I n l I I I r -J-- a a - o j o ~e ~ II I I I I ~n~l„~M~e ~ I I I II I I I I i II I i I I L____JJ I I I I I I I I I I ~ I I o k I p I I I I ~ I I I I I ~ I I I I ~ I I I I I I I I ~ I I I I I ~~o I I I - I I I 8 gb list 'a. d is ~a~ o Z c~.~ ui ° s 2 O Lp ~~J.. N ~ Z ~bg g~3ggE8~ ~ W In g § . 9118.] hill] 1111:1 ° u Ludy m i~~. t ~ r q I~ 'o 'o o 'o 'o oo"o h gf g~g 9t q ~rn .~Ia T~T~~ 43 I k 4 i ~ r 1 g €~O$~$$o TOM. F yy A ~ K 1 1 1 1 414 t 2 g :g, alp aW ~„,o ..,,ol g b- ~~a Ana b ill all oil d u Y ,*"wr wonsin Department of Commerce SOIL EVALUATION REPORT Page Of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County 57- G,e 4/' 'V Attach complete ; inctude, but not ib EROSION CONTROL PLAN must be Parcel i.D. Z-nT ya 3 a 3 Perch sue. sc completed before sanitary permit issuance b e/. Personal kftm-ton you provide may be used for secondary Purposes (Privacy Law. s.15.04 (1) (m)). - 13 1 Property owner PropeftyLocatiet•on ©F I-O pp Z3 ER5 Te7D ~ Ggut tot, " Jt 4' E; 1/4S ~L T 2•v N R & (or) W Property owners Mailing Address of # # Subd. Name or CSM# !~0I5 CAWiLL V.~ y WALNvr tit I Cky, SM MR State Zip Code 'Phone Number ❑ • ❑ Village W Town Nearest Road 6x006 Hn MN 5S# We ( &5t) ayf• tof~ --,coy so. eIovek 'R 0 O Oa GPD New Corstructiorf Use: 0 Residential / Number of bedrooms Code derived design (low rate ❑ Replacement ❑ Public or commercial - Describe: 11A Patent material l0 ES S el/A, "fiYIS Flood Plain elevation if applicable ft General comments and recommendation: • 42vE* r&,'rC-v 5'017,tale ,~ie ~Yo v v vs r2:---41 7-eslve N t Borir,,g # D Boring i o 0• C~ S 5. s s. o Pit Ground surface elev. R Depth to limiting factor V- in. Sol, Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDlfF in MurtseA Ou. Sz Cont. Color Gr. Sz Sh. *M1 'Eft#2 C o ~oy/2 z S le <S4 ~S zf . 2. • ;21 /o 1 3< c, Lf 5he s cc~ / . S \A l !o!t to shy 4 c4v . 2... • 3 g / D y c2A MoT5 Y16L S6 /W I/ • z- 76 Y/2 sib Boring # ❑ Boring , d o • CO S Z y S.sS . ® Pit Ground surface elev. ft Depth to Writing factor r! in. Soa lication i2ade V1 Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPM in. Mtusell Qu. Sz Cont. Color Gr. Sz Sh. 'Efl#1 'Efl#2 0-& /o vx2 .51 L Z <S Gi w Z-f- .5 N Z 0 Y12 bA S c / F- N -5 ep L •Sa D c2 ~f rf 5161- - Z /a 11A (/tZ 4 EHkrent #1 = BOD > 30 1220 mglL and TSS >30 < 150 mglL ' Eftiert #2 = BOD < 30 mglL and TSS 5 30 mglL CST Name (Please Print) , ,u R (G signature CSTNumber co 3 -7 5; Address Ulbricht & Ass9ciates Conducted Telephone Number Private • / b O 3 715- 77A • 3 YY 2- 2812 10th Ave. Spring Valley, WI 54767 w} OR I GINA L /X)5' " fak 4PRO,)( . Z yO 4 ACS • oY0 • /off s • sa o~ aYo . /o . ~a • o~ 0,Y, q. /0*(v • Z p • oaa oyo•/o81~• o Yo • io 96 - 70 oaZI a y~ . lo~~ ~p • ~ 4 ?oDV 13 JE e 5 rE©T- Z 3 property OVMer Parcel ID # # g LO/- F ~ Q 8o-v ofp 2 SsS c Ground swlace eiev / d • !D ft_ Depth to WnnMV factor / IM l~odzon Soil Rate Depth Dcxninan€ Cokx Retlwc Desa~Gon Texture Strut a consistence SOtmdary Roots GFUflF In. Munseff cu. Sz Cont. Color Gr_ Sz. Sh. `Eff#1 .FrAV2 a~0 Y/? 47 S/G Z dSl~ w Z~ .S Z D• /~o /o J//P Si G 2 S K S . S 3 G• ~o ~ ~ c i ~sh~ . z. 3 'S. s~ D o rS S c t/ J~ v Z. 3 /d V'e 4l X-- ' S~ i T Bo"O # aw0 Pit Ground surface etev ft. Depth to firnlting factor in. 50 i~Non Race iiocizon Depth Donunant Redox Desa"on Texture Stauckwe consistence Boundary Roots C~ Mua>sett t2u Sz. C OM Color tom. Sz Sh. 'E1 'E ET Bonng # ~ i3onng pit Ground surface elev. it. Depth to Orm ke. S &VkWon Rate Horizon Deptlt D~nfnarrt Redox Description- Texture Consistence fts dary Roots GPM in. Mu nett Chu. Sz. Cont Color 'sr. •Etll#1 'Eff#2 l y i - a F-1 Boring # Borng pit Ground surface elev. Depth to G dit factor in. Soli Rate tiortzan Depth Don*mt Cow Redox Oes«lption. Texb" Structure eonsistenoe aourwaKy Boats GPOff In. Mur"N OU Sz. (Cont. Color Gr. Sz. Sh. `EW1 "Eff#2 ` Effluent #1 = BOD$ > 30 < 220 ffxA and TS5 >30!i 150 n7gtL ' Ettluerrt #2 = BODs < 30 rngIL and TSS < 30 mgrt. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seaasaa lrtumot TDGl7 73 Jr*E L*S rFD7- Z Z 3 L ~ Fage of F31 )"tYr # - E) so PM-cal ID # Sys y yo Z S I Ground surface elev. _ tl_ Depth to limiting factor in. Soil ication Rate Ftorfzrort Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP[Nf IM Munseft Qu. Sz. cant. COW Gr_ Sz. Sh. -Eff#1 "Eff#2 YR V/4 s/G z 1,~ ds C, w Z f . S Z D• /G /o /e Si G 2S k 6 . S 3 G• /a V12 , c/ csh/e' d'4 S Sa p cz o rS S c L / L 4-M V/- Z S~ Boring # Q 'Bating Pit Ground surface elev. ft_ Depth to limiting factor in. rarofl icaUian Rate i`torizan Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD(w fn. Munseit Qu. Sz. Corti Color Gr. Sz. Sh. Vim 'l_fM E Baring # ❑ Boring , ❑ pit Ground surface elev. ft. Depth to l' In. SoAf2ate t torizon Depth Dominant Color f2edox Description_ Texture Consistence Baurxlary Roots G in. Munsep Cie. Sr. Cant. Color s. h. "Eff#1 'Eff#2 Bating # Boring 0 pit Ground surface elev. Depth to limiting factor in. tiorr Rate ' Mka V Sol Horizon Depth Dw.nlnant Color Redox Description. Texture Structure consistence Boundary Roots GPDMe In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eti#'f •Eff#2 Effluent #1 = BBD. > 30:S 220 mgll- and TSS >30:S 150 mg/L " Effluent #2 = BODE < 30 mg/L and TSS S 30 rnWL The Department of Commercc is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 6€38 264-8777. I PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 d = Contour elevation lines. • = Backhoe Soil pits. p = Benchmarks set, maRRED WITH FLAGGED lathes. 1/2° steel conduit pipes. GA 00L) j,A SCALE : 1 " Z Q ] Or o~ iS s (3~sT~ ZINi ~4'~i`! ,n~' n s~yy / oo ~S Sys T 70 f s p ere Z /DD, o