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HomeMy WebLinkAbout020-1329-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561024 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 Hudson, Tow of 020-1329-60-000 CST BM Eiev: Insp. BM FW: T M Description: W,`.6 f'&^- Section/Town/Range/Map No: / 1J rn 65T- 24.29.19.1719 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / O bZ /bb • Dd Alt. BM F~ ems. F'( L... 9'~• Aeration Bldg. Sewer .9 95. 3 Holding St/Ht Inlet 7► 95 TANK SETBACK INFORMATION St/Ht Outlet 5• 9~, $ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 5d > /O / _ Dt Bottom Dosing Header/Man. 9J . Aeration Dist. Pipe (0 - re 7-Ce 9Z- to Holding Bot. System '7. 4 9Z • Ce PUMP/SIPHON INFORMATION Final Grade 3.rj`J(o Manufacturer Demand St Cover GPM . 9g , Model Numbe TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 2- Ve,.4L,1~J 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture~r://~ INFORMATION CHAMBER OR :i ~I • a-l", Type Of System: / UNIT Model Number: ~ 24 M_ - C k 4 4 57L.-- DISTRIBUTION SYSTEM All /U +-/(a ~ 32 Header/Manifol it Distribx Hole SiZ~ x Hole acing Vent;,A;irr Intake \ .WI Pipe(Length Dia LDia \ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth 1xx Seeded/Sodded xx Iched Bed/Trench Center y Bed/Trench Edges ` Topsoil Yes D No ` Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 870 Wyldwood LLaane~ Hudson, WI 54016 (NW 1/4 SE 1/4 24 T29N R1 9W) Wyldwood Lot 6 Parcel No: 24.29.19.1719 1.) Alt BM Description = * I j~ COJ_. C rL 6"- 2.) 1~ Ca ~ ~OGR. 2.) Bldg sewer length = /5 - amount of cover = I a' 3 e Plan revision Required? ~ Yes ~No - a3~ - - - ~3zl 75 Use other side for additional information. L i IL SBD-6710 (R.3/97) Date Insepcto gnatur Cert. No. Soil Test and System PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 24 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX r MPRS Shaun Bird 226900 DATE 4/29/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 32 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 91.0/91.7 5' below qrade 346' Property Line B.M.* Scale is 1" = 40' unless otherwise noted 64' B-1 B-4 2-3' X 66' Cells with >3' spacing 38' 28' 70' B-1 10' , eplacement area 7% Slope 10' B-3 B-2 5' 46' , Vents 30' 10 0' B-3 28' 98' ST Vent 38' 15' BM. 20' >6„ Quick4 Standard g_ B-5 of Cover Leaching Chamber Pro 3 with 20.0 ft2 of Area Bedroom 12 10.2ft^2/pair of end caps House 4' Long " 34" ft- Grade at System Elevation 0 W 190' Property Line Well is to meet all setbacks required by WDNR Town Road All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. „a { TCounty 1 Safety and Buildings Division / 0''` 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, W1 53707-7162 o At -616 24 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the approp ' e t A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned T roject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide sed for secondary purposes in accordance with the Please Law, s. 1 , Stats. I. V 76 1 w Application Information - -Print All Ail Information Property Owner's Name Parcel # VA ~0- Property Owner's Mailing Ad s Property Location t3 l 7/ 9 0 c~t ~~C~ Owl? CPi City, state Govt Lot Zip Code Phone Number n~ ~ '1a~'/a, Section t-,7 Nit/ • yx~ J J` circle II. Type of Building (check all that apply) Lot # T~ N; or W I or 2 Family Dwelling - Number of Bedrooms 6 Subdivision Name Ott- Block 4 ❑ Public/Commercial - Describe Use p 1, Ia,^ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z L own of t.v C - III. Type of Permit: (Chec 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) g• ❑ Permit Renewal ermit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 56/02q- .ZZ G7 Z© ' IV. Type of POWTS S stem/Com onent/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (expla' V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Applic n Rate(gpdsf) Dispersal Area Required ( Dispersal Area Prop System Eleva ' n 171. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks '2 ~ y- 0.3 yr r w C7 R, Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume ponsibility for installation of the POW'I'S shown on the attached plans. Plumber's Name (Pr int) Plumber's lure MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) 3 2_d l VIII. Coun /De artment Use Only Approved Permit Fee Date Issued Issu' gent Signature 15.06 y /3 Ow ~ 'ven Reason for enial IX. Conti lReasons for Disapproval 1. , Septic tank, of wit filter and` 3) tVJ / /1 e+.tr dispersal cell must all be serv ices as per management plan provided by pkimbet CA, 2. AN ise4ack requyements must be mskttak* ' cods / 7 B m -j7, O Ca Attach t o complete plans f o r the system and submit to the ounty only on paper t less than 8 1n i l l inches in size SBD-6398 (R 11/11) Soil Test and System PLOT PLAN PROJECT Oeverina Homes LLC ff\ ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 24 /T T/R 19 W TOWN Hudson COUNTY ST. CROIX .L MPRS Shaun Bird 226900 DATE 4/29/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 32 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.0/91.7 5' below qrade 346' Property Line B.M. * ICI Scale is 1" = 40' unless otherwise noted 64' B-1 38' B-4 28' 2-3' X 66' Cells with >3' spacing 11-411- 70' B-1 10, Replacement area 28' WA ~ 7% Slope 10' B-3 B-2 5' 46' 96' Vents 30, 100 B-3 28' 98' ST Vent >6 38' 15 ' BM. 20' '9 Quick4 Standard B_2 B-5 of Cover Leaching Chamber Pro 3 with 20.0 ft2 of Area Bedroom 4' Long 1295 10.2ft^2/pair of end caps House 34" Grade at System Elevation 190' Property Line Well is to meet all setbacks required by WDNR Town Road All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. CEIVED Wisconsin Department of Commerce SOIL EVALUATION RPage of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code APR 2 9 2013 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 ~OUN7Y/ tReviby RE percent slope, scale or dimensions, north arrow, and location and distance to nearest road. p? O b P/ease print all information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). 3d 13 Property Owner Property Location i Q JA L Govt. Lot / A J 1 1 /4 , T N R E (or W Property Owner's Mailing ress Lot # Block # Subd. Name or CSM# l~ r Ale- 6 - 4c.-'C'i City ?,"late Zip Code Phone Number ❑ City ❑ Villa Nearest o d New Construction Us Residential / Number of bedrooms Code derived design flow rate w GPD ❑ Replacement ❑ Public commercial -Describe: Parent material Cx"6eic~t Flood Plain elevation if applicable ft. General comments and recommendations: System Type Z0 y2nx, ~ !fit System Elevation 1-7 Boring # ❑ Boring F-1 I A Pit Ground surface elev. 0 ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3 , c nl / , r (~D Boring # ❑ Boring / 19 Pit Ground surface elev. ft. Depth to limiting factor ZI L) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 it -Ito Effluent #1 = BOD > 30 < 220 mg/L anh TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print? CST Number Bird Plumbing, Inc. Shaun Bird Si 226900 Address ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 3 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring J4, pit Ground surface elev. ft. Depth to limiting factor l/ in. Soil Armlication 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 31?- -5/ 3 - J ~/l F-1 E] 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 E Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mgA- 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. SBD-8330 (8.6/00) Property Owner _ Parcel ID # Page of Ong # ~ Boring pit Ground surface elev. ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 J2 1- / t s Z e 4,0 LOU a 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 GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # E] Boring F-1 11 pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 = BOD5 > 30 < 220 mg/L and TSS >30 1150 mg& ' Effluent #2 = BODS < 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. SBD4330 (8.6/00) coo" Ice.W1.90V My and Buildings Division County t 201 W. Washin oo, Aye., P.O. Box 7162 t#1 W 1 3707-71~~ anitaryPermit Number (to be filled in by Co.) sconsin Pt ¢ 14n 0 't!"rbsiefft of Commerce OZ Sanitary Permit Application Stake Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS arc Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary sea in accordance with the Privacy Law, s. I5.04 1 m , Stats. #'9;7e) V 1. Application Information - Please Print All Information Property Owner's Name Parcel # ~r L C- qc2 Property Owner's Mailing A ss Property Location 1 71 /y3 Govt. Lot ~r, City, state Zip Code Phone Number Section 1_ 8-~2 i _ T _ N; 1 or W Lot # 11. Type of Buildiag (check all that ripply) 2 Family Dwelling -Number of Btoo Subdivision Nan} ed Q~ C~ 14 Block# /j [I Public/Commercial-Describe Use El of CSM Number ❑ Village of ❑ State Owned -Describe Use I 1 ownuf III. Type I Permit: (Check only to box on line A. Complete line B if applicable) New System 11 Replacement System El Treatment/Holding Tank Replacement Oniy ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued n Owner v~• B. tTa-nk0tthhcr wal ❑ Permit Revision ❑ Change of Plumber ❑ Permit'fransfer to New IV. T S S stem/Com onent/Device: (Check all that apply) No-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ HoOther Dispersal Component (explain) ❑ Pretreatment Device (explain ) V. Dient Area Information: Design Flow (gpd) Design Soil Application Rate (gp f) Dispersal Are Required (af) Dispe aI Area Proposed (sf) Smote Eleva ' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units D U _ u New Tanks Existing Tanks Ir F 1 U rn to v~ i+ C7 Rte - Septic or Holding Tank Dosing Chamber 41 VII. Responsibility Statement- I, the undersigned, ass sponsibility t')r installation of the POWTS shown on the attacked plans. Plumber's ame (Print) Plumb gnature MP/MP Number Bus as Phone Number Plum is Address (Street, FState, pC 1 Z IZ-16 Al/ VIII. Cou nt /De artment Use Only Permit Fee Date Issued Issuing t Signature . roved V,-s a pw iven Reason u enial J IX. Condit"TO weasons for Disapproval 3 t)r / p(~ Jtl 1 SeptlC tank, effluent fiKK and dispersal cell. must 311 be senAM / rrtaintatfmt! pt,ry~ r r as per management plan provided by'pkm,*M 2 Ad so=k re4tArel dents Must, be IT d / /L Iro(.I~.o~"l ors- r Attach to complete plans for the system and submit to the County yon not less thong 112%. It Inches in size O J 4) Al (R. 01/07) Valid thni 01/09 C , PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 24 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/24/13 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 650 # of chambers 32 BENCHMARK V.R.P. Top of NE lot stake ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.2/95.1 3.8' below grade 346' Property Line B.M.* Vent Scale is 1" = 40' >6„ Quick4 Standard unless otherwise Leaching Chamber of Cover with 20.0 ft2 of Area noted 64' 10.2ft^2/pair of end caps 4' Long 12" Grade at System Elevation Vents 34" B-1 38, B-4 28, Please note:further testing 2-3' X 66' Cells with >3' spacing 28 will be done to lower system elevation B- 46' Pro 3 28' Bedroom House 3 8' 20' 10 B-2 B-5 ST 60' 30' All piping shall be SDR 30/34, within 10' 190' Property Line of tank, piping shall be Schedule 40. Well is to meet all setbacks required by WDNR Town Road d i I Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/27/13 Owner: Oevering Homes LLC Location: NW1/4 SE1/4 S24 T29 N,R19W Lot Wyldwood Hudson 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 heet Signature License numb 26900 ~,I PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4s 24 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/24/13 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 650 # of chambers 32 BENCHMARK V.R.P. Top of NE lot stake ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/95.1 3.8' below qrade 346' Property Line B.M.* Vent Scale is 1" = 40' >6" Quick4 Standard unless otherwise of Cover Leaching Chamber with 20.0 ft2 of Area noted 64' 12" 10.2ft^2lpair of end caps 4' Long 34" Grade at System Elevation Vents B-1 B-4 38' 28 Please note:further testing 2-3' X 66' Cells with >3' spacing 28' will be done to lower system elevation B 46' 0-411- Pro 3 28' Bedroom House 38' 20' B-2 B-5 ST 60' 30' 10 All piping shall be SDR 30/34, within 10' 190' Property Line of tank, piping shall be Schedule 40. Well is to meet all setbacks required by WDNR i 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 10.2ftn 2 pair of end plates g Finish grade elevation Typical Installation 99.0' Vent Grade Vent XTank ALong 4" 3' 19 1 5' S' Long 1 Grade at System Elevation 3611 Grade at System Elevation Spacing 5' i 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A I B 16 chambers per cell System elevations: A 95.2' B 95.1' POVVTS OWNER'S MANUAL & MANAGEMENT PLAN Page or FILE INFORMATION SYSTEM SPECIFICATIONS al ❑ NA Owner Septic Tank Capacity F Z Permit # Septic Tank Manufacturer Effluent Filter Manufacturer ❑ NA AIIA- DESIGN PARAMETERS Number of Bedrooms 11 NA Effluent Filter Model ❑ NA Pump Tank Capacity al NA Number of Commercial Units , a1/da Pump Tank Manufacturer NA Estimated flow (average) al/day Pump Manufacturer NA Design flow (peak), (Estimated X 1.5) Soil Application Rate aVda /f 2 Pump Model Monthly average" Pretreatment Unit NA Influent/Effluent Quality ❑ Sand/GrHvel Filter ❑ Peat Filter Fats, Oil & Grease {FOG} 530 mg/L ❑ Mechanical Aeration ❑ Welland Blodhemlca! Oxygen Demand (80135) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s) ❑ In-ground {pressurized) round (gravity) Biochemical Oxygen Demand (130135} 530 mg/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) 530 mg/L ❑ Other. Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Dri ine Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-cornmerclal) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event At least once every ❑ months (s) (Maximum 3 yrs.) Inspect condition of tank(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (S) of tank volume I At least oncg ❑ month r(s) (Maximum 3 yrs.) Inspect dispersal cell(s) ❑ months r(s) Clean effluent filter At least on, At least once every ❑ months ❑ year(s) NA Inspect pump, Pump controls & alarm At least once every ❑ months ❑ year(s) NA Flush laterals and pressure test ❑ months ❑ year(s) NA other At least once every over At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual carrying one POWTS Maintainer, Septage certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector, missirt or broken any hr war Operator. Tank inspections the volume of combined sludge and scum a d to check for any back up or easure u levels on the hardware, identity any crack shall or ponding of effluent on the ground surface. The dispersal ing of effluenlt on the ground slurface~he podckin g of the effluent effluent in the observation pipes and to check for any Pondreg latory ground surface may indicate a failing condition and requires the Immediate notification, o mthe ore of the tank volumeauthority. the When the combined sh sation of sluge and scum In any tank equals one-third hall be removed by a Septage Servicing Operators and disposed of in accordance with ch. NR entire contents of the tank 113, Wisconsin Administrative Code. ~ rents, and any The servicing of effluent filters, mechanical or pressurized POWTS components, prdt e a certified POWTS Maintainer. other maintenance or monitoring at Aervals of 12 months or less shall be performe by completion of any service event. A servicd report shall be provided to the local regulatory authority within 10 days of comp START` UP AND OPERATION for the presence of painting products or other For new construction, prior to use of the POWTS check treatment tank(sdispe ) gal cells If high concentrations are may contents of the tank(s) remo oved by aoseptage se ecing operator prior to use. detected chemicals th have the Page of START UP AND OPERATION For new construction, prior to use of the PO S' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or d mage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing opera or 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 w411 be discharge of effluent. discharged to the disperse{ cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface 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 primp 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 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination 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 scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT 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. • 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac ment system: 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 and proposed structure, lot lines and wells. Failure to protect the replacement area will result 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 Me 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 removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINE _ Nam _ Name Phone ✓ S Phone ~~~vZ J SEPTAGE SERVICING OPERATOR PU PER LOCAL, REGULATORY AUTPORITY Name Name Phone T~' Jr1 Phone ~~O 6 fj 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. ~3~ . f , FILTER CARTPJDGIE INSTRUCTIONS Installation 1 '3T--'P Z Dry fit the filter case onto the end of the nutlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pie onto t pipe. P he outlet r' ' While the case is still dry fitted on the outlet pipe, measure the length of -V4-inch pipe needed to brace the filter to the tank and wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four, P For installations utilizing the optional supplemental side support: solvent weld the 3/.-Inch pipe onto the filter case. If side support method is not ;Ryt7; utilized, proceed to step four. Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°. Maintenance 1, 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 completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. ; 5, slide the cartridge up and out of the case for cleaning, 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. A. , 7. While holding the cartridge on its side (large fiat surface facing { down) over the access opening, rinse off the cartridge with water y only, making sure all septage material Is rinsed back into the tank- r~ v 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°, -,,k•;..~• 9, Insert the filter cartridge back into the case, pressing down until I, + the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank,' 1:• 51'a.. 4A;•"r. ,i d'+lec rk~Fr; r www beamnsite.corn 877-ML'FILTERS (653-4583) 12 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q (.7 r( 1V Mailing Address Property Address A ( o a tie-, - - (Verification req fired from Planning & Zoning Department for new construction.) T` City/State Parcel. ;Identification Number _Qo2p ~~02~ _ L17" LEGAL DESCRIPTION L Property Locati.oAAA-b) Ya .5 Ya , See.2T , T Z~ N W y W, Town of Subdivision _ ~-~1 ' - _ - - a Lot # Certified Survey Map # Volume Page # Warranty Deed Volume , Page # Spec ]rows yes no Lot lines identifiable oyes 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 three years or sooner, if needed, by a. licensed pumper- What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in. §Comm. 83.52(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 owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than l/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. 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 three year expiration date. I/we certify that all statements on t is form are true to the best of my/our knowledge. I/we, am/are the owner(s) of the property described above, by virtue of a w rranty deed recorded in Register of Deeds Office. - Number of bedrooms a - o? b?6 /l-3 IGN' 4 OF .APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit. being revoked by the Planning & Zoning Department include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) II IIIIIIIIIIIIIIIIIIIII~I II ~I) 8115807 State Bar of Wisconsin Form 1-2003 Tx:4092463 WARRANTY DEED 969641 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Daniel R. Krueger and Elizabeth M. 12/17/2012 3:19 PM EXEMPT#: NA Krueger, hushand and wife ("Grantor," whether one or more), REC FEE: 30.00 and Oevering Homes, LLC TRANS FEE: 144.00 PAGES: i ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address Z6, ed, please attach addendum): River Valley Abstract & Title 1200 Hosrford St. Suite 201 Plat of Wyldwood in the Town of Hudson, St. Croix County, Hudson WI 54016 File: 2810363 Wisconsin. 020-1329-60-000 Parcel Identification Number (PIN) This is not homestead property, (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated December 14, 2012 r (SEAL) (SEAL) * Daniel R, Krue er * Elizabeth M. Krueger I (SEAL) (SEAL) I AUTHENTICATIO~tttltnl1rr~~` ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) v ) ss. authenticated on ~~+OT Aq g ST CROIX COUNTY ) * N All Personally came before me on December 14, 2012 5 the above-named Daniel R. Krueger and Elizabeth M. TITLE: MEMBER STATE BA~PV, IFISQQN(If not, WIS?5\, authorized by Wis. Stat. § 7Q6.0 ~Itttltttttto me known to be the person(s) ww ex~ u d the foregoing \ instrumem arf c ledged_th. THIS INSTRUMENT DRAFTED BY: * Lorri . DeMars Doug Berg /Xoota ublic, s ate 1200 Hosford St. Suite 201 Hudson WI 54016 mission•is m anent) (expires: March 20, 2016 (Signatures may be authe ticat ledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRAN'T'Y DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 ' lyaf lame below signatures. ..~v a N 85.1 CID S 89'27' BENCH MA\RK ELEV.1014.82 Ln 10.00` N 001511 150,00' , 40.00 340.5 - 182.08 ALLOWED BELOW o S 0.32'27° E N 89'27'33° E 139.90' 166.98' CO 20.00' 2C' DRAINAGE EASEMENT N 0'15101 _ ~ 188.91` S 88°55'40' E %P N 0'15'01' w 10 41 171;.55' cpQ rr - W ell 4.90 'S!9. 4p ~ rIj tai W . 1 (Xi ~u to i~ ~ o ao ni / b D DRAINAGE EASEMENT--- - . f 6sr kl~001 . f o i * r w r WAX M f - i t f 4 Ail 7 IWA d rITTI l O a ~ AL spa s+a y ' NI Wiscorii; • Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of I '-tor and Human Relations t . ision of Safety & Buildings in accord with ILHR 83.05 W 0~ W",?- ! ' f COUNTY St . Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. fF~'fanxnust i tude,, but not limited to vertical and horizontal reference point (BM), direction and %of~-sfopascal ` N ~ 4n CEL I.D. # d - dimensioned, north arrow, and location and distance to nearest road. I `T ED B DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI`j01~1 t~ -J ZZ PROPERTY OWNER: PROPERTY1OGATfiON,, "Ji Gr-e - 13U1lT LOT tY4LS ,S 24 T 29 N,R 19 for) W PROPERTY OWNER':S MAILING ADDRESS0 - J3LOCK I-SliBE d1AME OR CSM # 1416 3rd. st. nay ` ldwood `1'7I1 CITY, STATE ZIP CODE PHONE NUMBER nOtTY E]VtUAGE, 4NOWN NEAREST ROAD Hudson, WI. 54016 (715 386-3674 Hudson Badlands Rd. [x] New Construction Use [ x] Residential / Number of bedrooms 3 [ ] Addi •on t exist' !9 building j J Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate __7_bed, gpd/ft2_._8__trench, 9Pd/ft2 Recommended infiltration surface elevation(s) 95.9=alt. area=94.9 It (as referred to site plan benchmark) Additional design / site considerations alt area backfilled to code Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL WHOIDINGTANK U= Unsuitable fors stem f7 S❑ U ZS ❑ U ERS ❑ U E] S❑ U {c7 S❑ U SOIL DESCRIPTION REPORT I Depth Dominant Color Mottles Structure Borin9 # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Ronone sil 2msbk mfr 2U2 8-45 10 r5 4 none sil lcsbk mfi 9W if .2 .3 lcsbk mfi na 14 .5 Ground 3 45_61 none 10 r4 4 elev. 30.00 ft. 4 61-10 7.5 r4 6 none cos os ml na na .7 .8 Depth to limiting factor CQ +100" S C 3 S°?o Remarks: Boring # 1 0-10 10 r2 2 none 1 2msbk mfr gw 2f .5 .6 2 2 10-40 10 r4 4 none si lcsbk mfr gw if .2 .3 Ground - 7.5 4 6 none cos os mi na na .7 .8 elev. 98.9 ft. Depth to limiting factor +84" Remarks: AJ, CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 20 Ave. Ne Ri nd W1,44017 Signature: Date: 10-16-96 CST Number: m02298 Z Z~L4 -A PROPERTYOWNER Greenwood Ent. SOIL DESCRIPTION REPORT Page' I- PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench -8 1 r2 2 none 1 2msbk mfr 2m .5 .6 2 8-34 1 r4 4 none sil 2msbk mfr Ground 3 34-84 7.5 r4 6 none cos os ml na na .7 .8 elev. / 99.9 ft. Depth to limiting factor l~ +84" Remarks: Boring # n-8 10yr2/2 none 2mqbk Mfr 9w 2M 4 2 8-3 mfr c1w if .2 .3 Ground - elev. 98.9 ft. Depth to limiting ' factor 71 +86" Remarks: Boring # 1 10-1 2msbk mfr 2m .5 .6 5 2 10-38 10 r4/4 none sil lcsbk mfr 9w if .2 .3 Ground 3 38-80 7.5 r4 6 none cos os ml na na .7 .8 elev. 98. loft. Depth to limiting 1 factor +80" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: I~ SBD-8330(8.05/92) J Wisconi Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of oor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05,' ' 0 9 < COUNTY St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. n 'ust iOud,but not limited to vertical and horizontal reference point (BM), direction and op e~ CEL I.D. # 0_ 1? 2- _ d (o dimensioned, north arrow, and location and distance to nearest road. c r l , ED B DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT !`1: 4 ri 3 2Z ,u i PROPERTY OWNER: OPERTY SON . , a G; LOT J,Gt=/d 4,S 24 T 29 N .R 19 fir) W PROPERTY OWNERS MAILING ADDRESS ~ .FLOCK.#, AME OR CSM # ~ 1416 3rd. st. ldwood 7 1 1 CITY, STATE ZIP CODE PHONE NUMBER SeY MOWN NEAREST ROAD Hudson, WI. 54016 (715 386-3674 Hudson Badlands Rd. [x] New Construction Use [ x] Residential / Number of bedrooms 3 ] i •on t existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate __7 _bed, gpd/ft2_y8_trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.9--alt. area=94.9 ft (as referred to site plan benchmark) Additional design/ site considerations alt area backfilled to code Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL %.2..3 U= Unsuitable fors stem KI S❑ U Z S ❑ U CIS ❑ U F] S❑ U 0 S ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. none sil 2msbk mfr 2f 2 8-45 10 r5 4 none sil lcsbk mfi 9w if Ground 3 45-61 10 r4 4 none lcsbk mfi gw na .4 .5 elev. 100.00 ft. 4 61-10 7.5 r4 6 none cos os ml na na .7 .8 Depth to limiting O i. factor +100" s c 3 S°~a Remarks: Boring # 1 0-10 10 r2 2 none 1 2msbk mfr gw 2f .5 .6 2 10-40 10 r4 4 none si lcsbk mfr gw if .2 ':•.3 Ground 40- r4 none cos os ml na na .7 .8 elev. 98.9 ft. Depth to limiting +84r Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 20 Ave. Ne Ri nd WI 4017 Signature: Date: 10-16-96 CST Number: m02298 Y STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NW4SE4 S24-T29N-R19W New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 I- lot #6-Wyldwood N 1"=40' BM.= top of NE lot stake C el. 100' cc d t,e rte [2 ~ ~5~ Iof44S7 of i lu 'V ~.A~ A Le' • fig' g ~yc h G~ G Gary L. Steel 10-16-96 1/4 OF THE SE' 1/4, AND BEING PART OF THAT 9W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. N A 12' utilit easement _ - - easement shall not extend lcloseP iron which marks angle points or e' )tat are subject to State, County and Township laws, rules and cel, etc.). Before purchasing or developing any parcel, contact i Town Board for advice. This statement put on this plat at the irks Committee. "~C~'°% %Y RESTRICTION CLAUSE: All driveways which require culverts are the appropriate apron endwall on both ends of such culvert. 57 w a O DS 56 in 0 0 HE NW1/4 EE THE SE1/4 V o CZ) '33' W 1328.56 BENCH A~RK ELEV.1014.82 127.56' CC) 136.00' 1W 340.56150.00' 340.00' o 69'27'33' E .D NATURAL AREA--NO STRUCTURES ALLOWED BELOW S 0'32 139.90' IN 1027.03 p~ 0 166_98'20' DRAINAGE EASEMENT - C p0~ / S 88°55'40' E ° I to, N 0015'01' W 10' x$66 ~~1'3• ~cz; %Po #1 176.55• 00 \A 0 (D 3 " N ~ ~2 Sf /i ) 99. C ">9 ~s Z 4 / ~0 / tK• Z DRAINAGE EASEMENT Ct) 4S~ 13 / s ~ M Parcel 020-1329-60-000 03/24/2005 02:22 PM PAGE 1 OF 1 Alt. Parcel 24.29.19.1719 020 - TOWN OF HUDSON Current I X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner DANIEL R & ELIZABETH M KRUEGER ' KRUEGER, DANIEL R & ELIZABETH M 2539 SCHALLER DR MAPLEWOOD MN 55119 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 870 WYLDWOOD LN SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.038 Plat: 2645-WYLDWOOD SEC 24 T29N R1 9W PT NW SE 2.038AC PLAT Block/Condo Bldg: LOT 06 WYLDWOOD LOT 6 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 24-29N-19W SE Notes: Parcel History: Date Doc # Vol/Page Type 06/14/2000 624847 1519/230 WD 06/24/1998 581676 1334/387 WD 2004 SUMMARY Bill Fair Market Value: Assessed with: 49741 69,900 Valuations: st Changed: 10/30/2001 Description Class Acres Land tmprove Total State Reason RESIDENTIAL G1 2.038 54,100 54,100 NO Totals for 2004: General Property 2.038 54,100 0 54,100 Woodland 0.000 0 0 Totals for 2003: General Property 2.038 54,100 0 54,100 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