Loading...
HomeMy WebLinkAbout040-1306-28-000 PRIVATE SEWAGE SYSTEM County: St. Croix .visconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561037 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: Shafer, David & Wanda Troy, Town of 040-1306-28-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: OD- /00 --v C-1/ ilL 08.28.19.1855 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 9 /AM:e DD Q Benchmark 5:3 /OS_3 /db yb Dos g / ` Alt. O p Z vv ~ 0 0 Aeration Bldg. ewer or 0 q-7 3 Holding St/Ht nl St/Ht ~~7 TANK SETBACK INFORMATION Q7 6- • TANK TO P/L ELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom / b F;4~ Dosing Header/Man. ff - v 9~ 3 law 11 112 Aeration Dist. i e UU q • G .1 4 Holding Bot. System ` 1 19 Fi de /OD PUMP/SIPHON INFORMATION Manufacturer GP nand St er 7 ~ S 3 ss /0/. -7 Model Number TDH Lift Friction Sys ead TDH Ft Forcemain gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM (O / L BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG EL LAKE/STREAM LEACHING Manuf re : J , , / INFORMATION CHAMBER OR y SQ' I UNIT Model Number: Ty Oem D i ry/p~ DI IBUTION SYSTEM S SI~f2 Pii'S /x- S Z c wn b•t~• Bader aan,if~old 3 Distribution , x Hole Size x Hole Spacing nt Air Intake ] Len th Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 14- Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M Ic d Bed/Trench Center Bed/Trench Edges Topsoils Yes g No E] Yes [E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ Inspection #2: / / Location: 429 Jordyn Lane Hudson, WI 5401x6 (NE 1/4 SE 1/4 8 T`218/N' R1 9W) Sunset View Lot 28~~//~ Parcel No: 08.28.19.1855 1.) Alt BM Description = ! P rnM(~0'~-'fir J,C' G~ f~~~Q q y 2.) Bldg sewer length = ZS iC ~Ct ~ Y S -amount of cover= ~3~II M 3~ T - - - Plan revision Required? ❑ Yes No Use other side for additional information. - Date Insepctor s Sig lure Cert- No. SBD-6710 (R.3/97) PLOT PLAN PROJECT David Shafer ADDRESS 429 Jordvn Lane Hudson Wi 54016 NE 1/4 SE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/18113 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 97.3/97.2' 4.7 below grade of tank, piping shall be Schedule 40. Jordyn Lane Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area p 5.6ft^2/pair of end caps ,~Q1~ 12" 1N'" 4' Long Grade at System Elevation 34" Pro 3 Property Line Bedr om Hou e 15' Please note: Tonal boring is going to be ST be done to to r system elevation 20' B-2 i sf Well is to meet all setbacks required by 75' SI'WDNR 1 y / - p 3-3' X 66' Cells wit 3 s k din 2% SLope - ; B-1 Scale i 1" = 40' 40' o, unless therwise noted Property Line 100' Vii" Wisconsin Departmen~of C k~EwJD SOIL EVALUATION REPORT Division of Safety and 'Buildings Page of with Comm 85, Wis. Adm. Code D County Attach complete site plan on paper not lex 11 inches in size. Plan must include, but not limited to: vertical an~ ~nce point (BM), direction and percent slope, scale or dimrlsJb cation and distance to nearest road. Parcel LD. <~~4WV """PTease print all information. Re ewed by ''Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Vu, Z 2 2~oS- Property Owner Property Location $ L kl:L Q7N N 1/45L.1/4-S T ?U N R E(r) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# o. Sox 3 3 2(6 - I SUrQsi-3~T \1IQ^j7 ~ , City State Zip Code Phone Number ❑ City ❑ Village 2 Town Nearest Road t3f}~Sfl-r~ ~RIc.,E I 5 ~l $~10 (1 I S) 4~S _33 s i T 1Z-O`-i' New Construction Use: ® Residential / Number of bedrooms - Code derived design flow rate S 0 - `j UO _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L_~Cl 1 L j ].y~~ } Flood Plain elevation if applicable r~ ~1 ft General comments and recommendations: ~CO / IBC GLZQ yv/ 1 L'~f`C L~l CL`f-'1 8 L)`t' ()M OF C-~L F-1 I Boring # ❑ Boring F'4, ZED ® pit Ground surface elev. b, 0 ft. Depth to limiting factor 3 in. U C Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z z_~l 10 6z 3l - s i ?'M s •S- 3 L16 3 10-~ ~2 y 1 ~ - s U Sq ell I _7 Z Boring # ❑ Boring ® pit Ground surface elev. ft, Depth to limiting factor 2 y in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 c _ r D `12Z/ - S~ z sU'~ hr1 Clu Z~-' oS ,€5 Z ~Z-so )oy~Z 3/b si I z'msb'~ rn~- 3 so ay ,oyrZ~l6 - S ~ ~a ~ \ - ~rZ a Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ature CST Number Arthur L. 'we'gerer '',f O3 z 1S - Z~ 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 1, Hain St. River Falls, WI 54022 1Z_ 1C1-0 3 715-425-0165 Property Owner Parcel ID # ❑ Boring # ❑ Boring Page of ® pit Ground surface elev. ~Z O ft. Depth to limiting factor 7 S In. Horizon Depth EDorninant Color Redox Description Texture Structure Consistence Boundary Roots Solt A GF/fton Rate n. nsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E02 U-~ L 10`12 Z/Z 7 - -S - `u c1~s - •S -cl 13 ❑ Boring # ❑ Boring ❑ pit Ground surface elev, ft. Depth to limiting factor in. Solt Applfca Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth FD ant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. nsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or M 608-264-8777. SBD-8330 (R.6100) Property Owner Parcel ID # J 1 KJ G Page ' of Boring # E] Boring 3 a ® Pit Ground surface elev. , ~Z O ft. Depth to limiting factor 7 S in. Soil Application, Rate Horiz on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots rY GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 v-~ z oar rz Zlz Z s~q~C`fr F Boring # Boring it Ground surface elev. 2- ft. Depth to limiting factor 1.30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Roots GPD/fl' Gr. Sz. Sh. 'Eff#1 'Eff#2 Zz G ~ ❑'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/ftZ In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/L Tlne Department of Conunerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fonnat, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD•9330 (11.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ` of in accordance with Ccmm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. County S C~ include, but not limited to: vertical and horizontal reference point (SM), direction and' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Reviewed by "Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I Propery Location h J t »Zz. 1/4 S L.1/4'S T? Pj N R E (cO Property Owner's Mailing Address Lot K Block Name or CSM# o. y3ox 3 2 `c~ - [Subd. S C't' State Zip Code Phone Number City ❑ Village Town Nearest Road Bfl'_SM ~R 11," I 5 cl X10 I ,)'~$S -?3 I TZ-0`-~' i New Construction Use: Residential / Number of bedrooms Code derived design flow rate U S Q - UO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G Lie) 1P - L Flood Plain elevation if applicable General comments ft. and recommendations: ~~eOY I f `Lr Ct~3~'RS _ © Boring # ❑ Boring ® pit Ground surface elev. C~ ft. Depth to limiting factor a-3 in. Horizon Depth Dominant Color Red p Soil Application Pate ex Cescrilion Texture S ructure Consistence I Boundary I Roots GPD/ftz in. Munsell Cu. Sz. Cont. Color I ( Gr. Sz. Sh. R Z 'Effm1 'Ef tt2 3 L) 6 °c3 Ion tz L/ 1 G _ s _ 17 ❑ Boring I I El Boring # ® pit Ground surface elev. 1 t Z ft. Depth to limiting factor 2 y in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Effn2 o_lZ t p`i2Z/ - S~ ~ Z~U:; YY1 i t Cw Z~ oS Z ~Z_SO ) py tZ / 6 _ S 1 I z`m S 1; tiK`7- - S G 3 so g y l 0~/ tZ V S ~Sa wl ~ - ~rZ Effluent #1 = BOD > 30 < 220 m _ _ g/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) 0 Si a - Arthur L. [degerer 03 2.15 Z~ CST Number v 220254 Address V e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11. Hain St. River calls, UI 54022 1Z-1q_v~ 715-425-0165 PLOT PLAN Pale 3 of Scale 1' =Sp ' i i L v-r zf3 ~ UT 2-7 { ~ ~ ~ ~J ~`11~P'f'c ^~SLLS I JU ~~S ~ p 0-s' ~D s ` I i ' YByv) Otv PI PS CVr C-o1Z-Yj 2 - ` gM Z _ L 1OZ-3 ' 0►ti 9 "T~c~~ ; 3Lc%' lb! A V Q- PI Pe- W/ L _ - C~. \ Z -ta _0 3 715-425-0165 220254. p _ CST Signature Date Telephone No. CST No. Job NO. PLOT PLA.4 Paae of Scale 1'=Sp i L~~ zg I LuT Z7 Z S u 1~-p~-,3 ~Z jo o Ub S S,j i J are # 1 = - . ~ p p: ~ ` 0P'j t It ~ , ~ ~ \-L(3Q P:1 P ~ LQ CU 1??ti Z C l0Z.3 o►\i 9 "T~-~ C ; fit . iW A _w C= Pt P~_ w/ L ' \Z-lob-03 715-425-0165 220254. 0 3-Z1S-Z CST Signature Date Telephone No. CST 'No. Job NO. Safe(an y 9 --d }3uildings llivision Count - - W 201 W,Washin Washington Ave., 1' U Box{ 2 isconsiro M ' ~'WI 5-3707--V GZ [>leprartmentR of Camrneme nuuEc iu I;y - - Sanitar~jl Permit Appiieat State Transuc(ion N unbef - In accordance with s. Counn. 83.21(2), Wis Adm. Code, submission oi, this form then) iate unit is required rim to obtaining a sanit l p ► geevcmmcntat _ N A P ary permit. Note: A r lication fitrms for a-owned POWTS are Proles[ Addtrts (if ditlttrent than moili ngaddress] submitted to the Department of Commerce. Personal iatbrrnation you provitk cony tw used for secondary purposes in amordatim with the Privy -Law, s, 15- 04(1)(gl , Stats. 1. Applic=ation Information - ideas .1'rint ll_Yn_f_ormati yac~ -1 ) Property Owner's Name _ Parcel /1 00 Property Owner's Mailing Address Property Location - . - u- - _ Govt. Lot C.ity. State J Lip Code p 1TY Zy'/.. Section 'rcde t - _ N; R fi W -1 1, Type of Building (check all that apply) Lo! _ Family Dwelling - Number of Bedroun - - Subdivision Name ` - - - - - -j! 1 alp 4A per,, I3It,clt u E ] Public/Conunereisd - lscribe Use - p-- ~ U Cityut', (1 State Owned -Describe Use CSM Number 0 Village of own of 2 C. Ito 1--ho 4~ 1140i~~ Till. Type of Permit: (Check only due box on tine A. Coinpfete line a if applicable) - - - A`' ew System ❑ Repluccinvat System ❑ Treatment/Holding Tank itepiamnent Only U Other Modification to Existing System (explain) U. ❑ Perrin( Renewal ❑ Permit 1 e0.•isioa ❑ Change of Plumber 11 Pennit Tiatsfar to New List Previous Penuit Number and Date fssued - Before Expiration Owner [ ` , rr 1 .Type of PO WTS Systern/Compun ant/Device: (Check all that apply)-_-_- - - - - - 71-~_. _ 24 n-Pressurized In-Ground ❑ Pressuc ized in-Ground ❑ At-Grade LI Mound 24 in. of suitable soil ❑ Mound : 24 in. of suitable soil ti'M f' L Holding -rank 0 Ut r Dispersal Component (explain) - _ - - E ] Pretreatment Device; (explain).. - V. Dis ersaIrfreatr ent Area Information: _ Design Flow (gpd) Design Soil Appficas.ion ltate(gpd D ispersal Area Required (sf) Dispersal Area Propus (sf) ' yst to Elevation r 4 - S VI 1'anlt 111fu Caaacity in Total Not, Marlufacturer ( Paltom Galions Units 11' New Tanks Exiatiug Tanks U septic or Holding Tank ~y~ - 1 - pnsin v(. - - - baatbtrr V.11. Responsibility Statement- 1, the undersigned, -XV-sponsibility for installation of the POWTS shown on the attacheyt plans. - pili is Nana; (Pritlt) Plumbs tgnature MP/MFRS Number Business Pltone Number Pl+.tmber's Address (Street, City, State, 'Lip C - 1: Count r1)e artment Use Only Approve) 1 Disapprovar Permit Fee Date Issue Issuing ntSignature 3Lzi /3 iven Beason ]or Dial I~i:. Conditions ofApproval/Reasons Iur Disapproval - SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as f applicable $ grdl~libQ~glans fm the xystara and subwit to the Caanly only on patnx not less Oran 8112 x 11 inthes in size SI3D-6398 (R. 02109) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/16/13 Owner: David Shafer Location: NE1/4 SE1/4 S8 T28 N,R19W 429 Jordyn Lane Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications eet Signature License nu er #226900 PLOT PLAN PROJECT David Shafer ADDRESS 429 Jordvn Lane Hudson Wi 54016 NE 1/4 SE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/18/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 97.3/97.2' 4.7 below grade of tank, piping shall be Schedule 40. Jordyn Lane Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 3471 Grade at System Elevation Pro 3 Property Line Bedroom House 151W ST Please note: additional boring is going to be be done to lower system elevation 20' B-2 Well is to meet all setbacks required by 75' WDNR 3-3' X 66' Cells with >3' spacing 2% SLope B-3 B-1 Scale is 1" = 40' 40' 09 unless otherwise noted B.M.* Property Line 100' 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 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 102.0' Vent AbGrade Vent 3' 4" 3P X30/34 Septic Tank 191 Long 5 5' Long 1 Grade at System Elevation 36" Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A__97.3 B 97.2' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND j OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _r z1b Property Address , L V v_ (V'erifioation require om d fr Planning & Zoning epartnnenk for new construction. City/State _ Patcel Identification Nwrriber ~ ~ LEGAI DFSir..~Rrp~tly Property Looation ,~!F_ T R W, Tom of-- T/4 Subdivision -V-- - T _ - Lot # Certified Survey Map ft. _ > Volume Page # Warranty Deed # - _ , Volume ~ page # Spec hour Lot lines :identifiable es no SYSTEM M AINTENANCE A UWN R CERTIlMCip~ Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofpurnping out the septio tank every three years or sooner, if needed, by a li,:ensed pumper. What ycru t into the system can affect the function of the septic tank as a treatment stage in the waste disposal s responsibilities are specified in §Co . 83.52(1) and in Chapter 12-St. Croix County sanitary ftdinaOnoe, maintenance Tbs property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, sighed by the owner and by a master plumber, journeyman plumber, restricted plunilrer or it hoensod wastewater disposal system is in proper operating condition arid/or (2) after inspection and In per verifying that necessary), the oxrseptic tank is less than 1 /3 full of sludge. A g (if necessar the sept I/we, the undersigned have read the above requirements and agree to txa;inta:h the private , sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and Elie Department of Natural Resources State of Wisc Certification stating that your septic system has been ~ rnisin. Zoning Departruent within 3 Q days of tare three year aation damust he completed and returned to the St. Croix County planning c I/we certify that all statements on this #'ornn 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 wa my deed recorded in Register of Deeds Office. Number of bedroom- - gTU]2E OF APPLICANT(S) ~ DATF, ***Any infaxtnation that is misr epnesented niay result in the sanitary permit being revoked by the Pljnnning & Zoning Department. biclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified surve preference is made in the warranty deed. y snap if (I REV. 081US) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of ]FILE INFORMATION Owner SYSTEM SPECIFICATIONS r _ Kermit # -Z - Septic Tank Capacityy al ❑ f A Septic Tank Manufacturer ]ESiGN PARAMETERS ~ NA _ Effluent Filter Manufacturer Number of Bedrooms - - L~~- ~L. O NA Q NA Effluent Filter Model Number of Public Faciihy Units El NA J;MA Pump Tank Capacity Estimated flow (average) al NA e_pal/day Pump 'tank Manufacturer Design flow (peak), NA ~ (Estimated x 1.5) V3-2-> al/day Pump Manufacturer NA Soil Application Rate Standard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats,' Oil & Grease (FOG) S30 rng/L C1 Sand/Gravel Filter NIA Biochemical Oxygen Demand (BODE) 5220 mg/L 0 NA © Peat Filter Total Suspended Solids (TSS) 6160 rn /L ❑ Mechanical Aeration ❑ Wetland !Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODE) 53o mg/L ❑ NA Total Suspended Solids (TS8) -930 mg/{ In-Ground (gravity) ❑ In-Ground (pressurized) NA D At-Grade ❑ Mound Fecal Coiifonn (geometric mean) X10' cfu/100m1 iMaxi Emrr►u ffluent Particle Size - ❑ Drip-Line 11 Other: in die, ❑ NA Other: Other; © NA Other. NA "Values typical for domestic wastewater and septic tank effluent. other: ` 1 AINTENANCE SCHEDULE NA Service Event !inspect condition of tank(s) Service Frequency At least once every: moat e (Pump out contents of tank(s) ears (Maximum 3 years) Q NA When combined sludge and scum equals one-third (h) of tank volume Ilnspect dispersal cep(s) ❑ NF~1 At least once every: month(s) Clean effluent filter ar s (Maximum 3 years) ❑ NA At least once every: ~ month(s) Inspect pump, pump controls & alarm ear s) ❑ NFi At least once every: ❑ month(s) 1=lush laterals and pressure test ❑ year s) NA At least once every: 17 month( s) -ether: ❑ year(s) NA At least once every; ❑ month(s} year s) NA. MAINTENANCE INSTRUCTIONS NA Unspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses !Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. include a visual inspection of the tank(s) to Identify any missing or broken hardware, ldentify any cracks or leaks, or ease a the v Master icombined sludge and scum and to check for any hack up or ponding of effluent on the Tank inspections must visually inspected to check the effluent fevels k for in the observation pipes and to check for any ponding Of effluent measure on e the asure the ground v su volume of via onding of effluent on the ground surface he Indicate a failing condition ground surface' The dispersal rep(s) shall be 'rhe p es the r face. egulatory authority. may and requires the immediate notification of the local When the combined accumulation of sludge and arum in any tank equals one-third Administrative she Cod Code. tank shall removed by a Septage Servicing Operator and disposed of noaccordancee tank volume, the entire contents of All other services, including but not limited to the servicing of effluent filters, mechanical or with chapter NR 113, Wisconsin pressurized any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shah be provided to the local regulatory authority within 10 days of completion components, pretreatment units, of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thFit may impede the treatment process and/or damage the dispersal cell(s), if high concentrations are detected have the contents of thl) 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 91 above normal highwater levels. When power is restored the excess wastewater will ble discharged to the dispersal cell(s) in one large doss, overloading the cell(s) and may result In the backup or surface discharge of effluenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to ft effluent pump or contact a Plumber or POWTS Maintalner 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 calls. 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 elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWI",$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin (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 propejiy 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 sipil, 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 compllslint replace ent system: 7A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. 11 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 nc~ed for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must comply with the ruleai in effect at that time, Cl A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances In POWTS technologv a holding tank may be installed as a last resort to replace the failed POWTS. 17 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 tnstalledl as a last resort to replace the failed POWTS. 11 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biamat at the inf ltralive 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 O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ` . Name c Phone EE E yy'v~ Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name r7 > Name /7? Phone - L° Phone I Ll This document was drafted in compliance with chapter SPS 383.22(2)(b)(I)(d)&(f) and 383,64(1), (2) & (3), Wisconsin Administrative Code, AR I NSTRUCTIONS I bt lon S'rK p x try CA flee riitset' cese+ untrt the end fit this outlet pgxe to ensure it is Centered under flee +ac cvtrs apalning. If awl, than eithrfr Insert trrttre plria into thrr tank thrieugh true outlet or aaleeret weld (Ditto) oti ttlaha! pipe teretu the uuthrt Pipe. :,,V MP 2 Whik the case As stil "i'ftt.ed Uri the outlet telpit, rseeasurv tba lanyth of sA°huh pipe neended too bre" thu "live to the tank and weR if utilBllttll }fist upthenal supplot"alutel ride support. IF vide yttppart neafthud Is not utliked, prateed to step four *T1FP1 It Fur eistaHattutus uttl4my thv vittlenel 6Up1111rrftoolial side support: x0luetrt weld the %--Ionch p1per onta the r*&r cesk. If side support rnethpd isj eat utilized, prtwead'te step tout; solvent tsprld the filter gave nhta the outiot cartridge Iola Via case, preasini ! dotrorr Uhtfl th v ipe. Y the filter the cases. the filter lurk, Into t Into the butttxext of If a AS L*tch is utili:,ard. insert tutu the Ciilck9!Ilse goo, idtetr and luck ley ttirrrirtg `•ps }r , M~~etr~inlte 1. The effluent filter should be cleaned every time We septic tares( is serviced. 2. Open the outlet access apeolou to Inspect the tank, and k1tttr I 3, Pw-np Ilea septic tank corripisitely, making Serra to verrturfe the nudge t layer ors the bottom of the Wrtk and not just the sGttm and e;fflutnet, V 4. once LFee effluent level leers ttuaer }towered o beloW to the i art ref tiro outlet pips, firmly pub up an the utter handle dislodge the cartridge frame the co1w. 5. stlda the rar•tridae up and or rd: of the case Ivor cleaning, " 6. V a VAS swi th eutonnestnd to are alartef is Present the switch r hduld be ramw ed by turrUnry e=raunterdudewisq it)- and leaued ' with water only. 1• Y.. 7. While hWdiny t'he cartridge con its Mollie florae flat surNee facing • ' ti do ws) over the acr.'ess upeniltp, ewe aft the valtridua Wit wmkae ,y only, making sure ab aaptaae rewrte"a} Is rinsed back ihtu tine tank- ` a. if Vks switch Is utilizedr repligt* by lirsertlhg into filter seed ` terming dtldeWixv 90°. t' y. Xirsurt the ftitar cartridge back INN the tai*, Are"J"a dower until the filter lacks into the hnttann of tiro case. IU.Replace and secure the accehffi upetdnu oft the tank. dr s,~•;fit"* ~ •..ee-14 "40C,%t•.,Jxtti leg;' "i r;,relr4t'i.r.`. :•V:~i!n1A ~J`. wYA1'til}i.`.bean Iatl.ICom 7-WPIL oy `t' (6.53-4a 83) 89'32'3"E 431 S83'32'32"W 4.31 ~p 181.:0' OD Z 200-68 29 ~N t LOT 28 LOT c 3.F. 45844 S.F. 47808 S. Ac. 1.Q5 Ac. ! OD ~ 1.09 Ac. cob L 5~ II.J 201.14' 200.70 S asro4! i 6"MI NE-SF- U NPIATTE.Q L III II VIII I I I I I I I I I I I I I 8 Tx441114077 7 975305 State Bar of Wisconsin Form 1-2003 BETH PABST WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name 03/20/2013 2.34 PM EXEMPT#: NA THIS DEED, made between B & L Land Development, Inc., a Wisconsin REC FEE: 30.00 Corporation TRANS FEE: 140.40 ("Grantor," whether one or more), PAGES: 1 and David A. Shafer and Wanda M. Shafer ("Grantee," whether one or more).. Grantoi, 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 needed, please attach addendum): River Valley Abstract & Title 1200 Host-ford St. Suite 201 Hudson WI 54016 Lot 28, Plat of Sunset View Development in the Town of Troy, File: 3899469- St Croix County, Wisconsin. aa'/D~y7 / 040-1306-28-000 f Parcel Identification Number (PIN) Dated this -day of March, 2013. This is not homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fcc simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. B & L Land Development, Inc., a Wisconsin Corporation ;7~2~ 1 (SEAL) (SEAL) * e T. Weatherholt President/Treasurer _ (SFAI.) (SEAL) ` ~=AUTHENTICATION ACKNOWLEDGMENT I'.: St nat~~ S STATE OF KENTUCKY ) ss. 'KuthenliC fed..on ) • JEFFERSON COUNTY ) R,; 1 fit: *'r'" Personally came before me on this[?day oi'March, 2013 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Lyle T. Weatherholt, (if not, President/Treasurer authorized by Wis. Slat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and ackno a ged the same THIS INSTRUMENT DRAFTED BY: . CLAYTON Doug Berg Notar ublic, State o Ke cky I 1200 I-losf6rd St. Suite 201 Hudson WI 54016 My ommission (is permanent) (expires: 61017_ I ~ t ~P ) (Signatures may be authenticaird or acknowledged. Both are not necessary.) NUFE: THIS IS A STAN DARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD OF CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 " Type name below signatures 1 of 1 C 31~2~ §3i~l~i 3 §~3~ $3 E all N O W $ s a ca z LL S II .r~lll • ~ ~ W 1 , I_-~ 41 t j j 1 2 I M I I ix III II ,c9;11 r I g 17. ~a 7 r....~______ _________r -l I I I I I I I _ it 1 wIl -L 1 ..Ijy I Ara __i I I .er,a I L-____ I 1 n Jill L--------------' ~p H Q N O ggI 5 9 z z~g $ pd~ d O hoa hill, 111m 1111#1 0 R NMI w,f I r, w Zn a 3 a 9a Pt m r p I i a I ~ I I: I I I I I II I I I. I ooaxeannmuomf.9' rn~ i b i i'• - - lI1J I'. I I I - - I II I I I I I I 11 1 I I I I I n..n I I I x a. it I 1 11 "'I I I' I i I L_______ 1 1L II I f I I I i ~ I _ ~ ~.'II N e e I I I III I II ~I-x ~ ~ I I }y~•~]7+ 1 ` IIL 1 a I LJ II II, 1't i b !6 I1, ~II 4 \1J I_.._J L__ - 9 I I ~ I ooaxnaxwluoou.ri ~ l I I i I I r---- - I I I I p 1 I I g~ I I I OW I I I ,I e.x 1 I I.I I f ~p I y ~ $ I 1_-___ ~ y I ,'I I I I ;.I 1 I I I I I I I I':;I I . I I I 1 I I 1 I I I I t I I I •I II - 6 ~x ¢ $ s Y 9n ~~3a~ 4 F~ J C7 i Q SS I : o ~ ~ Z f ~ •C ~ Z_ Eli A a .¢.e M¢ Ai .uie A G A'•9 I I W ~ f I I ~Ed I i I ~ 30 o~ i i ypp~ d s ~ ^ a I ( m I I & 1 i ro~ I Iw om~YOwave9roa cea,en ' , . TYntaeYfYa z~8 Ak z~ :,~.t•~•': ooaal aacYaYe uaov. ~ O 7 mr1o --------iR % { e ~ ~i •fi b ~ 4 { ~ mop x '~'•~zL'~ ~ R o„AI § 10 ~wiau.~wwu nil plgNN MP6~' i,a,0 i~erolTwn oeavY➢ I ~W~W • 9 5 tr I u:u9~ vn I RC e~, 3xn TVMA3~ , I s . .a I I s ~ I I I $ ~ I I - i I a6 I I 3l~¢ I M.-M= I i I I Ilk 9 .v r,a A•.e - ~b o~ t'9 E IJtI ` z u O tlYpy B R Z S~ y iY C W Q 1 fill', . W u., 0 d~d 3 a x ~a 1 lwaw= ____I a0 . ~ I " k I I I ° R R ---T- R R a~tl i -h I A .,r i ,•r a~ ~ i e O ` I N ~ O R R d I i .urs .v I i - C~ Rr R _ ---J• e i R O I a6 I 4 ~di ~lvirou w~ I I I I I I I I t I f ~ + I i I_F i J I I ~ N ' ~ j ~ I e q I I I r i I , I I I i i I I