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HomeMy WebLinkAbout040-1306-20-000 County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No - Safety and Building Division INSPECTION REPORT 561068 i 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)l. Parcel Tax No'. Permit Holder's Name: City Village X Township Troy. 040-1306-20-000 Town of Oeverin Homes LL C, aka Oeverin Pro ertie Section/Town/Range/Map No. CST BM Elev: Insp. BM Elev: BM Description: 0$.2$,19.1847 J3 rrA r e✓ ".a'. O TANK INFORMATION ELEVATION DATA ANUFACTURER CAPACITY STATION BS HI FS ELEV. TYPE M D S h • 4 Benchmark Septic Zip ~ ~ •J Alt. BM tlr' Bldg. Sewer L • L ~f 3 Aeration Holding St/Ht Inlet -7.3 4? 3 St/Ht Outlet 7 (p T2 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Veit to Air Intake ROAD Dt Inlet I ~j r'~-' Dt Bottom Septic 750' ~IW 4D /Z9" Header/Man. Z • 5 Dosing 2 Dist. Pipe Aeration S I 9L Bot. System 9. C. 9 9 Holding . 1 9 Final Grade Z 17.3 PUMP/SIPHON INFORMATION Demand St Cover qlct . Manufacturer GPM ~•'1~•a.~ o Model Num TDH Lift Friction Loss System TDH Ft Forcema ia. Dist. to Well SOIL ABSORPTION SYSTEM pth /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dc BED w DIMENSIONS STREAM LEACHING Manufacturer: It SYSTEM TO P/L BLDG WELL LAKE/ CHAMBER OR i..Y ~ INFORMATION Type Of System: n / ^ ' UNIT Model Number ~,~da-*e ?511 t03 NA Vent to Air Intake DISTRIBUTION SYSTEM A'~ I 1 x Hole Spacing Header/Manifold Distribution x Hole Size Ea,S ~ 3 9 Pipe(s) N-~" _ Dia Spacing _7 Length DiaLength SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only rx Mul hed Tt Depth Over xx Depth of xx Seeded/Sodded =Bed/Trench Topsoil es 7No Yes No 'IV ~ ~ I Bed/Trench Edges COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Inspection #2: Parcel No: 08 28 19 1347 Location: 453 Jordyn Lane Hudson, WI 54016 (SE 1/4 NE 1/4 8 T28N R19W) Sunset View Lot 20 1.) Alt BM Description = r' I L`.&' O 2.) Bldg sewer length = So - amount of cover = *A Plan revision Required? F*,~ Yes No / 113 Use other side for additional informatiioon'' -~i - - CeO No. Date Insepctor's Si ture SBD-6710 (R.3/97) County ..Mf Safety and Buildings Division C 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co..) x Madison, Wl 53707--7162 `r'°~sraa~~- 5416(o 1 1 l N - S _ !t Application StateT'rantsactiosewnb--- In accordance with SPS 383.21(Lis. Code, submission of this fbrai to the appropriate governmentalu!~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWT'S are submitted to ddress (il'diflerent than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for se:: ndary _•purposes in accordance with the Privacy Law, s. 15.04(1 (m , Slats. r 1. Application Information Please Print tAlnlor on Ai kCll ~ Property Owner's Name sTCRO' e y_ Property Owner's Mailing Add Irr)ly-L.oca Lion ~ Govt. Lot 'it y, State / Z~L/~J Phone Number ' Section 8 4 ole on - - T2 g N; R r-EelfW) If. Type of Bniltling (check all that apply) ~ Loi k - - or 2 F unify Dwelling -Number of BedrOOms _ U Subdivision Name Block U Public/Commercial - Describe Use f - - City of.------~.~___---------- C) State Owned - Describe Use CSM Number [l Villitge of Al,own III. Type of Permit: (Check ox one box on line A. Complete lice B if applicable) - - - A. ew System ❑ Replacement System (_J 'freatrnent/Holdurg Tank Replacement Un1I CJ Other Modification to Existing System (explain) B- F-1 Permit Renewal eList Previous Permit Number and Date Issued ❑ Change of Plumber 6 1 ernil I'r ursfer to P1ew _ Before Expiration owner IV. Type of PO'_WTS System/Cum onent/Device: (Check all that aunly) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade U Mound? 24 in. of'suitabh: soil U Mound < 24 in. of suitable Soil s T J 1oi ingraunk ❑ Other Dispersal Component (axplain)_----_-----^ - - - ❑ Pretreatment Devit:e (explain) _ V. Dis ersal/Treaty - t Area Information: y--- _ - - - _ _ fG~f~- Des gn Flow (gpd) Design Soil Application Rate{gpd Dispersal Area Required (sf} Dispe.v al Area Proposed (st) System Glevat p VI. Tank Info - Capacity it, 'I'ota! of Manufacturer Gallons Gallons Units U New T'anlcs 4Lxisting Tanks w C o a, U vp rn w C7 n, Sceptic or Holding Tank rJosing Chamber-- VII. Responsibility Statement- 1, the undersigned, assu i ponsibility fur installation of the POVVTS shown on the attached plans. - - !'lumber' Name (Iprirlt) Plumber' atttre MP/MPTLS Number Business Phone Number Plumber's Address (Street, City, Slate, Zip Code - I.ZD VIII. County/ eartment Use Oul Approved tsa PerYnit Fee Date I •'ued Issuing it signature '65 cd 30 iven Reason for De. ' _ IX Condihj0qFjqj*0*M40(.Reasons for Disapproval _ ~ 1 15ep0c tank, effltlertt filter and ~~-t"~r•~ ~ ~ - ' v Ae-j o Alspersal cel'must all be.servlces /maintained W 44, 4.{,~: als W management plan provided by plumber. 2_ A00 im Rln7aitltained 4) Al P,.J G 5 ,~jT T d / ~~'ct a Attach to complete plain for the system and submit to the County only On prer n Imi than 8 in Y ll iuches in vice SBU,-6398 (R_ 11/11) PLOT PLAN PROJECT Oeverina Homes /Y ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4s 8 /T 28 ~f /R 1 9 W TOWN Troy COUNTY ST. CROIX 5/28/13 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROU 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 651 # of chambers 32 BENCHMARK V. Top =stake ASSUME ELEVATION 1001 Filter BEAR Filter D BOREHOLE Same as Benchmark SYSTEM ELEVATION 95.2/95.1 4' below grade Jordyn Lane Vent All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. >6" Quick4 Standard Leaching Chamber Well is to meet all of Cover with 20.0 ft2 of Area setbacks required by 5.6ft^2/pair of end caps WDNR 4' Long 12" Grade at System Elevation 34" Scale is 1" = 40' unless otherwise noted Drainage Easement 46' Area of poor soils B.M.* 10' 150' 125' 3% SLope B-2 2 ' 10' -1 70' 30' 20' ST Vents 88' 1101 Pro 3 20' 35' B-3 Bedroom House 2-3' X 66' Cells with >3' spacing COPY ~-a 717' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of bivision of Safety and Buildings n a rdance with Comm 85, Wis. Adm. Code s than 8 1/2 x 11 inches in size. Plan mustnri ~p ly- Attach complete site pla p no~Zarrow include, but not limited to. I a ontal reference point (BM), direction and Parcel I.° percent slope, scale c=m sic , no, and loc ation and distance to nearest road./V, Oy 6-- 2 1) uo-O lease print all information. R ry Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)) `ST ` / Properly Owner ` Property Location N ✓ PJL~ / Govt. Lot 5F- 1/4 1 4 T Z N R (orCw) Property Owner's Mailing Add Lot # Block # Subd. Name CSM# city State Zip Code Phone Number ❑ City ❑ Village own Nearest Road / \7-6 r G~ COnstiuction LlseResidential /Number of bedrooms Code derived design flow rate J~ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: Q System Type System Elevation / J. Z p / (S i l F1 171 Boring # Boring Q Pit Ground surface elev. v 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 4'$ /v - Boring # C] Boring a~ a 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. Munsll Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o-~ Z rn ~J , u 2 , y 44 L- 21~ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Name (Plem Print) 7-1 CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 55 77 r/ 715-246-4516 Parcel ID # Page of ,party owner _ Boring # ❑ B Pit oring 9 Ground surface elev. l ft. Depth to limiting factor- in. Soil Application Rate FHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPDIft Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 z,a 1 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots tE GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence BoundaryRoots .E GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Effluent #1 = BOD5 > 30 < 220 mg1L and TSS >30 < 150 mglL ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mglL 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) P OT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 8 /T 128",,,/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/28/13 BEDROOM 3 CONVENTIONAL XXXX IN-GROU 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 651 # of chambers 32 BENCHMARK V.R.P. Top of stake ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.2/95.1 4' below qrade Jordyn Lane Vent All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Quick4 Standard >6 Well is to meet all of Cover Leaching Chamber setbacks required by with 20.0 ft2 of Area 5.6ft^2/pair of end caps WDNR Long 12" Grade at System Elevation 34" Scale is 1" = 40' unless otherwise noted Drainage Easement 46' Area of poor soils B.M.* 10' 3% : 150' 125' pe B-2 20' 10' B-1 70' 30 ST Vents 20' 88' 20' 35' Pro 3 B-3 Bedroom House 2-3' X 66' Cells with >3' spacing 717' Property Line OR County a~ C Safety and Buildings Division CJ_ .y+ 201 W. ngton Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) a Wl 53707-7162 `~S1pNA1 0 Sanitary Pe i Application State TransactionNum UU In accordance with SPS 383.21(2), Wis. Adm. Code, submission of'this form to the 5nav%"Abi, governmental unit /v is required prior to obtaining a sanitary permit. Note: Application forms for state-ow S are submitted to Project Address {If tferent than mailing ad ) the Deparlrncn[ of Safety and Professional Servtes. Personal information you provide secondary ess purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. I. u Application Information -Please Print All Information 1 $ Property Owner s Ndme - ' nr en~~ / III 4.11, j~ Parcel # Prop s erty Owner'Mai Mailing ess -C?U ` A/ 3 3, Ce Property Location N"7 City, State _ Govt. Lot Zip Code Phone Number %a, Section Qp •irole ones II. Type of Building (check all that appl y) Lot # T N; 1t~ E y(W/ >41or2F ily Dwe ing - N ber of Bedro im _ 2-v Subdivision Name v Block # ❑ Public! Pial •ce ✓Gp - ! Q~ ❑ City of_ ❑ State Owned - Describe Use C M_ Number ❑ 'Village of Town of /O III. Type of Permit: (Check only one box on line A. Complete line B if applicable) env System^ ❑ Replacement System ❑ Treatment/Hofding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner It V._ Type of POWTS System/Component/Device• (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mo d > 24 m. of suitable soil ❑ Mound < 24 in. of suitable soil I~ Holding Tank ❑ Other Dispersal Component (explabb retreatment Device (explain) o1 Y V'. Dispersal/Treatment Area Information: oZ G , D .11 ien Flow (gpd) Design Soil Application Rate(gd t) Disper al Area Required (sf) Dispersal Area Proposed System E1ev do , C! c /3 ✓ f 7 7, plc V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~q New Tanks Existing Tanks L5 'd v ~ h i O Y g [0 a U r7 y rn w 0 Q, S<:ptic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, ass espousibil}ty fur iustallation of the S'O'R'T' shown on the attached plans. Plumber's Name (Print) Plumbe S" ature MP/MPRS Number Business Phone Number 1! Plumber's Ad1dress (Street, City, state, zip Co A V~ . Conn /Department Use Only Approved ❑ Disapproved Pe/m~ti~t 7Fee Date Issued suittg Agent ign- ure ❑ Owner Given Reason for Denial $ I / S~ ~/t / 3 1 . Conditions of Approval/Reasons for (Disapproval r' SYSTEM OWNER; 1. Septic tank, effluent filter and Cs"~`i+n IN~~ dispersal cell must be serviced /maintained - + as per management plan provided by plumber. l~N setk~a~{c-regi tirPmeats_ mijgt he maintained 0 ` as per applicablL' 9u& for the system and submit to the County only on paper nor less thou 8 i/z x 11 inches iu size SBD-6398 (R 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/30/13 Owner:Oevering Homes Location: SE1/4 NE1/4 S8 T28 N,R19W lot 20 Sunset View 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 Specificat'o Sheet Signature License n m er #226900 P PLAN PROJECT Oeverina Homes A DRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 8 /T 28 / 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/30/13 BEDROOM 3 RESSURE CONVENTIONAL LIFT HOLDING TANK CONVENTIONAL XXX IN-GROUrE 00 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANKS 0 HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Ground at lot corner ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 97.8/97.4 4' below grade Jordyn Lane Lent All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. >6" Quick4 Standard eaching Chamber Well is to meet all of Cover ith 20.0 ft2 of Area setbacks required by .6ft^2/pair of end caps WDNR 4' Lon34" Grade at System Elevation i Scale is 1" = 40' unless otherwise noted Pro 3 Bedroom House 20' S 4% Slope B-2 30' 100' B-3 ents 60' 0' 102' 2-3' X 66' Cells with >3' Spacing B.M.* B-1 65' 100' Property Line 0 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 >i' above grade Finish grade elevation Typical Installation 101' ,jv,ent Grade Vent 4" 3' X30/3:4S eptic Tank 5' S' Long 3 6Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A_97.8' B 97.4' Wisconsin DepaLR SOIL EVALUATION REPORT Page of Divzsicrr of Sai~ty d Bui f accord nce with Comm 85, Wis. Adm. Code Attach complete to pla8 1/2 x 11 inches in size. Plan must County include, but not li ited tr erence point (BM), di rection and Parcel LD. percent slope, \ sca or 1_~ ~.`/n a location and distance to nearest road. tsr (.JCJ Revi ed b rmafion. • Y "Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). \ UkM ~i ZZ 2e~ Proparty Owner Property Location , ~G: 1/4.N X1/4• SF-::~ • T 7 8 N R E( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# o. BOx 3 3 ZO - SUv.~S v~~~ 7 L City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road t3~}~r~ ~Rk.~ ~v ~ 5 ~l x'10 I S ~ ~~S _33 5 I TZ-0`1' ~ New Construction Use: ® Residential /Number of bedrooms -4 Code derived design flow rate LI S Q - lj OCR GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G LAC) 1Z~r }-t Flood Plain elevation if applicable i~ General comments ft and recommendations: ZL COY"1 t~ U,~!., C~ LS ~1-i-or~ 0 -ETLLS `7 o x~E- M / ti .y Z Prh,~ m t1X SZ_' D` / ~y l ❑ OA Boring # ❑ Boring ~ . 2~ ~ ®pit Ground surface elev. !00 ft. Depth to limiting factor y in. U Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rat in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef #1 'Eff#2 0 1D`1 tZ. 3 l z - S i t Z.`F Sb ~ rn`~- C w Z-P • 5 Z I o - 2 tp~ iZ 31~ - S i I Z ~ S ~ ~ C S. ~ ~ • ~ p i I Boring # ❑ Boring ® pit Ground surface elev. 00. O ft Depth to limiting factor 7 01 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I -1 U`-t (Z 3 LZ - S 1 I ? b ~2 1 n`FV C1iU 2 - S f3 Z n-ZV 113 -tom 31b S 1 1 Z S k 77 cg 1~ , S .3 .qo to~ti2-yob - _ ~b K9 Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sin re -Arthur L -Wegerer g 03 Z1S - ZO 220254 Number Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St, River Falls, HI 54022 715-425-0165 f Property Owner M E),X,-- Parcel ID # 1-Zlk~51-jz) Pi Cj Page of ~ Boring # ❑ Boring Q / ® Pit Ground surface elev. ft. Depth to limiting factor 7 ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z 1 -3 ►0~~316 - i Z~ S f> cS E Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In, Horizon Depth Dominant Soil Application Rate Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 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 Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 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 = BODE < 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 TTY 608-264-8777. SBD-8330 (R.6/00) PLOT PLAi1 Page of Scale 1' = D) ' i i i i i i P 1 z) ! 1J o I it Irrk I- Sv 1TP~-13 l~ C~vZ 1►v l T1 ~l-! j ~ / ~r,~ fi~ `C~-► Pry: e.~.t- S . goo O ~•3 16 1 L) 5M3 n - IZ_~q~03 715-425-0165 220254 t -z _ CST Signature Date Telephone I.To. CST No. Job NO. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner O r i Septic Tank Capacity ❑ NA Permit # al Septic Tank Manufacturer p NA {)ESIGN PARAMETERS Effluent Fitter Manufacturer Ti -A NA Number of Bedrooms - 3 DNA Effluent Filter Model ❑ NA Number of Public Facility Units X1 NA Pump Tank Capacity al NA Estimated flow (average) al/da Pump Tank Manufacturer E+NA -307-) gy Design flow (peak), (Estimated x 1.5) J-a gal/day Pump Manufacturer Soil Application Rate z Pump Model > ai/da Ift Standard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection 13 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L >16A 0 At-Grade ❑ Mound Fecal Coliform (geometric mean) 5109 cfu/100m1 Cl Drip-Line C] Other: Other: NA Maximum Effluent Particle Size X in fEA Other: Other: NA "Valu es typical for domestic wastewater and septic tank effluent. Other: NA IAINTENANCE SCHEDULE 'i Service Event Service Frequency (inspect condition of tank(s) At least once every: O oath s) ears {Maximum 3 years) ❑ NA IPump out contents of tank(s) When combined sludge and scum equals one-third ('fa) of tank volume D NA (inspect dispersal cell(s) At least once every: `ear(sjs) (Maximum 3 years) ❑ NA (::lean effluent filter At least once every: / 11 tear(s) DNA aspect pump, pump controls & alarm At least once every: ❑ month(s) NA 0 year(s) 1=lush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) 6ther: At least once every' 13 month(s) NA © year(s) j.)ther: ❑ A MAINTENANCE INSTRUCTIONS Ilnspections 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 Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of ';:ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 'visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local -egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of j:he tank shah be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin h+dministrative Code. Ihll 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. PL 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 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals tot 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 fill above normal highwater levels. When power is restored the excess wastewater will bis discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge oe fro thle To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power 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 `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 ai roltantthfatf fof the oOn T$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dralin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting producils; 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 propelly 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, ail tanks and pits shall be excavated and removed or their covers removed and the void space filled with s(I►il, 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 comp ipn kable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. re7;entreplace'ment system, area should be protected from disturbance and compaction and should not be infringed upon by requhled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:i in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN 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 removal of the biomat at the inf ltral ve 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 BE DIFFICULT IAN CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OI A ENTER A SEPTIC, PUMP OR THH F A T TREATMENT PERSON FROM THE INTERIOR OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Namei Phone -r~SA/ Phone SEPTAGE SERVICING OPERATOR (PURER) LOCAL REGULATORY AUTHORITY i o-- Name S Name Phone /,J e Phone 3,3' ~t7 0 1 d & and 383.54(1), (2) & (3), Wisconsin Administrative Code. This document was drafted in compliance with chapter SPS 383.22(2)(b)( (f) ILTER CARTRIDGE INSTRUCTIONS '~IIS~flt~lf~ltf! • • STEP Y Dry lit tine 11111ter Case Into thu isrul Of t:hr ufltiet blpe to tlnsure it is ceittored under tim atcm- opening. Yf nit,, then tither insert tome 0bd ihto tim e tank through the outlet or eol#nist weld s<ll~lue) additluha, pipe oral Ch1 outlet pipe. ite SvFP J While the case is dMil dry fitted url the outlet phin, measure the length of 46-1vach pipe nauded to brar the 111ter'to the tank and wail if utilFelnfi tf►e aphonal Supplemental UWe supwurt•, If sido support tnathud. Is nut utilized, proceed to step k,tu.. yri<.w Fer• instanlitkrinsi tatili'z"M the UPtlaivai SUpplaftiontal side support: saieler.t weld Mile % -inch plprt qutu the Altar Cast,. If tilde support Mdtlibd jr scat utlli2od, prareed -to step f'om. - Solvent weld the litter ease nhto the outlet pipe, Xhsart Cfte filter s a; rartrlrigtr into the Ci!(6B, hae1a51/t.1 down until the filter IO&S Into the button,, of ='Y r; tine casu_ •i: of If a VRS switch is.• utlli'AM: insert Itito time + Clockwise 900. deter and luck h y turnip maintenance 1. 1he effluent f9ltor should be tioaned every time tine otiptic Canli is service& f 2. Upeh the outlet accrsig opwr ljig to inspect the tahk 4nd ftltur. f S. Pump the septic teak ccorrrplcitely, rnaking .yurQ to rufnuve tho s:fudgia layer on the batiorrr of the Wrik and not,lluut the scum and effluent, 4- once the timus" level has buen lowered below thss dye of tfao outlet pipe, IVrnily pull up on the tatter handle to dislodge the cartridge from the crane. 5. 941de the cartridge up and ai W of the carer for ch laning. G. 1P a V&i swlkh cunhssctod to alit alarm is W1osent, the switi:h should be removed by terrrrrrey imunterduckwlse 50v kind dearied with water only. t K. r , 7. While holding the carrtf•idile on Its side (large But surfatce tacbrg ..''w +ra imy~aya,., down) over the access upnnii•i1jr rlh6d aft the ciutrldyat with WataY + only, r'rrakhig sure all septalle fuusterlal is dosed hack Intu the tank. At' n. jr VR5 switch is utilized, rsepliii:e by insertlho latu Niter acid . turning c#ackwise ran°. 9, limart the filter cartridge back into the tat* than olter locks into the horn of thw ca~ gtarslnff dawn until J,. 10. Replace and secure this recetklib ttpllnhrg an the tanii. • Y.rlr••:nt•r';'°oat "a x;;4W ;'!t a'.Sxd •kr,i. 'Y rt.r tSrit•41.`. :,VASlP1,]•r+. .Y~ w+W`IUIKIU!!'~Ii~s~.r"fflNCt ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _---O e o t ! h\ - - Mailing Address ~'_--N-~ w - Property Address "153 (Verification required from Planning & Zoning Department for new construction.) City/State ~-[V l~ T Parcel Identi Ccation Niunber(/ LEGAL DESCRIPTION Property Location Y j, `/4 , Sec. T Z$ N .R /j W, Town o:f O yJ` _Z Subdivision Lot # Certified Survey Map # Volume Page # - - -T-- Warranty Deed , Volumt;' Page # Spec house no Lot lines identifiable es 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 &Z,oning Department a certification form, signed by the owner and by a master plumber,. journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 1 /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. Qoix County Planning Toning Department within 30 days of the three, year expiration date. l/we certify that all statements on this form are true to the hest of my/our knowledge. l/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms---~ GNAT 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) f~ 1573.74• f 5 0(T56'04"E 1313.16'--/ N 8 N 88'51'18"E 702.20' Z02 34 J g•.z . f war a L.. VISION VISION 6~ \ TRIANGLE TRIANGLE b~k Ln 10- 33' 33' co ^N 89'1Q - 23Y.ls._ - a 8 EASt $ LOT 20 ' ~ Fj1$E1~EhI T l eo.?.~•~J ~ i t.+ r .90 909.95' i a LBO 910.68' 50. 296583 S.F. s o w c C 8.81 Ae. Z Ii i tier i 150' -2 Z-1 s~o.a 717.26 LOT 18 N 89'58'48"W '44609 S.F. q r 5.82 Ac. y t I 4 i 5a z~ I ~a LOT 21 I 50 ' State Bar of Wisconsin Form 1-2003 8 1 5 3 1 1 4 WARRANTY DEED Tx :4124739 978108 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Hendricks Investments, LLC 05/07/2013 2:25 PM EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), and Oevering Homes LLC TRANS FEE: 187.20 PAGES: 1 ("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 Name and Return Address St. Croix County, State of Wisconsin ("Property") (if more space is David J. Estreen needed, please attach addendum): 304 Locust St. Hudson, WI 54016 WI-21451 R Lot 20, Sunset View Development in the Town of Troy St. Croix County, Wisconsin 040-1306-20-000 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 right-of-way of record, if any. Dated May 2013 Hendricks Investments, LLC (SEAL) (SEAL) * *Ed Hendricks, principal/manager (SEAL) (SEAL) AUTHENTICATIPNO"Ir"It", ACKNOWLEDGMENT Signature(s) r~', QALETT°'•, STATE OF Wisconsin ) ss. authenticated on St. Croix COUNTY) s G 2 = Personally came before me on May 154- '2013 * y the above-named Ed Hendricks, principal/manager for TITLE: MEMBER STATE BAS18e0 Hendricks Investments, LLC (If not, ~~~''•~,,,~F,,,,.ut`''`~ to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) inst um t and a n w ed-the same. THIS INSTRUMENT DRAFTED BY: Attorney David J. Estreen Notary Public, State of Wisconsin 304 Locust St. Hudson, WI 54016 My commission (is permanent) (expires: lr~ (Signatures may be authenticated or acknowledged. Both are not necessary.) ' 7 ) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003 firRcpame below'signatures. 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