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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit 563812 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town of 040-1303-00-040 CST BM Elev: Insp. BiElev: BM Description: ~ ~ Section/Town/Range/Map No: (~J(6 13 22.28.19.1775 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. /b4 / /fib Septic #J + AM Benchmark 3. Z. /a3• /4~n Dosing Alt. BM 3 ~ ~dd p rw~o ~ 00 dy 774. A~aU" Bldg. Sewer Co l~Qding St/Ht Inlet c _t 9S• J TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WEL BLDG. ento Air Intake ROAD Dt Inlet /1~ ~`A 3 Septic 17- 7 164 Vy .r. \ Dt Bottom ;t IZ.7 TA S Dosing 7 /56I 16 - Header/Man. 6 Adz I Aeration Dist. Pipe 1 /dZ 2. Holding Bot. System PUMP/SIPHON INFORMATION Final Grade !I /-3 Manufacturer Demand St Cover fa,~.t~•._ GPM 166 l Model Number <5A) _46~ /a TDH Life • Friction Los System 3 Hgal - TDI I ,Ft ; ' ` Ls 103 p. G g IQ 3. 3 Forcemaiin I .6z Length DDistto well 7166 r~ LL r-, SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of TyQnches PIT DIM NE SIONS No. f Pits Inside Dia. Liquid DIMENSIONS j7 J[ _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of m: p Y CHAMBER OR O J ti I o ~G~ A'Z) A)4- UNIT Model Number: DISTRIBUTION SYSTEM 4e J Distribution Ix Hole Size x Hole Spacing Ve t Air Int Header/Manifol / lPipe(s) Length Dia Z Length ~4 Dia Z Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C"A Depth Over Depth Over xx Depth of 7ded/Sodded xx Mulche Bed/Trench Center /.49 Bed/Trench Edges Topsoil I es No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:7/ / (e°/ /3 In pection #2: / / Location: 226 Walnut Hill Wa River Falls, Wi (SE 1/4 SE 1/4 22 T28N R1 9W) Walnut HLII Far/m`~kka The T 'bute Parcel No: 22.28.19.1775 1.) Alt BM Description = Fa ~~e 2.) Bldg sewer length 10/6ci - amount of cover Plan revision Required? Yes No Use other side for additional information. - - SBO-6710 (R.3/97) Date Insepctor's 'nature Cert. No. - -County Industry Services Division. /DJ S p 6~I 1400 E Washington Ave Sanitary Permit Number (to be filled i by Co.) P.O. Box 7162 ` Madison, WI 53707-7162/_~ I lQ pp G-- a `eP1111t App1lCilt1011 StateTrransaction Number- In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governrll r unit is required prior to obtaining a sanitary permit. Note: Application fonns for state-owned POWT`' are subrt t~ to Project Address (if di Brent than mail ig address) the Department of Safety and Professional Servies. Personal inFormation you provide may b for seco tlr ores in accordance with the_Privacy Law, s. 1.5.04(1)(m), Stats. ~NNN~ J.~ / ~~r l L A licationInformation - PleasePrintAlllnt' mat' /f~Z w 1 Property Owner's Nerve '------C' r- - - p eel # - O ~ _O.e 11,,17 i ~ c G;v, - 1363 - Db - 640 Property Owner's Mailing re s -.yam Property Location ' 7 75 Vt. Lot ~ S" _ l - City, State Zip Code Pho ne Nu mber ~ , Section 2l rcle oneLw% 11. Type of Building (check all that apply) Lo - I or 2 Family Dwelling - NLlmber of Bedroor _ Subdivision Name ~V Bloc Public/Commercial-Describe lJse ~4`• ~ ~~`~~fv ~ ` - ❑ City of - - CSM Number l~ Village. of ❑ State Owned- DeFs ribs Use - - A- 7 CU a J C wn of j-~ - 111. Type of Permit: (Check only one box on line A. Complete line B if applic able) A, zw,4 stem y ❑ Replacement System ❑ •I'reatment/Holding'1•ank Replacement Only ❑ Other Modification to Existing Syste n (explain) B. ❑ Permit Renewal Permit Revision - List Previous Permit Number and Date I sued Change of f lumber ❑ I cnnit "frarrsfer to 1'Jew Before Expiration Owner IV, 'Type of POWTS System/Component/Device: (Check all that El Non-Pressurized In-Ground ❑ Pressurized In-Ground LI At-Grade ati > 24 in. of'suiulbl e soil 11 Mound < 24 in. Of suitable soil - U Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)_ V. Dis persal/Treat nt Area Information: - - - - ~ Design Flow (gpd) Design Soil ,Applicetio ate(gpd t) Dispersal Area Kequt d (sf) Dispersal Area Pro osed (st) Syst i El vation Vf. Tank Info . 'Capacity in 'total ii of Manutitc,turtr - Gallons _ Gallons Units ~ 2 o New Tanks Existing Tanks ° v v v " w - IA o o v -n w <a n, U cn rn 1!: 0 a-. Septic or Holding Tank VI 1. Responsibility statement- 1, the undersigned, assu ponsibility for installation of the_POWTS shown or) the attached plans. Plumber's Name (Print) Plumbe ' mature t1ZZ_AseerP MP/MPRS Number Business Phone No ber Plumber's Address (Street, City, State, Zip Code) Vlfl, Coun /De artment Use Only Approved ❑ sapprove Permit ree llate ssuec Issum,> ent Signature - ne n Reason for Denial gs . IX. Co riditi8N$4W0 9Reasons for Disapproval -0- 1 Iteptic tank, eft7irentfMel, end 3) tJo ~ t~ tfispersal cefl•must all be serf t:es I maintained /X ZeA4-e tCt..,t C9- ~ ea per management plan provided by plumber. iAN ssj~a& esquiremyenis must be,maint AW ~ as Wk3lille 06&TordinpiiM. Attach to complete plans for the system and submi to th ounty 'n^qn paper of s th n B 112 z I1 I. •s in size Y Cu-Q- w 3 SBD-6398 (R0313) aEeARra~N g3' Toy DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 ti ? Contact Through Relay ' ow www.dsps.wi.gov/sb/ 0pa~~ www.wisconsin.gov '`~ssroxP~ Scott Walker, Governor Dave Ross, Secretary September 10, 2013 CUST ID No. 226900 ATTN.- PORTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2015 PID entification Numbers ID No. 2302875 SITE: 791665 Oevering Homes to bo th identification numbers226 Walnut Hill Way , all correspondence with the Town of Troy a encv St Croix County SE1/4, SE1/4, S22, T28N, R19W Lot: 40, Subdivision: Walnut Hill Farm FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1432608 Revision; Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.D, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED, This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • The approved changes will become an addendum to the plans previously approved. All o rtions of the installation shall conform to the original approval. This system is to be constructed and located in accordance with the enclosed' p o~A qAA,~,~ 1' s a~l~,i d _ Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD=46%1- l' "Pressure Distribution Component Manual for Private Onsite Wastewater Trea en SyAQ ~ SBD-10706-P (N.01101). NOSY , ip The building sewer and distribution network piping shall be of material I' able 84I!N-3 and 384.30-5, Wis. Adm. Code. F Cp ~RF In the event this soil absorption system or any of its component parts malfunctions so as to `create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound mm-ponent Tvanu 1. A copy of this information must be given to the owner upon completion of the project. SHAUN R BIRD Page 2 9/10/2013 All holding/treatment tanks are to comply with SPS 384.25(7)(a). Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(4), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of constriction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sin ely, Fee Required $ 85.00 This Amount Will Be Invoiced. Julia Lewis-0sborne When You Receive That Invoice, POWTS Reviewer 2, Integrated Services Please Include Copy With Your (262) 397-6005, Fax: (608) 283-7481 Payment Submittal. julia.lewis@wisconsin.gov WiSMART code: ?633 Note: Effective January 1, 2012, all codes under the Jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page ono AtIG212013 USr /C Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/ 20/13 Owner: Oevering Homes Location:SE1A SE1A S22 T28 N,R19 W 226 Walnut Hill Way Troy System type: Mound System (Revision to plan # 2257384) Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigen y Ian 9-11. Soil test 12. Filter Specifications and s se n Shaun Bird Signature License number 226 ,C' ~ "C4F S F PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 101.2' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark Wallnut Hill Way Property Line 1 acre Parcel 00 i Pro 3 bed roo m house 2 1 Property Line Huffcutt Combo Tank ?6 Grading is to be done to divert run-off away from system B-2 B-3 100.5' E3 rn Scale= 1/4" = 10' 100.2' Tank is to be properly bedded and provided with 99.5' lockdown covers with B-3 approved warning labels area 1 5' below 3% Slope system is to remain undisturbed area of poorer soi Is ia- B. ~ Property Line Mound System ("Toss Section and Plan Vie'w _ d v... Drrrrerrsiun >E+ret f _ 1 - - - A .}Ky{r,~{1r1r r rL~i.r ;nitr.J{y. J rflrt{,~~,~e F rtr {•;rtr r ~{r.r~i.{1~1r1,;tr r r:r.l.r.r:}:r2} r.` .r.}1.t Y ^ ~ .F•f r.r.r:F.r75:r7r•r•r.r• r.Fu,F.r.r.r F•r Y,FK. 1 [-I r r r:37r1r r.}:i.iti}r:}+,F;;:S1.'r:F:rTF.l1F J1l r r}J J r l J.r}i:r:F:e`i "riw•;i,1rt.r F`:+Yr"..•. 1 . ,.I, rr:bt.S:'r•r. •i~r13wr;i:F}i~F}F:•w.Y.~.F~.ti.ArytsyFtFsF..v:i~r1i?F:'i:F:'.w.w}}w.ti`~,'t.}.}rt.{.~i. t:•l.ti.irtr Y - _ _ ftJ1P.JiF.tf.}}•t• 1. t.t•ML 1.1•ti +t.1.1•t•ti ,nt•K.1.t.t•K• rK { { 4•~ .{•~t: ..41.tK.1: L14{ ~y l.l.r..~.J ly.J.r~l.}irM.r{JT rMJ r.: •r411 r JtJlrlflr'{ 1Jt.1•++t~1•'1ii{Yti{a'.'xltr J, f r r.r.J 86 Y r - r Y _lI[ Y J r - Y 4 9,0 Slope 7 = Topsoil = AS"CM C-33 Clean aggregate 4 in. wh. 40 pvc Cap Material ~ sand fill '/1 to 2in. di.a. 0 observation pipe Geotexti.le Fabric • ti.Nt. vt•1 ~ . ~ ' rr:r ..r.r•r1`i•r.l{r•r D Plowed Surfacea /~9 d Ft Contour y a 11 a X4 k Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is rrrowed and raked off the site. The mound basal area (l., x W) is plowed with a rnoldboard or chisel plow. Plowing; may not proceed if the soil is wet enough at the plow depth to Form a'/4 inclr soil wire when. a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed intermediately after plowing. Sand is placed with a tracked machine keeping; 12 or more inches of'sarrd under the tracks or is placed overhead by a backhoe. Special care must be used whoa placing saj:rd of less than one foot thiclcrress to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire around is seeded and mulched to promote vegetative growth, lirnit erosion and protect frorn freezing. '1'1-ic observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet (.'large. 0/07 lei Page - of Pressure .1._,a.te:ra Layout J'wo f,aterals - E ri.d Manifold 'I'lea e Aded (Acanout Lateral ' C'urn- up M► Plug Manifold ' L - Force Main J 4" S WWP c)0 13t;rui llisfrtbcrtcon CVeiworrc Spec~xlxcataons Vmsure System C'oustruc ioxi Lateral Diameter - c In, LAxtcrals ar~ c,onstructed of, chedule 41.) PVC Manifold Diameter ~ ~ Orifice Diameter Ixi, pipe. Orifices are drilled perpendicular to X (Orifice Spacing) lrc, the p[I)e with a sharp drill bit: and fia.ce down. L, l: atcral Len Tt.lt i t. Lateral tu-n-ups terminate with a threaded 1Vl (_Mantfolcl l cnli.tx} c,ie:arIc>ckt: plug and are enclosed in st 6-9 Inch - - F'orc c. Main r)ra.rxcc.t:er ciiarrieter I swn sprinkler valve box accessible tore r Main f urll~th fi-o xc liruslied grade;,. - l t. - w w w w w (Trade,->..... r._r G-S lnch I ,awn Sprilkler Va.lvc Box 0:3/05 lg) ,I e ic;-'Dose Ta k Cross Secton..r d. Pump Performance Specifications - _ !'utrnp 11Unu;Eacturer d 'rank Manufacturer Vamp .114octei ~Turx>tber ✓ loat '.l'axalc C apacity _ KO ~ Alatm Manufaczturer Mann lvtodel ]`lumber e:- swioh .Ype H) - feet Total Dynamic ad D Filter MI~nufacturar -Filter, Model Number D'i-Aw Pressure jNetwoik Loss _ Mu>tixnurn Pump rerfornume Reyfuired Force Main Loss Ft TDH outlet Manholes Njin. 4" Above Guile With Manhole Mir,. 4" Nbove Grade d ith Locking Device, (,nuking ll?er ice..Inlet Manhi)lt; ( With Mounted c5" Below Cuticle Seal+cl ~1at+ i ht: Wouther-proof Junction Box N,. W N, ..L rrNA N.Y av... N-- Finished Cxade `D'ent Agin. 12" Disconnect Above (trade Means With "Vent Cap ! Y N a b! L b Y> b b b l a b>! b> _ Y , ILiY~ ~ `i;+ i,> Ylbi>i,{;OYJ>i iY~'.YAYdNd~ Ytlbdb~b~ tlLJ~ d dYd ~ N J>ib~>ild1~ldltl>">iNA>.be'L~il_S. > ;>i> F x.' ()utlet ?Filter Wet Baffie Inlet ` ilk: A. L/4N~ aj and Reserve CapadtY ettrigs Weep d switch 8 40 Tank, Volume_ - /`.~~M- -Cxrxf ~ )f=ink; Di>rnension; lur-hcs 'Volume Gal. (ire A _ e~+~ O Ml[.`alevt~4tlon b,> , ;d (,alarm ~ i6d; ~ b'f; N°• l~oti;Unn ' lE:levabou l/ J/ :Na D ,'`i iti__..r..r.. t uF 4 > >iY~ N Y~ >,i~ Ft - "-lTiirc-'C~ r'r~~ a t >i> Y ~ >~Y4Ptl>VY Y >V>~Y~>~ VnJ•i•i>V• •"6..>..r-r-~'c's'C-s -rc-c-cs-N-f+r~F-r: '->-I'JL Hi#TF~I~~r'~C'Y'~YT~GyI~",Y~~~~s dr{N'N Yla'Li Y b li> b) bd/+Y > 6 / , iYV YiY iYi tl J tl i d i V V d tl J i• V < d b D L b Y >~i 1 5 Y NYb r> Y idL b! i> i Y b Y N YLi D Y Ibn~Y •1 Yd i i i tl~!` d d•J)d.tl>{sd., L ii.{+7.1~1-L i Ii t;tl~d.f.ii.Y d V4{.iLJii)iLY.i4iad~ .Y i tl i. i i 1 i i i Y i i idi GENERAL iNs>TA LATItoN: The septicidose tack is bed and baok ~ ledt in accora nee arwith ch t not manufacturer's p~oduct,approval sp ,ifications. Maxiaaurn depth of vary -a$ speotfi be exceeded without prior approval. Manhole covers exposed to grace have an effiwfive looking device (padlock) tank installed. Piping at the hilt and oui.let is of approved materlmis S itth a h• i h PVCrttg ht fitti the, and laid on stable soil to pitnvet►t settling or sagging. The farms excavation and the sleeve is sewed Vratertight. Elearlcai service conylees with NEC;'3(() and Comm 16.111. page of 02105 U EN-40 Series 4/10 lip Submersible Effluent; Pump, 3/4" Solids Construction How - Liters/Minute . 0 oxX"cal~tc~c~ cast Will r 5U IOU 15{1 200 tall 3 - 1 -M - 7~ M t hirf $ ~~f~q y4 .¢6 #e~d cyst i►qn!~ ' 10 Cover y, x ~ at°>' 1O 30 - :9 In1pellet, Material lheflvlopiastirjoastomer ~~111 141 ! ea 5r h\^II 11 C~IYJ Volute Lp(my'-(a)nted oast iron QI LO 5 ro 15 _ _ _ m t Qrl and u, v MmoaC~ `Shaft Witr~ le with Garb - - - - 3 :ti. e7e[tl 413i~1r71iC tf1GBS _ 1. ~ldtdl j .l Y' erlatajR1l69~I teak halt Steal U 0 o xU ON (10 a~ ~l~pet irl Ala ~I ~ lS~atlnf Hwy 1 sirlc~4~;~ri{►F; Flow UailanslMinute u t. t17I`R1 d - - .trN-413 SPIV-All-AF Specifications x 14 2q 213 6 1750 . SEN . 0 50971 f b110 1 1 5 1 I RW f' 9/920 ~Q t 70.t f 00 4 2 2' 1 3 4190 il> ' 2~ t 1 G(7 i~, ~ .Owl F11 1 ~ ~ 4e" 11( is I sfA20 [10 SQL r,l> 20 27.5 1750 S 1/2" F U Q,U.6'i 9EN-40 AV S NPf 26 31 14 J3 "'A U9 2 i 3A11 Q ! 15 $ f Paz J ° Ida/s ' ` ~ ~1.r R ' ` NO, <8(1n i` ,r Franklin Elactr0c; 400 East Sprliiq Street, Bluffton, IN 11611n "rel: 260.824.2900 • Fax: 260.1324.2909 ww vv.franltlk►-eiertric.com Foral, 996199 1-1.1 f~QVlf T'S OWHEFt"S MANUAL & MANAGEMEN'[• PLAN SYSTEM SFEIG!F- r:ATIONS_ t'IC.E (NFORMATION - _ C] NA t septic 1 anlc Gapacrty-- - _ ~ C)vrr{er - fieptic l-an'c Manufacturer C] NA Permlt Effluent Filter Manufacturer - - ~ C7 NA DESIGN PARAME TERS_ C[ NA _ 2 Cl NA Effluent Filter Model Number of El NA pump Tanic Capacity CNumber of commercial Units ; - Tan( Manufacturer NA Estimated flow (average) - alld 1 ump . Dump Mar,ufaicturer - - - "A NA 1 5) aVda Design flaw (peak), (Estimated x [.7 NA Soli Application Rate _ aUda /ftz Pump Modes - - - Monthly average" pretreatment Unit Influent/Effluent Quality Monthly Cl Sand/GMvel Filter La Peat Filter Fats, Oil & Grease (FOG) X30 ing/l. I~1 Mechanical Aeration 0 Wetland fiiochemica[ Oxygen Demand (BODJ 5120 mg/L ❑ Disinfec;tion CI Other: _ ~ Manufachu-er_~--------.___._---.-----------------__._______________. 7btal Suspended Solids (TSS) S15o n{ /L Pretreated Effluent Quality -m >1~ 'NA Monthly average** Dispersal C011(s) La in- ground (pressurized) en L)emand (6005) s30 mg/1- 1-1 In-grade (gravity) ,~.~~oand Biochemical Oxyg l:l At grade r" ° Total Suspended Solids (TSS) 53U mg/L ~1_1 6ther~-_ etric mean) S10'rfu/10C)mj -]Driire ter Fecal C;oliform (g-c 'om-____-_ inch diameter values typical for domestic (non-r0mmeraial) wastewa and Maximum Effluent Particle Size Ya septic ank effluent. - - values typical for pretreated wastewater. MA[NTENANCE sCHC-DULE ~S,rdiG@ Frequency-------- - = earls} ( yrs.) Service Eve"t - Maximum 3 At least once every [I months *Ly Inspect condition of tank(s) when combined sludge and scum equals one third (Y,) of ken vo urncI Pump out contents of tank(f) - - - - At least once every U months ear{s} (Maximum 3 yrs.) Inspect dispersal cell(s) At least once every C:1 months ear{s} Cleaneffiuentfilter ears U NA least once ever L I monthsy ( ) inspect pump, pump controls & alarm At Y - months ear(s) ❑ NA c Af least once every Flush latL-rals and pressure test I- months C 1 year(sAt least once every Clther: _ At least once every C:i months Cl year(s) C1 - - MAINTENANCE INSTRUCTIONS al cells shall be made by an individual rarryinll one of the following licenses or inspections of tanks and dispers ffifflu, certifications: Master VlU r Master Plumber de visual nspection of the lark(s) tof derWiU(y anYrm slsm9 or broken Servicing Operator. Tan inspections back u hardware, Identify any cracks or leaks, measure the volume of cxmtbined sludge and scum and to check for any effluent e s (-.led to check the or ponding of effluent ran the ground s #rfaa The disspoe gal elm on hthe all nun) lly in surface eT he poi di g of effluentorlitl e in the observation pipes and to check any ponding e may indicate a failing condition and requires the Immediate notification of the focal regulatory authonty ground surfac nk valurne When the combined accumulation of sludgy and scum in any tank equals onc- -third (Y,) or more of the ta, the entire. Contents of the tank shall be rernove" by a Septaf Servicing Operator and disposed of in, accordance with ch. Nit 113, Wisconsin Administrative Code. Maintainer. The servicing of effluent filter mecharessurized nical m iths or less sh be peiformedtby a certified components, other maintenance or monitoring at interva s o A servic$ report shall be provided to the lo(:al regulatory authority within 10 drays of con{pletion of any service event- START UP AND OPERATION rcxSuc is or other For new construction, prior to use of the pt)wt's check treatment tank(s) for the presence of painting p chernicais that may impede the treatment process and/or damage the dispersal cell(s). if high concentratior{s are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. page OPERATION rodur;ts or other chemicals thr.:~t cnnc°epresance of earn ng p If for fle high the S`Foy, n AND damaS~fe the check dlspersal treatment tank( cell(s). s) ptrations are detected have the contents of thl~ nr new w constrt.rctlon, prior to use oftn the Paws may impede the treatment process a sister prior to use. ~ tank(s) rernoved by a septaye servicing op f System start up shat) not occur when sail cranditica )s are frozen at the infiltrative surface, )using power outrages p.rmp paler is restored the excess wastewsp~r'Will uefrlt normal ttlghwatef levels. lhlhe result in the bfickup or surface discharge r tanks ntay fill above d stay discharged to the dispersal c all(y) In one large lase, overloading the removed sell( bys) an i°oavoid this situation have the contents of the pump tank a .~eptoga 3en+icing Operator prior to restoring power to thle a Plumber or PUWTS Malntat to assist in, manually operating the pump controls to restore normal levels " effluent pump or contact the area within within the pi.anp tank. 0o not drive fir park vehicles over tanks and dispaerssa calls. area not drive or park av+ar, or otherwise disturb or Compact, of the PQWI ,~3: 1f'r feet clown slope of any mound or at-grade sot absorption Reduction or elimination of the following from the wastewater stream may improves ttie performance and prolong t oil; life ofith p swaps; ciegre asers; dental floss; diapers; disinfectants; fat; foundationndali ls; antibiotics; baby wipes; clyarette butts; condarns, as swa grease; herbicides; meat scraps; medications; (surrrp pump) water; fruit and vegetable peelings; t) pesticides; sanitary napkins; tampons; and water softener brine. O W1'.S faits andlfar Is permanently taken out of service the following steps shall be takel'i tc) Insure that the system is prope:i y ABANDONMENT When the I and safely abandoned In compliance with chapter ConrrYr 83.33, Wlsf:ar)sin Administrative seated. a All piping to tanks and pits shall be disconnected and the abandoned Pipe Penings to Servicing operator. « The contents of all tanks. and pits shal be removed and properly disposed cf by a 5~ t1a in, all tanks and pits shad be excavated and r'ernoved or their covers rernoved and the void space filled with si0l, « After pump g, gravel or ana#her inert solid material. CONTINGENCY If PLAN If the he F' PO t)W7'f3 -fails and sonnet by repatrec tyre following rYreasures have beeii, or must be takers, to prcivide a code aornpfi;pn replacement system: ement soil r1 A suitable repiacaamer)t area has been evaluated and disturbance utilized d compaction anidrshcx Idenot~be infringed bspar► by) requr~rled setbacks replacement should be protected , from with the rut el in Replacement systems mus~c comply result in the Hale rnentaal ea to protect the setbacks frorn from existing and proposed structure, e tot 11naan ed wells. for anew soil and xitte evaluation to iastabllsh a suitable p► effect at that time. 0 A suitable replacement area Is not imallable du to setback and/ r sell Smitatifms. Barring advances in POV TS teehno og a holding tank n)ay be installed as a last resort t replace the fail POW-l. evaluation maandy sit be site, installed) as area Is failure cif the available a pOWTS holding a tank soil e he site has not heen evaluated to dentify a stalt~t ble re area. if no piacernent area. repiacem~,nt Upon The be performed to locate a suitable r^eplaren a last resort to replace the failed POWTS. Mound and at-grade soil absorption systerrts may be reconstructed in place following removal of the blornat at. the Infiltrea'live ;dace. Reconstructions of such a) stems must comply with the rules in tdfect at that trolls. <<WARNI NG>- ~ATIi MAY OXTYGEN. RESCU~tIi"• / "f^P'i'tO, Pt1Mf' AND OTHER "TREA'fM111NT TANKS MAY CONTAIN LETHAI ~ GASSES UNDER ANY ~ RCt ANDIOIR INSUFFICIENT ENTER A srPTIC, PUMP OR OTHER TREATMENT TANK PERSON FROM'rt•#E INTERIOR OFF A TANK MAY HE OlFr-IC66' OR IMPOSSIBLE. AtJf31TiC1NAL. COMMFN`f iar~VIITS lVkA1NTAINf~R ~ i~~ SFPTA POWTS INSTALLER ~.~...~..n. , LOCAL RI"(3ULATO Y aiJ't-t^~alTV rd LOCAL GF SERVICING t]P)"FtA'IfQRUMP )A Ntrme -7 Phone This document was drafted in ccc))piIance with chapter SPS 103.22(2)(b)(1)(d)&if) FA rid 3$3.!:4('1), (2) R (3), WIat,onsIti Administrative C.;od to kop"" ry v;.rV~ `Y~r fk'Y'i?~1s ro l:rrir klfu' railktr r„adw ,aar~tt llfMfii uu1rlP illlf t'Pfu, tl111t4rMt Naipae car aaafl►YYYd ii Ilr. tlalwltawu'aw4 alYadbr'ilrq wrt~..-w,i~fr, u,rpwrorrYgY 1`Paarryu'Z4ryr1 Wj(Pl,yl' ItAtlwl'~'rrNwrr fp11La utrrb r.irur tafik through th6 rauk6t or wRthttfsrk loviAt rflrtuiYj 141►aa iordsritlYrlaial111Y►Id rYadn tber ufMl:teYr 6-"V1Sr'o C 1lyhlira Rims Kitt is; NIAN1 191 V rMull utl the fiiltlYit 641" 1, rrr1Y11Gw1Ylw 0116 IUIV#lli 10 %-Inch piµu waedtid tw, lrralc:f., ilia tylkwi' ttkt Ove lank rtbrl AngAll of wtfthing ilw f4puaovi4o r;0004wflYtl tog WISIV„auuww ort. If witirk mryy rrlt IAYw1:PYall I1a mot 110114ud, 1knolmu l to ft (M.R., 'y,'r'Ir.as .d f~'taY' kal:~MMpityruYtW aliYllaili'iff t4Nf1 YdkN;kry1r111~YIp9tlkludYaWrxPeri:,-idr, r:tarY1P11Yd uvituatrt Ironic) Nr4, +11,•-t„,.tY pagru r,o,i;ss rivra rill:tsr a~fWin. NiNrla► .,ilirplarl• trlratitl?ul Oat tudi +Itillxdrll 1►intretul 4kf A;tetla irmflr.. zae4lfttst Wolff4 kir j'. N 4PIk{ti 141100 ON r FP YreftFkl: 1tiiv,,, lus,srr tlaf, fil!>.w' ca'I" dsior ita tf Of" 14faup, i'IrflioalblJ duwh Uiwt'll B:' i1,9 ON41k' latirft lwrto the bwYtarra, ur K r fire, COV1.90. _ il' VPt~j 6V1 AX 41 Bs: 1111A WWW', itINOOt 4491 fba, fiiltYtY ara►ui 4uCIC Icy tllwlilrr(i 4 r:ftlG4 wIsl9 4011, +~liat>M~'~If~tll4i~l 1, 'i'lt,1 OYIIrIwaYt'Owt mPsKrYtlel baa vbks'rbartfi radYery sfarrii 401 knplFtY4i^.l~hll I;; 'I(lalduoll 1.. 1i1W1ytl CIi1k Iflfl'ikt hi-C aSOI iri1nr91arpp ku IYwblrawlG ilYt1 t~1tEE uyirrJ P4tfltl; I. Piltop L'6w witptic tatfra wolb,4 1111twigr ftffl4lllli 5t!1'1y ttl I'btrftlllU tlar► s~ulipwtt luvoA' of" riu Frtat4clrta fall' lim bililk lwfd VIVA JIM V.110 Sulllff i1111I kOfoulovt. Jt.. INNUAs Maw mPwkra,tal: hsutei recur: 1:, tmav flow"r ad PwYll)frWr Chra frrYakl•k Yai 4hai _ itti'tlet Itlpft, irr gly pith rwp are, 64ty littur latttlrlt l Ul lllwlnflkfl tlltl cuveor4d1td /ravoo tell", Ea., ~qsPlllaf tIfa COSI►'it411d oil :arafi ,►uf: 4YP'AFeu a;irtlw ltll',~p~lilYty, An1 rY it 1#146 Switttr tiawUrrar.lrid if, :iwa'Jurlli fir late wit. the swiltuh " slatruld taw varlaa.ved ivif irlr•ralkaup Yslvlltlttwdar.•wglop rltl Yt1111 tiuNgtlr) with wi wr iudtk., W Whira homin tile wwId44Cf oo kni Alk (ll:f1'~ 11 flat!: &II41J: cm t kiblva as Iw1W1,Y. aluwrlr•) a w"t, 43►ar .'1Y rW:rw ri rYlrrit Al ' ~ r81a s~ ii~l' ~f'itr (31ryP~F~'~I~dliiM tviklt Wkrk:<Ik' . ,I. IYr14'y, Y'alrilitlWry alalY'aY rllll aalulftaajfyak INMiN4'OkIlil it9 flttl;rtlt4 wpr..i. liti,t6 "it, i ft.. W vkf: switf:fa W eti"Ovili 64110141"'o ' 'iY ° a v 414IlrCllllyj Iu1rl PiMQltr° wulaal i' . -..,.+Ufrtw4hoo rw4wrtllawivatt ffwla i Xiwmrlt ttfw airier r:urtYdallyrt iwwk fvli{r t4rp {;pN"a p!tAIbtLaiO df+ilurr Yttlt4f fffL. the ltlLaN lar:lui: ibkw i4elr 4rrv11'rdull W Ila w1 xmwv, t I dii 1 D.f1..FYrlpikea wtul d4rwu'19 r:ltu Uwt.urtiGi fiitwiMilll rltf thtro ltil!tiU.. ttr L^.i14b~• ' •'1, °:'Y: ; 9A1 ;YB ;a'YI\'{f 1:1.. "I Il,i F iiWll,l.? :.Jadi111.'llr'• „ 4~~V'Mfl+wit►la►alrltMlwllNld~llYsr~f~:rlr~rar ~'~'"~~"'F,NN~1MGilE~~l~!1'7",'Ir~1t~,~ ~Il'~~i~ilw'►'"'IN~.K~~ s `Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site pan aper not less than 8 1/2 x 11 inches in size. Plan must County include, b t lilrriited to: vertical and horizontal reference libint (BM), direction and Parcel I.D. percent sl scale or dimen ' ns, north arrow, and location and distance to nearest road. O Q 3 D 3-00-0`16 R ed Date Please print all information Personal information you provide may be used for secondary purposes (Privacy Law, . 15.04 Property Owner Property L ~tyl ovt. t 1 /4ft 1 /4 S 2 7 T Z N R E (o w H G J Q Tr 1~ '5-c- 2 Property Owner's Mailing Address Lot Ls". Name/ or CSM# Bit city State Zip Code Phone Number City ,O/Aj- Village own Nearest Road IZA-J ) 6410 1 ( ) ~N t f or~~L(J 0-New, Construction User esidential / Number of bedroom Code derived design flow rate yJZ~ GP ❑ Replacement Public or commercial - Describe: Parent material Flood PI in elevation if applicable General continents c d and recornmendations: "'r- System Type in u v-7 System Elevation M 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 GPDtrf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-12- 10,,,- 31z 5; C 01, ~ - ~ - s F'Boring # ❑ Boring h~ ® Pit Ground surface eley~~'!A • ✓ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtlf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef1#1 •Eff#2 Z 11-.2-5- s' ' cJ .41 • Effluent #1 = BOO > 30 < 220 mg1L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) tare CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 7~~- II' 715-246-4516 r Property Owner _ Parcel ID # Page of Ong # ❑ Boring ® Pit Ground surface elev.1~ ~ 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. r* Eff#1 'Eff#2 to d r 3/ C~ > 21-46 / J J7~ UV - 21 F-1 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 mg/L. and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330 (RAM) Property Owner Parcel ID # Page of a Boring # ❑ Boring ® pit Ground surface elev. 1 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 1 _,)-/0 rv 3l 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 GPD/ff in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate . Horizon . ')epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Eftiuent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BODS < 30 ffKA 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(R.6/00) . Soil Test Plot Plan Project Name Oevering Homes Shau ird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 CST #226900 Lot 40 Subdivision Walnut Hill Farm Date /20/13 SE 1/4 SE 1/4S 22 T 28 N/R19 W Township Troy ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation 101.2' *HRPSame as Benchmark Wallnut Hill Way Property Line 1 acre Parcel Property Line B-2 B-3 100.5' E3 E3 Scale = 1 /4" = 10' 100.2' 99.5' B-3 3% Slope area of poorer soils B.M.* Pro ert Line - County - / Industry Services Division n ✓Z) L P i ~p ~ '1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) " P $ I P.O. Box 7162 0 rty Madison, WI 53707-7162 3 b11 ! r nitary Permit Application State Number accordance with SPS 383.21(2:), Wis. Adm. Code, submission of this form to the appropriate governmental tln~ 94 In "ss (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to r e2- the Department of Safety and Professional Servies. Personal information you provide may be used for seconda~yT 1 W1~~~V ur oses in accordance with the Privacy Law, s. 15.04(1)(iTt), Stats. _ C ;SLS I. Application information Please Print All Info ti RO/ 2 _ n j t-J l Property Owner's Name J 2 Parcel PbTvfTy 2dl(~ - 0 - U Property Owner's Mailing Addr - Property Location 1-77745~ Govt. Lot City, State Zip Code Phone Number y~ 1A Section Z7i rcle on _ T N; R41 Et/rW/ CI, ype of Building (check all that apply) Lot _ I Narn10 Family Dwelling - Number of Bedroot Subdivision Block # ~~--r?G1' `lam / ❑Public/Cornnercial-Descri'oeUse dk k°,*jj2_ _ C. - - ❑ City of CSM Number ❑ Village of El State Owned- Describe Use r ~Qwn of k S - - - - Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew Syste I.7 Replacement System ❑ Treatment/tlolding ' Replacem Only ❑ er M i-on to x' (explain) st P' us P umber and Date Issued B. El Permit Renewal Permit Revision ` ❑ Change of Plu er ❑ ennii Tra o 1 Before Expiration O er IV. Type of POWTS Sys tem/Corn onent/Device: (Check all that .a I) _ - _ ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grad Mo suit -oil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) etreannent Device (explain)'. V. Di is ersal/Treat entAr_•ea Information: D sign Flow (gpd) Desigr Soil Application R gpdsf) Dispersal Area Requir _ Dtspe sal Area Propo System Elevation VI. Tank Into I-opacity in Total # of Mill l n facwrer v o Gallons Gallons Units u y New funks ExistngTanks 1!5 U V :O N r Y ( w o l w y D- - W U , • v3 ice: C7 a. 0 Septic or Holding Tank Dosing Chamber y - v _ VII. Responsibility Statentent- 1-the undersigned, assume r nsibility for installation of the POINTS shown on the attached plans. Plumber's ame (Print) Plumber's to MP/MFRS Number Business Phone Nu, r _ j Plumber's Address (Street, Cit)', Stote,Zip Code) xg- Vl1 'oust /De artmene Use Only ed Permit Fee `Da--tt ssuueed ` Issu.n nt Signatur ppro Aved $ Z~ to Z ~7 t~ - ❑ Owner ITT Reaso T.all IX, Condit, glMl asorts for Disapproval 3 ldlef / Qetxl .r, Qf~O'✓ t Ott 1 $eoid tank, effltdll *MW brid r / dispersal cen arts al) be servkes / mah►t W t' ~'p (vv ~-rt ~7j t? - Ot ~wP~. . t .per managt>RltleriE plant provided by plumber. aAlFa ackr4q mttet_baf=n"IrAd \J (.D ~i~?drt`~ its S ~t ~Ift K Ik` ood~ftordhrie~ ° Attach to complete plans for the system and submit to the County only on paper not less thp~ $ 112 x t lrinches in SBD-6398 (R0313) Wr6 f 4i. IIA ~pARTa4g DIVISION OF INDUSTRY SERVICES g0 Njq~ 141 NW BARSTOW ST FL 4TH o~ m WAUKESHA WI 53188-3789 Contact Through Relay www.dsps.wi.gov/sb/ 7 y www.wisconsin.gov Q 9SION~~ S Scott Walker, Govemor Dave Ross, Secretary June 14, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/14/2015 Transaction ID No. 2257384 Site ID No. 791665 SITE: Oevering Homes Please refer to both identification numbers, Walnut Hill Farm Lot 40 above, in all correspondence with the Town of Troy agency. St Croix County SE1/4, SEl/4, S22, T28N, R19W Lot: 40, Subdivision: Walnut Hill Farm FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1432608 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved p and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0 SBD-10691- ® 1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Tre~t~stat 2.011 SBD-10706-P (N.01/01). D/(//S,j~o/~~SJJS FS~ 0 4~ N / The building sewer and distribution network piping shall be of material d 7 -3 and 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts 'tc'' ate a health hazard, the property owner must follow the contingency plan as described in the ap addition, the owner must comply with the operation, maintenance and monitoring duties as describe i on VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 6/14/2013 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component- Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RECEIVED MAY 2 9 2013 A Cover Page INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/ 25/13 Owner: Oevering Homes Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 40 Walnut Hill Farm Troy System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-13. Soil test 14. Filter Specifications and cross section Shaun Bird Signature License number 226900 ~ ioND4c,41 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 164 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 997 1' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons DOSE TANK SIZE 630 MOUND )OOC SEPTIC TANK SIZE 456 # of chambers none HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' BOREHOLE O WELL * H.R.P. same as benchmark Tank is to be properly bedded and provided with lockdown Walnut Hill Way covers with approved warning labels Well is to meet alI WDNR setbacks property Line Grading is to be done to divert 100. 1 Arce Lot run-off away from system 99' B-2 98.7' 98' Scale = 1 /4" = 10' B-4 Pro 3 Bedroo 2% Slope House B-3 ❑ Woods ❑ Huffcutt Combo Area 15' below system 6-1 Tank is to remain undisturbed ~,B.M.~ ❑ Property Line B-5 Mound Syst.c.-m Cross Batt on zand Plan View Dune"SiOn Feet " " JMri 1 1 1r j1-L L•1 1r'tti~f 1.51,a~. 1X1f1- 1r:r.ry'f}{Li1f'%F:FL}}r;.2r.}}r.r'~F;}}F`r•i1 ~itr rr.r:}.r~•1r X 1 p r'VrYl•1.f''1t•• 'irY.47:ytif{i4rLi1}4~4r.'fKX1r1 .LX'Yr1 Kr1r'Yf"LJLf1:\r{Kf1rt f'h'L'I'L.-.~'{:1r'{i1'Y1 4i '~y Z ! t •}.,r r•F7X• r.X rwJr.r.F•f• J.'w•'=J.}.'r' i.iw.• F.•:'.r.' r.r.{v r~X - _ :.r'v,~•k{irk:n.i}1~iti'r..w•{tiJ:{r11•,Fii:}:'i:°Fir1ii1ii{'i1fi}ii1F{.r•`iSiRFi~ryF*;y1F1}y}tiJ1;4F}p¢ r}.1r1 " " }r.r.F:F.r.}.r•{ X.F.} r.f..F`r r r•.rLrft Lr r r r J r J.r•r r r•r.r r 1r1}.FtiiLX}u VV k•1•'wk]1y_k1~1^3.-7r~',115:+•1+.L. i]~._. .f.• .1.~.-L•YaS11`S•1!i1.!SS.1 eY5i.4.! 5.}S _ p -~t _ u, . W 26,5 l Z ~L7 slope Z, "/<o S . t Topsoil ASTIR C-13 Clem aggregate 0 4 'it. sch. 40 pvc r.r•i.r, Cap Material sand fill % to /z in. dia. Observation pipe Geol.extile Fabric ~ 11 L Lrk.1.Lr5JLXL ` ~ l'~ _ ' ~J1J Y~'XL'1 {r1r r1 if/ C~ 4 lrz, bat vJ,~iT`\ l l h \ L; . lalclwe'd surfacer 't C ontour "dope., Direction GENERAL INSI ALLATION: The rnuc"nd area is staked out along the design contour. l xisting vegetation is rnowed and raked off the site. 'the; ►riound basal area (I, x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enotigh at the blow depth to form a'/4 inch soil wire} wl•aera a sample is rolled between the palms of the hands. AS,rm (.33 qualil:y sand is placed irramediately after plowing. Sand. is placed with a tricked txtachinc keepitag L') or r core inches of sand under the tracks or is placed overhead by a backhoe. "laecial care must be used wlr(n placing sand of less than one foot thickness to minitnize conapactio11 of flag plowc,d warfare. After the r)psoil cap rs placed, the entire mound is seeded and mulched to pron-tote in.getcalive growth, liinit ero;;ion and prtttec:t from freezing. The observation pipers are slotted in the low h inches and secured in pla,;,-, with rebar or to closet flange:. 10/07 t11 page - of rc,.°9i~l.,i.-q-(e ~.rd~l,l,r~a l Layout Two Laterals Itind.M.;~,infIbld _I 1 (:1canout J,atvral Turn-up Plug I!!Xarufolrl M Long Force; /lain Sweep r 90 Bend Distribution Network. S crlir°atxorts ' Prossure System Construction I_.ateral Diarrteter Z_ lrl. Mand'old Diameter IrE. i ate rals ar; cons tructod of ,Schedule 40 PVC Orifice [Narneter - In_ pipe. Orifices are drilled perpendicular to (()rtl wc:: Slrt. I:hc 1riI with a. sha up drill bit: and laces clown. ~ ~racirt~) c e 1 1 Lateral Le ta tlr 11. Lateral tnvrr-upc terminate with al tbreade;cl m (Matrtio_l(l L .'o.1-1 ill} clt;arroert p'.r.t€ and are enclosed iirl a 6-'8 Inch fore, mktirr DiarrtrWt, 2- 1rl. diarneler t,,wn sprinlder waive box acc;~ssible l orcc Maita Length from finisted grade:;. ~I 6-8 Inch Lawn 1 `t 13o~c Far€ c 03/0`; 11'1 i SFJ.fic -Dose rfank, Crass Section And .Pimp Performance Specifications Tani 1VYanulac:turer Pump max. BWy Depth ll~tarctidact~rreri e.r[t f/j/ -1*" ~L~l O&I Number I c~zr ~t ~ ~ tyy~rrx~s N 145 el I~'tunt?er ~ _r .m_ +Capac;ity Alarm f'dttumt4t'S't11t'er. - _ c%' t > ~ s t ~'otxl T'ar~s: Depth Alarrxr >"dtoulel Number ~ c G'- Filter Marrufk4ure l a►~tl Y7 yna mic Lead C DH) - Feet Filter lVV1!odel Num er ; lE;llevafiuu.Head. Netwoer LOSS Mt irrr 1.crs„ Minimum Pump er ormwe Required Fore VT TD14 Total Outlet M=hole Mm. a Bove Grade With 1VYaritcole 1Vlirr. ay° Above, Crinttr Looking Ded ioc- Inlet Manhole- ~ Mounted Witte Locking Device 611 Below Gr a Sated Watet iWit Sc~Urrre~Ey Mounted CY 'VVouthtm -i,rmof +w ew WA. Fini"d Grade Vent tip. bt. 11'+" ~ ` ~ 1Jisc c~nrrecsr Ahovo Orade tVlr ar~~; With v r!'rt trap ~V~~b ~•'r~1_t ~+Y~M+'Y ~ I+Y•r Y~ VVY ~ ~V4 +`V~I`V~PYn~.tGY~ L 4 6 1' Vyy b bY+6VY YV P b b+ba6dY+YJV+Y+PJY y y JYJ VItl tr1 VVd,JVJPV V J +yV VYVYJ tlytly+ JPJPiiHnlyf.JnVdry+y ay ly M,~y~`VYV +V..~Pa"i~v~i.. y..a .u lyre - iJ,J, 1 ay y~b~ r Outlet Filter ;(islet "a~lc~ y ~ Inlet A-'-°~ ;~LJy ? L+Y~ dyV 1 " lytl~ +YJy any'. aYdr Switch 8et4up ii~dRaserve Capu ty Jy<~ `~Y P .d X Tank Volunw 0111 Hole, aches 'Volume G dt. E y Y Dimensions x ,a (reserve) A r~•~- - y bayV ~ ~ ; v ;r 4I ik+Y ILL. .i .-(ll,l b'ar o l d I LL(dnse) A ; Y Y 1 (dead.) D Ellevatioyn} a.'r+ br . J y V ` VTOt21 •YJV VYb +YVi3+9YV VYJ +R4i-i- -i R~ ,trti i•°ti Y'-i'ti'T-i+rf Y'V~YS yi`"Y Gl`i'bd G-, ,nyV rd,a~l•'~~4 tlCb~~ ~R ~IiVa JbcyJ bGry-I~b°z~`VY3yVY~y~Y~. V~Y~Y~i ~f~i+aya V~V"ir ey ay b +Fy V tl b V V V J t Y b + J Y "-a " YVb LVY VY+ a Jy V,a x_R.k~i_1-k-L.i b y VVYVY V V Y S b Y Y P Yyi' k b Y Y P I Y V 4 Y Y i Y h S Y,Y~~~Y~~~y dY+,+Yb1VyJy `tlyt t V J iyJ,dy Vy V,VYYyV+Jwbyh+YbkV.Vyd~+.S Cu V.+~y, .2. k..Y.•~tl~i~V 1 V 4yf J V VY Y+ GENERAL YNSTN.LJ ATIONs Y,fhe septizidlose resale. is tied"] and 1~u;1c t lledd irr acur>Ydarrc:e with ttc<; manufacturer's product a roval spec ficatiollsJ riucuru doptic'if h,iy.a Specified by tlr~s imanufacturer rtrtcy r►oi be exr."eeded Wittiout prior oproval• Manhole covers exposed to 91-ad', have, an ei'hwtive locking device (padlock) installed. Wiping at the iulet~ acrd'outlet is of, approved r~'Y rain is sleeved WtlE irt#%u~wit pVC J() c tight ale ~tc~yrx rrtc Laid on stal71e sail tO preVeat sei;tling or WVog'"S. '11c+~ fa C'.~rmrrt tfi"7 . excavation and the sleev is sealed.'vvatedight. F.le+ctrical sor~vim ~;orrrpEiess ruittr SC :?Itttt and Page of _ „ OAS L7 Was.,-.~ 4 6 2400051= SEWwlc%0 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids How - II- arc/1U11rude U 5U 1UU i;iU 200 250 300 C,ovo 1.[Joxy r orated cast u<N1 si00,. 1Giacw u`}tHrl -st Oil 30 rlr~ellur w Hi;eriaN Therlncliala~tir, Glastorrll~r 25 Fpoxy-caud r'~rsL Iron Vcill [e 4 u IAOC.11lark, AI ;;1 ia)t Nitrite with (,;arbo n and cral"dnllc fork e' of - ~ trl"i~t1 Stool 1)_ 20 U 6U 8U u ` Uit~ia~s~ ;t!Ewr? nrls/Minupe Flaw - Gall r u l" t :;Fhl..dil sari-40-A1F °sp"Ificiati nns 1[1 1 r ,cl ro uu at, zs 1 14 20 50921 f 4110) 91S 1 l?" NPi ?IB2U. bEN 4t! ` n qO r ~L i I r.=d {t41 i jWWO~ 4 /aAW ~ , "i5 ft3 32 14 1[) ~7 `l l r`,V eo €r0 c( 3~N O~Ah X9213 grti 115 11f2w1"FNitf 9/41 !1 b I45 s2,~ ' 14, ~ ~aa ~ . 4' ~rr"ery1~>i~ww ~ye1~°II~.r~1~ 11UU East yprlny Street, BILM11)n, IN R6'/tn I e1: Z(50.824.2,900 rax: d,Ge.Ul~4.1.9U9 vauuw.tran Kli[rvHltictric.ro"n Horror: 9FKi'198 7-1 I POW TS O'UU'NEWS MANUAL & MANAGEMENT PLAN page rat ,:ILA:INIFORMATIONx_.__. .~.~...~._wti..., SYSTEM SPEGIFIG'XIFIONS r)wr+Hr „ . septic: f,arik Gaparity I.. NA I'er'nrut # / ' eptic tutik Manutaut urer , NA L7 I 7 ,)ESIGN PARAMErims i fflttcant filter Manufacturer I.1 NA Number of Hodrounis Li NA Effluent Filter Model H NA - Nurrrt-mr of Public. Facility units t4,NA I'urmp Tar k Gcapacaty _ E-1 NA __.5 > ! ..jLaI.. t stimatedflow(average) _-~5 L) 7 al/da purrrfr 1aril;Maanutacturat ~ t.lNA 11`lesign flaw (peak), (kstknated n 1.6) c!' at/cia t rnrrlr 11Aarrufa(turor t~ 1 / l 1 NA Soil Application Rate A 1,) al/dra /ftl Pump Mol lot > ( L1 NA I Standard Influent/Effluent Quality tdirartti'iiy average1, pretreatrr"I unit Lj~tA Fats, Oil & Grease (1`00) 530 lrr( ,lfL LI Sand/gravel Filter E J feat kilter ✓ Biochemical Oxygen Demand (BODri) 220 trig/L D NA 1) Machin ikml Aeration Cl Welland Total Suspended Solida (TSS) 5150 nigh, [;l i:)isitttw thin EI Other. i Preheated Effluent Quality Monthly average Dispersal :"ell($) 11 NA 13icachemical Oxygen Demand (BODt;) -5.30 +ng/I.. [J In.-C=eround (gravity) El In-Ground (pressurized) Total ;,suspended Solids (TSS) 30 ingot. /Ik H At-Gr'gce 'ourtd Fecal Coliforni (geormetric irrean) <00c:fu/'lftrl [A Drlp-I._ire [1 Other: ilvlaxirnurar Effluent Particle Sufi ~a in t~grl, t`1 NA r?kher. I NA C]ther' I'] NA OthFir° -1 NA' "Values typk al for domestic wastewater acrd septic tank effluai it. Other -1 NA it~IAIN't ENANGE SCHEDULE Service Event w _ 3urvlce Frequency » wa IInspect vonctit+on of tank(B) 4" latter onus every U month(s) (Nrlaxtmurn 3 freers)- l I NA . _ ear s l,l'urrrp out contents of tank(s) When combined sludge and scurry equals one-third cif tank Wturyre 1-1 NA Ilrrspeut dispersal coil(s) At least our a saver L rnantir(s} y ear(s) (tVlaxtmurrt years) L i NA loan effluent filter At least onus evcaty. I, rnonifr(s) l_f N/A /~a 9aC(b - I _ I nspect pump purnp controls & alarm At least once every ~ [ 7 rncinth(s) Cl NA k lush laterals and fuessure test At least once every. G month(s) - t ear(s) I l N/A ~.)ttrer. At least once every L7 morlth(s} L I N/1 at rgr: NA INSTRUCTIONS iinspeetions of tanks and dispersal oells shall ba made by an individual carrying cmo of file following licenses or certifications: Master IPliornber; IUMester Plumber Restricted Sewer; POINTS lnspectur; POWTS Maintainer' .3uptage Servicing Operator. "rank Inspections roust linclude a visual Inspection of the tank(s) to WerlAy any missing or broken hardware, deritify any cracks or leraka, measure #re volume Of I:;ornbined sludge and scum and to check for any back up or porldiny of effluent on the ground surl'aace. -rho dispersal cell(s) snail be r,risually inspected to uback the effluent levels iro the observation pipes and to chech for any podding at effluent on the ground surface, 'r'he ponding of effluent on the ground surfaco may indicate xa failing conciltion and requires the imrriedlate notiflcatlon cif the local 1•eigulatory authority. When the combined accurnr.tlation of sludge and scum in any tank egtials orta4hird or more of the tank volume, the entire contents of i;he tank shall bo removed by a Septage Swvicing Operator and disposed of in accordance with chapter NIA 113, Wisconsin Administrative Gode. All other' services, including but not limited to the servicing of effluarit filters, rneachan+carl or pressurized components, pretreatment units. I:+nd any servicing at Intervals of sl2 manths, sh:ail be perfornied by a i ortitled 1-'OWt:'Yi Maintainer. I'-A service report shall be provided to the weal re tulator•y authority within 10 stays of ca npletion of any service event. f'atae - of ~rciducts or other' Ghelmic'As tth0t START UP AND OPERATION >aaI1Ce of trraint rift f For new COrIF;trU(:t1an, prior to use (a'f the 1:)()W-FS cfiaacc treatrrient tank(s) tank(s) for the pro may lrnpede the treatment process and/co damage the dispersal cell(s). If high cranrptaniratiaris are dr3tc+rfed have the contents of thl tank(s) rerrioved by a saptaga servicing operator prior to Lisa. System start up shall not occur when soil conditions aare frozen at the infiltrative surfarictbr is restored the excess wabtewfater will t:r~a During power outages purnp tanks may fill above normal highwater levels. Whe" l~lav~a discharged the dispersal c In one tzar9a doses, overloading the cell(s) and may re,, tAit In the backup or surface discharge of effluordt. he fa avoid this s situation tiort have the ctrrrtents of the pump Wit isktinytiraruupy capa~:~atingrtFdie l~uorC'o-°r'trols tocr stone normal klev„Is e(fiuent pump or contact a Plumber or Y OVNITS iUl within the pump tank. V )o riot drive or park vehicles over tanks and dispersal crops aDo riot drive or park ovor, or otherwlaer disturb or rornpact, the area within 'l.i feet dawn slope at any rneurtd or rat-grade rtioN rabe3t7rptl fi iff1p ia th thetiorr ciraliri Reduction of elimination of the faAowing fr•cirri the wsrstevuater' syrt~rrn niary irrrprerve the pr'arfor•rrranrrce, cra anti i prta prolkrrig tt the lift} fiea Podur.ris; aarurnpti baby Wa uigrarrd isutta r o peelings; cotton r;ui►ralr• deIf a dr floss; diapars; tti tci fat: foundation pump) water; fruit and vegetable ptiscatine; greF.lNti; trr~rlJlt;ldeaa; rrreat scraps; rnr3rfic~itlons; oil; painting F pesticides; sariltary napkins; tampons; and water softener firine. ABANDONMENT When the POWYS tails andlor is pcarmanarrOy taken out of 3 vice the following sto istrtvi1ps h all be taken to Insure that the system is prope;liy and safely abandoned in compliance with chapter G(mir u All piping to tanks and pits shall be disconnaeted and the abandoned pipe oporiifigs, sealed, cr The nontants of all tanks and }nits %hrall be removed rand properly dispersed cab 6)y a Septage `'orvlcing Operator. e After purnping ail tanks and pits shall be excavated and reimovud tar their lovers removed and the void space tilled with :;rail, , gravel or ranot6l. inert solid material. CONTINGENCY PLAN If the POW`i"S fells and cannot be rei ared the -following werasures tiave beers, tar must be trakun, to provide a code: comp irprr replacement system; rnent soil absorp 1_1 A suitable melt are has been evaltiated and may be utillirud frarri dis urbr~nce and ~ tor the an d shoulderiot be infringed uponkfayr r`,:ctuilled The reea area Should hta be protected ct the replacement area setbacks from gnt arrn existing and proposed structure, ealsuiitrableareY lacer er taralreo. IrRieplaece "ril systems Irarst Comply with the r lefl in for a new soil and site ovaluertiontYari to establish affect ,at that time. atid F.) A suitable replacetnient area is not available ue o setba fait d/orsoil lira tations. Barring advances In POWTS techno n9tN a holding tank inaay be Installed as a last rilrk to f the )W, -rho site ties not been evaluated to YdentlfyV n suitable r pl ifc iryien area. re;u area isuavail available a holding tank maild she ay beein ull adhere "i'must be performed to locate a suitable replacement area. a last resort to replace the failed POWYS. at tlt rrremovral of the blomrat at the infiltraalive Mound and at-grade soil absorption sy st rls maorri a fecO Sb Uc ed in spicine keet following surface. f~econstr ur~tloris of such asst , X Y eeWAktlrllNCy SEPTIC, PUMP AN[) OTHER TREATMENT TANKS ltfiN'y CONTAIN UNDER ANY C 1 lt">I~^V STAIifC~~FDltlar'A~'H MAY RES~1 l..T~ RES~'kJt~~()j~ A IENTIER ASEPTIC, PUMP OR OTHER 1`I~EA'"tylEItl°I C'dNtC UN PERSON FROM THE iIN'l'ki oR OF A TANK MAY 1315 DIFFIGUIX (:JK IiIMI''C 8811,3t.E.- ADDITIONAL COMMENTS _ pClW~l'S lillAtNl'AINI~ , POWYS IINSTALLE., r f Warne < 6 hone SEPT s C;t1L~: r'~CaRlf l\i.l'1"ti1:1RI'1"Y " I\ -OH SERVICING OPVR ATf 1a'lJlU PV:' t l_.-.-.-t~C;AL AL 11° Ill ° ` r - lucent a x.___ flame Phone ~1fUlsrtrrr~rn 1ldrrtinistrtativt~ e;od. this document was dratted in rarriplience with chapter SPS ura3.22(2)(b)(1)(d)&(f) and 383 64,1), (x) & (3), t~AR INSTRUCT YliYtl~~~YiII~~MYYIIr Ii'Y'iYW 't go Ovy fit vow vttw 04.~lrm ►YI'Ytlt' r VtYItlY uWltiY tYYY~ IYYYIY lYl l1►id rlulAit r: yaYrrr, trv vrtlr j*j' wttasYYYe3Y veyrtlYrillYpy~ Y'f' i~l1~, WlY1r1Y 4111iYY4r1' ~tYNUr4 krlkYY yIIYYUrot i►?,V tltlvY (auk i lp fIYrYltIYIy►Yl iAYW rrt11164 I. wulntvatlitwYwiu IliQOW 011,46"W29 Wlyt►Y Uftlklt Yliri citlrYaf <va't;,ty is V/Ulrlfu dYvu rdw:Yiryr tYr Utfr9 W1•lr ~l''YY11P rrrl Yiitd aYrli.'141Y' falyrux, Yvrw;wlprrr+ 4hw dvrlVYyfYt wl' +IlwlYlcl► WIEAYr YY4rrirryydl 6'va Yrrj,o., jjkrl rV,kW. 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CROIX COUNTY SE,P'TXC TANK MA-IMMINANCE AGREEMEN'C AN]) GWNERSHIP CER.T)F1CATYON FORM 4'ucmei /B uyer __~'~zP l~L~ Mailing Address/ 'Property Address ('V'erification required from Plartuin ~ W g Lottrng f)epartment for now c stntction.) - Parcel Identilication N'tunbei EGAD I ESCRU]P''ifiOlY .Property Location / t Subdivision VSO, Town ol• . _ - - _ Certified Survey Ala # _ - - 'V~oltlmt; _ age Wurrauty }deed # ___'Volume, i . Page # r-- Spec house l..ot lw&g idetifiabl es no SYSTEM M_.A TE:NANCC AND OWNER CERTIFICATION lxttproper• use and maintenance of your maintenance consists of'purnpin t out the se septic system could result in its prernafrrre failure to handle wastes Proper the system call affect the function of the steps tank as a treatrne t Years 01' sooner, if reedrd, stage it, the waste di posal s stem f responsibilities are specified in C" 1' a lrc.etrsad pumper. Wlrat you put irrtcr 'ouun• 83.12(l) and ire Chapter l? St. Croix cow 1V Sanitary Ordinance. et tintdnarrce fhe property owner agrees to submit to St. znix Count owner and by a master plumber, jouine y i'lar '~Ytg & Lorin„' Dopartwent a ccitilication forrrr, signet! by (fie yrrian plumber, restricted plumber or a licensed pnrnper verityiug that (1) the on-site wastewater disposal syste»7 is in proper operating condition apd/oz' (2) after less than 1 /3 full of sludge inspeetio n amt pumping (ii'necessary), the septic, tank is 1/we, the undersigned ]lave read the above regaireniente and agree to maintain the private sewage disposals ste standards set forth, herein, as set T~ r ~ the Department Of~Corruneme and the DePartnrent of' y tYr with the t;ertification Stating that your septic system has been maintained must be completed a:id returned to the St. C Natnrat Kescnrr't a&, State of Wiscotn n. fp12it1 g lJepartmeut within 30 days Qfthe tluree Year expiration date, iota County Planning Xr. ,/We certify that all statements on this form are true to the best oi'my/our knowledge. f/we arrr/are the owner(s) of the property described above, EY virtue of a Warranty deed recorded in Regis ter of Deeds (Vice. NUMber of bedrooms--,_:~> ^IGNAT OP' APPLICANT 6krr? ***Any information that is misrepresented may result h, the sanital'y permit being revolted by the Planning tot zoning Department. i f Ynclude with this application a recorded warranty treed firotti the Register of Deeds Office and a copy of the certified survey rap map if reference is made in the warranty deed., (RF, V. 08/05) it 1111111 III I I I I I I i l i l l l l l l l l l l $ Tx441013916 9 STATE BAR OF WISCONSIN FORM 3 - 2000 975248 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Oevering ST. CROIX CO., WI 03/20/2013 09:08 AM Homes LLC, Grantee. EXEMPT#: NA Grantor quit claims to Grantee the following described real estate in St. REC MPT NA FEE: 30.00 Croix County, State of Wisconsin (the "Property"): TRANS FEE: 449.70 PAGES: 2 Lots being sold `as is'. SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Title One File 19240 Together with all appurtenant rights, title and interests. see attached Parcel Identification Number (PIN) This is not homestead, property. Dated this 15th day of March, 2013. Citizens State Bank , A0A * 1 i H Van erBroeke, ice Presi ent * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 15th day of March, 2013 Personally came before me this 15th day of March, 2013 the above named Citizens State Bank, Alan H VanDerBroeke, Vice President to me known to be the person(s) who executed * TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing instrument and acknowledged the same. (If not, - authorized by § 706.06, Wis. Stats.) Evelyn Jaeger THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: ) 12/16/2016 Michael H Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) EA *Names of persons signing in any capacity must be typed or printed bel s ip td NotaN + State of W~sao~g 1 of 2 QUIT CLAM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 File No.: 19240 EXHIBIT A Lots 8, PIN 040-1303-00-008;Lo1PIN 040-1303-00-009; Lot 23, PIN 040-1303-00-023;Lot 28, PIN 040-1303-00-028 and of 40 IN 040-1303-00-040 of Walnut Hill Farm, All in the Town of Troy, St. Croix County, isconsin. 2 of 2 S 00011'24" E 2847.9$' EAST UNE OF THE SE 1 /4 650.57' 1757.80' 13567' 147.00• 126.53' 151.14' 137.62• 150.71' 66. 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F ~ m ff a3 P 4 o h ~qq a A N Q Q pppp ~ 8 12 Q IJ ~C~ O Da~~~ d4 C N Z Ws LX 0 5e> i I b`~3~ { I ~ I I b 1 I I e~naxi 1 I - 1 , iiivMw.tYU: I ~ I I I I I~ I / Ll I ~ 'E R I i b i 1i I I i 1 i - 21 Iw) _ I I7 r..J - 1 L_J~ 1 I N 11 ° 1 1 1 I .wine .o..r~n-~-' I x 1 1 ~ I [ I I II Q~{I IL{p~yq 1 ~ I g I - 1? I I R ~ s}zobxll! 6~ 11 E~ I I ~Y ~S 11 I ¢B gI 1 F~ _ - $3 1 b H31 I I ~S 1 I w • s i 1~ ,i (^7 r ,ice T_ ; 1___T''}•-f ,r.~ y I J fq l (~J I - I T___T I ~ ~'r' 1 I 1 L J t I 1 ~ _ I 1 1' I 1 I I- s I i r--- - I !1 I ~I~j n°Fn~saoen~u uav.v~ i I i I I~ ~ I I j r. 1 I ~ I II I d I I I I 11 1 1 yy q 11 1 I I ' v l l ~ ~~c I I &S I i I I "I-' 9 € 4 I 1 I 11, I ~ I - t e I v tavmw.oa°v i f ILL 8 ~ - s E LLI 0 'k Tmmim HUSH z ~ N t a s 11'1 0 J J W I ~ I I 1 I I I mss ~ I ;ei I I I I I I . I I 1 x 1 ! 9 ! ~ b ry a i k M $ ® ~9A MGM= R - - ! ox~iao,n,rrin ~ Ili ~N3w1iiv 1119JYYA%e 1 `IR I1 1 _ I 1 ~1 - - - - - - - - - - - - - - - - - - - - - s;SMII ~ ` `•$i ~B Iii ¢~k ~ ' . 5 F ~nniJJnannvn I WYM3J ~:3mm~ / I I ) P iI p RECEIVED MAY Z 9 2013 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of -3- Division of Safety and Buildings r.Rnix COUNTY in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q VO 36 3- D Please print all information. Reyiewad Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). 6j 3J Property Owner Property Location L2 Govt. Lot .51C 1/433F 1 /4 S 20 T G N R E (or) 9 Property Owner's Mailing Ad#ss Lot # Block # Z:7 or CSM# 3 3 C~ % r a rr✓ Cit y late Zip Code Phone Number ❑ city ❑ Village Town Nearest Road Construction Use: Residential / Number of bedrooms- Code derived design flow rate GP ❑ Replacement ❑ Public or commercial - Describe: Parent material c~„R~ri t, ~r f Flood Plain elevation if applicable General cormients and recommendations: i n System Type o i-w n.clL System Elevation 9q. 7 Fq Boring It Boring ® Pit Ground surface elev. g, - ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z~ 12 Boring # CI;7]I Boring c? a h3l Pit Ground surface elev. 8 • 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 xr~ )V) 0 - Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L mjfL/ CST Name (Please Prim) S' re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 5--d J - 715-246-4516 Y Property Owner _ Parcel ID # Page of F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication 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 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 mglL and TSS >30:E 150 mgA- ' Effluent #2 = BODS 130 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 (8.6/00) r Soil Test Plot Plan Project Name Oevering Homes Sha ird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 , TM #226900 40 Subdivision Walnut Hill Farm Date 5/25/13 Lot SE 1/4 SE 1/4S 22 T 28 N/R19 W Township Troy County ST. CROIX Boring Q Well PL Property Line 16,BMorVRP Assume Elevation 100 ft. Top of 1/2" steel conduit 99.7' *HRPSame as Benchmark % ystem Elevation Scale is 1" = 40' unless otherwise noted Walnut Hill Way Property Line 100' 99, 1 Arce Lot B-2 98' Scale = 1/4" = 10' ❑ 2% Slope B-4 B-3 ❑ Woods B-1 NB M * ❑ Property Line B-5 w. ~ n V'otSa tofCommerce SOIL EVALUATION REPORT / 3 Buildings Page Of accordance with Comm 85. Wis. Adm. Code Attach oomph C0untv ST: G,e D/' •V in Percent slope, clude, W rx EROSION CONTROL PLAN must be Parcel I D ~T IAJ C completed before sanitary permit issuance gad. p&.uDl,-3 G-- Re wed /Date b O1N you provide may be usod for saoorWary PirPo=es (Privary Lew. R 15.04 (1) (m)). owner T'opD I~3ERS T~f~ T-" % ToDO Property Propertyowners Mailing Address// Govt , of Al of' 5 ZL 2'8 O 49 1/4S T N R ( E or) W 9rol O t s CA (LL 1'~ue Lot # Block # Subd Name or CSM# y SAlu~,e state 4~ ~AL/VV Y !tA-l~~'( Zip Code . Phone Number & PPOE H T3: A4J SSo 74P CAS! Zy~ • Off ❑ city ❑ Village ( Town Nearest Road c TR~y so. &IovER New Canstrnction use: U9 Residential I Number of bedrooms Code derived design flow rate D " !r0 ❑ Replacement GPD ❑ Public or commercial -Describe: tA Parent material _ 40,65 S Gy / i //S Flood Plain elevation if applicable ti R General corrrrnerrts" and recommendations: a Boring # Bork9 CJ (D c3 ~j -S'~ S:s / N ® Pit Ground surface env. ft Depth to Inning factor v in1 Rate Hod= Deplh Darr~netn Desa"on ;GPDff In. Murtsed Cokx ~Redoox Texhxe ~Struchxe Consistence Boundary Roots 'Etf#2 b ~ • /0 ! ~ / shims s w ,3 c S c Sid. 2 c / •S z M o Ts slcG /ash ~v . Z. 3 'S"14 0 n a Boring Z Boris # ® Pit Ground surface elev. Depth rig factor in. s s s cafta Hortmn Depth Dominant Sod Rate In. !,mt Cokx Redgx Description Ts*" Structure ConsWence M Roots GPD ft= Qu. Sz. Cont Color Gr. Sz Sh. 'Elf#1 'Eff#2 n 0•13 is y~3 s . G 4 l s si 2 sb/ CS / 7- . S N ~s sz, / d c - 4 •S c sL Q • 3 . s is I/R ~f Z CST Name • Efl1uent #1 = BOD > 30 < 220 wc& and TSS >30 1150 mg& ' Effluent 42 = Boo < 30 mg& and TSS < 3Signalize c ~ ~ • Z1~6 R i ckT- S zZ CST'Nurnber Address Ulbricht & Pate Evahla6on Conducted Telephone Number Assgciates s~~~ . ~ 0 3 Priv t 71 s77A, •3 yy z-- 2812 10th Ave. n Spring Valley, WI 54767 PiNS FOR 4 PRO x. 2 yD 4 6tCS oyo• 1696. /o • 0M 67y0 • /096'.20 • ovv oyd•1096. 610 •cvo oyo• /0 *6 • 70• ova a yo • /o~~ ~D • ofi~ t ~ r ~ ?-ODl7 T,~ JE ~ 5 TED7- L Q ~ Yb Z 3 Parcel ID # POP °t ~rol~~r a~ S, s- S . 1 Boring E) Bo9 o t Ground surface etev 9 r ~ ~ ft_ Depth to g factor ssw hate 3 Horizon Depth Dominant Redox DesaipGon Texhrte strt►duta e«~s9st a Boundary Roots Gr_ Sz. Sh. `Eifflt 'Etf#2 in. Munsell (2U. Sz, cont. Color 3 . o /0YR3 I- ;6,~ sL, 2 51 2 S G S s S T SL D, • 3 S '0 S ~o Y S ~G ss' Boring #Socing • ❑ Pit Ground siufaoe elev. ft. Depth to ltmipng factor In. 50l APPI- Rafe horizon Depth Dorninant Color Rfttox Desaip M Texture StrICture Consistence Boundary Roots GPD![t? in Munsetl thr. Sz. cord. Color tar- Sz. Sh. `Efl11<t `~#2 Boling Q B°"ng In. Sol # ®DOO Pit Ground surface elev. fl. to lunitxtg factor Rate Fiaizan Depth Dominant COW I Redox Desaiptim- Te St ucture Consistence emrdary (toots t in. Munsell Qu. Sz. Cord. Color Gs. Sz. Sh. `Eff#2 i Boring # Q Boring ► Grocmd surface elev. / ft. Depth to WT&B (odor ~ Rate 0 pit QppAp Dominant Redax pesatp~iorr- T@'dL°'e Structure ~ ~ t~ooss Effdt `Eff#2 t•iortzon Depth Gr. SZ. Sh. im MunseN M. Sz Cord. Color Effluent #t 8t?DE > 30,.-,c .220 nx-}il and T,-3S >3o :S i,% nigh. ` EtBuerd #2 = 8Ms { 30 mg& and TSS 130 ntgl! = The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services Of need material in an alternate format, pie= contact the department at 608-266-3151 or TTY 609-264-9777. sen-ss3o trtanrot 7'oP12 T3 .?E k s Te~©T' Proper€y owner 'acei 11) L Q # Y6 Pages Z ~ t G<'oundsurfa 9~• /d s s. DVth ce~" D"th to tinmmv tacxor 3 S In S . ttorizo~ Dorrrinant Cot Redox Description Texture ~ Solt lire Rate In. Munset[ Qu. Sz. Cont. Color Structure - Consistemce Boundary Roots GPf ffl Gr. 5z. Sh. 7S Y~ . 75 S~ 2.S AC y 8onrig # Boring Pit Gmund surface elev. ^ ft. i iorizon Depth Depth to rrrniting factor In. Dominant Redax Description Texture Structure Soil action Rate Munselt Sa. Coot Color Consistence Boundary Roots GPf?fftt tau. Gr. Sz Sh. 'Etf#9 4Eti92 Boring # Q Boring P Ground surface elev. Pit fl. Depict to limiting factor ~ Horizon Depth tr Redox Description Texture- Rate in. Munson Sf+rrctrrre Qu. Sz. Coat Color Sh. Consistence Boundary Roots G ~ Gr• Sz. / 'Etf#1 '01#2 w j , El' El t_ f Boring Boring # Pit Ground surface elev./ ft. Depth to rrmiting factor In. Horizon FZ;Rj- Dantinant Gol Redox L)escdPff r►_ Texh" In. Stx7 GUn Rate Sfinx#rere . MUnSe~ ~ Roots iit'i?!FF Qu• Sz. Cont. Color Cvnsistenee ~Y tar. SZ 5h. -EfF#1 'Eff#2 i Effluent #1= BOD. > 30 < 2213 rng& and TSS >30 c 150 in9d- ° Effluent t12 = Bt]ps < 30 mg 1L and TSS < 3t) trrglL The DePaftmcnt of Comtnercc is all equal Opportunity service provider and employer. if you need assistance to access services or need rtratcria3 in an alternate fo"nat, please contact tite department at 608-266-31 S 3 or TTY 6Qft 264-$777. sea.alro tttaroo) 'PLOT PLAN WALNUT HILLS FARM. LOT # 40 ' Pg. 3 of 3 Q = Contour elevation lines. = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. S0ieUFs``~D12 f 'Orr ~L d r SCALE : 1 " =3o a,Aj # z DoT yA" o • o 4 Tg.7o' 3 woods BM 000 f v 99. ~Q /ZS-Sv L o j G iu `t-- zor-19 s'U e"oti -A0 VIC G.:v.2 1 y; 7v moo. 70