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HomeMy WebLinkAbout040-1303-00-045 Wisconsin Department of Conimerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567234 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: Westview Construction, Inc., c/o Aaron Clay Troy, Town of 040-1303-00-045 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /� S m 1 C 5--/-- - 22.28.19.1780 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER/) L CAPACITY STATION BS HI FS ELEV. r� J Septic �/C � / / Benchmark 16 /14 Y /on Dosing �',�� '' J Alt. B / Cb a P sad �e i,gz /62. �3 Bldg.Sewer <<�.t. Po� Ib 5z5 7 11,17 Holding St/Ht Inlet — — 77S 9 . G7 . St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. n to Air Intake ROAD Dt Inlet Septic 4z AA /3 5 — / ` Dt Bottom 1/ 17, 16 Dosing / ht' ' Header/Man. gL /VAT .5 '� �z /3 2 � Aeration Dist. Pipe / 10 77. gS Holding Bot.System C 5 2Z. 11". 33 Final Grade a PUMP/SIPHON INFORMATION 6ir... ,3. 1' / 2 Manufacturer 7bGr GPM St Cover Gam- f I/L�dZ.�3 Model Number l� TDH Lift Friction Loss System H TDH�" Ft *.J441 -7, 41.ci C 1.11% Forcemain Length 35 2/ Dia. t( Dist.to Well �A SOIL ABSORPTION SYSTEM BED/TRENCH Width f Length/ / N f Trenches PIT DIMENSIONS No.Of Pits Inside Dia. .�• I Liquid eth DIMENSIONS C.3 .1•1 �"5a lle �_ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer, e+ INFORMATION CHAMBER OR •Jl iri 1.k-i'w _ Typ Of System: .� I. (n l j�nn / �a `"'�'�`-' /v �� UNIT Mo65.:Aber'4 /( ...AI AIIJS DISTRIBUTION SYSTEM �1(fic Tj Header/Manifold 66 /1 Distribution x Hole Size x Hole Spacing Vent Air Intake J S 1.5r Pipe(s) \_ ` �_ V elrt„M4D. Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4- 6 w fe, 4A. 6r...,,_. Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 2.0_4. Bed/Trench Edges \ Topsoil Yes No Yes G No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 216 Walnut HillVay River Falls,WI 54022(NE 1/4 NE 1/4 22 T28N R19W) Walnut Hill Farm-aka.The Tribute Parcel No: 22.28.19.1780 1.)Alt BM Description= trf Ga°'�- GI 41. ,A,6 '4-+ LaGlh-� ti CV 2.)Bldg sewer length= ii -amount of cover= / .4/ / , Plan revision Required? v Yes `�fi�No Use other side for additional information. 0 Er. •—�• SBD-6710(R.3/97) Date Insep •r's Sig,. re Cert.No. ..," Plot Plan for Site and Soil Evaluation Page 3 of 7 ," Property Owner WF-- -Tvrev3 UN c 5rg-ikcIt N.-161c i 1 . 1" = 40 ft. Legal Description t.vr 45, WALIsial Att.I..VAKAP‘i (except where noted) kje 1/44 oF -ifia. NE. q, SZZ, -IZ. R.FttA) , --rov,A) m. ,M* =Ilackhoe pit 1.1e.tty auArri) Lostat4,51.A.a , ai, 41 J.4e,g-&- ai5._ za, viAtiotzt iitLi... oAy North La 0 4-. „A„eit" Li'I--"VDT _.„d tf...$F-1;11:i'K:4' 41v,..*-rwAt.z.,-..-spuce' Lovi:Az"--iiiANDe rve... 5; 91pEz sem, yo t 74 ;E- -... fr sa 4, %X 4 e :; ::-2:,„ _ owl- i.., %t iiiPiznPIP k •,4' ` ei s ' 00/ PO ' ,.. 7 e ST * 4 4 i I • Al°j14 A (1) 1 1 , ii) 1 . . • ,.. , P10 {i$1 ' ft.,41,61000#44:i‘' , 0 .) A .0 4 4 oz PPDP-4,> 4 -- . V pii- 4 ''' 11 - miutoiki 4' . d 51mw rP /41/. f R-0-1.0 LINE '0%" 'M.t1-'4 it4"..AILAsi-r vol.)... t&pNli 4-1- (200.-.? ,L1 Site Locati in: 75 ikl rit_TKATtP,s 4z- iriteive.-5 aoi %, ' rg " :+''') (5) . Y.-4,,,A'-'7A2ExietiV-s - .... rjavi- kaV33) Ail o~¢iarCt~v~ County Safety and Buildings Division 7' C Y U 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 r S Cod -3 ti.'YIONPi Sanitary Permit Appli tion State Tran;~A_ 'nNumber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of s o the appropriate governmental unit Zi is requ ired prior to obtaining a sanitary permit. Note: Applicati or state-owned P W f S are submitted to Project Address (if different than ma' n a dress) the Department of Safety and Professional Servies. Pers n ton provide maysed.for secondary purposes in accordance with the Privacy Law, s. 15.04 1 s. 1 , 1a~ N J I J 1. Application Information - Please Print All rma ' 0 //a W y` (~tJ 141 Parcel # Property Owner's Name rob , 7 .y YJ r Q13 6 40 - )"3c, 0 -U S V1~ eSTv e c,,,~ Property Owner's Mailing Address 4 COV Property Location ~ D a I) S C n, N7~, Govt. Lot 45 City, State 1 ZipL Code Phone Number / _ALE-_ y, y., Section a a 6Z I Vt✓ t I' Lt, S40LZ 7 /S • 7Ge, y 6 G T ~N; R circleoon-) II. Type of Building (check all that apply) Q Lot # 1~ uw) ,Ka or 2 Family Dwelling -Number of Bedrooms e Subdivision Name J l Block GLI12yt ! /T Fx,m ❑ Public/Commercial - Describe Use ❑ City of SM Number El Village of [I State 0 ned -Describe Use Town of r CJ 6d' 5 ~ (..Ina ~OelS III. Type of Permit: (Check only one b x on line A. Complete line B if applicable) A. ' Replacement System ,New System El ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El List Previous Permit Number and Date Issued Change of Plumber El Permit Transfer to New Before Expiration Owner ^ X ~-f~ IV. T e of POWTS S stem/Com onent/Device: Check all that apply) J_ 5 Q_Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil 6 t%,,L . 6e_C ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) n 5) V. Dispersal/Treatment Area Inform on: 11(07 25-75 66i~ v Desi n Flow (gpd) Design Soil li tion 2ro- f) Dispersal rea equircd Dispersal Ar Propose s~ System Elevation Io I DD `(JVi 99./~ 6 d 36,0 VI. Tank Info Capacity in Total # of Manufacturer c Gallons Gallons Units p U Y N _ New Tanks Existing Tanks / G Y Y fl ` 0 v a a ~ ~ ti ~ w c~ o, Septic or Holding Tank /01100 I .C ' 1 CSC U he- _T Dosing Chamber Pj 90p t' ` t VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig//nature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code gga' j,6 ~v o e- 71(0 (,J ~L S~6 z L VIII. Count /De artment Use Only Approved Permit Fee Date I sued Issuing A e t Signature ❑ en Reason for Denial IX. Cond"lliT~WReasons for Disapproval Septic; tank, efftuaht fitter ®nd 3) 1 V7 dispersal cell.must all be senilces / maintained as per management plant provided by plumber. be,t to t," q IQ ri''- S 0 MCk rpq*ements must bo rnairttalW n per oplic" code 1 ordiria~ices. ( u t' e~J Attach to complete plans for the system and submit tote unty only on paper At less than 8 1 x 11 inches in size'f rr SBD-6398 (R. 11/11) J /J&F-,, ' " - ,'o-1- ` pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: F_VJ 00A<zKl 'TI D I J C GIeU iA cvn► l 'rte QN,AL- B EN Project Name and System Type. Location: Z 1 /a W,4" ACT fi i Ll, Street Address , / ion Legal Vunly Zt C RD I TownDesign Criteria (Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: ❑ SBD-10571-P (6/11/1999) ❑ SBD-10567-P (R. 6/1999) ❑ SBD-10855-P (3/2007) Version 2 'SBD-10705-P (N. 01/2001) Version 2 Contents: Page 1: Page 2: AN lE U~ Page 3:Lf1~ Page 4: P0 W 1-5 D WNI _`5 /1r1 Ni LL f1N rD /Vl Af J~ EEAAq l°[4i/1( 1A Page 5: Page 6: P?lc. TAniK ~6tMi' CtJAAAF CU SS S II OAS Page 7: LOA P s N~ Page 8: • Xttachments e EPTjc rtfl~ M~AUy i 1~1RNCC A GR-T,EN~ni't- -:Sb 4 U p Signed: kill "s 71 Credential Number:~9'~0 Date: ~l v & 3iMVV7 0_1 J_ fi fool 93M dmmOm g ggib IwT~ 7 No ~ X36 _AN j/vG? 'RATE, u cK - i 1 T = Ali T5 -7Q, AREA I'll©-~-~(~ -~y~c ~3yn1 ~✓r ~'~L~~oK ..`'S L VT L4 ~ ~~r~,cn! D.NS PI©t Plan for a and Soil Evaluation Purge 3 of 7 property Owner 1 " = 40 ft. R tt an (except where noted) Legal eser = Backhoe brit North IJ kZ~ 'Kkk-L '€•~S . e -IdOT L " P s~ A4PV To 7. Site Locati n r~ } ,a F7, rig )-4> W J WWI- Feb-26-2013 01'.22 PM St. Croix County Plan/Zoning 715.386.4686 POWYS OWNER'S MANUAL A MANAarim T PLAID doge -1'- of PION 31YaTlM BrQCIr1QATlOtrt6 Owner V t r Vj 1a n2~tL X10 Septlo Tank Capacity gal - 13 NA perrhk of Septic Tank Manufacturer 1EfZ C NA DOM MARAMTM Effl unt Flksr Menuteoturer p ~ t OK 13 NA Number of Bedrooms D NA 6f ant Filter Model Z15' 0 NA Number of Pulft Fw ty Units V NA Pump Tank Capacity 00 al 13 NA EahvW d flow loveerage) d Pump Tank Manufacturer JERK 17 NA Design fkhw 11psak).1Estimsted x 1.61 a el/d Purnp Manufacturer 0 NA Boll Appiloation Rate s Pump Model 0 NA Standard InfluwnrJCffluent Qualky Monthly average" Pretreatment Link NA Fats. ON A Grease (IN) 990 mq& O BWAIGravei Flier 0 Pant Filter Wooftemical Oxygen Demand 10017,) $220 mgX Q NA 0 Meohanlosl Awstlon 0 Wetland TotalSuspended %No (T8M X180 mp/L 0 Dlsirnfmton L] Other: Pretreated !'ffluerht QuWW Monthly average Disperahd Call(s) NA BhdwnW Oxygen Demand (BOD51 120 mg/L n-around (grwityl 13 kp&wnd twessurized) Total buspandod Solids (TSS) 980 mgA. 47NA 0 AtAlrode 0 Mound Fiscal Coliform (goomeMo mom) Al 04 ofu/lWN 0 Drip-Lino a Other: Maximum Efnueet Farads 5116 K in dim. 0 NA i 0 NA 13 NA O NA "Mskm W*d for *on* wwwwater and sspdb nnk etlltrnnL odher: O NA MAIHTPNANQE SCHEDULE swvtm ovum Swirl" lh6queaoy m:p.ot ornrciitton of tenkls) At least awe every: 3 13 nw V% in) (Mandmum 3 yaws! 0 NA Pump out conanU of tank(s) When combined sludge and soum equals cnadhlyd (%I of tank volume 0 NA monthis) Inspect dispersal collie) At least once every: 3 (M01roum 3 yeas) 0 NA Clean effluent filter At lout once every: f C monthfol 0 NA Ihepect puntp, pump controls & alum At least once every: 0 NA gush lotersls and pnwwre tort At least o<noe Every: 0 13 month(s) JhNA ft an At asst once every: 0 ont NA yearls) 7 M JNTUTANOB W8=C=AM InspsotbM of tanks and dkpwvW calls shall be made by an Individual carrying one of the following konses or corMloaliona Mader Plumber; Mastor Plumber Restricted Sewn: POWTS Inspector, POWTS MaintaIner; Uptage Servicing Oparetor. To* Inspections must Include a visual Inspsothm of the tsnk(ei to Identity any mining or broken hardware, Identify any creole or looks, measure the volume of combined sludge and scum end to check for any book up or pending of efflwnt on the ground surface. The disprrsel collie) shall be visually Inspected to check the efflosnt levels in the observation pipes and to check for any ponding of sfilhent on the ground serfceo The pondIng of effluent on the ground wufaos may Indloats a faigng condition tend requires the Immediate noWiootion of the local regulatory authority. Whm the combine accumulation of sludge and scum In any tank equals onathkd (K) or more of the. tank volume, the anttns contents of the tank shad be mmoved by a Ssptege Servicing Opon for end dleposed of in accordance with chapter Nil 113, Wisconsin AdmMtatratlve Code. AN otter savioea, Including but not Iimked to the servicing of effluent fikers, mechanical or prod compormts, pmrtrestmero unit, and any nMohV at intervals of &12 morhtha, shall be performed by a owdfisd POWTS Mointalnu. A servlos report shag be provided to the local rogul8tory authority within 10 days of completion of any service event. Feb-26-2013 01:22 PM St. Croix County Plan/Zoning 715-386-4686 START UP AND OPERATION For new oonstructlon, prior to use of the POWTS check treatment tank(s) for the promos of painting products or other chemicals that may kmeds the treatment process and/or damage the dispersal celi(sl. If high oonoattrations are detected haw the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shell not occur when soil conditions we frozen at the Infiltrative surface. During power outages pump tanks may 61 above normal highwatw levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the call(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the oontehts of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntelner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within 16 feet down slope of any mound or d-grade soil absorption area. Reduction or oftinstlon of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; olgeretoe butts, oondome; cotton swabs; degressers; dental foss; diapers; disinfectants; for, foundation drain (sump pump) water; fruit and vegetable paerings; gasoline; grease; herbioides; meat scraps; medications., ail; painting products; pesdoldea; sanitary napkins; tampons; and water softener brine. ABANDONMltf11T When the POWTS folio and/or Is permanently taken out of service the following steps shall tie taker to Insure that the eystsm is properly and safely abandoned in compliance with chapter Comm 83.33. Wisconsin Administrethre Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings welled. e The contents of all tanks and pits shell be removed and properly disposed of by a Ssptage Servicing Operator. e After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soli, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS fees and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; A suitable replacement area has been evaluated and may be utilised for the location of a replacement soli absorption .19 systsm. The replacement area should be protected from disturbance and compaction and should not be Infrtnged upon by required setbacks from existing and proposed structure, lot lines end wells. Fallure to protect the replacement eras will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in affect at that time. la A suitable replacement area Is not svaNsble due to setback and/or soll limitations. Barring advances in POWTS technology a holding tank may be installed as s last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and do revalustion must be performed to locots 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. 0 Mound and "redo soil absorption systems may be reconstructed In place following removal of the bianat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tkne. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANi68 MAY CONTAIN LETHAL GASES AND/OR INSUFFICM OXYeW. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. ROME OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Nine GAMZL 44l S&- EN CL s{i5~ Phone . 1-' l9 Z- - g~_~ c f SEPTAGE SERVICING OPERATOR PUMPER IACAI REGULATORY AUTHORITY Eg,,'71 DAR9ai,.s SEP71C S~VICC?✓ EN-71 3l'_ C90t>< doWi - HzS-- I c T S" 5- 3$b-LIC19D Page Ofl SEPTIC TANK b PUMP CHAMBER CROSS SEC_ r1, jkND SPECIFICATIONS CI VENT PIPE lZ" MIN. ABOVE GRADE 6 WEATHERPROOF a" JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COV FRESH AIR INTAKE ~ W/ PADLOCK ~.-.-WARNING LAB, FINISHED GRADE GX,rnvm q" MIN. r ZY :Cor,artt S.O. u \ 18 MIM• 18p IN 1 INLET GAS-- WATER TIGHT SEALS TIGHT, \/APPROVED _ JOINTS WITH A SEAL , pFcol L-ok 6-2-67 LM APPROVED PIP PIPE 3' APPROVED , , ON SOLID SOIL ~ ONTO SOLID C OFF SOIL PUMP OFF ELEV. ~ , ol~ IF , W.00 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE W1 NUMBER DOSES PER DAY: TANK MANUFACTURER: TANK SIZES: DOSEIC GAL. DOSE VOLUME FLOWBBACKK: s~ GAL. _ CAPACITIES: A = INCHES GAL- MODEL MANUFACTURER: iAs E S 19 MODEL NUMBER : g - 2 INCHES = yg GAt' ' SWITCH TYPE: /►l..A4M C 3,5 INCHES = ZW-..-GAL. .PUMP MANUFACTURER: MODEL NUMBER : ' p /a INCHES = 2ZZrI® SWITCH TYPE: PUMP E ALARM WIRING, AS PER TROW 1 REQUIRED DISCHARGE RATE _6[hL_ GPM VERTICAL DIFFERENCE BETWEEN PUMP Off AND DISTRIBUTION PIPE FEET. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . • . . • _ FEET / a /oO FEET FORCEMAIN X ,L.J FT/100 FRICTION = L-Z,_3q_FE£T INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH: DIAMETER LIQUID 9 a/p -7-7 ?q Ito, 30 lato ®v rho 0 1/4 HEM CAPAC C MODEL "9ir 4 5/8 30 e zs e ~ ~ I 3 5/8 e ~ + + 15 Q 4 4 3/16 to 9 5 T 1/2-11 1/2 NPT 0 US C.~I lOlIS 10 ZO 30 40 50 ED 76 so tJIEaS 180 240 0 80 Flow PER uaanE , moo& 9e So CYCLE real cAftm Velars liters y 72 1.0 273 to fl 3.1 231 10 a s f 170 12 20 25 ft !y I.otk V•bk ?S Offf71 4-3/16 SKIN! CONSULT FACTORY FOR SPECIAL APPLICATIONS • EkK&* d a%emators, for duplex systems, are available and • Venable level fbat svlritas are avakd to for Obntrofng siflgle supplied with an alarm. and three pulse syst0mil . • Mecuhita mss, for duplex sys6ems. are avallable • Doug piggyback variable level float swillf M are evaiblble with or. vA#x td alarm swkhes for variable level long cycle controls. SELECTION GUIDE 1. IMapPal float operated 2 pole meclonioal a &*k no a 6WW calmed required- ' Sta d all models - Wei ht 39 lbs. H.P. 2. ab101a piypyb wk valisltM $rid loot awtlch or double pWwbedl variable level. ll8adilt COR W aeloctloa Ode ti' Rgil rlof1A0477. Model Volie ft Node 3 Medgnkal aNsrneW 10-0072 or lo-007s. 118 1 Aub 8A 1 «13 7 4. See t7110712. foramad model of EMok sl A Mmaia Nee 11 1 9A 2 30x4 8. Co" aulN d 1041= used as a r n I ac~lor. specify duplex (3) or (4) DYb 1 Auld 4 7 1 ar 13 7 - & Faw(4) hob J•Pa kawWn bon, &r walsrWd cm wcfion ar Wmt41 E9ti 230 1 NM 4.7 2or238 3or435 sirlplexorduplex operallon./04M. 7. Two (2) hole J-Pak, for watertiplN collrnecaon or spice- CAUTION rorialas1t41ona1 atldiliosdZae/xploduck roffrto ot>fslep m l Wds61s LevN All installation of controls, protection devices and wiring should be done by a qualified R WP.BeddeelA%N4lor Rlgla Modw*aiAllrelf w.FIl01a6C&vgOerrole8nI F111 W, licensed electriclan. All electrical and safety codes should be followed Inciudhtgt the wheat g*ftW %rplsxP0*CrnYSI. FM=t Nam 8y21asf. F110M recent National Electric Code (NEC) and the Occupational Safety and Health Act (08M RESERVE POWERED DESIGN For unusual oondidofm a reserve safety factor is engineered into the design of every Zoeller pump. &#A M P.a am 18817 L, latiwlrt KV.411156A 7 0 & dWT& 8Q11QoraAauAbad tolriwie~Ky102f1-1861 ~y "Jew,SW~ Itfip~fWMt2laelfaLCOar Pl/MP ~ ~ _ ✓rs w vl/©sru ST. CK01X COUNTY SEPTIC TANK mAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ovvmoffi " E15`f U (Et/j 6/4--)TK•Lke i ( 0 Maffi"Addrew ZO >tX A)['C\-) Coup- , Ki UU~KA LL-S 1--a 5440Zzz Property Addren ;-716 W A LN U-r 14 (LL-1 -Ay (Verification requued. 6rom Plaamog dt Zoning Department for new ocoekucfim) City/State F S Pared Identification Number D 4 D- l ?.r- b 3- DD ° ~f J`~ R1U~pZ Au_ LEGAL DLSCB~1"ION Properly Dion Ne V., N G V. , Sec, Vf- , T _ZYN R)LW, Town of ~ f~ U,-T F-) Lot # Subdivision Ptat. WIAral LA1- -H 11L r-A KM f=-( E) Coed SUyT app # , Volume , Pap # Wmtrrmtty Deed # Oefbve 2007)Volume , Per # Spec house U yes ll no Lot fines identifiaw U yes U no SYSTEM MA1NTENANCE AND OWNM CEBTIFTCATION Improper use and make of your septic system could result in its pie failure to handle wastes. Proper nm oe consists of prmnpog out the septic tank may tluee 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 jComm. 83.52(1) and in Chapter 12 - Sc Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning d:. Z,on mg Deparbnent a embficatiOn foam, signed by the owner and by a master plumber, lmwmymmply, restricted Phi or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) ate inspection and pumping (if may), the septic tank is less than 1/3 full of sledge. Uwe, the undam need have trod the above requirements and agree to maintain the private sewage disposal system with the standards set fordr, herein, as set by the Depwfinent of Commerce and the Depwtment of Natural Romffoes, Stake of Wisconsin. CaMf cation stating that your septic system has been maintained must be completed and twinned to the St. Croix County Plan=* dt Zoning Department within 30 days ofthe three year eapimbon date. Uwe certify that all statements on this are true to the best of my/err knowledge. 1tw a amlare the owner+(s) of the property descn'bod above, by vidue of a deed recorded in Register of Doods Otliiee. Numbw of btu 4 SIGN PLICANT(S) DATE sssAW in&cmation that is misrepsunenlod may rrsul t in the sanitary permit being revolwd. by the taming & Zoning Department. sss lnclde with this application a recorded wanrmdy deed from the Register of Deeds Office and a copy of the certified survey map if refi niece is made in the warranty deed. 0My "AM UNPLATTED LAN wffii~ P HY~j SN 4L N 89'16'45~ E 145.9' mdlmt 4 4616 3S.F. 3 ° ~ ,.rte Ac. +s z 1 1646og' ,o: moon %Mftm t 4 nr 11 IIIII III III II ill litlll lill III $ Tx?4097072 STATE BAR OF WISCONSIN FORM 3 - 2000 970915 Document Number QUIT CLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, ST. CROIX CO., WI and NVeshiew Construction, Inc., Grantee. 01/07/2013 4:07 PM Grantor quit claims to Grantee the following described real estate EXEMPT*: N/A in St. Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 TRANS FEE: 135.00 Lot 45 of Walnut Hill Farm, Town of Troy, St. Croix County, Wisconsin. PAGES: 1 Lot is sold "as is, with all faults" Recording Area Name and Return Address: Title One! #19(X)3 Together With all appurtenant rights, tide and interests. 040-1303-00-045 Parcel Identification Number (PIN) This is not homestead property. Dated this 28111 day of December, 2012. Citizens u Bank * Genc I ab erman, Vice Chairman ' I * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) S"1°,CI:OI\ COUNTY. ) ss. authenticated this 28th (lay of December, 201.2 Personally came before me this 28th day of Dezember, 2012 the above named Citizens State Bank by Gene Haberman, Vice Chairman to me known to be the person(s) * Who executed the foregoing instrument and acknowledged TITLE: MEMBER STATE BAR OF WISCONSIN the same. (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY *Jay P PeI d Notary Public, Sta Isconsin My commission is permanent. (If not, state expiration date: M(60,6 h-lrt°e i, M t-arrw 8!7/2016 (Signatures may be authenticated or acknowledged. Both are not nec ry.) 'Names of persons signing in any capacity must be typed or printed below their signature pS a~No a Publ 0f, ~ o~dise n 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3.2000 Wisconsin Department of Commerce SOIL EVALUA ION REPORT Page 1 of 3 Division of Safety and Buildings Pions, n accordance with Comm 85, Wis. Adm4 ;.1 e A ttach complete site pla ss than 81/2 x 11 inches in size. County ST. CROIX ust 14-4 include, but not limi ed horizontal reference point (BM), directfoh a0d 4&rcel I.D. 040 - 1303 - 00 - 045 percent slope, scaled orth arrow, and location and distar". to nea4tpmy~d. r Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 16.10W%$n)). Property Owner Property Location WESTVIEW CONSTRUCTION INC. Govt. Lot NE 1/4 NE 1/4 S 22 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 20 Serenity Court 45 Walnut Hill Farm (Tribute) city State Zip Code Phone Number []City Village own Nearest Road River Falls, WI 54022 ( 715 ) 760 - 9900 Walnut Hill Way Troy E] New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement Q Public or commercial - Describe: ft. Parent material sandy outwash Flood Plain elevation if applicable NA General comments recommendations: Conventional In-ground Trenches 0.6 loading rate C114 l L ~ I and 1 Zo Test conducted to move system out of proposed dwelling location. F-1 I Boring # a Boring 1 l Pit Ground surface elev. 100.83 ft. Depth to limiting factor 63 in. El S61 ' lion 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 1 0-8 10YR3/3 1 3fabk ds cw 3vf-m 0.6 0.8 2 8-18 10YR3/2 sil 3f-mabk ds cs 2vf-m 0.6 0.8 7.5YR3/4 - grlysl Osg dl cs 2vf-m 0.6 1.0 3 8-30 4 30-50 7.5YR4/6 is Ifabk dl cs lvf-f 0.7 1.6 5 50-63 7.5YR4/6 sl Ifabk ds lvf-f 0.4 0.7 Horizons 3-5 have many s cts. a Boring # 11 Poring 102.63 60 • Ground surface elev. ft. Depth to limiting factor in. Soil A 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 1 0-9 10YR3/3 - 1 3fabk ds cw 3vf-m 0.6 0.8 2 9-18 10YR3/2 - 1 3f-mabk ds Ste' 2vf-m 0.6 0.8 3 18-30 7.5YR3/4 is Osg dl cs lvf-m 0.7 1.6 4 30-40 7.5YR4/6 - sl 2fabk ds cs lvf-m 0.6 0.8 as lvf-f 0.7 1.6 5 40-60 7.5YR4/6 - is Osg dl 6 60-64 7.5YR4/6 W7.5YR5 IS Osg dl 0.7 1.6 Horizons 3,4,5 have many s cts. * Effluent #1 = BOD > 30:5 220 mg/_ and TSS >30:5 150 mg/L ' Effl nt #2 = BOD < 30 mglL and TSS < 30 mgA_ CST Name (Please Print) Sig CST Number MARY JO HUPPERT Hollister's Soil Testing & Design 224832 Address Date Eva ua onducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 10-01-13 715-426-1775 nnr. o~~n mnn~nm Property Owner Westview Construction Inc. Parcel ID # 040-1301-00-045 Page 2 of 3 Boring 1-11 Boring # ® 11 Pit Ground surface elev. 100'83 ft. Depth to limiting factor 64 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 1 0-7 10YR3/3 1 3fabk ds cs 3vf-m 0.6 0.8 2 7-14 10YR3/3 1 2fabk ds cw 2vf-m 0.6 0.8 3 14-24 10YR3/4 p It sl 2fabk ds cw 2vf-m 0.6 1.0 4 24-31 7.5YR3/4 grlyls Osg dl cw lvf-m 0.7 1.6 5 31-44 7.5YR3/4 is Osg dl cw lvf--f 0.7 1.6 6 44-64 7.5YR4/6 sl 2fabk ds cs lvf-f 0.6 1.0 Horizons 3,4, 5,&6 have many s cts. '1 F-1 Boring # Boring 6. P 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 # H Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * 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. SBD-8330Test (K07/00) Y Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner 1"=40ft Legal Description Lart 45, WALN ~LT AtL fAK, (Mept where noted) e' or -me, Np- %4, SZZ, -M-~M, RR w , -M WK) M Backhoe pit. oy , '5-r. MMY d-()%ANTY. W►=Qb)s1 - 66 Aeg-&,% WALA%a fA t L. - t,,AY North LJD•r ~ S ~ocb U% Z ~6M~Z= SPK~ ►N~oW~tU@ ~ /GAD, 3s~ ,PIPE 3` h h ~Nf3t stAK~~) N do . ite Locati n: • zz '3~ t ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County ST GA Ol A - Attach coin include, bu EROSION CONTROL PLAN must be t Parcel I.D c v7- / 4~+ percent slol completed before sanitary permit issuance troad. p~.vDu~ f:-- wed by Date Heraonti iMortnation You provide may be used for secondary purposes (PrtvacY Low. c. 15.04 (1)(m)). ' ' Pity Owner r P49 Property LacLocation l~ p 'o aD Z3 UR$ T~fl T- ~ ~G^' ~/~1• Govt. t.ot A// V4 5 *'1/4 S 7L T Z U N R / / E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSfM t 5 CA i}i LL AV-P- ys• wq~n~~ r qtr t t ~ARAf ~ m city ,.-Cmt& R State Zip Code Phone Number 0 city Road bpovc H]3 MN 5S07(P (&S! Z'/8• tofF .T-Royge [Town o vER 51 oa New Construction Use: 19 Residential 1 Number of bedrooms Code derived design flow rate ~ GPD ❑ Replacenient ❑ Public or coni:dai - Describe: ,~-y_ _ Vr► Parent material /O _S S d 1, //ls Flood Plain elevation if applicable General conwrients and rrc«ri n indations: • ,42V,6-A- 7-&-s7-&z:) 5'v/ re*61.a' eR ~4 /`lo t>.vQ kA VS Mr,"'I WI'A- F " 5~4•v0 Vii'// N Boring# DBorirv qy z 8 S. S. S Pit Ground surface elev. ft Depth III) Wrilting factor 1rn. soy Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW b in. Munsep Qu. Sz. Cont Coker Gr. Sz Sh. -E1t#1 -Eff#2 o • 11 76a 511 z-fs hie S a, w Z • 5 • e c L 2-,w, Sh S1 c4 j / s ~A C 40 A MoT5 L d Gf • 3. s 0 Z ❑ Borim q ~Q 4n, # ® Pit Ground surface elev. ` • G ft. Depth to Ong factor ~v Nt. Hor SoN Application Rate izon Depth Dominant Color Redgx Description Teidure Structure Consistence Boundary Roo GPDW in. Mumsell Qu. Sz Cont. Color Gr. Sz. Sh. -Eff#1 -Efr#2 I •li ~DY 31/L 2-Fshe 3,54 alto Z . 5 4 ' N z is • t? /oY a,~, s s cS / s N 3 7• 1/2 7•5 0 G S ICS !lc "IM v-fA • 7 Z Effluent #1 = Bop,:- 3o :S no mg& and TSs >30 < 15o mg& ' Effluent #2 = BM .:S 30 mg& and TSS 130 mgfL CST Name (Please Print} •l-y .u LB R ( C i►.-r- Signature :x , s - Address Ulbricht & Assgciates Dam E C inducled Telephone Number -Private ~ s- d 3 71S- 77x1.3 yy Z 2812 10th Ave. Spring Valley, WI 54767 y PINS°~ 4PoRo x . yos oya • /4006S • s-o • o-&0 Dyp• /49(40• /O•OW r- , oyo•/og~ - 70• oar oyp. /'0 000.010 ' l TOD!? ~ .T E I S TED7- L b~ ~s Z 3 taropsrtyQvrrner Parcel ID # Page of F3-1 B g 2 . t Ground surface efev. 96 Vft. Depth to NmF6ng factor S.S.S Soil Rate Horizon Depth Dominant Colo, RedoxDescription Texture Shttdure Consisterrce Boundary Roots GPDM iru. Munsell OU. Sz. Cont. Color or. Sz. Sh. 'Eff#1 'Eff#2 0-12- SOY/? s/L Z S/1~ S a w z 1 5 Z .1 • Z / p / L 2 i►+" CAS C rsv .5 , 3 L• ~.S1 5L D d A CS . 3 . S. to • -7 •.S f2dQ 1`ro G U 3 S s Y s/ :ter El Pit Ground surfacee elev. R. Depth to fieh'itiing factor soa ir+fiarr Rate Horizon Depth Duxrureant Cdor Redox Description Texture Structure Consistence Boundary Roots GPDff im Munsell CZu. Sz. Cont. Color Gr. Sz. Sh. `Eft# t °'Ell#2 O"'ing# Boling F-I Pit Ground surface elev. ft. a ~ factor IrL M Rate Horizon Depth Dommnant color Redox Description- Texture Structure Consistence Boundary Roots GPDff in. MunseN Carr. Sz. Cont color Gr. Sz. Sh. 'Eif#1 °Elf#2 Boling Boring # Pit Ground surface elev. ft. Depth to b yd" factor in. rsOfl AVpksWn Rate Horizon Depth DomUnarlt rte ox p~ion_ Texture Structure Cionsistence ammwery Roots GPON IM Munseff Qu SL Color Gr. Sz Sh. °Eff#1 *EM Ef ueW #1 = 0ODs > 30:S 220 mgt.. and TSS >30 < 150 rnglt. ° Effluent #2 = BOD5 < 30 mg& and TSS < 3o mglL The Department of Corn►nercc 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 608-266-3159 or TTY 6€18-264-8777. l,8DE37~ (R6+rl0) r J ' PLOT PLAN WALNUT HILLS FARM. LOT of 3 = Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRRED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : l 7-0 1 No • to r lw Nx.-- O ~N 0016 gag a Oq, qq. no ~A5-r 5v6-G°e!Y ~i~~ ~U 1rfN/~jJC~M ~IQ v.~~? s svs5 , Ys 7-.L'- 11 'mooVUO r 101'X J-)," _S4AJP -fl-11