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HomeMy WebLinkAbout040-1303-00-020 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567248 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 040-1303-00-020 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /110% /d (3 X1/1 I Cyr 22.28.19.1755 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. __ •Septic Benchmark p Lit'C.s.•�. gl L„� ' /ZOO 9 -5.4$ /6/.541 TV. /A Dosing `3 / Alt. B Gv1A... Lamto Pa-up 3 $� 3 /O/. �`S Aerf IT". Bldg.Sewer Z. 9 � 9 � Holding Pb 11' a lc, 52 5 _ St/Ht Inlet 3./Z 7$ .4(o St/Ht Outlet �, \ TANK SETBACK INFORMATION TANK TO PA WELL BLDG. 4 l Air Intake ROAD Dt Inlet Septic C / ,/� �._ — Dt Bottom ?4',( 3 / � r /3 Dosing r I Header/Man. 3,�' Ia4- NA- /3 z 567.7/7 Aeration Dist.Pipe 9 �j 7 .7 1�,, 3.9 97.t, Holding W , Bot.System I`/ �dt�QaC. +'�. 97./Vi 7•/V o{C L.D� y• 5 q7.2Y PUMP/SIPHON INFORMATION V Final Grade 9G.94' 1...,„„ S�'��.. 3. L 9 7 .TTt Manufacturer Zo e(L GPM -1"" } St Cover^ - „� 3 /��. $S t �5 / f�,. o Model Number 98' TDH 1Li3. S Friction Los. System Head ci TDH.4. I Forcemain Length ' Dia. i( Dist.to Well N./I_ 56 z SOIL ABSORPTION SYSTEM pp�� BED/TRENCH Width / Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 48"2., 5 �� e( '..._____ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact rer INFORMATION Type f System: ',1 f �/ / CHAMBER OR Tom, `t -r...4-,.t Q✓•2� 49 Ci Q/�1/ ''RAC 4'1 57 �k AJ� UNIT MogYa[mbe /� /9�,5 DISTRIBUTION SYSTEM �J1-.. �,,,�//////!////////////������ Header/Manifold i/O it Distribution x Hole Size x Hole Spacing V o Air I ke Length �T Dia Length\� Dia` Spacing \� /� SOIL COVER i x Pressure Systems Only xx Mound Or At-Grade Systems Only 76)(3-4166 GL..,.`,.lo.` Depth Over P Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/'Trench Center / Bed/Trench Edges Topsoil I es D Nos w No' 0 COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2 / / Location: 268 Walnut H' Wayy VER FALLS,WI 54022(SW 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Tri Parcel No: 22.28.19.1755 1.)Alt BM Description= I"l c,00.4".._. ���,r„. s a� 2.)Bldg sewer length= Z 5 -amount of cover= n Plan revision Required? 7 Yes to 1 it X 13 P G 31Use oter side for additional information. !/ / Date Insepctor's ignat/ Cert.No. SBD-6710(R.3/97) . Oct 23 13 05: 59p Hollister 's Soil Testing 715-426-1775 p. 2 Plot Plan Page 3 of 7 Property Owner i Y iE+Al LA nisrR cn ti`s-' ' 4 1" = 40 ft Legal Description Lc-r 20, T w_Ar .,t-= ., pgr_ cr (except where noted) i 1/ �1 = Backhoe pit ..mow l� L+�T�£ sc 4, S zZ`''iZ��li, �1y''��� -t�w�V D� T O Y/ T. C1 ...iX. Cc i.tti r Y, IA) ecnlsi ti - ic iJt) ..,4-C,e&s North 5 d 0. v � / rya ' .I ' 1 , ,fror YT7 •1l i .-Atilt- . .'A\k.' roly_4 to.C111/ 11> ,1:00 ' k ,‘i. ..... . . V* /1 • •-c. Al _ -1, .4" . •. --\. 1,4, *, ,,,,, x - 1 i NO ,,‘ c *\-'1\ N■ * i -i-„, , -vaQ.-- c WI lam' Site Loc • n: d A,6Y1s�.. la-mil 2J3-13 / ` SLY / F. ar-iir~\ County Safety and Buildings Division r 0 ~ ~ 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 rESSIONPk i ermit Application State Transaction Number In accordance with S y m. Code, submission of this form to the appropriate governmental unit is required prior to ob ~ itary N''1Qote: Application forms for state-owned POWTS are submitted to Project Address (if different th /mailing address) the Department of Sa d P onal Servies. Personal information you provide maybe used for secondary purposes in accordance with t e Pr.vac Law, s. 15.04 1 (m , Stats. l~ w 1. Application Information - Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address w Property Location \ a -f e W J ."00 &A/ 14 - Govt. Lot ~ c City, State Y + J Zip Code Phone Number j y,, 1 y,, Section ~ e on is { r5 W 7 oz Z (s 9 ~d T N, R ctrclE ore II. Type of Building (check all that apply) Lot # 3 ~ ~ Subdivision Name ( 1 or 2 Family Dwelling - Number of Bedrooms f ' 1 / YA 4 ~ Block # ~Y t Ou. / e Li [I Public/Commercial - Describe Use 41 Vie- L±~_ ❑ City of CSM Number El Village of El State Owned -Describe Use EXTown of Y III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 4New System El y Replacement S System [I Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that i 1 Non-Pressurized In-Ground El Pressurized In-Ground El At-Grade El Mound ? 24 in. of suitable soil [I Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (exp am 7719/ LOA,,) 11 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appli ate(gpdsf) Dispersal Area Re Sired (so Dispersal Area Prppm ~'.©a 3 ) ~06 /CPO0 J 3 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks w C7 f% Septic or Holding Tank a 6> Q 7~G C1 t sc;y o. C 1 ✓o Dosing Chamber g a D'ac I VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu tier's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number S~ 49~,? 85y ay r ein ~Aof ~ iL o~ 0 ~SS.4 Plumber's Address (Street, City, State, Zi Code) \ Ra z( I c l Lo 7 S4 2Z- VI . County/ eartment Use Only Approved El Disapproved Permit Fee +Date I-s7ued Is ing Agent S gnatur (~L~f ❑ Owner Given Reason for Denial $ ✓ ` 0 L I IN If /l IX. C~YSTW 8~'~pgral/Reasons for Disapproval 1. Septic tank, effluent filter and ~7~'iJL /J tGClinU C dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained 5rj r as per applieeble Ad ac o comp e e p ans for the system and submit to th County only on paper not less than 8 1/2 x It ine¢e; m size 13. SBD-6398 (R. I1/11) 45( Oct 20.13 04:02p Hollister's Soil Testing 715-426-1775 p•2 Pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: Project Name and System Type: Lo+y t~Jv Oti At_ Sni-~Ro µv ~i~fJVC#i Location: :216F (,AAL/QLtT Rta..l_''t~ Street Address cz7 ZZ), -t RtJ SStcrr..~ PtZT o F :5W j,+ aF T-Has SF- .SIZ TZS,') Legal Description rID Sr. RO/ To"Whi ounly Design Criteria (Check one): Holding Tank Component Manual: in Ground Soil Absorption Component Manual: * SBD-10571-P (6111/1999) 0 SBD-10567 P (R 6/1999) Q SBD-10855 P (3/2007) Version 2 V SBD-10705-P (N. 01/2001) Version 2 Contents: Page Z: M pg X Aj~jD i-TL-E 5tAr='Er a,1 to 23 3 Page 2: -FLAA; y taw Page 3: P t :r PL.A,%J Page 4• r0V%--(S 00JAIlee-15. MaJv ~AAL MtLIS 'nil ~ 1~ 1~ i~ cl « if Page 5: Page 6: SEPTIC TA/y' 1~ j PWA P Gfl lrvlt P a$Dtt ' 5~~ old S ~ Page 7: d' A-m e C uRV e Paige 8: Page 9: .sai1~ ~vflutf~-rioN ~F~~ OCT 'L Lei Mme"- ST CROMCOUN } ~D -t) U 1'1cl Sighed: slum A9 C' % Py elp 'i~Tut»be'r' lam/ CD 7 Date: Uct 23 13 06:14p Hollister's Soil Testing 715-426-1775 p.2 Plot Plan Page 3 of t7 Property Owner W ; Y r pisT2 1"=40ft a (except where noted), Legal Descriptions ~p 5W/~ CIF -r+t~ sct/4~ s~ rz" , R%ej Backhoe pit ,112r~. CRGIX. CC it~ti"~ In: ~SCGNSt113 • IZD .~~5 North e~..v 0 G~ C11 jw p Site Loc ' n: Oct 20, 13 04:02p Hollister's Soil Testing 715-426-1775 p.3 r 16ty Tom" r~_ ..Ttin t /A tf tendft r J ` tomdft 11 . l- U dM~ -r^ ~ ea ales ss■ --•f ~ . - f- tw doir sal . . me-4 r p~1~111 ssis f~ 7sw 'Ih.y,, ~w+~'t ~ t 1I - ' ~ - ~ - fem.. • ; . J u~ ►LTRA'y0 60 rya 1~T. TCTAL- 3 TK SAN Oct 20 13 04:04p Hollister's Soil Testing 715-426-1775 p.7 Paae tP CF 7 SEPTIC TANK E PUMP CtiAMSEK CROSS SECTION AND SPECIFICATIONS ~ 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED MANxoL= c0V FRESH AIR INTAKE WITH CONDUIT WI PADLOCK FINISHED GRADE WARNtNG LAB & 4" HIM. P flor+pto[f 18 IN f ♦ ~$"Mtw. F rNLET WATER TIGHT SEALS GAS- A SEAL► TIGHT VAPPROYED _ JOIKTS WITH APPROVED '1OL3L k SZ~ to , AL4 APPROVED PIP PIPE 3' ON 3 ONTO ONTO SOLID F SOLID SOIL SOIL C t PUMP OFF ELEV. ~t'C.by FT_ OFF ~.,.r. %~i• Old r 3" APPROVED BEDDING UNDER TANK 1 CONCRETE PAD SPECIFICATIONS_ SEPTIC ! DOSE TANK MANUFACTURER : ~.~11~~7C 14UMBER DOSES PER DAY : TANK SIZES: DOSE SEPTIC : 1= GAL- GAL- DOSE VOLUME FLO INCLUDING ZILOO GAL. ALARM MANUFACTURER: !jT +100F)R'S CAPACITIES: A = 1q INCHES MODEL NUMBER: 2 INCHES = Elul.14u rm SWITCH H TYPE: :c&yG CA i- B PUMP MANUFACTURER: ?t~ErLli , C = INCHES = ll &~40 GA MODEL NUMBER: <rfi-- D = t SWITCH TYPE: INCHES = Z7,2.L G!} M~~Kflwt REQUIRED DISCHARGE RATE GPM PUMP E ALARM WXRING AS 6DDE VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + 141HIMUM NETWORK SUPPLY PRESSURE _ . - J 2- FEET FORCEMAIN X FTI100 FT_ FRICT20 FACTOR 2.3 FEET TOTAL DYNAMIC HEAD - N INTERNAL DIMENSIONS OF PUMP TANK: LENGTH to L4 if ; WIDTH gL' DIAMETCR ~b LIQUID dflsTli a.~ ►-Lui+J 131~C~ 111. zo 9.~rla~►s M~.9s~ r /D zH + nos 404 4u.~a,~ !l'`~• 24~f J'r, ~f~1 X0.5 Pa's. CAY Oct 20.13 04:04p Hollister's Soil Testing 715-426-1775 p.8 a r/o 0 1w HEM CAPACITY CURVE MODEL "gi1" 4 S~t3 70 8 • g 3 5/S z a 20 r a5 a V to _ti 4 3/16 7D+~ e 0 1 1/2-11 1/2 NFr V,S,g ID 20 30 4 so eo 70 80 o eo 1b0 2,0 FLOW PER UVARE MODEL 99 60 CYCLE AAA Feet caumn IMetem Liters \ 3 72 IS 273 10 ar 3.1 231 .s 4s •e Ito 12 20 73 a 1c aoatol f 4 3/16 =1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical altematorsl for duplex systems, are available and • Variable level float switdM are available for coniroli tg single supplied with an alarm, and three phase syst ems. • Memel aitenlators, for duplex systow are available • Double piggybadt variable level float switches are available with or wilhout alarm swkctm . for variable level long cycle conlrols. SELECTION dune Standard all models -Wei ht 38 lbs_ -'!2 H.P. 1. trdegWfloatoperated2potsaleehanlwlswi4dl.Iloasxlelldaloontrclle 4tdled 2- Single pWybadt vaMft iwM doer mvfth ordotble pl0yybadt vark b)e level. ?>8 Sawa conuml Seteetlon 9OA wAwL PA1w tO FMD477. Modal VON94 ql 11011a Aw4M hex 3. Madtimipd 8llaanat0r10.0072 or 10.0075. Am 115 1 Arlo 9A 1 or l &7 - 4. See FM0772, foroolla - model of Emetrical Alternmr_ 115 1 Nan & 6 3 or4 & 5 5 Cw*W sv fth 104M used as a cwlhah activAw specify &0w (3) or (4) 9A 230 1 Nw 4L? 1 or l &7 E96 g F-w (4) hola.h•Pak P-cffml box forwate14gtu emmeoffm arwwK m E 230 1 Narl 4.T 20r2&6 3or4&5 dMPI11KOl`&4 elt0PwadM10•Q002. 7. Tvo (2) hole.t-Pak forvjowoght cwmec*m orspuce. CAUTION Feriefelllr9aem addlaan}Iod&xpioduais"(WIow11toamPI110 VaMb geed All Moteltation of controls, protocitoa devicas and airing should be done by a tpgtiNed Fid0 TP Adsuelo►, ModmftdA9a11rstm,Fld01969un~Saeag~e8eakls,FMDW. licensedalearician. auel0etricalandsaK-Codesahoehibefollowed Including themost SaglaRlaseasm0wPompconvot ftnawmanoSflouzz p w3L camnt National Electric Code (NEC) and Iba ocwpationa) Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual Conditions a reserve safety fad Dr is engineered into the design of every Zoeller pump. &4UL TM Pa BWIW / r UP74M 31 Qt.wRuaR kfaers~a~slsof.. - [ 8 ~ SttJP7><f: Sar8CdlsRe,aRbad • ~~r• toliaa9k, KY d0Zr1-1901'/t.~/4 /ss r !>apdivvn¢zadrimem ozz LLB (5fl~T78,2F3f•i ll~Pls7P`- s r PAID RECEIVIM Wisconsin Department of Commerce IL EVALUATION REPORT ~I +9 page I of 3 Division of Safety and Buildings SEP 1 2 2013 in accordance with Comm 85, Wis. Adm. Code County ST. CROIX 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 paw I.D. S 040 - 1303 - 00 - 020 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evi Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(l) (m)). 2 -313 Property Owner Property Location WESTVIEW CONSTRUCTION INC. Govt. Lot SW 1/4 SE 1/4 S 22 T 28 N R 19 E(or)W E( Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 20 Serenity Ct. 2 Tribute City State Zip Code Phone Number ity []Village • Town Nearest Road River Falls, WI 54022 ( 715) 760 - 9900 Walnut Hill Way 1 Troy 0 New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Q Public or commercial - Describe: Parent material sand outwash Flood PIa elevation if applicable ft ~i l i h 1z a ng rate 5i and reecommendations: Iva Conventio al In- and trenches -mooi A / ~Z n in . r~ ~4 Cam- iv-~~''i✓A{a ~5~ j AoJ A-21 a- lrlz~, 2&8 W WtrT 14 1tL wfl 01 1A444 -i~z 0) Boring {(c--(l Cf-Ill/BZ• ❑ Boring # Pit Ground surface elev. 98.45 ft. Depth to limiting factor 60 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 1 0-13' 10YR2/2 1 3f-mabk ds cs 2vf-co 0. 0.8 2 13-24 10YR3/4 D w I Z` 1 2f-mabk ds cs 2vf m 0.6 0.8 3 24-34 10YR3/6 sl 2fsbk ds cs lvf-m 0.6 1.0 4 34-40 7.5YR4/6 is 1 fsbk ds cs 1 vf-f 0.7 1.6 5 40-60 7.5YR4/6 s Osg dl 0.7 1.6 F F 2 Boring # Boring 97.75 52 0 pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR2/2 - 1 3f-mabk ds cw 2vf-m 0.6 0.8 2 6-18 10YR2/2 .b I 2f-mabk ds cw 2vfm 0.6 0.8 3 18-52 7.5YR4/6 sl 2fabk ds cw lvf-m O.b 1.0 4 52-56 7.5YR4/6 c2f7.5YR5/6 sl Ifabk dsh 0.4 0.7 Horizon 1&2 have some broken pockets of I m 1. * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = SOD 30 mg/L. and TSS 130 mg/L CST Name (Please Print) Sig CST Number MARY JO HUPPERT Hollister's Soil Testing & Design 224832 Address Date EvaluadW Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 09-11-13 715-426-1755 Westview Construction Inc. 040 - 1303 - 00 - 020 2 3 Property Owner Parcel ID # Page of 1 11 Boring 7 3 >Ang # El pit Ground surface elev. 99.12 ft Depth to limiting factor 62 in Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-21 10YR2/2 1 3f-mabk ds cs 3vf-m (:Q~) 0.8 2 21-34 10YR3/6 sl 2fabk ds cs 2vf-m 0.6 1.0 3 3 62 7.5YR4/6 s Osg dl lvf-f 0.7 1.6 One pocket of cl in horizon 3. ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Sal Apphcation 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 SPit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 * Effluent #1 = BOD5 > 30:< 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = BOD5 < 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.  .bbt. EU,1]V lest tfLuf! ) J Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner UL2,-y t- 1"=40fz Legal Description Paz i.tir-,r_ r (except where noted) OF zff£ sr'/4, s -~z n~~~ -r~wN p l = Backhoe pit .5 I 2cli, sT tc~ Cc 4LNi ( Y. w ~secS~~i ~i . North i 0 ON _ v cop. 91, T c o ~ Site Loc ' n; AZ5 z a Oct 20 13 04:03p Hollister's Soil Testing 715-426-1775 p.5 AOWTS OWNER'$ MANUAL & MANAGGMRNT PLAN page -q-,-7- oN !il?~CIFICAT(ON13 Svc= 0 lank ~ ~ ~ ~ /?tQ al II NA ~ Ev": dt wner # Z S alida Tank Manufaaturar ' /E5EK 0 NA DE81lN PARAttAErMS Number 1?Pfluerrt Frltar Manufacturer L r.01C Y 12 NA Of Sed►ee1tU jWNA NA Effluent Model SZ-5r D NA Number at Public Faculty Urpta puma Tank Comity O NA 500 Estimated flow (svetega) pump rank Manufaoturor ma 5EK 13 NA Caelgn flow (peak), Mdmated x 1.61 au d Manufacturer hIA $all Application Rate L~.J 1/d Irt' PUMP Model S! 4 NA Standard influantlEffluent CWaihy Monthly average" pretreatment Unit -9 NA Fah, Oil it C19180 (FOG) 930 mg/L C sond/Gravsl Rhor GI Past Filter Ipaohemioal Oxygen Demand JBODe) an mg/L D NA 13 Meoharllcal Aeration D Wetland Total Suepsnded 8ollde aM) S9140 MWL p IAMrKaotton 13 Other. pretreated Efftuent Quality Monthly average D)apereal cell(a) D NA Nocd1em108) Oxygen DoWd (8017.) 430 M& W"raund jawity) t] In-ctnx~ (ptassurlrod) Total Suspended Salida (TSS) Sao Mali. NA D At-trade p Mound Fecal Conform ltf aft mean) sto" atuawnil D hrip-Line G Other. MIWMWn Effluent ih rMil Site 3# In dla. D NA nr DNA tluir. ~ DNA "vetoes typkai for damtepel~ wawtawStar era! asptla tank sflplsrtt.'t: D NA MAWIg MIX S0gDULE aOrvtce Evew Service Frequency Inspect candition of tankla) At least once every: .3 0 M } s (Maldnu a 31 ) 13 NA >'p out contents of tank(s) When combined sludge and SCUM equds anardrbd (v,) oof tank volume D NA Inspect dispersal Cards; At least once, every( tnar (pRelibtftina 9 3 F i heels) D NA clown affluent fllhr At least once ovary: j 12 ve") m (e) DNA Inspeee Pur►P, purmp controls d alarm At least ones ovary: / %=V, O iVA Flush laterals and pressure test At begat once aver: 13 13 moet(tj ~ ~ Others At hm at once every: a 13 m e t WA er: )VOWA MAINTENANCE INSTRUCTIONS lmsPeedons of teaks and disperad calls shell bs made by an Indlviduel caffvbg one of the fottowing aCeneee or osrttftead es on Master Plumber; Master Plumber Aeaa ated a3awar; t>OWTS Inapsotor, poWTS Malntaka; Septege 9ervioina Operator. Tank htepeations must tnolude a visual fhawatian Of the tank e) to Identify any mieeing or broken hardwarce, Identify any oracka or leaks, messure the volume of combined "ge and stunt and to check for any back up or pond)ng of 011kift on die ground surface. The d)spOM111 001(9) shall be visually inspected to aheok the effluent hvets In the observation plpes avid to check for any pand(ng of effluent on the ground surface. The ponding of effluent on the around eurf8ft troy Indicate a tailing condition and requlrea the Immediate notifi ation of the face! regulatory authority. When the oontblned accumuk*on of sludge and scum In any tank equals onerthlyd Vj) or mom of the tank vokirrw, tlta amore Aontente Of the tank Shall be removad by a 8eptege Servicing Operator and dleposed of In accordance with chapter NR 113, Wisconsin Adm)nlev"ve Code. AN other sorvicss, Ineluding but not llntited to the sennotng of vNluent f)Itere, sMaoltardcal or pressurized compongnts, prOtieoUWt unh slid arty 911114 hhp at intervals of 112 morrtht, ahd be parforMW by a cardflad POWTS Maintainer. A eervke mood shall be provided W the faced reptrthtary auftfity within 10 days. of oomplethm of any service avant. Oct 20.13 04:04p Hollister's Soil Testing 715-426-1775 p.6 ~ START UP AND OPERATION Page of 7 For now consstrutcttom prior to 1150 of the POWTS 41100k treatment tank(s) for the presenoe of painting products or other allow loals that may impede the ttestmarnt process mWm damage the dispersal cslt(al. If high oonosntratione are detected have the contents of the tank(s) removed by s soptage servichl; operator prior to use. System start up shall not ocour when soil conditions are frozen at the htflitr&&* surface, During power outer pump tanks may fill above normal highwater levels. When. power is restated the exam wastewater will be dkmheWd to the diisPersa( Cetus) In one large dow overloading the calla) and may rault in the backup or surface dlachame of effluent. To avoid this situation have the oonterm of the pump tank removed by a Septage- Servicing Operator prior to resttaing power to the effluent pump or comet a Plumber or POWTS Malntalner to assist. in manually operating the pump controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compw4 the area within 18 feet down slope of any mound or s"rerde soil absorption area. Reduadon ar elimination Of the following from the wastewater etreem may improve the performance and prolong the Ufa of The POWTS: antiblodow baby wipes; cigarette butts; oondome; cotton swabs; de8ressers; duct floes; dlspers; disinfeetam; fat; foundation drain (sump pump) watar, fruit and vegetable peermas: gasoline grease; herbioides; meat scrape., medications; oil; Painting products; pestlcldss; sanitary napkins,* tampons; and water softener brine. ABANDONMUNT When tits POWTS fails and/or is permanently taken out of service the following steps shall fie taken to Insure that the systam IS prapedy and safely abandoned In compliance with chapter Comm 85.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be dimonneated and the abandoned pipe openings sealed. • The contents of alltanks end pits shall be removed and property disposed of by a Septags Servicing Operator. • After pumping, aN tanks and pits shall be excavated and removed or their covers removed and the void spa" filled with sell, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the followtrlg measures have been, or must be taker, to provide a code aomphat replacement system; A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected. from disturbance and compaotion and should not be infrbped upon by required setbacks from existing and proposed stnrct urs, lot !Ines and walls. Failure to protect the replacament area will result In the need for a now soil end site evaluation to establish a suitable replacement area. Replacement systems must comply with the miss in effect at that time. CI A suitable replacement ores Is not avallable due to setback and/or soli llmitatlons. Barring advances In POWTS technokW a holding tank may be installed as a mat resort to replace the failed powTS, 13 The aria has not been evaluated to IdentW a Suitable replacement was. Upon falure of the POVM a sell and alb ,,evaluation must be performed to locate a suitable repleoe meat area. If no replacement area is available a holding tank may be hnatalled as a last resort to replace the failed POWTS, 13 Mound and st-grada sea absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. PlaaOnOtructlona of such systems must comply with the miss In effect at that time. < < WARNING> > BEPTIC, PUMP AND OTHER TRBATH IVdT TANKS MAY CONTAIN iFTHAL GASSES AND/OR INSUMCIENT OXYQEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADWTIONAL CONEi F TI S POWTS INSTALLER POWTS MAINTAINER Name -~-I~1 SE Name K L I f> Phone 7'i5- `fz.~ - 177 Phone 71 5'-,lab j 77 SEPTAGE SBViCING OPERATOR tPUll#E+ER) LOCAL REGULATORY AUTHORITY i Name EDAVW-LL S --SEPtIC AUVAC Name 1 OIA lN~ tlX'!~ ~ )'none 1715 ~Q2 Phone E E ST. CROIX COUNTY SEPTIC TANK NIARITENANCE AGREEMENT AND OWNERSIUP CERTIFICATION FORM Owner/Buyer Mailing Address 20 ` Ekrr CT-,_1Z vW,,4 us W_ ~SSkf oZZ_ Property Address WA L/V +J ILL IAMY 4) f2 (Verification required from Planning & Zoning Department for new won.) City/State W~ Parcel Identification Numbero LEGAL DESCRIPTION Property Location 5 U~ Y., 51?- , Sec. Z 7 , T 2-8' N RI? W, Town of ` KOV Subdivision Plat: -1"KI R u7 ~►'~9" Ili4W Ur M2l. FAieft 1 , Lot# ZO Certified Survey Map # Volume _ Page # Warranty Deed # ,?Y& I S/& (before 2007)Volume Page # Spec house U yes U no Lot lines ide~ifiable{ J y J no SYSTEM MAINTENANCE AND OWNER CERTIFICATION l./ Improper use and maintenance of your septic system could nesalt M& premat M failure W handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance respon ibilikies are specified in §Comm. 83.52(1) and in (meter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certificatim fort, signed by the owner and by a master plumber, journeyman plumber, reshi ted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to mairAm the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and reburied to the St Croix County Planning & Zoning Deft within 30 days of the dim year expiration date Uwe certify flat all statements on this form are true to the best of my/our knowledge. Uwe am/am the owner(s) of the . property described above, by virtue of a vvarianty deed recorded in Register of Deeds Office Number of bedrooms q Z02 13 SpiATUR=-may DATE "*Any informationthat is in the sanitary permit being revoked by the Plamring & Zoning Department. ass include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if refe -c= is made in the warranty deed. (REV. 09/" 10/29/20 Parcel 040-1303-00-020 PA3 01:45 PM GE E 1 1 OF 1 P F 1 Alt. Parcel M 22.28.19.1755 040 - TOWN OF TROY Current [X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - CITIZENS STATE BANK CITIZENS STATE BANK 375 STAGELINE RD PO BOX 247 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 268 WALNUT HILL WAY SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.120 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T28N R19W PT SW SE WALNUT HILL Block/Condo Bldg: LOT 020 FARM LOT 20 (1.120AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 22-28N-19W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 03/28/2006 821622 WD 12/10/2003 748768 2471/594 WD 11/19/2003 747018 9/92 PLAT 2013 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/20/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.120 27,500 0 27,500 NO Totals for 2013: General Property 1.120 27,500 0 27,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.120 27,500 0 27,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 P~I~~IPi ~ I P I P ~ ~ P I I 8 Tx84154232 986869 • STATE BAR OF WISCONSIN FORM 3 - 2000 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Westview ST. CROIX 10/02/2013 CO., 10:36 WI Construction, LLC, Grantee. Grantor quit claims to Grantee the following described real estate in St. EXERECMPT MPT#:NA NA 30.00 Croix County, State of Wisconsin (the "Property"): ' TRANS FEE: 56.40 PAGES: 1 Lot 20 of Walnut Hill Farm, All in the Town of Troy, St. Croix County, Wisconsin. Property to be sold `as is. Recording Area Name and Return Address: Title One File #20012 Together with all appurtenant rights, title and interests. 040-1303-00-020 Parcel Identification Number (PIN) This is not homestead property. Dated this I st day of October, 2013. Citize tate Bank 4nl * Gene Haberman, Vice Chairman AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 1st day of October, 2013 Personally came before me this 1 st day of October, 2013 the above named Citizens State Bank to me known to be the * person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN ackno d the same. (If not, authorized by § 706.06, Wis. Stats.) * ' vel M e er THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin •-*~e~y° M' My commission is permanent. (If not, state expiration date: Y : 12/11/2016 ) Michael H Forecki, Attorney (Signatures maybe authenticated or acknowledged. Both arerit n'ec ) Luc *Names of persons signing in any capacity must be typed or printed'Q heir si 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000