Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
040-1303-00-066
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567251 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: Oevering Homes LLC, aka Oevering Propertie Troy, Town of 040-1303-00-066 CST BM Elev: Insp.BM Elev: BM De ription: � ti Section/Town/Range/Map No: / 0 a •o DO- o `�bs��2/ 7 P /S — 22.28.19.1801 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER /.1,tioCAPACITY STATION 4l3 1 Il,4S ELLEEVV. AC Se tic Benchmark `t p ild ccc ti•I -- 2 • MID Q G: 2 /�T12-- /06). a I":(1, - 3 J Alt. BM Dosing / t _ /� �' 1 / p 91 5 Aeration V S Bldg.Sewer � 12,3 9z• i Holding O t-� St/Ht Inlet /�/ 6 90 r 1 7/ T� St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent .Air Intake ROAD Dt Inlet ` t` Septic A / `_ Dt Bottom , $ 3 Dosing 7 z6 ,,I A _ y-g ) 4 a i Header/Man. 3-a /6/• 'f Aeration /V/� Dist.Pipe ' / 3 . a /D/• T l Holding / - Bot.System /.1' St kl-ti l( ~loa '-f 3 .1 /46 .7 Final Grade c PUMP/SIPHON INFORMATION i . , . Z •o /6 2_4 t, ■ Manufacturer ` 1 ins, .' Demand St Cover'/ 60 r 9, ? .9� G �.0 � wN GPM '� /Qn� i iH,. � J Model Number 8 • /5 - `iv /1 _/ _ 3 . 2 /� i (_ D-y� �U 1�(�Z� 6. v TDH 1Lift%c , Friction Los System Head TDH Ft / 3 3,°I /8tl Forcemain Lengthy Dia.L /" i i Dist.to Well /� C' SOIL ABSORPTION SYSTEM BED/TRENCH 'Width / Length / No.sench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 S7 `- �"— L 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T e O em: / CHAMBER OR r� yp ./1 Z� p� ^'� /_A_ UNIT Model Number�r ' /oJ 7 /" /V!t DISTRIBUTION SYSTEM Header/Manifold a I Distribution / 2 x Hole Size x Hole Spacing Ven 4'r Inta""`/-iy it Z Pipe(s) `f " /�, Length Dia Length � Dia Z Spacing SOIL COVER , Pressure Systems Only xx Mound Or At-Grade Systems Only Di f' °,' Depth Over Depth Over xx Depth of xx Seeded/Sodded • V..... Mulched Bed/Trench Center J .-7 Bed/Trench Edges l Topsoil 1 s No "el 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / 7 \ Inspection#2: / / Location: 689 Heritage Pjs RIVER FALLS,WI 54022(SE 1/4 SE 1/4 22 T28N R19W) Walnut Hi I Far aka The Tibut Parcel No: 22.28.19.1801 Kilt)... Lo Je k._ ISe 6( q S C 5-)J z(A, J. 1.)Alt BM Description= 2.)Bldg sewer length= S l a -amount of cover= fi I-�n ~• �� �O` Ifz aN- �4, b�� d el a,---L._ Plan revision Required? Yes 'No fi (2 ' s Use other side for additional information. �� I 1` 1 0341 �__ SBD-6710(R.3/97) Date Insep Si ature Cert.No. PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 S 1/4—S-E- 1-4-S 22 /T 28 N./R-1-9—:V-TOWN—Troy COUNTv ST CROIX SYSTEM ELEVATION 100.3 1.7'sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX MOUND __ SEPTIC TANK SIZE1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none ■ BENCHMARK V.R.P. Top of 1/2" steel conduit ASSUME ELEVATION 100' r El BOREHOLE O WELL *H.H.p, same as •-,� ark Pro Town Load //,_,L/ kq --Prr- J � �QIs r 1 Acre Lot Pro 3 Tank is to be properly Bedroom house bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank $ 98.6 6-2 Property Line 0 Scale = 1/4" = 1 0' i 6-a Property Line 8% Slope Grading is to be done to divert Area 15' below system run-off away from system is to remain undisturbed 06- 1 97' 98' i�. -" Property Line (ph y - - - County L 01 ' Mw Industry Services Division 1400 E Washington Ave Sanitary k errnit Number (to be filled in by Co.) r S 1 .j P.O. Box 7162 P °~y 5 Madison, WI 53707-7162 Aagy State Transaction Number Sanitary Permit Application I 3 ! ' so1_---- - In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govarnme trot_ _ is required prior to obtaining a sanitary permit. Note: Application forms for state-ot1+ ' TS are submitted to ProjectGAddress (if different than mpailing duress) the Department of Safety and Professional Servies. Personal information you praviCYWj ftt~ t &c. e-,bTondary l/Y8 1 H L i a!a xfr ores in accordance with the Privacy Law, s. 15.04(I)(m), Stats. 1. Application Information-Please Print All Information - -_"``~1tJe•7~p(~N~,. Parcek td Property Owner's Name ~ ~~-r _ - - - --4__/3a 3 Property Owner's Mailing Address Property Location 03,10 Govt- L,ot City, State Zip Code Phone Number Section 2 Z_ nrle o -7 / 5V r N, ]t - E I W w 11. Type of Building (check all that apply) Lot # _S ubdivision NaIrte or 2 Family Dwelling- Number of B rooms Block dd r Ej City of' ❑ PubliclCornmercirtl -Describe Use CSM Number L Village of ❑ State Owned --Describe Use r- town of . L_Q- - - - - 11I. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A. ystem ❑ Replacement System ❑ Treatment/1-tolding "tank Replacement Only n Other Modification to Existing System (explain) - - - List Previous Pennit Number and Date Is;.ted B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit 1'rursfer to N+;w Before Expiration Owner - - 1V. Type ofPOWTS System/Component/llevice: (Check all. that apps) - Non-Pressurized ln-Ground L.1 Pressurized In-Grnund ❑ At-Cnade ❑ Mound ? 24 Irr of suitable soil ound ~4 in. of sune~ble soil ❑ Other Dis rsai Com onent (ex iair~,) ❑ Pretreatment Device (ex lam} _ V. Dispersal/"Treatment Area Information:____~ ~ - titem Elevation Desi n Flow (gpd) Design Soil Applic lion Rate(gpdst Dispersal Are Rec aired (sf~ dispersal Area Pr posed ('f) sy; ~~"U_~Bp- /a - -Manufacturer O O V V1. "Tank Info Capacity in Ib al f! of R Gallons Gallons Units p" all - u New Tanks Exisfing Tanks C) v~ w C7 a• Septic or 1401 dill g Tank L~~ - - - _ - Dosing Chamber v ` _ VI1. Responsibility Statement-, 1, the undersigned, assu a espousibffily, for installation of the PO"."I'S shown on tire attached plans; > Plumber' i attire MP/MPRS Number Business Phone Nu fiber Plum s Name (1 rmt) _ Piuntber's Address (Street, City, State, Zip Code) 11 Count /De artment Use Only - - Permit Fee OV Date Issued Is~ vg Agent si aturro Approved ❑ Disapproved $ ~I ~ ~ / ❑ Owner Given Reason for Denial / - Ix. C~gftAo6f al/Reasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained NV f/J'~ as per management plan provided by plumber. ~ 2. All setback ,requirements must be maintained GtlL 6_/l- ----aS-peT--appir~g11XtHtEHtt3 r MPf r '-rnr the system al" sah~tol ~Tuni;, ap er not less than 8 lla x l l inches in re r W / 4 S13D-6398 ((10313) i EeARTDIVISION OF INDUSTRY SERVICES PO BOX 7162 °o$ MADISON WI 53707-7162 Contact Through Relay 3 ~"S P S; www.dsps.wi.gov/sb/ 9~ °w www.wisconsin.gov O SSIONA~ Scott Walker, Governor Dave Ross, Secretary September 27, 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 PLAN APPROVAL EXPIRES: 09/27/2015 Identification Numbers Transaction ED No. 2315041 SITE: Site ID No. 796075 Oevering Homes Please refer to both identification numbers, Lot 66 Walnut Hill Farm above, in all correspondence with the agency. Town of Troy St Croix County SE 1/4 Lot: 66, Subdivision: Walnut Hill Farm FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1451536 Maintenance required; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, 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: Reminders • Horizontal setback parameters shall meet the requirements of SPS 383.43-1 Wis. Adm. Code. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). All industrial waste shall be properly disposed of onsite or offsite. • Your design still references "Dept. of Commerce" code sections. To prevent future plan review delay, CONDIT please update all your plan details and/or management plans so that they are current with SPS code. APP • To prevent future plan review delay, please remember to include the ASTM Nos. for all piping material DEPT OF S used in the construction of this POWTS, including pipe material between the tank and the building. PROFESSION Owner Responsibilities DIVISION OF IND • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. SE ORRE SHAUN R BIRD Page 2 9/27/2013 • 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). • 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. • 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 local inspectors. All permits inspection by authorized representatives of the Department which may include 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, Sally Shum er Please Include a Copy With Your Engineerin Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am to 4:30 pm Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 RFrI!/ED 715-246-4516 CEP 2 0 2013 Date: 9/ 18/13 INDUSTRY SERVICES Owner:Oevering Homes Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 66 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 9-11. Soil lificadcro/ss 12. Filter SShaun s tion BirSignature ONALLY OVED License nNFETY AND ERVICES AL S 1STRY SERVICES ~PONDENCE 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 100.3 1.7' sand lift 3 BEDROOM 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 1/2" steel conduit ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL * H. R. P. same as benchmark P ro Town Road 9~ ~afs 1 Acre Lot Pro 3 Bedroom Tank is to be properly house bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank 98.6' B-2 Property Line Scale= 1/411 = 10' B-3 Property Line 8% Slope Grading is to be done to divert Area 15' below system run-off away from system is to remain undisturbed ~B-1 97' 98' 99' Property Line B.M.* Mound SYsteln Cross Section. and Plan View •~j+~?~?'r`3'r'iM:i:'r.3•t''ti:L:Lt'L:L:Li L } +-.•-•_::a-~._ ~ -I..`"~ A rL •Y.4f}f .Lr4.4t;Y;+~.f}•r•r1.Hr JV f r.Lr .YLrLf1 L.t: j}s,1,'ryr4 1 L t t L ~:4`.~,ti.y \~tiry •ti Y 1_ _ '{:{r. ,1'}•L-}`trY}..Li?r;r}•}•...-.':v.:{{{:ti tr..-ri ~ } N..,...r-..}.:s• ;r-{.';:{r{ u ~r Y i7rTr t}Lr1 }r ♦ ~t ti.4 4dZr } .L. {;!wti;!{r{rMi'~. .:ir.ry •{r r{S :lit- ~s:iy` ;.LSy y:{ t L k. , .....t L .r r i1.11.1.1. t.1. r. { r.r s r r r r r:rLV:iti:iT r~r1'~j j' r - I v.vv~. rtr}r.rti:r:✓r~i:r.m:r:.'r:r~'i.r.rv1 ~rtrurLrl a z 1 L 14. - - - ---Y - - - - - - - - - - - - - - - - - ~ psoil AST1V1(~--33 Clear. aggregate Cap Material sand fill ;:tr;•;() _ ~l irr. sell. 10 pvc kr to 2 ' •\•L•L.'4 .'z In. d1ca. observatior pipe Geotextile Fabric G" ll :D Ft Contour A` Pao wed Surface Slope Direction i t.ENE1tAL INSTALLATION: 'l'ire rnou.nd area is staked out :along the design, contour- xistil, , vegetation is mowed and raked off the site. The mound basal area x `1N) is plowed with a moldy )rani or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to fornr a % inch : c it wire when a sample is rolled between the palms of the hands. ASTNl C-33 quality sand is placed itnar c diately after plowing. Sand is placed with a tracked machine keeping 12 or more inches ol"nand under the 1 arks or is placed overhead by a backhoe. Special care mtrst be used whets placing sand of less than c c e [bot thickness to minimize compaction of the plowed surface. Aller the topsoil cap is placed, the entire riound is seeded and trrulclied to promote vegetative growth, limit c,r•osion and protect li•om treezin; The observation pipes are slotted in the lower 6 inches anti secured in place with rebar or a closet flange. 1O/071gj fags; of -TI re;aded ("I ::arlo u t I.,ateral Jbrri_:crp __-.__1► Plug 1111E [61,6 1d M - x L H l-"oc-c;(: Main .are(; 90 3erccl i 1) st ributkon Network S ~eckfic ati(ins__ ~ Pressure System Construction Lab ral Diameter _ In. . Mai Il1L)ld t~ldrlleate;t Late;ras il arc constructcd ol'Scheclu.le 4t) P VC Ori icc Diameter pipe. I p It; _ pi. Orifices ai~e drilled per er>,diciilaa 1:0 i e pipe with a sharp chill bit and face do vn. l (Lateral (Cpgj.) ' u t, I.AIGI-al tUria•-ups t.errriin tc? with a tl3rea led -M-( Oarulold c,leanout plug and are enclosed in a 6-8 i is h t of ;e Main Dia ne,t(M diaruete- lawn sprinkler valve box access) ble t of Main Len 1j.li frciirt finish+.d grade. A e) M ~t 9 Grade 1M 11 • C~ p tti s • • i 6-S finch La.wD cz hiin-fer Valve BOX - - - c~l03 ,0 IV' Sep: tic-Dose Tank Croon Section And Pu m.p Performance S cif cations 'C'anak iVl untxfactut~er , , _ _ Total _..____._.._..___M_._.-_..__._____ Capac;tty c Alarm Wanu:Tartitrer ,i. __'c - 1L~ C~? is~ c ~c' 1'~[a lax De ptlx ' ' Alarm Model Number Switch'Type cam'/ _ l ilte7 lV anufacturer Total .Dynamic read (TD.11) Feet 00 V oriel Number _.r elevation Head / ( lp` Distal Pressure 0 ~ Network doss WI: nimum lump f erfornmee, Required Force Maim Loss 0. rtlet Manhole NOn. 4" .Above Grade With Locking lDe~'ice..lEntet Manhole Manhole Mitt. 4" Ab~ ►ve Grade 6" Below Guide Seabed WatortiOt Securely Haunted With GoaYcingl Nice Weather-proof' i Junction Box J } ]Finished Grad i Vent Mist. 12" Above er a Wen ro Vlaras With Vent Cap f i ~A aY Aa} ! Y 1 6 YaA Y } 1 Y 8 J ~ I~ AtY >♦Y Y Y I Ae YaA - Ilia i i u d A i~ y9e i /~f•~g1Y i a a Y A}tlbgly~ 6 q l}Y q Ya} 1 4•s r~n,Y+i,Y 1~~ Y;y~}aYyY Tai wl i • Y . LEA Y A }✓r~_ ! Ar4 a Ya1a ~ k_i ()utlet Filterr Raffle fillet 'wet SwttC~l Se qugs and Res o. al;;t`~a}} r+a o~ q°tunlc Volume ~ f om _ Hole ° a Dimension. Inches 'Voluxnc ~~al, e (rese.rvrve} A V,~ ' , ; 1 (alarm _2 (off l±;levati ~r► Ia r}uY L. Sri. (dose) llottom (dead) ] D evation Total i/ W1-_` V! / t/. 'A'°• `c ~c'~s-cyx-A+c'~irc~>+T-A~:: 'c~ . +F c~c-cn --rrx-Y-cY-~e-c-•r~sr ~~c~L"~ci `."Y . ~F`T'c'CC'K"c"'c' ° 4a 11 f d a 1 i~ q i A f,q,a Y i t L i J 1+} t~1lfp { f 11L J tl I t a a r IAV,Y <II v 1 I v. b 1 1 b A •r 4} A A Y Y Y P Y Y~ Y Y P,Y I Ya 1;Ya Pa e11la1a11°aY'11Ia°Jltly rYl Ye°i ~~i t h e°{ iAA YYI°aIV ~ O~ Iytli a~ V,a11;+Ii +'iaL~_ ,'aY a a i d i.<eii brill d°tlbisdpa ~q 8L4°t~va°{;°9 1 •lYa e ``<T,~l:.1i..l.°YYa iJr t=i 1 A ` Y ' A_L~.s..a.•a-1' G F,N] Iwo, INSTALLAT ON: 1'be septitc/dose taint is bedded and back filled in accordance with the inanut tcturer's product approval specifications. Maximum depth of bui), as speoified by them ufacturei may not be ex( aecled without P0017 approval. 1Llanhole savers exposed to gxatda Have an ei frtctive looking device padlock.) install ,.d. Piping at the; inlet and outlet its of appproved material, conneetad to the tank with watertight fit i inks, and laid o a stable sail to provextt settling or sagging. The force main is sheered with 4" Schtl 40 PVC to bride ;the tank excav ition. and the sleeve is sealed watedight. Electrical service c()rnplies with NEC 300 and C:ormm 16.2. . of page 02,10' U " p Vlastevwto Mv. S! "IV-40 Series 4/1 J hp Submersible Effluent Dump, :3/4" Solids Construction (Flow Liters/Minute lF 60 100 150 200 250 300 (:iovel' , Epoxy-coated cast iron . 11~ ~abt i~1f}CI }St IC~!n • 10 10 Impeller Material -1 hetrnahlaslic Elastomer Au Ilnpya(tczrI'6 Ndn-•rijg 7 u. 6 ~ c1Sl it on f ' • is , poxy^IA c,3lPd c, Mr~chanwal .;haft JfillV NIt111e'tafih carbon and e .ionf C(irEt1711G faces ! ~t~elf@ 'R', trA~l!119$se~F yid;} 0 20 ! 60 fll) N i Flow - IAallot►s/Minute e> III I r llppoR {GtkB~ari.`. IoHV~, 1..r . • loin, 44:1 M' a-- SI KJ-40-AI"' :SERl-40 SpecilIc ions SEN 40 50911'1 4/10 1I ~ 1 2 F.NP-v }3/910 80 r0 Go ~5 2, d; 14 ~0 26 1 '50 440 Sa~'12i &41y k$ 20' Q w" U~t 2 I 139 ~tI <ti .I SQI uEN 4U A 609213 4/10- i Ib 111P PNPT ~11u10 90 70 60 46 114 0 2f 5 160 N Q0 twat $~00-91 n,5 ,t d fli IA A;~O b t b F'lrawlr111k~Nlnl ENi~IGi~IrN~ 400 East Spring Street, Bluffton, IN, 6714 iel: 260.824.'1.900. t=ax; 260,824.290 I Form 006'15 i 7-'11 m(ww1ranklin-electric.com 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT pop O Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST-" G,e Gf •V C A include, but ttach cans L ~ O~/ EROSION CONTROL PLAN must be (road Parcel I.D. 7, D 30 3- ~Gro~ completed before sanitary permit issuance Re b Date Personal inIbmut w you provide may be used for secondary purposes (PrWacy uw. s. go- ht) (m)). - w~-._ U Property Owner TORO Property Location 010 To>7D 133ERS T"a7fq T- %a j4110A) l#M Govt. Lot A11 5 C v4 S ZL T ZB N R / f E (ar) W 11 Property Owners Mailing Address # Block # Subd. Name or CSKW !n o 15 CA It-i aL AV-R 42 I WALW u r ~'k~ 11 City -CM MR - State Zip Code Plane Number ❑ City ❑ Village (5d Town Nearest Road ~ 6-0006 H T3: Mtv 5So7(P (C„5!) Zy8• --Roy sD• 6• f ouE R 0 New Construction use: cg Residential J Number, of bedrooms code derived design now rate r Da GPD ❑ Replacement ❑ Public or commercial - Describe: y tA Parent material ~O~S $ O ~1.e(i O l0 Jul i'7t-e Flood Plain elevation if applicable ~I fl General comments and recommendations: . ,-Ve, } ?"~S TED ,$•l9i' Tf}/~l f j~2 ~9- /'9ov vp s ysr~.~ _sss " F Borkv# ❑ Borkv qq. , Z ,q r ® Pit Ground surface elev. R Depth to iarutin® factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQ fI: b In. Munsed Qu. Sz Cant Color Gr. Sz Sh. 'Eff#1 *Eff#2 / o• /3 ioV 3j hi, 2,-FSh1<' dSAt w a • s • - v A,41 z • /I 1 p ,e- 2,f,5 dA c / . S %A 3 •31 ~o ~z~- M0 S/ct /-FShk /)n vAF1` aS - . z - -iA Borft 0 Boring --\k- ® Pit Ground surface elev. ft Depth to biting factor in. Sod lcation Rate Horimn Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPDff (1.~ In. Munsed Qu. Sz Cont Color Gr. Sz. Sh. 'E1#1 N 100? 3/3o 2 9.17 o S~~ z cs S N /o Gz~ )1075 151 GL / AM ~ • Qs' Z ' 3 love tZ - ' Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mqA- ' Effluent #2 = BOD < 30:221 and TSS 130 mWI CST Name (Please Print) •17 , 'u t t✓ ~r Slgnatuns 22 5 Address Ulbricht & Assgciates S Date Eva 7t S, Condijcled Telephone Number Private 2812 1 Oth Ave. Spring Valley, WI 54767 l ORIGINAL PINS " ig°ko 4Pieo X - z yo 4 &es oyCj • 10* S • so . t& p /p k6 • /O • OW yo dyp • log6 • 20-0010 oyo•10Z- &D•M ayoe /0 *6 ' 70 6M o y/0 . /o~C~ ~D • 0~ -T'pp~ T.~ ?E ~ 5 TED r/ ~-/7 3 Properly owner Parcel ID # Pam Z of E) Boe-V Pit Ground surface elev. ti. Depth to w"wV f2ctor in soil Rate- Depth orizort €?artinant Color Redox Description Texture Structure Coxesistence Boundary Roots GPDAW in. MunseN Qu. 5z Cont. Color Gr. Sz. Sh. `Eff#1 Tlr#2 ' /o Yie S~ L Z Fs hl~ w 3 . s ,r<1 L D s/ I- G S & ~loT y/CL / S • 3 . It YX ~<Z +r- 13 F-] Soong # 11 Pit Graurrd surface elev. ft. Depth to funning factor 50 icatton Rate horizon Depth Dorrur a n Redox Descr"on Texture Structure Consistence 8ourtdary aoEs GPI Munson Qu. Szz. Cora Color Gi. Sz. Sts. `awl F-1 Boring # 0 Pit Ground surface elev. it. #a firrov factor in. Sod Appkation Rate Hod2 on Depth Dwilrtant Cola Redox Description- Texture Structure Consistence Bonxxiary Roots GPM in Mtmseft Qu. SZ. Coon. Cola G,r. Sz Sh. °Etl#1 °Elf#2 r 8 i Y F-1 i pit Grocrr>ci stxface elev. it. Depth to WnMV facts' in. App~l Rate' $p~ FiottzOrt Uepttt Doxr kwA Color Redox Descd Texture Structure Gonststence D=xkwy Roots GPM in. Munsell (AL Sz. fort. far. Sz. Sh. °EW1 °Eff#2 Effluent #1 = BOD, > 30 < 220 rng& and TSS >30 < 150 mgll ° Effluent #2 = BOD, < 30 nx A. and TSS < 30 ntglt. The Department of Commerce is an equal opportunity service provider and employer. If you treed assistance to access services or need material in an alternate format, please contact the department at 608-266-3 i 51 or TTY 608-264-9777. sev-rs~a tR-~oa PLOT PLANT WALNUT HILLS FARM. LOT # ~ Pg. 3 of 3 © = Contour elevation lines. r = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. ' S. ! lT `'~l• ~''C~ s!/ SCALE : 1 " _ l , ~20 S,4wv /0 0 9 ,S1 133 Z9 ,,y S O • L~ T i ~ v ~v~~5 h1` CAM FILTER CARTRIDGE INSTRUCTIONS 20 TM Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3A-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 901. Maintenance 1. The effluent filter should be cleaned every time the septic tank is , serviced. s , y ' 2. Open the outlet access opening to inspect the tank and filter, t 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge then cartridge from the case. ` 5. Slide the cartridge up and out of the case for cleaning. '*VIA 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 9011 and cleaned with water only. ¢ +Ilq 7. While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. ; 8. If VRS switch is utilized, replace by inserting into filter and 4 turning clockwise 900. a 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. z aC 3k, 10. Replace and secure the access opening on the tank. BEAR ONSITET" FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five (5) years from the date of consumer purchase. BEAR ONSITET" Filter Case -Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use, Bear Onsite will, at its election, repair, provide a replacement part or product, or make appropriate adjustment. Damage to a product caused by accident, misuse, or abuse is not covered by this warranty. Improper care or malfunctions resulting from units not installed, operated, or maintained in accordance with instructions provided will void the warranty. Proof of purchase (original sales receipt) must be provided to Bear Onsite with all warranty claims. Bear Onsite is not responsible for labor charges, removal charges, installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. T~ aJ .'x 1 POWTS OVINER'S MANUAL & MANAGEMENT PI_-.AN Pa of f FILE INFO RMATION SYSTEM SPECIFICATIONS ~ - - Owner Septic Tank Capacity ----NA laemiit 2 eptic'rank Manufacturer CI NA - DESIGN F ARAMFTERS Filter Manufacturer ".2 C1 NA Number if Bedrooms _ FJ NA Fffluent Filter Model NA . 1-------------.---- Cf Number )f Commercial Units _ _ _ _ _ _ Ptfmp "I'ank Capacity c al I'1 NA g w stimatc :l flow (average) ~ - aUda Pump Tank Manufacturer !VA Design fl nor (peak), (Estimated x 1.5) ~f i aMlda . Pump Manufacturer ✓,-v' ra NA Soil Appl cation Rate clav a fft~ Pump Mode! I i NA InfluenUl fluent Quality Monthly average- Pretmatn'Ient Unit NA Fats. Oil & Grease (FOG) S30 tng/l_ B Sand/Gr)vel Filter U Peat Filter Biocl Iemical Oxygen Demand (BODj s220 mg/E.. 11 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) Cl Disinfection CI Other- Manufacturer Prntruati d Effluent Quality 1 NA Monthly average" 61spersal Cell(s) Noel Iernical Oxygen Dernand (BODJ -,3U mull. f=1 In-ground (gravity) t -ground (pr(sstuized) fotal Suspended Solids (TSS) s30 mg/1- 1-1 At-grade Mound Fecal t-.oiiform(geometric; mean) - s10[.fu/1U0ml t-i ()ri lire` [_I of ier_- Maximur 'i Effluent Particle Size Y inch diarnefer Values typical for domestic (nom e~mrnerc al) was swatar mild . septic lank effluent. Values typical for prekeated wastewater. MAINTEN kNCE SCHEDULE - . Service Fvenf Service Frequency Inspect ( undition of tank(s) - v - - At least once every 1=] monttj; } ar(s) (Maximum 3 yrs.) PUMP of t contents of tank(s) When combined sludge and sc uni equals one-third (Y,) of tank vole me Inspect t ispersal c all(s) At least once every 1-1 rnortth year(s) (Maximum 1 yrs.) Clean of luent filter At least once every 11 months or(s) Inspect 1 ump, pump controls & alann At least once every y IJ months-,,'year(s) I-i NA _ Flush fat ;rals and pressure test At least once every IJ months or(s) Ca NA Omer. At least once every 1.1 months t~1 year (s) 1-1 NA At least once every -17 months El year(s) l-1 NA MAINTEN f%NCB INSTRUCTIONS Inspectic ns of tanks and dispersal ce-lis shall be rnade by an Individual carrying one of the following licenses or certifical ons: Master PlUmbef; Master Plumber Restricted Sewer, POW FS inspector; POWT;S Maintainer, Septa( e Serviclnn I Operator. -lank inspections must include a visual Inspection of the tank(s) to identify any missing or broi ert hardwar i, identify arty cracks or leaks, measure the volume of combined sludge and scum and to check for any br ck up or pondi ig of effluent on the ground surface. The dispersal cell(s) strap be visually inspected to check the effluent levels in the tat servation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent o I file ground urface may indicate a failing condition and requires the immediate noti'ic:ation of the local regulatory auth( rity. When If a combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume the entire c( ntents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with :h. NP 113, Wi! cousin Administrative Code. The ser icing of effluent filters, mechanical or pressurized POWTS cofnponents, pretreattFment components, and my other m~ hitenance or inonitoring at intervals of 12 months or less shall be performed by a certified POWTS Mainh iner. A sefvie report shall be provided to the local regulatory authority within 10 days of completion of any service even . START 0 p AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or ether chemlc. Is that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detectec have the contents of the tank(s) removed by a Septage servicing operator prior to use. Page START UP, eNU OPERATION l=iar new c instruction, prior to use of the POW's aleck treatment tank(s) for the prc)sence of painting products or other l=iar thr:i# may lmpe to the treatment process anchor damage the dispersal cell(s). If high concentrations are detected have the :ontents of thin tank(s) rer roved by a septage servicing operator prlor to crse. .system st; in up shall not orc;ur wtlen soli conditioner are frozen at the infiltrative surface. r_)uring pa var outages pump tanks may fill agave normal hlghwater levels. When power is restored the excess was .ewater will biro discharge I to the dispersal cell(s) In one large (lose, overloading the cell(s) and may result in the backup or surface dischi rge of effluenlt. O avoid his situation have the contents of the pump tank removed by a Suptacge Servicing Operator prior to restoriri t power to the effluent pi rnp or contact a Plumber or POWT'S Maalnttairter to assist in manually operating the pump controls to reston , normal levels wlthin the :rump tranic f)o riot del ve or park vehicles over tanks and dispersal cells. Do not drive or park otirar, or otherwise disturb or wrnpact, the area withlu 15 feet do mi slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream rnay Improve the performance and prolong the life if the POWIJ, I' antibiotic: ; baby wipes; cigarette butts; oanderris; cotton swabs; degreasers; dental floss; diapers; disinfectants: fat; f rundation dralln (sump pi rnp) water; fruit and vegetable peaalings; gasoline; grease; herblcldes; meat scraps; medications; ail; pa ^rting products; pesticide , ; sanitary napkins-, tampons; and water softener hrtnt'. ABAiNDOr MENT When the POWTS falls and/or is permanently taken mat of service the fallowing steps shall be taken to insure that the sy item is prope ft and siafel' abandoned in compliances with chapter Gomm 83, 33, Wisconsin Administrative Code' A piping to tanks and pits shall be disconnected and the rabandoned pipe apeninp sealed, -be contents of all tanks and plts shall be rtamov0d and properly disposed of by a Septa)ge Servicing Operator. ,fter purnping, all tanks and pits shall be axt.avated and removed or their covers removed and the vold spec ! filled "th soll, ravel or another inert solid material. (;ON TINE ,NCY PLAN If the P( WT'S fails and cannot be repaired the following measioes have been, or must he taken, to provide a 1.0de cornphiprd re:placem ant system: C I , k suitable replacement area has been evaluated and may be utilized for the location of as replacement Soil ab sorption systelmY `he replacement area should be protected from disturbance and uompactlon and should not be infringed u son by requirjed ;etbacks from existing and proposed structure, lot lines and wells, (=allure to protect the replacement area will r :suit In the neled or a new soil and ratta evaluation to establish a suitable replacernertt area. Replacement systems must comply with the, rule *i in affect at that time, i Z k suitable r'eplacerrient area is not available elite to setback and/or soli linlitations. Rarrirtct advances In POW 1^8 technolotV a iolding tank may he Installed as a last resort to replace the failed iIONnrl S, lava site has not been evaluated to Identify a=a suitable replaceirtent area. Upon failure of the I'OWTS a soft ar :t site evatura ion nest he petforme d to locate. a sultnbliy replacement area. it run replacement area is available a holding tank rna y he installed a:a I last resort to replace the failed l--_10V1TS, >9114U1011faC,e. und arid at-grade, :call absorption systems may he reconstructed in piarr: following removal of the biornat at the infiltrative ReC0r1struc;ti0r13 of such systems narist comply with the rules in effect at that timoz <<WARNI I IG>:- SFPTiG, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN I-ET11AL GASSES AND/4',)R INSUFFICIENT OX-GEN. r)O NJOT ENTER j, SEPTIC, PUMP OR OTHER TREA71-MENT TANK UNDER ANY CIRCUMSTANCES. CIIEAI'H MAY RESULT, RESCUE c:)i^ A PERSOP FROM THE INTERIOR OF A TANK MAY HE DIFFICULT OR IMPOSSIBLE. ADDITION IkL COMMENTS _ POWTS lh wrAi LER PQWTS MAINTAINER ~ 7~c F hoet~ [ LNonea SRPTAtaF SCRNICiNG OPERATOR P MPER LOCAL. REGULATORY AUTHORITY amc klame F'hanF Phone This docuin, ant was drafted In complisance with rtiapter SPS 383,.r2(2)(b)(1)(d)as (t~ and 383.54(1), (2) & (3), Wisconsin Administrative Got s. SEPTIC TA NK MA NTLNAN(Tt ACY'REEMBN'i' AM O N R0'F11P CERTU:fCA -(ON l.{oRM Owner dyer Ma,ilirag Address t y 3 3 1'rat,erty .Address ~ - - (Vexification regrar'red frYl~tr m .i lanaxtirng . Zor,i[, _ g Dep;tztznent for Clew Vole; /State ttuctic,rt.) 011 'V .l.'a,rcel lrlentiiicxtti()nlUmber Property t,ocatiotr Sew _u. , r ¢ i i~eG.2 7i N R. 7P S 11"Vision _ ~l ~'lti►2!1 - - ' • 7 Tom, o1' )eo ee rtifiecl Survey I+Rp Lot # r Ct A ffi - V alttme i.V Y)eeei # pitge # luunc til1ec .house: V7 _itt~f ye 'S no S YtST.Ca 12 l of liras : itlentitiahlr rta mAINTEIVA Yes CERTlrarpr'uper use and rrnrirrtenaoce Of' your se r ~•"E~ trrainterranee consists of prtmpu g out the se pixc systern could Yc:srelt the system call affect the tirrrc ill its pxernatrtre failure to laa tiorl of tlr pets, tankevery ttu.ee years, „dle wastes . sooner lei' responsibilities are specified in §Corru > 83-52(l) M& as , if :needed, by,, licensed prarnper, w ro. you d treatrnent staf" un the waste: disposal s l ut' irrtu deed in char" ha ter l1 yste,n. Owner rr hat you r raintenax, e St. (;ror~t t ou;nty Sanitary ordinance, 7lre Property owner agrees owner artrd 'b y a master plit mber to submit to St. Croix County 1'laxttuitt Owner avid disposals see g & zotttxtg t)eparlment a certification tort a1 jolarneyrrat3n K,lrunher, restricted pltrxnbex t,r a license;d trm less nz i , than l%3 belt of sludge, p per verifying that s Proper operatirnt; condition and/or (Z) deter inspectiGn and porn i• I si Wed by the (1) the nrr-~s' :e ping { i necessary), ttie septic T/we , the r„rdrrsigned have read tank: is standards set forth the above iequirerriente avid agree to rr~rrirrtain herein, as set l~ Certitit anon stating by the Tie C.;mrnrraert:e die 11r.ivate sewage disposals stern g that o paatxnent of and the lllepartrnearl of Natural Restrrrrces, l on'ttg 1:)eparhnerxt Witte, U ear s veil,. t has been maintained must be completed aiad returned to the St. C • y with the y three year- expir'atian dates. State of W'ist: arrbin. 1/wr. certifjr that all statements on r, this toter, are true lxo• ~ t-ouuty r !craning Property described above, by virtue nt,s filisdeed recorded lee to the best nl'arty/oox lsxit►yyleage )/we anllare the "Wrier(s) of he Warranty N"Mbcr Of hedroonis gt~tez of seeds C)ftiee. SIGNAT ***.Any intbrrriation that is rrtisrepresented,riay rest-lit in the sanitary permit !rein , R. b & 1:orrinb .Departs went. **y- Include with this application a recorded wa,ranty deed tiv,trn the pegister of"Deeds t)f, orevoked by the.planrnna , reference is made it, the warranty deed. rrcf, and a copy of' tile certified survey in rp il- Owl V. !18/05) 40 'poopPdPr 4d 40# 1 of . ' • 1 ...r..+ OWdPp co I rf„ , * q 40 / 11 l[Ill i I IlI.III 1111111 II,NI I 1l 8191675 Tx:4159210 STATE BAR OF WISCONSIN FORM 3 - 2000 988302 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Oevering ST. CROIX CO., WI Homes, LLC, Grantee. 10/29/2013 3:20 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 TRANS FEE: 120.00 PAGES: 1 Lot 66 of Walnut Hill Farm, Town of Troy, St. Croix County, Wisconsin. Lot is sold `as is'. Recording Area Name and Return Address: Title One File #20179 Together with all appurtenant rights, title and interests. 040-1303-00-066 Parcel Identification Number (PIN) This is not homestead property. Dated this 28th day of October, 2013. Citiz s late Bank - 'a'a ~j * Gene Haberman, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 28th day of October, 2013 ersonally came before me this - day of _21t2 the above named Citizens * State Bank to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foreg ' stru ent and knowled d the same. (If not, • ~~ewn M..,~P• ~ authorized by § 706.06, Wis. Slats.) NO i A.14y-. s *Evelyn Jaeger THIS INSTRUMENT WAS DRAFTED Bt Notary Public, State of Wisconsin % PUBLIC My commission is permanent. (If not, state expiration date: 12/11/2016 ) Michael H Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) .Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000