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HomeMy WebLinkAbout040-1303-00-012rmi" ..' '''.---------1 epar tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix uilding Division INSPECTION REPORT Sanitary Permit No: 567252 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: , Town of 040-1303-00-012 Nickolaus & Hover, Robert& Brianna Troy, CST BM Elev: Insp.BM Elev: B"MDescription: Section/Town/Range/Map No: /D0'c) / 0U- r] 0� / - /opal. SV(/ Tr 22.28.19.1747 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER /2,,,,,43 CAPACITY STATION BS HI FS ELEV. "S / 3.Z /63.Z. /aD Septic J G J �/ /�O `L q Benchmark /C ' / 0 G Dosing COwA.r ob 7,,. I 0 6601 Alt. BM z,. 60 7. C, "7! O., Qe 6A,ar I Bldg.Sewer 4, 40 is Holding _.-%"..<% St/Ht Inlet 'S $7 9 -J"' St/Ht Outlet `_ �� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. 41)o Air Intake ROAD Dt Inlet �1 -1 Septic 7 5b, /1 - Dt Bottom 11 •, Dosing 7 50' N,/4' 3l / Header/Man. 3 . f � Aeration Dist.Pipe 3.56 (S 8. Holding Bot.System !,05 91* /S T / Final Grade PUMP/SIPHON INFORMATION 2 ,3S /56 ,SS Manufacturer 2d GP Rand St Cover /t ea Jam, 7.(1 9 S,(p Model Number art .0 15 5 *. 1Ct-J GYJ.6� ) 7 1�.. TDH (Lift Friction Loss System Head TDH t ' '$, I0� 3. 3.3 Z2. G-C.,' 9 I, L1_1 11 i'l ti'-t f y 4:r �*7-"L,z.- , Forcemain Length / Dia. it Dist.to Well �'y►L,C� f% '�1 s" i /ao 2 A)4-- V SOIL ABSORPTION SYSTEM DEMENSIONS Width d/ Length No Trenc s PIT DIMENSIONS No.01 Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION / i CHAMBER OR Typ O System: /6 95 , /^ ,)/ UNIT Model Number: T OJ DISTRIBUTION SYSTEM Header/Manifolii 11 Distribution , /( / x Hole Size» // x Hole Spacing / Ven Air Inca ,/ Pipe(s) s �f J Z /y d Length T Dia 2 Length 4,14 Dia 2 Spacing //1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a..` e/ De th Over ( Depth Over xx Depth of 'xx Seeded/Sodded xx Mulched / Bed/Trench Center . '7 Bed/Trench Edges `_ Topsoil 1 Yes No J3tEf Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: i, /_„ '_._/ Inspection#2: l f/ 20 /3 Location: 641 Tribute Pkwy RIVER FALLS,WI 54022(SE 1/4 SE 1/4 22 T28N R1-9W) Walnut Hill FaEa The Tribute Parcel No: 22.28.19.1747 Rl 1.)Alt BM Description= F'•.L. £ U ./∎.• v "tea' �O GICS 6 2.)Bldg sewer length= 3 6 -amount of cover= 5 If•A— elak—• ik Plan revision Required? 0 Yes 0 No [ 6f32/7� Use other side for additional information. /1 2. 13 _I J Date Insepctor's•ignatur= Cert.No. SBD-6710(R.3/97) i PLOT PLAN PROJECT Rob Nicholas ADDRESS 771 Kinnv Road Hudson Wi 54016 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 99.4' 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( 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 steel fence post ASSUME E,LEVATION 100' ❑ BOREHOLE O WELL *H,R,p, ame as benchnititvo4 B.M.51c v 1 68' Property Line B- 1 ` _ Scale = 1 4" = 1 0' B- 1 acre lot Off Slope Huffcutt Combo Tank Grading is to be done to divert run-off away from system Area 15' b low 0 system is t remain 98.5' B-2 undisturbe 98.4' 97.5' 289' Property Line Pro 3 Bedroom House Tank is to be properly bedded and provided with l oc kdow n covers with apprpved warning labels 369' Property Line Well is to meet all WDNR setbacks o P Tribute Parkway a>Lb'`~'~v~., County X r r, Industry Services Division r ` $ P #w:~ '1400 E Washington Ave Sanitary Pennit Number (to he filled ii by Co.) - _ S '%wr P-0, BOX 7162 _ AM Madison, WI 53707--7162 anrta ry permit Application State Tlallsacdon Number In accordance w th SPS 3$3.2)(2), Wis. Adin. Code, submission of this f'orrn to the appropriate governmenIII unit C, is required prior to obtaining a sanitary permit. Note: Application forms for state-awned POWTS are submitted to Project Address (if different than maili tg address) the Department of Safety and Professional Servies. Personal information you provide may tie used for secandary ur oses in accordance with the Privacy Law, s. 15.04(f)(m), Stats. 1. A ) lication information - Please Print All Information Pro (y Owner's Name _ Property O t ling Address - Property Location ~~o Govt. Lot City,. tale - ` / ZiP Code - Phoue Numbcf~/ iY, ` Section :s ?O ir'cle o II. 'Type of Buildin - 8. N; IZ g (check all that apply) Lot - - - P ur W or2Ally Dwelling-NumberofBediooms Subdvision CtrncBloclc it ❑ Public mercial - DescribeJse _ 11c:'ityof- - State Owned- Describe Use CSJVI Number - ❑ Village of - .,K )WI rwn of l .'T'ype of Permit: (Check only one box on line A. Complete line 13 if applicable} ew System ❑ Replacement System ❑ "freatrnent/tloiding I auk Replacement only D Other Modification to Existing Systr n (explain) B• D Permit Renewal ❑ Permit Revision change of Plurnbcr List Previous Pennit Number and Date sued Perniit "transfer to New Before Expiration Owner V. Type of POWTS S stem/Corn ronent/Device: (Check aq that a 1 _ 1_1 Non-Pressurized In-Ground 11 Pressurized In-Ground 11 At-Cirade Mound 24 in. of 'suitable soil 11 Mound <24 in of suitable soil C1 Molding "Tank ❑ Other Dispersal Component (explt' ) Pretreatment Device (oxphun) / V. Uis persaUfreatment Area Information; ~ - - - _ f ---ff_ Design Flow (gpd) Design Soil Appli aeon Rate(gpdsf) Dispersal Area Required (st) Dtspt.rsa Area I ro osed (sl) Sysiem Llc vabon - ~.(o ill--- Total - Mayj ~j zg . Tank Info Capacib~ in ? ( VI F 1! of i f acturer Gallons Galloris Units New "Tanks Existing 7'a Iks - Dh s'T" ro U _ w U0 Septic nil I I-Idi g Timk - - - - - - - - Dosing Chamber - V11 L Responsibility Statement- 11 the undersigned, assail" possibility t_u_r_inst'allation of the POINTS shown on the attached plans, Plum r' Name (Print) Plumber's attire - MP/MPRS Number 13usiness Phone N anber- _ Plumbers Address (Street, City, State Zip Code) N I • Count /De artrnent Ilse O _ ` Approved U Disapproved ued Is ung Agent S' nature - - - Pennit Fee-- Date f13)TI ❑ Owner Given Reason enial W > O IX. Conditions o ' /Reasons for Dis royal - SY M OWNS 1 T - Sepannk, effluent filter and S-~ dispersal cell must be serviced / maintaine r-- 07 e 76AIIall as per management plan provided by plumb r. / as pera II ttac u , .r s and submit to the y on yi mt pa er it less than a I1L inches io si p - - ' ' pp cabl~e co efor~lnances. SBD-6398 (R ~'/f~s7l LG~j~Q"31 S' -sv ! ptiyARTA DIVISION OF INDUSTRY SERVICES PO BOX 7162 To 0- 9 MADISON WI 53707-7162 D Contact Through Relay 3 I .S K www.dsps.wi.gov/sb/ 9 ~ P c ~ www.wisconsin.gov ~o Scott Walker, Governor ON Dave Ross, Secretary October 24, 2013 CUST ID No. 226900 ATTN.- POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/24/2015 Transaction ID No. 2325735 Site ID No. 796979 SITE: Please refer to both identification numbers, Rob Nicholas above, in all correspondence with the agency. 641 Tribute Parkway Town of Troy St Croix County SETA, SETA, S22, T28N, R19W Lot: 12, Subdivision: Walnut Hill Farm FOR: Description: Three-bedroom Mound, 4% Slope Object Type: POWTS Component Manual Regulated Object IDNo.: 1455467 Maintenance required; 450 GPD Flow rate; 26 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.Ol/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 • 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. • Building sewers shall be insulated beyond 30 feet per SPS 382.30 (11)(c). Your design still references "Dept. of Commerce" code sections. To prevent future plan review delay, please up ate your plan details and/or management p ans so at they are current with SPS code. CO • To prevent future plan review delay, please remember to include the ASTM Nos. for all piping material A used in the construction of this POWTS, including pipe material between the tank and the building. DEPT Owner Responsibilities PROFES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions ❑IVISfO OF 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. A101 SF CJ SHAUN R BIRD Page 2 10/24/2013 ' • 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 inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. - Sincerel , Fee Required $ 250.00 4A6~ This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh er Please Include a Copy With Your E.I.T., E ' eering Consultant, Integrated Services Payment Submittal. (608) 26 -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 Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. 1 a Cover Page 2013 Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/ 9/13 Owner:Rob Nicholas Location:SE1/4 SE1/4 S22 T28 N,R19 W 641 Tribute Parkway Troy 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 test 12. Filter Specificati s a d cross section PP P Shaun Bird Signature License numb r A00 DITIONALLY -,PROVED SAFETY AND ONAL SERVICES .1DUS RY SERVICES ,`ESPONDENCE t i I PLOT PLAN PROJECT Rob Nicholas ADDRESS 771 Kinnv Road Hudson Wi 54016 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. ~ame as bench mark' B. M. 168' Property Line B-1 :Scale = 1/4" 10' B-3 1 acre lot 4,% ,1 rL? Pe Huffc utt Combo Tan Grading is to be done to divert run-off away from system area 1 5' b low system is t remain 98.5 B-2 undisturbed 98.4' 97.5' 289' Property Line Pro 3 Bedroom House Tank is to be properly bedded and provi ed with Iockdown overs with appr ved warning l bell 369' Property Line Well is tom et all WDNR setbacks Tribute Parkway ~i Mound System Cross Sect oti C-Ixuj Plan View - ect _ : /p~ gg : ' : }R 7:.,:isir'r'rir.i.r,r.J.f,r.i;i.J.r}.}} r fM1r r r r J r r r'' Lr4 f'' rM1r i JLJ~t~'"'r L-+w L L•.; • _ / \ U •ML 1i'ii 'J}f}S}f} Y}.':!}r}r}.'}f}JLJ l r J rM1fLJLf L L L L LrL L 1.4.L.L•L~iM• R •J}f}JJ}r}1. r it}~'VLY'l:LrL~'L~Llt11\lLVl 1?M1fti.'4';1:1~1~~fL1i•?i:".{}Jrj}J.`Jif: r}J}!}/},•1J}f '}~+.~}f.~}f}f F Jvv r rir.r +..5.41• ' t ,!8 F .L'~1.1.M1.1-L~-M1.L.L.'4.\.Y±iiti.i:L.1i1i~G. • • •J.f.J.r.r.fM.J}JLrLJ1~}.L.1ft`1;M1 VV .p^J. ..}l,Lr } L 4.Y L .J.J.J.:J J rL~r•J}}:i}rr}Lra.s~laJLS~ti.+..SrL f'Lirir..rs}J}s},r',3fy I r - r rC7 I I 1 - . : a K 12 L _ _ pilot e -1, soil I I Glean aggregate? 4 in. sch. 40 pvc :;ap Material sand rill. r}r~JLr~ to 2 r~ in. dia, observation pipe M L L•1 6cotextile - Fabric f5f'.: .A•~,~~ys.r.r.rL:- .-.._~._..._--~J,f-_ fi .rL: r'r M1rr'ra i:"i / r~ r 1 f ~JL f rM} } ~ ~ 6 i rl YJ a"l.JJ f"t L.S, sw.Las{Lw • _ ttt"' rr~ Plowed Surf ac ` Ft C,ontOtll- is.~ Slope Direction GENET At, INSTALLATION: the mound area is stal(((l out along the design contour. 1 xishnt'; vegetati( n is mowed and vzdce:d off the, site. `1-he .nound basal area. (I_, x W) is plowed with a moldh )ard or chisel pl ,w. Plowing; may not proceed if the soil is wet: enough at the plow depth to form a 'i,t inch scil wire when a ! aniple is rolled between the palms of the hands. AS TM C;--',3 quality sand is placed irnrric cliately after plo vizag. Sand is placed with a tracked rriachine keeping 12 or snore inches of sand under the t:r ccl(s or is :place( overhead by a. backhoe. Special care must be used when placing sand of less than o) sea toot thickness to mintanize compaction o:1'the plowed surface. After the topsoil cap is placed, the entire 7iound is seecle I and mulched 1:0 promote; vegetative growth, lini.il erosion, and protect from Reezing The observa(i :)n pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 ltj l age; o f. Pressure Lateral Layout Hirt i► led C .1 CL'c r: Alt I atcral I'lirli--up -ho- PI -r Manifold J ~ t1 n~ fi Force Main ~ S v e l, Distribution YVettwok,k ~specdYcatlioxrs r' mssllue'Systeill Collstructirrrr Lateral Diarrreter ;tr]. Manifold Diameter Y11. Laterals are constructed of ~`Sc;Ilectl.lle 40 h'V Orifice DiarntAer (t)[1t1ce Soacir - lrr. the hive with ;r sharp drill bit and ].'a dove i - - L_(Lateral Lett tY~-- Fit. Lateral (Urtl-ALPS WI•rrlilffcltc- Witt] a tlrreadce-- M (Manrtold I_cn th) list. c-leanout plug and are onclosed in ~A 6-8 In( t For1c, Mari1 Diameter diarncter• lawn sprinkler valve: box acc ssib t. Force main Len~tlr from j un she] ;tai 1. ~r ]r r GradE 6-•8 hlch Lawn _ Spr•irrlcler Valve Box - Page c►I' 03/05 lc~ Septic-Dose 'f, Cross Section And Pump . erfornian e Spec.ii j Catio n,%, I"an]k. f✓ltrritxi~acturr~r - Pump Munufwturer Y'tttak.lv[odell~trrnl~et` _ Model total Tank Ca Ott taco $ury Teptlt ; ..d _ A.lartxt Model Number L r~uslAJiI Type Y'ilter iVlaritxfactu~rer - l'oet Mom Iquinber Head ~L ✓ - bis'tsa Pressure Netwoxk Loss min, IMU ni lPutup fedora et; Required Force I g&t Loss ondet manhole f4inY 4" Above Grads With Manhole Min. 4" At wo Gmdc Looking Y.7kc,eY .Trtlet MaUhOle _ V .~3° With Loclkir Y ' / 1VYduttted ~ Gir,tYY'el~s < byy Below (m' a sealed ''atcrti tt - Weatlmt-Proof q~~ functioru Box mew dWlb uldad rde YYYr MAO `O ft" Gr.G ~a& ~ _ dLeW e.r4 Finished + I Y,em t Vent Min, l.Z"y Above Grade Moms with V,:nt Cap `b' y 4y btb JYJYrY yJGt4 6 YyyY Y~Y~i 'Y ~O~iti LY 6~'11'Y'WaW,`bV" bCV °V°V~ yWYY Y Y Ytb Y<Ya VYIIVV ayJ JvJV y+ Vr rYY tl~laiyibJYYWJYYL LLY. _qi GJVY ViYtl Y.U Jy1bi 4yi Y Ya iY L e vY Y+Y yy YY r 0 ~e v YsuYJa s. i Yty ~4Ytiy+ YJYJY .:Y J J ~'aaJ u - ILi• Outlet Filter abJY } _I inlet V u iY~Y Y~ LytY Vi YYJ ilt~ _ L;VL 4t Y y...~ __.,...-T..._.._ e J yJy ~ YY 1 a4 / YyV14 Switch setOugs arid! ROservre CapM,itY M ~4JY /a y uYUV4 _ - YtY uy Weep u 1 u Tank Volunle 25 Y~►irrrez torn. Ynches Volumek"al, Hole .,.ay i~ Of` Elevation C r24; X L e I J•J r (dose) 4,J ! J ±YJL IN ~i~YdNlyw~4' ..a,.. ; `1 Boot /m teJ {+~{{1~ny ~{Y~■, ;`//~yy~ J~JY Y♦®y~) Y ~i~L'ry ~Iy'`ye `L~fe tIi ad) 8i V 4b13V 1E ili4iM1lu~ ivJ• y'VdV~uy JYJL iytyi44 x[.11..//~l AS- ' u '1`V'"L;i-ti-i-Y~ ~L"1 T'G; 6'T-19'~Y G'-i-1'b'Y-G'Y T6'T"ti'-Y"G'V 0'ti 'G'"Gai ~V~i'C~'T°L"'L fiLYY+'L"G~Cry-`ir-rµ's`1"{`C Y`L JCL-S~i'•~''Y'~'~~ +.I a J~ <ya~u~i Yi YVy Yd JYVGJYYbWY6YYy+YJ SditbJY yVYtVJbJLJti Y,YpyiT JV YYS yiYY6Y'tY eY Y.eYY YJ i tyu <Y YYaa+ Jv LI tYJ a Yv YYJYYV YJLCLJLt YVYY6YYiL tJyVYJY ~y ~YJ6 ~yYYC 4~6iLV,i 1 i Vv > e uYt J t 3 J i J J J t t JrJ a4ibaeJ Js vCyYrJ~G~ VC JVt C d CytbiV341+4+iLYLtIr VLJ illy iaivi Y Y C i Y Ybib84pvJVVpJ J Y J V i4 iv JYVVi V S Y. yvl..t.Y x S .GJi L&.kn1.~k.L,+ r y r ~~.,y.W~..Y.t.Y..Y-1..L.2..k_1.1.kYl.i«2~.1 ENE AID YNSTALLAT-ION: '1'Ite septic/dose tattle is beck; gad back, filled in Wootdanc:e uvith the ntaY►rttscturerys produttat approval specifications, m inriura depth of bw Y c5 specifte by the tnattuft ctur+ 1118Y not be exceeded without ptityr ppW'Vhl+ Ma1thtslc; covers eX,pcysed to grade ttttvre an effective looking device Padlock) installed. Piping at the, inlet and outlet is Of "Proved material, connecsted to t he teu~r lr vxri tlt watertight li itchy, and laid on stable soil to PreVettt s ing or s Ning. fhe farce nuda is slt*,~►ed with 4~' Sch. O ' o ri ttrc ~ccrctc Ulm 1 excavration and the sleovra is sealed ~vrtight. lrctxic:al servicta crytnpli-.~s vnrifhFr~; ~o(y MITI page of = - 02109 L J SErd-40 Series 4/70 Grp Submersible Effluent Pump, 3/4" Solids ~:;~rrrrr~t'~i+~rrra Now - !literst Mitruto 0 So 900 16u 200 25 300 (.ovor t'poxy Goatod U(ASt h0rr 30 1trIPUJIL1 MatOrial Therrlraplastlo Hd4,tolne 20 Vc~lgite Epoxy-tmated (ast ir'Vrr Mfwhanic 11 t3ha t- Nitrite with uarb~)) i arat Sri ai vet-arnlc (izCjGS Shaft Stein U zU U GU BU ppur''BirltaC+~ti$~ Flow - GallonslRMBtute li~~ri►t~i~, ,e~~~ Al~r ::;I~Prd,~p~~~b~I,Iw~ry~a~ll~r~~ v;' DIU, G U411 8CN..40--/1F" t rV..~tu sp ecifficarttions mum kN 40 60921) N10 116 1-1004 (+/02(I . 8tr 70 SU 46 25 32` 14 7R 2f3.5 150 Sr-N-40 AF I1UUV1113 4110 115 1 f/2° rYor Ojai o 81) 10 60 try ~Ei 5l r<r 1tr t~T + 5U I N A ' 0~1 wit, i '~,'1 '10 °I" pr r " 10x(1 I r3U 10 , Y: Franklin Electric ~I 400 [asi Srsrrny Street, HlufitUll. IN 1 7,111 `('el: 260APA-2900 m I~ax: 260 .tr7ILAC r wwvu.irarrklirr-alectric:.u~r"1 Form: U96 199 1-11 Wisconsin Department of Comme SOIL EVALUATION REPORT Page/ of 3 Division of Safety and Buildings i ccordance with Comm 85, Wis. Adm. Code County Attach complete site plan o r less than 8 1/2 x 11 inches in size. Plan must 1 include, but not limited cal d horizontal reference point (BM), direction and Parce41Q. Z percent slope, scale or r4si s, north arrow, and location and distance to nearest road. O 3 3 o '00 v Please print all information. eeed by _ Date Personal information you provide may be used for segondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner 4975 Property Location -Rp J ) 20 a t v~ Govt. Lot S 1/4 Q/4V Z ZT Y N R/ E o W 7/ J\j Property Owners Mailing Address L-It # Block # Subd. Name CSM# Z 1-4) `/l r State ode Phone Number ❑ City ❑ Village Town Nearest Road Lill -54C (6.5 t) S > 2663 Tro T r cif Tar §jCplew Construction Use: Residential / Number of bedrooms Code derived design flow rate J~ GPD ❑ Replacement Public or commercial - Describe: Parent material r= _ Flood Plain elevation if applicable ~l'V / f ft, General comments and recommendations: To u System Type ©~l lc~2- System Elevation ~r 1 F-1 I Boring # Eit oring GG Ground surface elev. 6 ft. Depth to limiting factor 97 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 s a , Y d-7-q-7 ? s r b► .-rn M 1 1 Boring # I~t Boring L^J 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 d -~o 3/z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 • Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Eval ation Conducted Telephone Number 1008 192nd Ave, New Richmond, W140117 lie 715-246-4516 Property Owner _ Parcel ID # Page 13-- of J © Boring #❑1 Boring 9 P .1 l Pit Ground surface elev. ft. Depth to limiting factor in. Soil 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 0-7 13/2- Ye- r7 2 - U 6 3 1' 1 m ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30:< 220 mg/L and TSS >30 1150 mgA- ' Effluent #2 = BODS < 30 mg/L and TSS 5 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (RAM) AemlJed ainqul aul-1 Alaadoad ,69£ aull Aljadoad ,682 ,S'L6 2-8 ,S'86 adolS %t 101 aaoe L ❑ £-8 10 L = II-V/ L = aleDs L - g aull Alaadoad .99L *'W'8 ,V86 Naewgou9gse9uaeSdbH, ,17.66 uolIena13 wa}sAg Isod eoua3 1991S jo dol 'ji 001. 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" ~ ~ d, r"" i>♦r~:, yat . •u4:k:1r[.p i.vr:...Y (Lid 1 V - f- i~{►~Yc ~~~,•~:"~,i~Yr~ d[~9" 1~`~:~lttE~R.M,f,""y,yr~y,, f 1 POWTS OWNEWS MANUAL., & MANAGEMENT PLAN P, • " ear r-ILE tNFORMATION SYSTEM SPECIFICATIONF, Owner Septic Tank Capacity Aw_ t NA septic Tank Manufac-,turer b-7 2, r .1 NA DESIGN PARAMETERS C-_'ffluent F=ilter ManufaCturtOr _ d~y f=I Nil Number of Bedrooms Ll NA Effluent Filter Model Number of Commercial Units - - - A Pump Tank Capacity t'G7 aC- - NA Estimated flow (average) `f aUda Purnp Tank Manutacturer Na AL Design flow (peak), (Estimated x 1.5) 1/0 allda Pump Manufacturer NA Soil Application state 0alld~ft~ Pump Wiclel ~ ~c ~V ' r3 A Influent/Effluent Quality Monthly average' Pretreatmerit Unit - rats, Oil & Grease (FOG) __30 cigit_ 0 Sand6rgvel Filter ` 0 Peat Filter 8WIemlcal Oxygen Demand (60Dj a20 rng/fw 0 Mechanical Aeration CJ Wetland Total Suspended Solids (YSS) S1150 IL n Disirlik4ion CI Other.- -919 Manufacturer Pretreated Effluent Quality NA Monthly average" Ufsparsal i ,ell(s) Biochemical Oxygen Demand (E30 g) X30 mg/t_ 0 In-ground (gravity) t7 41( round (Pr- surized) Total Suspended Solids (TSS) S30 Irigh- 0 At-grade und _ Fecal Colifomr (geometric mean) ~104 cfu_11 oornj _ i C )f C vl Other .:11 Maximum Effluent Particle Size f, inch diameter a Varuw; Cypk:ar for dorne:stie (non-Gorurnerctal) wa: b water and - r eptie tank effluent. Values lyplcal for wotreate:d wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every .3C7 rnonths,>4~year(s,) (Maxiniurn : yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y;) of tanl( volt 1 fie Inspect dispersal cell(s) At least once every C7 monthar(s) (Maxlmurrt A yrs.( - - Glean effluent lilts, At feast once every' C l months e ar(s) Inspect pump, pump controls & alarm At least once suety IC:i months 1 ear(s) C=J 1VA- - M1 _ _ Flush laterals and pressure test At least once every 1 month" - year(s) DNA Other: At least once every I'J months 1-7 year(s) EJ NA At least once every I-1 months Cl year(s) 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying carne of the following licenses or, certifications., Master Plumber; Master Plumber Restricted Sewer Powl'S Inspector POWTS Maintainer, Septac I Servicing Operator. `Bank inspections must include a visual fnspection of the tank(s) to identify arty missing or brol r In hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any W t k up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent I )vets in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent of I the ground surface may indicate a failing condition and requires the immediate notil'imbon of the local regulatory authc I ty. When the combined accumulation of sludge and scum In any tank equals one-third (Y) or afore of the tank volume the entire contents of the tank shall be removed by a Septage Servicing Operator ar d disposed of in accordance with I. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POW f-S cornportents, pretreattment components, and 1,1y other maintenance or monitoring at intervals of 17 months or less shall be performed by a certified POWI-S Maint{ i te(. A servicf report shall tie provided to the local regulatory authority within '10 days of completion of arty service ever) . STARTUP AND OPERATION For new construction, prior to use of the POWs-S check treatment tank(s) for the, presence of painting products or : ,her chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have tire contents of the tank(s) rernoved by a septage servicing operator prior to use. Page of S'TAR'T UP AND OPER plwF~ATIC)N c orriciits tht:li For, new construction prior to use of the I'(aWTS check trteatinent tank(s) for the presence of painting products or rathear h may impede the treatment process a?rndlor• damage; the dir4mrsel c ells}. if Ngh concentrations are detected have the -,mtonts of thl tank(b) rernoved by a septa3ge servicing operator prior to use. System start up shall not occur when sail conditions are frozen at the infiltrative surfai'3H. During power outages purnp tanks may fill above normal hlghwa:►ter levels. When power is rostored the excess wai b water will tali discharged to the dispersal ell(s) in one large doss, overloading the cell(s) arid may result In the, backup or sul'facrs dlsch r 90 of ef'fkrerrit. T'o avoid tills Situation halve the contents of the pump tank removed by a Septage: Servicing Oporator prior to restorer i; power to thlo effluent pump or contact a Plumber or POVVTS Maintainer to assist in manually o;paratinq the pump cuntrois to rester s rsormtal levels within the pump tank. Da riot drive or park vehicles over tanks anti dispersal mills. Do not drive or park ovar, or otherwise disturb or compact. 1 ie area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream rnay improve the performanco arid prelerrg the lifer t f the f'CyWIli;: antibiotics; baby wipers; cigarette butts; nondomrs; elation swabs; degreasers; dental floss; diapers; disinfectants; tat; ' ,i nga ion der I.On (sutrrp purrtp) water; fruit and vegetable feelings; gasoline; grease; herbicides, moat scraps; medications; oil; prs r pesticides; sanitary napkins; tampons; and water scaltener brine. ABANDONMENT When the POWT.S falls andlor is permanently tak o serve the following stalw shall be taken to Insure that the st s ens is prupelj•ly and safely abandoned in compliance with ch ar Gomm 133.:1 iscorrsio AAdmirristrtrtive Godo: u All piping to tanks and pits shall be disc the abandoned (ripe oponings sealed. The contents of all tanks and pits shall be removed arid properly disposed of by a Septagei Servicing Operator. u After pumping, all tanks and pits shall be excavated and rarnoved or their coverts removad arid the vold sNaa( a filled with sq>il, gravel or another inert solid material. CONTINGENCY PLAN If the FlOWTS falls and cannot be repaired the following measures have beers, or must he takon, to provide a ocle cornphipnt replacernertt system: C:1 A suitable replacement area has been evaluated chid may be utillzed for the location of a replacement soil at s arption systelrn. The repiaacernent area should be protected from disturbanGe anti comptc:tion and should not bo infringed i F. on by requirjed setbacks flour existing and proposed structures, let lines arrd wells. F allure to protect Vw retplacernent area will a stilt in they ticied for- a new still and site evaluations to establish r:e sultabla replacennlt-fit area Repiacernenl systems must cornpl, vith the ruteil in offoot at that time. Cl AA suitable replacement urea is riot available due to setback and/or atoll li citations, (:tarring advances In 14OVa 1 S technologIf a holding tank may be installed as a last resort to replace the failed I.10v0s. K``'it to site has not been evaluated to Identify sa :suitable replracainent areas. Upon failure of fire POWTS a soil aai a site eavaluadlion must be perforated to locate a suitable repinc:ernont area. If no repltavernerit area is atvail4blo a holding tank in s - be installed as /d last resort to replace the failed POWT S. ound and at-grrede sail absor'ptior'1 systems may be reconstructed in place following removal of tfre: biorna it the infiltra~live surface. Reconstructions of such gsterfra roust comply with the rules In eftect at that tirrlo. <-< WARNING>> SEPTIC, PUMP AND OTHER TREA'l1Ulew "I"ANKS MAY CONTAIN I..E THAL GASSES AND/OR INSUFFICIENT 0) 1 GEN, 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREA'T'MENT r"ANK UNDER ANY CIRCUMSTANCES. DEATH MAY RE SUL`! . RESCUE 01 A PERSON FROM THE INTERIOR OF A 'TANK MAY 6ki. UIFFICULT OR Wn59 BLE. ADDITIONAL COMMENTS t'OWTS INSTALLER POVVTS lUAJNTAIfNER i- IUe'ame Nairle _ ~Ac y: 1 Pholle SEPTAOE SlrRVICINC OPERATOR P PENl~ LOCAL REGULATORY AUTHORITY Name Ifranc Phones' stS8.54tYt), (2) S, (3), Wiscorrsrn Administrative a( i This docuntent was drafted in carrsptierrue with Chapter 8118 303.22(2)(b)(1)(d)&(t) and- ST. CROIX COUNT'le SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address C Tr r _ (Verification required from Planning & Zoning D tment for new construction.) City/State e11/y- 1r vLS Parcel Identification Number r LEGAL DESCRIPTION V VV " 3 D Property Location<5,1~" % , 5f~' %4 , Sec. Z z, T 2 4?N RW, Town ofTra Subdivision U L y ~ 1 06. Al 4 1 mac, l Lot # 1 Certifmd Survey Map # 70 3a, Vaiume Page # Warranty Deed # Volume , Page # Spec house yes no lot linen identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the wasl.-e disposal system Owner maintenance responsibilities are specified in§Cnenmr 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. .015 383.52( I) The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Departurer~ f Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has bt~en faint e ust~e cornpletccl and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroomr-3 SIG ATURE OF APPLICANT(S) DATE TE ***Any information that is misrepresented may result in the sanitary permit being ro:.voked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed (REV. 08/05) ru: LL N t r+4 . N vi a I 1 ! ^ to . t • 211 W-lv U.: Oll Ch 1 1 N 't / 4 a / .000 cQ C4 ^O 1 ~ 1 / ~ ~ p 07 LL: - All vlb vi 00 < F" vi .4c C14 %n Vo 0 ~ ~ /33 1 OC; 016- r 19 r r 0-) m ~ r I ' ' r NA' ID VRM 8 N I~ 8 Tx74154729 9 STATE BAR OF WISCONSIN FORM 3 - 2000 987032 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Robert R. ST. CROIX CO., WI Nickolaus, and Brianna A. Hover* Grantee. 10/04/2013 12:21 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: 61.80 PAGES: 1 Lot 12 of Walnut Hill Farm in the Town of Troy, St. Croix County, Wisconsin. *both single persons as joint tenants Property is sold `as is'. Recording Area Name and Return Address: Title One File #20075 Together with all appurtenant rights, title and interests. 040-1303-00-012 Parcel Identification Number (PIN) This is not homestead property. Dated this day o W-V-1011 2013. Citizen to Bank * Gene Haberman, Vice Chairman AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this Personally came before me this 30 day of the above named Citizens * Sta Bank to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and acknowledged the same. (If not, Z,;L _v4, authorized by § 706.06 Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY ~~Je`yn M'Jio„ *Evel M Jae er Notary Public, State of Wisconsin NOT My commission is permanent. (If not, state expiration date: 12/11/2016 ) Michael H Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are nod *Names of persons signing in any capacity must be typed or printed below (loft's gnature 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 Parcel 040-1303-00-012 10/16/2013 04:36 PM PAGE 1 OF 1 Alt. Parcel 22.28.19.1747 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 P ress(es): ' = Primary Type Dist # Description 641 TRIBUTE PKWY SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.030 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T R19W PT NE SW WALNUT HILL Block/Condo Bldg: LOT 012 FARM L 1 1.030AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 12/10/2003 748766 2471/591 WD 11/19/2003 747018 9/92 PLAT 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/20/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.030 27,500 0 27,500 NO Totals for 2013: General Property 1.030 27,500 0 27,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.030 27,500 0 27,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00