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HomeMy WebLinkAbout040-1303-00-007 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 567259 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 040-1303-00-007 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 97,li Z ‘6r 22.28.19.1742 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER /i/,„,,�5 CAPACITY STATION BS HI FS ELEV. I ,'.. 3 g Benchmark /� �, r 2 /O�. o�i� Septic ;1u /�j^`c J ie:( S ✓d VC!I kJ''Z G�7t J p� T rlSreYµ �� ' J Alt.BM / r W✓4t� /' / ✓Lb — " Bldg. Sewer Aeration L ( Holding St/Ht Inlet 7:d '7144/..e, St/Ht Outlet if .7./.TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. en to Air Intake ROAD Dt Inlet \ �\ Septic E,3 T _ / l 1 �� Dt Bottom �„� �_ NA" �Z 78 Dosing _ Header/Man. 6" (0 914 Aeration Dist. Pipe or . 1. 94 I V • V 94,/ Holding Bot. System 9,(i 93` / ek- Final Grade 3• /9� PUMP/SIPHON INFORMATION ei Manufacturer GPM Demand St Cove',t Lou-a"... , i q /� I or Model Nu /J C•0.../ &f 6"4 t•7 /CO TD Lift Friction Loss System Head--� TDH Ft .6!(S( Forcemain Length hia. Dist.to Well SOIL ABSORPTION SYSTEM „JJ G^,05 BED/TRENCH Width / Length i No.Of Trench PIT DI NSNI� IONS No.Of Pit- Inside Dia. 4Liquicpp eth DIMENSIONS �Z 94 14,1---c.., •••.� SETBAC K SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer://�'� INFORMATION CHAMBER OR In 4-'1' (1 ol-r.....1-0-1._ Type Of System: n mob Mo Number: DISTRIBUTION SYSTEM eix. 2a +23 = 94 'f--Q Header/Manifold' ii Distribution x Hole Si x Hole Spacing Vent to Air Intake a L, Pipe(s) ` �►�._ __ eat,0 Ad- Length D Dia 7 Length ` Dia Spacing e° ✓"ei+' a /f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only in.4.4",0124.--. a.,.....44 Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 6.3 Bed/Trench Edges .■` Topsoil \ es No Yes 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 656 Tradition Trail RIV R FALLS,WI 54022(SE 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Tribut Parcel No: 22.28.19.1742 1.)Alt BM Description= 's.c-FGA_. LO vim. C `'"- L d rj 0 2.)Bldg sewer length= 20 4_ Zg = ag/ L �ak.e...- amount of cover= eta. Plan revision Required? Yes 'No 1i/�' (q � (3 ! ..! 1 (,„27$. 1, Use other side for additional information. Date Insepcto' Signat,/ Cert.No. SBD-6710(R.3/97) 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 10/30/13 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 ■ BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.p. Same as Benchmark SYSTEM ELEVATION 95.0/94.9 4.4' below grade • ' Property Line 1k11 piping v tx/P) .. shall be SDR 30/34,within 10' Please note: borings are to be dug of tank,piping shall be Schedule 40. deeper to install system at a proper depth B-39-7.86' Scale is 1" = 40' 90' 2% Slope unless otherwise 63' noted 98.5' 2-3' X 94' Cells with 4C& k _ �� >3' spacing B.M. \(4____1•7.44 5' 50' ,, ci, — ent 3b Z.•g I' ,/ °V./4( a. t/ 20' J/,i,,JC.Q� >6" Quick4 andard of Cover Leach' g Chamber ST 4t. 0.0 ft2 of Area . tA2/pair of end caps 4' Long 12" 20' 34" /'4 Grade at System Elevation A Pro 3 Bedroom ) � • House 303' Property Line Tradition Trail V • County !r k Industry Services Division t ; bi 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) PMl P.O. Box 7162 Madison, WI 53707-7162 -7 r anitary Permit Application StateTransacti°""PA In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address if different than mal ng address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary I jl u ses in accordance with the Privacy Law, s. 15.04(l )m , Stats. J ~w PH", , 1. Application -information -Please Print All Information ~r "e wS Property Owner's Name ! Parcel # v J~_ V v _VV 1~94e e r/ ` Property Owner's Mailing Address Location 7 C C7 /f ' Govt. Lot j City, State Ip Code Phone Number Y4 . Section G ° S '-,FCO aa,, (circle on L L T mac, N; 'r Cry II. ype of Buil ing (check all that apply-) Lot # 1 or 2 Family Dwelling ✓ ~be of, Subdivision Name (-k# ❑ Public/Commercial - Describe Use ov-v ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of own of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑ Moun > 24 in. of suiuittaable soil ❑ Mound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)' etreatment Device (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Appli Rate(gpdsf) Dispersal Are Required (sf) Dispersal Area Proposed (sf) System Elevati n VI. Tank Info apacity in Total # of Manufacturer Gallons Gallons Units a U0 New Tanks Existing Tanks c A a U in H w C7 C. Septic or Holding Tank / Dosing Chamber VII. Responsibility Statement- I, the undersigned, a m responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) /7 Plu s Ignature MP/MPR62&D S Nuumber 7Bu)siness one Number / z, t /dry Plumber's Address (Street, City, State, Zip C e / J Z s,: VII . Coun /De artment Use Only Approved El Disapproved Permit Fee Dat Issued Iss ng Agent Si atur LV' ❑ Owner Given Reason for Denial $ 7 S I `~6 L~ M O j s r ~t ~`S IX. COWY gfWpIlVVfkrooval/Reasons for Disapproval 1. S3eTpticc tank, effluent 3 filter and S Vv^t~/~` S n uGl/v~Gt?vV / Jrt/ tpI/ 1 dispersal cell must be_erviced / maintained V as perLnanaaement plan provided by p.iumber,~-~ 2-C, per applicable AXns for the system and submit to the Co ty only on paper not less than n x 11 inches in size DQ 3, IAI~_ V~b S B 1 6 398 (R0 13) 2 1 ✓~~2 ~Y~- 1/t' J~/ Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/26/13 Owner:Oevering Homes Location: SE1/4 SE1/4 S22 T28 N,R19W Lot 7 Walnut Hill Farm Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingen Ian 7. Filter Specifications Sheet 8.-10. Soil Test Signature License number #26600 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 MPRS Shaun Bird 226900 DATE 10/30/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 931 # of chambers 46 BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/94.9 4.4' below qrade 167' Property Line ION. All piping shall be SDR 30/34, within 10' Please note: borings are to be dug of tank, piping shall be Schedule 40. deeper to install system at a proper depth B-3 q-7. go Scale is 1" = 40' 90, 2% Slope unless otherwise 63' noted 98.5' 2-3' X 94' Cells with >3' spacing B.M. , 99.5 5' _ iL- 50' 50' B-2 q~.~Fa Cluj . Vent 20' U >6„ Quick4 Standard Leaching Chamber ST of Cover with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" 20' Grade at System Elevation 34" Pro 3 Bedroom House 303' Property Line Tradition Trail Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 99.4' Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 11 5' S' Long 1 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A_95.0' B 94.9' ~I li r1o ;Ksconsin Deportment of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 5T•' G~, O/ •V Attach complete r L v7 - ~ /N "do' w not 6 EROSION CONTROL PLAN must be Parcel I.D. P~,v p~~ G-- Percent slope. sc ~j completed before sanitary permit issuance R Dat Personal kftmawn you provwe may to uses mr seemawy purposes (Ymacy Law. s. 15.o4 (7) (m)). 1713 Q 3 Properly Owner TOlDD Property Location D~ Q A •r•O f'D BJ ERS Tef >T" % 14110A) #'q Lot All &A 5"1/4 S -4L- T ZD N R ! & (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# a t 5 CA H-i LL AV-e- • 7 IVALVO r W11 CRY ,SNMR State zip Code Phone Number ❑ City ❑ Village Town Nearest Road 6~PVVE HT3 MN 5So7(P (&Sl) iy8.109F -rRoy so. if jdvER . o P1 New CorMMX: w Use: [A Residential I Number of bedrooms Code derived design flow rate 0 r Oa GPD ❑ Replacement PLblic or ~0 E s D!1 Lt S/1'l~l~ commercial ~7/ W Rood Plain elevation if applicable ft Parent material General comments and swrranerndations: 7 ae. a e # ® pit Ground surfaceelev. ! ° ' S ft Depth to inviting tailor 1> Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD W b in. Munsell Ou. Sz. Cont Color Gr. Sz Sh. 'Efl#1 'Ef#2 I 9;z 5/& s ctij 1-14 Z. lie . 'h ❑ Boring 1 yh # ® Pit Ground surface elev. ft. Depth to limiting factor in. Sod licatjon Rate t„ Hortmn Depth Dominant Color RedQx Description Texture Structure Consistence Boundary Roots GPM In. Munsell Ou. Sz Cont Color Gr. Sz. Sh. -Eff#1 'Eff#2 IN /D Yl-~~? L / f /c S w -t` • y . G N Z •2 /0 SL s Cs Y 3 s A Q s - --3 r. IV 9-A ' ElNuent #1 = BM,:- W :S 220 aVL and TSS >30:5 150 mg& • Effluent #2 = BOD < 30 mg& and TSS < W mglL CST Name (Please Print] • -A LB R i 1, - slgnaaAe -2-63-75; Address Ulbricht & Associates Data Evaluation Conducted Telephone Number Private • 3 - Lvov 3 715. 77A • 3 yy Z 2812 10th Ave. Spring Valley, WI 54767 PI~05 4P, 0yo' 16155• 5.0. coo 0y0. lox . /o - awn oyo-/o~'lo- ~o'~ oyo•/o~(-70•060 o yo /,q ~o • a TODl7 131E ~ S TED7- Panel ID # G y f" ~ Pap Z of 3 131 t Groumd surface elev. f7' 0 o fl_ Depth to s factor WL Spit hate Depth Dominant Redox Deser"m Texture Structure consistence Bou~rdary Roots in. Munselt Qu. Sz Cont. cow Gr_ Sz. Sh. `E o fy goy i s~~ a' w 7' t2- iO 4.1 7-S G- { Boling # soling Q Pit Ground surface elev. R. Depth to biting factor in. Sod ApOkaban Rafe Horizon Depth Dorrarard Redox Description Texture Stye Consistence Boundary Roots Gtr in Munse8 Qu. Sz. Count Color Gr. SZ. Sh. `Eff#1 *EfM2 -j Pit Ground s urfaoeleiav . ff. Depth to liirWft factor Jr Horizon Depth DMninant Color Redox S9~ Rafe aesusiption_ Texhre Structure Consistence Boundary Roots G In. Mussel Qu. Sr- Cont. Color (3r. sz. Sh. `EM1 'Eff#2 F-1 i Boring # Boling Psi Groe.Kxi surface ft. Depth to Carutitmg factor in. Spit MOSCOWRate Horizon Depth K Cokx R Description. Texture Structure Conafstence soumfery Roots GPON in. Mansell QM f;Ot1t. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 e Effluent #1 = BUDS > 30:s 220 mg& and TSS >30 < 150 tnglt. " Effluent #2 = BADS < 30 mglf. and TSS < 30 rnWL 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. S86a3.~0(R6JIi0) r PLOT PLAN WALNUT HILLS FARM. LOT -7 Pg. 3 of 3 Q = Contour elevation lines. = Backhoe Soil pits. Q = Benchmarks set, maRKEA WITH FLAGGED lathes. 1/2" steel conduit pipes. W _ 2,0 SCALE : 1" = F dV /67 N (33 x ~I 1© k 13 4 g O4~ c1l. (el 5 k/O M ~ J M POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paga of _ FILE INFORMATION SYSTEM SNECIFICATI(iNS Owner Septic Tank Capacity 11 NA - ~ - - -gal ❑ NA Septic Tank Manufacturer # Se tic _ rmit p Pe it # DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model - ❑ NA Number of Public Facility Units _ NA Pump Tank Capacity - - al NA Estimated flow (average) - gaUda Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal/day, Pump Manufacturer _ - ' NA_ Soil Application Raise S' gal/day/92 Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) :530 mglL ❑ Sand/G•avel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220, mg/L O NA ❑ Mecharical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150'mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal t;ell(s) ❑ NA Biochemical Oxygen Demand (BODr,) 530'mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L --VNA ❑ At-Gracie ❑ Mound Fecal Cohl'orm (geometric mean) 5104 cfu/100m1 ❑ Drip-Line _ ❑ Other__ Maximum Effluent Particle Size X in dia• ❑ NA Other: -R - ' ❑ NA Other: - - _1e Other, - - NA ^C, Other: ❑ NA *Values typical for dornestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency At least once every: month's) (Maximum 3 years) ❑ NA Inspect condition of tank{s} ~i LSLY ear si Pump out contents of tank(s) When combined sludge and scum equals one-third (3j) of tank volume 0 NA ~ - - earth (Maximum 3 - years) _ 13 NA Inspect dispersal cell(s) At least once every: El onth! s) At least once every: ❑ monthi s) ❑ NA s; Clean effluent filter ~gyear( - - L Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA ❑ year(s; Flush laterals and pressure test At least once every: ❑ manthls) NA p year(s) Other: ❑ month's} NA At least once every: ❑ year(s) Other: - - -J-^.--_- - NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground siaface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chect: for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ( 6) or more of tl ie tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanca with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurzed components, pretreatment units, and any servicing at intervals of 512 months, shall be perforated by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an!, service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill ab3ve normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o effluent. to the To avoid this situation have the contents of the, pump tank removed by a Septage Servicing Operator prior to restoring power effluent pump or contact a Plumber or POWTf, Maintainer 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 compact, the 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 may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoins; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap: ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chaptiv Comm 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealel • 11he contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replace 7nt system: 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 compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is avaiirible a holding tank may be installed as a last resort to replace the failed POVVFS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. Dr:.ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS, POWTS INSTALLER POWTS MAINTAINER ` Name Name Phone l )J'_ c7Z ZI Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AU'T'HORITY I Name NaEe7j' Phone -7/J - Phr This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ' FILTER CARTRIDGE INSTRUCTIONS sr.2 8 -T Installation STEP I Dry fit the filter case onto the end of the outlet pipe to ensure it is -f 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 3/4-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 note w 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 ' y the case. I STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. :1 r.,..... Maintenance 1. The effluent filter should be cleaned every time the septic tank is - - serviced. t 2. Open the outlet access opening to inspect the tank and filter. 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 t outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. y 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch t r: should be removed by turning counterclockwise 900 and cleaned ' with water only. 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, a turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until ` the filter locks into the bottom of the case. 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. e ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bayer Mailing Address Property Address S~ je,4-D 77 O '4/ (Verification required from Planning & Zoning Department for new eonstmtction.) - City/State &",Vvv parcel Identification Number LEGAL I)EIRVARYPTInN Property :Location ~G Y4 %a , Sec. T G F N R W, Town of ~ Q Subdivision . Lot # . Certified Survey Map # , Volume Page # Warranty Deed # . ,Volume ~ page # Spec house yes no Lot lines identifiab yes no SYSTEM MAINTENANCE OWNER CERTIFICATYON Trrproper use and maintenance of your septic system could result in its premature failure to handlc wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed umper. What you put into em can affect the function of the septic tank as a treatment stage in the waste disposal s y P Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary syst Ordinance. The property owner agrees to submit to St. Croix County k' owner and by a master plumber, journeyman plumber, restricted plu mber o a licensed pupartment a certification farm, signed by the wastewater disposal system is in proper operating condition and/or (2) after inspection and verifying that the on-site less than 1/3 full of sludge. Pig (if necessary), the septic tank is 1/we, the undersigned have read the above requirements ands ree to standards set forth, herein, as set by the g maintain the private sewage disposal system with the Department of Commerce and the Department ofNatura] Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are hue to the best of my/our knowledge. Uwe am/are the owner(s) of property described above, by virtue of a warranty deed recorded in Register of Deeds Office. the Number of bedrooms IGNA F APPLICANT(S~ ~2 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning i4t Zoning Department. lholude 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. OUS) . 1 l I Illy , IIIIIII, 6 7 3 Tx:4i59209 STATE BAR OF WISCONSIN FORM 3 - 2000 988300 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 3:17 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: 60.00 PAGES: 1 Lot 7, of Walnut Hill Farm, Town of Troy, St. Croix County, Wisconsin. Lot to sold `as is'. Recording Area Name and Return Address: Title One File #20180 Together with all appurtenant rights, title and interests. 040-1303-00-007 Parcel Identification Number (PIN) This is not homestead property. Dated this 28th day of October, 2013. Citize S to Bank * Gene Haberman, Vice Chairman AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 28th day of October, 2013 Pe onally came before me this day of , the above named Citizens * State Bank to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoin instrument and acckknowled the same. (If not, X . authorized by § 706.06, Wis. Slats.) IIA•j THIS INSTRUMENT WAS DRAFTED BY °O~ *Evelyn aeger NOTARY % ;Notary Public, State of Wisconsin : My commission is permanent. (If not, state expiration date: ' DURI IC 12/11/2016 Michael H Forecki, Attorney (Signatures maybe authenticated or acknowledged. Both are not n *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 Parcel 040-1303-00-007 11/06/2013 11:18 AM PAGE 1 OF 1 Alt. Parcel 22.28.19.1742 040 - TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Current 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 O - 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 656 TRADITION TRL SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.110 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T28N R19W PT NW SE WALNUT HILL Block/Condo Bldg: LOT 007 FARM LOT 7 (1.110AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-19W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 12/10/2003 748768 2471/594 WD 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 1.110 27,500 0 27,500 NO Totals for 2013: General Property 1.110 27,500 0 27,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.110 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 b o . y ,1♦ ~ ~Z~ I ~ ^ s ~e~.''~ t Ivy ..►.~--7 w 345A e s Sn 1 !ti N 06"- cm (V rr r .SIC co qr 1 1. 6: • w w 3 t 1 U7 G7 tat 'r l 1 ! 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