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HomeMy WebLinkAbout002-1012-30-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT X69555 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 0evering Pro ertie I Baldwin, Town of 002-1012-30-200 CST BM Elev: Insp.BM El �v: BM Description: G JT Section/Town/Range/Map No: 717. 06.29.16.82E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �� •mot 1 Benchmark 9 /D3. Dosing tj Alt. BM ` i �1 Aeration t Bldg.Sewer Holding St/Ht Inlet m c� TANK SETBACK INFORMATION St/Ht Outlet TANK TO 1 � P WELL BLDG. ELto Air Intake ROAD Dt Inlet Septic / Z 0 Q Dt Bottom ••7 Q$ .•-� Dosing O Header/Man. z• 1 /oaf L/ � 7 Aeration Dist.Pipe Holding Bot.System �/ f 3A. Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover Model Number PM►p rr � TDH Lift Friction Los t`11- d - a ��o•� fc�g tj o •`�C r Forcemain Length / Dia.1,4- Dist.to Well AA)SOIL ABSORPTION §YS TEM BEDITRENCH Width Length No. 8 - 9 ench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 'Q 5 ___� SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f ystem: 0 UNIT Model Number: DISTRIBUTION SYSTEM .�-- Header/Manifold/ Distribution /(Z x Hole Size x Ho e le Spacing ve Air Inta Pips) 3 u Length Dia Z- Length Dia _ Spacing 2 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded x ched Bed/Trench Center % Bed/Trench Edges Topsoil 1 s � No Yes � No 6 COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / 0 / Inspection#2: Location: 2157 Cty Rd DAD B'aldwin,WI 5544002(NW 1/4 NE 1/4 6 T29N R1 6W) NA Lot 1 g) Parcel No: 06.29.16.82E 1.)Alt BM Description- tf'r (-Z 0-, 2.)Bldg sewer length -amount of cover yz Plan revision Required? FQ Yes No Q L 1— Use other side for additional information. Date Insepctor's ignat Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NE 1/4s 6 /T 29 N/R 16 W TOWN Baldwin COUNTY ST.CROIX SYSTEM ELEVATION 100.2' 1.7'sand lift 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 3/4" pvc pipe ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Cty Rd DD Scale = 1 /4" = 10' S acre parcel Tank is to be properly bedded and provided with lockdown cover with approved warning labels Pro 3 Grading is to be done to N Bedroom divert run-off away from Huffeutt House s stem Combo Te BV.* -2 B- 1 ` 99.5' 98.5' 97.5' 96.5' 8% slope B-3 Wel l is to meet al I Area 15' below system WDNR setbacks is to remain undisturbed 285' Property Line county Safety and Buildings Division 4_,11$ 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) 0 . Zi Madison,Wl 53707-7162 Store Transaction Number 'ganitary Permit Application IZ39 in accordance 383 21(2),Wis.Ada 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 ddfcr=than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Stets. L Application Information-Please Print All Informs tm Property Owners Name LA parcel# /I -3i ��oL Property Owner's Mailing Addrcsr Property Location A/ -K Z_ _5 6/, Govt LA City,State Zip C�e Phone NZA&; ,J�, i/,W2L%. Section; / 7 1 / W4 C"i K I'/I-1�s A�r_7 N; R W 1 F 11 Type of Building(check all that apply Lot# -4-- Subdivision Name 2 Family Dwelling-Number of 4 "R�L 30)[AY. 01 ❑Public/Commercial-Describe Use 6k 4,N iou. 4D' f ❑City Of ❑State Owned-Describe Use A CS9N­=ba Val Z0 ❑Village of :7=P (� a c xown Of Ti " — - - )MR. oSPermit: (Check only one box on line A. Complete line B if applicable) ❑Rplawment System ❑TreaurientJ11.1ding Tank Replacement Only ❑Other Modffiobcni to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Clump of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration I I owner TV.Type of POWTS System/Component/Device: (Check all that app] I L_,O"Ook ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound Z 24 in.of suitable soil ;��d<24 in.of suitable soil ❑Holding Tank ❑Otter Dispersal Component(explain)— ❑Pretreatment Device V.Dispersal/Treatment Area Information:,#-, Design Flow WV Design Soil ApplicaboaJ61w"dsi) Dispersal Area R i (sf) Dispersal Area PrV&ed System Elevation '7- VL Tank Info Capacity in Total #Of manufacturer Gallons Gallons Units NOW Tanks Existing Tanks 91 "1 ii C7 CL Septic or Holding Tank Dosing Clnunber _VII.Responsibility Stater t-1,the undersigned,assume es ibft for installation of the POWTS sbown ou the attached pl. Plumber' N ,"ria, hPfNUW Number Business Num 2,76 (� * Plumber's Addren(Street,City.State,Zip Code /_?,&, C4Ub,)) 01. _7 VIII.Conn artment Use Only 3Approved isapp Permit Fee Daft Psuc# Issuing Signature Pv�� 5151J* 'm 1 62:5. th5wnerl(; en Reason for Denial DL Con ­-6SVq#J4WVtsons for Disapproval P 3) eff Julint filter 9M dispersal cen•must all be services I maintained as pe.rjrnaqegernent plan provided by plumbqq. ad 0 vk A#49�. requlrernetft Must be'jnaintainL A,go f_AtrA�" Aftwl to complete plow for the system and submit to the County only no paper not less than 9 in x 11 iwjm in sin AJ)l GC v_ SBD-6398(IL 11/11) > EeAR DIVISION OF INDUSTRY SERVICES yo p TQ� 141 NW BARSTOW ST FL 4TH m WAUKESHA WI 53188-3789 Contact Through Relay 3 K www.dsps.wi.gov/sb/ 7 www.wisconsin.gov ��xssroNSti Scott Walker,Governor Dave Ross,Secretary April 29,2014 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: 04/29/2016 Transaction ID No. 2395722 Site ID No. 801534 SITE: Please refer to both identification numbers,' Oevering Homes above,in all correspondence with the 2157 Cty Rd Dd Town of Baldwin agency, St Croix County NE1/4,NWI/4, S6,T29N,R16W Lot: 1, FOR: Description:Mound,3 bedroom Object Type:POWTS Component Manual Regulated Object ID No.: 1481651 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.01/01,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: This system is to be constructed and located in accordance with the enclosed approved plans and with the"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P(N.01/01,R 10/12)and the"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment S SSII,ON 2.0" SBD-10706-P(N.01/01,R 10/12). APpW The building sewer and distribution network piping shall be of material listed in bi 4, T1451M 384.30-5, g pp g Wis. Adm. Code. 's In the event this soil absorption system or any of its component parts malfunctions as to create a health hazard, the property owner must follow the contingency plan as described in the app rov a :in addition,the owner must comply with the operation,maintenance and monitoring duties as de i don VIII of the mound component manual.A copy of this information must be given to the owner upon coppletion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 4/29/2014 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. Sin ely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 WS14ART�`' julia.lewis @wisconsin.gov 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. Cover Page 2 �O g ,ND� APR 4 2014 S TRY SERV! Shaun Bird CFS Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/21/14 Owner:Oevering Homes Location:NE1/4 NW1/4 S1 T28 N,R19 2157 Cty Rd DD Baldwin 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 Conti enc Ian 9 Yp 9-11. Soil test 12. Filter Specifications and cross section Shaun Bird SALLY Signature VED License number 6900 JgFETYAND SERVICES -�USTRY SERVICr PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NE 1/4S 6 /T 29 N/R 16 W TOWN Baldwin COUNTY ST.CROIX SYSTEM ELEVATION 100.2' 1.7'sand lift 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 3/4" pvc pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL 11 H.R.P. same as benchmark Cty Rd DD AL Scale = 1 /4" = 10' 8 acre parcel Tank is to be properly bedded and provided with lockdown cover with approved warning labels Pro 3 Grading is to be done to Bedroom divert run-off away from Huffeutt House system Combo Tank B.M.* B-2 B- 1 9'9.5' —i 98.5' 97.5' 96.5' 8 slope B-3 Wel I is to meet al I Area 15' below system WDNR setbacks is to remain undisturbed 285' Property Line Mound System Cross Section and Plan View - - - - - - - - , - - - - - - - - - - - - - " � Dimension Feet i� r i i B J i i D i . 4 • L .•4 L •A 4 h . 4 •4 4 •J' .,•Y4 •J .J •Y4•L • f •r •L •!f •h•L •I 4.4 •f 4•M1• •r•f .f .••4• r . 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' f Y4•YL•4•L•,�LfLfY�J�r�J 4•M1•M1 h 1 .f.(�'f.f•f•f.r• •4.4.4.4•L •!•f•f•f•r•M! ..Y4•L•L•h•Y4•Y ..f.f.l•J•J.J•f•r . .-- a j:}if•J•f~f .•4•M1•L•,•h L ..J•r•f•t f .L•,,•4, F L.. ••f•r• ••M1•h.4.4 4 •r•f•J•r J ..M1.M1•4•LK .• •f f .L 4 •r•r•f 4.4 4 .J•J: A ' •{4 L,,•h •L•L•L•L•L•, •f•1•f•J.f•{ L ti•ti{L{4.h{�.rti{y{y{1{i{1{y.�{�?y{�{.'•{4{L{L14•L.4.,.4•L•,.L.L.L.Y4• t •,•\•Y4 4 hi•JY•J•J.J•J•}•J•r•f•{•f•f•r•f•f•!•r•r•f•f••J•f•f.r•f•!•r•f.f•r•!•f•r•!•!•f•!•!•r•nr•f-f•!•r f•f•f f i i G W Z H 0 i i I J i i I i i J 7 I i K f i L R i - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - W 0;Y � - - - - - 1 Z 9 K --T- B Slope % L i' 1 =Topsoil F77 =ASTM C-33 Clean aggregate = 4 in. sch. 40 pvc '/2 to 2 %z in. dia. 0 observation pipe L _ , Cap Material sand fill Geotextile G H Fabric F • L•Y L h•h•L•L•\YL• I f .rLrhr •fyf1{1?�{lJti{\{•. rM•J �JV•J•f•J•J•J•r•'':'• D E Plowed Surface Ft Contour Slope Direction the GENERAL INSTALLATION: The mound area is staked area out laXO� is p owed with acontour. Existing o ocee site. The or vegetation is mowed and raked off d if the soil is wet enough at the plow depth to form a '/4 inch soil wire chisel plow. Plowing may not p is placed immediately when a sample is rolled between the palms of the hands. AST inch ofsand under the tracks or after plowing. Sand is placed with a tracked machine keeping 1 r more inc is laced overhead by a backhoe. Special care must be used when placing n is sand of less than a one ire mound p p topsoil p thickness to minimize compaction of the lowed surface. After t e from f is seeded and mulched to promote vegetative growth, limit erosi lacewi hdrebartor a closet flange. g The observation pipes are slotted in the lower 6 inches an d secured m pac 10/071gi Page of Pressure Lateral Layout Two Laterals — End Manifold �-- Threaded Cleanout Lateral Turn-up Plug Manifold M * X L Long I // Sweep Force Main 90 Bend Pressure System Construction Distribution Network S ecific�nIn. Lateral Diameter 2 In Laterals are constructed of Schedule 4]down. Manifold Diameter In pipe. Orifices are drilled perpendic Orifice Diameter �,�j� In the pipe with a sharp drill bit and face X Orifice S acin " Ft. Lateral turn-ups terminate with a thL Lateral Len th Ft cleanout plug and are enclosed in a 6 M(Manifold Len th ` In diameter lawn sprinkler valve box accessible Force Main Diameter r_ In from finished grade. Force Main Len th • • • • • Grade • • • • • • • :� .. : : ; ::: ::::. 6-8 Inch Lawn Sprinkler Valve BOX Page of __-- 03/051gj i Sec tion And pump Performance Specifications Septic-Dose Tank Cross Pump Manufacture1 �i ✓ Tank Manufacturer ✓' pump Model Number Tank Model Number Manufacturer d z� Total Tank Capacity Alarm Model Number Max.Bury Depth Switch Type , Total Dynamic Head(TDH)- Feet Filter Manufacturer Elevation Head. Filter Model Number i Distal Pressure 3' Network Loss M m pump perfoMMU Retluired Force Main Loss ' —, Ft TDH Total , Manhole Min.4"Above Grade Outlet Manhole Min.4"Above('Trade With With Locking Device Locking Dr,lice- Inlet Manhole „rely Mounted <6"Below Grade Sealed Watertight Weather-proof - ...— junction Box -- Finished Grade --► Vent Min. 12" Disconnect Above Grade Means • With Vent Cap "et Filter ---.._,i ----- - --- '• Inlet Baffle Wet A Weep Switch Setgnp and ReseYVe GPI Hole Tank Vohune= -:5 B e Gal- Inches Volum '. Dimension: (reserve)A::: C)ff Elevation C B 2 Ft Bottom (alarm) _ �` (��) c �'� D Elevation a (dead) D ' ::• :•.•:::::::::: Total >...:.::,:...,..<.................... with the and filled in accordance ALLATION: The septic/dose tank is bedded ified by the manufacturer may not GENERAL 'NST specifications- Maxim th of bury as.spec (padlock) val spec w , grade ha an effective locking de t fittings, and manufacturer s product.appip roval. Manhole covers expo' echa . the tank with watertigh be exceeded without prior app oved mate 4" sch,40 PVC to bridge . piping at the i�and outlet is of approved main�sleeved;with and Comm the tank installed P or Wig. The force mab! 16.2:1. laid on stable soil to prevent settling t. Eledrice►1 service complies with NEC 3 excavation and the sleeve is sealed ,Olrtigh Page of 02105 L) Waste SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow-Liters/Minute Epoxy-coated Cast iron 0 s0 100 150 200 250 300 Cover 35 11 N� eir,.t C ec1 t Ifgn 10 30 8 Impeller Material Thermoplastic Elastomer r 7 m Volute Epoxy-coated cast iron 20 6 m s 15 ° d Mechanical Shaft Nitnie with carbon and = 3 = Seal ceramic laces 10 2 0 Shalt Steel o 0 20 16 60 80 1lilCd�e6dYQ ' Flow-Gallons/Minute �� � ni9Wba61I ? " aea 6.87 Ur 1 4383' B UO' SEN-40 SEN-40-AF S peclacations • •e • • e S ; 509211 M10 115 1112", PT 9/920 80 70 60 45 25 32 14k 20 26.5 17y50 EN-90 3A6 e 70 60 45 25 32 14 20 27 5 1750 -40-AF 509213 4J10 r 116 1 1M ?T 2� �7 ". 0 Franklin Electric 400 East Spring Street,Bluffton,IN 46714 Tel:260.824.2900•Fax:260.824.2909 www.franklin-eiectric.com Form:096199 7.11 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page_ of SYSTEM SPECIFICATIONS FILE INFORMATION t Septic Tank Capacity al ❑NA Ovmer e E' Septic Tank Manufacturer NA Permit# .-� Effluent Filter Manufacturer �',�',E„� ❑NA DESIGN PARAMETERS Number of Bedrooms ❑NA Effluent Filter Model ❑NA NA Pump Tank Capacity al ❑NA Number of Comm Units erclal Tank Manufacturer NA Estimated flow(average) aUda Pump Design flow(peak),(Estimated x 1.5) qL� al/d Pump Manufacturer , ❑NA Soil Application Rate U al/da /fF Pump Model V ❑NA Monthly average' Pretreatment Unit ❑ peat Filter influent/Effluent Quality C] Sand/Gravel Filter Fats,Oil&Grease (FOG) 530 mg/L ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality A Monthly average" Dispersal Cell(s) ❑ In-ground(gravity) ❑ In-ground(pressurized) Biochemical Oxygen Demand (BODS) 530 mg/LMQund suspended Solids (TSS) 530 mg/L ❑ D igrade Total Suspe ❑ Other. Fecal Coliform(geometric mean) 510'cfu/100m1 ❑ Dri ine Maximum Effluent Particle Size Y,inch diameter Values typical for domestec(non-commerdaq wastewater and septic tank effluent +• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every ❑ months earls) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third(Y,)of tank volume Inspect dispersal cell(s) At least once every ❑month ar(s) (Maximum 3 yrs.) At least once every ❑ month ar(s) Clean effluent filter a s ❑ NA Inspect pump,pump controls&alarm At least once every �❑ month K ) At least once every ❑ months ear(s) ❑ NA Flush laterals and pressure test ❑ months ❑year(s) ❑ NA Othec At least once every other At least once every - --nth-. ❑year(s) ❑ NA MAINTENANCE INSTRUCTIONS one of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual carrying Septage certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector,POWTS Maintainer, 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 ot���eoeffluent levels or ponding of effluent on the ground surface. The dispersal cell(s)shall be visually inspect ponding of effluent on the in the observation pipes and to check for any ponding of effluent on the ground surface. The po g authority. ground surface may indicate a failing condition and requires the immediate notification of f more of theulato volume,the When the combined accumulation of sludge and scum in any tank equals one-third(K) with ch. NR entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance w 113,Wisconsin Administrative Code. The servicing of effluent fitters,meth nical or pressurized POWTS components, pretreattment components and any other maintenance or monitoring at i ervals of 12 months or less shall be performed my certioi f POse viceMevent'ner. a of co p A service report shall be provided to the local regulatory authority within 10 days START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s)few I cell(s). lf high conlcentrations are detected offer chemicals that may impede the treatment process and/or damage the d p detected have the contents of the tank(s)removed by a septage servicing operator prior to use. Page ,of —, START UP-AND OPERATION for the presence of painting products or other chemicals thIlt For new construction, prior to use of the r damage check treatment tank(s) if high Concentrations are detected have the contents of the may impede the treatment process and/or f{e�d dispersal cell(s)- tank(s)removed by a septage servicing p prior System start up shall not occur when soil conditions are frozen at the infiltrative surface. or surface discharge will be power outs es pump tanks may fill above normal highwaterlevels. end may result in the backup the excess wastewater f effl l thie During pow g cell(s) operator prior to restoring p discharged to the dispersal cell(s)in one large dose,overloading the Servicing pA or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels To avoid this situation have the contents of the pump tank removed by a septage effluent pump within the pump tank. compact,the area within Do not drive or park vehicles over tanks and dispersal calls.on area not drive or park over, or otherwise disturb or comps , 15 feet down slope of any mound or at-grade so prolong the life of the POWT1b: Reduction or elimination of the following from the wastewater stream may improve the performance and pro g cotton swabs; degreasers; dental floss; diapers; disinfectants; fat: foundation drapn asoline' grease; herbicides; meat scraps; medications; oil; painting produa>I.s; antibiotics; baby wipes; cigarette butts; condoms; (sump pump) water; fruit and vegetable peelings; 9 pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT p system is roe I When the POWTS fails and/or is permanently taken out of s 33 ice thhee folio ing atstrata aCodetaken to insure that the sys P P t Y and safely abandoned in compliance with chapter Comm 83. • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The 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 s(I)II, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compli�pn replacement system: re uii ed ❑ A suitable replacement area has been evaluated distmrbance and utilized compaction and should not be infringed nfri ged upontby s qs�m. The replacement area should be protect with the ruled it setbacks from existing and proposed establish structure,,lot ilines and welmentaarea.t Repltacement systems must comply with t the 0 it for a new soil and site evaluation to effect at that time. ❑ A suitable replacement area Isg of available tou replace tthe failed POWTS. Barring advances in POWTS techn ogN r a last holding tank may be installed a -94, site has not been evaluated to identify table eapfa o Qeplacementa area fallure available aOhoding tank may be installed ha must be performed to locate ssui able replacement a last resort to replace the failed .,Mound and at-grade soil absorption systems smco be reconstructed cted in place ffect at that time.moval of the biomat at the infiitrafiiv surface. Reconstructions of such systems <<WARNING>> SEPTIC,PUMP AND OTHER OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES AND/OR[DEATH MAY RESULT. RESCUE OI= ENTER A SEPTIC, PUMP OR OT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MAINTAINER POWTS INSTALLER �- Name _ Name Phone 7 Phone SEPTAGE SERVICING OPERATOR JPUMPE R LOCAL REGULATORY AUTHORITY Name Phone 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. -GE IN VILTEK LARrR Ij S41P I Dry Hrr I*". -". "to din t1w non"t 04'.t- ClillAwl'ad"Wiliv.t6 Q".V"Up"'111111. V OOK tank through thig aWW jw wjv"k w6w to")a,wk1w fhgwt kowo j4jj�'O itflyr tour ddft�jajIdj pipe twlku tile"Ilt6t of iNi�fhclt ot,the 10111fifi, 04M"lollij to War,,,, ilia ftv,•to oft tank rNtlillttol"UPP'"IM21"4MIDOwt-If We mal WON 0 Ut"110 ifre to 4"fauir. MWOUtt lou"Oud W Itut"U114W, Fur kWkWWJ&kS A"-ajjjq the VpMUW WWUftW'VtW. Salmetst wield dw 4-6-11 pipe oolka this N*v C.4mv. It Wde ,id,gUM.Ort: 00114rvtf 11tor"d to bum fi*ul� Sulotwt k"ISW641 i4i but &Olftht WOW OW MCI tagg Wtv th, Okes. OW-Wil9w irav ma cost, PrUwAfiq 09wh ailt" the hhv itleks I'Itts tile tiffs t:"w rkm*wkelf'd VRS"W" 4makk into t4k%0aur jjtjfj luck j$V ttltrnsrk A. The 41044"t fter SIVUU14 be Clow"ovary Wrte live lawle tahk Surv"d. upwwo4m to Inspect tab tank Oild safe to tu"A)v the duliva A. 'tly"tiff 01"1111111*0th of tiva Unk 4o"d hot JtjA tile#;Vlllrl Ihd Jfil,lent" O#x;'"a"0'*41#hL'Iwvwt hart t,""towwred bale to tits ilowrot"I '#atlet D'P*' ('P"n tW-911twor Noodle to gidjUdyt, 00twidw hvilftf#*t!"V. the 5. Shilm the nw"w tri,vgj till,�j,the c"a rte le a VAE;Sw", infiln-trid to avv wwol ifi RtwMA,Life stviid� shtruld he'Swtsvwd by t-11il4sp 1�4MotarduckwWV with wiper only. 011"VAkd dU;AkdJ /. UlNhile Itultlliid Lire MrWWUD Mi tts-Sidw(1wjj*nut uuttla j4r 'Imu only,dow")ever the'kumw upw*'%tr"14V GOOddoe Ni makikis wire all supgago.110twW is rk*Vd baCk 6t71 k" it"k d. If vki& N ttbr anti mAv datimisty 1101"- 9' """ga the#N'm'cm"WdlM bb"k 14""m t*kj down.until the WWI,10aw i4a rise bOU"m 114'Ow Cw". 10-RePlave and jumm Ow OC%;W6"OUlIllig all UIS tallk. r'41 -14 "'!V; 401 1 LL) ST. CROIX COUNTY . SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerJBuyer 0e�,ei► �Q,p Mailing Address /�3 ee i2 Property.Address 2-) (Verification `C?) from Planning&Zoning artment for new —----- construction.} City/State_ Parcel Identification Number �9G��/oZ -30 a D72 EGAL DESCRIPTION Property Location&�c2�' , Sec. / T N R `—' ,l jo W, Town of Subdivision — ) Certified Survey Map# C -- - Lot#_1 _ - trolume Warran ty Deed# �- Page#�OIJ , � �� 7) , Volume Page# Spec house yes no Lot lines identifiab yea , o SYS�'EM MTENANCE OWNER CER T�'ICATT4.N lnlproPer use and maintenance of your septic system could result in its maintenance consists of pumpinig out the septic tank every three ears or soonerf mature failure to Dandle wastes. Proper the system can affect the function of the y needed,by a licensed �'�Ponsibilities are specified in Cow ink as a treatment stage in the waste disposal per' What you put into § mm.83.52(1)and in Chapter 12-St.Croix County system, Owner rnaintertance ty Sanitary Ordinance. The property owner agrees to submit to St Croix Co o and by a master plumber,journey un Plumber,restrict d p Plumber �e�d Department a certification fo'Dning wastewater disposal system is in propel argued by the less than 1/3 fu]i of shtdge. ° condition and/or(2)after inspection and verifying that ar the a site P�pmg Unnecessary),the septic tank is I/we,the enders' standards set forth, r,as s have read the above requirements and agree to maintain the private sewage disposal system with the �'herein'as set by the Depart of Co Certification stating that your septic system has b �Oe and the Department of Natural een maintained must be completed d Resources,State of Wisconsin. Zoning Departrnant within 30 days of the three year expiration date, mtumed to the St.Croix County pTaiming& Uwe certify that all statements 0nWU form are true to the best of my/our knowledge. I/we am/are th Property described above,by virtue of a e owner(s)of the deed recorded in Register of Deeds Off�, Number of bedrooms �O�FAPI�UCANNT(S)�� S 12_/ *w* DATE�� Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning D include with this application a recorded warranty deed from,the Register of Deeds Office and a Department reference is made in the warranty deed, copy of the certified Survey map if (REV.08/05) II 111 IIIIIIIIIIIIIIII 111111 I I STATE BAR OF WISCONSIN FORM 2 - 2000 13 Tx?4184605 i3 Document Number WARRANTY DEED 995093 BETH PABST THIS DEED, made between Gabriel G. Feuerhelm and REGISTER OF DEEDS Kathryn M. Feuerhelm, husband and wife, Grantor, and ST. CROIX CO., WI Oevering Homes, LLC, a Wisconsin limited liability 04/23/2014 08:58 AM company, Grantee. EXEMPT#: NA Grantor for a valuable consideration, conveys and warrants to REC FEE: 30.00 Grantee the following described real estate in St. Croix County, TRANS FEE: 123.00 Wisconsin: PAGES: 3 SEE EXHIBIT "A"ATTACHED HERETO AND MADE A PART HEREOF Recording Area Name and Return Address: 3 Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, Wl 54016 1115706 Exceptions to warranties: 002101230200 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN) This is homestead property. Dated this April 11, 20 4 l A I Gabriel G. Feuerhelm . � Kathryn M. reuerhelm WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 St. Croix County 995093 Page 1 of 3 � AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W II Pb 0 ki 11 COUNTY OF authenticated this April 11, 2014 Personally came before me this �' j * the above Gabriel G. Feuerhelm and Kathryn M. TITLE: MEMBER STATE BAR OF WISCONSIN Feuerhelm, husband and wife to me known to be the (If not, person or persons who executed the foregoing authorized by§706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Martin D. Henschel V;4 ) 6800 France Avenue South, Suite 410 Cheri Brown Edina, MN 55435 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My commission is permanent. (If not, state the Both are not necessary.) expiration date: 03/01/2015) *Names of persons signing in any capacity must be typed or printed below their signature. CHEFl R© ra� PW uer SNSCO l WAR DEED WARRANTY D STATE BAR OF WISCONSIN FORM No,2-2000 St. Croix County 995093 Page 2 of 3 /S 7 9 9 6 3 1 VOL 20 PAGE 5015 KATHLEEN H. REGISTER OF DEEDS ST. CROIX CO. UI RECEIVED FOR kECORD 07/08/2005 03:13PH CERTIFIED SURVEY MAP - _ j �l T (/ �j /( /��aPC rrr. i5 N �_• �J 1 FIE L �) l.J R V E 1 .Li/.:A ES: 3 4.00 LOUR-ED IN PART OF TH, NORTHWEST 1/4 OF TAE NORTHEAST 1/4 OF SECTION 6, TOWNSHIP 29 NORTH. RANGE 16 WEST. TOWN OF BALDWIN. 3.. CROIX COUNTY, WISCONSIN. OWNER: LEA TABLE: NOTE: GRANT FLEISCHAUER LINE# DIRECTION DISTANCE BEARINGS REFERENCED -0 THE 4027 220TH AVE. NW NORTH LINE OF THE NORTHEAST OAK GROVE, MN 55303 L1 S 00'26.16" E 38.06' 1/4 OF SECTION 6, T29N, R16W L2 N 87'24'47" W 709.61' ASSUMED TO BEAR S 87'24'47" E. L3 N 01'45'37" E 38.00' L4 S 87'24'47" E 708.15' N 1/4 CORNER DEDICATED SEC. 6 FOUND 1" UNPLATTED LANDS_ TO THE PUBLIC BERNTSEN NAIL 26937 S.F. 0.61 ACRES 613.46'— — L4 _ NORTH LINE OF THE NE 1/4 S 87'24'47" E 2643.26' 25' JOINT 00 L1 1321.65' DRIVEWAY - UNPLATTED�AIJDS cr EASEMENT z L2 o a NE CORNER VOL. 2838 0o_ 5 8T24'47" E 711 53' o o SEC. 6 FOUND PG. 138 U y O— — —O — — — — — — — — — _ _ 50.06' 1" BERNTSEN NAIL v I I rn I I N 1 IZ co I I °o IZ I� "' I LOT 1 I 1-0 m L 348495 S.F. I rn y t o \ 8.00 Ac. m l m l o L" I z ill CD �\ I I- I \ I 'se \ 1 - - - - - - - - - - - - - - - - -I i N 87'45'13" W 416.83' UNPLATTED LANDS SETBACK NOTE: LEGEND: FRONT SETBACK = 100' • SET 3W4" BY 18" IRON SIDE SETBACK = 12.5' PIN �w�l 1.50 LBS./FT REAR SETBACK = 25' -40 COUNTY SECTION MONUMENT (FOUND AS NOTED) ' - - - BUILDING SETBACK LINE SCALE: 1• _ 200' L 3 00/ - - 25' DRIVEWAY EASEMENT 0 50 100 200 HIA'Aw m.S- `- (g) SOIL BORING �ry�SO..... ,,��•� - PROPOSED JOINT DRIVEWAY THIS INSTRUMENT DRAFTED BY JASON PAUKNER SHEET 1 OF 3 HUMPHREY ENGINEERING Vol 20 Page 5015 1593 SOIL Wisconsin Department of Commerce - K; UA1ION REPORT Page 1 of 3 Division of Safety and Buildings in Accordartce'm7 ht Comm 85,Wis.Adm.Code Steel's Soil Service,Inc. Attach complete site plan on pa harF8%x 11 inches in size. Plan Must County St.Croix include,but not li 'ed to o talWerence point(BM),Airectiorf and „ percent slo o Viand location and distance to nearest road. Parcel I.D. print all intprmaon, R ewed Date Personal information you provide may be used for da ur O( )) secnaPr � s(Ravee�taVfr;s.15.04 1 m . Property Owner Property Location Fleishauer, Grant Govt.Lot na NW 1/4 NE 1/4 S 6 T 29 N R 16 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 4027 220th Ave NW 1 na CSM#-e iw S� City State Zip Code Phone Number J City I Village �+ Town Nearest Road Anoka MN 55303 715-753-2419 Baldwin ;?/ Cty Rd DD Id New Construction Use: 16 Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD ,I Replacement J Public or commercial-Describe: Parent material End moraines and ridges of ground morarines Flood plain elevation,if applicable na General comments and recommendations: Mound design,System elevation 100.17ft. based on contour line elevation 98.50ft. r la Boring# I Boring 01 Pit Ground Surface elev. 99.50 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 none I 2msbk mfr cs 1c .6 .8 2 9-16 10yr6/4 none sl 2msbk mfr cs 1vf .6 1.0 3 16-18 7.5yr4/4 c2d 7.5yr4/6 sl 2msbk mfr cs na .6 1.0 4 18-36 5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 Boring# I Boring 01 Pit Ground Surface elev. na ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 1 0-8 10yr3/2 none I 2msbk mfr cs 1c .6 .8 2 8-23 10yr4/4 none sl 2msbk mfr cs 1vf .6 1.0 3 23-43 7.5yr4/4 c2d 7.5yr4/6 sl 2msbk mfr cs na .6 1.0 4 43-50 5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) ignature: CST Number David J. Steel 248956 Address Steel's Soil Service,Ind Date Evaluation Conducted Telephone Number 994 200th St.,Baldwin,WI 54002 10/26/2004 715-684-5680 Property Owner Fleishauer,Grant Parcel ID# pending Page 2 of 3 F Boring# Boring 1 Pit Ground Surface elev. 96.40 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 none I 2msbk mfr cs 1 c .6 .8 2 8-25 10yr4/4 none sl 2msbk mfr cs 1vf .6 1.0 3 25-42 7.5yr4/4 c2d 7.5yr4/6 sI 2msbk mfr cs na .6 1.0 4 42-50 5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 F-1 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 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 F-1 Boring# --1 Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. FSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<_30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format,please contact the department at 608-266-3151 or TTY 608-264-8777. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Grant Fleishauer 994200 th St. CST-POWTSM SE1/4,NW1/4,S6,T29N,R16W Baldwin, Wl 54002 Lic. #248956 Town of Baldwin, St.Croix Co. Bus.(715) 684-5680 Lot 1, Pending Fax.(715) 684-3449 This soil evaluation was conducted to satisfy a zoning requirement,it may or may not be suitable for your use. The location of this test may or may not be as shown,as permanent lot lines were not established at the time the soil test was conducted. Legend N 1"=40' =Benchmark Ele. 100.00 ft Top of 3/4"pvc pipe • =Alt Benchmark Ele. 100.00 ft Top of 3/4"pvc pipe ❑ =Borings Boring Elevations B 1 = 99.50 ft B2= 99.50 ft B3= 96.40 ft -- B4-°- ------- Q_Q0 ft-- - -- �J c r/Vl �4 � 7 W, s��f- • r /S RECEIVED �- 7g--3831 � VOL 20 PAGE 5015 - 6 � REGZISTER OF DEEDS RECEIVEDxFOR.hECORD 07/08/2005 03:15PM CotjNTV��CR01X1 T T T` �;j T IFIED SURVEY MAP 1 J� E L S) �.l R V E 1 .Lip.;` ESFEE3 4.00 LOCATED IN PART OF THE NORTHWEST 1/4 OF TIE NORTHEAST 1/4 OF SECTION S. TOWNSHIP 29 NORTH, RANGE 16 WEST, TOWN OF BALDWIN. S-. CROIX COUNTY, WISCONSIN. OWNER LLIE TABLE: NOTE: GRANT 2 AUER LINE DIRECTION DISTANCE BEARINGS REFERENCED "v THE 4027 220TH 0TH AVE.A NW NORTH LINE OF THE NORTHEAST OAK GROVE, MN 55303 L1 S 00'26'16" E 38.06' 1/4 OF SECTION 6, T29N, R16W, L2 N 87'24'47" W 709.61' ASSUMED TO BEAR S 87'24'47" E. L3 N 01'45' " E 38.00' 37 L4 IS 8724'47" E 708.15' N 1/4 CORNER UNPLATTED LANDS DEDICATED SEC. 6 FOUND 1 TO THE PUBLIC BERNTSEN NAIL 26937 S.F. 613.46'— L4 0.61 ACRES NORTH LINE OF THE E_ —L3 ° S 87'24'47" E 2643.26� 4 25' JOINT—� o?� DRIVEWAY _ UNPLATTED LANDS L2 Ll-- , 1321.65 EASEMENT o NE CORNER VOL. 2838 S 87'24'47' E 711.53' o PG. 138 _ — — — — — _ o o SEC. 6 FOUND & 1 0s O Qs — — — — — — — _ 50.06' 1" BERNTSEN NAIL CA C N I I I it i 1 I IZ LOT 1 i C i 348495 S.F. �° \\ 8.00 Ac. vi Io y io m Z \ rn r N 87'45'13' W 418.83' , UNPLATTED LANDS SETBACK NOTE: LEGEND: FRONT SETBACK = 100' 0 SET 314" BY 18" I ON SIDE SETBACK = 12.5' PIN w1 1.50 LBS.�-O REAR SETBACK = 25' \SC_ONS��.1� (FO ND ASCNOTED)ONUMENT �•� — — — BUILDING SETBACK LINE SCALE: 1' - 20d 4 so i1010 °_+%30o�� — — — 25' DRIVEWAY EASEMENT. o 200 ( SOIL BORING r'?°ggurye�����•`` PROPOSED JOINT DRIVEWAY THIS INSTRUMENT DRAFTED BY JASON PAUKNER SHEET 1 OF 3 HUMPHREY ENGINEERING 1 Vol 20 Page 5015 . i 1