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HomeMy WebLinkAbout040-1324-36-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569554 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 ax Nq Bast, Kernon J. Troy, Town of CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/ No: 0 9. 4 1 A - Z 6.6T TANK INFORMATION �.IN(7 g' 4 2: ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (,,,a t, (�_(�W I 'n C� Benchmark � � 1 /6L y Dosing U ! ,„1_ � � Alt. BM Arraft Q�(�,1[V1J Bldg.Sewer Holdina St/Ht Inlet / • /_ / C} TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Ot nt 'O� O�, Dt Bottom O Dosing Header/M an.an. / '` lb ,v I P I b5 1 0 MV507 ea 5 on Dist. Pipe /3 Bot.System /1 ;J I PUMP/SIPHON INFORMATION Final Grade Manufacturer �-p"�,I 1, G Demand, St Cover k I � Z. Model Number G!/- `�. BEN 6 �o��o.► q.'l 1113 TDH Li9 f I Friction Loss System Head � Forcemain Length h 5 Dia. Z� Dist.tot Well N J A- lQ SOIL ABSORPTION SYSTEM MWN3 BEDITRENCH Width Length No.OfTre s Ne-5fllts— In Liqui h DIMENSIONS 1 SETBACK SYSTEM TO t P/L BL G WELL LAKE/STREAM LEACHING Maneffa^' Type OSystem: INFORMATION CHAMBER OR —� n�h v � UNIT 1_W N1 N N M�e ber: DISTRIBUTION SYSTEM Header/Manifold FD stributio`nj x Hole Size x Hole Spacing Vent to Air Intake 9 �� � ngs) `Zr P g� 5/32- z t Len th Dia n Length Dia S acin SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 61 1 Depth Over Depth Over xx Depth of xx Seeded/Sodded U Iched Edges soil g Bed/Trench Center �� Bed/Trench Ed To P �--��es � No =£: Yes 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / ��/ Inspection#2: Location: 582 Schwalen Drive�,Hudson WI 54016(NE 1/4 NW 1/4 1 T28N R19W) NA Lot 35 Q; e l 1.)Alt BM Description= t' J�� �ap 2irc P'�`"� �� 2.)Bldg sewer length= 11 { / l L,/I L IQdJ� a J -amount of cover= 1-1 6 Plan revision Required? FO] Yes No � � Use other side for additional informati n. _ _ SBD-6710(R.3/97) Date Insepctor's Sign re Cert.No. PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarae Road Hudson Wi 54016 NE 1/4 NW 1/4S 1 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 112.5' BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XX)OC SEPTIC TANK 5IZE1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° ❑ BOREHOLE O WELL H.R.P. same as benchmark Al Property Line B.M. 428' Property Line Tank is to be properly Area 15' below bedded and provided with system is to remain lockdown covers with undisturbed approved warning labels B- 1 8 Slope 0 B-2 112' 111 .5' B-3 Grad i ng is to be done to divert run-off away from system Huffcutt Combo Tank el I is to meet al I DNR setbacks Pro 4 Bedroom House Pro Town Road to Schwalen Drive I County c s Safety and Buildings Division J' 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 �� 5to q unitary Permit Application s<ateTra In accordance with38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental uniQ ✓! is required prior to obtaining a sanitary permit Note:Application forms for state-owned POWTS are submitted to Adi ss(if di than mailing address) the Department of Safety and Professional Service. Personal information you provide may be used for secondary Zj l� '�� 5�� ses in accordance with the Law,s.15.04(1)Cm),Stats. Gy��O 0 , L A lication Information-Please Print All Informatio Properly Owner's Ijame 0 p ' a e,t� Property Owner's Mailing Address Property le, & Govt Lot / City,State Zip Code Phone Number A_y., 1/., Section l / Ic 1 ,�i T z;N; R W If Type of Building(check-all that ap Subdivision Name 2 Family Dwelling-Number of - ❑Public/Commercial-Describe Use, ❑City of ❑State Owned-Describe Usy / CSM Number ❑Village of X 75 Town of ✓��IaAltza - III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A-,- New System ❑Repl...ur System ❑Treamtent/Holding Tank Repl ameut Daly ❑Other ModiScation to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑(Mange of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Owner IV.Tvpe of POWTS S stem/Com onent/Device: Check all that appl J ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade vlouod>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Otber Dispersal Component(explain) ❑h a trnent Device(explain) V.Dis rsal/Treatm t Area Information: 4 Design Flow(gpd) Design Soil Application 3atffVV I Disp7 Area R G> Dispersal.Area Proposed(s System Elevation� t* VL Tank Info Capacity in Total #of Manufacturer c Gallons Gallons Units $� New Tanks Existing Tanks A� • rn h Septic or Holding Tank �t�y Dosing Cbambec VII.Responsibility Statement-I,the undersigned,anausVpAxisibility for iustallatioa of the POWTS shown on the attached plans. Plumber's ame(Print) Plumber' MPINIPRS Number Business Phone Number Plumber's Address(Street,City.State,Zip VIII Coen /De artment Use Only Permit Fee Date sued Issuing t Signature en Reason tur s Gz 5. 00 -/,4 IIL Con ns for Disapproval /D 1 ., .v taM,eflhilri finer tend-, . n ,. / 4 :�spw"*-,must all be ier*As/ naintilrW (A—) t:JQ- l �S as per management plats provided by;plurrlber. 2. A11 t1lBtiaaG�(rgcluirefr►ertts bell t st /'A/"b ri^•� t o/` , Attach to eomplese plans for the system and submit m the County only an paper not less than g x2:11 inches in sine 14) 6J;�7'dvt� .%A 544, SBD-6398(R.11 111) pEenxrr DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 Contact Through Relay 9� vvm.dsps.wi.gov/sb/ ,o www.wisconsin.gov � SSIONPk Scott Walker,Governor Dave Ross,Secretary April 25,2014 CUST ID No. 226900 ATTN.•POWTSInspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:04/25/2016 Identification Numbers Transaction ID No. 2393409 SITE: Site ID No. 801419 Kernon Bast Please refer to both identification numbers, Lot 35 Cottonwood South above,in all correspondence with the Town of Troy agency. St Croix County NEl/4,NW1/4, S1,T28N,R19W Lot: 35, FOR: Description:Mound,4 bedroom Object Type:POWTS Component Manual Regulated Object ID No.: 1480974 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver. 2.0, SBD-10691-P(N.01 101,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-10 1-P(N.01/01,R 10/12)and the"Pressure Distribution Component Manual for Private Onsite Wastewater Treatm� % �QN 2.Q" SBD-10706-P(N.01/01,R 10/12). DEpT®FpROVED(.Y The building sewer and distribution network piping shall be of material-Ji Pd O S- an� 30-5, Wis. Adm. Code. VV S1O1V OF AL or In the event this soil absorption system or any of its component parts malfunc ' so as to cr to a health hazard, the property owner must follow the contingency plan as described in the appr dition,the owner must comply with the operation,maintenance and monitoring duties as VIII of the mound component manual. A copy of this information must be given to the owner up Q%n of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 4/25/2014 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. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osbome Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 WiSMART, i:x'633 julia.lewis @wsconsin.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 Coimnerce 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. RECEIVED Cover Page APR 21 2014 " INDUSTRy SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/ 17/14 Owner:Kernon Bast Location:NE1/4 NW1/4 S1 T28 N,R19 Lot 35 Cottonwood South 1st Add 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 Specifications and cross section Shaun Bird Signature -AND License number V26900 �r2VICES `Y SERVICES 5—r,75-7D ENCE , PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarge Road Hudson Wi 54016 NE 1/4 NW 1/4S 1 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 112.5' BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line B.M.* 428' Property Line Tank is to be properly Area 15' below bedded and provided with system is to remain lockdown covers with undisturbed AL approved warning labels B- 1 8% Slope 110, 0 B-2 111 ' 112' 111 .5' B-3 Grading is to be done to divert run-off away from system Huffcutt Combo Tank Wel l is to meet al I WDNR setbacks Pro 4 Bedroom House Pro Town Road to Schwalen Drive Mound System Cross Section and Plan View - - - - - - - - - - - - - - - - — — — — — — — — — — — — — — — — — Dimension Feet i A J 1 1 B r 7 - 1 D /. v 1 1 •••h•L•L•L L •L L .�L : ti L L ••L L •J J •••L•h L •J J ••YL•L L N••J f ••h h .•L•L•h•M1 h ••J• ••L J•J .••YL•M1•h•L•M1•L•L•h•�•M1•M1 h J•f•f :..r}r•r•r.r•r.rvr•J-r}J•nrv-J.r.r.r.J•J•J•J•{•{-{•{-+•r•{•{{{{{{{{{{{{{;J{.YY{.M1.L{h.L{L{L. .r•L•L.YY}};: 1 1 .VYL•M1•Y •L••L•VY•Yh•Yh•\•}'L•L•}•L}M1}L}L}r}r•J•J•f.J,J•J,}•ry,JyJ•J.J.{•{ {J•r•!•J•J E ,. {{{{{{{{{{ '{y{{{{{{{\{{{{{H{?J Y{{{{'M{{h,ti,{{M1{{.M1.M1.YM1•L•YL}}f}J}r}l•J}rh•H}i}}J}l . rL•S}i; : : .'. �' {.J•J{J{!.7{ ��,!•J•J{{{fLJ{J{f{J{!Y{J{J{!'{J{r{l{,L,L{{{{{{{{r{{{•\{{•Y}•}}}}}}}}}}}}}}y}}r }}}f}J}r}JM1f 1 A 1 •,%}}•}.}}l K:f:f}J•r.}.}•}•}N•}•f.JY•}•}Y•}•r•f•1•J•f•f.}•l NCI{f{{M1:YM1.M1.M1•L•L.L•L.YL.L.L•YL•L.YM1•{• ;. i {YY• •\•L M1•\N•\• M1•L•YLK•L•\,h•\•YL•\• hK M1 M1 YM1 F r 1 r.r•f}r}}}}}r.f.}.r.J.r•7}}}•r.r•r.r.ry.f•r.J-f•r.J}}.J.J.J.r.J U.}.i.J y.J.r.J.r.J.J.J•J.f.J.r.r.r.r.J•J.Jy 1 W 41 G S 11. . •Z 1 I T� 1 H 1 i + I 1 1 I I J J. l� 1 b 1 1 K i t i L Z_ .y ♦ f _ — - - W Z B K � 1 Slo e L Topsoil =ASTM C-33 S*i3i =Clean aggregate = 4 in. sch. 40 pvc i•r.r. Cap Material sand fill }"}{}{ 1/2 to 2 '/2 in. dia. observation pipe Geotextile G H Fabric {.J.r J.J.Jf...f.J.{.. L• M1.M1.h•M1.h•'•'• F Yh• YYYVh•Y\H• {L. {.L•YVM1•h•M1•M1• D � E i ` Plowed Surface 1 i �. JC Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page of Pressure Lateral Layout Two Laterals — End Manifold -4 Threaded Cleanout Lateral Turn-up --► Plug Manifold M X ---� I L Long Force Main Sweep 90 Bend Distribution Network S ecifications Pressure System Construction Lateral Diameter In. Manifold Diameter � In. Laterals are constructed of Schedule 40 PVC Orifice Diameter j In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) 7 In. the pipe with a sharp drill bit and face down. �' Ft. Lateral turn-ups terminate with a threaded L Lateral Len th °`� ceanout plug and are enclosed in a 6-8 inch M Manifold Len th) Ft. _ - diameter lawn sprinkler valve box accessible Force Main Diameter In. Force Main Length Ft from finished grade. Grade • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05193 i • Cross Section And Pump Performance Specifications Septic-Dose Tank Cro P Manufacturer Tank Manufacturer Pump Model Number y✓ Tank Model Number Alarm ManufacuuPr C •� Total Tank Capacity Alarm Model Numb Max.Bury Dept Switch Type Total Dynamic Header- Feet Filter Manufacturer Elevation Head �. Filter Model Number Distal pressum , .7 Network Loss erfoxmance Required Force Main Loss Minimum Pump Ft TDH Total With Manhole Min.4"Above Grade outlet Manhole Alin.4"Above Grade With Locking Device Locking Device. Inlet Manhole Securely Mounted <6"Below Guide Sealed Watertight Weather proof - Junction Box •- Finished Grade —► Vent Min. 12" Disconnect Above Grade Means With Vent COP outlet Filter -----�y ----- - --- r Udet Baffle •. valet : A '/4' Weep and Reserve Capac1tY '' • Switch S bole Tank VOh me GPI X. Volume Gal• Dimension; Inches �- (reserve}A J :; off Elevation C '' �Ft BOtCOffi •.: �alalln ,, S /. S :;} Elevation > (dose) D Ft s3 ., D Total .. •::.•, ;:: >`.•:.}';:>;•:t: ,..;, ,..:. accordance with the and 'back filled in dose tack is �be manufacturer may not GENERAL LLATION' The septic um depth of bury es.specified.by device(padlock) 's product. specifications. Maxim have an.effo�ive locking and manufacturer p royal. Manhole covers exposes to ° to the tank with watertight tbridge fittings, be exceed without poor app approved material,Conn ��Sch•40 PVC to bridge the tank installed. Piping at the Wet and outlet is of aP�e force main.is Sleeved w� 3��d Comm 16.2 insta or sagg�g• sen+ NEC :t. laid on stable soil to Prevent s Electrical ice�mPltes with NEC and.the sleeve is sealeA page of 02105 LJ Waste _ sEN40 series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow-Uters/Minute Cover 250 300 ox coated cast iron Ep y- 0 50 100 150 200 *•. 35 11 M ¢r -c ed t It. 10 30 '1 Impeller Material Thermoplastic Elastomer P volute Epoxy-coated cast iron L zo s fr " ONE= 1 4 d Mechanical Shaft Nttdle with carbon and i 3 ceramic faces 10 Segal 5 1 o Shaft Steel 0 f �t 0 20 60 ao reev Flow-Gallons/Minute � ' �I I aea I 1---+°s'- u.s• + LEM - 680" am• I l53' B G5' SEN-40 SEN-40-AF SpeCMcations HP VOLTS1110,06ra. MODEL NO, ITEM NO, 80 70 80 3214 20 28.5 1750 SEN.. 0 '509211 "41/10" 115 1-1/2"FNPT 81920 AAgg S#&' t f .N .:'. _. ... SEN-40-AF 509213 41110 -'1 15 1-1/2"FNI?T 91920 g.�SO 70 60 14 20 27.5 176 32 �* X17 Franklin Electric 400 East Spring Street,Bluffton,IN 46714 Tel:260.824.2900"Fax:260.824.2909 www.frankllwelectric.carn Form:998199 7.11 Property Owner_ Parcel ID# Page of IN Ong# ❑r] Boring ,_ ,� 2a Pit Ground surface elev. I Z U 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 1 O'/Z to r3/2- ­_ I 2 M Fr Cs 1 F , 4 9 Z 1'3Z o ,�/ C, m4cV, cs .Y1 A. .c "AL _T_ F-1 Boring# E]C]❑ 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 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-6330(R.W00) ` Wisconsin Department of CoVVin SOIL EVALUATION REPORT Page of Division of Safety and Buil co rdance with Comm 85,Wis. Adm. Code County Attach complete sitean 8 1/2 x 11 inches in size.Plan must include,but not limit tal reference point(BM),dir ection a Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to near Please print all information. f� _ Date /,. Personal information you provide may be used for secondary purposes(Privacy law,s.15'04 m)). Property Owner 'fpperty n (,'wk Gov��k 114 /4 S T N R E(or Property Qyvners Mailing Address Lot# # Subd. Name or CSM# L�ofFv^ og � 1� City State Zip Cod Phone Number ❑City ❑ Village Town Nearest Road I r �k ,l✓ Dr ew Construction Use5kResidential/Number of bedrooms 41 Code derived design flow rate GPD ❑Replacement Public or/commercial-Describe: Parent material fi° � / Zo Flood Plain elevation if applicable _4z zs¢ ft. General comments and recornrriendations: System Type 19 System Elevation 7 J l Boring# n Boring s !.r/� ' ft. Depth to limiting factor 3 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 I •Eff#2 2 I# -3s s r- • y 3 J <, i ® Boring# E] Boring '361&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 Z —t s-3-- r 3l / .Z �' yn Fr 4S /1c ► O 12-30 o TA4 u ask, f .Fr- e.s •Effluent#1 =BOD >30<220 mg/L and TSS>30 1150 mg/L 'Effluent#2=BOD 130 rrg&and TSS<30 nVL CST Name(Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 1 --,;2 b --/3 715-246-4516 Property Owrw Parcel ID 9 Pty or Pit Carottrtd surtaoe atarr. ft. Depth to*wft fa� Sol Applicabon Rate Redox DescriPkm Texture Struch" C:orrsistence Boundary Rods GPDW Florimn Death � •EttYt2 in. Munse# Qu.Sz. COM Odor CO,U Sh. 'Etfrsil p7Z to ys1L -° m Ar G S F • 6 .� F SO" ra u Pit GMM surface ewv. at. Depth to taerx Rate HodZw Depth DombMtWor Radon Descxipaivn Texwm S#UCk a Cautwetm Boundary Roots GP[>#F ir MtnaeH Ou.SL Core.Color Gr.Sz.Sh. *M 'Efa#2 Barg# ❑ Pit Comm sixlace elev. K. Depth to WW"sacaor 3of1 ApplimOon Raft taotiaort 'luplh Domawnt "' 7exl►a+s Suucue uraWtence ammday Roots GPOM at. Munsd Cau.Sz. Corrt.color Cx.Sz-Sh. 'Ett#1 `EtNl2 i 'EAhrerx#1 a BODO>30;S 220 niWL and TSS>30 1150 MWL 'Eft wt t#2 m BAD„30 mWL and TSS_S 30 mWL 'Y x Department of Commerce is an equal opportunity service provider and employer. if you toed assistance to access services or treed material in an altefnate format,please contact site department at 608-266-3 151 or TTY 608-264-8777. f Stlrft330ta.f/�t Y Soil Test Plot Plan Project Name Kernon Bast Sha ird Address 948 LaBarge Road Hudson Wi 54016 M #226900 Lot 35 SubdivisionCottonwood South 1st Add Dat 11/26/13 NE 1/4 N W 1/4S 1 T28 N/R19 W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation TBID *HRpSameasBenchmark 203' Property Line B.M * Scale is 1" = 40' unless otherwise noted 90' B-1 8% Slope 110' 10' 90' B-2 20' 112' 30' 45' B-3 428' Property Line Pro Town Road 1 Page of -- POWTS OWNER'S MANUAL& MANAGEMENT PLAN I SYSTEM FILE INFORMATION .— Septic Tank Capacity gal ❑NA Owner i Septic Tank Manufacturer NA Permit# ��t7 NA Effluent Filter Manufacturer DESIGN PARAMETERS ❑NA Effluent Filter Model ❑NA Number of Bedrooms pump Tank Capacity % j al ❑NA Number of Commercial Units aVd Pump Tank Manufacturer NA a - ❑NA Estimated now(average) _ Manufacturer _ aVd .Pump ��, n flaw k),(Estimated x 1.5) ❑NA (Peak), I Des Mode 19 um f� c.-� aVda /ft� pump Soil Application Rate pretreatment Unit F Monthly average• ❑Sand/Gravel Filter ❑ Peat F11ter influent/Effluent Quality Ag mg/L ❑ Mechanical Aeration ❑Wetland Fats,Oil&Grease (FOG) ❑ Other. Biochemical Oxygen Demand (BODs) 920 mg/L ❑ Disinfection Total Suspended Solids (IS :150 m /L Manufacturer .s rsal Cells) A Monthly average Dispersal round(pressurized) Pretreated Effluent Quality �i0 mg/L ❑ In-ground(gravity) ❑ o lb Biochemical Oxygen Demand (BODs) :30 mg/L ❑At-grade ❑Other. Total Suspended Solids (TSS) ❑Dri L Fecal Conform(geometric mean) S10'cfu/100m1 rcta wastewater and Y inch diameter Values typical for domestic(non- n1E Maximum Effluent Particle Size septic tank effluent •+ Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event At least once every ❑ month r(s) (Maximum 3 yrs.) Inspect condition of tank(s) y)of tank volume When combined sludge and scum equals one-third Pump out contents of tank(s) c ❑ months ear(s) (Maximum 3 yrs.) dispersal cell(s) At least once every Inspect ❑Mont ear(s) At least once every s ❑ NA Clean effluent filter ]months r( ) controls&alarm At least once every s) ❑ NA Inspect Pump,Pump months At least once every ❑ Flush laterals and pressure test At least once every ❑ months ❑year(s) ❑ NA �r At least once every ❑ months ❑year(s) ❑NA Other. n one of the following licenses or MAINTENANCE INSTRUCTIONS Inspector. Pe o% Maintainer;Septage an Inspections of tanks and uTSpe dispersal Plum r Restricted Sewer,POVVTS Inspe missIn or broken certifications: Master P to identify any 9 Servicing Operator. Tank inspections must include a visual inspection of the tank(s) II be visually inspected to check tite effluent legs identify an cracks or leaks, measure the volume of combined sludge and scum and to check for any back up hardware,ide fY Y The dispersal cell(s) ponding of effluent or ponding of effluent on the ground surface. Pe authority. in the observation pipes and to check for any ponding of effluent c the ground surface. The po 9 d surface may indicate a failing condition and requires the immediate notification of more�f tank volume.the NR group a and scum in any tank equals one-third(l4) e servicing Operator and disposed of in accordance with ch. When the combined accumulation of sludge entire contents of the tank shall be removed by a Septag g vents, and any 113,Wisconsin Administrative Code.mechanical or pressurized POWTS components, pretreattment compo The servicing of effluent filters, Performed by a certified POVVTS Maintainer. other maintenance or monitoring at irlervals of 12 months or less shall be be provided to the local regulatory authority within 10 days of completion of any service event. A service report shall P for the presence of painting products or other START UP AND OPERATION If high concentrations are For new construction, prior to use of the POWTS check treatment tank(s) e the treatment process and/or damage the dispersal cell(s). 9 chemicals that may impel a servicing operator prior to use. detected have the contents of the tank(s)removed by a septag page —of — for the presence of painting products or other chemicals thElt START UP AND OPERATION if high concentrations are detected have the contents of the p0VVTS For new construction. prior top Process ndlor damage the dispersaltcell()S) may impede the treatment p o erator prior to use. tank(s)removed by a septage servicing p wastewater will ble System start up shall not occur when soil conditions are frozen at the infiltrative surface-result in the backup or surface discharge to effluenit. es pump tanks may fill above normal highwaee l�()land may re ult I is backup or s excess toying power to the During power outag P in one large dose,overloading al levels discharged to the dispersal cell(s) tank removed by a Septage Servicing operator to restore norm To avoid this situation have the contents of the pump o erating the pump effluent pump or contact a Plumber or POWTS Maintainer to assist in manually p otherwise disturb or compact,the area wrthln within the pump tank. Do not drive or park vehicles over at srade cells, Do area- drive or park over, o the 1'rfe of the POWl,r 15 feet down slope of anY mound 9 performance and prolong im re the p die diapers; disinfectants; fat; foundation drepn Reduction or elimination of the following from the wastewater stream may painting Produclls; e etable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; pa antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; (sump pump) water; fruit an 9 ftener brine. pesticides;sanitary napkins;tampons;and water so s shall be taken to insure that the system is properly ABANDONMENT When the POWTS fails and/or Is with chapter Comm 83.33!Witsconsin dmini trative Code: and safely abandoned In P sealed, • All piping to tanks and pits shall be disconnected and the abandoned pipe openings Servicing Operator. • The contents of all tanks and pits shall be removed and properly disposed of by d its shall be excavated and removed or their covers removed and the void space fined with scull, • After pumping, all tanks an p gravel or another inert solid material. iii nt CONTINGENCY PLAN cannot be repaired the following measures have been, or must be taken, to provide a code comp If the POWTS falls and c n s telm. replacement system: replacement soil absorption Ys be utilized for the location of a rep b requilled ❑ A suitable replacement area has been evaluated and may action and should not be infringed I upon t to the nE{ed The replacement area should blprotected rcurer lot lines d wells.dFailure to protect the replace" with the rule:l in setbacks from existing and proposed replacement area. Replacement systems must comply for a new soil and site evaluation to establish a suitable rep effect at that time, area is not available due to setback and/or ed POW'TSmitations. Barring advances in POWTS techno ogN a ❑ A suitable replacement holding tank may be installed as a last resort to replace the fail n failure of the POWTS a son and be installed as The site has not been evaluated to identify a suitable replacement area. Upon mu be performed to locate a suitable replacement area. if no replacement area is available a holding tank may infiltrative The resort to replace the failed POWTS. llowin removal of the biomat at the a last and at-grade soil absorption systems may be reconstructed in place following Reconstructions of such systems must comply with the rules in effect at that time. INSUFFICIENT OXYGEN. DO NOT <NUARNING» SEPTIC,PUMP AND OTHER TREATMENT T ANKS TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT- PERSON RESCUE o7 A TANKS MAY CONTAIN LETHAL GASSES ANDIOR lNS ENTER ASEPTIC,PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE• — ADDITiONAL COMMENTS -— pOWTS MAINTAINER ---� 7Ph INSTALLER Name me Q. _ Phone l/J ne /�j "- 1 LOCAL RE AUTHORITY m7nm Name Phone wit cp SPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wlsc;onsin Administre4l++e Code. This document was drafted m compliance F ,4 ILTER CAIrfRIDGE INSTRUCTIONS IrtlP % 0v1V M tim Mar casw r Mgo Ogg Wahl ilf Mitt 0,0,NJ elidwe it Is. milidwrad ►1dirs,ON WAM"vivalitho. 11 wit,them wumv ills'wt inefe 1011M 014*trrue tw4k thriough t6 uu&A qw"wA eveiw tofto) Addkju,1,m1 04"tutu the uIttle plpv� -a While the Calais is stio dry fitted uh tbu auddi,0106,144"8"N t6v iuErlytfa ur*A-ir4th 0*8"e"t"t&"c'"11lo ft'w'tv 0#0 tmk alud wall ie uuuutj t&A MA40"W v0platou"'"i"Out-ou"L'r'Ado mall'"it InuMnul Is JmA ut", to Put inst"6Ck"m U110-1,10 Oft UP09ml WAMIubmAid KWO m6#tft*.t WW tine 11114v*011 PI►U oliv*m mthr cmm. It Ptue"d to d*0 fi-; SOIV*ht WW tiro MCI j."V Uhte thi! oUilat AVV# he i►d"the cuse, Prevainq d9wh ahm ON Me i0eks firth the bitmll uk lim to if V45 6-j1tdo is 4114%4. ilftawt&Ao tim ftur and lqi;k try L*"Wke L "Che Oftent Mar allsould be survio"d. "Olved etfury tl#r'fJ Clay cryptic MAhk Is diMlit 6=0*14 w—him to inspect t1w tlalk gild khr PUMP klite suptiv tank%vnj***jV, "a"Soria tU ttt"tA)v dU," Itrytot'bn'his bvft*vv1 of th'a tA'V'k 41"1"at$us*the 51,41111 dhid Oftent. A. Mml till Oi*Jw*fiwvui 1146 t,wan howured bul"W the h1vol.i.wf th,3 outlet Po",firmir pub gip Oft tk&0"t1w Mmgme to i1minive the tulftw"60M 40 C"". S. Sildim"m rA •trW*,iti,immi mic of the amw&W It a VAS s;W"wifinvoicilud tm ayi,Wartv,JS UIVOMA, tj&L. 'J"buid he'rumtovag by 1:0"OhIP eAmhittWduckwWm 911*Wkd disakwel With Water jujil, While huMi"110 tore uWWM9Vj rAl b Aldw flue W um&Lu#or ON 11,16 1211trwile wwt wmittw Only,mWirill—as 660486 notimal is d"Ad b"k 6t. 11"we rr U. It:VP.S aWkch k.-Mll-d,MpN,*by jjogrtlilig j"itj#lt4lr 41W turoAsia clawkwive than fter eetridge bw 1,4,o the filter 1"-w 4*0 the 6d4uW11 gd"We tMNS. Mgapifta ghd secure ties Aitxwjj jj0vj*jV oil U19 tat& (653-4683) R � dW.£f,4+d wi+i`x ik t k:aR r;1a pE�� a #kAtik� �'�*b•-F 7At Y i #r tE,.#+t §i I �;t � << s.� to e :►t t�ri r«+ r,.�.-a,_ .,s, a .a>. r.�•atc a Y s t.'.�r.+�1- a�w t£�;RY �+i.:as.a",�•�+saw Wit, a`:>i��t,�R'tr.' e t st:-f`:RO��< r.r. iie :, vaa.�Y; -'€s�c:� n< «a. t � i�.�i�=�e s-issts.: Y a• a � a � a b Y `d �- fY aat t� a t( fvi n'+ ta' � _ i • ia4 f F � \ ,ai _IY%Rx tf=�1.>, n � [<< 0.3':. > r t to M < � R rin'an�F ♦ ➢-: Y} •a f i vt � ♦.a�"#; lSx id 3 3'a:t t? a tp .itt :ham t!-. fl¢:.- '�k- � r 1;k.£ � Y' 6t S�+rt Rt £F+ •• E:-0 i[ ..y 7 Y S:tt[��. :df f L$4 iF+e'6•: Ctl:yi • S f w.'"f�s #:F- r "� 1'� £W lPOf"rr _icfa e_ AE.�e '4�#• wxi A9t_. 6 ,P-C +t :a#.f €O kE.rf ya tY�� � i♦ Y -T!i3!� t t ° W.}t--i a)t-•t## £f{ ` trr; fa+ t 18 :�-�l 4 i i- a.: c !do' Y.f:y11..+`3d� ,V Ei • � = f N ➢b. 3':arV } a) P# a.• �b� .N, 1£ � 9 Y t " 4 3tF t 4d+'%e(f £S- qd3'i ti'.9(it=a. ".q �"S i£. t- a:X £4ij#y�k 4i a b ic# Y !.- :8!£ ♦-t i�f S t5 t f YR et -' <t ,ia:9k t t '. ♦ b.:,( � K,:v'! � ♦'3Y ii+ f -:il 4 I.. i 1 09._ :i#.1 t`a 1 R� .� t£of G Y ALI 11 111111 State Bar of Wisconsin Form 1-2003 8 0 0 0 0 7 4 WARRANTY DEED Tx:4000054 917583 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Neil L.Wilcoxson RECEIVED FOR RECORD 06/15/2010 3:45 PM WARRANTY DEED ("Grantor,"whether one or more),and Kernon J.Bast and Donalda J.Speer-Bast, EXEMPT #• 13 husband and wife,as Survivorship Marital Property , REC FEE: 11.00 PAGES: 1 ("Grantee."whether one or more). Grantor for a valuable consideration,conveys to Grantee the following described real Recording Area f� estate,together with the rents,profits, fixtures and other appurtenant interests, in Name and Return Address St.Croix County,State of Wisconsin("Property")(if more space is Leo A.Beskar needed,please attach addendum): Rod1l Beskar Boles Krueger&Pletcher PART OF THE NORTHEAST QUARTER OF THE NORTHWEST QUARTER(NE'/.OF PO Box 138 NW-/4)OF SECTION ONE(1),TOWNSHIP TWENTY EIGHT(28)NORTH,RANGE River Falls,WI 54022 NINETEEN(19)WEST,TOWN OF TROY,DESCRIBED AS FOLLOWS: Beginning at the North Quarter corner of said Section 1; thence S00°26'27"E along the North-South Quarter line of said Section 24.00 feet; thence N45 118'02"W 34.02 feet to the North line of 040-1000-90-000 the Northwest Quarter of said Section; thence N89°50123"E along said North line 24.00 Parcel Identification Number(PIN) feet to the point of beginning. This is not homestead property. OR)(is not) Grantor warrants that the title to the Property is good,indefeasible,in fee simple and free and clear of encumbrances except: This transfer is exempt from the Wisconsin Real Estate Transfer Fee as per Section 77.2(3). Dated May �,2010 (SEAL) (SEAL) * Neil L.Wi xson (SEAL) (SEAL) ;;;TIaENTICATION ACKNOWLEDGMENT Signa (s Neil L.Wilcoxson STATE OF ) )ss. authen i a d on May 20 COUNTY) [/ Personally came before me on > *Leo A Be ar - the above-named _. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis.Stat. §706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Leo A.Beskar Notary Public,State of Rodli,Beskar,Boles,Krueger&Pletcher,S.C. My commission(is permanent)(expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO.1-2003 *Type name below signatures. INFO-PRO'°Legal Forms•(800)6552021•infoproforms.com 1 of 1 - - 30' WICAE DRAINAGE EASEMENT DOC. #838231 HWL.=1041 .0 10.18' 193.40 V--12.521 - - - - - - - --203,56' - - - - - - -- - - - - --. � _� - - — B- LOCK DIST1- 626.12' � I i 125' 25' I 25' 25' CD i i I I C6 I LOT 35 1 ` I LOT I i 2.00 ACRES i 2.01 AC T. 0 87,125 SQ. ET. a 87,562S .0 I ° L.B.G.=1043.0 ° I L.8,0.=1 ! � i I CD zz i i I I i Icoi 25' c W Ll1 I m r 203.56` �. ! i 50.64' co X189`50'23"E 457.76' SAC c) ,I I IIII G I{ `1��t I I ��� Yn.Ym RxAtltt.Mi.M NMI IU{jl�a�i�ShlhlyE,i�411�'+i!�. �' NMI r�ftt�l lrl�t+�llft��l�f lE l�rii NSI )ft (]].;t11�71'11'i(trt71l!t 111 i It �IIIIIIIIIIIIIIIIIIIiiBI� ,f+�y�, r +t�,l;+r� rl�'i'lfi��t��+llrti{li�{{iilh ��1 I I�Illlllllillh+� � fill�161i- �. I I ,illllllll � � ...� was m ut �w munnnu+ I 1 ft II i illt�t u .M III I � '�I ■ � � �t fly j r �lil;. 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