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HomeMy WebLinkAbout040-1303-00-019 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 569562 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: Westview Construction, Inc., c/o Aaron CIa7y Troy, Town of 040-1303-00-019 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No. (o CST 22.28.19.1754 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER i`�•y j CAPACITY STATION BS HI FS ELEV. Septic L,) � / �d Benchmark ,E 16 7,I -,l� 6 Dosing / Alt. B 3• 65 •�! pwatiory Bldg.Sewer 4-16 i �D ( Holding St/Ht Inlet I 13 . 5 TANK SETBACK INFORMATION St/Ht Outlet I• <7 3 TANK TO P/ WELL BLDG. ent t it Intake ROAD Dt Inlet Soy .,�-- �7 Septic z� '7 3/ Dt Bottom 1Z•3 'R /• $f 1 Dosing Z'• 1 -74 / 3 1 T U92- ! Header/Man. 4'-7 9,s• jl Aeration Dist:Pipe (0• `F •�` to•t„ �S•S(� Holding Bot.System 7• t� 7 7.37 Final Grade 7 -47 4• (; PUMP/SIPHON INFORMATION 4. 1 -7 T. -b Manufacturer Demand St Cover GPM 3• a G Model Number .9 6- 5 TDH Lift Friction •ss System Heal I TDH Ft Forcemai✓✓n Length! Dia.JJZ l Dist.to/Lj Well 7� / SOIL ABSORPTION SYSTEM Z) I BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS b I J . "`�" SETBACK SYSTEM TO W-P�/L JBLIDG IWELL LAKE/STREAM LEACHING Manufactur f /1 �^ INFORMATION CHAMBER OR J ,r'•: �T�1 Type Of System: ` 47 20 UNIT Model Numb r. la , 7 �%G.�G DISTRIBUTION SYSTEM WeZ �-- J707 +-! 0 Header/Manifo // Distributi n Ix Hole Size Ix Hole Spacing Ve/�t to Air Intake �� Pipe(s) -------Spacing �� �, ��. TG� Length Dia Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only �'" Co i Depth Over Depth Over jxx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3-I=, Bed/Trench Edges Topsoil es 0 No � Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: /� / Location: 270 Walnut Hill Way River Falls,WI 54022(SW 1/4 SE 1/4 22 T28N R11 9W) Walnut Hill Farm aka The Tribute Parcel No: 22.28.19.1754 1.)Alt BM Description= /�•!~. �J G h•c„ ..3 r �"'�'' a 2.)Bldg sewer length= / -amount of cover= .1 is -- - �� Plan revision Required? ❑ Yes No � Use other side for additional information. ! Date Insepctor's Si ature Cert.No. SBD-6710(R.3/97) plot Flan Owner ��Jt:��cv��1 1'raperty 1» =40„f�` Legal Description �tiY tit r�_Q ,� c: (except where no l =Backhoe pat 1,D31 �. aux►� +�:�c.���in1 • _ '� North JAI 71 r t er`�•�LL Weil � { PO 0 60 TO tU 9 ►�At �a W ISO Tp + ' Site.Location: r ' 06 �N� County �C I Safety and Buildings Division 7 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) P r 41 Madison,WI 53707-7162 X itary Permit Application State Trans ction Number In accordance with 38 .21(2),Wis.Adm.Code,submission of this form to the riate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state own TS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide ma sed for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. � 76 I 'a/^V 4— /1'`I I. Application Information—Please Print All Inform ti T lJJ (^/ l 14 1 Property Owner's Name Parcel# _ S�� ` Vie J �o �Q+C� °-1 Property Owner's Mailing Address Property Location �1 7 L�. �� / 'e Y� � � Govt.Lot 1q ( ' " City,State Zip Code Phone Num , / f Y J �/a, ,S� /,, Section 7a W� 1 ,540Z,-L_ �S gq o circle one T �N; R_Eor� II.Type of Building(check all that apply) Lot# 11 or 2 Family Dwelling—Number of Bedrooms � 9 Subdivision Name / Cl BN�O Block# f •/I try ❑Public/Commercial—Describe Use J 0 , n El city of 11 State Owned—Describe Use ino r l d� CSM Number El Village of 3 ibt �7�17�-1(0 L) `Town of `© 11I.Type of Permit: (Che k only one box on line A. Complet 41ine B if applicable) A. New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner — IV.0pe of POWTS System/Component/Devi e: Check all that apply) t^ on-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treat ent Area Information: Design Flow(gpd) Design Soil Applicatioq Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(s Syst Elevatio Zo O, Q VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units o c v New Tanks Existing Tanks w e v y y r,. /z SZ o U J a �a :n H w C7 a Septic or Holding Tank J J� j Dosing Chamber / / f I CSe O 0 ova VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Sere MP/MPRS Number Business Phone Number ax I e)5 e ��l 49� �s 94 Plumber's Address(Street,City,State,Zip Cod LJ 91631- 7 (#Y vC 1ver _ if �6�Z VIII.C un /De artment Use Only Approved ❑Disap d Permit Date ssuued Issuing A ignature rven Reas Denial $ �G5' 4�) ✓ �✓ l IX.Condi"Wm (SReasons for Drs approval 3 n✓�1 O / �� n Septic tank,effluent filter end ,p (�L• ` // dispersal cell must all be serv[r es/maintained kom-e. 0 4A f 4 1 J t �5 t rt L°✓�A✓t CQ� as per management plan provided by Pl�timber. 11 0"fb>»ck requlremertts must be maintalnibd r✓� �a I`M-g,��`o v` Pf spWpicable aode:l Attach to complete plans for the system an mit to a County only on paper not less than In x 11 inches in size ' A V"o O k ' f SBD-6398(R. 11/11) �OJ� a(' t Jt re y ry Pg of Private On-Site Wastewater Treatment System(POWTS) Index and Title Sheet Owner: Project Name and System Type: J)J-(0,rP-vuND �oN vENTtoN�l� -[r �tt�S Location: i LL W7i� Street Address S 7-7- T7-9 R Iq'" LO? iq -T KI CiUfiF Sint�A( OF rt tt& S t�4 Legal Description Township/ ounty Design Criteria(Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual- ❑ SBD-10571-P(6/11/1999) ❑ SBD-10567-P(R. 6/1999) ❑ SBD-10855-P (3/2007)Version 2 1 SBD-10705-P (N. 01/2001)Version 2 Contents: Page 1: Page 2: l. W vtEVJ Page 3: t WT 'PI-A-4 P A mac YK,UT P c IJ Page 4: POt�-rs OWNS s M/lA�t � � r Page 5: Page 6: Page 7: Page 8: iM s C Page 9: Ptk�F T:Aeu K s PAC ts: So f I— A LLkA-t 1 Qlv 'RE�r ol2 .. f pT1C C-6 E E �i31�� OWNS SHI P C� S D 18 J0 A U Signed: P � �y�/�! �••'••... •'•• r ��� SSh"-U0-7 Date: 7° r J �..r air r.• 7 At W •OW S'AAN of —allwdbo Ley 37 dmWAm w dim am Mmmd� T�M1aM, �/� ILwgdw�IrYtaY.NMJ. ���/ � A .Geis 1 mkftefeMr sI , fv 0 z ,p, .�O 5 X Ctl % ZDO .1R�IUCf1�-� b e4, - �► 1 f e��,.�D a G I CIS J,9 4 C f�LyLOK �� IL7�/� 7TH t3� USED tN 'TA/J K w esw J408,00 Zou � q T P 'age 31 r<,a plot Flan a property Owner ill acv�r �� =4o f� c: (except where no Legal Description Lv'r to *�'�"" '� - ackh�►c h ` 11 ISO 5 OF Tim not ap - M�N' NSW w 2 4 TWO Q p�L. T "�. PIPE 25 r TO c T>�X . 5° Site Location: y° e- POWTS OWNER'$ MANUAL & MANAGNMENT PLAN Page 9,of IgLE nON 8v8 W SMCIPICATWNs Owner 01 clu C-ew .GtCT/Dpi XAC Septic Tank Capso)ty 12-00 gal O NA Permit S Septic Tank Manufacturer l E5&4�, O NA 0E816N pARAMEI"ERS Effluent Fdtw Manufacturer Poz yLD/C O NA Number of Bedrooms �'f 0 NA Effluent ice'Mods Z Q NA Number of Pubes Facility Units 'izCNA Pump Tank Capacity 8990 aid 0 NA Estimated flow(average) b p a doyv Pump Tank Manufacturer WIE3E-JC 13 NA Design flow(peak), (Estimated x 1.51 &00 goVday Pump Manufacturer O NA Soh Application Ran 0•4� _OWMayW Pump Model 9' D NA Standard influentlEtfiuent Quality Monthly average" Pretreatment Unit XW Fate, 00&Greene (FOG) S80 mg/L 0 SwWVGravel Filter 0 Peat Fitter Machemical Oxygen Demand (ttODs) 5120 mo/L 13 NA O Mechanical Aeration D Wetland Total Suspended Solids (M) 5150 MOIL O Disinfection Q Other. Pretreated Effluent Quality Monthly average Diapers!Ceuta) O NA Biochemical Oxygen Demand (BODJ S30 MOIL 143mund (gravity) D M-Orournd(preasurlted) Total Suspended Sohdo (TSS) SOO nag/1. i?NA D A*41We O Mound Fecal Copform (gwratrio meat) $1W cfu/10OMI O Dip-Line 0 Other. Maximum Effluent Particle Size in die. -0 NA 0 NA Other. 0 NA Other O NA *Values typical for domMic waecavrstar and septic tarar effluent. Other. O NA MAINTENANCE SCHEDULE Service Event Service icy Inspect condition of tanks) At least once every. a)file) yw(Mwdmom$ e) 0 NA Pump out contents of tanks) When combined sludge and scum equals onerthlyd pj)of tank volume O NA Inspect dispersal oell(s) At least onoe every: a (Max)mum 3 ymo) 0 NA Clean effluent filter At least once every: /, 4 monthio 0 NA M Inspect pump, pump controls&alarm At least once every: / h(s) 0 NA Flush loterels and pressure test At least once every: 0 month(s) )0 NA At beat once every: O )s) D NA yearia Outer. O NA MAINTENANCE INATRUCTIONS Inspections of tanks and dispersal cogs shall be mode by an Individual carrying one of the following licenses or certiflcadom Master Plumber; Master Plumber Restricted Sower, POWTS inspector; POWTS Mauytalner; Septage Servicing Operator. Tank Inapections must Include s vivual Inspection of do tank(s)to identify any missing or broken hardware:, ktentfty any cracks or leeks, meows the volume of Combined sludge and scum and to check for any back up or ponding of effharit on the around surface. The dispersal collie) shell be visually inspected to check the of rent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fairing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one*" %) or more of the tank volume, the entire contents of the tank shag be removed by a Septage Servicing Operator end dispoeed of in accordance with chapter NR 113, Wisconsin Adminletrative Code. AN other services,including but not limited to the servicing of effluent filters,mechanical or premaked components,PNVOetinertt units,std any eervloing at intervals of tt Z monthe, shell be performed by a certified POWTS Maintainer. A service report shah be provided to the local reguStory authority within 10 days of completion of any service event. 1`608-61, 608 J at l START UP AND OPERATIM Or otitar ahmrrfoali For new 0W5V rcden.prior to use of the POWTS check treatment"Wil)fW the presence of ps�dng prvdvats that MW krpeds tine treatment process and/or dameas the dbporsd cats). If high oonoentratione era deteoted have the contents of the hank(e)(Wwved by s 660611®servlo V opareu:or prior to use. System start up"not ocW when veil QWWWats are frozen at the knflitraivs During per o pump testis may flit above MMI&I iuphwater hevele. Man power le restored the sxoea@ was�raeer W�be Macharged to the dispersal cWW in one large done, overloading the:refits) and may MOOR In the backup or a@feoe dIscharge of effluent. To avoid this situation have the aontwu of the pump tank removed by a 80IM m Sertrk"OP mum Prior power to the effkmn pump or contact a Plumber or POWTS Maintainer to soft m manually operating the p restore normal WnW within the pump tank. am Do not drive or park vehicles over tanks sold diapered toile. Do not drive or park over,or atharwlse disturb or .the within 16 feet down slope of any mound or M-WWs=0 absorption eras. Reduction or elenpnstion of the following iron the waatewster stream may improve the performerm and prolong the Ife of the poWrS: a►tibiottca; baby wipes: cigs GM butte; condom; cotton &webs;doWesemrs; dOntnd 1100: dlaPWV tcattons; oils foundation dr* isumP pump) water fruit end vegetable peelings, paW*W greess: herblaides; mast WJVPes med painting products;peeticides;esn"napkins:tampons;and water softener brine. ABAWONIii IT When the POWTS foe end/or Is permanently taken out of so(u)se the following steps siwil tie token to insure that the tlyetasrl is properly and safely abandoned in comPganes with chapter Comm 83.33.Wisconsin Administrative Code: e All piping to tanks and pits sheii be disconnected and the abandoned pip•openings seated. e The contents of all tanks and pits shall be removed and properly dlaposed of by a age Servicing Operator. e After pumping, all tanks and pets shall be owevatei and removed or that covers remove) and the void space filled With soil,gravel or another inert soled materiel. CONTi IMCY ELAN e a cods compllaM If the POWTS fob and cannot be repdmd the following measures have been, or :nut be taken, to provide replacement system: A suitable replacement area has been evaluated and may be utilized for the location of fad gmme �abenrPtio�upon system. The replacement area should be pro�00cted from and wells. Pefiute to proosot tta rePtsosn+ernt required Setback@ from $01ting and propose!stwcturo, lot Ones result in the need for a new 80 end OR•Gv'duetlon to establish a suitable repleosment arms. Replacement systems must comply with the rules in effect at that time. CI A suitable �aC°"'�t k may be Installed as a last resort to replace the failed POWTS. . g �verroe: in POWTS technology holding C7 The ante has not been evaluated to iderrdfy a suitable repleoemont ere®. Upon femurs of the POWTS a soft and ohs yevalustion must be perforated m locate a suitable replaoeena►t aoea, if no replacement area le avalhtt►te a holding tank may be Installed as a last resort to(apiece the failed POWTS. C3 Mound aid et grade soli absorption systems may be reconstructed M place following removal of the blorrat at the infiltrative surface. Reconetructlons of such systems must comply with the rules In dKect at that tine. <<WARINNO>> SR�'i'IC, PUMP AND OTHER TPXATMMNT TAM MAY CONTAg1i LETHAL 6ASSE8 AND/OR INSUffKffiNT OXYGEN. DO NOT ENTER NAR FROM THP PAP OR O�TAEA N�IAYTt�L°T�CUNDEROR Y CIV MWANCES. DEATH MAY RESULT. OF A pERSO ADDITIONAL COMMENTS POYYTS INSTAi.t.6di POWTS MAINTAINER Nave fZL ft tI Name e-Algu Phone f��l'�l9Z—$59 / j Phone qZ— SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REHULATORY AUTHORITY Narr►eQIeFL�S S�PnL lG� Name L`R�(JC COIt/ijTYv1!I�Co Phone :7Y6-lqz5 107-5 53" 41" 96" z �n Y s" Q 44" QD Fpm 1 � 1I < ,I n(7o ) Z CA A •a O C z ^� ° c D A p- N� z r c x z °� °c F, Fn o z gZ n ^°�D a�DCFR*Rrnye oy� r a FN i8� X00 2a0�a _ �F(A v g c ri z m rn ' o�C FRi U1Z 0D 89 F��:Ofw _ Q n x N --I. sN D m Oo N w a au N 1 -1 �� �'°� OD �i m x z � o N� D DD °°` O cO� I : s O O m ° Z\ C �� rmr arp -4 N O ° p '0 -i DD mDmo �o v ; O �n z c D rr A,=D PO S m D �O Z O 8 Z2 D W D ca 0 0 mm ;o 14 i o° fl �> 0 N n D v rn m c� r 2 Fl Z4 rn \ e WLP1200 800-MR SCALE:1 , - �' REV No. DATE: SEPTIC MANUAL 111IIETE DRAWN BY:SWT W3710 US WMO. MAM ROCK.YM 54730 DATE.JANUARY 2008 0 \o REV. JAN. 2008 800-325-8456 Flvi:WLP1200 800-MR � ,1 1 1,1 1111111 - r �r,�aata •rte '��� •• — ; � !��)id`�f1i�i�li�ichaiili��i�i��i"i�iili�h'h'i�► : . , mjs sM-11, �i I Mi r r,��i41si1�l y 1 h t J //O 0 1/4 HEAD CAPACITY CURVE MODEL_ "9fr 4 5/B 30 6 I - 2s 3 5/8 6 20 m v -F- 4 ft405'0 4 3/16 z 1 1/2-11 1/2 NPT o so US. GALLONS 10 LITERS 0 80 180 240 FLOW PER MINUTE MODEL 98 60 CYCLE Feet Callon Meters Liters 5 72 1.5 273 t0 6t 3.1 231 15 45 4.6 170 12 20 25 6./ 95 tpcY VoMe: 23' 001071 4-3/16 exi/62 ✓ CONSULT FACTORY FOR SPECIAL APPLICATION, • Electrical aftemators,for duplex systems,are available and • Variable level float switches we available for controlling single supplied with an alarm. and three phase systems. are available • Double piggyback variable level float switches are available • Mec�lanical aiterrlattxs,for duplex systems, for SELECTION level long cycle controls• with or without alarm switches- SELECTION GUIDE 1. Integral float operated 2 pole switch-no extemal control require d Standard all models-Weight 39 lbs.-'/z H.P. 2 single piggyback Variable ism float switch or double plggyback`ariable 104el, 98 Series Control g float switch.Refer t0 FMO477. 3. Mechanical alternator 10,0072 or 10.0075. Model Volts-Ptr Mode 4. See FM0712,for correct model of Electrical At e"U tor- M00 115 1 Auto 9.4 1 1&1&7 "- 5. Control solich 10-0225 used as a conboi actitrator,spelafY duplex 13I or(4) N96 1151 Mn 94 2 or 2&6 3 r4&5 float system. forvrete 9tlt connection or 098 230 1 A� 4.7 1 or 1&7 — 6. Foan(4)hole J-Pak.Iunction box 230 1 Non 4.7 2 or 2&6 3 or 4&5 simplex or or duplox operation,10-MR. or splice. 7.Two(2)hole J-Pak,for wateftht connection E96 CAUTION additional Zoeller products 10�9 an Variabie Level SwAlct es. All installation of controls,protection devices and airing should be done by a qualified For inlennalion an FN0477 .�g�pip487• licensed electrician.All electrical and safety codes should be followed including the most &ilk?.Eb FM1596:Atem recent National Electric Code(NEC)and the Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. "I71):P.O."16317 Ky.402VhM7 sfaP TO.3W Caw VI-19 Rod 1 Q f otASn7ir,KY 1021!-100f Queue/�/ °�✓%'� r fHgc/A.e�n aodre..00mm W. PUMP !O_ � 92trAUlltP FAX(3M 17+3624 - Iq, —Mlz uT4-- Pacte SEPTIC TANK PUMP CIIAMBER CROSS SECS Ik! D SPECIFICATIONS ABOVE GRADE E WEATHERPROOF u'• CT VENT PIPE 12 MIN. ./UNCTION BOX APPROVED > 2S' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COV FRESH AIR INTAKE W/ PAD LACK WARNING LAB FINISHED GRADE 1q•+ MIN. S.D- u 1e" xN �1 E8 MIN• INLET GAS-- , WATER TIGHT SEALS —T" TIGHT. \./APPROVED A SEAL ' JOINTS WITH FILTER �� LM APPROVED PIP APPROVED B + ON 3 ONTO PIPE 3' -T— , ± SOLID SOIL C ONTO SOLID I OFF SOIL PUMP OFF ELEV . FT- `�' D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: -- TANK MANUFACTURER: I—j LANK SIZES: SEP'T'IC 12�a GAL. DOSE VOLtUME FLO BACIK--- 133 � G A DOSE GAL. �� t, ---.— S CAPACITIES: A = INCHES = G/ ALARM MANUFACTURER: j TF .�Z'Hl1M� MODEL NUMBER: B = 2 INCHES = � SWITCH TYPE: C = INCHES - y13i PUMP MANUFACTURER: MODEL NUMBER: D = /0 INCHES SWITCH TYPE: M REQUIRED DISCHARGE DISCHARGE RAT£ GPM PUMP E ALARM WIRING AS PER I LHR 16.23 _ VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE EET, F FEET + MINIMUM NETWORK SUPPLY PRESSURE . . • • • . . . • . . . _ r // FEET + /Oo FEET FORCEMAIN X Al // FT/100 FT- FRICTION FACTOR = / FEET INTERNAL DIMENSIONS OF PUMP TANK: LIQ WIDTH DIAMETER DIAMETER UID ffrP Tom____.._.._.____. boo x / 33 v _fw_,� 1. k j 2r0'-011 Walk-Out-FVOundatton 6'-011 201-011 Look-Out Foundetlon - - ------------ --- - -- - 1 ------------------------------ - ----- v ; v D 4 v Dd p d • �• i D d p d • v� -- 1 .. 1 � •---------- all b ' IB" 1=1`iCsINEERED FLOOR TRUSSES s 19 " o.c. 1 Q /w E Ix fb lip / b �' ------------------ --- ---'- - ---------• u 1 41 �------- 1121 1-4" x ist O " 2'-4" x.61$u; ; / 1 x a` / For dq _1A lip '� 1 13 Ix . :37 1 1 Jol, 1 ., tJ 1 4 , x30 Tub/Shr, 1 1 1 ; ` - - - 1 ' , 2x4 Bearing Wall ------ 1 UF' 15 R. ; 2x4 f5saring Wall ' ------- -- •- ---- 1 1 1 p a 1 p . Plot Plan t d ,. Property.Own er » 46 ft �rR� (except where nolerl) Le gal Description Lb-r ca Q = ackhoe t R D-3 AdkJ5 �, amt �rrts�stnl North w v�'sw'tiep JQOr'l ti al t- 41 -AOI� ► 4C q4t. o 60 pre- �. '7"A 1'��' � �,, /J �• .gyp �j 5Gll.�0 -roe F► LS VJ 7 5�a 7p .�pAI 07 q4.0 t Site Location: y N Wisconsin Department si Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 569562 0 Personal information you provide may be used for seconds State Plan ID No: secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Westview Construction, Inc., C/o Aaron Clay P Parcel Tax No: Tro TOW of 040-1303-00-019 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: TANK INFORMATION 22.28.19.1754 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI FS Septic BS ELEV. Benchmark Dosing Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot.System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. DIMENSIONS Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold AjOistribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Bedrrrench Center Bedlrrench Edges Topsoil Seeded/Sodded xx Mulched P Yes 0 No Yes 0 No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 270 Walnut Hill Way River Falls,WI 54022(SW 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute Parcel No: 22.28.19.1754 1.)Alt BM Description= 2.)Bldg sewer length= -amount of cover= Plan revision Required? ❑ Yes ❑ No r- Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Signature -J --�--- -- Cent.No. Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4686 1;1 ST. CROIX COUNTY SEPTIC`TANK MAlNTCNANC'C AGREEMENT AND OWNERSHIP CERTIFICATION FORM r-- owner/Buyer_ i- _--w C_ Mailing Address_ 0 Set-- , T Property Address (Verification required from Planning&Zoning Depwment.for conat uetiun,) City/State W, TT Parcel Identification Number (7 10 130 0 I LEGAL DESCRIPTION Property Location.5' W '/� . '/ ,Sec. d�o7 ,T2-8N Rj �_W,Town of TY pX Subdivision Plat: 1�czlhu _, !_ lr ,�-e ,Lot# ]]q Certified Survey Map# ,Volume ,Page#�. Warranty heed# (before 2007)Volume ,Page# Spec house .a no Lot lines identiliablo no SYSTEM MAINTENANCE AND OWNER CERT 1FICATI N Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the Nnetion of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in§Comm.83.52(l)and in Chapter 12-SG Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)ilia on-site wastewater disposal system is in proper operating condition rind/or(2)after inspection and pumping(if necessary),the septic tank ix less than 1!3 Rill of sludge. 1/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certifaation 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. I/we certify that all statements on th' form are true to the best of my/our knowledge. l/we am/are the owner(s)of the property described above,by virtue of a wa my deed recorded in Register of Deeds Office. Number f bedrooms 4 lISIf NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department,*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified away mnp if reference is made in the warranty deed. (REV.08/05) 1111111 IIN II IIIIIINIIIIIII Ili 8192212 State Bar of Wisconsin Form 3-2003 Tx:4159687 QUIT CLAIM DEED 9$$450 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 10/31/2013 2:12 PM THIS DEED,made between Citizens State Bank EXEMPT#: N/A REC FEE: 30.00 ("Grantor,"whether one or more), TRANS FEE: 72.00 and Westview Construction, Inc. PAGES• 1 ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the Rccordine Area rents,profits, fixtures and other appurtenant interests, in St.Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): David J.Estreen 304 Locust Street Lot 19, Walnut Hill Farm in the Town of Troy,St.Croix County,Wisconsin Hudson,WI 54016 #WI-21753 R 040-1303-00-019 Parcel Identification Number(PIN) This IS NOT homestead property. (is)(is not) Dated October 2013 Citizens (SEAL) (SEAL) * * Gene Haberman,Vice Chairman (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on RRinnFT K nFi )ss. NOTARY PUBLIC St. Croix COUNTY ) * "i r v iscolV�iI Personally came before me on October 10 2013 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Gene Haberman,Vice Chairman of Citizens (If not, State Bank . authorized by Wis. Stat. §706.06) to me known to be the person(s)who executed the foregoing instrume,tU and acknowled ed a same. THIS INSTRUMENT DRAFTED BY: Attorney David J. Estreen 304 Locust Street, Hudson, W[ 54016 Notary Pu Ic,State of Wisconsin My Commission (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:TIIIS IS A STANDARD FORA9. ANY.'VIODIFICATIONS TO THIS FORM StIOULD BE CLEARLY IDENTIFIED. (�Ua#fLA1NI DEED O 2003 STATE BAR OF WISCONSIN FORNI NO.3-2003 * rype name below signatures. uj�' ' /c V �► SQ � ' i► � ool oor . rn CO m ,.a1 -4 �� �. n � Ne RECEIVED R j Wisconsin Department of Commerce ApR 0 12014 SOIL EVALUATION R Page I of 3 Division of Safety and Buildings in acxo �y�h Comm 85,Wis. Adm. Code ST.CROIX Ct d Y County ST.CROIX Attach complete site plan oQ j!1 trW_U0Ft�A&Wes in size.Plan must include,but not limited to:v�or. ontal reference point(BM),direction and Parcel I.D. 040- 1303-00-019 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Rkiviewed oat y Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � Property Owner Property Location ■ WESTVIEW CONSTRUCTION INC. Govt.Lot ----SW 1/4 SE 1/4 S 22 T 28 N R 19 E()W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 20 Serenity Ct. 19 -- Tribute City State Zip Code Phone Number ity Village • Town Nearest Road River Falls, WI 1 54022 1 ( 715) 760-9900 1 lroy I Walnut Hill Way E] New Construction UseE] Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial-Describe: Parent material sandy outwash Flood Plain elevation if applicable NA ft• General comments ). / �� '� rCo vention 1 In-ground trenches--0.6 loading rate and recommendations: �S-}�iV►.� X11 J�2.c-r.c T'��,ltil,�l liiti� �41 -�•— `t'�c.(r't/�I• —1 (✓ � �J r C•�o Ic 1❑ Boring# � Boring �El Pit Ground surface elev. 99.40 ft. Depth to limiting factor 86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-14 7.5YR2.5/2 - sil 3fabk ds as 2vf-m 0.6 0.8 2 14-23 7.5YR3/3 - sl 3f-mabk ds cs lvf-m 0.6 1.0 3 23.47 7.5YR4/6 Is l fsbk ds cs l of-m 0.7 1.6 4 47.86 10YR5/6 s Os dl __ lvf-f 0.7 1.6 Horizon 2 has some gr 1-3% Horizon 4 has some gr 5-10%with few bands of 10YR3/4 some cobs Boring# O Boling 98.10 82 ■ Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 *81#2 1 0-14 7.5YR2.5/2 sil 3f-mabk mvfr as 2vf-m 0.6 0.8 2 14-24 7 5YR3/3 sl 2f-mabk mvfr cs 2vf-f 0.6 1.0 3 24-57 7.5YR4/4 — Is Osg ml cs lvf-m 0.7 1.6 4 57-82 7.5YR4/6 s Osg dl -- -- 0.7 1.6 Horizon 4 has 25%gr;few cobs;I stone *Effluent#1 =BOD >30:<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD <30 mg/L and TSS<_30 mg/L CST Name(Please Print) Signature CST Number MARY JO HUPPERT Hollistees Soil Testing&Design 224832 Address QA Evaluation CorAudited Telephone Number W9875 690th Avenue, River Falls,WI 54022 09- 11 & 11 -19- 13 715-426-1755 Westview Construction Inc. 040- 1303-00-019 2 3 Property Owner Parcel ID# Page of 3 Boring Boring g E] Pit Ground surface elev. 97'20 ft. Depth to limiting factor 84 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 0-14 7.5YR2.5/2 -- 1 3f-mabk ds cs 3vf-m 0.6 0.8 2 14-28 7.5YR3/2 -- 1 2fabk ds cs 2vf-m 0.6 0.8 3 28-42 7.5YR3/3 -- l 2f-mabk ds cs lvf-m 0.6 0.8 4 42-46 7.5YR4/4 -- sl 2f-mabk ds cs 1vf-f 0.6 1.0 5 46-84 7.5YR4/6 -_ s Osg dl -- -- 0.7 1.6 Horizon 5 has some broken bands of sl. F-1 Boring# Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 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 Effluent#1 =BODS>30:5 220 mg/L and TSS>30<150 mgA- *Effluent#2=BODs 5 30 mg/L and TSS 5 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. SBD-8330Test(8.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner W F-Jcu vwAJ Cmtg, wC-Tf 2J T"J" I" = 44ft Legal Description LoT (4, -rR i p u-m, pxr. av (except where noted) s0/4 or- ros sz/�, sic. zz rt?-fAJ RIghb -M wn) =Backhoepit North 44 00 of �u ,ev N opt e Pt L- Sri to qak.k° o' g2 t Q-1 r� J /'rof of.•ZV � 51 Site Location: ,C sowC P �v • a I TOD/7 5316 P,5 TEDT Properfyoww parcel ID# o T I! p�,� z 3 •am of :7 E s°"'� � 5 �d 3� s.S.s p t Ground surface e3e'r fl. Depttn to lac. in rt..f lo(fzon Den. DoMunst t�etlox Deipti Texture Structure Consistence Boundary Roots Gfur trt Munsef1 t2u Sz Cont Color Gr.Sz.5h. ` -F} / o•)-v /d yR 3 iL 2-,ft,At dsti cur 3 1 . -5 sy2 s/� k •7 /Dl�jz fl H OTS F—] sl*V#. Cl { /o Y2 �lZ Boeing Q pit Ground surface elev. 1t. Depth to uniting factor ar. 508 Application Rate Horizon Depth 6ontinarrt CZIM Redox Description Texture Structure Consistence Boundary R7 GPDff in. Munsett M Sz. Cunt COW Gr.S2.Sh. `Etf#1 f # ❑ � Q pit Ground surface elev. fl. Depth to run"' factor kn Soil Rate HM12n Depth Dorninant Color Redax Description. Texture Consistence &wndwy Roots In. Mtnrsell OU ST_ Conn Color G;• Sh• `EW1 'EfF#2 Aw z Boring# !Q Boring Q pit Ground surface eiev. Depth to Wni"faetw &t. Sob kark n Rate Horizon Depth Dominant Colof Redox Description. Texture Structure Gan*stence Boundary Roars c3PDRF In. Munsell Qu.SL Corti.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 i Effluent#1=BOED >30:s 220 m-q&and TSS>30<150 mglt- °Effluent#2=BOD,130 mgA.and TSS<30 mgft_ The Department of Commerce is an squat opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 609-264-8777. seaa3�o nzsnoT Wiiscon_,Departm mm ent of Coerce SOIL EVALUATION REPORT Page j of 3 Division of Safety and Buildings Attach complete site plan� EROSION CONTROL PLAN must be - include.but t1of graced fo- COMP before sanitary permit issuance )el I.D. 4 o percent slope.scale or din p f>• Ptease print att information. R wed b / Date Personal information yar PavIde my be used for secondary Purposes(Privacy Law.s.15.04(1) Property owner �, ToDO Property ZL ZB 0 •r o 17D 133 ERS Te7fl 7_ Z7 Al/�#A Govt.Lot Ai �p 5 c 1/4 S T N.R /9 &(or)w � Property Owner's Mailing Address L #� Block# subd.Name or CSMIf (� i4 Jed'( (n o t S` CA Ili LL ,�u�e WALWO r �t� city yN�cR state Zip Code_ Phone Number ❑city ❑Village R Town Nearest Road blot» HT% MN 5507(o t (,S/) Z' 'F- i'0fF TRoy 50. Cffo0ER 0 (�blew castiuction use:1a Residential/Number of bedrooms Code derived design now rate o � Oa GPD Q Replaoement ❑ Public or commercial-Describe: Parent material /0&55 0 b iX $qN PY J3/�0" Flood Plain elevation if applicable �/ � fL General coriments O v wA- and reoorrxrrendations: 1-:b le �ioa.�v IPA AT"• &X4A5_ N Borkv# ❑ Boring 9g.s 4 > 7� r ® Pit Ground surface elev. R Depth to li niting factor in. Sod Rate Horizon Depth Don*wt Redox Description Texture Structure Consistence Boundary Roots CIPM in. Munsell Qu.Sz Cont.Color Gr.Sz Sh. *M1 •Eff#2 C 0• 12- 1,09 3/3 10 SiL 2n,.,Jb,� �SLI cw Zf 5 N z la 30 0 YIP V4� w /f • S • 6 0 .1 / w/A 8,,4N05 S d r 5 X1,2 ci.s -- • Z y Boring# s 5' > 7 . ® Pit Ground surface elev. ft. Depth to bnbv factor eh. Soil lj Rate Horizon Depth Dominant Color Red_Qx Description Tex ure Texture Stuck" Consistence Boundary Roots GPI n( In. Mtmseil Qtr.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 (N / 0 . 6 Ioye31 s/ L z"hsh ds4 cw 7C- ?--3/ : z Z 1 �o _----- Z_ 1,-.q sh w N IV/'&6 NOS LS D G► a-5 — • S o'r- •Effluent#1=BCC >30<220 nhglL and TSS>30 1150 mg1L •Effluent#2=BOD <30 ntg1L and TSS<30 mgt(_ CST Name(Please Print).R,,u ,`G ,� �'M Address Ulbricht &Associates Date Evaluation Coed Telephone Number PrivateSEAT /g• v 3 715- 77A• 3 yy 2- 2812 10th Ave. Spring Valley, WI 54767 �n m P�Ns °� �4PORo x . 2 Jo Pats . rya /ors • s� • oyo • fo�� • io • onv dyp• /tag( • zo • oaa 0,Y0 • /0Z - �4 t oyo • /0*6 - 70 • aa� X0 r N A L PLOT pg. 3 of 3 '^ LOT PLAN WALNUT HILLS FARM. LOT # Q = Contour elevation lines. • = Backhoe Soil pits. i oow 0 = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. , zo SCALE: 1 FI f OV RAJ I'- boo, o t� N 13M 4 Nn . !!�7- LV'NJP- t 0 0 0�' 3 (.00 OD° i3 � �3 3 13 42 9 5, qj_. 4,4y490T" 7?� f3 ivs�}y�G� ore j0xs1 vAez_ . L, So . Gor 0 7- } Guq�N v 7- h111 ,ter M Tov� 3 le e s T-EEAg T- 7— /q Ptopedy 0wr�r Parcel to# G o / / / page of 3 ❑ Bonny / O 3 # t Ground surface etev. I •tD tt. Depth to limiting factor 340 in. SW AW Wn ate t"Oftm - Dominant C olor Redox Description Texture Structure Consistence Boundary Roots GpU11F Munseff Qu.Sz. Cont.Color Gr.Sz.Sh. i -EN#2 gay/? 3/0 t L //W A c� Z Zei.S h l I;e VIn C w Z 3 SYR s/6 A '7 /0 Y i/ t H oT G d, . Cp /o Y2 . E1 ao�ng#' Borings Q pit Ground surface elev. ft. Depth to limiting factor In. Soti&Jtcofion Rate Horizon Depth Dominant Color Reft Description Texture Structure Consisterice Boundary Poo GPDM IM Munsetl clu.Sz. Cont.Color Gr.Sz.Sh. TO 'Etfff2 tz Boring# t3oang ' pit ground surface elev. ft. Depth to 1" factor In. uW AppkWM Rate Horizon Depth Dominant Color Redox Description. Texture Consistence Boundary Roots Gfflff In. Munsell Qu.Sz, Cont.Cola QT. Sh. 'Eff#1 'Elf#2 Bating F-1- # �-i � t� pit Ground surface elev. Depth limiting factor in. • 7*EffW#1 Rate Horizon Depth Dominant FtedoxDescdpdvn. Texture Shucturs Consistence Boundary Roots In. Munsell QU.Sz. Cont.Color Or.Sz.Sh. fl#2 I Ef fluent#i=SOD,>30:s 220 mglL and TSS>30<150 nrgl! "Effluent#Z=B006:S 30 mgti•and TSS<34 mglt_ 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 609-264-9777. sea-esro tRSmor r