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HomeMy WebLinkAbout040-1304-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569590 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: Precision Builders JP2 LLC I Troy, Town of 040-1304-21-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: lOd - 08.28.19.1827 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER . CAPACITY STATION BS HI FS ELEV. i Septic Benchmark 90�,�� •� /� J g06 m9 Alt. BM Aeration Bldg.Sewer 3• � /Q3. � Holding St/Ht Inlet S L ,6 f. TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/LL WELL BLDG. ent Air ntake ROAD Dt Inlet Septic 76 � Dt Bottom Dosing Header/Man. �• Z /� • Aeration Dist. Pipe (, •8 94. l� Holding Bot. System 7• a�c� 5• PUMP/SIPHON INFORMATION Final Grade Q 1 Manufacturer Demand St Cover �`� � b d v 5.7 Model Number GPM TDH Lift Friction Loss System Hea TDH Ft Forcemain Le Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ? / It, �j¢ ( A �_ _ SETBACK SYSTEM TO V V P/L BLDG1' �, �W,cE,LLLLp[, LAKE/STREAM LEACHING Manufacture INFORMATION Type Of System: l x CHAMBER OR t1� 1�C N�"'-I O �u GI y �� UNIT Mode �`bery DISTRIBUTION SYSTEM f �a�- �S Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air I ke Pipe(s) ` �4 Length Dia Length ` Dia`%-- - Spacing `- SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 177e eSdded jxx Mulched Bedlrrench Center Bed/Trench Edges Topsoil **_ _ No = Yes U No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 445 Sunrise Circle Hudson,WI 540116(NE 1/4 SW 1/4 8 T28N R1 9W) Sunset Valley Lot 21 Parcel No: 08.28.19.1827 1.)Alt BM Description= I;:-i L ! C�CJei` Goa,:^, �}-- O O✓% 2.)Bldg sewer length= �i -amount of cover= `f Plan revision Required? 0 Yes No 7 �� Use other side for additional information. 7�141 (- -- - g SBD-6710(R.3/97) Date Insepctor s Sig ature Cert.No. PLOT PLAN PROJECT Precision Builders JP2 LLC ADDRESS N5740 1242n . Prescott Wi 54021 NE 1/4 SW 1/4s 8 /T 28 N/R 19 W TOWN Tr COUNTY ST.CROIX SYSTEM ELEVATION 98.7/98.3 F below qrade ^ , f� f 3 y" BEDROOM CONVENTIONAL XXX AT-GRADE CON NTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top"�<Pipe -6jrr._f-f:C_ APe:r U ELEVATION 100' ❑ BOREHOLE O WELL *g,g,p, same as benchmark Property Line 100' Sunrise Circle Pro 3 Z Bedroom House 37 Q Zl S 6% 2-3' X 66' cells with 20, Slope >3' spacing , B-1 g 104' B-2 dots 30' °. 102' 85' B-3 40' Townsvalley Road B.M.* 50' Road _00 °erµ �� Safety and Buildings Divisiion 4 201 W.Washington Ave.,P.O.Box 7162 Sanitary Pewit Number(to be fillet is by Co.) iso " 5 07-7162 �ur� 27 ��� ' I 5� 5 , r,cnix C.OuNlry °p - State Transaction Number :0 5a6j 1'6?M pptiMon unit 1n accordance with SPS 38321(2),Wis.Adm.Code,submission of Ibis form to the appropriate governmental is required prior to obtaining a sanitary permit. Nate:Application forms for stn"weed POWTS are submitted to Pr jest Address(if different than malmi address) the Department of Safety and Professional Seavies. personal information you provide may be used for secondary in accordanoe with the Law,s.15. 1 m Scats. L APPlicationIn formation-Please Print All Information Parcel# Owner's Name � . 0 ZI.P Z Z-L-C-- a�b- i3� - Z I oov ProPerty owner's Mailing Address Property Location (. l TZ7 City,State , Zip Code PboncNtrmber y{Y '/,, Se am rJ t/V I � T-.2dN: R e or W IL a of Building(check all that apply) Lot# ) / S ock# ubdivision Name Family Dwelling—Number ofBcdrsa r l (� �,� ❑pubIic/Comarercial-Describe Use � �----- ❑City of CSM Number ❑Vlkage of ❑State Owned-Describe Use of 2 IN 5 mit. (Check only one box on line A. Complete Iine B if applicable) ❑Replacement System ❑Trean nent(Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑Permit Renewal n ❑Charge of Plumber ❑Permit Transfer to New Before Expiration owner t i �'l� t�l✓ IV. of POWTS System Com nent/Device: Check all that apply) l J S In-Ground ❑pressurized T,-Grreund ❑At-Grade ❑Mound>24 m.of suitable soil ❑Mound<24 in.of suitable soil G ❑Holding Tank ❑ Dispersal Component ❑Pretreatmem Device(explain) V.Dis 1/Trea en t Area Information: Sys on Bo Flow(gpd) Design Soil Application dst) Dispersal Area Required(st) Dispersal Area Proposed t �..s-v VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks 8 Taatcs �t y �i yrz'C7 w w ,8 rill Septic err Holding Talc Dosing VII,Responsibility Statement-L the and ponsibitity for installation of the POWTS shown on the attacbed plans. petillpes Name(Print) PI MPMIPR3 Number Business Phone Number �Z ft 7/J� W-K-51 s A. ddress(Street city,stare� 1� Cozen ment Use Only Permit Fee Date Issuin t Signature proved �e.nRmeas. S O` � / ❑ nial 7 IX ConditlI&*6>F'f�Vmns for Disapproval I., Septic tank,effluent Olt and` dispersal cell must all be services f maintairti w V � p,�n ,�- t '� r A. as per management plan provided by plumber: 2. All t; ')Wk re:gt*;e>¢nertts mu-t*' a1 coder/ordiri�txres.' Attwb to eomphte plans for time syshan and submit to the County only oa paper not ices than S rut 1.11 iaebns is sise SBD-6398(R 11/11) RECEIVEU" Wisconsin Department of Commerce SOIL' EVALUATION REPORT Page of Division of Safety and Buildings Z 7 __ in accordan h dm 5 vVis. Adm. Code �/ CountyS7= Attach complete site plan on paper not less than Sjj./Mi WhM.Plan must include,but not limited to:vertical and horizpp�� �8t and Parcel I.D. 36 Z1_ � percent slope,scale or dimensions,north art an ovation and distance to nearest road. 7 Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). l ProplOwner Property Location -P Govt.Lot 1/4Jt�/4 S ( N R 2 E(o W Property Owner's Mailing Address Lot# Block# S Name CSM# State Zip Code Phone Number ❑City C:1 village own Nearest Ro ew Construction Ust��tesidential/Number of bedroomtis�. Code derive design flow rate GPD ❑Replacement � ��,�❑ Public or c mmeraal-Describe: -- Parent material nU�� Flood Plain elevation if applicable _l 114— ft. recommendations:General cornments and System Type System Elevation �� J Y Boring# Boring r, [7/—] it Ground surface elev. 63' 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#2 312-- --. Z"— Ej U jab Boring I ® �# Spit Ground surface elev D i 7. 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 r r. o?' - �' r-. o IV) e L D Effluent#1=BOD >30<220 mg1L and T >30 1150 mglL 'Effluent#2=BOD <30 mg/-and TSS<30 mg/L CST Nwv (Please pnnQ Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conduct d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �' 715-246-4516 ECEIVEIT ' 7 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings �Q �� in accordan h is. Adm. Code Attach complete site plan on paper not less than / County�J t 911.�Rl�ii�fcGds�idhJi�'.Plan must T include,but not limited to:vertical and horizpp(;�� MoMdOIIfM�and Parcel I.D. ,L percent slope,scale or dimensions,north art n ovation and distance to nearest road. t b v 36 Z + zl- OCC) Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). PropefV Owner Property Location 1-10 2.L L Govt.Lot F-7 1/4 o/4 S 3 N R E(o W Property Owner's Mailing Address Lot# Block# Subd. Name CSM# State Zip Code Phone Number ❑City' ❑Village own Nearest Roe/ ew Construction Us5" .yesidential/Number of bedroorrUss Code derive design flow rate GPD ❑Replacement ❑ Public or c mmerciai-Describe: Parent material 0 � Flood Plain elevation if applicable / ft, General comments and recommendations: System Type (it%/)1/ System Elevation l V •-7 ! O 1/7 Boring# Boring it Ground surface elev. ft. Depth to limiting factor_lgi4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 A�W A11.4 lab �.7 Boring# ❑ Boring / &Pit Ground surface elev.`D r 7 fl. 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 I •Eff#2 7 / Effluent#1 =BOD >30<220 mg/L and T >30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST flame(Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird �� 226900 Address Date Evaluation Conduct d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ��� 715-246-4516 Property Owner_ Parcel ID# Page of ® Boring# ❑ Boring j� J ®, pit Ground surface elev. V(' ft. Depth to limiting factor Zg�- 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—I Boring Boring# — Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Boring Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication 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 =BOD,>30<220 mg/L and TSS>30:5 150 mg/L 'Effluent#2=BOD5<30 mgA-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. SBD-8330(8.6/00) PLOT PLAN PROJECT Precision Builders JP2 LLC ADDRESS N5740 1242n Prescott Wi 54021 NE 144 SW 1/4S 8 /T 28 N/R 19 W TOWN Tr COUNTY ST.CROIX SYSTEM ELEVATION 98.7/98.3 5' below grade C_zz31*,_z7 BEDROOM 3 CONVENTIONAL )00( AT-GRADE ' �-1/ CON NTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Property Line 100' Sunrise Circle Pro 3 Bedroom House 40' S 6% 2-3' X 66' cells with 20' Slope >3' spacing B-1 80' 104' B-2 Vents 30' 85' 102' MB-3 40' Townsvalley Road B.M.* 50' Road Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.i ft^2 pair of end plates Finish grade elevation —7 Typical Installation �U3 Vent � Grade t3l 3, 4„Ai30/34 Septic Tank 5' Long 1 5' S' Long Grade at System Elevation 3611 Grade at System Elevation Spacing 5' X14 2-3' X'9-4 ' Cells Same on other end Observation tubeNent At end of cell A B X83 chambers per cell System elevations: ` \ A_913, 8' �`6 . County ✓ Safety and Buildings Division " ,�t- /X- :''Y' K �� 201 W.Washington Ave.,P.O.Box 7162 Sa"muy Permit Number(to be sued in by Co.) Madison,WI 53707-7162 State c� o anitary Permit Applicati T Number In acxordan& �38321(2),Wis.Adm Code,submission of this form to the ap unit ' is obtaining a sanitary permit Nome:Application forms for state-owned POWTS are to Project Address(if dim than maiilin8 address) the of Safety and Professional Smvics. Personal information you provide may be used for secondary � in acoordance with the Law,s.15.04(1)CM), [Stars. A *5 51,A n'S.0- 61 L Application Information-Please Print All Information 6 Parcel# sName^ 774 Property Owner's Mailing Address y � /' i D p z7 �� ��"✓ �' Govt Lot (� City,Stale Zip Code Phone Number /y / S Sacti orr T % N; R/E W II.Type of Building(check all that apply) / / Subdivision Name *Q1,-2 Family Dwelling-Number of Bedroo 6 k- 11 OA B mr PublidCoaereiai-Describe Use ❑City of CSM Number ❑Vrllago of ❑State Owned-Describe Use own of r_ Z 6,G - wz IIL Type of Permit: (Check only o box on line A. Complete line B if applicable) o A new System ❑Rep1womant System ❑Treatment/Holding Tank Repl ❑Other Modification to Existing System(explain) B- ❑Permit Renewal C1 Permit Revision ge of M=bq to New Last Previous Permit Number and Dame Issued Before Expiration IV of MATS S stem/Com aent/Device: heck that a on- Pretreatment In Ground ❑Pressurized In-Ground nand>24 irr of suitable soil 11 Mound<24 is of suitable soil ❑Hoidmg Tank ❑Otber Dispersal Component(explain) ❑ Device{°� ' V.Dis aUTrea eat Area Information: A Proposed System ^' Flow(gpd) Design Soil Application Dis Area Required(sf) rea VL Tank Info Capacity in Total #of Manufacturer Ciallong Gallons Units 3 New Tanks Existing T B S $3 A i rn rz C7 a Septic or Holding Tack Dosing(bomber /\\ VII.Responsibility Statement- the rndersigaed,asanm po sibility for installation of the POWTS shmm oa the attached plaas. P Nerve(Print2 Plumber's MP/MPRS NN ber Business Phone Number- turn Plumber's Address(Street,City,State, p VIII.Coon /)e artment Use On Permit Fee Date bsuA Signature ❑ for DL Cor ms for Disapproval \ /a J t /)_ J:C_ n I Septic tank,efttWnt fiftiw iituf° J IJ du^• r ` t dispersal cell must all be serv6s/Mamtaine f vAper management plan provided by plumbs r. I s ack requirements must be maintalhid as applicable codel orditta8itxs. At tack to nmpiete pbms for the system and submit to the Cooney only OR pales'Dot tea d"a i/2 z 11 lacier is slat SBD-6398(R.11/11) PLOT PLAN PROJECT Precision Builders JP2 LLC ADDRESS N5740 1242nd St. Prescott Wi 54021 NE 1/4 SW 1/4s 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 902.8/902.7 2' below grade BEDROOM 3 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL H.R.P. same as benchmark B.M.* Property Line B-P21 25' 100' Contours are unknown 5e� 0 Road to be>5' 2-3' X 94' Cells with 2%Slope >3' spacing B-21B Vents 30' 0' 75' B-21 C Please note: S soil test will be redone to find a more suitable area, and the soils appear 20' to be better as you go south, Pro 3 Bedroom House Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/11/14 Owner: Precision Builders JP2 LLC Location: NE 1/4 SW 1/4 S8 T28 N,R19W Lot 21 Sunset Valley Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8-10. Soil Test Signature License nu er#226900 PLOT PLAN PROJECT Precision Builders JP2 LLC ADDRESS N5740 1242nd St. Prescott Wi 54021 NE 1/4 SW 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 902.8/902.7 2' below qrade BEDROOM 3 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 hk BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark B.M.* Property Line B-P21 25' 100' Contours are unknown See. �61 fuvr- Road to be>5 2-3' X 94' Cells with 2%Slope >3' spacing B-21B Vents 30' 0' 75' B-21 C Please note: S soil test will be redone to find a more suitable area, and the soils appear 20' to be better as g o ou Y south, Pro 3 Bedroom House Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 904.8 Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 5' 5' Long 1 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94 ' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A-902.8' B 902.7' POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of FILE INF RMATION SYSTEM SPEpFICATIONS r � Tank Manufact urer �t 0 � OWher �- _ L cc Z L 1H_Permit# Septic D Dose D Holding Volume: �,�{(g�e1�) DESIGN PARAMETERS Tank Manufacturer .i'O M Number of Bedrooms: 3 ❑NA 13 Septic 13 Dose El Holding Volume: (9a1) Number of Pudic Facility Units: Vertical Distance Tank Sottom(s)to Service Pad: (ft) _ aY) Horizontal Distance Tank(s)to Service Pad: /1,/�� (ft) Estimated(average)Flow: �e (9 servicing mechanics mud be provided if vw*al is>15 feet or Design(peak)Flow a(estimated x 1.5): t J (9811day) N horizontal Is>150 feet. Spoclflc UsamIW"to be provided on back. In Situ Sal Application Rate: - (gaYdayfle) Effluent Filter ManufacXurer ��� ❑ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,Od&Grease (FOG) s30"mg& Pump Manufacturer: ANA Biochemical Oxygen Demand•(SODS) ,220 mglL D NA Primp Model: . Total dad Solids SS '&150 mgfL High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 fL' ' Manufacturer: D NA (BODs) ❑Mechanical Aeration D Peat Filter SS) >150 ❑ownfection ❑Wetland Pretreated Effluent Monthly average ❑Send/Gravel Filter ❑Other. (13006) 00 mg/L Soll Absorption System (TSS) s30�mgA. round(gravity) D In-Graund(pressure) O NA Fecal Conform eometrio mean s10 0 At-Grade Q Mound Maximum Effluent Partide Size 16 in dia.. ❑NA ❑Drip-Line 0 e'er Other A Other. 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency hen combined sludge and scum equals one-third(Yi)of tank volume Pump out contents of tank(s) p When the high water alarm is activated r_> month(,) (Maximum 3 years) 0 NA Inspect condition of tank(s) At least once every: s) morsh(s) (Maximum 3 years) 0 NA Inspect dispersal cells) At least once every: s) Clean effluent filter At least once every: 1, month;,) ❑ NA Inspect pump,pump controls&alarm At least once ❑yeaarr((,s))`every: m ) DNA _ff NA Flush laterals and pressure test At least once every:. ❑month(s) 0 s) Other: At least once every: ❑morth(s) D NA ❑ s) Other: D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Servicing Operator m Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage 9 P� (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware.klen* scracks The soli u or ponding o ground measure the volume of combined sludge and scum and a check for any bads R po 9 and to check for any ponding of effluent absorption system shall be visually inspected to check the effluent levels in the observation pipes on the ground surface. The ponding of effluent on.the ground surface may indicate a failing condition and requires the immediate notification of the loot regulatory authority. When the combined accumulation of-sludge and scum in any treatment tank equals one-third(%)or of the tank volume,p NR 113, contents of the tank shall be removed by a Septage Servicing Operator(pumper)and disposed of 'Ai' Wisconsin Administrative Code All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,pretreatment units. and any servicing at intervals of 512 months,shad be performed by a certified POWTS Maintainer. A service report shad be provided to the local regulatory authority within 30 days of completion of any service event GMW W5(02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process'and/or damage the soil absorption_system. if high concentrations are detected have the contents of the tank(s)removed b�v a Septage Servicing Operator(pumper)prior to use 7•. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is net recommended,as the excess wastewater will b&discharged to the ad absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)Prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the inftvdve surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not.drive or park over,or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream rm may Improve the perfoance and prolong the life of the treatment tanks and soil absorption system: adds, antibiotics, baby wIpes,'-dgeratteetutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants,fats, foundation drain (sump pump)discharge,fruit qnd vegetable peelings, gasoline, greases. herbicides, meat scraps,medications,oils,painting products,pesticides,sanilliqy napkins,solvents,tampons,'and water softener brine discharge. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s.Comm 83.33,Wisconsin Adniihistrat(ve Code- • All piping to tanks,pits and other soil absorption systems 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(pumper). c • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Oiled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: /" __ suitable replacement area has been evaluated and may be utilized for the location of a replacement soft absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lit lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. -Replacement systems must comply with the rules in effect at the time of their permit Issuance. .❑ A suitable replacement area Is not available due to setback and/or sdl limitations. If the soil absorption System cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank maybe installed,as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the.biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, .PUMP TANKS, AND MOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK , SUFFICIENT OXYGEN TO SUSTAIN LIFE NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name '57 �, v✓ Phone Phone SEPTAGE SERVICING OPERATOR PLNPER LOCAL REGULATORY AUTHORITY Name Name / r _ ©!� Phone / = <�! Phone 7r'.) � 0 l� This document was drafted by the stalls d the Green Lake, Marquette and Woushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1xd)d,(f)and 83.54(1),(2)b(3).Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUCTIONS S-nP s Dry At the aw case ar"the red of the outlet pipe to ensure it is centered under the acmm ophathias. If net,tree ether bhsw t more pie late the tank throe b the autlrt or solvent wdd(Vkw)iddMtlonal pipe onto the outlet Pipe- STEP 2 While the case is Ad dry fitted on the outlet pipe,measure the Impt h of 314-6&pipe needed to brace the Aker to the tank end well If utifEtinq the optional suppiarrhentel aide support.It side support Method is not utilized, proceed to stop four ! T7F.P 3 For instalrtlotis utilizing the optional supplowentai side support: solvent view the%-inch pipe onto the ftw ore. )f side support Method is not udibwd,proceed to step fow. Sohnnt WOW the Aker case onto the outlet pipe. Insert the fitter cartridge Into the case,Pressing dawn until the Aker locks into the bottom of ,.;� .4", the ease. 'a a►S. If a VRS W*ch Is utilisd:insert into the Afd:r and lack by during clockwise 9a'. +'.`. . . Maintwumme i. The affluent Alter should be domed every time the septic tank is serviced. 2. Open the outlet aceess opening to Inspect the tank and ARet + t 3• P'urmP the opt tank carnpletdy,nulkins sure to ramawe the sludge - layer on the bottom of the tank and not just the saint and ef%wnt. 4. Onus the aiUuent teed has been khhwered below the invert of the ` wtkt Pipe P�on the toter handle to didodse the cartridgio S. SAde the cartridge up and out of the case for doming. 6 tf a VRS switch connected to an alarm Is proeent,the switch f• should be mmoved by turning courtardadmiso W and domed *.- with water only. 7. While holding the cartrid a an its side dorw►)ow to access 1) (large cat surface A water �I+*�aura� aperhiaq,rinse off the cartridge whklh water wptW Materiel is rinsed beck into the tank. IL V VRS switch is utilized .replace by lreseu#irq it�o Alter and tunhing dodowise!era-. ~' 9. Insert the Aker carbidge back into the rose,pressing down ura the Aker bode into the bo"Un of the case. IO.Replum and secure the access opening on the trek, - ::�ts^..:ft?s'r-'+ht-`S:4M'It:r!(� -\vE-"t r..:ttret':.L'•rniW.tY"- wrvw.besarolnus��ect►m 877-NUUMS(6534583) 12- -t�- Ow LOT 18 + 1.SAC ACRES r R"W W jr W354 SY. u '- o� 1 ! i '4 s o+an LET 21 ►� �...^_ M395 SF _] o 71M, 29-lq VWWOD' E 201. r �I ' 574.W 57,OF A - ;( 338.95' OUTLOT I �, U25 ACRIE 27,2M S.F. f LOT 7 .. + d 1..5c�ACM • 65,624 S.F. x L80888.0 III ST. CROIX COUNT''Y SEPTIC TANK MAINTENANCE-/kGREEMENT AND C� OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Address / -2 s"72 (�__—�, , _ _ I Property Address (Verification required from Planning&Zoning Depart ment or a construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location 1/4 ,SC...s.) 1/4 , Sec. D , T Z 6N R1 W, Town of C= Subdivision �Cl lel Oct - , Lot# . Certified Survey Map# _ ,Volume ,Page# Warranty Deed# �� _, Volume , Page# .1 Spec house yes no Lot line;; identifiable C no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the wasir disposal system Owner maintenance responsibilities are specified in§Comm 83.S2(l)and in Chapter 12-St. 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)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a ty deed recorded in Register of Deeds Office. Number of SIG A OF APPLICANT(S) DATE ***Any information that is misrepresented*nay 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 survey map if reference is made in the warranty deed. (REV.08/05) i 1 II 1 8232461 State Bar of Wisconsin Form 7-2003 Tx:4190223 TRUSTEE'S DEED 996446 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 05/27/2014 2:34 PM THIS DEED,made between Arthur N. Feyereisen and Marilyn E.Feyereisen EXEMPT#: NA as Trustee of The Feyereisen Revocable Trust dated December 28, 1995 REC FEE: 30.00 ("Grantor,"whether one or more), / TRANS FEE: 210.00 and Precision Builders JP2,LLC,a Wisconsin limited liability corporation PAGES• 1 ("Grantee,"whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Name and Return Address River Valley Abstract&Title Lot 21, Plat of Sunset Valley, St. Croix County,,/ 1200 Hosford St. Suite 201 Hudson WI 54016 Wisconsin. File 400521 040-1304-21-000 Parcel Identification Number(PIN) Dated May 27,2014 (SEAL) � (SEAL) *Arthur N.Feyereisen,Tr1ustee *Marilyn E. Feyereisen,Trustee (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticate I on )ss. ST CROIX COUNTY ) STATE OF WISCONSIN * Personally came before me on May 27,2014 , TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Arthur N. Feyereisen and Marilyn E. (If not, Fe ereisen Trustees of the Feyereisen Ikevocable Trust authorized by Wis. Stat.§706.06) to me known to be the per s w ecuted the foregoing instrum ac e. THIS INSTRUMENT DRAFTED BY: *Lo L.Della Fran Iverson 1200 Hosford St. Suite 201 Not Pub tc,M isconsin Hudson WI 54016 �� M Commis; n(is permanent)(expires:March 20,2016 ) (Signatures may be authenti or acknowledged. Both are not necessary.) SS NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. UGrof �CbO flFtyD 9f446 Page 1 of 1 ©2003 STATE BAR OF WISCONSIN FORM N0.7-2003 ype name a ow si a res. f,4 S U EA$GN z Y-- z. 4a eY !�$ PRBN5740 242ft eaavmrr,vn seozl 3Q� I�1 x 1 i .. 3 $ MA+FWM Q {J SItCT NA1oCZ. cmrevmu,eu c.osT,o�. T17E1 A-3 \ mm��.wmm.,s•au�a•� Y9 .109�R, 1853 f �•T c G'j� RECEIVED VVmcD>sin��t of OCT 2 2 2004 SOIL EVALUATION REPORT Pays 1 of 3 Division of Safety and Buildi s ST.CR(�I t mm 85,Wis. Adm.ZONIN Cody ST.CROIX Attar complete site plan an inches in size.P include,but not limited to:vertical and horizontal reference pant( Parcel I.D. percent slope,scale or dimensions,north arrow,and location and road. 977 Please print all information. Date Peal information you provide may be used for secondary purposes(Privacy Law,s.15.o4(1)(m)). l �D O Property Owner Properly Location ARTHUR&MARIYLN FEYEREISEN Govt.Lot —NE 1/4 SW 114 S 8 T 28 N R 19 E❑(or))WW Property Owners Mailirrg Address Lot# Block# Subd.Name or CSM# 420 Townsvalley Road 21 — Sunset Valley City State Zip Code Phone Nmber �v Tom Nearest Road Hudson, WI 54016 ( 715) 386-2122 Townsvalley Road New Construction LlseEj Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial-Describe. Parent material outwash/sandstone Rood Plaau elevation if applicable NA ft. General cornmerft t Conventional In-ground trerwhes- o be designed b e and recommendations:recommendations: Y installer 0.5 loading f 4O apt., C �t,. .Q-�.Pr aA-K S l4 k� -)- t � PB BodN# ❑ Bonng Q Pit Ground surface elev. 906.15 R Depth to limiting factor 61 in. Sod Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPQW in_ Murrell Qu.Sz. ConL Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-4 10YR2/2 — 1 3f-isbk mvfr cb 3vf-m 0.6 0.8 2 4-14_ 10 — I 2f-mabk mvfr cb 2vf-m 0.6 0.8 3 14-24 '­IOYR3/4 — I 2f-msbk mfr aw 2vf-m 0.6 0.8 4 24-33 1OYR3/6 — s 09 dl aw 2vf-m 0.7 1.6 5 33-37 10YR4/4 — s&gr Osg dl aw — 0.7 1.6 6 J67:1-664- 1 10YR4/4 — fs Osg dl as — 0.5 1.0 7 IOYR4/4 c2f IOYRM6 fs Osg dl — -- 0.5 1.0 B]F Borirg# Boring 904.78 41— �� <El of Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Lure Consistence Boundary Roots GPD/ffz in_ Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'EtTtR2 1 0-3 10YR2/1 - I 3fsbk ds cb 3vf-m 0.6 0.8 2 3-19 10YR2/2 — I 2fa&sbk ds ci 2vf-m 0.6 0.8 3 19-27 10YR3/3 — I 2fsbk dsh cw 2vf-m 0.6 0.8 4 27-35 10YR3/4 1 2fsbk dsh cs 1 of-m 0.6 0.8 5 35-42 10YR3/6 s Osg dl gs -- 0.7 1.6 6 42-110 10YR5/4 -- s Osg dl — -- 0.7 1.6 *Effluent#1=BOD5>30:5 220 mg/L and TSS>30<150 mg/L *Efltuer>t#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) attxe U� CST Number Ma Jo Hollister 224832 Address Date Evaluation Conduced Telephone Number W9875 690th Avenue, River Falls, WI 54022 01 - 13&07-09-04 (715) 426- 1775 Property Owner. FEYEREISEN,Arthur(Lot 21) Parcel ID# (Pending) Page 2 of 3 C Boring# Boring Pit Ground surface elev. 12 ft. Depth to limiting factor 109 in Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ? 'Elf#1 'Eft#2 1 0-3 i0YR2/I 3fabk OA J ds cb 3vf-m 0.6 0.8 2 3-12 IOYR2/1 1 2f-mabk dsh ai 2vf-m 0.6 0.8 3 12-24 IOYR3/4 -- 1 2f-mabk mfr cb 2vf-m 0.6 0.8 4 24-30 10YR3/6 -- s&gr Osg dl cs — 0.7 1.6 5 30-109 10YR5/4 _ s Osg dl — -- 0.7 1.6 (Horizon 5 has some gr.) F—I Boring# Boring aPit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx ture Consistence Boundary Roots GPDHF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 ❑ Boring# Boring QPit 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 E wen #1=Bl'4 30<MU rng: ark T 33%30<i 50 t=mwerA 3Oq,<:rig rrg1L and TSS<30 mg/L a � POf M W'3ff3 OWI :FAY mov. /o MAMUM o N PI PES S q C R0 1 s D�50L Pom W/ MAOM NO COMM 570 -ACRe-tb, r ),B-P21 7 qjD .1 7 8-218 � 904.7 - .905. 1 :904 2 , — 9030 LOT � FEZ j see, wNS / UCI 1 1 1 HL o' RED BRICK I ADDI TION / �4GICU T RE`--R SI ENTIAL - - - - - -+ - - - - 900.4 x 14" E 13 .11' 91p'8 EAST-WE'ST AN L/LEL "X—j -7.66' .29' 913 3 5 .0 2 `o LOT 19 (P ' . .604 ACRES OT 6 � .� 00 I 6 ,875 S.F. N N 1. A S 50 65,4 S.F. I rn l I �. 0�9s.a E �` '913.3 a B 19 0. 0 j x . 7- 0 1 6`• ,?0, 'O� ^h 911. 5 C,'2• to I Sao ip ul � C \ ' L 1 \ 15 E 0 =80' M \6 ,3 6 S. S' 00 -P21 s �=\ 87 4' w ' i � x I /19 s 1 0 o x I O 895. J 90501 C `7 00' n w' X oD 5 C S O� 81. 9 A 7 . ao '9 .F 330 1.570 ACRES ' w L=_ S.F. 5 I ( O O , O O 0 o t 2 2 0 95.5 in, 0 0 ° . I I I S 9 000 00" 20 145' O 00" E 06. _ Z1N -8 � - 1 ' N 000' 00" W 574.39' 8" 0.0 UT OT 1 .d. 3 E .62 CRE _ p N � ,206 S.F. N u'►`'- , �9° (LBO=888.0 50' o 00 1.506 ACR S: B- 7 S.F.624, 65 N' 8930 ORO p '�j 890.9 / I