Loading...
HomeMy WebLinkAbout030-2131-41-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 574350 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: Oeverin Homes LLC, aka Oeverin Pro ertie St. Joseph, Town of 030-2131-41-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: �� 23.30.20.1095 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER g 5 CAPACITY STATION BS HI FS ELEV. . N Septic -nom Z 1600 Benchmark S9, Dosing / ,1 i (Poo Alt. BM 162 . Z. (� Bldg.Sewer ► 2 1 -63- 4 Holding St/Ht Inlet 1- 7-7 `7 7 2 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet 11p J Septic Dt Bottom cJ3, S � / � Header/Man.1 ---_ Dosing / 7 S �d� Aeration Dist. Pipe Holding Bot.System 2 .55 lob Final Grade b•75 �eZ• PUMPISIPHON INFORMATION J T Manufacturer Demand St Cover Ile GPM /- 31LZ Model Number I —7 YO C r. 3j �Q3,�� 3 ,� 9�• (O TDH Lift Friction Loss/ Syste—m Head T�3•Z�Ft 7.95 /.7 3.9 Forcemain Length Dia. 1 I Dist.to Well SOIL ABSORPTION SYSTEM ^J BED/TRENCH Width Length No.Of3; PIT DIMENSIONS No.Of Pits_-Inside Dia. Liquid Depth DIMENSIONS 8 7 (`J� 1--m-- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer: INFORMATION Type py�ystem: ,�f A-- UNIT Model Number: rr 1 6 o-& 87 /"IT DISTRIBUTION SYSTEM aJ Header/Manifold/ f/ Distribution I x Hole Size I( x Hole Spac�g Ve t Air Inta Pipe(s) ` J(0 Z Length Dia Z' Length ✓� Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only llj.,� Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched p Bed/Trench Ede Topsoil ' ` Yes [ No Yes Fiji No Bed/Trench Center / $ 9 COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:g—/ / nspection#2: Location: 112 Heritage Trail oulton,WI 54082(NW 1/4 SW 1/4 23 T30N R20W) Settler's Gleen ,41 , a Parcel No: 23.30.20.1095 fr",L�.. V C� 1.)Alt BM Description= •'' ~/5 p,6,j 2.)Bldg sewer length f -amount of cover= �/ �et� P✓ r✓� Plan revision Required? Yes No l � r --- V 7 2_ 11111411 _ _ _ Xr7e �Use other side for additional information. Date Insepc J Cert.No. SBD-6710(R.3/97) PI f�T PLAN fl I I PROJECT Oeverina Homes j ADDRESj 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 114 SW 1/4S 23 IT 30 ,�5�/R 20 W TOWN St. Joseph COUNTY ST.CROIX 7121/14 BEDROOM 3 20 MFRS Shatin Bird 226900 DATE CONVENTIONAL IN-GROUNI ''R..SSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons 1,111' "LANK SIZE DOSE TANK SIZE 630 MOUND XXX SEPTIC TANK 517E HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none .1 V.R.P. Top of 1" pvc pipe oo, Filter BEAR Filter BENCHMARK ASSUME ELEVATION i 0 BOREHOLE WELL -H.R.P- Same as Benchmark SYSTEM ELFVATION 100.7' All piping shall be SDR 30/34, within 10' of tank. piping shall be Schedule 40. 177' Scale = 1 /4" = 10' 3 acre lot Well is to meet all Property Line WDNR setbacks Grading is to be B.M.* done to divert Area 15' below run-off away Heritage Trail system is to remain from system undisturbed B i [luffcutt Combo Tank Pro 3 2% Slope Bedroom House B- 2 100, e- 3 99.7' 99, Tank is to be properly bedded and provided with lockdown covers with approved warning labels PUMP PERFORMANCE PERFORMANCE PUMP •- •� MODELS EFFLUENT . .- • ail MUM MUM mmpm mnlamongam ■,■■■■■O®01�0�0f O��D®0000p�0�OD ■■■■■■■o°°eo°°estvo°os,000s,os,©° o°°°e°°°o°a°osto -x 0stv�0° ■■■■■E�o°°°e°°°e°o°°ester°aosto° o®°eoe°ee°°°°ettatt�°°eettt�tty ■�■■■■�tv®e°eels°°e°°°°ee°°°°°° - ■\■■■■Mots°°o°°eases°°a°°ee°°° � ■■■■■■�°�°°°a°°e°°°sea°�°°°°°e°°°e°°°°°°°°°a°°�°so°° .■,� stt®°etas°°a°°°°°°°°e°°°° ■1�■■s,°°atse°°�°tsa°ts°sets°ts°°° - \\foil■EE■■MEMO■ u■■011►■■■■■■■■■ 111REEMOVIRIME MEMO W-1 . WENEZZ ME: 0010E111�E\■■EM■■■ 000000.m.�oa00000v LINE 0o0�0maaom0mm�mom ����II�����■■■■■■ ovommm°aoo0ovov0 000v0m°aoo0m®tt®tt©0 ■■■iI■I■■■�■■■■■ 000vov°e�v�o®0v� oo©mote°aoo0o�■mom Vii■■■I�■I■E►►�E■■■■ oo.00000.voo�.v�ov� E�EE11��E■�EE■■■E ono®©o�.voo�omt�©m o0o0v0®0oovmvvv0 ■■!\111\■■■��■■■■ °a°ttsa°ao0000�0om°©o �� , � °eaa0vaao0omi®0om �,\�\i11II■■■■■■■■■ atstsetse°e®t®©ov0v� °00000°a°aaa°s0o iili -Q,W4�IIX,IW W NOO■■\■ ■■\\\��■I \►�►■■■■■ 30 feet ThH. _ Now EonMEEE■O■■M ENIONE SEWAGEA ov©o©oo©000 00000©ov©©00000 ©©oov®�00000vvvm©0am 0©o DEWATERING oovov0000v000vovv000ss0000 © MEN■■■000 0000000000©©000000DD©O 0000000000x000ODDOD©00000© omsassssossso0oo©00000©0vv E■■■■■omsassasssasssssovovov©ovo � omssasssasasssssasovov©vox oosssassasassssass000vvv®v oosssassasassassssssssovov . ■■',■■■■m®®ssassassasassssoc�vv v®ssasssssssassassssssasov ■��V■►\■■■■■■■■■■■■MEN v■■\ \�■■■■■■■■■■■■■ \"m\■■■►\■\■■■■■■■■■■■■■ m■\om■■\■\\`�■■■■■■■■■■■ �i.��\\■\■\�■■■■■■■■■■■ . . ' w■vim\\\■■\\V■■■■■■■ � . . . . . VON■■\ate\���■■\r\\V■ ■■■ ■� subjected Safety and Buildings Division CM7 c/b 201 W.Washington Ave.,P.O.Box 7162 sanitary permit Near(m be filled in by Co.) �,: Madison, 53707-7162 AUG ttp1 �;74/ 3 50 State Transaction Number ,pM1u. . '`Wft Appl ,mil 2 In>u c,-daucc wit{5PS 38321(2),Wis.Adm.Code,submission of this f� a m obtaining a sanitary peamiL Nabs:Application forms for�o pOWTS are submitted to Projcet Address Cif different than mailing address) ��'�� provide may be used for secondary ' the Dopartmcal of Safety and Professional Servics. posmal information You pr I ,10 ses in accordance with the privacy Law,s.15. 1 m Stets. L L A lication Information-Pleaae Print All lnformatio pared W property owner's Name , [ 3 ,V 'Qr i A - Property Location property owner' Mailing Andress Go -7 vt.Lot 9 l / City. 1ffie 7 , Zip Code Phone Number '/+ SeWon h�✓ N' R_LE V II.Type of Building(check all that apply) L/ Subdivision Name Family Dwelling-Number of Bedrooms O BI 111 ❑Public/Conmtemhd-Describe Use_ GL ❑City of J`�� CSMNumber ❑Village of ❑State Owned-Describe Use � K !"� III.Type of Permit: (Checl my one boz on line A. Complete tine B if applicable) A. system ❑Replacement System TrewmeaUHolding Tank Replacement Only ❑Other Modification to Existing System(-Plain) ❑Permit Transfer m New List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑Changer of Plumber owner Before Expiration IV.T of POWTS S atem/Com nent/Device: Check all that a 1 ❑Non-Prasstaized In-Ground ❑Pressurized In-Grormd ❑At-Grade >24 is of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Otber Dispersal Compa>trnt(explain) ����(��) , es- V.Dis VTre ent Area Informatio ��Area R .f��� D;e Pro I (sQ Sysbaa Elevation Design Flow{gpd Soil Appti eist) fyr,M+s� �� � D b � Manufscuuer VL Tank Info Capacity in Total #of Gallons Gallons Units New Twits Existing Tanta E 8 iz a U m ern 0 p. septic or Holding Tank Dosing Cumber VII,Responsibility Statement-i,the nndas ned. pondbitity for installation of the POWTS Ao"on the attached plans. V s Name(Print) Pi MP/lvtPR3 Number Business Phone Number Plumber's Address(Street,City,State,ZiP Code _ - - ) 1 Conn /De artment Use Only Tssue� _ Issuing Signature Permit Fix I roved isapprov S �26 �Z/l em Reason - 1X Con ns for V' PProval 13 �� P !b✓ ' 'tank,etlhtlant filtertl� . c�;n�t'�•a.v�GQ� r it i�a/',N•w. r Y .dispersal ceif-must all ea t••v►cea 'nl ntaineel LJ h as per managermnt plan provided by piurnblF. t f 2. x ll si k!eq l elrtents mt -Qs'.malntarih ! ) C..4���-r w�.� I�� SPa 1.2. ��� LC- c re— as per indleable code I Ordirtar►oes. 'T 1 Attach to ewmplete P—for the system and submit to the Coen tp PnPer not less than a 111 z]1 iochns in are SBD-6398(R.11/11) O�FpRTaN� DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 K Contact Through Relay p w www.dsps.wi.gov/sb/ �d 4° www.wisconsin.gov ° ssl g� Scott Walker,Oovemor Dave Ross,Secretary August 15,2014 CUST ID No. 226900 ATTN:PO WTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAIN APPROVAL EXPIRFS;PA115/2016 Identification Numbers Transaction ID No. 2442689 SITE: Site ID No. 804698 Oevering Homes Please refer to both identification nttanbers, 112 Heritage Trail te i Town of Saint Joseph agency. St Croix County NWl/4, SE1/4, S23,T30N,R20W FOR: Description:Mound Object Type:POWTS Component Manual Regulated Object ID No.: 1496709 Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver. 2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual -Ver: 2.0, SBD-10706 P(N.01101,R. 10112); 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 with the"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0",kBD-106W (N.0 10/12)and the"Pressure Distribution Component Manual for Private Onsite Wastewat ltppl � SION 2.0" SBD-10706-P(N.01/01,R 10/12). The building sewer and distribution network piping shall be of mate isted able 3$4l 13 and 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts malfunc s to create a health hazard, the property owner must follow the contingency plan as described in the approved ns. In addition,the owner must comply with the operation,maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). PP I P, {j� SHAUN R BIRD Page 2 8/15/2014 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 353.54(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 tracLing 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 coast:action/installatioWbp erauk?n. 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-Osborne Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 CiIAT :' ' julia.lewis@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services. Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page RECEIVED JUL 2 5 2014 Shaun Bird INDUSTRY SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/21/14 Owner:Oevering Homes Location:NW1/4 SW1/4 S23 T30 N,R 20W 112 Heritage Trail St. Joseph 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 Specificatiojan� oss se ion Shaun Bir d Signature License number 6 ,.y Y ,`W PROJECT Oeverina Homes PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW '1/4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/21/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE MOUND X)p( 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none IL BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.7' All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Heritage Trail 177' Scale = 1 /4" = 10' 3 acre lot Property Line Well is to meet all WDNR setbacks Grading is to be M• done to divert run-off away Huffcutt Combo Tank from system I B- 1 Pro 3 Bedroom House 2% Slope ❑ Area 15' below B-2 system is to remain ❑ 100' undisturbed B-3 99.7' Tank is to be properly bedded and provided 99' with lockdown covers with approved warning labels Mound System Cross Section and P*,VieW ; �< �. 7: �► Dime�ntiun Feet w J B fi D E l T A F – W t . 1 G t r ' Z. H .v �j I I t<- t K L r w �' i ri+b:"Igif-hir:^v7r':.,nr.rvw+ir':ir+.i:+sir-wir.`vr'1�itit*a:rY ,tlr.Wr-.i'1►yfGfraP�ir rr+.ir-a'nir wir wr wrW�rVrlr YYs"+ " Tom—' B Z K S % L t . =Topsoil =ASTM C-33 =Clean aggregate O =4 in. sch. 40 pvc t Cap Material sand fill 1/2 t0 2 1/s in dla. observation pipe Geotextile k H Fabric q �' - F /4 -Ft �t D E Plowed Surface 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 1/4 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. i 10/071gj Page of Pressure Lateral Layout Two Laterals -- End Manifold -o---- Threaded Cleanout Lateral Turn-up Plug Manifold M X —� L T Long Force Main Sweep ; a 90 Bend Distrtbntion Aletwork S ecifli cations Pressure System Construction Lateral Diameter In. Manifold Diameter Z� In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice S in In. the pipe with a sharp drill bit and face down. L (Lateral Le Ft. Lateral turn-ups terminate with a threaded M Manifold Len Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main L 'Q Ft. from finished grade. • • • • • Grade • • • • • • • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 Igj f i Septic-Dose Tank Crass Section And Pump Perfc rmwee Specification Tanilc Manufiactaum Me�nufarotuaaerr Twk Model Numbet �, p Model N Tots!Talc Capso�ty / 3� Ai>e<m Maos+ar v � Maus.Bury Depth 9 Alenw Mader lmber 11c,r/ j 3Wie0h Type Oz e C Filter _ Tots! Had CMH)-Feet Filter Model Number Elm4Wm Iwd /l� Died proom No".mch Loan 119 M pip Ratquire+d Faroe Mean Lou /. Total /S• �, Outlet Msmcle*,r Abmv Or*&With Mmhok Mia.r Above Gracie I,drug Dent* In*MU6016 Ste►�ouoeed 11M I,00ktng Device <6"Below Oride SW Ad W tei t WM*Wlroaf `—'—"'! ► Junction Haoc . FW@beOraate d .. �• .. �. .. •� ♦� .. ♦ r r "" 1 vat Mha. it Dnoomre« Above t>F&& Mom • wkh vent Cap Inla 4�et F1ter °—�-...-► -- -- A W :}• switch aM�d Rael`� .} eep Tani,V *' ON ':j: Hote Vohmm Gal- ;;:• Dimacmi�oa i :r• :• maerve A' :. (dose C S 7, > Boom r. &md Di J :r Ft :::: Total - •:. •: •r .'. does rick is beaded.std 14* ford ri aoroed " the Jay G� I,A' ON: The.trpticf the� may ad , , , M: of bwy-ae. -. a tos a!iotive lookfn8 dervice10 ) etc gRade vm�d%& piping et 1ho in*aid as t Is of Woved mow,o m od t4 dw toile wm, at , ink-is*Nod 4" ,40 p"VC to bridge the tank laid os tb�ble sdi tq .. va)MC 300 arrrd Caen+ �antdt' $-Almre.is seskd. •:g�rsaal.teNia � ;. low of 02105 IJ XI`�ent 71- A. SM040 series 4/10 hp Submersible Effluent Pump, 3/4" Solids two II • • , 0 50 100 1150 200 M 30 9 20 6 ����►�� I I ; 40 Go so r , `. I LUTU i �1 - 400 East Spring Stref#.oluffton,IN 46714 Tth 260-824-29W e Fax 260.924-2909 1 POWTS411kafER'S MANUAL its MANAGEMENT PLAN �$pg1i•7CATNS Oat Qfa %. PER%" C+ r 0 NA Peittrak NA r i1�andSCk9W DNA Naaoe of 13"A S Mason Fftw iii O" p Nae16erot commwdlk#units `: PIXW'Tw*Q*Odty ❑NA saw a+ e�i PWWTW*MWNkomw pests 996MW x 1A) p KA Od APPOOM n Rob /v Pamp Miflefed O idA it�rsrd �`' P�flail (FOG) s C3 S w M O Peet Fii W F^Oft Cl hbdwdoW rraon Q� Damend (80%) me Q Doom, ANpwded Soft OSM s15p Ptefi+e d NA � " CORS) �t Uerx,arod%� s3a�- k�pmw( M ) 0 M ) Tort sedan Said$ t T s3o°� #3 AtIade s W CIO'-dRiltBCmi 13 13 00w. FAWw a t fto t Ps", Size X sbec vaws ror dWftW.ro�oaa. t rw ear w+e N %f*"wW btprsWmof aim SOON" MAP"e d teak{:) At hi�t�Mb sway g) fifihr s -) Ptrgop ed COANeews of t s) 1NiAero"ow*Aned dw*and scorn wA"anstried(Yj of neck vokum At i a ► s s) { y►rs.) ckm No +ow 1 ,} PWRP corwob a skm Alloweonorrwwy o s) O'NA and pawn we Q s) DSA At aokoe aarec3► p motft p O(s) p NA At ierMiE am*emy 0 morofs C3 Via} W MA�ifM'i7NCE Tl�GT1i,1NS ` IMp e!tarracs anoieper+ i aaees shed ba an irowi aNrytnp one the Ito bosnrles or Masher Phomber:Maralsr Pkuartoer Norm PGNMTS lrapagiOt;PO%VM 1fiq0falM:Sipitge gp� '�p;F. Tank,irapw�rls roust i �v11t111 i�lp -d�s fiitila(�tj b idanMl��'aa�g Eft b�aioee� #auM ,lam►�tr�!'ads oriseks,ffdmm a the valum adcs d dmdp oW oxm mW b duck for wW bw*up OF Pm m os of eo grox nd rid**. WAORW uwgkmft Md b check to el&m**v4* in"+above l"m ion pipes ad b dwsrlt tw my po2Ki also"s4;�#OWW WAr*m. '�ha ct4kom on Nbe "*in aMIA a �land rsgnir+ss SO o nddical l of ft,kx*fq WA"W. tlAW the 00mbbod aa:rxrwk en of skidt and mm in 1e aroyr leak ee d SKI or rwor of tt,e:t a vim.du eow adis*&of the tank shd be'romovW by a �t)jws "W of in acme with dt.NR I#,WWounsin/&***ottive t;vde., Trig mWift or Mbuwd ids.modrdcd or prrosewb d PCiWrS compmoras,p mmopnent corapww nb,and anY oii�sr rnsiM4e a mvrdoring sit of f2 n�orolhs a bat slmM be i �by a oerRwd Pf)YMTS Mme• A ser kp taport shah be F—RUTO eid b iw bcel 16FIdWY auft*veil* 10&Ys of oompiefbn 4'ww servim evert. STARf'UP AND OP'ERATIM For toew corabsdon,p dw b�Of the POWS dfdcit trot ft*S)#vr be pr+e$wm of; prods or ofi + chemkx*1W nay impede the todma t pn�oees wA*w ds a to&Wsrsei ce14 if high m+e ddwbd have V*contwft of the tanks)ronwaed by a septige swvi*V opKabr'prbr,lo use. x Pops of START UP AND OPERATION s for',the P of Pain np produces or Gomm dtmdrksis#ZO For rww cam, Pt's to use of the pOWTS check iroaetti>Ient ) � are detected itsnre tom oorrtsnle of thp m impede the tneatmarrt process and/or dantags the ��(s)removed by a septags servicing operator prior to use. System start up shad not occur when sod conditions we frog,at the YVtten power Is restored the sums wastewater' vAll by During power outagsa pump Lanka may fM does,overioaKiing the oedl(a}end may result in the backup or surisce died"Of SMW" discharged to the dsParsat 061(8)in one Uuge a Ssrvidng pp�r prior to M*Ugft PQWW to the To avoid this situation hews the contents of the t�P W* removed by SOP corWOM to reactors normal Mvels affluent pump or contact a Plumber or POW?'S Maintainer to as"in manually oRmtatin9 the PAP oom the area within within the pump tank. Do not drive or park vehicles over tanks and dispersal oewa. Do not drive or park over,or OtltsnMse clis�b or 15 bet down slope of any mound or at-grade soli absorption area• tom so of the POWT:�: Reduction or elimination of tine f0l0wirKl iron the wastewater stream may IM PO" ��s; di* : fat: foundalton draMn andbk�tica; baby wipes; cigarette bum condoms; cotton swabs; degteaseos; meat eoxaps; modim"s; o1; pWry" prom; (MP pump) Mader; fruit and vegetable iree&W; gasp fin% grease; herbit�t; pest#cides;sanitary napkins;tampons;and water softener brine. ABANDONMNT taken out of service the following steps shall be taken to insure that the system is pq"Oy When the POWTS abandoned fads and/or anoe with chapter Comm 83.33,Wisconsin Administrative Code:. and safely absndorted in compel • AN ptplog to tanks and pits shell be disconnected and the abandoned pipe opw*lgO sealed. • The contents of all tanks and pits shall be removed and Property disposed of by a SePtage Opsrala • After pumping, all Wks and pits shall be Oroawated and removed or their covers removed and its void space tiwed with 8*11, gravel or another inert sold matertai. COOMMOENCY PLAN Lis following measures hems been, or must be taken, to Provide a cods comPn*t If the POWTS fad and cannot be reporad replacement system: ent soil absorption syst0n• O A suitable mpiaoement area has been evalu araN fOr °f a r°p<°OefA The replacement asst should be prewW and should not be immure w upon n �*W seemem horn existing and proposed structure,lot WW and wens. Falure to protect thee rap comply with the rule$IIn for a new sot and ass evaluation to eatabW a suitable replacement teas• Replacement systems mum effect at that time. in poWrS technology a 13 A aW table replacement area Is not available due 10 smtbe&arrdJor sow Ifrnitatlons. Bening advances holclng tank may be Installed so a teat resort to replace the failed POWCS. am evoluv4on ,aide has not been evaluated to Man*a uAtable rapin=nent area. Upon fa llure of the POWTS a�� �� must be perfomred to kxm to a suitable replaommsr d area. if no replacement area la avewabie a hokiNtg a Iasi resort to replace the tailed POWTS. >4 Mound and et-+X�edl absorption systems may be recsrstr,xted in pb,k,e ioitawing removal of the bforttat at the irttntrartive dace. Reconatrucil na of such systems must comply with the rules in~at that tkne. «WARNING» SEPTIC,PUMP AND OTHER TREATMENT TANK&MAY CONTAIN LETHAL�ee ANDfOR NNSUFMMNT OXYGEN. OE T ENTER FROM THE iNP OR OTHER A T TREATUM TANK E DUr UNDER Y CMCU ANCES. DEATH MAY RESULT. RIMCUE O A PE ADDITIONAL COwAMENT8 POWTS INSTALLER PtIWTS MAINTAINER No Naas Phone 7 S SEPTAGE 8MWING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name Name ` 4n Phone ThIs do=rW*suss draped in cornpllance with ohaplsr BPS 383.22M(bx1)(d)&M and 353.54(1),(2)&(3),VVMcorsin AdmkriaASO Cods• T W scorisin Department of COMMOr a SOIL EVALUATION REPORT Page of 'J DWWW of Safety and Buildings dt accordance with Comm 85.11Vis. Adrm. Goole qty _ Attach complete site plan an paper not less than 8112 x 11 inches in size.Plan must include.but not Ihr ed to:vertical and horizontal reference point(BM),dredion and Parcel I.D. percent slope.scale or dinrernsions,north arrow.and location and fiance to nearest road. 030 Please print of ..-- . y Date i'erscxul r>tanrtadon you provide msy be used < claw.a atu(1)tm))- �C.�. I 13J 03 purpom y Owner Location (2' FA 111 Lot /1/W 1/4 sw 1/4 S� T 3c/ N R Z CJ E(or)6 Gtr C w, or Property Owner's M��Add ll '� Name or csNl# ty fate ZIP Code Phone .. ❑City 0 Village -Town Nearest Road //L New Construction Use: Residential/Number of bedrooms Code derived design Crow rate �/SSA//O 4 GPD p Replacement Public or commercial-Describe- Parent material ` { Flood Plain elevation If applicable General e na 5ys4ew► zlev 8 /00,5­0 �bn�,��r -eteV. Y9• � a Bing Boring# B alt Ground surface slev. is O ft Depth to limiting factor��lo In. Sol Applicalim Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *EM1 -Eff#2 1 i b S i I 2-tnabL rY��r C_^ !v `j $ Z 3b_ I S i Z �5 r`I t t, 3c-1 _J Boring# a Boring Pit Ground surface elev.qf, f6_ft. Depth to limiting factor s In. Sad Application Rate Horizon Depth Dominant Color Redox Desaiphon Terre Sbucture Consistence a Boundary Roots GPDMF In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -EW -Eff#2 rust" C 1 14- ,4y- cs Lj 3 ID 4I6 s 1 2sY-t, nrS'r Efflnent 01=SOD,>30<220 mglL and TSS>30_<150 M91L 'Eft 92=BOD6<30 mglt.and TSS_<30 mg1L CST Name(Plea ) Signature CST Number A&rn .�-- S33o9 Address Date Evaluation Conducted Telephone Number 2113 SCTh Property Owner, au'� 1"` ,a Parcel ID.# �� Page of J Boring#- ❑ Bc ni g � h. Pit (around surface,elev. i t` fL Depth to iirniting factor -�y3 in. Soil Appticatioi Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAt= In. Mui s Qu.Sz. Copt Color Ce.Sz.Sh. 'Eff#1 'E Z -Z 10-,4(--14/6' ,�_� L(1��JlJ :lr� 4-1 y ly Boring It ❑ Borir►g ❑ pit Ground surface elev. ft. Depth to limiting factor in. :.oil Application Horizon Depth : Dominant Color Redox Description..__. Texture -Structure Consistence Boundary Roots GPD/W In. Munseli Ou.Sz- Cont.Color Gr.Sz.Sh. 'Eff#1 'Ef Boring# ❑ Boring Pil Ground surface elev. ft. Depth to limiting factor in. Soil Appiiplbn l Horizon Depth Dominant Color Redox Description Texture .Structure Consistence Boundary Roots GPD/ftr In. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff! ' Effluent#1 z BOD,>30<220 mgA_and TSS>30<150 mcyL 'Effluent#2=BODS<30 mg/14 and TSS<30 mgA. The Department of Commerce is an e(naI 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'I-I-Y 608-264-8777. SM-8330t OM) I • PAGE_�> OF NAME (�ccP f ia�, LOT# � LEGDESCRTPTION Uit! �ScR�� S Z2,T go N.R. ZUtor)l1 SCALE: 1"= BM I ELEVATION� y BM I DESCRIPTION}oQ o `` P—" BM 2 ELEVATION 1110 BM 2 DESCRIPTION 4- i I SYSTEM ELEVATION SYSTEM TYPE - CON'I'OIJR ELEVATION �l Q 0 . SIGNATURE ���-�-- -��/ DATE— Ailt FILTER CARTiuDCE a aw.woo�,,,�''""1•i.Iris d't/,,,.up,,t>�td.a„wu ie K ++yap 3 1 as wm'"is itlM now of of%'- 1�Ma1 4 boo t�hf I�r 4���w+�,Nsrr der 11�it l"Mo**Wb Y{ K( .is lM1t tjlC ?yFM' FrY Irby boo tlMr IIIIICrW tv 4w film w�is N1w it ct�t�&"*at ti'NIiaM1 ks N�oA SnN�ae�t amid liar cow oft lfllt aeAirt Mips. k .O IN, r b r�ihM c�Nwr,promN YbIN ltifl i t{odaa kip,Oft , 1r ty.. tF a Yes aiik is M*Aw : i iuo„th,igaw w cida�.wr. 1. Tha adllMnt IMW dhouN bw d w pro tHc for k!s viwd. 1, f)pIY11 Ult alliia�irc,cwd pmt to IFIONO the t"OW Ight y I 9. Piahp dw wNtr Aadc idm to f4A>w a tha d Ifs IYyw'o�iMe irbai.a o tlaa aKrc+a»t�yN, n+Ihd rt'Nliw�, + +►, IN*Nth*/ipwe,e,oneiit y k►uA 1p Ya+a I,wiw e akrbwrr,bd WOW the Woo*wl the WAO lr 6N Nl eun. ims b a�r ft 5, "dw wa to afti dig:or"m am*W 4W*16. G. ly w VOW owiinilr grfllMC' Im ON 460"j*WWMML LIM MMC6 � wlth mbar ono. by torwwq samew U`Md drpiw.! the twww"r. owr dr b a M��Idrl p a �1G r►widu�a1M1+i�11rrp�rMt11�1 ON��MM ` u. �NRb saw is ebrMr�Nlti►Mwr tawk. .;�}. ' • dN p1'NII/t1Uir illtiq INbYr awl „y y. 7aa,rrt IMw fIIMr U*tw t black M#r qN at*, the Alhw 6j"b"iM I,riho.n of Mw mew , tq. + Wplowr and Ma�tY t1/Y�;1M�IMid DN{1t�bilk. ; x,sr •�ni.� c: +u'7�;w KS+K.r �,�G.'l it,(►k11'lL1:YAbu..v�. �. -fez- ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � Owner/Buyer 0 e J Mailing Address Property Address_._L Z,,,,,� required from lanning&Zoning Department for new co ttuction.) --` City/State� �� --- Parcel Identification Number 030 LEGAL DESCRIPTION .Property Location Ya , Ya, Sec. Z -- T3D N R D W, Town o1'.n _ Subdivision --- _-___ _, Lot# Certified Survey Map#_ -- Volume — — Page# Warranty Deed# 9(� :�2 d- I ---- , Volume , Page# _ Spec ho usr{ yep no l.nt Imes identifiable�� .�S 1R0 5YSTEM MAINTENANCE AND OWNER CERTIFICATIUN `�/J .Improper use and maintenance of your septic system coul ma d 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 waste disposal system. Owner maintenance responsibilities are specified in§Comm,83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance The property owner agrees to submit to St.Croix County planning owner and by a master plumber,journeyman plumber,restricted Plumber &�licensed pumperver a certification form,signed by the wastewater disposal system is in proper operating condition and/or(2)after inspection and pumper that(1)the on-site less than l/3 full of sludge. p roping(if necessary),the septic tank is 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 Wisc Certification stating that your septic system has been maintained must be completed onsin,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 warn deed recorded in Register of Deeds Office. Number of bedrooms IGNA OF APPLICANTS) - DAT.F, ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&'Lowing Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey neap if reference is made in the warranty deed, (REV.08/05) "WOO' , ' • ••- FFF • �■ • 3 +, + • 40 + • gg • t • . • 1 .!T ci■ r • ■ 6 ■ • 11 � • s � • • r • • ■ • ■ •a • + j iii R &4 6009 lido i� 8238188 State Bar of Wisconsin Form 1-2003 Tx:4194940 WARRANTY DEED 997529 BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI 06/20/2014 3:17 PM THIS DEED,made between Mike Dorwin and Kay Dorwin,husband and wife EXEMPT#: NA REC FEE: 30.00 ("Grantor,"whether one or more) TRANS FEE: 137.70 and Oevering Homes LLC PAGES: 2 ("Grantee,"whether one or more). Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area estate, together with the rents,profits, fixtures and other appurtenant interests, in ? St. Croix County,State of Wisconsin("Property")(if more space is Name and Return Address needed,please attach addendum): Land Title,Inc. See attached Exhibit A 2200 West County Road C,Suite 2205 Roseville,MN 55113 LT File No.505406 030-213141-000 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: Easements,Restrictions and Covenants of record,if any. Dated '7 Day of 2014 1� (SEAL) �— _ �^ (SEAL) *Mike Dorwin *Kay Dorwin (SEAL) (SEAL) * [Enter Data] * [Enter Data] �"'" AUTHENTICATION AUTHENTICATION ��P��EE ACKNOWLEDGMENT ,..e�, , S ignature(s) ': •� T�:t'l- • I STATE OF Wisconsin ) ss. authenticated on a r ) ,�.• ba=r-� ,: :;= St.Croix COUNTY �• * � Personally came before me on May 27"i,2014 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Mike Dorwin and Kay Dorwin,husband and wife (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. ti 706.06) instrument and cknowl d same.�/� THIS INSTRUMENT DRAFTED BY: * Meril e J. Bune Larry Mountain, Attorney; Land"title; Inc.,2200 West Notary Public, State of Wisconsin County Road C,Suite 2205. Roseville, MN 551 13 My Commission(is permanent)(expires: 10/17/2017 ) (Signaurres may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM. AN)'i\•IODIFICATIONS"1'O"PIiIS FORA SHOULD BE CLEARLY IDENTIFIED. ',861�0*10bgh"97529 Page 1 of 2 C 2003 STATE-BAR OF WISCONSIN FORNI NO. 1-2003 Type name below signatures. LT File No.505406 LEGAL DESCRIPTION EXHIBIT A Lot 41, ettler's Glen,Town of St.Joseph,St.Croix County,Wisconsin. St. Croix County 997529 Page 2 of 2 i Property Owner (VaGc- Parcel ID# I page of Boring — J a Boring#• ❑ oring v " ' g Ground suracelev.9 � , Dept to liming factor In. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GlIcati In. Munsell l]u.Sz. ConL Color -: G�.Sz Sh. 'Eft#1 •EffN2 l IU 3�Z CS 15 Z ( ^2 IU ZrnSb� m C - �-I (x--36 to F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sail Application F2ai Horizon Depth Dominant Color Redox Descripffon.._.. Texture _Structure Consistence Boundary Roots GPD/fl= In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F Boring# ❑ Boring ❑ Pif Ground surface elev. R Depth to limiting factor in. Soil Application RaIt Horizon Depth Dominant Color Redox Description Texture .Structure Consistence Boundary Roots GPD/W in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30<220 mg/-and TS >30<150 mg/!_ 'Effluent#2=BODS<30 mg/la 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. SBDpIO(R07/00) 'Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must �� � ' include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. / /I /�x 1 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print al �"� Review y Date e 0 E'4...,�tiad Personal information you provide may be used for ndary purposes(�n d law,s. 5.04(1)(m)). � 3 63 Property Owner P operty Location 2002 wt.Lot Nth 114 1/4 SZ T jU N R ZcJ E(or)(W C Property Owner's Mailing Addreft L t# Blodc# Subd.Name or CSM# ig/ City State zip Code Phone Number ❑City ❑Village &Town Nearest Road //j. 1�ux��c t� 5' ((05] )�+A1--Z4-\q s -� New Construction Use: Residential/Number of bedrooms Code derived design flow rate D GPD ❑Replacement ❑ Public or commercial-Describe: 1 , Flood Plain elevation if applicable material � /��/� ft• General comments 5 and recommendations: y �oA'fOOC z1eV• �9 ❑ Boring# [t�]t Boring l Pit Ground surface elev. 9f �"p o fL Depth to limiting factor -3�, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -Eff#1 I 'Eff#2 1 ©-33 1 D S I ) C° 2 3p- l 3[1 Z►r�s bk �Y�� C-5 3 (o C 2P-I 5'd mob m� r" q 10 7 Boring# Boring / Pit Ground surface elev.. -fL Depth to limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description FTexture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 c cl 3 -LS to 416 Sal Zm-sbk Effluent#1 =BOD5>30<220 mg/L and TSS>30_<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name Please Print Signature CST Number S \ rnC)�.e -- 2 3.3d9 Address Date Evaluation Conducted Telephone Number 2At3 Y PAGE_�5 OF NAME OG(c r is�4&= LOT# LEGAL DESCRIPTION Quj YSW`/a,S Z T 30 N R ZG (or) SCALE: I"= yv BM I ELEVATION_1pc). 0 BM 1 DESCRIPTION P c- P-',D BM 2 ELEVATION qLT, :© BM 2 DESCRIPTION�� ---- SYSTEM ELEVATION /ov• ,S o SYSTEM TYPE moo nA - CONI'OUR.ELEVATION q,7� -7-6 1 8 � v SIGNATURE �, �G � DATE