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020-1481-09-015
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574379 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oevering Homes LLC, aka Cievering Pro ertie Hudson, Town of 020-1481-09-015 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: ?i Id. 2 yt�j/. !� 07.29.19.3066 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark 91 • S /�-7 0. Dosing n . (p Alt. BM �0�„ ar�utd Aeration B . Sewer 1-4 />y,� 7.S /,p7. 3 Holding t/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet N TANK TO ,P/L < WELL BLDG Vent to Air Intal ROAD Dt Inlet Septic i p G t h Dt Bottom S ///•to// Dosing Yo- -- ea er an. .2 vT„ / W ���� C -7 Aeratio / Dist. Pipe Z a 1//,&.l 4 D %•-7 Holding Bot.Svstem J 2� / % Cj , /C PUMP/SIPHON INFORMATION all% Fin�J,. de 4Ae- ItA Manufacturer Demand St C verf GPM f�yi (� G'/ j7 C �1 J o Model Number &J,J �SZ W y,�S pY, a TDH IlLifts Friction Loss System H d TDH O Ft Forcemain Len Di� p Dist.to wel�ZA SOIL ABSORPTION SYSTEM KGw B DIMENSIONS Width Lenk I No.Of Trenches PIT DIME NS ONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS �— SETBACK SYSTEM TO fj_:5 JBLDG WE L LAK L TREAM RING Manufacturer: INFORMATION C ER OR Type f stem: / / r I U Model Number: j11 DISTRIBUTyON SYSTEM S y 4W110 Heade anif�ld Distribution / x Hole Size x Hole Spacin Pipes) �� l 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 xx Seededft e xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil /v i p Yes [] No Yes j] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / 7/ Inspection#2: /D Location: 1058 Autumn Oak Lane Hudson WI 54 16 N 1/4 SW 1/4 7 T29N R19 Whis en�ak0 s Phase II Lot 15 Parcel No: 07.29.19.3066 1.)Alt BM Description= i 0 4, 2.)Bldg sewer length= -• -amount of cover ? LIZ 0 f '�"ra*-k- Plan revision Required? [] Yes [/lo r r, f ti� /r(�C '✓►'� S . Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Signature Cert.No. PUMP PERFORMANCE C-URVE PUMP PERFORMANCE CURVE EFFLUENT MODE • 31F.irr&3/4'SOLID PASSING CAPA, CITY MUMWIWI m®000mo��■®m®�aoa� ,s o■��®oo o®is°i°e°°°°ee°somas°e�■m ,� ■■■■■■■'Mme°°°eo°°°°°°°°■■°°°°°°°°°e°°°°°°°°i°e ■■■■■■No�i°s°°°ea°°°e�°°°e°°°°°°°°°ems°°a°io°°i°° ■■\■■■■' �, �e°ee°°�e°e°ease°°°°°° ■ 110■N 0 0■■■■0 \\\Mil■\■■■■■■■■ 11.� ■ � 0■\■111 WINE■NONE oom�maoaoamm000. nIM\\11E01 �M■MOON ov©mmm°°°°oNEM 0mm ©0 ovov0maaoo0m®®©m momm ■nMi1■INN\\►\M■MM■ o©©■mmmm°°°m°m°°m � 0�0®©000�0000�00 \IORWNE\1■■■■ 000•®o.�®momv�°vov� °a®©o0v®oo0m�oovm IRWHII►N■\�\NEON °°a°v0000m®momv0 MEN RMIUMA III aaea0v°aomo0®0om E aae°°°°°°°aaeav0 ■. NO,,i. ►,u's■■■W H. explosion proof ou p,seeFM0219. ■■Nfi ■■■■■■■■O■ SEWAGEAND v°omo®0oovovvv0mvovoss®0vv DEWATERING oov000vvovoomvov®o©oss©v0o ' M■■M■■ 00000v°ovvo©ov©vv°v®v°o°v omssssoo0vovov©ovvo©ov°v°v o0sssssssasso0oo©ov°vv°�°° va�ssssssasssssasovo©ov°�°° � o°sssasssassssasssoovo©vv° ■■■■■o©sssossasassssassovov©�®v msassssassssssssassasovov � ■■',.■■■� sasasssasovoo NNE ©sssassss osssssssses sassassasasov , �■�-.m\�■■■■■■■■■■■■■ 62 ■■n■■►�■■■■■■ NEW h"m■■■■■■■■■ . . . . , . . .� !�►�!�■►`���\�►\►\MOON affi- subjected to less than 15 feet TDH PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 108.0' DATE 6/17/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' Scale _ 1 /411 = 10' of tank,piping shall be Schedule 40. Property Line (not to scale Autumn Oak Lane Area 15' below system is to remain undisturbed Property Line 1 Acre Lot B-2 Wel I is to meet al H uffc utt D N R Combo a setbacks B-3 Tank ' � B% Slope u ' Grading is to be done to ' / — t water awa f B.M.* B- 1 m .2t 332' Property Line 105' .1051 ^� 107 Safety and Buildings Division I-Dj D q. ivision Coup C� %"'f P.O,.Box 7162 Sanitary Permit Number(to be filled in by Co-) 201 W.Washington Ave., V; Madison N 53707-7162 -74 3 7? SVState Transaction Number Applicatton 15,A d ra,code,submission of this form to the appropriate governmental-it in accordance with! IV, -uhrinned to Project Address(if than mailing address) is required prior OA�jj sanitary permit Note:Application forms for state-owned POWTS are s the Dcp,,ft,,t of safety and Professional Servics. Personal Information you provide may be used for secondary purposesin accadan c with the Er'M Law,s.15.04(l)(011 or -le - L Apporation Information-Please Print into tion parod# property Owner's Name 3 OZO 114 Irl —09, Location Property Owner's Govt Lot ec city State , 12; fion Zip Code Phone Number �/Z:W'/, 'an k t# Type of Building c ee&k a apply) LA) Subdivis' ame ❑1 or 2 Faraily Dwelling-Number of Bedrooms 6k- 6,6 0 PublieXomrnercial-Describe Use ---------- CSM Number D vidiagr of ❑State Owned-Dcs_/Use own of — % A- 5 OJ Ill.Type of Permit: (Check only one box on line A. Complete me B if applicable) Z11 r_e_ >11 A. syst= Replacement System Tratineot/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued Plumber ❑Permit Transfer to New B. 0 Permit Renewal ❑Permit Revision El Change of Plum;;] 11_P_1ft Transfer Before Expiration Owner box I�1.1 z�A S B. Permit Expiration A. clml�lllte H, IV.Type of POWTS SYsteln/UiimponentlDevice: (Check all that&PP21 ) -Pressurized bGround 11 Pressurized In-Ground 13 At-Grade ouod_>�24ixaLr of�suitablc soil ❑Mound<24"L of suitw#soil ❑No, ❑Holding Tank 0 offia Dispersal Component(explain) ❑Pretreatment Device(explaia) /Z V.Dis aVrreat e t Area Information: Dispersal Pro (st) System-Elevation,,.,, Flow Design Soil Application Area R uir ✓ , (J I b- . ��kj �6�_ D VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units Now Tanks Existing Tanks F. Septic or Holding Tank Dosing Chamber ility Statement-1,the undersigned,an ponsibility for installation of the POWTS Shown 011 the Itt"bed plans. VII Responsibility MPIMPRS Number Business Phone Number- ol Plumber's Name(Print) Pluinber' i M6 ��l Plumber's Address Street city.State,Zip Code) Z/ 2 VDL oun e artment Use n Permit Fee Date sued Issuiag Sigaattue Approved 0 $ 1 ,74 IEM)XL Conditii FW Disapproval , fVWnzvxftwnsforDi P 8d:uj V 11.. septic tank,effluent filter and dispersal cell must all be services I maintained �by plumber. S%:W management pl�;;Z�provid V%c,^,A—b U....V�_A_ 2. T" AreMelft must tofriaintaln6d A A1140*0 as per V,F—1. bps coda/ mances. in X I inches in size A#mb to compkite plaw for the ten and submit to the County 9019 om pope not Im than 8 14 SBD-6398(R. 11/11) ' 9�psxT � DIVISION OF INDUSTRY SERVICES �o� 2331 SAN LUIS PL STE 150 p f P GREEN BAY WI 54304 3 ` w Contact Through Relay www.dsps.wi.gov/sb/ yyL www.wisconsin.gov A�OFESSioNA�S� Scott Walker,Governor Dave Ross,Secretary September 11,2014 CUST ID No. 226900 ATTN:POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/11/2016 Identification Numbers Transaction ID No.2452629 SITE: Site ID No. 805530 Oevering Homes Please refer to both identification numbers, 1058 Autumn Oak Ln above,in all correspondence with the agency. Town of Hudson St Croix County NE 1/4, SW1/4, S7,T29N,R19W FOR: Description: Residential Mound-New Construction Object Type:POWTS Component Manual Regulated Object ID No.: 1500465 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual- Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes,is responsible for compliance with all code requirements. No perscn 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: C Key-xtems(s)-POWTS Design Approval • This system is to be constructed and located in accordance with the approved plans,and the "Mound REF Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.01/O1). PRO# i • with the approved plans and with the"Pressure dIVIS110 This system is to be constructed and located in accordance t pp p D _Z 3L Jn Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P t 1 • Fence off dispersal(mound)area during construction to avoid disturbance and compaction. r SEE • ",�'tctew iter enerated from contractors cleaning of equipment and tools and/or left over construction g g _ss h _ not bedischarged into the drains discharging to o the private o nsite wastewater treatment sysr em (POWS . Waste generated shall be properly dispos ed of on-site o r of site. t • ^ny tall gasses, leaves and shrubs need to be cut short and removed prior to tilling the surface for installation to prevent marting under the dispersal area. • 1'r �r c ;,ons ruction of the dispersal area,check the moisture content of the soil to a depth of 8 inches. �ireanna and compacting of wet soil will result in reducing the infiltration capacity of the soil.Proper soil SHAUN R BIRD Page 2 9/11/2014 moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4-inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare,do not proceed until it dries. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS)in accordance with SPS 383 and the approved management plan • Tlie G waer of a POWTS shall be responsible for ensuring that access opening covers remain locked or seOLI-ed except ior inspection,evaluation,maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for tae PCVJ° S described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. II A copy of t"e approved plans, specifications and this letter shall be on-site during construction and open to inspec`ion by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/insia ation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should coed.`,cns =i, sf niaici g them necessary for code compliance.As per state stars 101.12(2),nothing in this review shall eL v tY_s aesigr_er 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- eft addressee."shall provide a copy of this letter and the POWTS management plan to the owner and any othe,r&who are resppnf sible�for the installation,operation or maintenance of the POWTS. a Sincerely, + Fee Required$ 250.00 fi This Amount Will Be Invoiced. When You Receive That Invoice, Mark Si7 <�e= '� Please Include a Copy With Your POWTS Wastewater Sp" ialist I ,grated Services Payment Submittal. (608)574-1189, Fax: (608)267-9566 ,M-f 7:OOAM-3:45PM WiSMART code: 7633 mark.finger @wisconsin.gov cc: E dwir A Taylor, Wastewater Specialist,(715)634-3484, Monday-Friday 8:00 am To 4:30 pm 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 aadressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chanters 360-366. Cover Page AiJG 2d zo INp�STRY S 14 Shaun Bird �RV/CFS Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/ 17/14 Owner:Oevering Homes Location: NE1/4 SW1/4 S7 T29 N,R19W 1058 Autumn Oak Lane Hudson 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 'ONDITIONALLY 3. Mound Cross Section PPROVED T F SAFETY AND 4. Pipe Cross Section/Pipe Layout SS ONAL SERVICES 5. Pump Chamber Cross Section QF 1 T Y SERVICES 6. Pump Curve 7-8. Maintance and Contigency plan NcE C RES 0 9-11. Soil test 12. Filter Specificatio d cros rection Shaun Bird Signature License num 226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 108.0' 6/17/14 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' Scale = 1 /4" = 10 of tank,piping shall be Schedule 40. AL Property Line (not to scale) Autumn Oak Lane Area 15' below system is to remain undisturbed Property Line 1 Acre Lot B-2 Wei I is to Pro 3 meet al Huffcutt Bedroom DNR Combo House setbacks B-3 Tank 8% Slope Cale = 1 /4" = 10' Grading is to be done to divert water away from B.M.* B- 1 system 332' Property Line 106' 108' 107' Mound System Cross Section and Plan View - - - - - -- - - -- - - - - - - - - - - — Dimension Feet i J i t ' A c i B s . l D T A i ' W i F }� +- Z — G i H " v I I i i J s8 t i K _ �o L � - - - - - - - W J K - --- - -B - - - - - - - - = - - - Z 7 r ` L ---------Slope % 1 =Topsoil =ASTM C-33 #r: = Clean aggregate =4 in. sch. 40 pvc Cap Material sand fill 'r: f '/z to 2 '/2 in. dia. observation pipe Geotextile G H Fabric F �i oFt D E /Z,_0 Ft Contour Plowed Surface 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 '/o inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07lgj Page of Pressure Lateral Layout Two Laterals — End Manifold 4-- Threaded ' Cleanout Lateral Turn-up Plug Manifold M X L Long Force Main Sweep 90 / Bend Distribution Network Sp ecifications Pressure System Construction Lateral Diameter 2 In. Manifold Diameter Z In. Laterals are constructed of Schedule 40 PVC Orifice Diameter ? _�/6 In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) y In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter diameter lawn sprinkler valve box accessible Force Main Length G_ Ft. from finished grade. • • • • • Grade • • • • • • ;d ; : : ::::::::; • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 lgj i Septic-Dose 'dank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer i Tank Model Number (b 0 0 Pum Model Number Total Tank Capacity' 3 t7 Alarm Manuuei Max Bury Depth '' Alarm Model Number �,-�/ Switch Type z Filter Mangy Total Dynamic Head CMH)- Feet Filter Model Number ; Elevation Head �U Distal Pressure 3 Network boss Minimum Pump Required Force Main Loss GPM, / Ft TDH Total -S Outlet Manhole Ntm 4"Above Grade With ale Min.4"Above Grade Locking Device, Inlet Manhole With Locking Device <6" Below Grade Sealed'Watertight Securely Mounted Weather-proof Junction Box ♦ ... Finished Grade -' -M •• ••• •� •• ••• Vent Min. 12" Disconnect Above Grade Means • With vent Cap Outlet Filter et�.... Bale Inlot A. switch r and Reserve -ty ;:z Weep Tank VohWe= GPI Hole Dimension: Inches Volume Gal. B ' (reserve)A 7t Off'Elevation C (alarm B 2 g� .�'r Ft .f' :. Bottom Elevation Ft Total dose tank s bedded and filled in accordance with the 'I ION: The. of bury as.� by the mgnufacturer may not GENERAL INSTAL' product approval spocnficWW6' Maxims a to tang device(padlock) Manhole covers exposed to Si'�e�V0 �°ff0�v t fittings, and be excaeded without p�nof approval• connected to the tank�a 6 wdwdO installed. Piping at the and outlet is of approved material, 4 Sch•40 PVC to bridge the tank laid on stable soil to prevent settling or sagging. The force maim is cleaved whh "service compl 16.2x. excavation and the slemve is sealed waght Eloctfical ies with NEC 300 and Comm Page of 02/05 U Wasta. SEN-44 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow-Uters/Minute 0 50 100 150 200 250 300 covet Epoxy-Coated cW1iron 35 11 30 10 9 Impeller Material Thermoplastic Elaotomer 25 8 AWIFA i 20 5 Volute Epoxy-coated cast iron 15 5 o x 4 10 3 a Mechanical Shaft Wle with .carbon and S ceramic faces S 2 ° 1 - 0 0 Shaft- Steel 0 20 4 80 80 Flow-Gallons/Minute -1 a em I--4e7---i f - 9.tS xis• em LZM i x aes elq SEN-40-AF SEN-40 Specifications -5 1E • ? y1 S 1, 6/92Q 80 70 . 60 c 45 25 32` 14 20 28 5 1750 _ .. 1 ' am 1WWF p 3 0; 1 it 4-1 1!r .' WIWI ;80 70 60 46 25 3P- 14 20 27.5 1750 . 1 7 Franklin Electric 400 East Spring Street,Bluffton,IN 46714 Tel:260.824.2900•Fax:260.824.2909 Form:698198 7.11 www-frankiiwelectriccom 1 POWTS OWNER'S MANUA[. & MANAGEMENT PLAN Page_ of FILEINFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Pal� gal 13 NA Septic Tank Manufacturer ❑NA DESIGN PARAMETERS Effluent F#W Manufacturer r' 0 NA Number of Bedrooms 0 NA Effluent Filter Model ❑NA Number of Commercial Units Pump Tank Capacity al ❑NA Estimated lbw(8veta9e) 3 all Pump Tank Manufacturer NA Design stow( cj,(Estimated x 1.5) Pump Manufacturer / DNA Sol Appica5on Rate Pump Model ❑NA Influenvulitient Quality Monthly average' Pretreatment Unit NA Fats.Oil&Grease (FOG) S30�- 0 Sand/Grevel Filter ' O Peat Filter Biochernicai Oxygen Demand (BODJ 5220 m9/L 0 Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 0 Disinfection ❑Other Pretreated Effluent Quality XA Monthly average`" Disperse!Cel(s) Biochemical Oxygen Demand (SOD.) 530 mg/L ❑In-ground(gravity) ❑to-ground(pressurized) Total Suspended Solids (TSS) 530 mgfL 0 At-grade ><Mound Fecal Coliform(geometric mean) 510'cfu/100m1 ❑Drli>mline ❑ Maximum Effluent Particle Size K inch diameter • VaWes typical for domestic(non-oorrKnertdal)wastewater WW septic tank effluent- MAINTENANCE SCHEDULE Valves typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every O months ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third(Y)of tank volume Inspect dispersal ceIKs) At least once every ❑ months AZt year(s) (Maximum§yrs.) Cleat affluent filter At least once every i O months earls) Inspect pump,pump controls&alarm At least once emery O months ar(s) ❑NA Flush lat6rats and pressure test At least once every O months r(s) ❑NA 06W. ° At least once every ❑months ©year(s) ❑ NA 00>4r At least once every ❑months ❑year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifi=tions: Master Plumber,Master Plumber RestrkW Severer,POWTS Inspector; POWTS Maintahw,, Septage Servicing Operator. Tank inspections must irtcude a visual kw4mcdon of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,measure the vol urne of cornWned sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal ced(s)shall be visually inspected to check the effluent 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 fading condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third(K)or more of the tank volume. the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,Wisconsin Administrative Code. The servicing of effluent filters, menical or pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at" ervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory autfxxity within 10 days of completion of any service event. START"UP AND OPERATION For new construction, prior to use of the POWTS tied(treatment tank(s)for the presence of painfi%products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concelAtrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. Page of START up AND OPERATION For new construction, prior to use of the POWTS check dispersal treat tc a It)s) fo t prey concentrations a of p ntin prodt�have the to oftth may impede the treatment process and/or o operator prior to use tank(s)removed by a septage servicing p System start up shall not occur when soil conditions are frozen at the infiltrative surface. wastewater will ble excess During power outages pump tanks one large dose,normal verloading he cell(S)and may result In the backuupp or surface discharge the o{efrluenit. discharged to the dispersal call(s) To avoid this situation have the contents of the pump stainer to assist manually operating the pumpocoprrtrds aresrestor® normal levels effluent pump or contact a Plumber or PO within the pump tank. ct,the area within Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or comps 15 feet down slope of any mound or at-grade soil absorption area. Ion the fife of the POWT:$: Reduction or elimination of the following from the wastewater stream may improve the performance and prolong undation drain antibiotics; baby wipes; cigarette butts; condoms cotton gasoline;> b webs; herbiddestameat acrapsrsmedical�ona; of; painting produr-0; (sump pump) water, fruit and vegetable peelings; pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails 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 chapter Comm 83.33,Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, ail tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code comp irp replacement system: ay be utilized for the location of a replacement soil absorption systeim. ❑ A suitable replacement area has been evaluated and m The replacement area should be protected from disturbance and compaction and should not be infringed upon by requirled setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result with the htule I in for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. a 13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologl/ '�hohlediing tank may be installed as a last resort to replace the failed POWTS. ✓ musabe performed not onmed to evaluated to Identify a aultable suitable replacement area 1f no replacement area failure of ffm POWTS a soil and holding tank ay be installed)as Pe 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 irdiltrative Urfese. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GA38E8 AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER A TANK MAY BE TANK CULT A Y CIRCUMSTANCES.UMS ANCES. DEATH MAY RESULT. RESCUE O�A PERSON FROM THE iNTERt ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER a Name Name oel Phone r Phone '- i SEPTAGE SERVICING OPERATOR PUMP R LOCAL REGULATORY AUTHORITY Name T_ Name / l� Phone �J -� Phone fJ Code. This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wis(,onsln AdministniNe m Wisconsin Department of 7�-in SOIL EVALUATION I4�0�T�0 i 3 Page of Division of Safety and B 15 accordance with Comm 85,Wis. Adm. Code ST Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. j}26 69 Please print all information. Re vie by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location f_ w Govt.Lot #E 1/4 9(vi/4 s//7 T q-- N R /9 E(o<$ Property Owner's Ma" �r� ,� ^ _ Lot# B Subd.-tJame CSM# 8/71 a /^/L•it/ City; � Statet Zip Cod / .one,umber C3 city �Village Town Nearest Road G*New Construction Use:® Residential/Number of bedrooms Code derived design flow rate_ Dd GPD ❑Replacement ❑ Public or commercial-Describe: Parent material S a✓an Lim cSI&A Flood Plain elevation if applicable General comments and recorrimendations: System Type System Elevation ID Boring# O Boring Pit Ground surface elev./D� ft. Depth to limiting factor .jam in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. jMunsell Qu.Sz. Cont.Color Gr.Sz.Sh. �f •Eff#1 •Eff#2 Boring# �O�yy ins CJ pit Ground surface elev. 7—ft. Depth to limiting factor tn. FEoiiApplication 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 7 t, F'1F 5 r I/J. St -m- ekvFt o- j7/& . b •Effluent#1 =BOD >30<220 mg/L and TSS>30<150 'Effluent#2=BOD 130 mg/L and TSS<30 mg/L CST Name(Please Print) CST Number ;r��Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 S"-42—g-/ — 715-246-4516 -v/ED WiisconsinDepartment of Ct SOIL EVALUATION FJW92013 Page of Division of Safety and B in accordance with Comm 85,Wis. Adm. Code ST � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Revie by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location w P govidinas �� Govt.Lot wE 1/4 !WV1A S p� N R P Owner's Ma'' Address Lot# Block# Subd.Name or CSM# Spy •✓rr _P14 4'e 'Kcl — wh422c' 0444r State Zip Code Phone Number ❑City ❑Village M Town Nearest Road (lltIiew Construction Use: Residential/Number of bedrooms 3/ Code derived design flow rate OQ GPD _ ❑Replacement C1 Public or commercial Describe: Parent material (��✓dr` i�M t411WA Flood Plain elevation if applicable General cofmients and neconunendations: System Type ( � System Elevation b M Boring# E] Boring p pit Ground surface elev./p0•L ft. Depth to limiting factor �U in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 J - .r17"' a Boring# ° Boring ,�. pit Ground surface elev.7` " UZ-ft. Depth to limiting factor 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 p- to u r3/'1- CIO 2- to SI 4 C- a arms q0 t F . '-f • b 3 S-3 6 %j tF . �f . 7 FIF 5 r lh= St a/x- #)/,c • 6 Effluent#1 =BOD >30 1220 mg1L and TSS>30:5 150 'Effluent#2=BOD 130 mg/L and TSS<30 mg/L CST Blame(please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 1 �f—e2l ?rl 715-246-4516 Property Owner_ Parcel ID# Page of aBoring# ❑ Boring ER-pit Ground surface elev. d S�eft. Depth to limiting factor in. R*Eff#1 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D1fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#2 Y 3 Z Si 1 tt Ph trr'' cS Am w . ,6 `l a' YK Fir Syr q1L S Boring# ❑ .Boring I ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtfP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 'Effluent#1 =BODS>30<220 mg1L and TSS>30<150 mgA_ 'Effluent#2=BOD5<30 mgA.and TSS<30 mglL 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(8.6100) Soil Test Plot Plan Project Name NWP Holdings LLC Shau d Address 1844 River Ridge Road Hudson Wi 54016 M #226900 Lot 15 Subdivision Whispering Oaks Date /28/13 NE 1/4 S W 1/4S 7 T 29 N/R19 W Township Hudson F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBI *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted 120' Property Line 106' 108' B-2 8% Slope 10' B-3 80 45' 45' 0' 30' B-1 332' Property Line FILTE R CARTRIDGE INVTIRUCTIOjVS UA dTW JWYW, ,ut PIPU."I.*the W-W ,we U 401*0vt MdtiWr!to trot' 6'blv&ht "*41'91 G"IF uhto tall o1j&t j,,j,," ry C*bidvw irda the Cu**,prou*ih d A--t to"4fter the Lvv;u, lotb the bla+an, a As"wtoh is cluritwlie go", UY L The oftent fter shmw b* 15 2' th&"Utllkt&mu"WkwW449 to Impact tim 3- PU,,W 0.,._pb_U_k .a"Earl tU tW"bVQ 1,6 'by&*'ba A"buftfth Of thm NY*cant neat 4, ot—tj__jW_W*IWW%4 JuLt the*13111"Old utIdM OW*.Unvdy 0"up Wod bW*W the ijjVWt of tow ambWoo kam#*C"V. MW WWI,1.410WOO tile S. suds the W"ad WO aenj logo:of the'a"JkW qsvmlv 10 0 V"-W"WifterAnd toav,Woft in WWWj, "Oe",W, llhb"W b*""oviod 16V""p"AMI1Wd*i*wj",qW W"Waswr brrht While hawk low the Mwmufs ul Ws sidw ftt a—vW upwoh%Am vii)f,mawlis our*go sbotass"rabru Is thwed bm*�"WWk Wilkw",*j"- If V""fth k,uW"d,t"ft,*toy jWWt%V j"tU ok*r tgtYtl 4k tut*660 tiatinvivir Uft MW CbMdgd back livto the filbov lovw 140 t6a isoftevis tit the cmiw Pr*Q*g dutk".ohm 10-RoPiate and recurs the#44ftij the tshk. 41 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERMP CERTIFICATION FORM L Owner/Buyer 60 /0'?rl " Mailing Address s Property Addres anntng&Zoning Department for new cons cti City/State _ Parcel Identification Number Ado— LEGAL DRwipiprin Property Locatiou� �L42 V4, Sec. T Z P// W, Town of A Subdivision Lot# Certified Survey Map# ------- Volume Warranty Deed# Page#._ Page#--- Spec hou yes no SYSTRMUAY1VTrv,tp Lot lines identifiablyeg 0 10E A" OWNER CERTIFICATION Improper use and maintenance of Your Septic system could result in its premature failure maintenance consists to handle wastes. Proper OffurnPiu$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 wa t disposal system. wne ma na -St.Croix County Sanitary Ord inte nee responsibilities are specified in§Convan. 83.52(1)and in Chapter t2 c 0 r The property owner agrees to submit to St owner and by a master plumber,journeyman,P, Croix County Planning&Zoning Department a certification form,signed by the wastewater disposal system is in proper operating condition and/or(2) umber,restricted plumber or a licensed pumper verifying that(1)the on-site after inspection and pumping(if necessary),the septic i less than 1/3 full of sludge. tank s 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 Zoning Department within 30 days Of the three Year expiration date. Croix County planning& I/we certify that all statements on this form are true to the best Of MY/our knowledge. I/we 8111/are the owner(s)of the property described above,by virtue of a y deed recorded in Register of Deeds Office. Number of bedrooms--3 76 arty OF A-PP—L1CANi(S) YGNA DATE ***Any information that is misrepresented may result in the sanitary perrnit being revoked by the Planning&Zoning Department. fuclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nap if ref6rence is made in the warranty deed, (REV.08/05) Ilillll IIIIIIIII I IIIIIIiI Illill 82553 .76 Tx:4208783 State Bar of Wisconsin Form 1-2003 WARRANTY DEED 1001313 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 09/09/2014 09:46 AM THIS DEED,made between NWP Holdings,LLC,a Wisconsin Limited Liability EXEMPT#: N/A Company REC FEE: 30.00 ("Grantor,"whether one or more), TRANS FEE: 225.00 and Oevering Homes,LLC,a Wisconsin Limited Liability Company PAGES: 1 ("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. Lot 15,Whispering Oaks-Phase II,Town of Hudson,St.Croix County,Wisconsin. 2200 West County Road C,Suite 2205 Roseville,MN 55113 LT File No.509139 020-1481-09-015 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 Sewernber 5,'2014 (SEAL) (SEAL) * ohn Parotti,Member (SE ) .• (SEAL) AUTHENTICATION.. , ��� ACKNOWLEDGMENT Signature(s) ATE,6F MINNESOTA ) ss. authenticated on �'f ) 'WASHINGTON COUNTY ) r� f * --' Personally came before me on September 5,2014 TITLE:MEMBER STATE B OFzWISCONSIN the above-named John Parotti,a Member of NWP Holdings, . ' •. �::,.. LLC,a Wisconsin Limited Liability Company (If not, authorized by Wis. Stat.§706.06) to me known to be the person(s)who executed the foregoing instrument and ackno ge same.. THIS INSTRUMENT DRAFTED BY: * err e7.Bune Larry S.Mountain,Attorney at Law Notary Public,State of Minnesota My Commission(is permanent)(expires: 181/2016 ) (Signatures may be authenticated or acknowledged. Both.are not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 `Type name below signatures. St.Croix County 1001313 Page 1 of 1 SHUWN UN ULH I IF ILL) - co o ss A� SURVEY MAP VOLUME w Z ���s; 24, PACE 5709 f z Na355o1 F 1 `` + C LOT ' `° 41/ 43,751 St _^,______—_ ,�1� S87'02'S2"E 158.37'1 61.a � 1.00 AC Q' S82'55'58-E-TOWN RoaD- Na3'49'06"E C4 62.06' `�— '39'35"E 69'1 N85S8702S2"E —169.51' `� I I LOT 1 LOT 15 �� 4- -o 44, 31 o sc N � 1.02 ACF 45,038 SQ.FT. cli 1.03 ACRES t2 Q r j �^ I Z� C� I N89'02'42"E N85'06'07-W I (o 332.87- I cc LOT 1 -- LOT 14 o Q 00 N 44,181 SQ.FT. o r co o° 43,702 SQ °0 1.01 ACRES ♦ r M 1.00 ACR N Z I {911' J o I I N89'46'00"E N87'49'26"W 326.15' I I I � I LOT 13 , o LOT! 43,859 Sc Lq 44,731 SQ.FT. �" 33' 133' 0 00 1.03 ACRES M� 616' 1.01 ACF I I I I {9201 5} 588'31'0! I S87'49'13"E 319.77' 1 �5'� Y v AIM a ._. � a � • 17gf17 ® � ou a stag Owls A-IT � � a r I k - t WNW