HomeMy WebLinkAbout030-2153-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No:
572824 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)].
Parcel Tax No:
City Village X Township
Permit Holder's Name: 030-2153-23-000
Devering Homes LLC, aka Cieverinq Pro ertie St. Joseph, Town of
CST BM Elev: Insp.BM Elev: BM Descrip'on: Section/Town/Range/Map No:
cs-r 20.30.19.3093
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER . 1 CAPACITY STATION BS HI FS ELEV.
Septic T� Benchmark l e a 0 2
_• /Boa ,J
�
Dosing Alt.BM
Aeration Bldg.Sewer
Holding St/Ht Inlet
St/Ht Outlet S• 8 /.01;,Z
TANK SETBACK INFORMATION
TANK TO ,IP/L WELL BLDG. Ven o Air Intake ROAD Dt Inlet
Dt Bottom
Septic
Dosing Header/Man. IQ .5
Aeration ` Dist.Pipe .
S• g �er� 5
Holding Bot.System /0. '9 9 9. 5 k
Final Grade �I
PUMP/SIPHON INFORMATION `i'"� S' G� �5
Manufacturer Demand St Cover F,� / �✓ �,3 �� /
GPM �w
Model Nu r
TDH Lift Friction Loss System �toW�ell TDH Ft
Forcemain Length Dia. Dist. ------
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS V Z '�(��,a.,.�
SETBACK SYSTEM TO v P/L BLDG WELL LAKE/STREAM LEACHING OR Manufactu �`
INFORMATION Type Of System: �� //L / UNIT Model NGu�✓;:lv4 .16
DISTRIBUTION SYSTEM ,(l�, 3Z
x Hole Size x Hole Spacing Vent to Air f�r��ake
Header/Manifclld Distribution ��/ia+
Pies `` �,n
Length Dia Length ` Dia�"` Spacing� `�
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx
Bed/Trench Center �• 5 Bed/Trench Edges \� Topsoil �_ Yes E No Yes 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 1474 46th Stree Ho Iton,WI 54082(NW 1/4 NE 1/4 20 T30N R1 9W) Pioneer Ridge Lot 23 Parcel No: 20.30.19.3093
! LoJ G � /44k ova
1.)Alt BM Description= � �"' "�-
2.)Bldg sewer length= 10 !I n
-amount of cover= 7 q1 6 �(x,
Plan revision Required? Yes No
Use other side for additional information. olnsepctoft Cert.No.
Date
SBD-6710(R.3/97)
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NW 1/4 NE 1/4S 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX
SYSTEM ELEVATION 103.0/101.0 5' below grade 10/12/14 BEDROOM 3
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 32
, BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
OREHOLE O WELL *H.R.P. Same as Benchmark
B.M.*
Property Line 61 16' 22' ' _ '11 _ 101
5
18' 149'
51' B-1
9'
i
�D
d Vents
B-3 2-3' X 66' cells with>3' spacing
20'
21% Slope �d� 15'
-4
36'
8 '
101' Pro 3
a.) Bedroom
House
103' B-2
105'
107'
46th st.
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12" 5.6ft^2/pair of end caps
34" Grade at System Elevation All piping shall be SDR 30/34, within 10'
of tank,piping shall be Schedule 40.
r�TUtK, t
si Safety and Buildings Divi f ' ,DJ
201 W.Washington Ave.,P.O.Elok Sanitary Permit Number(to be filled in by Co.)
P' Madison,Wl 53707-7162
OCT 1 201 4 )
�SlpfF�•
Sanitary Permit Application MM.CKUlA
D v R3+umber N
In accordance with SPS 383.21(2),Wis.Aden Code,submission of this form to the appropn overnmental unit
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project.Address(if different thiin mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s.15.04 1 m,Stats.
L Apptication Information-Please Print All Information
Property Owner's Name Parcel#
Property Owner's Mailing 60ciress /f Property Location f 01
Govt.Lot 2-0 City,State Zip Code Phone Number , ,f/� ,� ��
le
T..5-2N; R E W
IL Type of Building(check all that apply) / Lot#
or 2 Family Dwelling-Number of B
L Subdivision Name
-3 L3 Z I- ' u ) Block#
❑Public/Commercial-Describe Use ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
own.L_�X CAS
III.Typ" Nrmit. (Check only one box on line A. Complete line B if applicable)
A. New S st� ❑Replacement system ❑Treatment/Holding Tank Replacement Only ❑Other Modification to En System( P lain)
B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
fV.lEpe of POWTS System./Component/Device: Check all that apply)
Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil
❑Bolding Tank ❑Other Dispersal Component(explain) X:1 vn' ' l i�L iMi reneatment Device(explain)
V.Dispersal/Treatment Area Information: /'k-
C,6 oil Application Rae(gpdsf Dispersal Area Required(sf) Disp a!Area Proposed(sf) system El on
VL Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanta y> (c ( .YG -�' l c y
n U m to ii G a
Septic or Holding Tank
Dosing Chamber L/v
VII Responsibility Statement-I the undersigned,a responsibility for installation of the PORTS shown on the attached plans
s Name(Print Pl ignature MP/MPRS Number Btuiness Phone Num
ZZ6
Plumber's Address(Street,City,State,Zip Code
-Z - / ��� C -
VI .Coun /De artment Use )ni
Permit Pee Date Issued lssitmo Agent ignatur d/Approved 11 Disapproved � j"'J t D. I ,� _ �I
❑Owner Given Reason for Denial L-i / r r i,��r ) 1 '
IJ{ C51(8S#iENq Wal/Reasons for Disapproval �1-L'Ge fI )
1.Septic tank,effluent filter and �- �j
LL��' . '�nG�
dispersal cell must be serviced/maintainer -��'���` �����L'c"""�'� �
as per management plan provided by plumber.
2.All setback requirements must be maintained L bf
Attar to comp for the system and submit to the County only on paper not less than 8 to ill inches in size
SBD-6398(E- 11/11)
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Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/12/14
Owner: Oevering Homes
Location: NW 1/4 NE 1/4 S20 T30N,R191474 46th St. St. Joseph
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 S, et
Signature-
License .
License num r 6900
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NW 1/4 NE 1/4s 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST.CROIX
SYSTEM ELEVATION 103.0/101.0 5' below qrade 10/12/14
DATE BEDROOM 3
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 32
BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter
OREHOLE O WELL *H.R.P. Same as Benchmark
B.M.*
Property Line 69 16' 22' 5, Cale = 1 /4" = 101
18' 149'
51' B-1
9'
Vents
B 3 2-3' X 66' cells with>3' spacing
20'
21% Slope 15'
B-4 ST
101' 86'
Pro 3
Bedroom
House
103' B-2
105'
107'
46th st.
Vent
>6» Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12„ 5.6ft^2/pair of end caps
34" Grade at System Elevation All piping shall be SDR 30/34,within 10'
of tank, piping shall be Schedule 40.
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
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 108.0'
Vent Al Grade �► Vent
3' 4" 31
X30/34 Septic Tank
5 Long 191 5' S' Long 1
3 6" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 0 ' Cells
Same on other end Observation tubeNent
At end of cell
A
r6 B
49 chambers per cell
System elevations:
A-1 03.0'
B 101.0'
N)PIsconsin SOIL EVALUATION REPORT #1456
a'c
Department of Commerce in accordance with Comm 85,Wis.Adm.Code Page 1 of 3
Division of Safety and Buildings Schmitt Soil Testing,Inc.
. .
Attach complete site plan on paper not less than 8'/:x 11 inche in siiii: liri m st County
• St. Croix
include,but not limited to:vertical and horizontal reference point(BSA),direction
percent slope,scale or dimensions,north arrow,and location and di ce to rarest mad. Parcel I.D.
Please pd At all 1 i By Date
Rev'
Personal information you provide may be for seoondary purposes(Privacy s.15. 1)(m)). Z / v
Property Owner
DEC 13 7006 Properly Location
Golden Harvest Capital, LLC Govt.Lot NW1/ , NE1/4,S20,T30N, R19W
Property Owner's Mailing Address ST.CROIX COUNTY Lot# Block# Subd.Name or CSM#
14906 Blakeney Road 23 Pioneer Ridge
Cry State Zip Code Phone Number ❑ City ❑Village ❑ Town Nearest Road /1�7Z/ _s,
Eden Prairie I MN 1 55347 (612)202-3234 St.Joseph
❑New Construction Use: M Residential/Number of bedrooms 3 Code derived desi n flow rate 450 GPD
❑Replacement ❑ Public or commercial-Describe: VV&f�(
Parent material Outwash Flood plain elevation,if applicable na ft.
General comments
and recommendations: Area is suitable for a conventional system with a 0.7gpd/sqft rating. P ssible system elevation for Area 1
(step trenches)is high ranch 10 ow rench 101. '
Fil Boring# ❑ Boring
Pit Ground surface elev. 104.90 ft. Depth to limiting factor 112+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft'
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. I *Eff#1 *Eff#2
1 0-11 10yr3/3 none I 2fsbk mvfr as 2f,2vf .6 .8
2 11-23 10yr4/4 none I 2fsbk mfr gw ivf 6 8
3 23-36 7.5yr4/4 none gris lcsbk mvfr cs 1vf 7 1.6
4 36-48 5yr4/4 none sl lmsbk mfr Cs ------ 4 7
5 48-102 10yr5/4 none grs Osg ml CS ----- .7 1.6
6 102-112 10yr5/6 none s Osg ml --- ----- 7 1.6
iol 4S
aBoring# ❑ Boring 1 f�p g
® Pit Ground surface elev. 104.9 ft. Depth to limiting factor 105+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft'
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-10 10yr3/3 none sl 2fsbk mvfr as 2f,2vf .6 1.0
2 10-20 10yr4/6 none Is icsbk mvfr gw ivf 7 1.6
3 20-63 10yr5/4 none gris Osg ml as ----- .7 1.6
4 63-105 % 10yr6/4 none s Osg ml ---- --- 7 1.6
*Effluent#1 =BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS s30 mg/L and TSS<_30 mg/L
CST Name(Please Print) Signature: CST Number
Thomas J. Schmitt 227429
Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond,WI 54017 812/2006 715-247-2941
SBD-8330(1t.07/00)
Rroperty Owner Golden Harvest Capital, LLC Parcel ID# 23 Page 2 of 3
3] Boring# ❑ Boring
® Pit Ground surface elev. 101.80 ft. Depth to limiting factor 108+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *EfW
1 0-8 10yr3/3 none I 2fsbk mvfr as 2f,2vf .6 .8
2 8-15 10yr4/4 none scl 2msbk mvfr Cs lvf .4 .6
3 15-24 7.5yr4/4 none sCl 2msbk mfr Cs ------ .4 .6
4 24-96 10yr5/4 none vgrs Osg ml as ---- .7 1.6
5 96-108 10yr5/6 none s Osg ml ---- ---- .7 1.6
Boring# ❑ Boring
❑ Pit Ground surface elev. 108.3 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Ef1#1 *Eff#2
1 0-10 10yr3/3 none sl 2fsbk mvfr as 2f,ivf .6 1.0
2 10-21 10yr4/4 none grsd 2msbk mfr gw 1vf .4 .6
3 21-26 7.5yr4/6 none gris Osg ml Cs ---- .7 1.6
4 26-38 10yr5/6 none s Osg ml Cs ------ .7 1.6
5 1 38-8 10yr5/4 none vgrs Osg ml as ------ 7 1.6
6 88-115 10yr5/6 none s Osg m1 ___ _____ .7 1.6
Boring# ❑ Boring (/3
❑ 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/ft-
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
'Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L "Effluent#2=BODS<30 mg/L and TSS-S_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(R,07/00) Schmitt SoN Tmft,Inc.
. 'Conducted by-
Page 3 of 3
Conducted For.
• 'Schmitt Soli Testing Inc. Name
tiokkn Hates Capital,LLC
• Thomas J. Sclnnitt,CST 227429 Address: 1440 Arcade St.N
1395 72nd St. City, State,Zip: St.Paul,MN 35106
New RkhIDDDd,W1. 54017
Phone: 715-247-2941 1 Subd-Name: Pioneer Ridge
Lot No.: 3
Dom Legal Description: IVY/ 1/4 NEIM S20 T30N R19W
Backhoe pit
�► Township,Count St,Joseph,St Croix
Bench Mark EL 100.00•Top oft"pvgc-pipe y:
A Alternate Bench Mark EL--&j 'S y' Top of 2"pvc pipe
Slope= V 9, Contour Line EL IYA Contour Line Length 1V,#
Scab V=40'
' .2a%
i
�
b+
� P• es
't�SSoi ao3 Sys wasoo�pkledb ame�segoG lt�sY q'eaYsarbeisa MoatioRie�r��
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner FTank Manufa cturer ❑ NA
C 1 Permit# ��� 8 ptic ❑ Dose ❑ Holding VolumeJC9�J� (gaq Manufacturer: A
DESIGN PARAMETERS
Number of Bedrooms: 3 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: � NA Vertical Distance Tank Bottom(s)to Service Pad- (ft)
Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: /WA (n)
f ,�'1T�j
Specific servicing mechanics must be provided if vertical is>15 feet or
Design(peak)Flow=(estimated x 1.5): (gauday) if horizontal is>150 feet. Specific Instructions to b/e�provided on back.
In Situ Soil Application Rate: (gaVday/fe) Effluent Filter Manufacturer: ❑ NA
Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model:
Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: � NA
Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA Pump Model: �"�
Total Suspended Solids(TSS) s150 mg/L
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer.
(BODs) >220 mg/L ❑Mechanical Aeration ❑Peat Filter
SS) >150 mg/L ❑Disinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BODs) s30 mg/L Soil Ab tion System
(TSS) 530 mg/L >dNA In Ground(gravity) ❑in-Ground(pressure) ❑ NA
Fecal Coliform(geometric mean) ❑ Grade ❑Mound
Maximum Effluent Particle Size )(s in dia. ❑ NA ❑Dri p Line ❑Other:
Other: NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Frequency
Service Event
tank(s) hen combined sludge and scum equals one-third(h)of tank volume
Pump out contents of tan
❑When the high water alarm is activated
At least once every: '�❑monts(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) ar( )
every: ❑ onth(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell At least once s) efy: -f earls)
❑month(s) ❑ NA
Clean effluent filter At least once every: �l ar(s)
❑month(s) C3 NA
Inspect pump,pump controls&alarm At least once every: ❑yws)
O month(s) NA
Flush laterals and pressure test At least once every: ❑year(s)
Other: At least once every: ❑month(year(s) ) NA
❑
Other: NA
MAINTENANCE INSTRUCTIONS one of the following licenses or certifi tions:
Inspections of tanks and soil absorption systems shall be made by ct individual carrying
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, any missing Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third ('%)or more of the tank volume,the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
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,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(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
use if high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior these
Pump tanks may fill above no as the excess wastewater will be-discharged t the soil absorption system t n one large
odose causing an
conditions is not recommended,
overload that may result in the backup or surface discharge of efficient and damage
to restoring power to he PUMP'or contact a Plumber
contents of the pump tank removed by a Septage Servicing Operator(pumper)p 9 P
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 infiltrative 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 he wastewater stream may improve the performance and prolong the life of the treatment
arette"butts, condoms, cotton swabs, degreasers, dental floss,
tanks and soil absorption system: acids, antibiotics, baby wipes, cig g g eases, herbicides, meat
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, 9r
scraps,medications,oils,painting products,pesticides,sanii, y napkins,solvents,tampons,
water softener brine discharge.
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 S. Comm 83.33,Wisconsin Administrative Code:
• All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
ed b
• The contents of all tanks and pits shall be removed and property disposed of Y a Septage Servicing Operator(pumper).
• After pumping, all tanks and pits shall 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 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 maybe utilized for the location of a replacement soil absorption system.
he replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells, Failure to protect the replacement area will r�witth the rules in
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply
effect at the time of their permit issuance. on system cannot be
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorpti ys
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 soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in a llect afollo Ume.emoval of the biomat at the infiltrative
surface. Reconstructions of such systems must comply d
WARNING TREATMENT TANKS. PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO LIFE. OF A ANY TANK TANK MAYtNOT BE POSSIBLE.
DEATH MAY
RESULT. ESCAPE O
�r
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER..
Name /
Nam 1�
Phone VJ_
Phone i✓ J�
LOCAL REGULATORY AUTHORITY
SEPTAGE SERVICING OPERATO PUMPER L
*-7--� Name J
Name /
Phone J aZ Phone �/cJ" j�b Caa
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
�= FILTER INSTRUCTIONS
TM
Installation
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the 3/4-inch pipe onto the filter case. If side-support method is not
utilized, proceed to step four.
STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 900.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is F ,,.,may f;,$,, 3 ►,y w „ ;
serviced.
w
2. Open the outlet access opening to inspect the tank and filter. 4 ;
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe,firmly pull up on the filter handle to dislodge the
cartridge from the case.
5. Slide the cartridge up and out of the case for cleaning,
i y
6. If a VRS switch connected to an alarm is present,the switch ld f
should be removed by turning counterclockwise 900 and cleaned
with water only.
7. While holding the cartridge on its side (large flat surface facing ,
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 90°.
9. Insert the filter cartridge back into the case, pressing down until �V t
the filter locks into the bottom of the case.
10.Replace and secure the access opening on the tank.
BEAR ONSrTET"FILTER CARTRIDGE-FIVE-YEAR.LIMITED WARRANTY
Bear onsite filter cartridges are wa^anteo to be free of defects in material and ,o,kmanship fo•five a.,from;the date of
consurner purchase,
BEAR.ONSITET"Filter case-Lifetime Limited Warranty
Bear onsite warrants the filter case:rill be free of defects in material and svorkmai shin during normal use for the car:od of inne
the original purchaser owns the product.
If a defect is found in normal use;Bear Onsite will,at its elcct!on,reoa,r,provUe a rep,acernent part or p,odu_�,w r*:ake
appropriate ad3ustment.Damage to a product caused by acc40ent,'nisuse,or abuse is not covered by thus warraritN-3mprop._r
care or malfunctions resulting from units not installed,operated,or maintained in ac_ordan e with instruction;provided wdl)
void the warranty.?roof of purchase(orroinal sales re�ei t)mutt be provided to Bear Onsite with all wanantq claims.Eear
Onsite is not responsible for labor charges,removal charges;rnstaltaticr.,or other uK]cienial or consequential costs.
In na event shall the liability of Hear Onsite exceed
the purchase pme of'he product.
ST. CROIX Co,tjNTy
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
-Property Address
('Verification required from Planning&Zoning Department for new construction.)
City/State../ 6 76 Parcel Identification Number 5�y,/
Property Locatiorl/f V4, Sec.-Zo, T N R-4�W, Town
Subdivision a9
Lot#Z-3
Certified Survey Map
Volume Page
ir-
Warren ty Deed# , Vol
-------�, page#
SYSUMMA Spec house,5 Ito Lot lines identifiable.0 no
INTENANCE AND OWNER
Improper use and maintenance of your septic system
maintenance consists of pumping out the septic tern could result in its premature
the system can affect the function of the ijure to handle wastes. Proper
tank every three years or sooner,if needed,by a licensed pumper. at you put to
responsibilities are specified in§comm.Septic tank as a treatment stage in the waste disposal system. Wh in
83.52(l)and in Chapter 2_St.Cr X Co a 0 d owner maintenance
The property owner agrees to submit to St. Croix o unty S nitary r inance.
county Plana, g&ZO
Owner and by a master Plumber,journeynun Plumber, n Ring Department a
wastewater disposal system is restricted Plumber or a licensed pumper certification form,signed by the
-inspection and p pumping(if Re s ) t
less than 18 full of sludge. in ProPer Operating condition and/or(2)after verifying that(i)the on-site
umP ce sary, he septic tank is
'/we,the undersigned have read the above requirements and agree to maintain the Private sewage disposal syste I with
Standards set forth,herein,as set by the D a th
Certification stating that your septic system Of Commerce and the Department of Natural Resources,State of Wisconsin.
am has been maintained must be completed and returned to the St.Croix County planning&
7`0"'ng Department within 30 days of the three year expiration date.
I/we certify that all stateme
Property described above, nts OR this form are true to the best Of MY/our knowledge I/we am/afe the owner s)of the
by Virtue Of a Warranty deed recorded in Register of Deeds Off-lee.
Number of bedrooms---3
�IGJ
NA-T O�FAP�PLICANi(-S)
'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.
fnelade 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,
(RFV.08/05)
. IIINI
1111
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IIII
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82617. 89
Tx:4213943
STATE BAR'OF WISCONSINFORM 1-2000 1.002719 .
WARRANTY DEED :P
. BETH ABST
Document Number REGISTER OF DEEDS
THIS DEED, made between Citywide Development, Inc.; a.Mmnesota` ST. CROIX CO., WI
corporation,'Grantor, and Oevering Homes; LLC,,a Wisconsin Limited 10/09/2014 1:04.PM
Liability Company,Grantee. . EXEMPT#: NA
Grantor, for a valuable consideration, conveys to Grantee the.folloWing. . REC FEE. 30.00
described reaf estate•in'St Croix'County, State:of .Wisconsin (the TRANS"FEE: 231.00
"Propel,.). °'PAGES: 2 .
SEE ATTACHED'EXHOIT:A
Recording Ans
Name and Return Address:' 1
Land Title Inc. #510193. d
2200 W County Road.C,Suite 2203
Roseville,till 55113
Together with all appurtenant rights,title and interests. 030-2153-23-000
Parcel Identification Number(PIN)
This is rrothomestead property.
Grantor warrants thafthe title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except
Easements,Restrictions,-Reservations,Roadways and Rights of way,if any,of record
Dated this 6th day of October,20.14.
Cityw' a De went,Inc.
.Kociscak,President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MWNESOTA ).
HENNEPIN COUNTY: )ss.
authenticated this
Personally-came before me this 6th day:of October, 2014'
the above"named`A. P. Kociscak, President of Cit}nvide
• Development,Inc.,a Minnesota corporation,to me known to be
.TITLE:MEMBER STATE BAR OF WISCONSIN
the person(s) who executed the foregoing instrument and
(If not, ackaowledged the same.
authorized by.§706.06,Wis.-.Stets.)
THIS INSTRWENT WAS DRAFTED BY
Notary Public,State of Minnesota
Larry S.Mountain;Attorney at Law ' My commission is permaa t. (If ot,state expiration date:
(Si ,edged Both are not necessary.)
be
•N� �Y or ado,ow!
persons signing in my capacity mvst be typed.or printed below their signature KATHLEEN A SAND
NOTARY PUBLIC•MINNESOTA
MY COMMISSION EXPIRES 1131115
WARRANTY DEED.W. STATE BAR OF WISCONSL't - FOR.M No.1-2000
St.Croix County 1002719.Page-1 of 2
LT File No.510193
EXHIBIT A
Lot 23,.-Plat of Pioneer Ridge in the Town of St.Joseph,St.Croix County,Wisconsin
J
'
St. Croix County 1002719 Page 2 of 2
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-----Original Message-----
From: Pam Quinn [mailto•Pam Quinn @co saint-croix.wi.us)
Sent: Monday,July 21, 2014 8:57 AM
To: Laura Meuwissen
Subject: scanned land use permit application
Pam Quinn, Land Use Specialist(POWTS)
St.Croix County Community Development Dept.
1101 Carmichael Road
Hudson,WI 54016
715-386-4680
pam.guinn@co.saint-croix.wi.us
-----Original Message-----
From:Administrator
Sent: Monday,July 21, 2014 7:48 AM
To: Pam Quinn
Subject: Message from "RNP15651F"
This E-mail was sent from "RNP15651F" (MP 6001/LD360).
Scan Date:07.21.2014 08:48:06 (-0400)
Queries to: administrator(@co.saint-croix.wi.us
z
Pam Quinn
From: Laura Meuwissen <Laura @OeveringHomes.Com>
Sent: Tuesday, October 14, 2014 2:56 PM
To: Pam Quinn
Subject: RE: scanned land use permit application \, , (JQ(�P/ ,►.c�
Thanks I will get this over to you asap! �t
Laura
Oevering Homes, LLC
715.243.0001
-----Original Message-----
From: Pam Quinn [mailto:Pam.Quinn co.saint-croix.wi.us]
Sent: Tuesday, October 14, 2014 10:51 AM
To: Laura Meuwissen
Cc:Todd Dolan (tdolan(@allcroix.com); 'sbird @frontiernet.net'
Subject: RE: scanned land use permit application
Hi Laura,
The land use permit application on-line has multiple uses, so yes,just check the appropriate boxes: Ag Res,Shoreland,
filling&grading>2000 sq.ft. within 300' of a navigable pond OHWM, Reference Ordinance Section 17.30.H.1.d. There's
a checklist for the application and I already have a copy of the deed in the sanitary permit application. I would use an
enlarged copy of the plat for Lot 23 to show where house, driveway and septic system will be located in relation to the
pond that is in the south 1/3 of the lot. Minimum distance from OHWM is 75', which I believe is shown as a dashed line
around the pond. The low building opening elevation is also shown on the plat, which Todd Dolan will need anyway.
Pam Quinn, Land Use Specialist(POWTS)
St. Croix County Community Development Dept.
1101 Carmichael Road
Hudson, WI 54016
715-386-4680
Pam.guinn @co.saint-croix.wi.us
-----Original Message-----
From: Laura Meuwissen [mailto:Laura @OeveringHomes.Com]
Sent:Tuesday, October 14, 201410:11 AM
To: Pam Quinn
Subject: RE: scanned land use permit application
Hi Pam can I use this same app for water front properties as well??
Laura
Oevering Homes, LLC
715.243.0001
1
Parcel #: 030-2153-23-000 10/21/2014 01:14 PM
PAGE 1 OF 1
Alt. Parcel M 20.30.19.3093 030-TOWN OF SAINT JOSEPH
Current XX ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
01/18/2008 00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
CITYWIDE DEVELOPMENT INC
0-CITYWIDE DEVELOPMENT INC
10500 BREN RD E STE 100
MINNETONKA MN 55343
Property Address(es): "=Primary
*
Districts: SC=School SP=Special 1474 46TH ST
Type Dist# Description
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC Notes:
Legal Description: Acres: 3.016
SEC 20 T30N R1 9W PT SW NE& PT NW NE
PIONEER RIDGE LOT 23('08) (3.016 AC) Parcel History:
Date Doc# Vol/Page Type
09109/2010 922253 AGREE
05/12/2010 915947 WD
01/22/2009 887070 QC
01/23/2008 867591 COV
more...
Plat: '=Primary Tract: (S-T-R 40%160'/GL) Block/Condo Bldg:
*11-028-PIONEER RIDGE 030-08 LOTS 1- 20-30N-19W SW NE LOT 23
11-028-PIONEER RIDGE 030-08 LOTS 1- 20-30N-19W NW NE LOT 23
2014 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/20/2014
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.016 52,100 0 52,100 NO 05
Totals for 2014:
General Property 3.016 52,100 0 52,100
Woodland 0.000 0 0
Totals for 2013:
General Property 3.020 21,100 0 21,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00