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HomeMy WebLinkAbout040-1303-00-063 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578907 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)]. ZS 7 Permit Holder's Name: City Village X Township Parcel Tax No: Adams, Matthew & Michelle Troy, Town of 040-1303-00-063 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: /00.1)0 /C> 3. 7, l 7b Ufa - L?4S'1& D L 22.28.19.1798 TANK INFORMATION ELEVATION DATA ">5'r) TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Wl /ZU n F W Z, S (0~$0 7- Dosing Alt. BM v~ D U i6't~p . 8'0 Aeration 6 `qt / Bldg. Sewer(,) olding Zy St/Ht Inlet 1KIN TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic T I yv I Z~ , y Dt Bottom /z a 4 - 73 f Dosing . /S ,n C t'OS 77 a 0.~~ Header/Man. 3, f 7 8?_ Aeration Dist. Pipe q. oz/ Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St-Ewer -Z" j GPM ~t~1-'Yfl~ aC R U,49 a cvv 105 G. 73 0l Model Number 4 3Again p '7w (Z) z ios 7 lad. Zl TDH Lift Friction Loss System Head TDH Ft I 9 °l• ~i 2 2. ZZi !oS $0 S9 ~tp Forcemain Length Dia. Dist. to well V SOIL ABSORPTION SYSTEM BED/TRENCH Width /C f Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / D SETBACK SYSTEM TO lB P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR g7~~ Zvt Inc UNIT Model Number: U N DISTRIBUTION SYSTEM Header/Manifold Distribution Tole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia LDia _ Spacing </4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1-, Depth Over 1 1 ,i xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bed/Trench Edges 7ti ? L Topsoil 7 [,Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /n / /1!;~ Inspection #2:~Q_/ 2 / Location: 221 Walnut Hill Way RIVER FALLS, WI 54022 (SE 1/4 SE 1/4 22 T28N R1,1 9W) W,alnu~lll Farm aka he rib Parcel No: 22.28.19.1798 1.) Alt BM Description = t Lf /LI fG '49t-6. UJ:J~T~ Z V6 2.) Bldg sewer length 1 > A)w -n~i1 A/IG irln/Dulk~ - amount of cover = 1 , I' , K ' h1~~ ~5~ 51 Plan revision Required? 0 Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Plat Plan Page $ of g Property Owner 14 t~ yi 71~bA, *S I„ = 40 ft Legal Description l o~ ~ T L© - - = (except where noted) -s ~'y s~.c.-~}~} -r~wN o~ • = Backhoe pit /,//0 North Ire, tl 0- foe c 0 0 v i /'S3 J ~ • NK I 4 i 4J ocation: j►E c 0i Y -9 g - 4 z SOU r EY z t o 7`oe~ a 51'C- L la'Z. l~ i/b) U ~D~rlS~ 3q.' w _ County ST c ~ b ~ ~ Safety and Buildings Division p f, 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ~h1. 1,01 INTY In actor State Transaction Nu#er :UN ' t Applicatio r"- r unit /A dance with SPS 38321(2)> Wis. Adm. Code, submission of this form to ~~or>'Ate ,ov *o al is required prior to obtaining g a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than 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 , Stars. 2_Z_ No, In u 4- Hr l' t-J L Application Information - Please Print All Information Property Owner's Name Parcel # IFYIW 6eu.3 m; e~e s Oqb 1303 bo --OlL Property Owner's Mailing Address \ Property Location ( I 'Pa I VJOA C31 1- l~~G~ Govt. Lot - ` City, State Zip Code Phone Number c ~ / L, F 1/4 ~li_ section 2,2- WT- CWT- "(circle one II. Type of Building (check all that apply) T N; R C( E or °t # U /9 3 Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms / 5,1 lock# I/VCA / 1 f-GOVA ❑ Public/Commercial - Describe Use V ( ❑ City of nu~& umber ❑ Village of CSM N ❑ State Owned - Desc 1rib'le Use / V~ X O M o o lJ D EL Town of T III. Ty mit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) I B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner e of POWTS S stem/Com onent/Device: Check all that a IV. Ty 0 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade d 124 in. of suitab Mound < 24 in. of suitable soft ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) D V. Dispersal/Treatment Area Information: Xna 1, f Design Flow (ggpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed sf) System Elevation l,0 0. 0 500 VL Tank Info Capacity in T # of Man Gallons Gallons Units W Ila 10 5 U d Q -a New Tanks ExLstmg Tanks v l a_ o r? a U v5 - h a; w v i% Septic or Holding Tank i Dosing Chamber VIL Responsibility Statement- I, the undersigned, as e,responsibility for installation of the POVi TS shown on the attached plans. Plumber's Name (Print) Plumb 's Sin MP/NIPRS Number Business Phone Number ZM4P J:7~ _715 69y` 937 Plumber's Address (Street, City, State, Zip Code) S Zoo lt:'~ S4- •~J ~~l l~Z~ VIII. County/De artment Use Only Approved isappmved Permit Fee Date Issued Issuing Ag S' even Reason $ 4 Ix. Conditions of Ap roval/Reasons for Disapproval v SYSTEM OWNER: C 6~ t tl ~n~ O~ C-`P 1. Septic tank, effluent filter and r~- ~'1S Permit] dispersal cell must b&PO-Nice - / maintained 2 T ~c (T as per management plan provided by plumber. 2. All setback requirements must be maintained @rnd submit to the County only on paper not less than 8 1rz z 11 inches in size SBD-6398 (R- 11/11) DIVISION OF INDUSTRY SERVICES ToN i~,..~.= 3824 N CREEKSIDE LA o D P HOLMEN WI 54636 3 S Contact Through Relay P http://dsps.wi.gov/programs/industry-services ~yo v`Gw . n www.wisconsin.gov srMS~yS~ Scott Walker, Governor Dave Ross, Secretary G O~ March 04, 2015 ,D CUST ID No. 224832 ATTN: POWTS Inspector MARY JO 14UPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/04/2017 Identification Numbers` Transaction ID No. 2514793 SITE: Site ID No. 810375 Matthew D & Michelle L Adams Please refer to both identification numbers, 221 Walnut Hill Way above, in all correspondence with the agency. Town of Troy St Croix County SE1/4, SE1/4, S22, T28N, R19W FOR: Description: Four Bedroom Mound System / 3% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1524705 Maintenance required; 600 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver.-rO, 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. CONDITI The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code APPR requirements. DEPT OF S/ No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06PROFESSIONA stats. DIVISION OF INDL The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CO RES • 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. • A state approved effluent filter is required. 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. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. MARY JO HUPPERT Page 2 3/4/2015 ' Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm I I i I i I i I', rlECEIVED FEB 19 2015 INDUSTRY SERVICES MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: MATTHEW D. & MICHELLE L. ADAMS Owner's Name: (same) Owner's Address: P.O. Box 144 Hudson, WI 54016 Legal Description: SE 1/4 of the SE 1/4, Sec. 22, T28N, R19W Township: Troy County: St. Croix ONALLY OVED Subdivision Name: Tribute (Walnut Hill Farm) WETY AND 4L SERVICES Lot Number. 63 Block Number: NA IA. RY SERVICES Parcel I.D. Number. 040 -1303 - 00 - 063 Plan Transaction No.: P E Page 1 Index and title :ti:rtii~rtfi$j. Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Ap 0`v -;,gi w w Aw o+ •'q a ~`'A N. R r Page 5 System maintenance specifications Page 6 Management and contingency plan o = Page 7 Pump curve and specifications o Page 8 Plot plan %irt •e• fi a Designer. Mary Jo Huppert License Number: 1859 - 007 Date: 02/17/15 Phone Number. 715 -426 -1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) a id Pressure Distribution Component Manual Ver. 2.0 SBD-107WP (N. 01101) Version 7.0 (R. 03/2012) Page 1 o. 8 Mound and Pressure Distribution Component Design Design Worksheet Site tnfonnation (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00. Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for _ _ _ fecal coliform of 36 inches. 1.50 Peaking Factor.(e.g. 1.5 = 150%) 600-OC] Design Flow (gpd) 10C, Site Slope _ 100.OC Contour Line Elevation (ft) 21.OC ' Depth to Limiting Factor (in) 0.4(,. In-situ Soil Application Rate (gpd/fl2) Dist_ributi Dn Cell Information 60.0(1 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) Dispersal Cell Design Loading Rate (gpcvfe) - I Influent Wastewater Quality (1 or 2) Are the laterals the highest point._____ - in the distribution Pres_su__re Disribution Information network? Enter ! or N (C or E) Center or End Manifold 3.3.] Lateral Spacing (ft) If N above, enter the elevation (ft) :1 Number of Laterals of the highest point. Orifice Diameter (in) _ 3.51) Estimated Orifice Spacing (ft) = 11.76 fiZ/orifice ^2.0 ] Forcemain Diameter (in) - - 2_6.0) Forcemain Length (ft) Does the forcemain drain back? 90.0 D Pump Tank Elevation (ft) Enter 1 or N 4.55 System Head (ft) x 1.3 4.24 Forcemain Drainback (gal) 10.84 Vertical Lift (ft) 55.97 5x Void Volume (gal) 0.43 Friction Loss (ft) 60.21 Minimum Dose Volume (gal) 0.00 In4ine Filter Loss (ft) 27.46 System Demand (gpm) 15.82 Total Dynamic Head (ft) Lateral DSelection Manifold Diameter Selection in. dia. ns choice in. dia. o lions choice 0.75 _ 1.25 x -.-x - 1.00 1.50 x 2.00 1.25 x X-- ff30000 - = 3.00 x x Gall_on_slin_ch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) ruent Total Working Liquid Depth (in) Wiesern (enter result in cell B49) Dose T.1nk Information formation 800. JO Dose Tank Ca aci al Filter Manufacturer 22.24Dose Tank Volume (gal/in) Filter Model Number Weiser Manufacturer Project: MATTH=W D. & MICHELLE L. ADAMS Page 2 of 8 =Z0 ST La q63 Z'd SLLT'-.9Zt~~STL 2u14sal 110S s,,a94sz j ToH c1`66 Mound _Plan and Cross Section Views T J - tl10 8 Observation Pie . . - 1 W l• s. b.5. y : B I .Q L Mound Component Dimensions Down slope toe e;dension made. A 10.0 Ift E 18.60 in H 1.00 ft K 9.51 ft B 50.0ft F 9.25 in 15.00 ft L 79.03 ft D 15.0in G 0.50 ft J 6.94 ft W 31.94 ft 600.05 (fe) Dispersal Cell Area 1500.00 (flz) Basal Area Available 10.0DJ(gpd/ft) Linear Loading Rate 6.00 (.ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grace 103.02 (ft) H GI , 101.75 (ft) Lateral iiiiii I F Dispersal Cell x.,,. Invert t.: 101.25 (ft)-l" - :1 <r„ Dispersal Cell D' Elevation 1 100.00 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Dispersal Cell See lateral details on Shading Key c, Q page 4 for number, size, Q . is i g Topsoil Cap c ~ 1.5 ft and spacing of laterals. _ Subsoil Crap Laterals are equally ASTM C 33 Sand F spaced from the ai 0.5 ft ~'.TV?iwl Lateral Tilled Later distribution cell's n I • =.1: centerline in the Aggrega:e A distribution cell (AxB). - Project: MATTHEW D. & MICHELLE L. ADAMS Page 3 of 8 F'd 9LL1-92•la-SIL 2uilsal jioS s,u94s11TOH dtE:aO ST LZ qaJ r End Connection Lateral Layout Diagram aC+ntat tbo N%t+e.sls osier tha A 6 B dOr"Sion • w Turn pswart a 1l vatvb et rsl aarcouip1w q 04 P Hales dhfed on the bottoM of the WOW All Laterals ue l,dentica! - Xe"lly spaeeE - 430 lateral's &fercetmairt Sch 40 PVC per SPS Table 384.30 S s Fotoe main coiuaeotioea via tee or eaass to matWold at any point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66ft Lateral Length (P) 58.56 ft orifices per Lateral 17 Lateral Spacing (S) 3.33 ft Orifice Density 11.76;ftz/orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67ft System Flow Rate 27.46 gpm Manifold Diameter 1.25in Total Dynamic Head ft Forcemain Velocity 2.80 ft/sec 15. $2 Dose Tank Information Locking cover w h warning label and locking device and sealed watertghi Electrical as per NEC 300 and SPS 316.300 WAC ftForrcceemain in. min. Tank component is properly vented Altemat9 outlet ocation d ameter Weiser Manufacturer ln. Capacityl 800.00 Gallons -T Volume 22.24 gaUnch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.36 452.89 C B 2.00 44.48 Pump off e.evation (ft) C 2.71 60.21 90.91 D 10.90 242.42 D Total 35.97 800.00 Dose tank levation (ft) Bedding un er tank. 90.00 -t - Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number °Tank Alert AB containinra mercury may not to used in Pump Manufactur Gould this syste -n. Pump Model Nu r ' PE41 155 2. Pump Must Deliver 27.46 gpm at 15.49 ft TDH Project: MATTHEW D. & MICHELLE L. ADAMS Page 4 0r` 8 Mound System Maintenance and Operation Specifications _ Service Provider's Name Darrell's Septic Service Phone 7.1151-425210-25 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E•" cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Ajm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent sail erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn - Threaded Clean:)ut Plug or Ball Valve Sprinkler Valve Box . \ Distribution Long Sweep 90 or Two 45 Degree Bends Sarne Diameter as Lateral Project: MATTHEW D. & MICHELLE L. ADAMS Psge 5 of 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G Mailing Addresses Property Addres (Ve ' cation required from Planning & Zoning Dep ent for new construction.) City/State ~ ✓ Fa f/5 4arcel Identification Number LEGAL DESCRIPTION Property Location Sec. T N RW, Town of r~ Subdivision Plat: Lot # Certified Survey Map Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house o yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by e o warranty deed recorded in Register of Deeds Office. Number of bedrooms J SIGNATORE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code Gengral & Component Adm. maintain , and shall SBD-10706-P (N• rdan This system shall be operated in accordance blwith ation 9.6 S PS (2- 81Wad Press a Distribution Compose t Manual Vence : with i manuals l (N. pertaining SSWMP P resent that Se could cause death. intenance enance 01!01)) and nd local or r state roles tes pertaining to sy~a k s' ace dangerous gasestmay be p porting. one should ever enter a septic or pump used Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. t ode when the tanks are n o longer es and sou dne: s! Access openings POWTS components. deemed Septic or pump tank manhole risers, access risers and covers should be inspected for wa servi open uns used for service and assessment shall eaccess openings greater than) 8 aches in dices eter shall'be secured by aC ueffectf a locki g subject to failure must be replaced. Exposed device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The c ntents; o the tank shall be condition of the p disposed of in accordance with NR 113, Wis. Adm. Code. The operating coed revisions assessed at least once ll septic I ery 3 Years by inspection. The outlet filter e filter cartridge should not be name-led unless P the an alarm, with shall be he tank enact as that may necessary slough to off the ensure filter ntermittentfilter proper ape ration. Th l from its enclosure. If the filter is equii ped wit s ndin I removed may indicate surge flows or an inipe 9 continuou are made to retain solids in the ' filter shall be serviced if the alarm is activated continuously. tank. If the contents of the tank are not t reremmoved at the time of a t tank exceeds 1/3 the liquid volume of the alarm. oved when the volume of sludge and scum in the shaft advise the owner of The septic tank shall have its contents nasals! assessment, maintenance personnel re when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. artmeict tank of Ceder ance is generally not required. He wever, if such products The addition of biological or chemical additives to enhance are used they shall be approved for septic tank use by the Dep Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be rested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System should he mo made ntin an the the coodad and mrulched cc nocoeecry tot pdrevent a osion andlto prow deasome protectaround from frostupeeation. Traffic (othethan fora!l be e mound vegetative maintenance) h in he wintis not recommended since soil compaction may er will promote frost penetration. Cold weather installations lti(October-February) dictate within he that the mound and sn mound be heavily mulched as protection from freezing. Influent quality into tho mound cyatem may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg1L FOG for se ptic tank effluent or 3 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cful100 mL for highly treated effluent. Influent flow may not exaet!d maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommend, -d that each lateral be fli,Shpd Af gQnt4mwIa1:,ad salidr; at least onra every 1 A months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reporte,J to the owner, and any levels above 6 inches considered as an impendina hydraulic failure requiring additional. more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in propper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) „hall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it %,rill be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged . bsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system ProJ'ect: 1) • /l~lcrNELc.~ L • ~.A~MS ; W1JATTN_--W F'age 6 of 8 a s- + - 10 -,--k -;t-1 Ima- t A602CY LOTOM 30 1 tT i S 25 J- Cks d 20 Tied 111111 UL 778 and CS 122.2108 Standards / , ,T• ~►CaradFiaSfanda~sA~o~iort ~ : 1 _ r "-'t-1"~-~ CiettttlsllrrrpeislS090of Asgts~red 10 0 ° 0 10 20 kn 40 so 60 70 ct~nn ' so SSE - P D~/~S~ TTNE l~ f3 Nl I CHEu 0 5 10 i 5 rrt3N+ • Plot Plan page $ ofg Properly Owner L. i MS P= = 40 ft Legal Description ur 1.3 -rp,_g uTiv Lo la, 1,1 -mr- (except where noted) = Backhoe pit Ste' 4 D fL~ ive y4, sip-cc. 2.-- T'ZON} 1G W Tb WN or 7 QpM Zoo S t v sT. R® ~ a~a Ent -7Z j /,//0 North VJ- LM t-T F ~L t~1A G 0101D 0 0 w R Cull -0~ 00-0 N`` i I p 1 k Site Location: ~ 31, oz4a V roP aF sr&tL /~K~zSauTH PJL T - #t 04 ON 0 u f -r III PE- A--x-, wo EEO $ Tx44196956 9 STATE BAR OF WISCONSIN FORM 3 - 2000 998063 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Citizens State Bank, a Wisconsin Corporation, .06 Grantor, and Matthew D. Adams and Michelle L. Adams, husband and wife, 07/02/EXEMPT2014 O 11:06 marital property, Grantee. REC FEE: 30.00 Grantor quit claims to Grantee the following described real estate in St. TRANS FEE: 119.70 Croix County, State of Wisconsin (the "Property"): PAGES: 2 Notwithstanding anything to the contrary set forth in this agreement buyer is relying solely on buyer's inspection of the property and buyer acknowledges and agrees that the property is being sold "as is with all faults" and seller makes no representations, warranties or covenants, express or implied with respect to the property. To the fullest extent permitted by law, seller expressly disclaims any and all implied warranties, representations or covenants with respect to property. Recording Area Name and Retum Address: Title One SEE ATTACHED EXHIBIT A File 20841 Together with all appurtenant rights, title and interests. 040-1303-00-063 Parcel Identification Number (PIN) This is not homestead property. Dated this 27th day of June, 2014. Citizens State Bank Shawn Tyler, Vice President Citizens State Bank * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. Personally came before me this 27th day of June, 2014 authenticated this 27th day of June, 2014 the above named Shawn Tyler, Vice President, Citizens State Bank, a Wisconsin Corporation to me known to be the * person(s) who exec ted the foregoing instrument and r•'~• 5c't +knowledged t TITLE: MEMBER STATE BAR OF WISCONSIN ame. T~ct_..,. (If not, authorized by § 706.06, Wis. Stats.) * THIS INSTRUMENT WAS DRAFTED BY PUBL Na C Schmitt o Public, Stat nsin '•q~. 1~ .commission is permanent. (If not, state expiration date: OF va ••••'"x/1/2017 ) _Michael H Forecki, Attorney (Signatures tnay be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or primed below their signature St. Croix CgufJ Ci RaWaf®ge 1 of 2 STATE BAR OF WISCONSIN FORM No. 3-2000 w ' EXHIBIT A Lot 63 of Walnut Hill Farm, Town of Troy, St Croix County, Wisconsin. St. Croix County 9911063 Page 2 of 2 r f `te`a' 1 l 88.53' S 00'09'39' E 358.85' ! u ~ • ~r ,y gyp,. ,r , • - - - - - \ ~b► / , / S 00'9'39 E 359.47' 66 N r a 4 88.7'1' 134.55 x56.21' i 33 00 s ta~ to 40 co r v 66 a o r I ¢ ,r .0,169 3 ,.OC.ZS.W N i+ i R' f t%1 1 f f u { i b ! cv n. , '34.5W. 109.36' t 243.81 I ► TODD 131E ~ STEDT- Properlyowrw t'aroel lD lO 3 Z 3 55, F' a GroLnid surface etev Q U ' €t. Depth to lkft g i for ~ 2 im Fforizort Depth Dominant Redox Soil Rate Desafption Texture 5trtec~rers Consistence Boundary Roots GPI)AF - Munseft Qu. Sz Cant Color Gr. a. Sh. -X- E011 s S ctv 3 . Z. 3 3 51 ' 0' I L 5 Z S O v CV F-] # awns Q Pit Ground surface elev. ft. Depth to gm tfng factor Sod #lorizon -Depth f3orr:inarrt ication Rate RedoxDescription TeAure Structr:xe Consistence Boundary Roots Gtr Munseff . Qu. Sz. Corot Color Gr. Sz. Sh. `Efl# f 4092 j -,,In, q# $Or"'g pit Ground surface elev. tt. fJeptfr to firniiing factor k~ Application Sc>4 Rate + t~epth faonunant QAM f2edox Description- Te Strtechrre Consistence Boundary Roots in. Munseeti Qu. Sz. Cont. Cotor Gr. Sz. Sh. S TE 2 t a F Bodng t, s Boring Pit Ground surface elev. ft. Depth to Ong favor In. Sod 8gkafinn Rate Holtzon Depth Dom1 eani Color Redox ption. Texture SUudure Consisterxxr aourwary Roots oPOff in. Munsell Qu Sz. Cotor Gr. Sz. Sh. •Eif#1 "Eff#2 s Effkw t #1 = BOOS > 30:s 220 and TSS >30,c 150 m g& " Effluent #2 = BODs < 30 mgtt. and TSS < 30 mg1L "f"ire Department of Commerce is an tl opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3154 or TTY 6€ 8 264--8777. SOD-8330 (RBX701 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code y ST G,e G/ 1 L- ~riv' C Attach cornple L v /N H include' but n` EROSION CONTROL PLAN must be Parcel I.D. percent slope, lad. p Dim Cr- b completed before sanitary permit issuance R by Date Persood 4Nonnawa ra P-- -y oe used W secondary PXPoses (Privacy Law. s 15.04 (1) (m)). 2 d Property -r-~ a Location Q !7D 133ER5 T-e7D t O rl11G^' r/ 1r~1 yq J«G 1/4 S ZL T ZB N R (or) W qovtiAk Property Owners Matting Address Lot # # Subd Name or CSM# ot5 CA Wf GL Ave. (3 wAL N0r w it FAJeAf c city --CM WR State Zip Code Plane Numb ' ❑ Village W Town Nearest Road &0006 HT5 MA) 5S07(.# (&51) '1.`!8• tog f TRoy so• cf►ovER _ilcll o New Construction Use: (9 Residential / Number of bedrooms Code derived design flow rate r Da GPD ~l ❑ Rep,acement ❑ Public or 1- Describe: tA Parent material /o~SS D y& fl /1 S Flood Plain elevation if applicable tL General comments 4F and recorrrnt bons: /~-rDV,vD sYs r- ~A= N s s. r D a # ® Pit Ground surface elev. y ft. Depth to lirdffV factor 5 in. Solf ,ication Rate Horizon DepM Dominant Color Redwc Description Texture Structure Consistence Boundary Rods GPM b in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'EB#1 TOM ~ / o• jl ,oI / sip I'M x4e S cw z l• /0 S iG lam, 129 c4t.) f • Z -vie 3 •i /o s - 51- o A/4 zP c / .3 S L cad- o s SL S SV 519 n 0 00-6 1 ( ® Pit Ground surface elev. ft. Depth to WON factor in. Sol Application Rabe HWtDDn Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPM in. Munseti Uu. Sz. Cont. Color Gr. Sz. Sh. / o- /oYR 1/3 -Eff#2 l L 1-f i- • 3 N z • ! 7 L l~wt d crv / • i. N L 5~ L z / S 3 /7 5 _71s, ~o s L . 3 s sy ~ EMuent #1 = BOD > 30 < 22o nVL and TSS >30 < 150 mg1L ` Effluent #2 = BUD < 30 M c 30 mpk CST Name (Please Print) R LB R i Gk-r- s Apature zZ 3 5 Address Ulbricht & Ass9ciates Date Evakawon coroucled TemphoneNumber Private S . ?-e • 3oa 715• 77A • 3Yq Z- 2812 1 Oth Ave. Spring Valley, WI 54767 /NS' ' jcok 4 ORO x. 2 yo its C A I °ya • /400o57. so • o-&n ow . 16 Bp • /0. Ora 0,Y0. /09(• 2-0- Oro oyo-/08G- &D•M a py0•/0~(~ - 7d• ~ r 1~ ~ , f PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 Q = Contour elevation lines. = Backhoe Soil pits. Q = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. = 3a O~sV\'t2n~r' SCALE : 11' N5. G v~ava~ ~ Pge\N` 1p,)710~/~ i S s T- C' 70 { r t3S r c 3 ~O g p i s t A L 99M so . Z-0 T ~~N~ 63