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040-1303-00-053
PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578934 -A1 GENERAL INFORMATION (ATTACH TO PERMIT) I State Plan ID No, C Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. J Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town 040-1 V3-00-053 CS; BM Elev Insp. BM Elev: BM Description Section/Town/Range/Map No: A(iL! 22.28.19.1788 TANK INFORMATION ELE*TInrd IYATA all TYPE MANUFACTU APACITY STATION BS HI FS ELEV. Septic q Benchmark (J Alt. BM ~ jl J O ~J lJ KLW n Bldg. Sewer v X3.0 Holding 5SrHt Inlet I Q~ St/Ht Outlet '1 TANK SETBACK INFORMATION TANK TO ~P WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /I I Li 1) Dt Bottom -1 791 L Dosi g Head 'W "5 Dist. Pipe 0,65 Aera iron Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover -fi, I 77 G ZALr~ GPM r L14" 29.4/1 Model Number QUA, mb /b 2 TDH Lift22 riction oss System Head TDH t C• J Forcers 7ngjh I IDia. Zj) Dist. to well r (n Q SOIL ABSORPTION SYSTEM a5 JC -fu A\a 06;M-'.71 BEDITRENCH Width 6, Length No. O s PIT DIMENS S No. Of Pits Inside ia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L DG WELL LAK /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f S stem: I UNIT Model Number: DIST T N SYSTEM Hea er anifold Distribution x Hole Size x Hole Spacing I Vent to Air Intake I Pipe(s) 541 1 [ I 2 i% Length Dia Length Dia Spacing I 1 -SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only i th Over Depth over xx Depth of ~`1 xx Seeded/Sodded fficbEd Bed rench Center Bed /Trench Edges Topsoil 1 Yes No es ~No COMMENTS: (Include code discrepencies, pers present, etc.) Inspection #1: / Z-/ 1 S nInspection #2: S"4- ✓►'fbuie.tY Location: 657 Tradition T Lail River Falls, ,W~I54022 (SE 1AtE 1/422 T28NCR1ra9`W) Walnut Hill Farm aka The Tribute Lo Parcel No: 22.28.19.1788 1.) Alt BM Description= 2.) Bldg sewer length = ~1 - amount of cover = *17 Plan revision Required'?? Yes [ No Use other side for additional informatiYr/' Dat Ipoes nat ure SBD-6710 (R.3/97) Ara County ( n t I tl i SAV a ~ s Division t K 201 W. Washington Ave., P.O. Box 7182 Sanitan Permit Number (to be filled in by Co) r P nn„a tnn F ~7n7-7182 -7q 0 nTUN~rr DEVELC~ht~ry Permit Application StauTCransa°nonNnnrber 9M accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to th77F9 unit L S S 3 is required prior to obtaining a sanitary permit. Note: Application forms for state-ed to Pu iect .Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you prdary u oses in accordance with the Dm-, Law, s. 15.04(1) m), Stats. 1. Application Information -Please Print All Information f s 7 Property Owner's Name Parcel 4 ~evPT, i7 D qo - b _ by _ p5 Property Owners Mailing Addre Property Location City, State Govt. Lot x-76 lip Code Phone Number ' Z Z Y., Section circle o n -Alp, J '2- 4 II. Ty e of Building (check all t t app) Lot 4 T SL. N; R E W or 2 Family Dwelling -Number of Bedr Subdivision Name F,:~ V Block tt 1 .L Fa l~V✓ ❑ Public/Commercial - Describe Lis p / 7$ ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of x O N CEI~ wr, of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. N11~ ❑ Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing Systcrn (explain) ❑ Permit Ren ermit Revision Change of Plumber ❑ Permit Transfer to New R' List Previou Permit Number and Date Issued Before Expirati Owocx f A'. Type ofPOWTS System/Component/Device: Check all th Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ A Grade > 24 in. of suitable _l Mound <24 in. of suitable soil 11 ❑ Holding Tank ❑ Other DLspersal Component (explain)! Pretreatment Device (explain) ~ ' J 1 V. Dis ersaVTreatment Area Information: lll~~~ Desi Flow (gpd) Design Soil Applic on Rate( gpdsf) Dispersal Area Required A) Dis ersal Area Pr ose 7j 72 p QP (sf) System Elevario~r V 'D VI. Tank Info Capacity in Total of Manufacturer Gallons Gallons Units New Tanks Eststing Tanks I I F7.1 I I YV 1/ne l1 = c : I n 'Septic or Holding Tan; I ^ Dosing Chamber L /3 I j VII. Responsibility Stateme t- 1, the undersigned., su c responsibility for installation of the POWTS shown on the attached plans. Plumber's ?game (Print) PI s Signature MPM MRS Number Business Phone Ntun ~J Plumber's Address (Street, Ci . State, Zi rd VIII. Countv/De artment Use Onlv Approve I Disapprove Permit Fee I Date Issued Issuing Agent S e I ❑ Owner Given Reason for Denial ~ IX. Conditio FAhWOYMYR ens Dis roval ,p 1. Septic tank, a uenMiilter JV 1 ak-f 1 O?Ve 1 bp--/ tb 1D~bV i dispersal cell must be serviced / maintained as per management plan provided by plumber. VofA-L.OW i 2. All setback requirements must be maintained In I as per applicable code/ordinances. q ,h AA C\ .Attach to complete plans for the system and submit to the C ty only on 4pot less than 8 1C 111 inches in size 0 S13D-6398 (R- 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM, ELEVATION 97.0' DATE 5/22/15 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 1/2" steel conduit ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 1 Acre lot Tradition Trail Area 15' below Scale 1 /4" -10' ~~I is to meet all system is to remain ,WDNR setbacks undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels H uffe utt Combo Tank. Pro 3 Bedroom House 12% Slope Property Line Property B-3 Li ne 91' 93' 95' 9 5' B-2 97' Grading is to be done to divert B.h1.* run-off away from system B-1 99 Property Line ~CJcopy 9tiYARTN DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 S Contact Through Relay P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov OssroN~tSw Scott Walker, Governor Dave Ross, Secretary June 10, 2015 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: 06/10/2017 Identification Numbers Transaction ID No. 2552353 SITE: Site ID No. 811931 Oevering Homes Please refer to both identification numbers, 657 Tradition Trail above, in all correspondence with the agency- . Town of Troy St Croix County SE1/4, SE1/4, S22, T28N, R19W FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1532912 Revision; Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. C0 • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and of-PT dispersal are prohibited. pROF~ • The distal pressure for the 3/16th inch orifice is three feet with a discharge rate of 0.72 gallons per foot.~ytS~~N • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c SE • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS 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. Stat SHAUN R BIRD Page 2 6/10/2015 • SPS 383.22(7) 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 Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 $ 85.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2, Division of Industry Services Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm R S i v SHAUN R BIRD Page 2 6/10/2015 • SPS 383.22(7) A cony of the approved plans, specifications and this letter shall be on site durinp- construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 $ 85.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2 , Division of Industry Services. Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm r i Cover Page Shaun Bird Bird Plumbing Inc. MAY 2 8 2015 1432 120th St. ` HY SERVI~ 7~, New Richmond Wi 54017 715-246-4516 Date: 5/ 22/15 Owner:Oevering Homes Location: SE1/4 SE1/4 S22 T28 N,R19W 657 Tradition Trail Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9. Filter Specificatio d cross section Attachments: Soil Te IDITIONALLY Shaun Bird APPROVED Signature OF SAFETY AND License number 226 0 ;SIONAL SERVICES F INDUSTRY SERVICES CORRESPONOENC4 9 PLOT PLAN -PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 97.0' 5/22/15 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 1/2" steel conduit ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 1 Acre lot Tradition Trai I Area 15' below Scale = 1/4" =1 0' /Well is to meet all system is to remain WDNR setbacks undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels H uffc utt Combo Tank Pro 3 Bedroom House 12% Slope Property Line Property B-3 Line 91' 93' 95' 96' B-2 97' Grading is to be done to divert B. M. run-off away from system B-1 99' Property Line n Mound System Cross Section and Plan View Dimension Feet A j J I I g - l I I T I I D--- L 1 1 r rr JJ rJrr J rJ r Jrr L ~'r:J 1 LL.JLJ. 2: J12yJ.f,•r~f~r: :••.:~::l.. .r r1r J.2~ ftiJL:1~,~fL~•:L L •f J1. :j1.1rL~1f1•~\/~(}'L~. ~ti f ~Zw A I f::•T•J•.. f f J J L ::1fy ;4:4:L: L.t:1j ::.1~1jL 4 LJ.r 11 t~ti ,:q:ti.1. l! ti.l: J { r Lr J•J• •J•r~ •.~'.....1.L.L.1:1:1fL: ::1.1r'.fLl1%Lrti ll1:L.ti~ti:ti~. ~tlijtil:t:ltill.':f:~:J: t:r:r1.•:t•r:~~J~l~r:J.J:r~l~r {5{} W I Z , G j~ H I I , I I ~ ~ i [-K W K l B 1 z Slope,`%, _ L - "1 = Topsoil - ASTM C-33 - Clean aggregate = 4'n. sch. 40 pN c Cap Material sand fill '/2 to 2 1/ in. dia. observation pipe L -.j Geotextile G H Fabric F! r:r r.ir..r r:J. l i L r L D } ~Ktiti 2' { k A, ~~✓,a~~S 4,x),4 Plowed Surface> k s 0 Ft Contour `K l ~ 1~5~✓) i K 3?.< Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Fxisting 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 '/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a baekhoe. Special care must be used when placing sand of less than one loot 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. 10/07 lgj Page of 1 Pressure Lateral Layout Two Laterals - End Manifold - I'hreaded Cleanout Lateral Turn-up Plug Manifold M - t L. Long Force Main 1 Sweep 90 Bend Distribution Network Specifications Pressure System Construction Lateral Diameter Z In. ' Manifold Diameter In. Laterals are constructed oi'Schedule 40 PVC Orifice Diameter -3 In. pipe. Orifices are drilled perpendicular to X Orifice S acin In. the pipe with a sharp drill bit and face down. L (Lateral Len th t. Lateral turn-ups terminate with a threaded Force Main Diameter Ft. cleanout plug and are enclosed in a 6-8 inch M (Manifold Length) -2_ In, diameter lawn sprinkler valve box acceSSiL~Ie _ from finished grade. Force Main Length J; c~..~., l't Grade ••••.:0:::::.:.. 6-8 Inch Lawn Sprinkler Valve BOX Page of 03/0519) Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer Pump Model Number r t Tani: Model Number p~ I - Alarm Manufacturer "I i i 0 Total Tank Capacity `t Max. Bury Depth Alar Model Number ~~r Switch Type Total Dynanuc Head (TDH) - Feet Filter Manufacturer' Elevation Head ~ - Filter Model Number Distal Pressure Network Loss" Minimum Pump Performance Required Force Main Loss I -z" - GPM' Ft TDH Total outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. inlet Manhole Seely Mounted With Locking Device < 6" Below Grade Sealed Watertight Weather-proof, Junction Box i ~1 ~ i tlr ilf~ >~1 ~ rlr w i.... Finished Grade 'w Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet Baffle inlet YY A Switch Settings and Reserve Capacity Weep Hole Tank Volume = GPI B ension. Inches Volume Gal. Dim 3 (reserve} A Off Elevation C (alarm) B 2 " u Ft Bottom (dose) c D Elevation ( Ft dead) Total : > . <;.;<;{;. t 1 > <•t i•. a {>t •r•Y•1>~Ya>i>+1 ~~i a>i>.>~ t i>~ .><><}i t a and back filled in aCCOrdancc with the INSTALLATION- The septic/dose tank is bedded the manufacturer may not GENERAL specifications. Maximum depth of bury as specified by device (padlock) manufacturer's product approv~vspeC Menlloie covers exposed to grime have an effective looking t fittin and roved material, connected to the tank with watertigh g' be exceeded without prior app installed. Piping at the inlet and outlet is of app T13e force main is sleeved with 4" Sch. 40 PVC to bridge the tank laid on stable soil to prevent settling or sagging. sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2• . excavation and the C_ of 02105 L1 Page r - CI r.^ VL1F1 A~ K-.L3 ~l CAPF'-IT ~r` - - or , i 4 30 I I a 8 - C 20 40 8u 00 - / ~ -----r--- T-- LITERS p:, ^n v: CONSULT FACTORY FOR SPECIAL APPLICATIONS f- _ Timed dosing panels available. p led with b _ Electrical alternators, for duplex systems, are available and supp an alarm. Vanabte level control switches are availab e for controlling single phase systems. Double piggyback variable level float switches are a`raiiable for variable a - level long and short cycle controls. - Sealed Qwik-Box available for outdoor installations. See FtJi" 420. • Over 130"F. (54°C.) special quotation required. - 1521153 Series 1521153 MOf)ELS --control selection_, i Mad lei Volts•Ph I Modems Am --t SimF ex ? rr 3_! ` ~ ,K2ooa 1 BN1 115 Non Inc!u7ed 2or3 BN152 115 1 Auto------ 2 or ? 1 E552~ 230 Non ' 4 3 - - _ or 3 2 .1 BE152 i 230 Auto 1 4 3 Inclu-ed N153 115 Non 10,5 2 or SELECTION GUIDE Auto 105 'nc,-,ec 2or3 BN153 115 - 2 or 3 ^ Single piggyback variable level float sv;itch or double piggyback variable level float i E153 230 Non 5.3 - 3 _7 1 P.uro l T `Oi ° 5vv t h_ Refer to F nCu T LGE153,1 23~ Cf~ 3----~-IndudeU See --Pir. 12 for cc rest model of E'ectrieal Altemator E Pak p CAUTION All 3 variao e level co~trvl svw'itch 10-022b used as a control aci Bator, specify duplex (s installation of controls , protection devices and wiring should be done by a qualified . licensed electrician. Ali electrical and safety codes should be followed including the most or L4 .1 bloat 5ySt0n1 recent National Electric Code (NEC) andthe Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller puma. MAIL TO: P.U- BOX 16347 46256 3-7 1 7 SNIP 70 364s Cnr cad [7 ou+Svil e 21' yo; ~O UTr ~UMPS N i~3 f5G , 78-2731 1 i300v, 3 P`rr;r' 74- http://www.zoeller.com - O Copyright 2000 ZoeilerCo M righis reserved. 9 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS al ❑ NA Owner , f+ z f z f Septic Tank Capacity Permit # GJ Septic Tank Manufacturer ❑ Nq DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Effluent Filter Model ❑ NA Number of Bedrooms ❑ NA Pump Tank Capacity aI ❑ NA Number of Commercial Units /Z 7 Estimated flow (average) c~ al/da Pump Tank Manufacturer y^ - ❑ NA x 1.5) aVda Pump Manufacturer , ' 1 ❑ NA Design flow (peak), (Estimated , t- al/da ll'? Pump Model ❑ NA Soil Application Rate Monthly average' Pretreatment Unit Influent/Effluent Quality ❑ SandlGrdvel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (RODS) 5220 mg/l. ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer A Pretreated Effluent Quality Monthly average" Dispersal Cell(s) en Demand BODs) S30 mg/L ❑ In-ground (gravity) 11 In-ground (Pressurized) Biochemical Oxyg ( Total Suspended Solids (TSS) 530 mg/L ❑ At-grade Hound ❑ Other: Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Dri ine Maximum Effluent Particle Size Y. inch diameter • Values typical for domestic (non-commercial] wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every onths Ay-ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume At least once every ❑ months ?f3-,year(s) (Maximum 3 yrs.) Inspect dispersal cell(s) Clean effluent filter At least once every /e ❑ months4 ar(s) Inspect PumPpump controls & alarm At least once every ❑ months"-)H-year(s) ❑ NA . FF us h laterals and pressure test At least once every ❑ monthsear(s) ❑ NA her. At least once every ❑ months ❑ year(s) ❑ NA other. 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 certifications: Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. 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 to check for any back up or ponding of effluent on the ground surface. The dispersal cell(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 failing 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 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, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations 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 the presence of painting products or other chemicals th,"t For new construction, prior to use of the POV'JTS check dispersal tank(s) • process andlor damage the dispersal cell(s). If high concentrations are detected have the contents oft ;a may impede the treatment P tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. estored the the backupsurface excess discharge wastewater will t, e effluent. sower is r tanks may fill above normal highwater Levels. When During power outages pump the cell(s) and Y operator prior to restoring power to thle loading discharged to the dispersal cell(s) in one large dose, °Veiank removed by a y Septage Servicing #e Pcontrols to restore normal lev€ s To avoid this situation have the contents of the pump effluent pump or contact a Plumber or POWTS Maintainer to assist in manuall operating pump or compact, the area within within the pump tank. rk over, not drive or park vehicles over tanks and dispersal cellls area. ot drive or paor otherwise disturb of the POWI ,a; 15 feet down slope of any mound or at-grade soil absorption rove the performance and prolong the life disinfectants; fat; foundation drain Reduction or elimination of the following from the wastewater stream may imp antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; (sump pump) water, pesticides; sanitary napkins; tampons; and water softener brine. Admisieps shall btaken to insure that the system is propel y ABANDONMENT S fails and/or is permanently taken out of service the folinlowing When the POWT and safely abandoned in compliance with chapter Comm 83.33, Wisconsive Code,. • Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings ba sealed, Servicing Operator. • The contents of all tanks and pits shall be removed and property disposed of • After umping, all tanks and pits shall he excavated and removed or their covers removed and the void space filled with soil, p 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 compl', ;in absorp replacement system: r the location syst ❑ A suitable replacement area has been evaluated and may be disturbance and utilize compaction and shoe Ids of be infringed uponiby quirec The replacement area should be protected from distu with the nE- it the re setbacks from existing and proposed strucure, a lot lines a ea.t Replacetment syst ms must coa will mply suit t the e nest for a new soil and site evaluation to establ effect at that time. rt Lou replace setback aed/POs~smitations. Barring advances in POWTS techna ogy • A suitable replacement area is not la available holding tank may be installed as a the fa, soil and ~ site has not been evaluated to idereplacement isuitable replaf no eat are area. Upon failure o available aOhotTS tank may iteinstalled o must be performed to locate a suitable 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 infiltralk ce, Reconstructions of such systems must comply with the rules in effect at that time. RESCUE 01:' <<WARNING>> R INSUFFICIENT SEPTIC, PUMP AND OTHER FNMAY UNDER ANY CIRCUMSTANCES!iDEATH MAY RESULTYGEN. ENTER a SEPTIC, PUMP OR OTHER OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER _ ' ~ Name Name / Phone `J) Phone "ORtTY SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY - L Name Name FPhonew Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. • 1 I i. f c ~ c~ P Gi G1 y t ~ ~ `4~♦ fi`t'` 77 max` ~~1 3 vVisoormin oapantrnerht of Carmwrce SOIL EVALUATION REPORT Page I Of Division of safety and BuOdwW _ in accordance Wth Comm 85, Ws. Adm. Code Canty 57' • G~ oil- Attach mnple(e ' tndude• w not t EROSION CONTROL PLAN must be Parcel I.D. c P vT~,,~ /A)S G.. perowdwope' completed before sanitary permit issuance Reviewed Date M Paeaond t/orr MOM you provide mq be Wad to teowW" papom (RmKy Law. 6.18.04 (1) (m)l. V P~oc) B3ERSTC''D1-` /i~ 040- PjF✓P Property HH corLta hl or ss /4SzL TaS N RI9 &(o)w -°nl Prop"OwnWs MaNng Address Lot # Block # Stbd. Name or CShW moIS CA WW- Av- • 53 !r/AINOT 1ti'I( FA+E'/ City :,romp state code Phone winner ❑ city ❑ wage W Town Nearest Road C PPP " HT3; MN 55-04-11651, IY9- Of --levy so. CrIovER Pt N.w Con*- t;on Use: M Residw" t Number a(bedroams coda deniwa design flow rate p - oar GM ❑ Replacement ❑ Ptbhc or comnwrcat - Desaibe: tA Panent matedd /0, S S~ ~!/cT. L,14 . Dd /O k : f -e Good Plan Neveson M ap0cade v7 ; ff- it. t General omnffwft -IF and tions: 't ~4- 141"ov-vp s ysr~~•. w~~ /a " s.t~vv f%~/ N ® Pit Ground surface elev. n Depth to 1-ft factor 3 2 in. Sa Rate Harmon Depth DoWnant Cdor Redox Description Texture Structure consistence Boundary P=% GPM in. Murad Qu. sz. Cori. Color Gr. SZ &L 3 'Etpf1 'Ett#2 N l 0-Ifn /o I/ 3 L Z ShK d. -5 S~ 2 ~.3 /OVA z s aQ c 4) / S %A 3 y ~Z A-4 ej a rG lf5b ~v c Z ~7 .s yie s!y icy s M 3 /-to S S/ G ~tl a S~1R y/G ~ L ® P G=nd avmce elev. 4 l S fL Depth ID IN factor Z $ S in. S. S . sa Application Rata ~ HAwn Depth Don*wnt Colomi RedgxDeeaip6on Texture SbucWna consistence ilonxdany Rods GPDAF in. Munseti Qu Sz. Cont. C.dor Gr. Sz. Sh. 'EI#t1 'M N n•I 1oyk3 L zfsbK s to 3 r- S N Z /A • 25 0 V'Re 2f5 K d Cf S ~ /o Elie f(f /mar oT 5 I L Sh U C Z 3 If -gi f -T- 3 y y Lii <.eSfa.v f> !o~•c. f y D !z v S. - EMuert #1 = BOD > 30 < 2M nVL and TSS 401150 ng& • Effluent #2 - BOD _ 30 n v& and TSS ~ 30 mgtL csr Name IPlease PrkQ Q ? 1 ~-6 R i C l l- S"- 96W 6~4~ -2. (3 5 Address Ulbricht & Ass9ciates Date Evaluation Conduced Telephone Nufter Private S- a o03 715- 77a • 3Y`/ Z- 2812 10th Ave. Spring Valley, WI 54767 'OR 4A0R0)(- ayp • /o8S • so • tso~o o yp - io ~lo i0 • ones oyo //~'G 20 oyo /0Z - GD d~ oyo iog6 - 70 OOV 0,Y0 • /Os'& • O Q D~ 7- TDDl7 ~ JE ~ ST~DT! Property Owner Pace, ID # L67 S 3 I'Ve Z a 3 ❑ B o jjr Q sss Gmcmd stxface de v. 90 • i<. Depth m W Mang rector 3 3 ha sat Rate i'torimn Depth Don RedmOesufptfon Texbxe SbUM" Cormslmroe Boundary Rooter GPM IM Munse R Qu. Sz Cord COW Gr. Sz. Sh. EyG91 'EM l o r3 ipYR3! ifshk d 54 w 3 s Z/ b y St ifs ,C G w 1 S 3 3 X01 St 2 ~K v!~ c s s 3 -S ? 5 y 6114 14013 SL D lest vft ~c S 3 S SOY (L ---P I-1'A05j'VAJZ 10 t9 le -1-e > E.3 # ❑ Pit G..W surface elev. R Depth to Smiling facbr. in. Solt Rale Horizon Depth DorrurwM Redox Desorption Texture SbucMe Carne 8.WW Rook GPDNf h Mutsell Qn. Sz. Cont. Cotes Gr. Sz Sh. 'EflW t i F Rorirg tK ° Bor;rg ❑ Pit Ground surfaoe also. fl. Depth to CxnPo'rg factor in. Sol Rate Hortzar Depth Darrerrara RedoxDesvipron. Texture Struotxe Consistence Boundary Roots K Munses Qu. Sz Cord Color Sz Sh. 'Eflti7 'EM br. t r # ❑ Bodrg ❑ Pit Groud elev. fl. DepBr to Ifmitltg feeler ~ In. Soff Appdkcalon Rate Horttoa Deph CXJMIn8ntCok* Redox Desortp6an_ Texture Stnrchae C,or ce boundary noota t3PpRp in. Mursefl CO. Sz Cont. Color Gr. Sr Sh. TWI TIM • F_8fuent tut = B . > 30 22o mg& atd TSS >30 < 150 mA • Effluent #2 = 1300j :E 30 mg& and TSS < 30 mgk The Department of Commerce is an equal opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TfY 608-264-8777. seo-aw~cano~ PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 = Contour elevation lines. 0 = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : 1 " - Ft 64,ufovi2 G%NZ 9 /S s~SSES T D /J0v"'D S S ST , ~'Gcv . LOT 53 i v a ~o qdr v • 133 ~A 5-r r Lv &7- 670 12, ~ti Q ~M 4 20~ - 15? CORM PV \ CDT . b UT" -0 ~ ; 5 vR v~~/a2' S V '-j ~o AT- ~ n r s PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578934 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town of 040-1383-00-053 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 22.28.19.1788 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size rle Spacing Vent to Air Intake Pipe(s) 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 Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Edges Topsoil Fjz~ Yes W No Fq Yes Fpfl No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection Location: 657 Tradition Trail River Falls, WI 54022 (SE 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute Lo Parcel No: 22.28.19.1788 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes 0 No Use other side for additional information. Cert. No. Date Insepctor's Signature SBD-6710 (R.3/97) - county ,~b 1 201 W. Number (to be filled in by Co.) der ECEIVED SaEan :T M <K (7 onNST. CROIX IT RI t Applica ion `Pis. Adm. Code, submission of this form to the appropriate S submitted in accordance with SPS 383 alb),> Pmt Note: APPhc°° forms for "wned POWTS are are submitted to Project Address (if different than mailing address) itwy is required prior to obtaining the Department of Safety and Professional Bevies. Personal information you provide may be used for secondary -Tel ses in accordance with the Privet Law, s. 15. 1 to Stars. Informatio parcel L Application Information - Please Print All property owner's Namc 0 t' r t oe- 0 ! (1 property LDcattQn / 1-7 I<X Property Owner's Mailing Address Govt. Lot ~^sE C V / II 'A, Section I Zip Code Phone Number Z. (cluck city, State ' / t C ) O 7 .Q N; ~ of W S T Lot # Ih. Type of Banding (check all that apply) Subdivision h i or 2 Family Dwelling -Number of J J Bloc 4,11-le ❑ City of ❑ Public/Commercial - Describe Use . ❑ CSM village of Number ❑ State Owned - Describe Use own of I z d 44-' f- I III, Type of Permit: (Check only one box on line A. Complete line B if applicable) Modification to Existing System (explain) ❑ Treatment/Holding; Tank Replacement Only A 3ystenn Replacement System List Previotts Permit Nnunber and Date issued l ❑ Permit Revision ❑ Change of Plumber 11 Permit Transfer to New B. ❑ Permit Renewal Owner _4 I Before Expiration TV. T of POWTS $stem/Com onent/Device: Chec all that a i in-Ground ❑ Pressurized In-Ground t-Grade ❑ Mound > 24 iti of suitable soil ❑ Mound < 24 in, of suitable soil -presgurizod [1 o Pretrre- ent Device (explain) ❑ H Hollding ding Tank k 11 a Dispersal Component (-Plain) Arcs Design rsI rea curt Area Information: Dis Area Required (sf) Dispersal Propose (sf) System Elevation r ✓ .-F~lto~w (god) Design Soil A ptication f) I~ VL Tank Info Capacity in Total d of Manufacturer u o y Gallons Gallons Units New Turks FY e,ng Talcs a U ~ ~ a v ( il/ ~LVIi 1r i " A `a~ m Septic or Holding Tank B~ Dosing Cbamber VIL Responsibility Statement- 1, the undersigned, a responsibility for installation of the POWTS shown on the attached plan&usiness Phone Ntart PI Signature MP /IvIPRS Number p 's Name (Pant) Plum 'Address (Street, City, State, Zip ~S 7 I ountv/De artment Use Onl permit Fee Date Issue Issuing. t Signattue Approved $ ~ . tX> j vet Reason (o2,5 / Iz~a,MC!?t..klL, ptExsons for Disapproval ` pC ~r7 f-p rd 'A n~ w IX Condit I 1 r I Septic tank, effluent filter and _3) a n dispersal cell .must all bfl services i aim tM 4"e n a~ as per management plan provided by Plurr►bef. ; ` r~ se~mg t r nl•r►t4; M* Fir whi Gil to r' d t `v,~11~ ; n St}~ (a v~.Q i. M plane for the system and submit he County only on pat not iem than 8 t2 x 11 inch su Atraeh to complwe to , ^ „ r ti 4Zjlk ~ SBD-6398 (R. 11111) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 COUNTY ST. CROIX SE. 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy SYSTEM ELEVATION 99.7' DATE 4/13/15 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none HOLDING TANK SIZE BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE 0 WELL *H.R.P. Same as Benchmark B•M•* 345' Property Line B-1 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Grading is to be done to divert run-off away from system B-3 4% Slope Wei I is to meet al I WDNR setbacks Area 15' below Tank is to be system is to properly bedded and remain Huffcutt providedwith undisturbed Combo Tank 1ockdown comers g- Pro 3 with approved Bedroom warning labels 99' 10 0' House 9'9.7' Cale = 1/4" = 10' 1.5 acre lot Tradition Trail Opy SHAUN R BIRD Page 2 4/27/2015 county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • SPS 383.22(7) 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. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)' utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 &';-5 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2, Division of Industry Services Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm . DIVISION OF INDUSTRY SERVICES 9tiyT.tir~T 3824 N CREEKSIDE LA 5tit' o~ HOLMEN WI 54636 o~ jp~ Contact Through Relay D S P K http://dsps.wi.gov/programs/industry-services www.wisconsin.gov S ~w Scott Walker, Governor ~QssraN~ySw Dave Ross, Secretary April 27, 2015 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 Numbers PLAN APPROVAL EXPIRES: 04/27/2017 rflddentification No. 2533451 1931 SITE: e refer to both identification numbers, Oevering Homes ave, in all correspondence with the a enc 657 Tradition Trail Town of Troy St Croix County SETA, SETA, S22, T28N, R19W FOR: Description: At-Grade / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1532912 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. CO • The changes made in red to this plan on 4/27/15 by this reviewer were acknowledged and approved by the system designer. DEPT • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. pp'OFE Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and DNIS10N 0 dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR-811 & 812c SEE • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated SHAUN R BIRD Page 2 4/27/2015 county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • SPS 383 22(7) 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. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer 2, Division of Industry Services Payment Submittal. (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 charles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 4+q .y _ .+wu^~ui'n+ngr. ' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/13/15 Owner:Oevering Homes Location:SE1/4 SE1/4 S22 T28 N,R19W 657 Tradition Trail Troy Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications 1DITIONALLY .PPROVED JF SAFETY AND Shaun Bird SIONAL SERVICES Signature ' INDUSTRY SERVICES License numb 26900 CO_RRESPONDEN PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE. 1/4 ,SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYS'T'EM ELEVATION 99.7' 4/13/15 DATE BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE LOAD RATE •5 ABSORPTION AREA 900 # of chambers none HOLDING TANK SIZE k BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B * 345' Property Line B-1 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Grading is to be done to divert run-off away from system B-3 4% Slope Wel l is to meet al l WDNR setbacks Area 15' below Tank is to be system is to properly bedded and remain Huffcutt provided with undisturbed Combo Tank lockdown covers B-2 Pro 3 with approved Bedroom warning labels 99. 100, House 99.7' Scale = 1/4" = 10' 1.5 acre lot Tradition Trai I 2°~ g e System Sloping Site Cross Section and Plan View At-grad F ~i I Dimension Feet ;••;L•L.f rtif::': 'L~ l :r:r r ref%j: :r~r~r r j•j•j•r•rti ti.LrtirtirL;ti•:~,,L, t ~ L~ j. j.j.r•r•j•. r•r• B _ I ••ti:;.~ti .,:y,::, : : L~'L :•L•:• :•L•'ti•'••L•'.•L•L•L•'••ti••'••'.•L•L• I r:'r'ti ~;~;:L~ti L:: ~:~L~'. S,:L~ti •,:•.~ti''L~L!L:~.iL ~L f'; rti jti f:•jtir~f5r~ fti j~ j'. jti j•'Lj.j•j•r• ( r~r.r,. t•j•j•j•j•j•r•r;r;`r;•r~jti;•:::';~?ti'•:•L•L•L•••:•'••'••L•L•L•L.L•L••.•L•'.•:•L•:• I 1/6 B r; f.'•:L'~'Jti L~'L~'LrLi%LILr,ti LL~Lrti ti,ti•".:L:L::~ti L~:••j'.•L••rL•'L.L•L•~;•L• I~ j~ j.r•r~f, r, j. •.r•1'•j•j. tir, .••Lr;•Y;~r;•~;~';•~,•: L:'.:Lr• :'r'r' ~•r•r t•., r;~• 1/ L L:~:~ • ti : L::~:.L ~.f j.j.r j~r1,..j~,•. r '&;v J'~~'•': : : fti'jij'• I : ::.:ti ' ti ti ti 'L : : : ~I~ r r:r;•r,yj; ~'1~1; 'rLr: ~L: J ~~''•j'L?; `~1'•'' D 2.0 t •SLrL :ti :~:r r:: r jL:LjL ti~ti~L .r.. l•j•. ~L?ti ti ti ti L • ;rLr: ~:r:r~rtirtir~ stir: 'ti :,~~:ti:ti:•: • ~L~•: ' ~L~'.•:•ti•'..• I E l.0 r .r•}.r.}. j:j:r~f r• j ~tir~:ti: t r'.'•~y;'•J; j;: f•~ti ;~'~.'f1 ti j; f; j~r~r. r.'~.ti1 ;L~L f.':~: `L •,,::;.r1:•• t _ j.. •r.r; r, ~ti~tir, ~ti~ti~ti~ ~~ti ::'.1:.~'.~L~:j:r~'Llt 'Lrtir:r.l', Si F j:'ti '••:~''•:L?'''' ••''ti'L~1 . L•: .••y.. ~y::•'L:L•: j; j, j, j. ~.r•. •.'•j•r. j. 1.0 t r•r, r•r;.,r;~~L;~;~;ti :;L;: :'j':'j•j"• •y,L•'.•L•~•'L.••. I j.r.j•r:r•r•r•r.r; r. :ti tirtijti:%rtirti ti':~.rti:ti tifti ~S,:ti,: ~.:ti~'S~•L•:• S,.L.:•. . L•L• i L•: j~;f:j.f•r•j•r•r•r•j.j.r'r•r•r•r•r, r'r: r'r'r'j'j' I t j.j•r, j:j•j•r• ,•,••,L•:•:•L~ ••.•'.•'•••..'..•,.L•L•L ~..L..••.,•L ~:•L ~L• L GTC..7 t 1/6B W E % Slope L - 1 = Plowed Clean aggregate O = 4 in. sch. 40 pvc t '/2 to 2 `/2 in. dia. observation pipe basal area L J Topsoil Cap Lateral with 2" aggregate over pipe Observation Pipe Geotextile G With Cap Fabric r:r, lrT_ Ft Lateral Invert j •r:r r Topsoil Cap r r r•: •j•r• f.~ j•r j. j. j.j•j•r :ti ;.r;.f;.~Lj:~'L:~:.rti':5~:'ti••~•L , :..L.ti.L•L•L .f .ti .r• j~ j,~ j. j_j; r r. j.?: .r•r• F ~:•L•:•ti•ti•:•ti•L•• Ft, Cor, 11 1f rtir, •';'j' [tour ,r.r!r, r, r; rti~ti?ti .ti; F Lf:ftijtiltil j, j k - .:1:1: ' r j•r r j.j•r•r j•j•r 1000 •.X, plowed Surface , Q C Slope Direction -411. GENERAL INSTALLATION: The at-grade area is staked oXt Walong ) is st desin contour. Existing out and plowed w th a vegetation is mowed and raked off the site, The basal area (L 11 Is wet enough at the plow depth to moldboard or chisel plow. Plowing may not proceed so' - of the hands. The A x B area is form a V, inch soil wire when a sample is rolled between palms cial care mus~ covered by clean aggregate deposited overhead by a bsurfacepeAfter the topsoil bcap is placed, placing the aggregate to minimize compaction of the plowed the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lgj Page of Pressure Lateral Layout One Lateral - End Manifold 4---- Threaded Cleanout Lateral Turn-up - 0 Plug Force Main X L Long Sweep 90 Bend Pressure System Construction Distribution Network S ecifications Lateral Diameter ` - In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X (Orifice S acin) c; y In. the pipe with a sharp drill bit and face down. 3 Ft Lateral turn-ups terminate with a threaded L Lateral Len Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Ft. diameter lawn sprinkler valve box accessible Force Main Length ` from finished grade. Grade • • Q 6-8 Inch Lawn Sprinkler Valve Box Page Y of / z 03/05 lgj Section And Pump Performance SpecificatSeptic -Dose Wank Cross rAlde facturers ✓ Tank Manufacturer - rJ - ~ - l Number J '1 ank Model l`I tunber uf, ~t!~?'ex `l' 4 f 'I ota.l ank Capacity l Numbere Max. Bury Depth Filter LDistal tal Dynamic Head CDH) feet Manufacturer Filter Model Number ,-t Head sure - - Network Loss - Minimurn Pump .performance Required l Force Main Loss c Total TDH ~K C}PNI: @ / i Outlet ).Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade. f ocking De~rice. Inlet 1VianhOle Securely Mounted With Locking Device < 6" Below (trade Sealed Watertight Weather-proof 1 Junction Box. Finished Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap rrrr Outlet Filter Inlet ,~h-- Inlet Baffle - A Y4" "witch SetOngs and Reserve Capacity Weep _ TTank Volume = ~'S Hole Dimension: Inches Volume Gal. X 13 A°: (reserve) f • Off Elevation C 2 (alarm) B Ft (dose) C Bottom (dead) D I7 Flev ti" n C Total rr> "i sT ~TF,T C-t-rr.ri , ,'P'T-r ~r ; era+~s~i ~risi Tci < • , . , , . , , . . r . > r,r , r r ,`r •)•1 •v`rrr r•,`r`> S~r~r; r;r i/~r {i,r~ ,r<>s't r•<•/•/•<'r•Ir'r•r :•1•r•r i•,•' GENERAL INSTALLATION: The septic/dose tank is bedded and hack tilled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approvat. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation mid the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.211. 02/05 L.I Page 5 of / 2 L4' 4T f~!Nv H;_F[] CAPFIlTY CuRV r--- Dtl 152/ 5 ~IW 3 -77 240 i52 34, 12~ j -zo F_ ZU _ a,Ga i 4 -1 _ ! i ' I ~ 80 100 20 40 60 GAL ON- - - C _ ► ► c i _;IERS g0 6v =d - -1 FLOW FOR MINU k "62C - CONSULT FACTORY R SPECIAL APPLICATIONS Timed dosing panels available. with alternators, for duplex systems, are available and supplied Electrical ' an alarm. variable level control switches are avaitab e for controlVing single phase systems. T • Double piggyback variable level float switches are available for variable level long and short cycle controls. - • Sealed Qwik-Box available for Oullc0onrreglaredons. See FM1420. quotation • Over 130"F. (54°C.) spec I -T- 152J153 Series -T Cont%__! selection - - 1511153 MODELS sgn,lex;_ Duplex--- svoea lL Model Volts•Ph Mode r 2 r3 --T 1 1 Non "1- 8.5 ----i. C y152_+ ~15 85 _nctuted `2113 --1 i BN1521 115 1 Auto 2 or 3 E152 ' 230 1 Non 4.3 t ~-3- I Lo, SELECTION GUIDE Auto _ 43 "cu"ed l aE152 230 10 5 1 _ 2 or 3 1. Single piggyback variably level floa? switch or double piggyback variable level loo, N153 115 1. Non I 2or3 - Auto I 50-5 nclu.ed ~BN)53 115 _ 3 1 2 3 E153- 230 t Non 11 5 ncluded 2 0L3 Switch. Refer to F^.1071. Auto 5.3 _ ~BE1531 230 2 gee cf,tv712 for correct model of Electrical ,4ltemator E-Pa. P CAUTION] a ualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex and t°. should be done by 4 the most or i4) `{pat system. All installation of conVOls, protection devices codes should t be followed including licensed electrician. All electrical and safety recent National Electric code (NEC) and the Occupational Safety and Health Act (OSHA) RESERVE POWERED DESIGN unusual ccnditions a reserve safety factor is engineered into the design of every Zoeller puma. For MAIL 70: P.O. Box 15347 lily^ufactu(ers of . . Louisville KY 40256034? t p p i SH1P70:364SCare ?.unRoad ~~TrPuMP~ SINCE /J3~/ LOujSvlle, Kv 40211 1961 Q 1502) 778-2731.1 l600) 923-PUMP Z L'w I ~AX (50) 774-3624 ,nU/VIP hp:7/www,zoefler.com J Copyright 2006 Zoeller Co r411 rights reserve POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page '7 of !FILE INFORMATION SYSTEM SPECIFICATIONS } Owner ifs L r r`~r \ Septic Tank Capacity l72)-7) al ❑ NA Permit T Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA j Number of Bedrooms El NA Effluent Filter Model El NA Number of Public Facility Units A NA Pump Tank Capacity / - al ❑ NA Estimated flow (average) al/day Pump Tank Manufacturer ❑ NA U Design flaw (peak), (Estimated x 1.5) al/da Pump Manufacturer 13 NA Soil Application Rate ai/da /ftz Pump Model,. ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) :220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L t-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximurn Effluent Particle Size in dia, 0 NA Other: b NA Other: NA Other: ❑)NA 'Values typical for domestic wastewater and septic tank effluent. Other NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: r~ month(s) (Maximum 3 years) ❑ NA ear s (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA ,inspect dispersal cell(s) At least once every: mon(k)s) (Maximum 3 years) ❑ NA t_~' ear s Clean effluent filter At least once every: f C;Vmonth(s) ❑ NA ZI-year(s) ❑ Inspect pump, pump controls & alarm At least once every: onth(ear(s)s) El NA Flush laterals and pressure test At least once every: <r ❑ month(s) ❑ NA }tear(s) I6ther. At least once every: ❑ month(s) ❑ NA 6ther: ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS 'Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master !Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(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. 'T'he ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 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 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, iand any servicing at intervals of 512 months, shalt be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of lz START UP AND OPERATION for the presence of painting products or other chemicals the{t For,new construction, prior to use of the POWTS check treatment tank{s} if high concentrations are detected have the contents of the. age the may impede the treatment Process cess servicing dam prior to dispersal cell(s). tank(s) removed by a septag operator System start up shall not occur when soil conditions are frozen at the infiltrative surface. tanks may fill above normal highwater levels. When power is restored the excess wastewater will be power outages pump result in the backup or surface discharge of effluent. During discharged the dispersal cell{s} in one large dose, overloading the cells an may the pump controls to restore normal /eve s e avoid this is situation have aePlthe contents of the pump tank remove a Setage umber or POWTS Maintainer to assistiny manuapy opera Servicing Operator prior to restoring power to t le effluent pump or contact within the pump tank. not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area wt ;n Do 15 feet down slope of any mound or at-grade soil absorption area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life ohe P ad ci;s; diapers; disinfectants; fat; foundation drain herbicides; dental flmeatoss; scraps; medications; oil; painting p neb grease; degreasers; antibiotics; baby wipes; cigarette butts; condoms; cotton swas; (sump pump) water; fruit and vegetable peelings; g g pesticides; sanitary napkins; tampons; and water softener brine. 33 i servce the folln Adminieps hall be aken to insure that the system is prope` y ABANDONMENT owing st When the POWTS fails and/or is permanently taken out of and safely abandoned in compliance with chapter Comm ative 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, 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 complion soil replacement replacement system: on of a absorp ❑ A suitable replacement area has been evaluated and may be from disturbance and compaction anid should not be infringed upontby equ led The replacement area should be protected nEled setbacks from existing and proposed a lot lines a ea.t Replacement syst ms must comply with theh ule,i in for a new soil and site evaluation to establish effect at that time. rt du replace tbthe ackaad/POs~Smitations. Barring advances in POWTS techno og;r a la available ❑ A suitable replacement area is not holding tank may be installed as a Upon sit soil and WTS the evaluall _site has not been evaluated table refilacemienblarea. ialf no replacement a ea isu vail ble aOho d ng tank may beeinstal ed!as ,must be performed to locate POWTSp f ❑ Mlast resort to replace t failed must comply with the rules in effect atlthat time moval of the biomat at the infiltratve oUnd and at-grade soil absorption surface. Reconstructions of such RESCUE O OA <<WARNI NG>> INSUFFICIENT SEPTIC, PUMP AND OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.. MAY RESULTYGEN. ENTER A SEPTIC, PUMP OR OTHER TREATMENT PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. - ADDITIONAL COMMENTS POW TS MAINTAINER POWTS INSTALLER r ENa Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name L Name e J'4.- Phone )J 3 Phone. This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. Q, 1414 • INSTRUCTIONS CARTRIDGE FILTER r installation e to ensure its ter., ' the end of ne uut1et p p' ipe into the x'. 4 STEW g prv fit the filter case onto p ti centered under the access opening TF not, then e her insert more lank through the outlet or solvent weld (glue; addit onal p pe onto the outlet r P pe. Il dfitted cn the outlet pipe rneasu e the length 2 While th e case is str STEP til zedh2 of 3.,-inch pipe needed tb brace the filter ro the t~rnkne end od `slnotru' optional supplemental side Support. if sde sup" ;;roceed to step four. XA, Tonal supplemental side support. -EP ^ For i~st~allations utilizing the opt ?f side support method is no' solvent weld the , - nch pipe onto the fil er case. ❑tilr_ed, proceed to step four. STEP 4 Solvent weld the filte `a eonun t e o l tepil e. Ins c thheaottom of ti cartridge into the case, pressing the case. STEP 5 If a VRS switch is utiliized. insert Into the filter and lock by turning * - clockw,se 90°. Maintenance the septic tank is + he effluent filter should be cleaned every t ser iced. Oper. the outlet access opening to inspect the tank and filter, Pump the septic tank completely, snaking sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. nvert a. Once the effluent level luP has peen the filterrhardleo std clod e thet e outlet pipe, firmly p cartridge fro- the case. from S. Slide the cartridge up and out of the case for clean'~ng, ro. if a VRS switch connected to a alarm is present, the and leaned should be removed by turning F with water only. 7, While holding the cartridge on its side ;large flat surface facing ~ used ba~kenwottheatank, - down; over the access opening rinse off only, making sure all septag r g. Tf `VRS switch is utilized, replace by inserting into filter and seam turning clockwise 90°. ing down until W " 9, irse t the filter cartridge back into the case, press -the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. ::.P.F 0+J,5rTE° F-,.TEF rARTr.ID e F 'v'E YEAn ESEPR OrvS:TE" Filter Ca -e -Life` ie is117t C w 3 - - is - 87 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERS.ETIP CERTIFICATION FORM F Owner/Buyer Mailing Address __-~-I ~ -5' ~ " ~ ?~~-C~." "C. ~ -Z-- Property Addres',~ I (Verification required from Planning & Zoning Department for tie onstniction.) City/State.. - - Parcel Identification Number LEGAL DESCRIPTION ► 17S c Property Location ,,51 % , Sec. ZZ- 7'l~ _-_-N It 1 TW, Town of----- Subdivision -25 Certified Survey Map # V _ , olume • Page Warranty Deed # ~ S / ✓ . Page # Spec house yes no Lot lines identirabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your maintenance consists ot,p f'pumpvn septic system could result in its premature failure to handle wastes. Proper out the s tic ever r, if needed by a What you put into ed pumper. the system can affect the function of the septic tank as a treatment stage in theewa to dis osal s stem. sOwner maintenance responsibilities are specified in §Comtrr. 83.52(1) and in Chapter 12 - St. Croix county sanitary y mamtenance Y tart' Ordinance. The property owner agrees to submit to St. Croix County Planning & Loring 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 necessa less than 18 full. of sludge. rY), the septic tank is I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal systern with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the tlnee year expiration date. 1/we certify that all statements on this f n are true to the best of my/our knowledge. I/we arn/are the owner(s) of the property described above, by virtue of a wary deed recorded in Register of Deeds Office. Dumber of bedrooms TGN T OF APPLICANT(S) - - DATF - ATE ***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. 08/05) ' 1 Q 1 D ;f1 } 1 F- vi cr Q6 iU1 Q N ~ sa sQ ~ ~ 1Z - f_~-• r ~ n, 70 ~'rt"'•' 319.42 l I ~ i ~ n Q J = .a~ 1 fP tr r w Q lr U~i..1i7 • vi 40 a vi *j4p loo a \ ' ~ 40 I cv Ul) 0; lt. V 1 V' ~-50 1 r- 7 11111 I i 1111 II I I I t! l I l l l l l l 1 DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-2003 WARRANTY DEED $ 2 9 7 4 1 2 Tx:4244568 1010933 THIS DEED, made between Corey Benedict and Amy Benedict husband and BETH PABST wife("Grantor" whether one or more) conveys and warrants to Oevering Homes REGISTER OF DEEDS LLC, a Wisconsin limited liability company ("Grantee", whether one or more), ST. CROIX CO., WI the following described real estate in ST CROIX County, State of Wisconsin: 04/22/2015 1229 PM Lot, Q53, lat of Walnut Hill Farm in the Town of Troy, St. Croix County, EXEMPT#: NA Win. REC FEE: 30.00 TRANS FEE: 108.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parce 040-1303-00-053 This i is no omestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2015 real estate taxes. Dated this 17th day of April, 2015. ict Amy en diet U AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 20_ ss. COUNTY OF WASHINGTON * TITLE: MEMBER STATE BAR OF WISCONSIN Personally carne before me this 17th day of April, 2015, the above (If not, named Corey Benedict and Amy Benedict, husband and wife to authorized by § 706.06, Wis. Stats.) me known to be the person(s) who executed the foregoing instrument and acknowled a the same. 47d1jalk THIS INSTRUMENT WAS DRAIFTED BY Robert L. Loberg / Loberg Law Office Notary Public County, MN. 1523484 / aim (,tp My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) =ANDREA ENTER sota WARRANTY DEED 31.2017 Form No. 1-2003 St. Croix County 1010933 Page 1 of 1 MM a „a ,W t, u A.- I '7 ~ N ~ • 171Q17 71 slo g s+a rr a~ N a ' d w xv- r a Y .--....r... «I c dr-Al O J Z 1 Property Owner _ Parcel ID # Page of Boring # ❑ Boring © Pit Ground surface elev. ~LLb,y ft. Depth to limiting factor J c/ 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 0-17- O v 31-L ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/t_ ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (RAM) E IVE IF 04ZZ,~It:. Wiscons►hDepartment of Commerce ~ ri SOIL EVALUATION REPORT Page l of ~ Division of Safety and Buildings ST. C'-:Olv Coul''JTY ,0M#ljo C14 KTfi(J Wis. Adm. Code County ` c Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must cJ 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. Review b - Dat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).~ / Property Owner Property Location "'Del A Govt. Loj,-'- 1/4_5,E 1 /4 S Z Z T Z 8 N R E( W Pro tty~ Mailing Address / , n r Lot~# Block # Subd. Name or CSM# 1! 1 cC4J l7 City State Zip Code Phone Number ❑ City ❑ Village Town . Nearest Road New Construction User) Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material u-'- Flood Plain elevation if applicable / ft. General comments and recorrunendations: System Type System Elevation ® Boring # Boring Pit Ground surface elev. l .[__I I ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 0-> Z 6 Yzr C4 J- - Z. 12 -.361 Ole Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 A-IJOL Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation C ducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 7 715-246-4516 10, Parcel ID # Page of property owner ❑ ©Boring # Boring Ground surface elev. / 'L2 ft. Depth to limiting factor in Pit Soil nation Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPDM •Eff#1 •Eff#2 in. Mussed Qu. Sz. Cont. Colo Gr. Sz. Sh. ^~L a 3r~.------ ~ ~ r ❑ firing # E] Boring " ❑ Pit Ground surface elev. ft. Depth to I+mflin9 factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOIN Gr. Sz. Sh. 'E1f#1 'Etf#2 in. Mansell Qu. Sz. Cont. Color ❑ ❑ Boring # Boring Ground surface elev. ft. Depth to timiting factor in. ❑ Pit Sod Application Rate Hoizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF Gr. Sz. Sh. •Eff#i •Eff#2 in. MunseN l]u. Sz. Cortt. Colo Effluent #1 = BOD` > 30< 220 rrgll. and TSS >30:< 150 rnglL ' Effluent #2 = BODE < 30 rng& and TSS 30 mgtL • _ 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. seD.euo(x"b+ O) t i • Soil Test Plot Pla' Project Name Dennis Friese Sh Bird Address N7778 690th St. River Falls Wi 54022 M # 6900 Lot 53 Subdivision Walnut Hill Farm D 9/3/14 SE 1/4 SE 1/4S 22 T 28 N/1319 W Township Troy Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation TBD *HRPSame as Benchmark 45' B.M.* 345' Property Line 5' B-1 Scale is 1" = 40' unless otherwise noted 50' 4% Slope 30' B-3 45' 10' B-2 99 100' Tradition Trail 09/10/20 AM PAGE E 1 1 OF 1 Parcel 040-1303-00-053 P Alt. Parcel M 22.28.19.1788 040 - TOWN OF TROY WISCONSIN ST. CROIX COUNTY, Current jX_ Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BENEDICT, COREY & AMY COREY & AMY BENEDICT 216 PLAINVIEW DR RIVER FALLS WI 54022 Property Address(es): " =Primary * 657 TRADITION TRL Districts: SC = School SP = Special Type Dist # Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: 1.060 SEC 22 T28N R1 9W PT NW SE WALNUT HILL FARM LOT 53 (1.060AC) Parcel History: Date Doc # Vol/Page Type 01/04/2007 841865 WD 08/24/2005 804300 2873/359 WD 12/10/2003 748766 2471/591 WD 11/19/2003 747018 9/92 PLAT Plat: * = Primary Tract: (S-T-R 401/4160% GQ Block/Condo Bldg: * 09-092-WALNUT HILL FARM 1/75 040-03 22-28N-19W NW SE LOT 053 2014 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/20/2013 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.060 52,500 0 52,500 NO Totals for 2014: General Property 1.060 52,500 0 52,500 Woodland 0.000 0 0 Totals for 2013: General Property 1.060 52,500 0 52,500 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 f T - TDO~? P3 ?E ~ S TFDT- Prwertytlwner Pamet ID # Z-6 7" s 3 To N Z 3 , sss I Gro and surface elev. Depth to wn€6ngtwo 33 k~ Hot= Depth Sod Rate Darartant Redox Description Texture Structure Consistence Sotmdary Roots GPt)Af Ira. Munsell Qu. Sz. Cont. Corr Gr. Si. SEa. `Eti#1 'Etl#2 l 0•~3 io yR3/ zfshk X54 w 3 . s JY-2-7 b y Y/ Z- 2fS h G w S , JN J,61 S/4- I 3 •S -7-5 y 62S )LIO -S WZ-O v-5 q S . 3 . S / o Y t!2-- F-] 8orang # Cj going Pit Ground surface elev. tE. 1[)LA to titruitirag factor. In. Sod ic~ion Rate f Naizon tlorMirtartt Redox Description Texture Structure Consistence Boundary Roots GPI?l Muraseff Qu. Sz. Corti. Color Gr. Sz Sta. •~1 'E{ EE, Boraaag ~ fl Pit Ground sur#ace elev. if. Depth to limiting fac w soy - Rate ► Dept Dountnaat Cakw Redox 0escripbora_ Texture Structure Consistence Boelndary Roots in. Musase8 Qu. Sz. Corot. Color Gs. Sz Sh. 'l it1 T02 i F-1 t3odng # 8onng P's! Grounds ce elev. ft- Depth o &9 tack in. Sod Appkatkn Rate Hortwn Depth DoM ftMW Redox Desniptim. Texwm Structure consistence souwary Roots GPON in. Munsell Qu. Sz' Cont. Cokx Gr. S7- Sh. °EM1 `Eff#2 ° EOiueM #1 = 3 > 30 220 mg& and TSS >30 < 15o mgtt. ° Efterd #2 = BCC[ < 30 ttgA. and TSS < 30 mWL 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 508-266-3151 or TTY 608-264-8777. 88Dl330 ~RbTq} 1 Wisconsin Departrnent of Commerce SOIL EVALUATION REPORT page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 57-- Gle o/IL- complete incr. but o I EROSION CONTROL PLAN must be parcel I.D. 1-07- percent slope, S4 completed before sanitary permit issuance Pe vDiN ft- Reviewed b Da Persomai kdonnation You Provide meY be used for secondary purposes (Privacy law. s.15.04 (1) (m)). ~17 ~3Ety T-E'fl T_ C/O 14ll r/M Property wt at ~t t ©yq S lG IM S ~Zl T 2-14 N R / / E (or) W Property owners MakV Address Lot # Block # Subd. Name or CSM# , t & 015 CA W I- L AQ- e- . 53 U/ALA>v *r wi l iFA RAf City --C V vg 2 State Tip Code Phone Number ❑ Vliage (@ Town Nearest Road 6-PPOE- HT3 MN SSoWe ( &5t) Z98• toff -Roy s0. [f1ouER New Corstrtxtion Use: Residential l Number of bedrooms Code derived design flow rate ~ ~ Da GPO ❑ Replaosment ❑ Public or commercial - Describe: tA Parent material Io_ E S 5 ? ~STe uLt _ .0010 c ; k- Flood Plain elevation if applicable fL General oonvnents reoommendatiors: . E,4. T T 501-7-l" /,Q 'f-' /`1ovvp V1 S SISTZ~-i Cvi~ /a " S/f~vv 7~i N S 5.s.s N a # ® pit Ground surface elev. l ft. Depth to krating factor Z in. Sol Apiftation Rate Morimn Depth Oominar►t Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= b in. Munsell Qu. Sz. Court. Color Gr. Sz Sh. 'Eff#1 'Ef92 l 0-/& to S/ 3 L shl~ ds 4 -5 w 3 -F' .-5 N 2 G•3 24 /0Y z s cw / S ~A 3 •S IG y c Z a 5t e- I fShkl vGi cS - • Z ~ .s Yee s/y •7 /0!/ S/ M 3 Mo~S 57 6 S ti!R y/ ~11 io 77 z772- Bo" Z. # Bming Ground surface elev. G f• t S ft. Depth to uniting factor 2 5 S in. Soil icatian Rate t,. Horizon Depth Domirmt Color Redgx Description Texture Structure Consistence Boundary Roofs GP`Dff In. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 / V• 12- / 0 yR 3 L z~sbK S Gv 3 1°- • s N 2 /a • Z5 o Vk VI - S/L 2fs K Cs . -s N z5-.A'/,o Vle fif I-f c> -r s !L / ~Sh v c - ' Z- • 3 f -T 3 y y L-i;y es fa v f~ `otic~ i! 7• o o 4 t> S . Effluent #1 = BOD > 30 1220 mqL and TSS >30 < 150 ffg& ' Effluent #2 = BOO 130 mgA. and TSS 130 mgfL CST Name (Please Print} , .u LB R t G 1►T- Signature 22 S per Adams Ulbricht & Assgciates cafe Evaluation Conducted 3 715. 7e7a 3umy Z- Private 2812 10th Ave. Spring Valley, WI 54767 mss. Q t FOR 4PORO X- 2 y°__.._.. 4 oya•/'09S• o yo , fO k6 . /o • oz~ dy0 • /0gG • z.D • oaa oyo•/o~G• Co4•~ oyo•/o*6-7L•a~ 0'Y0 - /09'(9 ~'p • Ofio PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 ,[1 = Contour elevation lines. = Backhoe Soil pits. p = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : ill _ F9 s~ y y~ 5TH Zlvi`1~~M /`'lo v,ul~ 64A.) v)e sass~~7 ~ IA100 .)o SYS7", 4~5 ~tv . w' - 1a" sAA)0 goo, ~s' T 53 Ld i 90,9o~ a I. 133 ~ T L AV io' sy III o~ S 2- Q Zo r Gad ~ 1' 0~ 5 y Sa 4T ~ a 5 ~R Otto?, S Gov tor