HomeMy WebLinkAbout026-1168-33-000 County:
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and'Building Division
INSPECTION REPORT Sanitary Permit No:
506111 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:
Davidson, Ron I Richmond, Town of 026 - 1168 -33 -000
CST BM Elev: Insp, BM Elev: BM Description: Section/Town /Range /Map No:
0 C,),- p Q , p I & yy! - T - 22.30.18.1339
TANK INFORMATION tLEVATi6N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 2 Benchmark
Dosing �r 7 Alt. BM
Aeration J Bldg. Sewer
cf •/ /� Z. !v
Holding 11-It Inlet •72 A6Z. 6 6
t/
TANK SETBACK INFORMATION Outlet 11 161. 93
TANK TO P/L W BLDG. Vent to Air Intake ROAD n 6t _ , Q&
WLQ- LA, Dt Bottom
Dosing �� / 1 S Header /Ma s O
Aeration — --'w- D ist. Pi pe dh d D/ ,
Y�/�+'� d
Holding Bot. System SQL 0/ - 0
F inal Gr ade
PUMP /SIPHON INFORMATION
Manufacturer ` Hand St Cover
GP `_• 6 f
co-yt r ►� s O -7 10 (o.
Model Number Z Y y� ,�• � t
TDH Lif�� Fri ti • Lq�s System He�tl— T� • !' Ft 1 ( O
Forcemaiiinn� th ( Dia. 2 tf Dist. to Well 7
SOIL ABS ORPTI N SYSTEM
BED /TRENCH Width _ / Le i th �� No. Of Trenches PIT DIMENSIONS No. Of Pits In ' ia. Liquid Depth
DIMENSIONS '{]�/
SETBACK SYSTEM TO P /L� BLDG WELL LAKE /ST M HING Manufacturer:
INFORMATION AMBER OR
Typ Of System: /+ ' _ ' UNIT Model Number:
xQ
DISTRIBUTIONS STEM
Header /Manifold Distribution J�� /� x Hole Size x Hole Spacing I Vent to Air Intake
I? p Pipes) b /' 6 A
L engt Dia Length L 3 Z j Dia � Spacing /� b / f'
SOIL COVER x Pressure Systems Only xx Mound O At - Grade S tems Only
Depth Over Depth Over xx Depth of /_ xx Seeded /Sodded xx Mulched C6 32 Bed/Trench Center Bed /Trench Ed es T-p0 soil L
9 / 2 Yes No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:�/ Z /D 7 7 Inspection #2: / /
Location: 1253 146th Ave New Richm nd, WI 54017 (NW 1!4 NE 1/4 22 T30N R18V)() Pond V�ie Meadows Inot 33 Parcel No: 22.30.18.1 39 OK
1.) Alt BM Description = P af4� SS � /°�
2.) Bldg sewer length= 2V' SAM q0
- amount of cover 3/
Plan revision Required? Yes 'rte '�
Use other side for additional information. /U /� �I nsepctor"s; Date S gnature Cert. No.
SBD -6710 (R.3/97)
• Safety and Buildings Di
201 W. Washington Ave., ox 7162 �
, WI 5\767 62 Sanitary Permit Number 1 (to be filled in by Co.)
,s n��n
Department of Commerce 5( (O / / l
Sanitary Permit Application State Plan I.D. Comm Number
In accord with 83.21, Wis. Adm. Code, personal information you X /
may be used for secondary purposes Privacy Law, A 5.04(lxm) Proje (if different than mailing address)
I. Application Information - Please Print All Information y
Property Owner's NOr # Lot # of
REGEIVED—
IX �
Property Owners Mailing AddL= 2 7 H07 P Dperty Location C 33
r
An ��s ��. Section >-2-
city, State Zip Code Pho her
(circle Wo
..fir T 1'A' S'TDIZ r /— ? — d0 T 3� N; R '�E
H. Type of Building (c eck all that apply) l o f[ aA llt� 5 ,j(o my N-e
1 or 2 Family Dwelling - Number of Bedrooms � I - A"� Subdivision Name CSM Number
V'
❑ Public/Commercial - Describe Use _ f L / �i/ A /
❑ State Owned- Describe Use 7. k /. A4 - 62,(e..L_Q ❑City ❑Village Wownship of
III. Ty ,�pee of Permit: (Check only one box online A. Complete lice B if applicable) Q z / 00
A. R New Syste ❑ Replacement System ❑ Treanne Molding Taok Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS gygteME C heck a0 tha a
❑ Non - Pressurized ht Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 9At -(bade ❑ Single Pass Sand Fitter ❑
Constructed Wedand ❑ Pressurized la-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Tre urneut Unit Recirculating Sand Filter ❑
Recirculating Syntltetic Media Filter ❑ Leach Chamber ❑ Drip Line ❑ Grav&tess Pipe ❑ Other (explain)
V. Dispersaltrreatment Area Information:
Design Flow (gpd) Design Soil Anti n Rate(gpdst) Dispersal Area Requi sf) Dispersal Area Proposed System Elevation
vv /der .
VI. Tank Info tZGallons city in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons of Units Concrete Constructed Glass
Now I Existing
Taub Septic or Holding Tank Aerobes Treamsent Unit
Doarag Clamber 510 /sr
VII. Responsibility Statement- 1, the undersigned, as came resspoasi ty for bastalhtion of the POWTS shown on the athcked pbas
Plumber's Name (Print) Pl Sigoahue IrIP/MPRS Number Business Phono Number
Plumber's Address (Street, City, StatA Zip
,zPzfF z�',ic - o Z AS !— $ TO—
VIII. CountyMma Use On
proved ❑ E rove Sanitary Permit Fee (includes Groundwater Date Issued Issuing t Signa Surcharge Fee) / 6o ❑ en Reason for ial
IX. Conditions of ApprovaMeasons for Disapproval 31 Gp ��;�• a,� S ^ 5 Qom- ('c Q
SYSTEM OWNER: J w I s 2 (' n• o � �-
1. Septic tank, effluent filter and lc,.Q.� , A
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. All setback requirements must be maUttained
as per applicable code / ordirwlas.
e M dw fir tae s ppn ant Im daa $1r1:11 rein 'a ais
Adaei a�lete Plains ( Caa4 cab) efa� a
SBD -6398 (R. 01/03)
Page 8 of 9
Public Road
A BM
2.02 Acres Site Plan
0 25 50 For: Ron Davidson
0 -phk SmaU (F-t) Lot 33 Pond View Meadows III Sub.
htch - 50 ft- NW1 /4 -NE1 /4 Sec. 22 T30N -R18W
Town of Richmond - St. Croix County
A BM = Top of NRCS Sign Post
HRP =Same
Building Setback Line
ASSUMED ELEV. = 100
#2
CIA BM = Top of Telephone Ped Elev. = 116.50'
Elevation Data I B #1 Proposed 4 Bedroom Home
B #1 = 107.90' c'
B #2 = 104.50' 600 GPD t
B #3 = 99.00'
g. er
Proposed w' er ' &rete 1250 Gal.
Septic Tank / r Q -100 Filter
Note: Maintain well and waterline k f
setbacks per Comm 83.43(8)(1) r'
B #2
Propos p
Piping. 1
103.00 7
101.00 Proposed i�ieser Concrete
t 750 gal. Dose Tank
i
99.00' � �P wed 2" Sick 40 F. M.
10%
B #
Proposed 7.5'x 14'At -Grade
System Elev. = 101.
#1 �-
3%
#1
x - BM
x
Page 8 of 9
Public Road
ABM
2.02 Acres Site Plan
0 25 50 For: Ron Davidson
Lot 33 Pond View Meadows III Sub.
Gm� 5 ft. NW1 /4 -NE1 /4 Sec. 22 T30N -R18W
Town of Richmond - St. Croix County
AL BM = Top of NRCS Sign Post
E RP =Same
Building Setback Line
ASSUMED ELEV. = 100
#2
BM = Top of Telephone Ped Elev. = 11650'
Elevation Data Proposed 4 Bedroom Home
B #1= 107.90' 1 B #1
B #2 = 104.50' 600 GPD
B #3 = 99.00'
4 "Bldg. Sewer
Proposed Wieser Concrete 1250 Gal.
Note: Maintain well and waterline Septic Tank w /Zabel A -100 Filter
setbacks per Comm 83.43(8)(1)
IB #z
Proposed 4" Conveyance
l�
103.00' Pip
_
101.00, Proposed Wieser Concrete
750 gal. Dose Tank
00' 10'� ,Pro posed 2" Sch 40 F. M. _
- B # —
��
97.E Proposed 7.5'x 134'At Grade Mound
System Elev. = 101.00' —
#1
3%
#1
x A BM x
Safety and Buildings
commerce.wi. OV 10541 N RANCH ROAD
g HAYWARD WI 54843
TDD #: (608) 264 -8777
1 s co n s' n www.commerce.wi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
December 05, 2006
CUST ID No. 221180 ATTIC• POWTS Inspector
DAVID B FOGERTY ZONING OFFICE
FOGERTY PLUMBING & PERK TESTING INC ST CROIX COUNTY SPIA
2473 ROLLING GREEN RD 1101 CARMICHAEL RD
SPOONER WI 54801 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 12/05/2008 Identification Numbers
Transaction ED No. 1346831 .
SITE: Site ID No. 719524
Ron Davidson Please refer to both identification numbers,
CTH G above, in all correspondence with the agency,
Town of Richmond
St Croix County
S22, T30N, R18W
Lot: 33, Subdivision: Pond View Meadows III Sub v.0
�R`!
FOR: Description: At grade system, 4 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1102820 (,O
Revision; Maintenance required; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade;
System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99)
WOO
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes OF Sl
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 the component manual(s) C
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance c�EE G
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This approval is for a revision to previously approved Transaction number 429646. The approved
changes are: the location of the at grade system has changed to a lower contour within the previously
tested area; the pump tank location has changed and the length of the force main is longer; there are
associated changes in the pump on /off settings to accommodate the slightly higher back flow from the
force main. (see plans).
• These approved plans will supersede the previously approved plans.
Key Item(s)
• 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. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater
particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to
the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening
used to service the filter shall terminate at or above finished grade with a watertight cover.
DAVID B FOGERTY Page 2 12/5/2006
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings 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 to the owner and any others who are responsible for the
installation, operation or ena ce of the POWTS.
Sincerely, Fee Required $ 75.00
Fee Received $ 75.00
Balance Due $ 0.00
atricia L Shandorf
POWTS Plan Reviewer ,Integrated Services
WiSMART code: 7633
(715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm
pat.shandorf @wisconsin.gov
Wastewater Specialist, 715
cc: Leroy Jansky, POWTS Was p , ( ) 726 -2544
Y
RESIDENTIAL AT -GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Ron Davidson Revised At -Grade System 12 -1 -06
Owner Same
Address 10420 Penfield Ave. North
Stillwater MN 55082
1- 715- 246 -0400
Legal Description Prt of the NW1 /4 -NE1 /4 Sec. 22 T30N -R18W
Township Richmond County St. Croix ®
Subdivision Name Pond View Meadows III Lot No. 33 RC ILNGS
v
Parcel ID Number
Plan Transaction Number Z E 1?0
EN
Index sheet Page 1
Calculations Page 2
At -grade drawings Page 3 I
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump specifications Page 7
Plot Plan Page 8
Site Evaluation (Re- stablish BM) Page 9
Designer Dave Fogerty License Number Mprs#221180
Signature r Phone Number (715) 635 -9609
Date 12/04/06
Designed pursuant to:
At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 3.11 (05/01) Page 1 of 9
i
PRESSURIZED AT -GRADE DESIGN
At -grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
400.0 Estimated wastewater flow (gpd)
600.0 Design wastewater flow (gpd)
10.00 % Site slope
101.00 Contour elev. below lateral (ft)
>80 Depth to limiting factor (in)
0.60 1 In -situ soil application rate (gpd /ft ^2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
4.50 Linear loading rate gpd /ft
7.50 Effective absorption width (ft)
7.50 Max. effective width permitted (ft)
134.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.125 Orifice diameter (in) e.g. 0.188
Not a final 2.00 Estimated orifice spacing (ft)
calculation
2.00 Forcemain diameter (in)
2.86 Forcemain flow velocity (ft/sec)
'30 20.00 Forcemain length (ft) y or n y Does forcemain drain back?
95.00 Pump tank elevation (ft) y or n Are laterals at highest point?
NA
6.5 System head (ft) x 1.3 3.3 Forcemain drainback (gal)
5.50 Vertical lift (ft) 60.5 5x Lateral void volume (gal)
0.34 Friction loss (ft) 6 .8 Jinimum dose volume (gal)
12.34 Total dynamic head (ft) 28.0 stem demand (gpm)
Lateral Diameter Selection ( tallons/Inch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in x Gal /in (enter result in cell G46)
one lateral 1.5 in X X
diameter 2 in x Treatment Tank Information
3 in x 1250 Septic tank capacity (gal)
Wieser Concrete Manufacturer
Effluent Filter Information Dose Tank Information
bel Filter manufacturer 750.4 Dose tank capacity (gal)
% Al Filter model number 20.3 Dose tank volume (gal /in)
� ` \Q Wieser Concrete Manufacturer
0
Project: Ron Davidson Revised At -Grade System 12 -1 -06
Transaction Number: Page
AT -GRADE PLAN VIEW
1/6 B Observation pipes (2 typical) A 7.50 ft
D B 134.00 ft
1/6 B 22.33 ft
.................
C 9.50 ft
W D 5.00 ft
E 2.00 ft
L 144.00 ft
D B .
W 19.50 ft
A x B 1000.00 ft ^2
L
�— Cap
Typical pipe.
in th
LL.... =Total aggregate cell A x B Slotted in the lower
= Plowed area L x W s e and anchored
l securely.
6"
AT -GRADE CROSS SECTION
Svnthetic fabric cover
102.79 ft Finished grade
Lateral elevation
invert elev. 101.50 ft
f-- Observation pipe
at aggregate toe
E
10 % Slope
Surface contour
101.00 ft C A
and system D _1
elevation T
® = 12 in. topsoil and subsoil Plowed layer
over aggregate and tapered to toes. below L x W
0 = 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Ron Davidson Revised At -Grade System 12 -1 -06
Transaction Number: Page 3 of 9
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
� P {
1f x - >I+H1 I 02 +I Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30 -5)
Hales drilled on the bottom of the lateral,
equally spaced 0 = Turn-up idball valve oroleanoutplug
Lateral Specifications
0.125 Orifice diameter (in) Center Lateral connection point
X 1.97 Orifice spacing (ft) 2 Number laterals
34 Orifices /lateral P 66.00 Lateral length (ft)
14.0 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
28.01 Sys. discharge rate (gpm) 20.00 Forcemain Length (ft) '?b
12.34 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather -proof warning label and locking device
junction box - -♦
Final grade 4 "
disconnect
ank component is Alternate
properly vented I toutlet
ocation 18" min.
Electrical as per NEC 300 and Approved outlet
Comm 16.28 WAG joint
Tank full
Inches Gallons A Provide 1/4"
A 19.8 402.4 Alarm on weep hole or
= B 2.0 40.6 antisiphon
C 3.1 63.8 Pump on B device. AV
o D 12.0 243.6 96.00 ft C
Totalsi 36.91 750.4 -�
Pump off
D
3" Bedding under tank ~ 95.00 ft
Goulds Pump manufacturer S.J. Electro Alarm manufacturer
Model# 387 -EPO4 Pump model number 10 -01H Alarm model number
Project: Ron Davidson Revised At -Grade System 12 -1 -06
Transaction Number: Page 4 of 9
At -grade System Maintenance and Operation Specifications
Service Provider's Name Tri -County Sanitation Phone (715) 386 -0114
POWTS Regulator's Name St. Croix Co. Zoning Office Phone (715) 386 -4680
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 1250 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 1000.0 ft Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL
Service Frequency
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Moundl Ins ect for ponding and seepage once every 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99).
Lateral Turn -up Detail
Finished .�����........ M Grade
6 -8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral g Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: Ron Davidson Revised At -Grade System 12 -1 -06
Transaction Number: Page 5 of 9
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD- 10570 -P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
S@Dtic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent fiker is installed within the tank it shall be inspected and serviced as necessary.
At -grade and Pressure Distribution System
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at -grade system may not exceed 220 mg /L BOD5, 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or
30 mg /L BOD5, 30 mg /L TSS, 10 mg/L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed 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 recommended that each lateral be
flushed of accumulated solids at least once every 18 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 reported to the owner, and any
levels above 4 inches considered as an impending 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 proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other 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.
Project: Ron Davidson Revised At -Grade Transaction Number: Page 6 of 9
Page 7 of 9
MGOULDS PUMPS Submersible
Effluent Pump
3871 EPO4
EPO5
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses:
• Effluent systems heat transfer. ■ Casing and Base: Rugged
• Homes Available for automatic and thermoplastic design provides AGENCY LISTING
• farms manual oration. Auto superior strength and corrosion
resistance.
• Heavy duty sump matic models include "
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic Gouts Rn ps is ISO soot
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
/4" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1 NPT. seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
BUNA -N elastomers.
• Temperature:
104'F (40°C) continuous
140"F (60'C) Intermittent. METERS FEET
• Fasteners: 300 series 10
stainless steel. 9 30 5GPM
• Capable of running
dry without damage to $ 2.5 rr
components. 25
0 7
a
Motor: _
• EPO4 Single phase: 0.4 HP, `—' 6 20
115 or 230 V, 60 Hz, 1550 5
RPM, built in overload with o 15
automatic reset. 15
• EP05 Single phase: 0.5 HP, o �ti EPOS
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with
automatic reset. z
• Power cord: 10 foot s
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 °
0 0 10 20 IV ao so FPM
foot length, 1613 SJTW with
N
thr prong grounding plug P 9 9 9 P 9 m
(standard on EP05). o z 4 6 a 10 12 m3
CAPACITY
Goulds Pumps
® 2001 Goulds Pumps ITT Indust
Effective May, 2001
83871
Page 9 of 9
FOGERTY PLUMBING & PERK TESTING
2473 Rolling Green Rd.
Spooner, W1 54801 �o' �` z3 Site Evaluation to Re- establish BM
(715) 468 -7000 csr z +� and Contour Elevations.
Cell (715) 416 -0000 I�• j? f '��'
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RECEIVED
Wisconsin Department of Com erce SOI EVALUATION REPORT Page 1 3
ac""anWQ�
Division of Safety and Buildings
NO n� h Co 85, Wis. Adm. Code
County St. Croix
Attach complete site plan on per not less than 81 inch in size. Plan must
include, but not limited to: ve I art"." point M), direction and Parcel I.D.
percent slope, scale or dimen ions, noLgy,r& distance to nearest road.
Please PFM# aµ Mwon"adeft, xis by
•7
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z �
Property Owner Property Locati
Richard/Robert/Loren Derrick Govt. Lot NW 1/4 NE 1/4 S 22 T 30 N R 18 E(r®
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1310 Hwy 65 33 Pond View Meadows la-- City State Zip Code Phone Number ity Village ■ own Nearest Road
New Richmond i WI 1 54017 ( 715 246 - 5425 CTH G
El New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement Public or commercial - Describe:
Parent material Loess over outwash sand and till Flood Plain elevation if plicable
General comments These are massive soils with the need for extremely careful installation techniques of the system being used by the
and recommendations: installing contractor. My recommendation would also be to consider a pressurized system, where the effluent can
be dosed over the entire distribution area. Not required, but recommended.
s s'te is suitable for a below c nve tional system.
Boring
a Pit Ground surface elev. 100.66 ft. Depth to limiting factor >80 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I - Eff#2
1 0 -7 10yr3 /3 sit 2mgr dsh cw 2f .8
2 7 -12 1 4/4 sit 2msbk dsh cw if �Y,b .8
3 12 -80 7.5yr4/4 sl Om dsh - - 3 .
21 Boring # Boring 97.40 >80
E] Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 10yr3 /3 sit 2mgr dsh cw 2f J� 4 .8
2 8 -16 1 4/4 sit I 2msbk dsh cam' if •
3 16 -32 10yr4/4 sl Om dsh cw _ .3 .5
4 32 -51 7.5yr4/4 _ s Osg dl cw - .7 1.2
5 51 -80 7.5yr5/6 sl Om dsh - - .3 .5
* Effluent #1 = BOO > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L
CST Name (Please Print) Signature _ CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 10/31/03 715- 246 -2454
Property Owner _ Derrick paarcel ID # Page. 2 of 3
3 Boring # Boring 92.00 �0 �� , v'cjc Lm;
"I L�
E] pit Ground surface elev. ft. Depth to limiting factor >81 in.
Soil fe
lotion Ra
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIFF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW
1 0 - 9 10yr3 /3 - sil 2 mgr' dsh cw 2f .5 .8
2 9 - 1 4/4 - sil l m l dsh cw if .2 .3
3 15 -22 10yr4/4 - A lmsbk dsh cam' if .2 •
4 L56-81 7.5yr4/4 - Sl Om dsh cw - .3 .5
5 7.5yr4/4 - s Osg dl cw - .7 1.2
6 7.5yr5/6 - sl Om dsh - - .3 . — t I
F-1 Boring # Boring
pit Ground surface elev. — ft. Depth to limiting factor in.
Sal — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F] Boring # spit Boring
Ground sur �. ft. Depth b limiting factor in.
Soil Appl ication 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
I
I
I
I
I
- Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 150 mg1L * Effluent #2 = BOR < 30 mg1L and TSS _< 30 mg1L
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.
M- 93301bat (R.07M)
a
POND VIEW MEADOWS
�OT 33
roe
N
jB 1
B
100'
�Q� BM2
d986 B2
215'
6r
B cs, i 696 410'
SLOPE
fi 2.02
ACRES
S 253'
83
65'
02' 235' -
98' 185'
SCALE 1'=40'
111' BM1 TOP OF CONDUIT 100.00'
BM2 TOP OF CONDUIT 98.20'
B1 1DII.B8'
(133 92.00' 5hxn�
SW LOT CORNER
THOMAS NELSON
227387
�n'l dLi/t/ �o • � � S I�c.6u�C c� G�i /Ulc� -- ,�1.�.� ,Lo T 3 �/ s• �
BM1 TOM OF CONDUIT 100'
BM2 TOP OF CONDUIT 98.20
' THOMAS C NELSON
B1 1.02.30' �,r,�e 227387
B2 10� pD r Lo
161 B3 96.3Q'
208
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2
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SLOPE L0�
loo 1"M 2
9s' ■ -• 98'
°nS 5 �.,Qo� 33
JAt"I r 3 253'
26 , g 3 c sv. Lo
235' S,7/
SCALE 1'=40' �.
181'
2.0
ACRES
SE LOT CORNER
POND VIEW MEADOWS II
NW1 /4, NE1 /4, SECTION 22
T20N -R18W, 7LOT; RICHMOND
P4�43OF3
v
POND VIEW MEADOWS
P T 33 /
role
N
B1 t
v
BMI
100'
�
BM2
B2
215'
6% 414'
SLOPE
2.02
ACRES
253'
83
202' 235' 65'
' 185'
SCALE I"=40'
111' BM1 TOP OF CONDUIT 100.00'
BM2 TOP OF CONDUIT 98.20'
B1 loom'
B3 92.00'
9o,6 �
GI��'
��
SW LOT CORNER
THOMAS NELSON
227387
G /1lGt� — .� - e - .C�oT 3 S� s•;�e_
.•0,7 vv 9I A "700.VV l "g -few
-- — - -• 441_89' -- -- — 11- -- 30.00'
............... .................................................
s 38 N 39
1.77 ACRES 1.70 ACRES
(77,041 SQ. FT.) r (73,886 SO. FT.) 6'a
g o) a
a i
i"
37
I �
I I 1.79 ACRES
I I (77,990 SQ. FT.) 40
C3 \ 1.65 ACRES
J
a i (71,731 SQ. FT.)
I
I�I LL Z ;
z N89 °40'00 "E 357.73'
LL I
' N85.3651 "E 347.66'
Z - - -- - - -- 22VW
36
1. ACRES
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ao I 33' 33'
CIA ao
W
— — — —;V r�3•F4 �� I o°° °c I 41 co
v I M q I 2.09 ACRES
v y w (90,845 SQ. FT.)
$ 35
N 1.84 ACRES M q I co
cv (80,199 SO. FT.) I ^�
PA................ ............................... m •
Ig d
I -- -- -- 66 - 2 -- -- —
1] i N89 40'23 "W 400.00'
I
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I —• -- 215.00' — _ -- -- 215 . 0 .__._ _ 21
I
............................................................................ ...............................
34 33 32
2.00 ACRES 2.02 ACRES 2.02 ACRES
(87,181 SQ. FT.) $ (88,150 SQ. FT.) $ (88,150 SQ. FT.)
co
d
8 � p
ff
210.27' 215.00'
215.W
S89 0 40'23" E 1238.29
----------------------
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State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
Document Number Document Name RECEIVED FOR RECORD
10/10/2006 10:40AN
WARRAHTY DEED
EXOIPT #
THIS DEED, made between Loren D. Derrick, Rose H. Derrick, Richard L. Derrick,
Joan L. Derrick and Robert J. Derrick ( "Grantor," whether one or more), REC FEE: 11.00
and Ronald F. Davidson TRANS FEE: 180.00 COPY FEE:
("Grantee," whether one or more). CC FEE:
PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is
needed, please attach addendum): Name and Return Address
Lot 33, Pond View Meadows III. St. Croix County, Wisconsin.
Kri 5tl na Ckt nd
026 - 1168 -33 -000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of recor , i any.
Dated
O e errlc�
(SEAL) {SEAL)
*Loren D. Derrick BY: Robert J. Derrick, Attorney *Rose H. Derrick BY: Robert J. errick, Attorney in fact
in fact
f �L (SEAL) (SEAL)
*Richard L. Derrick BY Robert J. Derrick, Attorney *Joan L. Derrick BY: Robert J. D rick, Attorney in fact
in fact
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Loren D. Derrick, Rose H. Derrick, Richard
L. Derrick. Joan L. Derrick and Robert J. Derrick, by STATE OF )
Robert J. Derrick Attornev in fact ) ss.
authenticated on COUNTY )
Personally came before me on ,
*Kristine QgIand the above -named
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Notary Public, State of
Attorney Kristin Otland My Commission (is permanent) (expires: )
Hudson. WI 54016
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* Type name below signatures. INFO -PROTM Legal Forms 800 -655 -2021 www.infoprofbrms.com
1of1
br-r 1It: 1 Ik N& WA11NTENANCE AURL;EMENT
AND
OWNERSHIP CERTIFICATION FORM
v
Mailing Address 0 &tLa�2 E! `,, ` 10 </ II f, Q�K ��„ � �.—��
Property Address l 6p � A't– tA
(Verification required from Planning & Zoning Department for new construction.)
City /State �,,, Parcel Identification Number
LEGAL DESCRIPTION
Property Location 1 /4 , pit= '/4 , Sec. _� , T _ N R W, Town of
Subdivision P L �el4e �' , nie � , Lot #
Certified Survey Map # -�''" , Volume , Page #
Warranty Deed # , Volume --- ------ ; Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result m 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 heatm ent stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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 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 three year expiration date.
Itwe 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 virtue of a warranty deed recorded in Register of Deeds Office.
N ber of bed ooms y
=�7
SIGNATURE OF APPLICANTS) 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. 08/05)