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Home My WebLink About026-1168-34-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463333 0 GENERAL INFORMATION State Plan ID No: 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: Adrian, Brian & Sarah I Richmond, Town of 026- 1168 -34 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: cl5r 22.30.18.1340 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5 C4- 2— Benchmark �, ✓� /04 •�j Dosing ,ems— 06 Alt. B� X M � 2R-7 keratiert- Bldg. Sewer_ 9 •.7� '7q' 7$ Holding St/Ht Inlet l t 5 � g TANK SETBACK INFORMATION St/Ht Outlet 7 2A,-1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 56 15 Septic C 7 43' L43' Dt Bottom J -- (0 Dosing 5 75 7 76 ' -7 76 1 Header /Man. 19-S19 0 5 � CI Z Aeration / Dist. Pipe 0 19-S19 115 . 5 Holding Bot. System q5 9 PUMP /SIPHON INFORMATION Final Grade S E 1 (7 ( , - Manufacturer -Demand St COV r ` I . GPM , L f ; T Model Number , ( Y c 6 3 TDH Lift, ZC Friction Loss System Head TD Ft '7 J Cl Forcemain Length Dia.2 I I Dist. to Well —1 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenchw PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ! 0 I _ _ � _ SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: 7 / W, 166 CHA OR Model Number: Ma� DISTRIBUTION SYSTEM Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 Pi 2 .01 Length_ Dia , — Le Length O u ' � � Dia /� Spacing 3. 3 4 / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ✓ `� �` Depth Over Depth Over xx Depth of reded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges �� Topsoil as No Yes : ]N, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /5 / I spection #2: la ti — 0 K Location: 1249 146th Avenue New Richmond, WI 54917 (NW 114 NE 114 22 T30N R18W) Pond View Meadows II L 3 p ar No: 22.30.18.1 40 ,A ( o� 1.) Alt BM Description= s��, L � � '' ' ' � v G � a:,n.S `�` �a ` � 2.) Bldg sewer length = y 3 - amount of cover Plan revision Required? [ 'l Yes No (� i5 Use other side for additional informati n. Date Insepctor's S' ture Cart. No. SBD -6710 (R.3/97) � t T Safety and B ' 'n s Division County Viscons 1 W. Washingt Ave 5 Madison, 153 '�,1 r San' ry Permit Number (to be filled in by Co.) Department of Commerce (608 266 -3151 �44 3 3 3 3 • M !r? S e Plan I.D. Number Sanitary Permit ton In accord with Comm 83.21, Wis. Adm. Codetion yt>}rp{ay {dg I�o•°6 H� ` may be used for secondary purposes (I)(m} 1� t; (.?f `, P jest Address (if different than mailing address) _ OAI p� ��t'FFI�' /a yq /S/�r4 iQt/E� I. Application Information - Please Print All Information tF w W/ Property Owner's Name Parcel # Lot # Block # B ., t1l, S4 RAki AP Aw � � 0"?)o.A.) Property Owner's Mailing Address Property Location 1 iJ f f 9, / , V �/� City, State Zip Code Phone Number O� �� Section 2 ' G!J �t!/'l �t+0&^. P 0/ 5� 27/ x / L 5_5 (cir T d N; R �� E>� II. Type of Building (check all that apply) tj I or 2 Family Dwelling - Number of Bedrooms P 0`�� 5 ��O M` Subdivi Name CSM Number ❑ Public/Commercial - Describe Use A �o nd Qw Yvl4-c aw S ❑ State Owned — Describe Use �t1d� rp ( -2' k- 90 QCity ❑Village *ownship of R' r_ k W .4 PO "T oV III. Type of Permit: (Check only one box online A. Complete line B if applicable) W/ dZ (r _ 10 b _ c b _ ) A. gNew System El Replacement System E) Treatment/Holding Tank Replacement Only El Other Modification to E System g Y B. Q Permit Renewal Permit Revision ❑ Change of Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Plumber Owner /// IV. Type of POINTS System: Check all that apply) `7' (O ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerebic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamb/ ip Line ❑ Gravel - less Pipe ❑ Other (explain) V. Disp ersal/Treat ent Area Information: " D. = D. Sc 5&- t_ C.-rf aw - Q 9 yi 5 Design low gn (gpd) Design Soil Application Rate(gpdsf) Dispersal Area�equired (sfl Dispersal Area Proposed (sf) System Elevation I) S /275.35 00a ) Iz�s 3t¢ (.0a 95.o0' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ' I ZSb I L✓a� �tti ✓ Aerobic Treatment Unit v n ; Z S Fr / O o T _ Dosing Chamber � / o / t Zo lam✓ `I ,� rrY/ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P Name (Print) Plu mber's Plumber's Signature MP/MPRS Number Business Phone Number C 11 oKm- 1 � ZzSo 3� �/Z - S= -f L7 Plumber's- Address (Street, City, State, Zip Code) / 0 - 76 fc 2, 11 d A, 's 0 (.lJ l S o�� VI . Coun /De artment Use Onl Approved tsapproved isi Sanitary Permit Fee (includes Groundwater Da Issued Issuin gent Si a r s) Surcharge Fee) �0 � ❑ O en Reason for Den IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: kL 0 Septic tank, effluent filter and U dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 00 ' p ro�o 3ed Mectc✓ouJS 2C Sec. z? 1 1 �6edraam s o algid, �iao.40; Propo6cd lS fGSer�y,.,Cfs.�C O W L P 1, 26D- K Q 5 eepp c 'one - - �lbwO eI,rl —zr1t Mtte. Ta burr 1 ` ` O PI-oposecl — Pw.,•,P s 1 C� 1 � ` 9lo0�corrEOU/ 1894 Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 of 3 Division of Safety and Buildings in accordance with Comm . Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'%x 11 inches in size. t d County St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio n percent slope, scale or dimemslons, north arrow, and location and distance to Parcel I.D. Pending Please Print all nfenR� E I V E D Q Reviewed By Date Personal information you povide may be used purposes purp (�ecy Lao, s. 15.04 1) (m)). Party owner JUN 0 2 2005 P Go o t. Lot Location NW 1 /4 NE 114 S 22 T 30 N R 18 W Mill Homes Of H udson, LLC Property Owner's Mailing Address ST. CROIX COUNT Lot Block # Subd. Name or CSM# 868 Kelly Road, Unit A_ L ZONING OFFICE 4 Pond View Meadows III City State Zip Code Phone Number _j City _f Village 1/ Town Nearest Road Hudson WI 1 54016 (715) 531 - 0714 Richmond 1 1249 146Th Ave. Y" New Construction Use: 601 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Pubic or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 95.00' at 6" above 94.50' contour, Boring # J Boring 100 Pit Ground Surface elev. 93.87 ft. Depth to limiting factor 68" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *EW2 1 0 -10 10yr3/2 none sl 2fsbk mvfr as 2f &m 0.6 1.0 2 10 -30 10yr4/6 none sil 2msbk mvfr gW 2f,lm 0.6 1.0 3 30-41 10yr5/4 none sicl 2msbk mfr cW 1f 0.4 0.6 4 41 10yr416 none sl/Is 1msbk mfr gW - 0.4 0.7 5 68 -82 7.5yr4/4 Qf7'5yr5 /8 & sl 1thinpl mfi - - 0.4 0.6 12f 1 0yr6/2 H#4 contains 1/2" - 3" thick discontinuous, irregular bands of 10yr416 Is and 10yr5141 msbk al. Loading rate reflects most restrictive permiabilky found within horizon. a Boring # Boring 1/ Pit Ground Surface elev. 93.45 ft. Depth to limiting factor 41 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 1 0 -12 10yr3/2 none sl 2fsbk mvfr as 2f,1 m 0.6 1.0 2 12 - 28 10yr5 /4 none sil 2msbk mvfr gW 2f,lm 0.6 0.8 3 28-41 10yr4/6 none sl 2msbk mfr cW if 0.6 1.0 4 41-64 10yr4/6 f2f7.5yr4/6 slAs 1msbk mfr - - 0.4 0.7 I H#2 contains approx. 20% cobbles & stones contains a octure of 10yr4/4 irregular, discontinuous Is bands, 1" - 3" thick and 10yr5/6 0sg Is . Loadingfate reflects reducqU permiability of horizon associated with banding. * Effluent #1 = BOD ? 30 < 220 mg/L and SS >30 < 150 Effl = BOD <30 mg1L and TSS < 30 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson �--- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/82005 715- 248 -7767 Property owner Miller Homes Of Hudson, LLC Parcel ID # Pending Page 2 of 3 a Boring # -� Boring 01 Pit Ground Surface elev. 95.34 ft. Depth to limiting factor 53" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3/2 none sl 2fsbk mvfr as 2f &m 0.6 1.0 2 7 -24 10yr4/6 none sl 2msbk mvfr gw 2f,1m 0.6 1.0 3 24 -35 10yr5/6 none s Osg dl cw 1f 0.7 1.6 4 35 -53 10yr4/6 none suls 1 msbk mfr gw - 0.4 0.7 5 53 -77 10yr5/6 f2f 7.5yr5/8 & sl 1thinpl mfi - - 0.4 0.6 H#2 contains approx. 20% cobb. & stones. H#4 contains a mixture of 10yr5/6 Irregular, discontinuous Is bands, 1" - 3" thick and 10yr4/41 msbk sl . Loading rate reflects reduced permiability of horizon associated with banding. F �f Pit Boring # -1 Boring Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -S30 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. • �.00d�ed �Op. S� /oS'Lo ,0 cJ. /�ro�oSecl 1 V ,Kea zz 4/6�d�oom r c,�' irrefa/ ,Qes.d�c� C�ndw� p'Pe ,¢ ssaen,e.o� O 98 .0 ------------ _____ - -- -- _ �o 97, 0 - - - - - - - - - - - - - - - - - - - - - - - - - - O L V \ \ 71 O Too o {Survey k.- 9e 9G V'�,rEeKi 8� \ yo . ZIO.,.7' P� 3 ee Y '� o �, tea, A, g rade e lev ProeoSed q i /Nea�✓ou>S Sec, .7-Z Q T o �',Q, Gli , nand 1 1 1 1 --4 P'o fused �QCSdQ+1CC C47o[cci� �o.�OF. ,¢ sscc�r+c -d Q /ed; S X00. Gb; 0 - - bu; /d; $ems'• � _ _ E /ed' = 98 zG,' 97, o� ltwO-t� l�E• I o s� ".4•S. T. m. 303f/ CfF /u ¢ n � /•h e. TV 0 - G,c. o(jo -me - \ s � r echnical'S ecifications p PL-525 EF U F ILTER (COM 4t 617 BALL CHECK I i� r. EXCEPTS B'SHD 40 � ��'I � +.• - ...'7 -. . FOR INLET EXTENTION 1157 � 14.35 OUTLET BUSHING EXCEPTS 4•SCH4066"SCH10 10.68 — . / 5.23 - 0 PL -525 FILTER HOUSING - % 1634 PART NO. - 30142 -525 I MATERIAL: HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5 BALL -HOPE SOCKETEXCEPTS FLOAT SNITCH - 10.23 I r — I 7 EXCEPTS 1' SCH w I I _ .98 � J� �- FOR HANDLE EXTENT10N 10.61 5WOFIMS'SLOTS .� 6.24 I__ - 6.47 9.56 SOCXETEXCEPTS BALL PUSH ROD I OPENING n O O • 7.09 OPENING - 20.71 10.02 2244 _ POLYLOK PL -525 FILTER CARTRIDGE PART NO. - 30141.525 ' MATERIAL - POLYPROPYLENE _ i I o • - I t !� k r .�aa 1A� a .1+a�' 3i.....� Safety and Buildings 4 03 N KINNEY COULEE RD commerce ALA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w w ww.coe.wi.gov/s sin.go / Department of Commerce iscosin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 17, 2005 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/17/2007 Identification Numbers Transaction ID No. 1119914 SITE: Site ID No. 695250 Miller Homes Please refer to both identification numbers, 1249 146' Avenue above, in all correspondence with the agency. Town of Richmond St Croix County NW1 /4, NEIA, S22, T30N, R18W Lot: 34, Subdivision: Pond View Meadows 11 FOR: Description: Proposed Four Bedroom Mound System - Revision Object Type: POWTS Component Manual Regulated Object ID No.: 1006152 Revision; Maintenance required; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2. 0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on February 28, 2005 under Transaction ID No. 1113361. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. i No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stars. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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 private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. RU L 4 pLt'AkTMENI OF NR�i��K[ 1NGS MICHAEL P MC DONELL Page 2 3/17/2005 • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(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: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of 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 maintenance of the POWTS. Sincerely, Fee Required $ 75.00 ey�!;A� Fee Received $ 75.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Miller Homes of Hudson LLC Oj� O MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN 6 �0 INDEX AND TITLE PAGE.' Project Name: Miller Homes of Hudson - 4 bedroom residential mound -- " REVISION Owner's Name: Miller Homes of Hudson. LLC Owner's Address: 868 Kelly Rd. Hudson, WI. 54016 Parcel Address: 1249 146th Ave. Legal Description: NW1 /4 NE1 /4, Sec. 22, T.30N., R. 18 W. Township: Richmond County: St.Croix Subdivision Name: Pond View Meadows II Lot Number: 34 Block Number: Parcel I.D. Number: Pending Plan Transaction No.: 1113361 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike McDonell License Number: 225036 Date: 03/09/05 Phone Number: (612) 865 -1927 Signature Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) y1VW�Uw V ' Version 4.01 (R. 09/04) Pagel of 9 P DEtJGE S EE GORR Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400 00 Estimated Wastewater Flow (gpd) Table 83-44-3 in -situ soil treatment for fecal 1.50! Peaking Factor (e.g. 1.5 = 150 %) coliform of <= 36 inches. F - 6 - 0 - 0 - 0 - 01 Design Flow (gpd) 5.00; Site Slope ( %) 94_.501, Contour Line Elevation (ft) 41.00! Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.00; Dispersal Cell Length Along Contour (ft) = F 6.67 Cell Width (ft) 1.001, Dispersal Cell Design Loading Rate (gpd /ft ii Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? e' Center or End Manifold 3.34 Lateral Spacing (ft) If N above, enter the elevation (ft) 2; Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Orifice Spacing (ft) = 6.67 ft /orifice 2.00' Forcemain Diameter (in) 40.00; Forcemain Length (ft) Does the forcemain drain back? Y 86.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 8.50 Vertical Lift (ft) 81.15 5x Void Volume (gal) 1.15 Friction Loss (ft) 87.67 Minimum Dose Volume (gal) 16.15 Total Dynamic Head (ft) 37.07 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x _ x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator Treatment Tank Information 1001.88; Total Tank Capacity (gal) 1250.00; Septic Tank Capacity (gal) 36 00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 1 2T831 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1001.88 Dose Tank Capacity (gal) Zabel Filter Manufacturer 27.83 Dose Tank Volume (gal /in) A100 !Filter Model Number Wieser Concrete Manufacturer Project: Miller Homes of Hudson - 4 bedroom residential mound -- " REVISK Page 2 of 9 Mound Plan View ................................ ................. J .. . . . . . . . . . . . . . . . observationPipe . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . FK-- 4-*A 0 A C� ... W .... ........... B * .... . . . . . ......... .................. ............... ................ ......................... ............................... I ......... .................................... ............ .......................... ..... ................................... .... . ................................... .................................. .......................... ......................................... ......................................... ......................................... .............. ............... .... .... ....... L Mound Component Dimensions A 6.67 ft E F in H .00 ft K 7.38 ft B 90.00 ft F1 9.50 in .50 ft L 104.75 ft 4.67 18.84 DA6.00 in GI 0.50 ft J Ift W Eaft 600.30 (ft2 ) Dispersal Cell Area 1 1275.35 (ft) Basal Area Available F 6 (gpd/ft) Linear Loading Rate 1 9.070 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.79 (ft) ► rirf.. G � H ,rrrrrrrrr 1 2 rrrrrrrr ............ .... F 95. Dispersal 50 (ft) Lateral 95.00 (ft) Invert Dispersal Cell Elevation E ........ ...... .... ........ ........ . . ........ ................ ..... ................ . . . . . . . I * * * , , , , , , * , , * * . . . * * , , E F 4] 94.50 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on = Topsoil Cap c 1.5 ft -4 Page 4 for number, size, 0 rrrrr Subsoil Cap 0 and spacing of laterals. .2 Cd 4- Laterals are equally ASTM C33 Sand :5 m .1 F FA] Tilled Layer c 0 0.5 ft Typical Lateral spaced from the distribution cell's Aggregate 0 centerline in the distribution cell (AxB). Project: Miller Homes of Hudson - 4 bedroom residential mound REVISIC Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A& B dimension = Turn -u p w l be I Iva Iva or of son out p l u g P Aflaterals are Wentical IF X�I Holes drilled on the bottom of the lateral S equally spaced Force main connection via tee or cross to manifold at any point. Laterals & Force main of PVC Sch 40 (per COMM Table 84.30.5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 88.44 ft Orifices per Lateral 45 Lateral Spacing (S) 3.34 ft Orifice Density 6.67 ft /orifice Lateral Flow Rate 18.54 gpm Manifold Length 3.34 ft System Flow Rate 37.07 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.15 ft Forcemain Velocity 3.79 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► — 4 in. min. Comm 16.28 WAC Disconnect y Tank component is properly vented E Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acity 1001.88 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.85 524.59 B 2.00 55.66 C Pump off elevation (ft) C 3.15 87.67 87.00 D 12.00 333.96 D Total 3 1001.88 Do se tank elevation (ft) 3" Bedding un er tank. 86.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BN98 Pump Must Deliver 1 37.07 gpm at 16.15 ft TDH Project: Miller Homes of Hudson - 4 bedroom residential mound -- * REVISI( Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Mike McDonell Phone 612 - 865 -1927 POWTS Regulator's Name St. Croix County Zoning 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 600.3 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 Should 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 Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ............. ............... Grade 6 -8" Diameter Lawn . . . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral �► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Miller Homes of Hudson - 4 bedroom residential mound -- * REVISION * Page 5 of 9 • Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General r _ This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD- 10691 -P (N.01 /01) and SSWMP Publication 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. Septic 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 fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter 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. Puma 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 filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 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 permft 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 6 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 mound 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 removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Miller Homes of Hudson - 4 bedroom residential mound -- ' REVISI Page 6 of 9 V y n -,F�AC cAPAC; T c'�RVE ENT MODE' Model 185i4185 snou c 135 - — - f- — — - ---- . - -._.. not be subjected to less than 30 feet TD:', - t -- 30 95 �- T '� - � -- 28 9G- I B6. 26 186 - f '4_rt__ 21 c 22-I �r 2 65 a j z I > 6c 6y I _ 6 ° C - - a0. 188. t I 1 I S5 1a0 °IBB -_4� -_ ` 30 � Y 25 i _ +_- - - - I r 5 I 5- 6 I I ' 1,5 ONS c 2' JO 40 50 60 'D 80 90 100 10 !20 130 L, 15.' 8J 6C 2a0 320 43C 480 56C ;'.Ow PER MINUTE 37 O �y p,ir7, m:nir.�um Suo�o�,, i`uze /'l� u � zzN " 'CTRL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERINC — �_� -, ., 98 '37 1a0 /a1a0 jI 61/c161 163/°163 165 a1 ' 'B9 /a B9 / 65 1 8S /a B5 86/a�86 1 88 /a1B8 ' 1- _ G- ;1 GaI Ua G LVS co ) I s Gal �i-Gol t", GI,1 T 1 a o 1�� _ C '63 1 2 ! 273 , 93 352 9' 3 4a iC X79 b1 2S1 61 1 < 1� tl '2 '°5 t.9 45 °9 -� 29 6` 331 7 gq r 8e 1 3tg 9i 352 61 2JI 61 _ 23 j Sd dC ' 53C 'a0 J.. r - r _.__. _,..__ _ _ 5 � 24� 76 288 85 322 tEl 227 61 + 23 � �-- ��- - �- a '70 6a 6� 1 S8 220 134 - 507 '35 25 95 36 1 U6 68 257 79 1 299 59 223 50 227 58 - 220 128 48 4 '31 1 8 3 I 59 223 70 1 265 57 216 59 2234 S8 220 '22 1 462 : '25 473 < - ., - 9 'BS 62 235 55 206 58 2.. 85 �- 322 SH 116 439 '20 454 a� 21 79 a5 :'0 a6 i72 55 2 265 56 220 'Oa }ga 109 a13 a5 �- 20 76 J� 11225- 5- 0 }-18 -9 51 9 _ 58 1 220 90 341 1 97 367 45 - 57 1 39 1°8 �32 `2 58 269 8 220 71 5 32 a5 23 B7 9 Sa r 52 - 197 51 ! Iq} 59 26 <5 -- -- - � •0 }g i 45 •70 28 106 51 g} b S< 29 - - -- i --�- ° g� (59m) 23 n (71,) 26 a (7 11411 1 (�.7 T) 66 L 20' - ( ' ^_118 6.5 n ,126.°1), 73 11 (221 a 1 ( 71,) 9 1 1�, ( II r 335 m)l� 3 7 �a __- SSPMA c MEMBER - CD at %1. (k © Copyright 1998 Zoeller Co. All rights reserved. �. 709 1894 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. Pending Please print all information. Rev iewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Miller Homes Of Hudson, LLC Govt. Lot NW 1/4 NE 19 S 22 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 868 Kelly Road, Unit A_ 34 Pond View Meadows II City State Zip Code Phone Number _J City _j Village J Town Nearest Road Hudson WI 54016 (715) 531 - 0714 Richmond 1 1249 146Th Ave. Ki New Construction Use: J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _j Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 95.00' at 6" above 94.50' contour. Boring # _J Boring ✓i Pit Ground Surface elev. 93.87 ft. 68" in. Soil Application Rate Depth to limiting factor App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -10 1Oyr3/2 none sl 2fsbk mvfr as 2f &m 0.6 1.0 2 10 -30 1Oyr4/6 none sil 2msbk mvfr gw 2f,1m 0.6 1.0 3 3041 10yr5/4 none sicl 2msbk mfr cw if 0.4 0.6 4 41-68 10yr4/6 none slAs 1msbk mfr gw - 0.4 0.7 5 68 -82 7.5yr4/4 �fzf'�0/ & sl lthinpl mfi - - 0.4 0.6 i H#4 contains 1 /2" - 3" thick discontinuous, irregular bands of 10yr4/6 Is and 1 Oyr5/41 msbk sl . Loading rate reflects most restrictive permiability found within horizon. a Boring # __.!. Boring ✓1 Pit Ground Surface elev. 93.45 ft. Depth to limiting factor 41 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 1Oyr3/2 none sl 2fsbk mvfr as 2f,lm 0.6 1.0 2 12 -28 1 Oyr5 /4 none sil 2msbk mvfr gw 2f,1 m 0.6 0.8 3 28-41 1Oyr4/6 none sl 2msbk mfr cw 1f 0.6 1.0 4 41-64 10yr4/6 f2f 7.5yr4/6 slAs 1 msbk mfr - - 0.4 0.7 H#2 contains approx. 20% cobbles &stones #4 contains a fixture of 1 Oyr4/4 irregular, discontinuous Is bands, 1" - 3" thick and 10yr5/6 Osg Is . Loadingtate reflects redu permiability of horizon associated with banding. ' Effluent #1 = BOD 30 <_ 220 mg/L and SS >30 < 50 mg/ Effluen = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson s-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/82005 715- 248 -7767 i Property Owner Miller Homes Of Hudson, LLC Parcel ID # Pendi _ Page . 2 of _ 3 3 ] F Boring # - — — — ✓! Pit Ground Surface elev. 95.34 ft. Depth to limiting factor 53" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -7 1Oyr3/2 none I sl 2fsbk mvfr as 2f &m 0.6 1.0 2 7 -224 10 y r4/6 none _ sl 2mbk g s mvfr w 2f,lm 0.6 I 3 24 -35 1Oyr5/6 none s Osg dl cw 1f 0.7 1.6 --------- - -- - - — -- - 4 35 -53 1 Oyr4 /6 none s0s 1 msbk mfr gw - 0.4 0.7 5 53 -77 1Oyr5/6 f2f 7.5yr5/8 & sl lthinpl mfi - - j 0.4 0.6 H #2 contains approx. 20% cobb. & stones. H#4 contains a mixture of 1 Oyr5 /6 irregular, discontinuous Is bands, 1" - 3" thick and 10yr4/4 1 msbk sl Loading rate reflects reduced permiability of horizon associated with banding. F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon i Depth Dominant Color Redox Description Texture Structure Consistence Roots in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I - - -- --------- - - - - -- I ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor — in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 'Eff#2 I I � I i Effluent #1 = BOD ? 30 <220 mg /L and TSS >30 < 150 mg /L ` Effluent #2 = BOD mg /L and TSS <30 mg/L The I)epartment 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. f P;lr-4 • diprls6 8 rode ¢ lel. • �.oCQ7�d �E�re�a S� las"60 P.O. cJ. .�G�.4ve • Sea/e: / _ �p " /lrofosed 1 b7:;;, F u.)e 0 /H e a ec. zz fin. o �',Q.►o; J�ro�lSed ,QeS.da+1CC al4 elcta � 40 sSoc�ncd ' o / ¢ le(/,' � /OO. GAO; x1 GE. b r✓I . 9/ a7 dw E . 97,0 "_ -- -- - -- -.. - -- - - -- -- --- _- - - - - -_ o ` 62 - V) 1 4- To o {Su I .9�! ' rrta i�tei led, 9&1)'coe•rto -o" yo, e� \ I I - Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Divisimi INSPECTION REPORT Sanitary Permit No: 4631OW 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: ' Adrian, Br n & Sarah I Richmond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section n /Range /Map No: CST BM Elev: Insp. BM Elev: 7 22.30.18. TANK INFORMA N ELEVATION DATA TYPE M UFACTURER CAPACITY STATION HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inle St/ utlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent Air Intake ROAD Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St \r GPM Model Number 04 TDH Lift Friction Loss System H d TDH Ft Forcemain Length Dia. Di . to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Le ngt No. Of Trenches PIT DIMENSIONS No Of Pi Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: UNIT del Number: DISTRIBUTION SYST M Header /Manifold Distribution x Hole Size x Hole 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 N Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COM/BDescription (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / Loca 146th Avenuew New Richmond, WI 54017 (NW 1/4 NE 1/4 22 T30N R18W) Pondview Meadows III Lot Parcel No: 22.30.18. 1.) Al 2.) BI ngth = - amount of cover = Plan revision Required? _] Yes 1 No Use other side for additional information. I Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County ` 11F 201 W. Washo gto v P.O. Box 7162 5 . C 0 40 1 �( isconsin Ma di 0 —' 62. Sanitary Permit Number (to be filled in by Co.) Department of Commerce r ( 8) 2 - 151 Z4 (,333 3 r Sanitary Permit ah n te�Plan I.D. Number In accord with Comm 83.21, W is. Adm. Code, ersonal informa on you prtrvlde lq,t)S, I 1113 may be used for secondary purposes Privacy Law, s15 (1)(` Proj t Address (if different than mailing dress) I. Application Information — Please Print All Information mss/! C Property Owner's Name karcel # Lot Block # 1a � Property Owner's Mai ng d ss Property Locati agtl a Is �Ary �3 City, State Zip Code Phone Number 6 f Y,, Section Z $ T N; RI o� H. Type of Building (check all that ply) �j�,�r; OM C. I or 2 Family Dwelling ling — Number of Bed, ms ubdiv ion Name CSM Number r Public /Commercial — Describe Use rt"ov tr �, S 3 �ek / &W /t a' D S El State Owned — Describe Use Ca.) X Q� p ❑City ❑Village ship of III. Type of Permit: (Check only one box on line . Complete line B if applicable) _ -� p A. � ew System Y ❑Replacement System tment/Holding Tank Repl ment Only ❑Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Chang /Peit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber IV. Type of POWTS System: Check all th apply) ❑ Non — Pressurized In- Ground 9mound >_ 24 in. of suitable soil El < 24 in. of suitable soil El At-Grade 11 Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank eat Fill El Aerobic Treatment Unit El Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter El Leaching Chambe>Y ll t ❑ Gr -less Pipe ❑ Other (explain) V. Dis ersa'Treat p ent Area Information: _ Design Flow (gpd) esign Soil Appli at n Rate(gpdsf) D' ersal Area Re u (sf) Dispersal Proposed (sf) System Elevation p, S` 'S3 `fir 2� Lack 3 3Y m o 9 f?. S 3 VI. Tank Info Capacity in Total I Nyorber factor r 'Prefab Site Steel Fiber Plastic Gallons Gallons I gfUnits Concrete Constructed Glass New Erdsting ' Tanks Tanks Septic or Holding Tank /� w O �� '/ Aerobic Treatment Unit C. b Dosing Chamber 21q S C , VII. Responsibility Statement- I, the u ersigned, assume responsibility for installation of the POWTS sho n on the attached plans. Plumber's Name (Print) ` ber's Signature MP/MPRS Number Business Phone Number m. i A W� S 7 L Z2_S'�3 � [012 - L - � % 2 Plumber's Address (Street, City, Stat ip Code) a VIII. Coun /De rtmeut a On] Approved ❑ Disapp ed Sanitary Permit Fee (includes Groundwater Date Issued XISSAgentSign (No Stamps) Surcharge Fee) ❑ O Given Reason for Denial �2S (),7 IX. Conditions of A roval/Reasons for Disapproval SYSTEM NER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) ' Adenus x • �e �ed l o�e,Et Sf,� 3 6 ��ade ekw x � Elv3Fi� f�•�ceJ;nC 0. X c. EE S6. C ml!r Of, uol.. x X Well o �a x P ro posC d dl y64dreom � �esr'dence X . 62— h see: qr e 5cl� <loP.e%C. �o�stcf :turCo»c �e GandaT� 4& n� � we _ P i co /Pad Cap. b:.�a, 2v, bw %d:n Sewtr Q.�Q.V': /�D.G0. r r4 T porCa.d. j. • E'!e� a 9e. zw 9 7- 5 - C) ' C,, `O ViJ X PrO posed tr ac',ld 0.6 l r 06' kY�'x /ca'd:sPcrsa /C�/ /. wo(Z) d; Stli iufo.� lafera/s A6 9V.67' X c. � /yP 404C o E .2,53' / 8' /'fa Socc�d /o G'ne z r X G PI X X X X x /. 8 Ole? �� r ' "+r �� Safety and Buildings COminerCe.Wl. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer sin.go www.w of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary February 28, 2005 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE A.C.E. SOIL & SITE EVALUATIONS LLC ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/28/2007 Identification Numbers Transaction ID No. 1113361 SITE: Site ID No. 695250 Miller Homes Please refer to both identification numbers, 1249 146' Avenue above, in all correspondence with the agency. Town of Richmond St Croix County NWI /4, NEIA, S22, T30N, R18W Lot: 34, Subdivision: Pond View Meadows II FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1006152 Maintenance required; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter 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: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(N01 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of See. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. f? 01N.T.S. Conditionall p • MICHAEL P MC DONELL Page 2 2/28/2005 I ' • Comm 83.22(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: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of 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 maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 1.75.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN U Residential Application �� 2 4r INDEX AND TITLE PAGE Project Name: Miller Homes of Hudson - 4 bedroom residential mound Owner's Name: Miller Homes of Hudson. LLC Owner's Address: 868 Kelly Rd. Hudson, WI. 54016 Parcel Address: 1249 146th Ave. Legal Description: NW1 /4 NE1 /4, Sec. 22, T.30N., R. 18 W. Township: Richmond County: St.Croix Subdivision Name: Pond View Meadows II Lot Number: 34 Block Number: Parcel I.D. Number: Pending Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike McDonell License Number: 225036 Date: 02/08/05 Phone Number: (612) 865 -1927 i Signature: < - Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ��MERC� on 4.01 R. 09/04 T OF COM Page 1 of 9 Version ( ) pEpAR7MEN DIVISION OF SAFETY AND BUILDINGS SEE GORRE ONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R' Residential or Commercial Design Note: Sand fill (D) calculations assume a - Table 83-443 in -situ soil treatment for fecal 400.00 Estimated Wastewater Flow (gpd) - -- - - - - -- <= 1.50; Peaking Factor (e.g. 1.5 = 150 %) coliform of 36 inches. 600.00 Design Flow (gpd) 5.00; Site Slope ( %) 97.53! Contour Line Elevation (ft) 80.00. Depth to Limiting Factor (in) 0.501 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00! Dispersal Cell Design Loading Rate (gpd /ft 1 I I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution ! Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 21 Number of Laterals of the highest point. 0 12 5 Orifice Diameter (in) (e.g. 0.25) 2.501 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2 OOi Forcemain Diameter (in) 40.00' Forcemain Length (ft) Does the forcemain drain back? Y _ 90.50; Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 7.07 Vertical Lift (ft) 90.53 5x Void Volume (gal) 0.92 Friction Loss (ft) 97.06 Minimum Dose Volume (gal) 14.49 Total Dynamic Head (ft) 32.95 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 - 1.25 x 1.00 1.50 x x 1.25 2.00 _ 1.50 x - x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.64 i Total Tank Capacity (gal) 1200 00 Septic Tank Capacity (gal) 36 OO i Total Working Liquid Depth (in) 11 W ieser Concrete Manufacturer 22 24 gal /in (enter result in cell 649) Dose Tank Information Effluent Filter Information 800.641 Dose Tank Capacity (gal) (Zabel Filter Manufacturer 22.241 Dose Tank Volume (gal /in) A100 Filter Model Number Wieser Concrete (Manufacturer Project: Miller Homes of Hudson - 4 bedroom residential mound Page 2 of 9 i Mound Plan View T J 1 /1 0 B • • • • . • • ; . • . ; • ; . . ; . ' Observation Pipe ; 3 ; l 5 A W .. B . I �•. . . . . . . .... L Mound Component Dimensions A 6.00 ft E 9.60 in H 1.00 ft K Nift ft B 100.00 ft F 9.50 in z 7.38 ft L ft D 6.00 in G 0.50 ft J 4.67 ft W 600.00 (ft) Dispersal Cell Area 1 1338.24 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.82 (ft) � .lip }!!! }} 2 G•1 F Dispersal Cell 98.53 (ft) Lateral 98.03 (ft) — Invert Dispersal Cell ;Q Elevation E . D .: . 97.53 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key �'. T Dispersal Cell See lateral details on Topsoil Cap c a 1.5 ft Page 4 for number, size, © ! Subsoil Cap �' c and spacing of laterals. ' Laterals are equally ASTM C33 Sand v spaced from the F = Z 0.5 ft Typical Lateral Tilled Layer : �' Aggregate distribution cell's 05 o ° centerline in the A distribution cell (AxB). Project: Miller Homes of Hudson - 4 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension 0 = Turn -up w1ball valve or cleanoutplug ` I P All laterals are identical IE X �I Holes drilled on the bottom of the lateral 3 equally spaced Force main connection via tee or Gross to manifold at any point. Laterals & force main of PVC Sch 40 (per COMM Table 84.30.5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 98.67 ft Orifices per Lateral 40 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 16.48 gpm Manifold Length 3.00 ft System Flow Rate 32.95 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.49 ft Forcemain Velocity 3.37 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E--- Afternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 800.64 Gallons Volume 2214 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.14 403.34 B 2.00 44.48 C P ump off e levation (ft) —t C 4.36 97.06 91.46 D 11.50 255.76 D Total 36.001 800.64 Dose tank elevation (ft) 3" Bedding un er tank. 90.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BN98 Pump Must Deliver 3 - 51 gpm at 1 14.49 ft TDH Project: Miller Homes of Hudson - 4 bedroom residential mound Page 4 of 9 I Mound System Maintenance and Operation Specifications Service Provider's Name Mike McDonell Phone 612- 865 -1927 POWTS Regulator's Name St. Croix County Zoning 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 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft 2 Maximum FOG 30 mg /L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 ears Effluent Filter Should 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 Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade \ , . 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution / . . . - - Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Miller Homes of Hudson - 4 bedroom residential mound Page 5 of 9 • r ' Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Genera This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 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. Septic 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 fitter shall be a ssesse d at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 ears. All switches, alarms, and pumps shall be tested to verify proper P� at least once every 3 Y operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 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 6 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 mound 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 removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Miller Homes of Hudson - 4 bedroom residential mound Page 6 of 9 HEAD /CAPACITY CUR 1 53/55 37 40 1 1 T MODEL l 42 49 57/9 72 6 941 39 4,40 52 153 HEAD CAPACITY . _a ILiI <f Cal Lilers� Gal �L:les Ocl l.ler, GaL tales Gu. Gle„ Gal. Lien Gai Cleo + G.. ,l<. CURVE I.. 10 1 J 0 11 1 1255 1 - 9 2 29 !0 1� 5 0 IS 6� 131 9 9 299 BI ),6 l 6y 6 SU 2 ?0 f L 75 - �- 16 28, 53 2 01 2J1 MP I EFFLUENT -, 25 8 30 59 "1 3, 29 159 —_ r ) + ' - od_ JO ; , 2, 1 95 36 36 _0 15] W 5] -- 6 2G _~ ' °. ' : -r 19]1 MODELS 2 1 22 -- --t- �. -- -- -� 1 „ 112" & l4 r -- +- r - 3 8 , 3 SOLIDS PASSING - - - r-~ -- C 9L 2] APACITY - -- _1_ �1... IW 30 - 1 t t H _ -_ - ` 1130 ' 39 7 1 � I -- - 1 191, I S.Bm) 1911 (5.6,) 9.JR. (59 )l fill. (55,) 1511 (, 6m) 7311. (1_O,) 261,. (J.9,) 1611. (14 Om) 3811. (_6,14.33 113..,) 15, ,s3 16s 1as 416 1414 - --- 4!61 f 4 16 3 a'LS 4185 4186 4138 - 3.11 cal ei.1e cal � coy cm. Gal L,l.n .. - .. . -...- .. 100 379 61 231 61 23 __ __ M 22C 145 4 5 )' 93 351 61 231 61 2 31 -- - 1 58 120 I40 1 40 41 BS 377 60 111 i 6 23 - � 5�2ZC I�SC) )5 - 19 299 59 223 W 7] - { �-_' M 120 128 48 3 IjE 15 ]0 26S 51 216 5,, 223 + . -- - 720* 122 467 1 125 - 62 235 55 106 56 270 BS 322 1 56 220 116 139 1 120 4 Ali E5 1J0 1 .fi 1)7 55 -r 206 10 285 58 220 G. 39. 1 1409 20 16 33 1 - 2 5 50 1tl9 1 5 , I 15: 50 9 I 51 � � 19J l 56 220 I 9C J. )E' -- -- 15 57 I 39 148 32 171 ' � p 1 1 1 j - .69 T 3 2: - - _ r 13 8] 9 3. I 52 ] l 5'. i 19 ]� 10 )B ... 10 16 10 J; ,5 r 5611. (17 66(1 (201,) ;261,)(1111 (223,711411 Oe ],)149 (27 . ]m) nen : 3 D CAUTION Model 185/4195 should not be sub)ecled to less than 30 feet TDH �, NOTE: For Head Capacity on Model 112. Industrial Column oclow /OUEt /'%Le explosion proof pump, see FMO219. 1 �. -' 4 SEWAGEAND -. 41 l�e 181 21 461 1 32 �00 -- - -- r -- DEWATE r -- as J3. is ,r 3c. J ,• - . 1 r .a 'iS 5L '35 SC tl5 L9 t6 .. HEAD CAPACITY CURVE SEWAGE MODELS 2" SOLIDS PASSING CAPACITY D CAUTION I Model 293)4293 snoulc ':c be SAljcCted to less than 15 tee( TDH I _ _...+ PEK r,rwu,e c� Copyright 2001 Zoeller Co. All rights reserved f Aveaua ■ Sa X ' Aca &W O r,0,4 S • F+v's � -ade ekw 0. X �- c G L,J/. x (� o po aed X � o 1 x Pro po5c d� gbcdr-eo n i X. bZ • t i ✓ O10 0oF p (6posee / coy) cre GonodtJ � u+�td c,,) Z-p,zcvpio Elegy s 9B. so. 4 7, SU'Cc cc t r n P roposed M.w, a.E /ro6'.t d'Str�buf on laf��'a.�s� /'r2'X 9�6T 404ctd" 2-:63' /S/ �a Soct� /of. tine X X ,jij vv[ivii an 'AN 18 2005 6:01PM R'[DINA- REAITV- NR0-1'ick X15- 246 -9d =N� BBB P. 2/4 .4 W4c -"a+ Dawwwv of Commerce SOIL EVALUATION REPORT p 1 01 3 uwv" of safer). and euuainds n wr eb0a )m elh Comm 08, WIa Alm. Cade 'mod` W ncit 11 Pmn on jaw ri ts le hen B tit x 11 Itrcllet n dm. l'M. mrm St. Croix d a u0e, Dui not ft 110d m. varecal Wig horbarrtal raYsence oaYt @Ml, oTuc�iwr Orsd PBtaei tD, P-0,t &tape, sore or aimensiana, nom wruw, and k4won end os1'twwa b newest oa rd. Plea" print fit o b"""on. h.Nea,ed by Date v—'e maraca" rot wwla ,nay be rood ref rooandnv wv.... Rwq �... 1e0� tl1 M+11 prop" o«ne. Pj6pieTY RichawF'obervLom Derrick GgNL LAA NW Iµ HE 114 8 22 T 30 N le 18 � a Prupary rNrw'a Np14tpAdyeae WW .or N Btor! 6 aOd. Narrw or CSW 1310 Hwy 65 34 Pond View Moadows II Slim zip Uwe X ly Vfto a Ton NsanatRoad New Klchmona WI 1 54017 ( 7f 5.246 -5425 CTH O I N ew 0w*r, w Uset] Reddw*w / Number d beortrome 3 to 4 Code, aeetved oeap, tsow n o 450 to 600 an Reotsuem'ra ❑ Public a cawnrssr • Oencribe Perm m0rrm loess over twash sand ■ad W1 Flan Ptah awAiwt M appeoebta &no „, • discontinuous bapda of b. 7.5yr414, I' to 4', Om Tlwse are massive soils with the need for exbrmely careful installation tcchrtiquea of the syatan bong used by the installusg convutor. My recommendation would ilso be to ooaaider a Pnasurimcl system, whore tho effluent oba be dosed over the entim disuibutlan am. Not required, but r000ntmmded. �� a Q Bovrrp Q ' Pit Grorw surface stave, 102.30 R. Oegth to smltap esaw "SO n. NatzOn RAW I Depth Dorninot cow Rsrdw 006agm T.M. Str%xAune Cond fence Bowdwy liaots K Mwreet t1. 8a. Cone Cbbr or. ez 9h. -15181 '. 0 Y sit 1 0yr3r3 2rngl dsE cw zr S .g � 9 -30 10 r4/4 oil 2msbk dsh cw l f .S g 3 30 38 7.5yr414 Is Osg ds c w .7 1.2 4 38.80 7.5yt5/6 Is* O&A i dsit 5 .7 i 2 eoctre4 Bonrg I_.J Q Ptt t3raa+dsrateo>eler. 100.64 ti OepG, X80 m 1016v bcW in rlorr?ta am u0jagon Dow Domh' Radon Oe -110on Tmmue eeum= gone Barmy Roars CirCYfP Raw { in M1urUC1 Gu, SL C t Color or. SL 11111. •EfAat 'E 0-7 1(W/3 sit zmgr dsb cw zf s s 2 7 -12 l OyrV4 sit 2msbk dsh c`^` if .5 .8 3 12 - 7.5yr4/4 sl 11rn dsh 3 5 ' EI►wsA M - BOD - 30 < 220 np1 end TBS -W S 190 mryL ' Egio t 02 SOD 30 nv and T38 30 mv CST None (F1mae P” S0 C.STNurber 1 - homa6 C Nelson --r 227397 �` Oda fitiatrfbn �rdudrd Tobphorw Nwr er 715- 2a6•za5a 1432 120th Street, Ncw Richmond, Wl IOn 1/03 i IVA —11 Jan !�N !B. 2u05= 6�OlPM RiEDINA- REALTY- NR oorrick 715- 246- 5e5 N0. 6 88 P, 4/4'� 2 �� may Derrick .,-. Patrol tb pa a Va d 3 acrVq Sor4tp a Q Pit aro urtaw elay. 96.30 L Depw to � ro 0 am >B2 aro Sd Application Rata Hwow OWth DeraawN Redoa D sa"on T*Ktwm Swdun Owabb ro bmaug y Roots DPD/k ti. haaaaM Qr. 8z. Cont. Color Or. Ss Sh tYMI I 'EM 1 0 -9 1Oyr3h Gil 2mgr drh cw 217 .5 8 9 1 OvW4 sil 2msbk d6h cw if S .B 3 23 -41 1.5yMA al 1msbk dsh cw .4 .6 4 41 -82 7.5yrS /6 it Om dsh 3 .5 F - I Boring a ❑ Q Pit Grouts wrbaa swo. R. Dooh to 11ini" bcer in. 8o FZeM Hcroan DoP9t Dwdrwtl Color Padot Dtaw"on Taraaa Strucwm OarWtlrtca tiaWry 04ota OP" iR wAxw a Oi SL CtnC Color Gr. fSZ. Sh 'EIM1 IM &win0 • Pit Ground *A*" swv. R DepM to *nttl V %cW k Sall Aopk~ Beta Hwtmn DaMit DOminant Color Radar Cosr+WM T-xLn f6 uMse CaUMOVs Smawov Raub CPDX K Muns" Uu SL Cat Color Gr. @z Sn. 'ERi1 *M ' Ettiuea 01 ' WO a ,TO 1 ZW mpl ad 168 W < 150 myL • E%xint 02 SM, s 30 m % and TSS S W rayL i 7U Depwimcat of Commerce IM an equal opporwn4 amvim pmvi4cr sad employer. if yoo aced assiataoce to armam sarvicw or noel ovAwW in as skomte knuio, plow cma ct the daparoateat at 606- 266 -3151 air M 609 - 2"779, scout �ti ttm�ot 1 �e� JAN 18.2005 6:01PM R'EDINA- REALTY- Werrtek v15- e4tc- tftlb NO. 888 P. 3/4' BM1 TOM QF CONDUIT 100' BM2 TOP OF CONDUIT 90.20 THOMAS C NELSON 81 102.30' 22 7387 82100,64' Bt 83 96.30' 20 ' to:• Bt 5% SLOPE too' $ Mx W 9s ■ + ---- -- 98' 9r 2es' 253' 235' SCALE rIAa 2.0 ACRES SE LOT CORNER POND VIEW MEADOWS II j NW1 /4, NE1I4, SECTION 22 T20N -R18W, TOWN OF RICHMOND LOT34 W TOTAL DYNAMIC HEAD /FLOW W PUMP PERFORMANCE CURVE PER MINUTE MODEL 98 EFFLUENT AND DEWATERING 37/6 61/4 25 MODEL 98 4516 i Feet Meters Gal. Liters Q 6 20 5 1.5 72 273 37/8 W 10 3.0 61 231 L) 15 4.6 45 170 15 . 20 7.1 25 95 4 0 4 Shut -off Head: 23 ft.(7.Om) � 10 I i.+rszii -�nrwr 009971 I I 2 I I 5 I 0 ! 10 20 30 40 50 60 70 80 12 v16 I GALLONS I i LITERS 0 80 160 240 421132 FLOW PER MINUTE SK1102 CONSULT FACTORY FOR SPECIAL. APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches. variable level long cycle controls. • Refer to FM1922 and FM0806 for temperatures above 130 °F. SELECTION GUIDE 98 Series control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts -Ph Mode Amps Simplex Duplex 2. For automatic use single piggyback variable level float switch or double M98 115 1 Auto 9.4 1 4 piggyback variable level float switch. Refer to FM0477. N98 115 1 Non 9.4 2 or 3 4 3. See FM1228 for correct model of simplex control panel. D98 230 1 Auto 4.7 1 4 4. See FM0712 for correct model of duplex control panel or FM1663 for a E98 230 1 Non 4.7 2 or 3 4 residential alternator system. CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FM0477; ElectricalAltemator, FM0486 ;MechanicalAltemator,FM0495 ;Sump/Sewage Basins,FM0487; licensed electrician. Ail electrical and safety codes should be followed including the Single Phase Simplex Pump Control, FM1596; Alarm Systems, FM0732. most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERE DESI For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. __._.._...__...._..__ ............ ................. _. .......... _ _..._..- ....._._____ .... __..... _. _ ...... __.__...._._..__.._ ... .. .... MAIL TO: P.O. BOX 16347 T O : 3 ll Manufacturers of.. SHIP IP is t , K 49 Cane one R R oad n /primp Louisville KY 0 928- (502) 77 (80) PUMP LJUAZ17Y PUMPS S NCE /Jt!✓ N httpYAvww.zoelter corn PUMP �O FAX (502) 774 _ ............ _._ ........ ... ._.- __...__..... — - ---- ----_._.__._---- _ ... .... ..___.—_. _.__.- ....... — _ .... _ ............... _ — © Copyright 2004 Zoeller Co. All rights reserved. RECEIVED a Wisconsin Department of Commerce Q EV LUATION REPORT p age 1 3 Division of safety and Buildings NOV 1 Q U S accordance with Comm 85, Nis. Adm. Code nh' St. Croix Attach complete site plan on paper r C I jBMirection e. Plan must include, but not limited to: vertical a and Parcel I.D. /� percent slope, scale or dimensions, north an and location and distance to nearest road. Please pf*?f all hwar"e"m R ' aixeri by f Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Locatio Richard/Robert/Loren Derrick Govt Lot NW 114 NE 1/4 S 22 T 30 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1310 Hwy 65 3 4 Pond View Meadows IV- City State Zip Code Phone Number ■ ity ©Village town Nearest Road New Richmond I WI 1 54017 ( 7j 5 -246 -5425 CTH G El New Constriction 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 Elood Plain elevation if applicable XT A ft. General commerft * iscontinuous bands of Is, 7.5yr4/4, 1" to 4 ", Om >7 a r �/� and recommendations: These are massive soils with the need for extreme y care ms ation tec ques of the s stPQmg ns y the 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. Boring Pit Ground surface elev. 102.30' ft. Depth to limiting factor >8Q in. Soil Appl ication Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i 'Eff#1 'Eff#2 1 0 -9 10yr3/3 - sil 2mgr dsh cw 2f .5 .8 2 9 -30 1 4/4 sil 2msbk dsh cw if .5 .8 3 3 _ 8 7.5yr4/4 is Osg ds cw - .7 1.2 4 38 -80 7.Syr5/6 ls* Os dsh _ - 5 7 2 Boring # Boring `Cx l Boo.64 '� � 33 > so El Pit Ground surface elev. ft. Depth to limiting factor in. Soil , won Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -7 10yr3 /3 sil 2mgr dsh cw 2f .5 .8 2 7-12 1 4/4 sil 2msb dsh cw if 5 8 3 ( 12 -80 1 7.5yr4/4 s) Om dsh - _ .3 .5 k) 36 " ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L " Effluent #2 = BOD < 30 mg/L 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 Parcel ID # Page 2 of 3 ❑ Boring � g Q Pit Ground surface elev. 96.30 ft. Depth to limiting factor >82 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. *Etf#1 'Eff#2 1 0 -9 10yr3/3 - sit 2mgr dsh Cw 2f .5 .8 2 9 -23 1 4/4 - sil 2msbk dsh cw if .5 .8 3 23-41 7.5yr4/4 - sl Imsbk dsh cw - .4 .6 4 41 -82 7.5yr5/6 - sl Om dsh - - .3 .5 F-1 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 GPDAF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 'Eff#2 Boring # Boring Pit Ground surface elev. ft. Depth lo lirrriting factor in. Sal Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots � GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 Effluent #1 = BOR > 30 < 220 mglL and TSS >30 150 mg1L ' Effluent #2 = BOD < 30 mg& 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 - 2648777. SBD- 9330Tea (207100) i ' BM1 TOM OF CONDUIT 100' ' BM2 TOP OF CONDUIT 98.20 THOMAS C NELSON BI 1.02.30' pis 14 227387 B2 10� 1 0 0 , (o ff Lo 1gt B3 96.30' ��. 208 SLOPE 100' "2 ss' ... 98' 253' v SCALE 1'=40' 235' 181' 2.0 ACRES SE LOT CORNER POND VIEW MEADOWS 11 l NW1 /4, NE1 /4, SECTION 22 T20N -R18W, TOWN OF RICHMOND LOT34 PAGE 3OF3 POND VI _MEADOWS T 33 / J �B ip N 100' � , BM2 B2 _ 215' 1 6% 410' SLOPE n �. 2.02 ACRES S 253' B3 02' 235' 65' 96' 185' SCALE V=40' 111' BM1 TOP OF CONDUIT 100.00' BM2 TOP OF CONDUIT 98.20' B1 100M! B ar B3 92.00' IT SW LOT CORNER THOMAS NELSON 227387 "cl a �� — ,ate- c oT 3 V s, , POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa ( C , _ -F!LE INFORMATION SYSTEM SPECIFICATIONS Owner A Permit — Septic Tank Capacity (Z S d a C N 3 3 33 Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model .4 — IO ❑r,� Number of Public Facility Units ❑ NA Pump Tank Capacity X00 a , h i Estimated flow (average) ( ©p ; al /da Pump Tank Manufacturer W S o� n f Design flow {peak), (Estimated x 1.5) 40 ®© gal/da Pump Manufacturer Soil Application Rate S s /ft Pump Model C� g r, Standard Influent /Effluent Quality Monthly � /da average' Pretreatment Unit `I Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter y Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) _ Biochemical Oxygen Demand (BOD,) 530 mg /L n- Ground (gravity) ❑ In- Ground (pressurizes; Total Suspended Solids (TSS) 530 mg /L ❑ NA �❑ At -Grade XMound Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip-Line ❑ r: Oth P e maximum Effluent Particle Size Y in dia. ❑ NA Other: G *,ner- ❑ NA Other: 'wa,ues typical for domestic wastewater and septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once'every: ❑ month(s) (Maximum 3 years) ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume _ Inspect dispersal cell(s) At least once eve ❑ month(s) ry' ❑ year(s) (Maximum 3 years) Clean effluent filter At least once every: ( ❑ month(s) _ year(s) inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) F ush laterals and pressure test At least once every: ❑ month(s) Other: ❑ year(s) At least once every: ❑ monthW ❑ year(s) Other: -- MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificat c Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator . a inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or iea� s measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surta_r The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pons of effluent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition and requires t, mmediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the er.' r_ contents of the tank shall be removed by a Septage Servicing Operator and dispoged of in accordance with chapter NR. N ✓isconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pre ssurized components units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer, ponents, pretrea, n - A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. _ I 1, AND OPERATION -� � construction, prior Page w to use of the POWTS check treatment tank(s) for the presence of paintin r ` maY impede the treatment process and /or damage the dispersal cell(s►. If high concen the tankls) removed by a se g P oducts or other cne , ptage servicing operator prior to use, trations are detected have he contents System stars up shall not o when soil conditions are frozen at the infiltrative surface. power outages pump tanks may fill above normal highwater levels. When power is restored the excess wa s t ewa t e r c scharged to the dispersal cell(s) in one large dose, overloading the celys) and may result in the backup or surface dis n r effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator 0 power to the effluent pump or contact a Plumber or POWTS M operating o a " , estore normal levels within the pump tank. aintainer to assist in manuals prior to ,es 10 n- Y p attng the pump ccn, ros .c Ce not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or com train 15 feet down slope of any mound or at -grade soil absorption area. Recuction or elimination of the following from the wastewater stream may improve the performance an pac ,. ~c V POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfects foundation drain (sump d prolong the P pum ) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; med cattaions '3 pa nt ng products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the s.ster- proper and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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 ;,, sec soil, gravel or another inert solid material. CONTINGENCY PLAN the POWTS fails and cannot be following repaired the measures have been, or be taken, to replacement system: p g provide a code comp�:an� A suitable replacement area has been evaluated and may be utilized for the location of a replacement soii acsorct:cr' system. The replacement area should be protected from disturbance and compaction and should not be infringed uper. required setbacks from existing and proposed structure lot Jines and wells. Failure to protect the replacement area w; result in the need for a new soil and site.e.valuation to establish a suitable replacement area. Replacement systems m .st comply with the rules in effect at that time, A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In P technology a holding tank may be installed as a last resort to replace the failed POWTS, v T N alua b 7 111 1 I e ate �fZ D4 - �101T�h 11 oI ra ; ar. ANSI KU D^j Mound and at -grade soil absorption systems may be reconstructed in lace nfiltrative surface. Reconstructions of such systems must comply with the rules in effect at that dime the biom at the < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ,DDITIONAL COMMENTS D'O'TS INSTALLER dame E POWTS MAINTAINER �oN €�L � Phone � /Z `r1L7 Name Phone :PTAGE SE ICING OPERATOR ( MPER) Name t 5 LOCAL REG TORY AUTHORITY pnone �C Name C' d Phone s o�cume t was draped in compliance with chapter Comm 83 . 22 ( 2 )(b)(11(d) &(f) and 83,64(1), (2) & (3), Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 1 5_ 4 R 4 V A Dz ,l Mailing Address Property Address 2 LI I if 4t A ✓ (Verification required from Planning Department for new cons tion) �1! 1� City/State Nd-� �lc.�t U1� Parcel Identification Numb r O 10 (oS -3 oS 0 LEGAL DESCRIPTION P 1 Property Location '/4 N '/� Sec. 2 7- T N -R j g W Town of Subdivision Pp M t n L42 S M . Lot # 3 Certified Survey Map # 7 17 -S , Volume Page # Or 7 Warranty Deed # 7 4 a te ' 4 , Volume ? 7 qZ . Page # yS3 Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintena ncc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the s)'scerr can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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 Zoning Office R�thin 30 days of the three year expiration date. LLP SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ovmeRs) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 A : aj--- - a / /( / o SIGNATURE OF APPLICANT DATE • * "" Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. `• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2 7 9 2 P 9 5 3 -7 8C=>85 cm, s KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO.. WI RECEIVED FOR RECORD Document Number Document Name 02/03/2005 10:00AII WARRANTY DEED EXEWT # THIS DEED, made between Loren D. Derrick, Rose H. Derrick, Richard L. Derrick, REC Joan L. Derrick and Robert J. Derrick ( "Grantor," whether one or more), TRANS FEE : 11.00 TRA FEE: 200.70 and Brian Adrian 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 l Name and Return Address ease attach addendum): Lot 34 and View Meadows III. St. Croix County, Wisconsin. ^.' i CrKIIEY AT LAW F'.0, COX 359 HUDSON, W154010 026 - 1065 -30 -050 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 1 Dated obert J. Derrick 17 (SEAL) * ren D. Derrick *Rose H. Derrick (SEAL (SEAL) *Richard L. Derrick *Joan L. Derrick AUTHENTICATION ACKNOWLEDGMENT Signature(s) Loren D. Derrick, Rose H. Derrick, Richard L. Derrick, Joan L. Derrick and Robert J. Derrick STATE OF ) authenticated on ) ss. V �,,' COUNTY ) *Kristina O land I Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson. WI 54016 My Commission (is permanent) (expires: ) (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- PROT" Legal Forms 800 - 655 -2021 www.infoproforms.com i 1 Ip op AV F . . . i • . . . r . . r . . - . • • r - r . . . • . 1 ,ACM (117,191 34 FT,) ll i }