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HomeMy WebLinkAbout026-1290-02-000 Wiseonsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 487961 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)]. p Permit Holder's Name: City Village X Township Nrcel Tax No: New Horizon Homes Inc. I Richmond, Town of eA • 7-90 - QZ -0 0 CST BM-Elev: Insp. WWElev: I BM Description: Section/Town /Range /Map No: 06 . Co(o 'So — u. $ I uaa aQ 22.30.18. TANK INFORMATION ELEVATION DATA TYPE MAINUFACTUj3ER CAPACITY STATION BS HI FS ELEV. ^AV _p h -too �• — �� -ler. Septic 1 /, Benchmark g 1 3� � . Dosing � e \ K U ' Alff BM ,t9tiwWt9 , Aeration Bldg. Sewer 03.2a r Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r \ _ p l Septic Dt Bottom rv�, )1 S • Dosing (A .� w �. � ( Header /Man. Aeration Dist. Pipe �c( :kf O / Holding Bot. System r I t s - . �O PUMP /SIPHON INFORMATION Final Grade `6 )\, I Manufacturer Demand St C er _ nn r b�i GPM O .O.rt'svSa•r er►. �w•�4 2. 0.(00 Model Number l v;� h 2J�. Z,o TDH Lift Friction Loss System Head TDH Ft o O' orcemain Length( Dia. rr Dist. to Well 1 5 0 2, C SOIL BSORPTION SYSTEM RENC Width i Length t No. Of Trenches PIT DIMENSIONS No. Of Pi Inside Dia. Li uid Depth DIM NS D QD ' SETBACK SYSTEM TO !! P/L BLDG WELL LAKE /STREAM LEACHI G anufacturer: INFORMATION CHAMBER Type Of System: -Z UNI ode[ Number. DISTRIBUTION SYSTEM Header /Manifold r Distribution x Hole Size it x Hole Spacing Vent to Air Intake Length Dia 2' Length SS •O Dia Z 'D Spacing �j Z 2-4 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over j xx Depth of j yx Seeded /Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes ` No Yes ^I No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: XPOV 0 Inspection #2: Location: 1402 129th Street New Richmond, WI 54017 (S 1/2 SE 1/4 22 T30N R1 8W) Lundy's North Lot 2 Parc I No: 22. 1.) Alt BM Description = ' '�� Z AP Bldg sewer length = ( +-�'�1 - amount of cover = I{Z N +. 9,zk cam_ Plan revision Required? No Use other side for additional CCC��� —, _ ►� �`O'" °� — - - - —� Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) �Yc -a-A � e ll— L I&I— N eu • ZZ� 'r A�s -- L lT h "� t1 PLOT PLAN t- PROJECT New Horizon Homes Inc. ADDRESS 1475 Hwv 65 New Richmond Wi 54017 S 112 SE 1/4s 22 /T 30 N/R 18 W TOWt10NAhLj ond COUNTY ST. CROIX SYSTEM ELEVATION 106.0' Y_ BEDROOM 3 CONVENTIONAL AT- GRADE. )OOC CONY LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter Zabel A -100 ❑BOREHOLE O WELL *H.R.P. SameasBenchmark AL B. M. 368' Property Line Area 15' below Nt system is to remain undisturbed 5% Slope B -3 104.5' 106' B -1 106.5' Grading is to be done to B-2 divert run -off away from system Huffcutt Combo Tank 321' Property Line Tank is to be properly bedded and provided with iockdown covers Pro 3 Well is to meet with approved warning Bedroom all setbacks labels House found in Comm. 83 129th St. 2 Zoo L•d d96'Z0 00 Ol 9aj Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7162 5 i_ ' C �('� 1 N vischansin Madison, WI 53707 —7 62 Sanitary Permit Number (to be filled in by Co.) 6 26 151 Department of Commerce < 8. Number t Sanitary Permit App cation State / Plan I.D. QQ In accord with Comm 83.2 1, Wis. Adm. Code, personaLinterrtvtlllf you provide ! P✓ maybe used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different t han mailing address) I. Application Information — Please Print Alt Information *- Iz1Q Z /2 / 5 Property Owner's Name n C T 9, 8 2 0 0 cep# Lot # Block # J1 I Property Owner's Mailing Address ST. CROIX COUNTY Property Lo ion ZONING OFFICE = Z Z ',y, J E ' / +, Section City, State Zip Code Phone Number / t T 3 0 N; ICE W 11. Type ot Building (check all that apply) 6X a ,p 1 or 2 Family Dwelling — Number of Bedrooms El /�OJ� Qia,ti /(�p Sub // division Name // CSM Number _r I k /VD �Yv Public /Com L mercial - Describe Use t � �Oea.SR.wtevW _ _ yy �` !� / ftl / ❑City ❑villag>'4ownshipof Il,� ❑ State Owned - Describe Use fti 111. Type Permit: (Check only one box online A. Complete line B if applicable) A' ystem ❑ Replacement System ❑ Treatment/Holding Tank 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 System: (Check all that appl ❑ Non — Pressurized In Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil t - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel - less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: Desist Flow (gpd) esign Soil Applicatio Rate(gpdsf) Dis ersal Area Requ ed Of) Dispe 1 Area Proposed (sf) System Elevation 7 j /off -J7- 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 n Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the unders' d, as responsibility for installation of the POWTS shown on the attached plans. Plumber's 's (Print) Plum s Signature Mp1A4P um r � Business Phone ber ,49 1,4'YZ 7 !77nr I Plumber's Address (Street, City, State, Zi ode) i =y m 7 VIII. Coon /De artment Use Onl pproved t Sanitary Permit Fee (includes Groundwater Date Issued Issuing nt Sign re Stem s) Surcharge Fee) G oa O ._e en Reason enial Z5 �� 3 bs IX. Conditions of Approval/Reasons for Disapproval 3) SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must all be services / maintained fI �n o,r�e of as per management plan provided by plumber. aU 1 l dtCC VAA06� 2. AN setback requirements must be maintained W o o J X9.1. 4 AaAC Q_ as per applicable owe i offtlarlces. A)o �- 116LAIdn' 8 eq%-,� Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size fi r SBD -6398 (R. 01/03) Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sconsin w ww.coce.wi.gov/sb www.wisconsin.go of Commerce iscosin.gov Jim Doyle, Governor Mary P. Burke, Secretary I October 26, 2005 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/26/2007 Identification Numbers Transaction ID No. 1208934 SITE• Site ID No. 706468 New Horizon Homes Inc Please refer to both identification numbers, 129th Street above; in all correspondence with the agenc Town of Richmond St Croix County Sl /2, SEI /4, S22, T30N, R18W Lot: 2, Subdivision: Lundy's North FOR: Description: Three Bedroom At -Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1047130 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); 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: Reminders • This system is to be constructed and located in accordance with the approved plans, and with publication SBD - 10570-P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD - 10573 -P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/8 1)". C0nnil ,,kggyy.���^^ ��� S i 1 • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. ' Soil compaction, excavation vehicular traffic and other similar activities that im pact the treatment and D ARTMENT P P dispersal are prohibited. OZ(OFFT, • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption SEE CORRE area. chs. NR 811 & 812c • 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. SHAUN R BIRD Page 2 10/26/2005 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • 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 inspec Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. 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. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of P construction/installation/o eration. i 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 $ 175.00 / Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 RECEIVED 715- 246 -4516 OCT 1 9 2005 Date: 10/15/05 SAFETY & BUILDINGS Owner:New Horizon Homes Inc. Location:S1 /2 SE1 /4 S22 T30 N,R18W Lot 2 Lundy's North Richmond System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and C ntigency plan 9 -11. Soil test ry s Shaun Bird 'F- Ciyn Signature - ° 67 Gs License number 6900 PONDery II PLOT PLAN PROJECT New Horizon Homes Inc. ADDRESS 1475 Hwv 65 New Richmond Wi 54017 S 1/2 SE 1 /4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 106.0' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark ge c t B.M. 368' Property Line Area 15' below system is to remain undisturbed 5% Slope B -3 104.5' 106' B - 1 106.5' B -2 Grading is to be done to divert run -off away Well is to meet from system all setbacks h cu Combo Tank found in Comm. 321' Property Line 83 Tank is to be properl bedded and provide with lockdown c ers Pro 3 with approve arning Bedroom / labels House 129th St. t • 4 M h dft r . L k-- tin, #4 L EA WELL STA it t �£D CB�� `�RTtb B [�'� � � - iISB 112 B i _ � FA CE �.t. o f fz � I2 2- rt84Ra�tEa 5�ru-ct#� c. Fabric # Distribu Lateral STRBILMLb O bservation------,. . Soil Corer Well >5 A Y 5 L &E. Wisconsin At - gxa� Unit with a Plan View and cross Section of in Site Single Ab Area on a S1 o p g C ��. ; i page Of Distribution Pip-, OetAil for Lateral Xetwork Arse s�' T URK - uP (Clx tr�ouT) y PVC Force Main PpvC Distribution Pi _ P = Last Hole Should Be Next To ruRN - Hole Dia;seter 1.3 � Inth X Inches Lateral Diameter __ Inch(es) y inches force Main Diameter Z r Inches .F Of Holes /Pipe �J Invert Elevation Of Laterals Signed: License Number; Date: SEP11C TANK P�3MP CHA C t}SS 5£CTsOX AND Sp£etr ICATIONS u'� G SENT PIPE IZ'* Mlrt _ ABOVE GRADE jUNCTION BOX �RE}j,�Ci7�Efi `RflM D4f3k. O �'�€ C ONDUIT W1 gADtcx IREa .�kIR INTAKE: r G�rn« MAIMING LABEL GRADE ✓ `rf� HZl. s s I #LET ' GAS WAT£R TI GHT SEALS rT ; �� ITH { �,- �C,€�. Lm _ APPS PIPE 3 • (?IiTO $ N SDI„ I D SOIL APPOVED plPE 3 SUL C OFF ID � FT. SEAL PUMP OFF ELF 3' ,APPRODVED BE'D' lXG UNDER T'NI CONCRETE PAD DAY:- SEPTIC f DOSE 3'f BE OASES P£R ____ ---- -- FACTURER : � � c JjDI NG s TASK mAlfi DOSE V OWME IN � GAL" SEP % C G E� GA 3.. P LOc ---- ----"' ? TA)lX SIZES: �� L. c �� DOSE __. - --- !� CAPACITT S: A~ 8 �3 '. ALAS MA f'AC'1 IR = " MaDEL �3TYP E: : � � _ INCHES = 0;7,0,S L S1iiiZTCM TYP . �' /� / C GAL PUl4P MANUTACVRER x N i .S` — KODEI. D1 Typj = I LHR i5. WA( SNITCf3 TYPE= �D i POtfP Ai:JARM W3[R'NG AS PER FEET REQUIRED DI5CNARGE �tAf 3ISTgIICH� pIP£ pUMP OFF AND _ _ _ VERTICAL DIFFER'ENCEagTWE�R£sSURE .F�' - TgI�TIoN FAeTQR - �-- FEET MI 13M N ©Ax I �T1IE3o . � 731 C �. _ FEET F�3RC / � wjlD FH__b/ - DIAMETER - F3�T£ft A3� DI"ENSl()NS g t�fP `Eti3,tK- L IQUID �.. '" { T y/ .Mt ♦{ �}[ .' ._ -DATE' 5IGNED- TOTAL DYNAMIC HEAD /CAPACITY • PER hilNIJTE o .FfLUENT A.ND DNATERING HEAD CAS ACITY CURVE E MODEL 152/153 152 153 j � MODEL f . 50 i Feet Meters Goi. Liters Gnl_ I Lters 5 1.5 69 261 77 291 153 10 3. 61 231 7D 1 265 12 40 152 15 4.6 53 201 61 231 a 20 6.1 1 44 167 52 197 T 3Q 25 ?.6 1 34 129 1 42 159 a 8 30 9.1 -L I 87 33 i 1 25 1 o 35 10.7 -- — 22 ' 85 r 9D .0 12.2 i -- ' -- t t ( �2 zi! o Lock V o l ve: 38.0 Ft. t11.6m)j44.0 Ft. (13.4m)1 4 0 1450 10 1 0 100 20 40 so so GALLONS �-�- s 1 / 4 LITERS D 80 16D 240 320 3 27/3 4 5 /e—j 1 FLOP! PER MINUTE i I . 3 27/92 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. °" ® 1 3 `7 /3z Electrical aftemators, for duplex systems, are available and supplied with 1 - an alarm. ��— • for controlling single phase Variable level control switches are available S systems. 1 • Double piggyback variable level float switches are available for variable ( 1 I level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130'F. (54'C.) special quotation required. I 12 152f153 Series • 1 �� i52h53 d Contt f Sete on 1 / R� l Model volts -Ph Alode +� St++1 1 � Du i 5 1/5 N752 Non 8.5 7 2 or 3 115 1 � 9� BN152 115 1 Auto 8.5 oc 3 included 2 E152 230 1 Non 4.3 1 2 or 3 8E762 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10'5 1 2 or 3 SELECTION GUIDE BN1 116 1 AuW 10.5 Included 2 or 3 E153 230 1 Mn 5.3 1 I 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 21 t Auto 1 5.3 included 2 or 3 swiicA. Refer to FM0477. d CptJT10N 2. See FM0712 for correct model of Electrical Altemator E-Pak- Au installation of controls, Protection devices and should be done by a qualified 3. Variable level control switch 10 -0225 used as a comrol activator, speafy duplex (3) kensed electrician. Alt electrical and safety codes should be followed including the most. or (4) float system. recent National Electric Code ( NEC) and the Occupational Safety and Health Act (OSHA RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL TO. P.O. BQX 16347 Louisville. KY 40256 -0347 MalluFAChsof.. SHIP 70: 3649 Cane Run Road Louisville, KY 40211-1961 Qveu�y f 7 l�lias SNCf I� : f 502) 778 - 2731.1(800) 928 -PUMP hftp://wWwsodler com Az FAX (64 774 -3624 p Copyright 2000 Zoeller Co. All rights reserved. POWTS QYIlNER'S MANUAL $� MAN I PLAN PaQe o SYSTEM SPEG[FICA7TONS • - rank Capacity at ❑ NA nt7N �- Sepfs INtf'OFRM Ftt A E , is Tank Manz r SePh ffluenf Filternu�aCtutsr .� ❑ NA Petmd - E �If�EDr, l Q NA Pp� EfRuent � DNA NwberOf OWT pump-Tank Caps ' Number of Unfls agd PUMP Tank E f Mar►ufatrBr NA bw (age} NA To � � . pilm� Mantrfaidut� Deem now ■ t�mated Pump Model 1 NA � aYd nt Unit Son Appr�' Rate Monthly average' Prt SandlGravel F .� - ❑Peat Filter inftt� QuarttY Sat? mg/L p Mechanical Aeration O Wetland G Other Grease a Oth Fats„008 `L2fl mg11. ❑ Disinfetdion �! oxygen Demand (13005) 50 m !L M BIOCth6 S .^°t'sds {TSS� 51 Mtn Monthly average Dispetsa► t;e(gr p in (pressurized} Pttef Efti�QuaRY OD S30 mg1L a L nd (gtavRYl p Mound en Demand (B ce p Other grocttemrcat t;1xYg � Sat? men- ne Total Suspended Solids (T ) :5, o cf&I OOmi 13 Fecal GortioaT' �yeotnetric mean) s tYp� for domestic (non axs+wdasl " 0Mri90C1n ' a Y inch diameter w tank effluent KA2ucimum Edituerrt Particle Size values typi:w rnr pretz"W rrasborruu. MjU NTStip,FiCE SCHEDULE service Frequency Service Event p month earls) (Maximum 3 yrs.y At feast once every eq u als one-third (t',) of tank volume inspect condition of tank(s) When combined sludge and scum pump out contents of tank(s) p months r(s) {Maximum 3 yrs.) di celi At least once every r(s) Inspect pe p month At least once every s) p NA Clean effluent filter mo At least once every s) 0 NA inspect pi p. pump controls & alarm —� 13 mon Flush ths Mends and pnWsure test At feast once every ftAt ast once ever)' D months f1 year( ❑ NA ob+e< Q months ❑ year(s) 0 NA ast O nce every oMsr. Plumbe iW NTENANCE INSTRUCTIONS it m2de by an Indnriduaf carrying one of the following ri tdmr. e InspedWA Of Ian" artQ dlspensaf spa Sewer, POvvTS inspector. Mas PONrTS Ma� htarner. Septage ter r:' Master Plumber Restrit�d or broken SAS Tank eons must include a visual Inspection of the fan a(�d sc um 'any back up teaks, measure the volume of combined sludg by o check c h ec k the effluent levers hartfwgre • an y ct the The dispersal ceii(s) shat! T be usercalfY to or pond'mg of effluent on the grptrnd surface- nd' of effluent cn the grrsund surface. The ponding of effluent on the the obseryafiort pipes and to check for anY po a fatTin cpnditfon and requires the irnmediaSe notification of the roof � vo �'" gro und fauface nay indicate g equals one (} nr more of When the combined accumulation of sludge and scum in any tank e4 of in aacordarfae with ch NR entire a of fhe tank shall be removed by a Septage Servicing Operator and disposed 1i3, WJSOOrrsin Admini�t"re Code- i nt components: and any nit ai or pm5surzed poWTS components, pretreat - The Sung of effluent fifth. mecha tW pOWTS Mainta+nef other maintenance or monkoring at intervals Z months or less shall f Q dorm comp a M leffoln of arry Service event. d,1YS Of A SOirbge n,.port shObe provided to the local regulatory authority wrthln 4 START UP AND OPERATION se= of painting produce , other 'or to use of the POWTS rheck,treatrrterattonk {s} far the p m For new oonstruaion, An COs . f f conCenbs one are chemkafS that may nnpede the treatment process and/or damage the cis a P Or to . n of the tanks? removed by a septage servicing pefe d have the conte , _ - Page or - c o nditions are frozen at the infiltrative surface - Sys� art U Shalt not o tr 1Eltieri sots co power is Frei the e=ess es t�F tad5 may fill aboHe n orm al higtnrrater levels. When paww s and may n�trft in the Muing „vg! tie d' rscttarSed tfte drspef in one Large dose, avetioadng the ce11( ) id this sifirafion have the bado�P d rof t To avo contents of the pump lank removed by a prier DD - te - - rl3 power to the effluent pump ar contact a Pfurnber or POWTS Maintainer to a e Seceic ng CWeraW P r r w b'as to restore normal revels within the pump land[ ash in ntanu* o 9 over ta and dtspersal its_ Do not drive car gall[ D not drive or park vef ww over, or of erwise dishirb or cotltPact, nks the area vein 15 feet down Slope any mound or at -grade soil absorption ar�ea m the wastewater Stream may de improve the performance and probrig ft fife Redaction or- erunlnaWn of the fo77own$ ��� butts; condoms, cotton swabs: grMs�- dental floss: dcapecs; of the PC)1NTS- anti"bioGt`s; traby curt eater, fruit and vegetable peeruigsi gasoline; gmase; herbitxdes; [neat dcsinfet �On dtaht {scoop p. p} . trted'x�tions; 0 ; }ring products. pe 'des. ` napkins; tampons; and wafer softener brine AWWD4NjWENT B taken out of service the fotloyAng steps shah be taken to insure that the wf2en the POWTS taUs and/or is p y. t"ance t� ch” Gomm 83.33. Wrscansin Admin7strative Code: system is property and Safi* at2andoned a isco disconnected and the ab All Plptn9 to tanks and pits sE2afl -be perfy di p Fife oOW2Se� SerWC' �p�r 71,c contents of aH tanks and pits shall be removed and pr operfy p riemoved antf • After pumping. a8 tanks and p� shaft be excavated and removed or their covers space Med yih soli, gravel or another inert solid material GONtT(NGENCY PLAN t be repaired th following measures have been, or must be taken. to provide a code if the pOWfS falls and canno COMptrant replacement system sod upon by required A suitable re placement - area has been evacuated and may be utilized for the location c a pac o n and should not absorption gym- The replacement area should be protected from disturt�anoe and c a well be infrirequired setbacks from e)asting and proposed structure, lot lines and welts_ Failure to protect the replacement area wiu result in the need for a new soil and site evaluation to establish a sortable ment systems must comply with the roles in efl`e- i at that tirrre reptacemerrt area Reptaoe A suitable replacement area is not ayaltabfe due to setback and/or soil limita5ons Barring advances in P01MTS technology a holding tank nay be instaifed as a last resort to replace the failed POWTS- of the POWTS a sod .and 4 _� site ttas not been evaluated to identify a su itable repiacerr�ent area Upo area is avertable a s evaluation ny t be performed to locate a suitable replacement area if no replacement kfing tank may be insWed ss 3 last resort to replace the failed POWTS- be reconstructed in place f removal of the biomat at ll[oursd a{sd at -grade so?f absorption hem s m �` the irtfila2 eve surface, Reconsi��ns of such systems must comply w ith the rotes in effent at that tune «WARNING» TANKS MAY CONTAIN LETHAL GASSES ANDfOR INSUFFICIENT OXYG & SEPTIC. PUMP AND OTHER TRFATNIE T CUZCUMSTANICES. DEATH MAY L) H M OT ENTER A 5EFMC, PUMP OR OTHER TREATENT TANK t1NDER ANY RESULT. - RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR MPOSSlIM E annm ONAL COAffMENTS POWTS INSTALLER POWTS N AINTAINER i�tame 5 �. cr. u 1✓ �! Name , - cr y✓ > > Phone --� Phone I SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY /�tJTHORI7Y Agency � ' L Name j �? - Phone / i� � Phone 'l ),J '` 7 Tins aoaxrrentwas *acted by. the sUft of Vw SOW LOLL AUMuette and Waushara County Zoning and SarAafion agwdm This doannent rrteets the minimum nqukamwts of ctt. Comm 8322(ZM)(1M&(t) and 83.54(l).(2) if (3). W+sconsin Admk1htta6vo Coda Use of 11275 doclrtnent d0C5 Mt guarantee the performance of the POWTS. G W MOI) I i Eaccp S _n [l scarlsin Department of Commerc e Wi EV LUATION REPORT Page of Division of Safety and Buildings l � s. Adm. Code County c Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revi ed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). � ` Property Owner Property Location n Govt. Lot 1/ 1/4 S OOT..30 N R/ � E Property Owner's Mailing Addr ss L% # 610dc # Name CSM# City State Zip Code Phone Number ❑ city ❑ villa e To Nearest r o Ne w Construction Us Residential / Number of bedrooms - Code derived design flow rate � GPD Replacement ❑ Public or com Describe: Parent material �� GdC�iTU/ Flood Plain elevation if applicable -- -- -- .eft. General comments and recommendations: s JS�Gy✓ �� l Boring # Boring J Pit Ground surface elev. �.�-- R Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 7n z a Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0 - 1 S 3 , a /. 'L- / S Lt I J ,,sjq /- Ld 9 1 1- - m� m a. rti • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 06A Effluent #2 = BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ig a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conduc ed Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �—1 715 - 246 -4516 Cot— Property Owner _ Parcel ID # // Page of Ong # ❑ oring F—il Pit Ground surface elev. " J ft. Depth to limiting factor L.. in. S«I ication fiats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 — 1 /D W ,- 3 1 7 1 a n. r t= c S e2 ( 1.6 2 d C_ < Y 1 F a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 'Eff#2 F Boring # C] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icafion Rate Horizon Depth Dominant Color Redox Description. Texture Stnxture Consistence. Boundary Roots GPDRf in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30:5 220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD, < 30 nVt and TSS < 30 VrVIL 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. SMM330 (RAM) .� Soil Test Plot Plan ProjVt Name Environmental Holdings LLP Shau Address 70619th St. Hudson Wi 54016 C M #226900 Lot 2 Subdivision Lundy's North Date 12/1/04 S 1/2 SE 1/4S 22 T 30 N /R W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 106.0 *HRpSame as Benchmark Alternate Benchmark Top of 1/2" Pipe @ 100.3' * Alt.B.M. Scale is 1" = 40' B.M. unless otherwise noted 368' Property Line 130' 5% Slope 30' B -3 104.5' S0 ' AL 35' 0' 100' B -1 100' 106.5' B -2 321' Property Line I Please note: soil test may not be suitable for owners desired building location, Soil test was done to satisfy zoning requirements, please verify system location before excavating. U. 2 8 0 5 P 2 7 6 7'135338 State Bar of Wisconsin Form 1 - 2003 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number Document Name ST, CROIX CO., MI THIS DEED, made between Environmental Holding Company,— RECEIVED FOR RECORD LLC, a Wisconsin Limited Liability Company 85/18/2805 12:45PK ( "Grantor," whether one or more), and New Horizon Homes, Inc. WARRANTY DEED EXEMPT # ( "Grantee," whether one or more). TRANS E: 675888 Grantor, for a valuable consideration, conveys to Grantee the following COPY ED described real estate, together with the rents, profits, fixtures and other PAGES: 1 appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Lots 2, 6, 8, 10, and 21 Lundy's North, Town of Richmond, St. Croix County, Wisconsin. Recording Arca Name and Retum Address �()t f 9 Part of 026 - 1066 -95 -00 and 026 - 1067 -30 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements and Restrictions of Record. Dated May, 1 2005 E 0 1 ding Company, LLC (SEAL) �._ (SEAL) * * by 5ehCWarren, President (SEAL) (SEAL) i s * AUTHENTIC a ACKNOWLEDGMENT Signature(s) y STATE OF WISCONSIN ) NUIAKY ss. authenticated on St. Croix COUNTY) PUBLIC Personally came before me on b!av, 17, 2005 , N>► Z` the above -named Jeff Warren * J. TITLE: MEMBER STATE BAR O S to me known to be the person(s) who executed the (If not, f egoing instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: *Mari a J. Bune Michael H. Forecki, Attorney At Law Notary blic, State of Wisconsin Eau Claire, WI 54701 My Commission (is permanent) (expires: 11/20/2005 ) (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 STATE BAR OF WISCONSIN FORM No. 1 -2003 *Type name below signatures. Attomey Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Chits W154701 -7928 Phone: (715) 835 -3029 Fax: (715) 835.4112 T60636262FX Merilm J. Bune Produced with 2ipFoltn*'- by RE FormsNet. LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (8001383.9805 www.zbfoan.mm ; j III I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer AaC-w JkUa /7 u,nJ Mailing Address 7 �_��} w -s add, Property Address n I �T 0 714 (Verification required from Planning & Zoning Department for hew construction.) City /State g aZj),22ve!V_ Parcel Identification Number LEGAL DESCRIPTION Property Location ! �_ 1 /4 , 1 /a , Sec. A , T 3 e� N R 1 _ W, Town of Subdivision L. "4 Y ^'z42 U , Lot # Certified Survey Map # Volume , Page # Warranty Deed # , Volume , Page # Spec hour yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Tmproper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put ipso the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §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. I /we, 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. Certifigation 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. I /we certify that all statements on this form are true to tficbest of my /our knowledge. I/we am/are the owncr(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. LSL47 - GN RE OF A ANT(S) DATE A ,: * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning De s *• 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) �•d dSO =IT SO 6Z 9nd • � � 2.32 AC. { -� \ (2.15 AC.) I � M 3.23 AC. LOT 2 \ . • / � (2.34 AC.) . •t \ � / I L.B.O. - 965.8 2.04 AC. / (1.85' AC.) �► �S`i ��, / 0/ , HWE + 979.5 2.84, y � \ (2.731 LOT 1 C.S.M. IN L.B.O. _VOL. 18 PG. 4828 v LOT 22 ---- - - - - -- 2.21 AC. .2 . se . { (2.06 AC.) (,-1N 14o ( Z D tV { ........ L.B.O. - 981 .5 .................... ...... Z { Ul Pat :4 0) N I S � IGN EASEMENT l ca 6 6• o — 442` 140th AV 30 ' M -- --- - - - - - - - - `-` 310.40' tD M S89 0 3 1 4 1 " W S 6 6' 1 E ®T 33 SOUTH LINE OF THE SE1 `, LOT 4 LUNDY'S PRESERVE � I ` P4 W i � ----------------------- SB9'31'11 "W 2652.09' { N i a ' )NED AG /RES CURVE DATA TABLE (ALL LENGTHS ARE IN I Curve Radius Central Chord Chord A i Number Length Angle Bearing Length L NTS C1 233.00 25'28'20" S11'59'15 "W 102.74 1 DO ANYTHING WHICH WOULD INTERFERE ON OF THE APPROVED COMPREHENSIVE EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, COUNTY )SION PLAN FOR THIS PLAT. THIS TOWNSHIP LAWS, RULES AND REGULATIONS (I.E., WETLANDS, MINIMI 1'0 BUILDING UPON, OBSTRUCTING, LOT SIZE, ACCESS TO PARCEL, ETC.) BEFORE PURCHASING OR ,ING, OR PLANTING IN ANY POND OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX COUNTY ZONING DRAINAGE DITCHES, WATER RUNWAYS, OFFICE AND THE TOWN OF RICHMOND FOR ADVICE. `IRASS SEEDINGS. 1` c7 i H 4-L- .69V i V) z u� wN n a49 too Z �0 O in cn :D w� cc 0 w I., C ! I (i �X v' Q4 0 �-U Q>t \ acn OZ oW .98b Z w ,561 Q0 w �� of v � .. w� Z� w cn w � wo D N •'•'� Ch T 0 �: p� r .4 1— �, p Val LL. 0 N O F. cd z ;it O1 � Oi J r „ J 0 W 00 t b/ US 3Hl 30 V/ l3S � �+ i 3H.L 30 3NII 1S3M W Z 13S 3Hl 30 */ LMS 3Hl 30 3NII 1S`d3 W I r-a 4; o N O Q E-. 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