Loading...
HomeMy WebLinkAbout026-1290-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488059 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: LeQue Builders LLC I Richmond, Town of O2 (o - 12 96. b 5 - 06 D CST BM Elev: Insp. BM Elev: 7 Description: Section/Town /Range /Map No: 22.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM 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 Mulched 10 Bed /Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1270 140th Avenue New Richmond, WI 54017 (S 1/2 SE 1/4 22 T30N R18W) Lundy's North Lot 5 Parcel No: 22.30.18. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes [1 - 1] No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) T ty d Buildings Division County W In 20 gton Ave., P.O. Box 716 «nsiin Ma 6 r�A V tary P it Number (to be ft11 in by Co.) Department of Commerce ( 66 1 g$p j9 Sanitary Permit Applic RR Ili Plan I . Number In accord with Comm 83.2 1, Wis. Adm. Code, personal informatio rovide H j I V ' may be used for secondary purposes Privacy Law, s15.04(I xm) (jpl�df CROIX Add r s (if different than mailing address) I. Application Information Please Print All Information Property Owner °s Name Q 1 arcel # Lot # Block #A1 Lli Q rS v yy ' o 00 Property is ailing Address Property Location 0. & s City, , ty, Lip Code Section Phone Number c ircle T � N; � or V� II. Type of Building (c eck all that apply) S � 9 1 or 2 Family Dwelling— Number of Bedrooms Es. Subdivision Name CSM Number d ❑ Public/Commercial— Describe Use �� t &)o t I T ❑ State Owned — Describe Use ❑City_❑ illage ownship of ` III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ` t t p IV. Type ofPOWYS System: Check all that a 1 R, f CV = ❑ Non — Pressurized In -Ground Mound _> 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurizes In- Ground ❑ Holding Tank ❑ Peat Fitter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ravel -less , \ V. Dispersal/Treatment Area Information: 6 .2 t}c J KA 6- kA/ /077. J Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required ys Elevation IQ00 oc? (p ©c ivl. a. VI. Tank Info Capacity in Total Number rfacturer Prefab Site steel Fiber Plastic Gallons Gallons of Units w' P PL S ZS Concrete Constructed Glass New Existing Tanks Tanks t' S Folding Tank t Aerobic Treatment Unit Dosing Chamber , / t F rS VII. Responsibility Statement- I, the andetsiga assame poasibi ity for is of the POWTS shown on the attached plans. uIr's Name (P tier's S nature RS umber Business Phone Number Plumber's Address (Street, City, State, Zip Code) l � tchi/no/ld t ui1t S VIII. Coun /De artment Use On X Approved ❑ Di Sanitary Permit Fee eludes Groundwater Date Issued Iss ing t Situ (No Stamps) Surcharge Fee) - yy�� _ \ El tven Reason Denial S 19 IX. Conditions p r"a al SYSTEM OWNER: 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 Comtry only) for the system on paper not less than 81/2 x t 1 inches in sire SBD -6398 (R. 01/03) � - yy � O , T - SID %P , QL iu Jet sz 1 E T- i � r r 1 s , } k , Jl- - -I- -_ - _! __I f_ I _�_ . ► _ Safety and Buildings 4003 N KINNEY COULEE RD commercemi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i s c o n s i n www.w www commer isco sin.go / Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary January 17, 2006 CUST ID No. 220537 ATTN: POWTS Inspector ZONING OFFICE CALVIN W POWERS ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/17/2008 Identification Numbers Transaction ID No. 1231141 SITE: Site ID No. 708821 Leque Builders Please refer to both identification numbers, 140th Avenue above, in all correspondence with the agency. Town of Richmond St Croix County S1 /2, SEl /4, S22, T30N, R18W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1058279 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Ezflow Mound Component Manual, (N.6/03), 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 enclosed approved plans and with the component manual(s) referenced above. • The EZflow synthetic aggregate bundles must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall have one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at the 12 o'clock position. The laterals shall drain fully after every dose. • All lateral ends shall extend out past the exterior end of the cells and terminate within 6" of final grade. An access box shall be installed for all laterals in order to provide access to them from final grade. The observation pipes shall also be located in between where bundle(s) come together. These requirements must be followed so that the aggregate bundles will not be damaged during the installation process. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. P.O.W.T S. Conditionally APPROVED DEPARTMENT OF COMMERCE nnmmf%u nC CACC ?V ALM R1111 niNGS CALVIN W POWERS JR Page 2 1/17/2006 • 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 $ 175.00 &46� Fee Received $ 175.00 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 jswirn@cornmerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 A� RECEIVED JAN 12 2005 SAFETY & BUILDIIUG r TITLE SHEET' S DATE PAGE OF MOUND SYSTEM FOR A4 BEDROOM RESIDENCE This plan has bmn Pared in accordance with the EZFLOW Mound Component Manual VERSION 2 -0 (N. 06/03)and the prmm Distnbirtion M VERSSION 2. SBD- 10706 -F (N. 01/01) 0 DATED IN THE II F THE 1/4 OF SECTION�T30N, R�W, TOWN OF � afl c�. ST. CROIX COUNTY, WISCONSIN. INDEX PAGE I OF 8 TITLE SHEET PAGE 2 OF 8 PLOT PLAN PAGE 3 OF 8 pLANVIEW CROSS SECTION PAGE 4 OF 8 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 8 PUMP CHAMBER CROSS SECTION PAGE 6 OF 8 SYSTEM MANAGEMENT PLAN PAGE 7 OF 8 PUMP CURVE PAGE 8 OF 8 CROSS SECTION OF E Z FLOW Le R �&Q P .0. �x is PREP D Y 205 POWERS EXCAVATING INC. 1969 185 AVE. NEW RICHMOND, WIS. 54017 PHONE: 715 -246 -5135 FAX: 715- 246 -5135 CELL: 715 -381 -9920 SEE CO ESPONDENCE 01 I -S_ -- w : A,! -c q J06 'i f t }t A4 T � { � i f , x_ � �___ (_. �___ ^_____ ( � G t_- i � {�_ -�.__� � ► (- { r r , E E , i t E t t f t �Q 8' Approved Barrier Cover -, 3 1 A5rM - 633F ill Material – . Distribution Cell Cap - _- 3 .► -- - — - ed Area %Slope Figure 3. Detailed cross section of a mound D lot i �l Cross Section Of A Mound System Using E /2 E F1 The Absorption Area F _� A Ft. H a fn B /0 C> Ft. K 918 Ft. :. L i Ft. Ft. Position I /! , 9 Ft. of -� a a3 Ft. Force Main L Observation Pipe EI K--) J F � ems. •.. >�- A w -- -- -1 - - -- ----- -L - -r� Distributiory Of p U i S Pipe Observgtion Pipe Plan View Of Mound Using A Bed For The Absorption Area r a DISTRIBUTION PIPE LAYOUT �9 Page�a c� Place 4 holes on the top side of the pipe and every 5 hole on the Bottom of the pipe. Extend the end of each lateral up with the use of long turn or 45* fitting to a point within six inches of the final grade_ Terminate the ends of the laterals with a valve threaded cap or threaded plug. Provide access fi om final grade for the valve, threaded cap or threaded plug. LAST CKWKE: AT c/9 poet AL c.AT L S ateral Manifold r -- Lateral l z x x x z z z x Lateral Len h Lateral Length Distribution Line Lateral Access box Manifold S Force main P O ft - Hole diameter l 5 � — $_ inch X _in- lateral - j — AY inch(es) Manifold A inches Force main a inches # of holes/pipe _ a !5 Invert Elevation of Laterals /oi, . Ft_ /00'2- t. 4" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHER PROOF 25' FROM_DOOR, WINDOW-OR JUNCTION BOX P ?AA_PPROdED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E WARNING LABEL L -- _ i ,� - ---_ 4 MIN . 1$" FIN • li LET i 'WATER TIGHT SEALS GAS- TIGHT SEAL APPROVED ...�_ ALM JOINTS W/ CI :I PIPE ! 5 -a .5 ' PIPE 3 ONTO 3' ONTO SOLID _T_ , SOLID SOIL SOIL PUMP OFF ELEV . g3. FT. t + ** RISER EXIT D PERMITTED ONLN IF.TANK . MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD ' SPECIFICATIONS SEPTIC 1 DOSE - TANK MANUFACTURER: NUM$ER'DOS£S PER DAY: TANK SIZES SEPTIC o GAL. DOSE VOLUME INCLUDING DOSE -J �o GAL. FLOWBACKi 99' Z GAL. ALARM MANUFACTURER: j fZ CAPACITIES: A = X9,5 INCHES = AL. MODEL NUMBER: 0 SWITCH TYPE: _ &No B = 2 INCHES = GAL. PUMP MANUFACTURER: Ce3 C = Gr3 INCHES = GAL. M ODEL NUMBER: TYPE: w D = / INCHES = o��Q� o� GAL. REQUIRED D HARGE RATE GPM C / ALARM WIRING AS PER I LHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . ... . . . . . .%. - FEET + ,50 FEET FORCEMAIN X 3.3 FT /100 FT. FRICTION FACTOR .,&5 FEET TOTAL DYNAMIC HEAD = 11�, �5 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH 38 �� a o, 6 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _�uf tgtE N1FOE�AATlON Owner S SYSTEM P ESE D ` 'Q rs Permit I) o o Tana Capacity aI Q NA Septic Tank Manufacturer r s Q NA DESIt3N PARAMETERS Effluent FiToer Manufacturer Number of Bedrooms Co Q NA Effluent Filter Model Number of public Q NA Facility Units Pump Tank Capacity © Q NA >= stimated flow [average) Pump Tank Manufactures Q Design flow [Peak!, !Estimated x 1.5) jAPump Mufacturer an Soil APPlicatian Rate Q NA Pump Mode! Q NA Standard influent/Effluent Quality y aeage Pretreatment Unit 8 m Q NA Fats, Oil & Grease (FOG) <-3() ©Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand [SOD 5220 mg1L Q NA Q Mechanical Aeration Q Wetland Total Suspended Solids [TSS) 5158 mg/L Q Disinfection Q Other: Pretreated Effluent Quanty Morsthty average Dispersal Ce11(e) Q RtA Biochemical Oxygen Demand (BOO 538 mg /L Q "round (gravity) Q In- Ground (Pressurized) Total Suspended Solids (TSS) 530 mg/L Q NA Q At -Grade Mound Fecal Conform [geometric meari) 518' cfu /100m1 Q Drip -Line Q Other. Maximum Effluent Particle Sue Y in die_ 0 NA Either Other. Q NA ❑ NA Oihar: Q NA 'Vak"s typicai for domestic wastewater and septic tank effluent. Other: 0 NA MANTMiTANCE SCHEDULE Service Event Service FnKpency Inspect condition of tanks) At feast once ev ery : a) iMardnntan 3 Years► Q NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y.) of tank volume 0 N Inspect dispersal cell(s) At least once every. Q months) [� 3 } ❑ NA Q yeffits) Clean effluent filter At blast once every: ❑ month(s} Vear(sI Q NA inspect pump. Pump centrals &alarm At least once every: Q months) years) Q NA Flush laterals and pressure test At least once every: 3 0 months) Other; years) Q NA At least once every; Other. motrthls) oth ©yrl8� Q NA MAWMANCE INSTRUCTION& inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber. Mester Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Se e inspections must include a visual in P9 S Operator. Tank Inspection of the tank(s) to identify any missing or bicker hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or po of effluent on the The dispersal ceUts) shall be visually inspected to aleck the effluent levels ai the observation g+ou surface. of effluent on the ground surface. The ponding of effluent on the Pipes and to cheek for any ponding Immediate notification of the local regulatory authority. ground surface may indicate a failing conditi and requires the When the combined accumulation of sludge and scum in any tank equals one - third %) or more of the tank volume, the entire contents of the tank shall be removed by a Wisconsin Administrative Code. ` icing Operator and disposed of !r► accordance with chapter NR 113, Alt other services, including but not limited to the servicing of effluent fitters, mechanical or Pressurized components, pretreatment units, and any servicing at intervals of 512 months. shall be Performed by a certified POWTS Matntainer. A service report $[call be Provided to the local regulatory authority within 10 days of completion of any service event. I — . START UP AND OPERATION Page •o; _ �. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). It high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting 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 system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS i1NST POWTS MAINTAINER Name Name Bone S a Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name C e C__�G)n i Phone Phone 3 This document was drafted in compliance with chapter Comm 83.22(2)Ibl(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. N � � s { i ss 1 { t I r { { r 1 - 1 n 1 i a a _ s= � ` fra isillirsriiisT ■���� :r�ssii�:.. r ~ NiaiCi n Cr2i Yii /! [. aMan :�llrii=memo,��MUZZUS e mam ms `*;= * a s mown i! pow now Ma#?i�si r!�sssiiL_�_ __ jioma�WWWO i a ma z iriiiiiiiaiiri � iss1 /iwli ir`siiissssiiissl/ssisi i" ' d � ' � •a liii�tiii►liiii� liriirilfirmmaiii '. � ii i�isi► \iiiilv!�iiiammoom amim \al�r►'iiii► isme,limaaiil��tiisi ►sfiiW -- � # i ►�liifr;�liiiR!'Callliil�iiiir E "t ll. ��.�idtii►ii��i�lilil�maamaiari #� �iA ► ►!� /amir:t7r ►!�ilir \ °lfiraiiii iii �1ia`[iil�lrii► mmamweMmiiii ■ lie► a[► • saif.`list;�tii #� #iOa.`iaiims ri m /f - •+' iit!lC�: iiii�r V�.`i.�iii #!l /iii .ir ' am =NM isiirii =ri #. "�ir:'iiiiir #.! #' /iii r.. iiriiiiai #itarr�iiiii,iiiiiisiiii mm ii isarnasisr iii #w is iiississsssi at .� 1 �a 8" zel., LIN � o� �' k;:k• Y slim f kA s on z W N m cQ � co O , tY a N- o COD �< CL s xt l J M 1 cu A I +- c �+ rA � p„ � w � � o A � � rn � a A fir,.a ` El 60 t` a �p 51 =. ?` L Q . r to O O+ �• Fi W QO © 0 O CD a) m d � 0 co c RECEIVED � D JAN 0 3 ATION e of m r SILT EV LU REPORT Pa Wisconsin Department of Com e ce 9 Division of Safety and Buildings in a'bEc�d3(>�w�IQQT'� County 85, is. Adm. Code ZONIN C " Attach complete site plan on paper no es in si e. Plan must include, but not limited to: vertical and horizontal reference point (B ,direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re 'awed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/ S 1/4 S 00�T ;),C) N R E Property Owner's Mailing Addr ss Lot # Block # Name CSkW J — A(Z2 rd� City State Zip Code Phone Number ❑ City ❑ villa e To Near�tRo il New Construction Us$. �Oesidential / Number of bedrooms Code derived design flow rate QQ GPD ❑ Replacement C1 Public or commeerci.V- Describe: — Parent material Flood Plain elevation if applicable A1/114 General comments S / and recommendations: F-/1 ✓ /1 � � d Ll /�CJiC� Boring # Boring Pit Ground surface elev. a' e ft. Depth to limiting factor _._ Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff' in. Munselll Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z- �s G ' r2^ cL2 a Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 6 la, r 3 Z _ S �I .3 f- 7a - 7 �S �t ro F - - a Effluent #1 = SOD > 30 < 220 rng/L and TSS >30 < 150 ` Effluent #2 = BOD < 30 mg& and TSS 130 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird ' 226900 Address Date Evaluation Conduc ed Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 - 246 -4516 I Owner Property — Parcel ID # Pa ge of Boring # ❑ onng Pit Ground surface eiev. Ift. Depth to limiting factor � in. Soil Appli Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 0-1 Z O ?/z , rn m w Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Sal igtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - E1f#1 '5#2 Ong # ❑ Bonng ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate . Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mgA- - Effluent #2 = BOD _< 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD.uw (L6=) Soil Test Plot Plan Project Name Environmental Holdings LLP Shaun Address 706 19th St. Hudson Wi 54016 C #226900 Lot 5 Subdivision Lundy's North Date f2/1/04 S 1/2 SE 1/4S 2 2 T 30 N /R W Township Richmond F ] Boring Q Well PL Property Line County ST. CROIX B or VRP Assume Elevation 100 ft. Top of Survey Iron em Elevation 101.1 *HRpSame as Benchmark Alternate Benchmark Top of Steel Fence Post @ 10 4.4' 274' Property Line 8% Slope 98.5' B-1 30' 40' 89' 30' 0' 100.5' A1t.B M B 2_. 50' M. 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. Scale is 1" 40 unless otherwise noted Property Line Sep 09 05 01:57p CRLVIN POWERS 715 - 246 -5135 P.1 t ' ST. CROW COUNTY SEPTIC TANK MAIlMNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer 5 Mailing Address Dy Property Address WDh Alp- K M 6nj �n r-% (Verification reyuircd from Phanring & Zoning Department for new construction.) City /State �i� Chmffl . b - arcel Idenf oc tion Number ' UL 10& q S rM + 626 (obl 30 • bDO LEGAL DESCRIPTION Property Location S't o %, Sec. 22, T _,�aN RJILP, Town of Subdivision � - O r+h - Lot #. Certified Survey Map # _ I , 'I , Volume , Page # Warranty Deed # 81 �T 2 `(� , Volume 29 `F 3 . Page Spec house / yes) no Lot lines identifiable (9 no SYSTEM MAINTENANCE AND OWNER CERTll�ICATION Improper use and muintenance of yaw septic system could result m ifs premature faidare to handle wastes. Proper maintenance consists of pumping out the septic tank every throe years or soon=, if needed, by a licensed pamper. What you put into the system can affect the function of the septic tank as a t reabnent stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comnx rce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been rmintaised must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements an this form are true to the best of my /our knowledge I/we am/we the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nn ber of bedrooms 12- 120 OS SIGNATURE OF APPLICANT(S) DATE ** *Any information that is mid nay result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nap if reference is made in the warranty deed (REV. OS105) i jj 61448 U; 2 9 4 3 N ':d 4 4 5 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM I —2000 RECEIVED FOR RECORD WARRANTY DEED Document Number 12/14/2005 01:30PK This Deed made between Environmental Holding Company, LLC WARRANTY DEED Grantor, and LeQue Builders. Inc. Grantee. EXDPT # Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County, State of Wisconsin (the "Property") (if TRANS FEE: 135.00 space is needed, please attach addendum): COPY FEE: Lot 5 Lundy's Nort Towno f Richmond, St. Croix County, Wisconsin CCF, 1 Recording Area Name and Return Address Wisconsin Assured Title, LLC 1810 Crestview Drive, #113 Hudson, WI 54016 Together with all appurtenant rights, title and interests. Part of 026 - 1066 -95 -000 & 026 - 1067 -30 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, Restrictions and Rights of Way of Record. Dated this 12th day of December 2005 * * Environmental Holding Company, LLC by Jeff Warren. Pres. E J, s AUTHENTICATION NOTARY � ACKNOWLEDGMENT Ar-G "... S 1*kE F WISCONSIN ) Signature(s) authenticated this ) ss. County ) M Personally came before me this 12th day of December , 5 , before me the above named Jeff Warren to me known to be the RTLE: MEMBER STATE BAR OF WISCONSIN person who executed the foregoing instrument and (If not, authorized by § 706.06, Wis. Stats.) acknowledged the same. —1- ;W THIS INSTRUMENT WAS DRAFTED BY ,ff Redmond, Attorney at Law *M '1 une oberts. WI 54023 Notary Public, State of Wis onsin ignatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date: November 8, , 2009.) Imes of persons signing in any capacity must be typed or printed below their signature. MUNTY DEED S GO5 STATE BAR OF WISCONSIN FORM No. I — 2000 i .• ♦ t y Ajo • U-1 S • 99 • 'Gr _ 1 • lt5'B Wd a N q o v Mf i IZ-ef ' - 9d " ZI 0 -- m *pfS'D E ioll �� r FA o. t „! 4 i D R