HomeMy WebLinkAbout026-1290-06-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463497 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:
New Horizon Homes Inc. Richmond, Town of 016- / Z 1 NP
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
is z .el 1=j Z 22.30.18. X45
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
cbjk Z. Cl m y
n (� Bldg. Sewer Lr . ra z S
Holding St/Ht Inlet � � �
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/II WELL BLDG. Vent to Air Intake ROAD Dt Inlet
E
Septic 5 1 /UA 521) 5 I Dt Bottom
Dosing G' i 54 + Header /Man. 5 . 164' L
Aeration J c � Dist. Pipe
5.1 la4.z
Holding Bot. System U. V 163.
PUMP /SIPHON INFORMATION Final Grade
Manufacturer ii Demand St Cover
GPM
Model Number n K) 1,5; zc�, . '3 b 3
TDH Lift Friction Loss System Head TDH Ft
7.5 1 0,7 ,(0 1 1 2.`6
Forcemain Lengtt> O Dia. Z/ Dist. to Well /�
SOIL ABSORPT SYSTEM N
B MENSIONS Width + Length No. Of rench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ' Z 90 I � _
SETBACK SYSTEM TO P/L « < B�� , LDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type WS System; 33, Q + ,� // UNIT Model Number: \
DISTRIBUTION SYSTEM Wei
Header /Manifold Distribution x Hole Size + x Hole Spacing Veto Air I ke
Pipe(s) V 2- Z
Length Dia ` Length � O Dia Spacing '� � t
SOIL COVER x Pressure Systems Only xx Moun Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges ` Topsoil
` \ es [ No No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: I� I 9 / O5 pection #2:
Location: 1268 140th Avenue New Richmond, WI 54017 (S 112 SE 1/4 22 T30N R18W) Lundy's NbPth Lot 6 ii tjS { Pa No: 22..30.18,
1.)AItBMDescription= LC"C_ " C'� { la"; L\'-
2.) Bldg sewer length
- amount of cover =
� r �
Plan revision Required? .] Yes ><
Use other side for additional information. ! I 6 �.
Date Insepct is Signa a Cert. No.
SBD -6710 (R.3/97)
l
r
i
Safety and Buildings Division County /
V isConsin
201 W. Washing' �+ -- C /V / JL Madison, I 53 REMI V E� S 'tart' Permit Number (to be filled in by Co.)
Department of Commerce (608 266 -3151
Sanitary Permit Applicati )n Star D. Number
MAY 2 ;� Z UFO..:
In accord with Comm 83.2 1, Wis. Adm. Code, personal informati n you p
may be used for secondary purposes Privacy Law, s15. 1)(m)S C GO U M " Pr t dress (if different than mailing address).
FlCE
I. Application Information - Please Print All Information
Property Owner's Name eM _ # Blo #
AJi&c
Property Owner's Mailing Address rro Wbion
� - 7
b V '— e l /,, �L- ' /,, Section
City, State Zip Code Phone Number
T
JJ ® ' /
/ " A Ul! 12?vj t ( cEcl r )
II. of Building (check all that apply) _ e, .
Family Dwelling - Number of Bedrooms Subdivision Name CSM Number
El Public /Commercial - Describe Use
El State Owned - Describe Use �— ❑City illage ship o -
III. Type Permit: (Check only one box on line A. Complete line 13 if applicable)
A y ❑ Replacement System g p y g Y
stem ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. Permit Renewal El 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 a I
11 Non - Pressurized In- Ground El Mound > 24 in. of suitable ❑Mot nd < 24 in. of suitable soil ade 11 Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter 11 A robic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Deli Flow (gpd) Design S lication Rate(gpdsf) I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units �, A-- ( OD Concrete Constructed Glass
New Existing rtCf.
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the under ned, assume esponsibility for installs n of the POWTS shown on the attached plans.
Plum er's Name (Pri Pltun s Si a MP/M S N r Business Phone Number
SA , cit, Lt [\,/ Plumber's Address (Street, City, State, Zip C
Ah J j
VIII. County/Department Use Onl
Approved ❑ Di Sanitary Permit Fee (" Ludes Groundwater Date Issued I um gent Signature o Stamps)
Surcharge Fee)
❑ Reaso r Denial lX.v
IX. Conditions qopprdv al
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be servicQd / 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 8112 x 11 inches in size
SBD -6398 (R. 01/03)
PLOT PLAN
Horizon Homes ADDRESS 1475 Hwv 65 New Richmond Wi 54017
SE i /4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
STE VATION 104' M ELEVATIO 3
/ NVENTIONAL 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
BEN MARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
WELL *H.R.P. Same as Benchmark
0 BOREHOLE
Property Line
Area 15' Below System to
g0 remain undisturbed
7%
Slope
1 2.5'
6-
104'
104.5'
B-
Tank is to be properly
bedded and provided with ST
lockdown covers with
approved warning labels
Grading is to be done to divert
run -off away from system
Pro 3
Bedroom Well is to meet
415' House all setbacks
Property found in Comm.
Line 83
P
0
r
14nth Ava
Safety and Buildings
- commerce.wi. OY 4003 N KINNEY COULEE RD
g LA CROSSE WI 54601 -1831
- TDD #: (608) 264 -8777
tisconsin www.commer isco /
www.wisconsin.go sin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
April 29, 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: 04/29/2007 Identification Numbers
Transaction ID No. 1131714
SITE: Site ID No. 697471
New Horizon Homes 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
Subdivision: Lundy's North; lot 6
FOR:
Description: Proposed Three Bedroom At -grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 1014981
Maintenance required; 450 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade
System(s): 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:
• 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 (01/81) ".
• 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.
• 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.
O ! C J' -E 4 L di J fril ly
V ®.
SHAUN R BIRD Page 2 4/29/2005
• 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 $ 175.00
&406-� 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@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
r r
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017 RECEIVED
715- 246 -4516 APR 2 2 2005
SAFETY &BUILDINGS
Date: 2/20/05
Owner:New Horizon Homes
Location:S 1/2SE1/4 S22 T30 N,R18W Lot 6 Luindy'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 " T Of COME jL INGS
p C fj�:�'AV< I N E X AND BU1LD t-
7 -8. Maintance and Contigency plan Dwys�ara
9 -11 Soil test ` SEE G pRRE
NpEN
Shaun Bird
Signature
License number 226900
PLOT PLAN
PROJECT New Horizon Homes 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 104' 3
BEDROOM
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
BEN MARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
• WELL * H. R. P. Same as Benchmark
B. M. * O BOREHOLE
Property Line
Area 15' Below System to
remain undisturbed
7%
Slope
B -1 102.5'
❑ ❑ B -2
104'
❑ 104.5'
B -3
Tank is to be properly
bedded and provided with ST
lockdown covers with
approved warning labels Grading is to be done to divert
run -off away from system
Pro 3
Bedroom Well is to meet
415' House all setbacks
found in Comm.
Property 83
Line
140th v
A P
I
L
2:5 B "
PYC FofXf -MAiN .�
2:5 "Tupw- UPS
t— otSrr% .uTt0VJ LATILR.AL ^f _
W
EA STA$tlt - ZED o8-.�`�ATtawt V�fEtL
a y a
Ir > 5
I /6B I /6B
Il2
A = #.
L t CELL of %y - 2 /Z A&CAEG ATE
RPPRoVEb SYmT - nL Fabr;o + Distribution Lateral
S TFO 1161Eb Observation r, �- Soil Cover
Weil t2 `
5` A 2 � ' > 5 '
plan View and Cross Section of Wisconsin At -grade Unit with a
Single Absorption Area on a Sloping Site
'�1GNA7� KE : UCr - t-j _
Page Of
Distribution Pipe Detail for Lateral Ifetwork
iQC Ce SS"
TURN -UP (CLERV40U
t - PVC Force Hain
t _ ," pVC Distribution Pipe
.i� P
* Last Hole Should Be Next To
riA RN -UP
Ft. P
F Hole Diameter 5 / 3 Z - Inch
X Inches Lateral Diameter 11 Inch(es)
y �! Inches Force Main Diameter Inches
J
f Of Holes /Pipe Z>
Invert E Of Laterals �Ft.
Signed- _.�._._..
License Nwnber:
Date:
i
SEPTIC TANK "AMP C #hM
BER CROSS SECTI AN SPEC ICA'TION'
BODE GRADE: EATKRPRWF APPROVED
VENT PZPE },Z" MTN. A � JUNCTION BOX
s }`
FROM D4flR. WINDOW OR WITH C€3NDUZT MANHOLE COVER
W! PADLOCK 5
FRE a1« S IR INTAKE � WAMING LABE'
r �r:.d
4" MIN •
FluxD GRADE
i
ri
�- 1 t� MiN•
38 Zlwt - t
_ t t
INLET r
. GAS a `�Pl�cwEt?
WATER TIGHT SEALS TIGHT
A SEAL L JOINTS VITH
FILTER _ t ALM AP PROM PIPE
B ' OR SOLID SOIL
APPROVEf3 "�F _
PIPE 3 C. i UFF
Oo SO L .� F T -
SOIL PUMP OFF EL Ey . � _J__ D
3 ,11 APF,OVED SEDDING UND£R TANK
� CQNCRETE PAD
SPrCIFZCATI�335 ' = gm
sEprIc r DOSE
NUMBER DOSES PER DA`L -
TANK MANUFACTUR VOWME INCLUDING ! /' � GAL -
GAL. ;3flSE FLONBA -" _
TAIiK SZZES : SEPTIC � GAL- L • C INCHES = 4GAL
DOSE CAFACITTES � A = - � l"��-- '�'GAL
/ 9 1 2 INCHES = ---
pyARli MANUFACTURER - v � 8 =
MODEL NUMBER � C �, S GA.L.
SWITCH TYPE: -~ �CG ✓ � C =4 • -� INCHES
pU!!P I4A�FAC3'LfR£R = / ' D t---
;HCHES = /� F -'� L '
MODEL NUMBER : I LKR 16.23 WAC
!SWITCH 'TYPE= !4 yRING AS PER
3 G?K PUiiP £ A LAR //> FEET
REQUIRED DISCHARGE ATE OFF AND PIPE
. �6
pvrlP DIS'£R -- FEET
VERTICAL DIFFERENCE B£T EPRE T /1£30- FT-'FRgCTIO4 FACTOR
+ Mi l4JM NETWORK SUPPLY )C URF EIYR IC H FEET
IH TOTAL
{ -- -� FE£T FORC£MA. l �£� ; DIAMETrR .r-- --
r, � DTH�.....r
11 MP
TANK: L MGTH
TNTERNAL DZMEl�
S I OI+IB i3F t I' ID 3 ` -- ---- -�
- -DATE = �.--- -----'
LICENSE NUMBf:R =
SIGNED.
if88
r
• - TOTAL DYNAMIC HEAD /CAPACITY
P ER M INUTE
HEAD CAPACITY CURVE EFFLUENT AND QEWATERING
to MODEL 152/153 153
j 15z 153
Feet Meters , Gal. Liters Gal. Liters
50
5 1,5 69 I 201 77 291
153 i 0 3.1 E i 231 70 265
12 40 152
15 4.6 53 201 61 231
°¢ 20 6.1 44 167 52 19
_ 25 7.6 34 129 42 159
30
a 8 30 9.1 23 87 4 33 i 125
} s I _ _ I - 2" 85
0 35 10.7
20 40 I 12.2 - -- - - 11 I 42
O
• L o (
d
L ock Valv 38.0 Ft. (11 .6m) 44.0 Ft. 13.4m)I
4 c�asoa
10
0 100 '0 60 EO 100
GALLONS
LITERS 0 80 160 240 X20 - 3 27/32 1 1 4 5/8 1
FLOW PER MINUTE 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS a f —
r 3 27/32
• Timed dosing panels available. with t---
• Electrical alternators, for duplex systems, are available and supplied
T
an alarm. '
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable i I
level long and short cycle controls.
• Sealed Qwik -Box available for outdoor installations. See FM1420. i
• Over 130 °F. (54 °C.) special quotation required. I
157J153 Series ! 1
152!153 MODE Control Selection
Am s Sim lex Duplex
Model i Volts Ph Mode 2 or 3
N152 115 1 Non 8.5 1 st<xtea
BN152 115 1 Auto 8.5 included 2 or 3 i
Et 4.3 1 2or3 52 230 1 Non 4.3 Included 2 or 3
BE752 230 1 A"t0 10.5 1 2 or 3 SELECTION GUIDE
Ni 53 115 1 10.5 Included 2. r 3
81 115 1 Auto 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float
E153 2;0 1 Non 5.3
BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477.
o cAUT10N of Electrical Alternator E Pak.
2. See FM0712 for correct model
d 3
. Variable level control switch 10 -0225 used as a control activator, spedly du p ( )
All installation of controls, protection devices and wiring should be done by a qualified 3
licensed electrician. All 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.
HAIL TO: P.O. BOX 16347
Louisville, KY 40256.0347 Manukhtersof. .
smp To: 3649 Cane Run Road ''O
O D Louisville, KY 40211 -196 rLwr Y1 9 1w , S SNCE �c9.lJ
(502177
Mtp; /lwww.zeeller.com
PUMP L O FAX (502) 7774 -3624 PUMP
Q Copyright 2000 Zoeller Co. All rights reserved.
�tT PLAN Page of
, g MANUAL & MA
htAGEME cca'rtoNS
p O WT S pwNER SYSTEM SpaCIF
g at
13 NA
Tarot. CSP'
Septic fl NA
iLF:INFoPjVI t+t ticTank M firer
owner
darer .(/ C1 III
penny f . Effluent Filter Many► ,l0`t7 [3 KA
DNA Effluent Filter Model i�3 U at 0 NA
)ESIGN P� pump -Tank CaPaclty NA
Number of pump Tank Manufacturer
Number Of Commercial Units al/da �1 NA
EsdmaWd flow (average) aVd Pump t muff 4_r7i NA
Ernated x 1.5) �_ pump Mode
poWn flow (Peak ( a11d /ftz
� preb nt Unit ❑peat Fitter
Soli APPS Rat Monthly average' O gand/Gravel Titer ❑Wetland
t Quality 530 mg1L p McChanicat Aeration ❑ other.
lnftut.nt/Efl O n & Grease (FOG) 5120 mglL C1 Disinfection
Fat' 60Ds�
Biochem�l OrAW De Sol d ( 5150 m �l- Manufacture u(s) (p ress at
Total suspended Monthly average" Dispe round (gravity) E3 a
moun
in-gr (P
p tuent Quality y � ❑ Maun
BOlJs) 530 mg11- ❑ l -grade ❑Other_
Bloch S Oxygen Demand ( 530 m9n- ❑ on fine rcralA fO" Y ' ter.na
Total Suspended Solids (TSS) 510' cfal coml Ic y for dorr+estic ( " °" O°n'rt
Feces Conform Y. mean) values � o f iuent
y, inct, dia meter ,w,sraeer-
Maximum Effluent particie Size
.. values typal for pmtmated
$e,rice Frequency
CE SCHF_DULE ear(s) (Maximum 3 yrs )
M pINTENAN ❑ months
Service Event ird of tan
nce k volume
At least o every and scum equals one-th (yi)
lnsped
condition of tank(s) vvhen c ombined sludge ❑months rte) (Maximurrr 3 yrs )
Pump out contents of tank once every s)
s) At least on
cells) 0 months r(s) [3 NA
Inspect dispersal At least once every ❑ months
Clean effluent filter At least once every s) C] NA
&alarm E3 rrlor►thS
mp, p P cO At least once every ❑ year ❑ NA
Inspect tw um
are test ❑ mantle s) O NA
Flush laterals end press At least once every C3 m onths ❑ Yew
odor At least once every
ors st of the following licenses or
go ne
CE INSTRUCTI be made by an indnridual c arryin c�nr: PO TS Maintainer; Sep�ge
MmNTENAN of tanks and dispersal vet4r s ha lt r s) to POY1rfs Inspector Ment]fy any missing a broken
Inspe� td Sew
Restricted ' on of the tank for any back UP
pilaster plumber: st in
Master Plumber e and scum D che& the effluent g els
i ns: k inspections trudude a visual inspec'd ed sl udg e
c ervidn9 Operator• T nk s or leaks, me sure the volume of coif udg visually infected Ing o f effluent on the
hardware, identify any The dispers on t
es cell {s) i a be authority
_ round surface- nding of effluent th e ground surface•
trig of effluent on the g for any Do lion of the local regulat�rY 0, the
or P and to check req ui res the lmmediate notifi or more of the tank vOl� NR
in the observat>on P ind a failing condidO
ground Su and req ird ( acc ordance ffdCe a and scum in a n y tank equals one
mulation of sludg by a $eptage Servicing Operator and dtsPo
sect of in
When the combined accu and any
tents of the tank shall be rem retreatf ment finer.
entire con Plate oo mponenn , ed by a �fied p0VVTS Mainta
113, Wisconsin Adminjs�U1e
C o de.
or Pressurized
The
Of comPlerion of any semce event
f�ervicin9 effluent filters, at intervals 12 months or less shalt be P?
e local regulatory authority within 10 days
oflter malntenanoe or moni
to t h e p roduc ts or othe
A WA* report shatrbe pr o v ide d the Presence of painting
treatment tank(5) for if hi h COI -
are
START UP AND OPERATION of the P01lYrs check. a e the dispersal cell(s). 9
�djpn, prior to u races andlor damag o prior to use
l:Of new fm a the tre2tin P a septage servicing PB
chenI Blot may Pe I removed by -
detecied have the contents of the tan k s
Page of
! are frozen at the infiltrative surface•
System start up shall not occur when sot is restored the excess
ks may fill norms{ hwater levels. When power
Ourin; Po+ver stages pump tan ce in one large dose, overloading the eet(s) and may result in the
waste yell be discharged to the dispersa id this situation have the contents of the P um P tank removed by a
backup or surface ciisch2iMe of e�csent. To avo
septa go ServicingOPOratorPrior -to . .
todng power to the effluent pump or contact a Piurnbe or POVYTS Maintainer to
assist In man operating dw PUMP
to restore normal levels within the pump tonic.
e or park vehicles over tarilts and dispersal Celts. Do not drive or park Over, or otherwise disturb or compact,
D not driv mound or at -grade soil absorption area.
the area a within 15 feet down slope any performance and prolong the fife
Reduction or e limination of the following from the wastewater strream may improve the as
of the POWTS: antibiotics; �babY wiPe5: cigarette butts: condoms; cotton swabs; degreasers; dental floss: diapers:
of the ants; fat; foundation draft {sump pump) water, fruit and vegetable peelings, gasoline
; grease; herbicides; meat
pes ti c ides; sanitary napkins: tampons: and water softener brine.
soaps: medications: met p ��s;
ASANDO r>t!y taken out of service the f steps shalt t>e taken to Insure that the
When the POWTS faits and/or is perm
and safely abandoned in compliance with ch_ Comm 83.33, Wisconsin Adminisl atnre Code:
system is properly nin s sealed.
Ali piping to tanks and pits shat! be disconnected and the abandoned
of�by Septage Servicing Operator.
The contents of an tanks and pits shall be removed and property
• After pumping all tanks and pRs Shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid materiaL
CONTINGENCY PLAN repaired the following measures have been, or must be taken, to provide a code
If the POVVTS falls and cannot be
compliant replacement system
been evaluated and may be utilized for the location of a replacement soli
❑ A suitable r,eptacement•area has
absorption system_ The replacement area should be protected proposed structure, no lines and wells n id not
Failure to
be infringed upon by required setbacks from existing and
replacement area will result in the need for a new soil and site evaluation to establish a suitable
protect the r
replacement area_ Replacement systems must comply wi ' th the rules in effect at that time.
in POWTS
0 A suitable replacement area is be idled as a eas se tback ort to replace failed POW1 Sn9 advances
techno a holding tank may n failure of the POWTS a soil and
The site has not been evaluated toide lfe a s uit a bl e sui table ee epiacement are
l lfno replacement area is available a
ite evaluation must be performed resort to replace the failed POVYfS.
holding tank may be installed as a last P
Mound and at -grade soil absorption systems may be reconstructed in place hollowing removal of the biomat at
infiltrative surface. Reconstructions of such+ systems must comply with the rules in effect at that time
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATME ER TAN
RE MAY O �K UNDER ANY C RC MS DEAT14 MAY
G
DO NOT ENTER A SEPTIC, PUM
RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE-
ADDITIONAL COMMENTS
POWTS INSTALLER POVVTS MAINTAINER
Name
Name 1
r_ L � � / / Phone 7 J'�.� � �...
Phone `� l
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name ! Een .
Phone 7
was d sniffs of the Green Lake' Marquette and Waushara County Zoning and Sanit 6w agendes. This document meets
This do cament ratted by ow .
the minimum requirements of dt Gomm s3_nf2)(bXfX�&(fl slid 83.54(l).(2) (3), Wisconsin Adrnln1S ratiwe Cede. Use of this doasment does not
GMW (1101)
guarantee the performance of the POLVTS.
;DECEIVED
Z�o�
0 .1 DD
�
S F. CRUIx COUNTY OIL EVALUATION REPORT Pa e of
Wisconsin Department of OFFICE g Division of Safety and Bui
in accordance with Comm 85, Wis. Adm. Code c
County
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 e ' ed by Date
2 ` - F
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
YV� 2cb�
Property Owner Property Location
Govt. Lot 1 /j 14 S o7t c�T3L'q N R / E (o6q
Property Owner's Mailing Addr ss Lo Block # Name CSA1#
j (�
City State Zip Code Phone Number ❑ City ❑ Villa a To Nearest Road
fit/ /
r New Construction Use42CResidential / Number of bedrooms Code derived design flow rate 5e GPD
o Replacement ❑ Public o commera Describe: — W
Parent material a� 4 -Z G�� Flood Plain elevation if applicable /��� � ft.
General comments
and recommendations:
Boring # Boring C/
Pit Ground surface elev. I i- r Depth to liming factor
Soil Application 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
/ 6 1 1 1 / ,
Boring # ❑ Boring (�
Pit Ground surface elev. C. -/-7 r �ft. Depth to limiting factor /
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
0-1 r at— S Cs - AZ)
- 7 ,3 r `// i f IG
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 ` Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address 17 Date Evaluation C uc ed Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �l 715- 246 -4516
Property Owner -- P rcel ID # Page of
Boring It ❑ ring L�
Ground surface elev. l�
Pit L� ft. Depth to limiting factor ^� in.
Soli Application Rate
Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM
in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Efr#2
! , U
�Z - 3Z S 1 S L� � • Fr w
3
0 V Y& Y V h a ,
F-1 Boring # Boring
❑
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ef#2
F Boring
Boring # a Ground surface elev. ft. Depth to limiting factor in.
11 pit Soil iaation Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPQM
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. •Efr#1 •Eff#2
• Effluent #1 = BOD, > 30 < 220 mg1L and TSS >30 150 mgA- • Effluent #2 = SOD, < 30 rrg& and TSS _< 30 mgiL
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.
SOD -8330 (86(00)
i
Soil Test Plot Plan
Project Name Environmental Holdings LLP Shaun B'
Address 70619th St.
Hudson Wi 54016 CST #226900
Lot 6 Subdivision Lundy's North Date 12 /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 o VRP Assume Elevation 10 t. Top of Survey Iron
S em Elevation 104.0 *HRpSame as Benchmark
✓Alternate Benchmark To of Steel fence Rost 104.4'
30' `Scale is 1" = 40'
unless otherwise
A1t.B.M. noted
B.M.
286' Property Line
80'
7% Slope
102.5'
10' 50' S0'
B -1
35'
104.5' Please note: soil test
may not be suitable for
owners desired
building location, Soil
15' Property test was done to
Line satisfy zoning
requirements, please
verify system location
before excavating.
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p u� s s� 6
....................... ........ ........ ......... ........ ........................ ............ ...... ...........................................
ST CROIN '01 w.
M.AIN FGPIEMENT
SEPTICTAI'4K TTENKNU A
ARD
I h
Iv
4 'z(.'
7
-n Pianning Department tor new
(Verffica:ioa required t1in .......
"ityP tate 1 Identification Numbf.r.
,,j ?1P <i►:t ;�; �` �!
Prof),! -ty n \V,'Tuwn of'_A
V4. Sec.
Are .
CO ri i led 8 1 1. v!: , y NUP u
Volurn
�•1't.A•, a.ta+�y �:?e �.� N ......../ .�.5 � . ............_ _........, Vc�lt:tn:e ....... .....��� Isis ;� Fi ....,,.,..,. ..... _.,.._....
spelt -louse 'I..'s LYno Lot lines idcnfifiab�s I no
Impro at i. i ►le and maiMemance of your septic system could result in its premature M lure to handle wastes. Proper ma pvlterancc
consiv.; of purap i:r out the septic tank every three ye-us or sooner, if needed by a iicemed vUWpnY. What you Put; into till' system
A
Can. at - stet the Till 1,::I i 312 of the soptic tank as a treatment stage in the waste disposal system,
'Ile p;m:! owner u1:•,rees to subrait to St Croix Zoning Depattruent a certificatign forro, sif 4.04 by a
.,ned by tbo. owner,
mute, Oluxube , i o 1:;tnoymau 1P ivulbor, itatrictcd plumber or a hocased pumper verifying that (F) the vu•site watstewatardispol4i•system
is in opAnioo: ►g condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 tutl of
Uwe:, c it =ders6.):1: -,d have rea• the above requirements and agree to maintain the private sewage disposal system with.th•x-,tzadArds
to( foij* berexii. , u . :i. net try -the Deparbnent of Commerce and the Depw of Natmal kesourcea; State of Wisconsin.' Ceii!(Iatiou
1 tt Ma 30
statinpld&t ,your • )!'-! vd-c system Las boon maintained. C roix County Zoning Office. (o ust be completed and returned to the St.
dayso
DA
OIA"ri I -OWN.
(wC); that all ctatements on this form are true to the best of my (our) knowledge. I (we) am (are) die ovi..Iflor(s) of
the p:r•.,-.)erty dcr;(!! iod above, by virtuo of warranty� deed recorded m Registrr of DeccLe Office
DAI r-
Any infiw(:)ation that k nusmlrepresonted may result in the sanitary potmit being revoked by , he Zoniqg
bhi, ude with - ,Nj10 applienti.;►n. a's%rnped warranty dead from the Register of Deeds off icc
a copy of the certified swvey,rxiap if refbrenve is madeW the weri•nqy� deed
U, 2 8 0 5 P 2? 6 79x338
State Bar of Wisconsin Form I - 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 , 05/18/2005 12:45PI1
( "Grantor," whether one or more),
and New Horizon Homes, Inc.
WARRANTY DEED
EXEMPT #
( "Grantee," whether one or more). REC FEE: 11.00
TRANS FEE: 675.00
COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE;
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 2,06 8, 10, and 21 Lundy's Nort Town of
Richmond, St. Croix County, Wisconsin. Recording Arca
Name and Return Address
' 0Kt,
_tbLZ l`? t " �1 - S -
�- (v.�f5
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, 2005
ErAvi o 1 cling Company, LLC
(SEAL) (SEAL)
* * by Se f Warren, President
(SEAL) (SEAL)
* *
AUTHENT e ACKNOWLEDGMENT
G
Signature(s) y STATE OF WISCONSIN )
ss.
authenticated on '111111, 0 41111' 1 St. Croix COUNTY)
Personally came before me on May, 17, 2005
N� $ the above -named Jeff warren
* J.
TITLE: MEMBER STATE BAR O to me known to be the person(s) who executed the
(If not, flofegoing instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
*Merl a J. Bune
Michael H. Forecki, Attorney At Law Notary FAublic, 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 DFED STATE BAR OF WISCONSIN FORM No. 1 -2003
"Type name below Signatures.
Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire W] 54701 -7928 Phone (715) 835 -3029 Fax: (715) 835 -4112 T6063626.ZFX
Merilee J. Bune Produced with ZipFonn by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 3839805 www.zipform.corm
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