HomeMy WebLinkAbout026-1290-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
S40ty and Building Division
Sanitary Permit No.
INSPECTION REPORT 515265 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:
Pahl, Douglas I Richmond, Town of 026- 1290 -08 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
/DID 611? 22.30.18.1461
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS , HI FS EL EV.
Zw ?•
Septic T.w. Benchmark
I ' / • Ii AU-9 /0S
Dosing tOa P Alt. BM b 9 L
7 � J 9
AoMtrOf1' � Bldg. Sewe
`b � A 9O 9 4 72—
Holding SUHt Inlet I , , � D• 7 7
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet All
Septic I Dt Bottom
5a 0 6+ 4.
Dosing � / .—. Header /Man.
7 6 N*- 5 3.15 98 • �3
Aeration Dist. Pipe ? 75 9 41. 7Z
..7 a I
Holding Bot. System
.$99
c �
PUMP /SIPHON INFORMATION Final Grade ,�• 9 / / • G.3
Manufacturer Demand St Cover W.
GPM g
Model Number 33 L tau
TDH Lift Friction Loss System Head T F
12.? I 3. 3. Z S. '1/
Forcemain Length if Dia. Dist. to well N A
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 /t .[ n - ` ` SETBACK SYSTEM TO P/L / BLLD�G ' IW�E LAKE /STREAM LEACHING Manufacturer.
INFORMATION I CHAMBER OR
Type Of System- , r /1 AA- UNIT
r JS 50 � Model Number.
r `
DISTRIBUTION SYSTEM �Cti
Header /Manifold Distribution rxHole Size x Hole Spacing Ven Air Intake
Pipe(s) C � Length Dia Length / Dia /• S 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
Bed/Trench Center / ¢r Bed/Trench Edges Topsoil )�s No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / / 16 Inspection #2: / /
Location: 1416 129th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 22 T30N R18W) Lundy rtn t 8 Parcel : 22.30.18.1461
1.) Alt BM Description = �V w� rv-a.n,^c La. "jek..
2.) Bldg sewer length = W 11 AI 4k
- amount of cover = Yi "' '
Plan revision Required? ❑Yes ;<No [ — :7] : /4 D/6
Use other side for additional information. ( p
SBD -6710 (R.3/97) Date Insepctor's Si nature Cert. No.
r
commerce.wi.gov Safety and Buildings Division County t
201 W. Washington Ave., P.O. Box 7162 S C
'
t i epartment sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
D of Commerce 5 / 5Z( -
Sanitary Permit Application -�.n State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to prQp,.W1' tiG e mmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project dd ess (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary I
p urposes in accordance with the Privacy Law, s. 15.04 ] (m ), Stats. � /CA M) � -
I. Application Information - Please Print All Infor 1
Property Owner's Name Parcel #
�Q Q"Ug V t> 67 a 9a - 400 0
Pro erty Owneq§ Mailing Address Property Location /�� /
T. CROIX COUNTY l ot �/ S �� s govt _�_
City, State \ Zip Code W y,, � y,, Section
� _ L �
/�� j 7^ � '/7 s- / T f�q'rcle one
v`TT e7 7 ! CA o N; R L'S E o
H. Type of Building check all that apply)
Lot #
YP g (
X I or 2 Family Dwelling - Number of Bedrooms S Subdivision Name
r- Block #
❑ Public /Commercial -Describe Use
� i ❑ City of -
❑ State Owned - Describe Use l 4 CSM Number ❑ Village of
r A-Town of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. fi( New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existi System ex la n
Y P Y g P Y g Y ( P �.1
i
B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem /Com onent/Device: Check all that apply) OeJ
❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground XAt -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain Pretreatment Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed System Elevation ,
J id/ VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o $
New Tanks Existing Tanks Z
�, /�\ a o 2 ,
,( b
/yam !✓ N �l U v H v i C7 a
Septic or Holding Tank 1 060 om
Dosing Chamber OO 6&)
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si ure PRS Number Business Phone Number
a a 3s ?/ ,37- 766
Plu ber's Address Street, City, State, Zip Code)
o x
VIII ount /De artment Use Onl
pproved [ Permit Fee Date Is ued Issuing nt Signature
5 .0 _ 0= rven Reason for ial
IX. Conditi "Off t (seasons for Disapproval
`1; Septic link, e131i)ent filter and (,16/�d;�T r / [� i•�+l'[. /�
dispersal cell must all be services / maintained
as per management plan provided by plumber. /
--n fair. mahmm, 2. A N setback requirements must be maintained Arelgoe,
a
ac o complete plans for Le system and submit the County my on pao not less than 8 112 x 11 inches in size
t � 1 -T 14A 6 tf-
Al f
SBD 6398 (R. 02/09) Valid thru 02/11 r
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Safety and Buildings
141 NW BARSTOW ST FL 4TH
COCfli11@t'OQr�11I.gOV WAUKESWA WI 53188 -3789
■ oommervP #'Wsb/
t(Ic scons�n ,�,,,,,�,.r,�„s,,,.go„
epartment of Commerce
Jim Doyle, Governor
Aaron Olver, Secretary
May 21, 2010
CUST ID No. 220357 A7TN. POWTS Inspector
BRADY J U GARD ZONING OFFICE
UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA
PO BOX 413 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/21/2012 Ideition Numbers
Transaction ID No. 1799287
SITE: Site ID No. 756686
D PW Please refer to both identification numbers,
129TH St above, in all correspondence with the
Town of Richmond, 54417
St Croix County
, SEl /4, S22, T30N, R18W
Lot: 5, Subdivision: Lundys North
FOR:
Description: At- Grade, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1266344
N* teaance required; 450 GPD Flow rate; 45 in Soil minimum depth to limiting factor from original Vie;
System(s): At - grade Component Manual, SBD 10570 - P (8.6/99); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administer
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constru*d and located in accordance with the enclosed approved plans and with any component manual(s)
refertae" above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with so 90c 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,
stets.
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 p ' ation SBD-
10570-P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for it e.
' Wastewater Systems ". The pressure network is to be constructed in accordance with publ' 1'13 -P(R.
6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater TreatiKR, or the
sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution ST -SAS
(01/81)". isoas ` ��r
In the event this soil absorption system or any of its component parts malfunctiond'create a boolth hazard,
the property owner must follow the contingency plan as described in the approved plans. In addition, the owner
must comply with the operation, maintenance and monitoring duties as described in section VIII of the at -grade
component manual. A copy of this information must be given to the owner upon completion of the project.
Maintenance ie tmation must be given to the owner of the tank explaining that periodic cleaning of the filter is
required. AOM 00 Att: Dker for cleaning must be provided per Comm 84 product approval conditions.
RESIDENTIAL AT -GRADE DESIGN
INDEX AND TITLE SHEET
Project LOT 8 LUNDY'S NORTH
Owner J PHAL
Address 1475 HWY. 65 NEW RICHMOND WI. 54017
LOT 8 LUNDY'S NORTH 129TH. ST. NEW RICHMOND WI. 54017
Legal Description GOVT. LOT 5 /SE/S22/T30 /R18W
Township RICHMOND County ST. CROIX
Subdivision Name LUNDY'S NORTH Lot No. 8
Parcel ID Number 026 - 1290-08 -000
Plan Transaction Number
Index sheet Pace
Calculations Page 2
At -grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Ma g m nt & c n ingency plan Page 6
/q 7
Designer BRAY UTGARD License Number MP/220357
Signature Phone Number 715 - 760-0946 f .
Date 05/07/1
/ r„ o BUS ` 9
Designed pursuant to:
At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and S !'O,v
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01 /81�FNC
Version 3.11 (05/01) Page 1 of
PRESSURIZED AT -GRADE DESIGN
Flows and Site Data Entry.
r Residential or commercial?
300.0 Estimated wastewater flew (0'd)
450.0 Design wastewater flow (gpd)
6.00 % Site slope
98.10 Contour elev. below lateral (ft)
45.00 Depth to limiting factor (in)
0.50 In -situ soil application rate (gpd /ft ^2)
Distribution Cell Information
1 Influent wastewater quality
4.50 Linear loading rate gpd /ft
9.00 Effective absorption width (ft)
9.001 Max. effective width permitted (ft)
100.001 Aggregate length (ft)
Pressure Distribution Data Entry
c Center or end lateral connection
L 2I Number of laterals
0.188 Orifice diameter (in) e.g. 0.188
2.00 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
3.371 Forcemain flow velocity (ft/sec)
150.00 Forcemain length (ft) y Does forcemain drain back?
88.00 Pump tank elevation (ft) y AMaterals at highest point?
NA
3. System head (ft) x 1.3 24.5 Forcemain drainback (gal)
9.60 Vertical lift (ft) 45.0 5x Lateral void volume (gal)
3.47 Friction loss (ft) 69.5 Minimum dose volume (gal)
16.32 Total dynamic head (ft) 33.0 System demand (gpm)
Lateral Diameter Selection Gallons /Inch Calculator
Pipe diameter Design options Design choice 602.82 Total Tank Capacity (g94
1 in 51 Total Working Liquid Depth (in)
1.25 in 11.8 Galin (enter result in cell G46)
1.5 in x X
2 in x Treatment Tank Information
3 in x 1000 Septic tank capacity (gal)
WIESER Manufacturer
Effluent Filter Information Dose Tank Information
Zabel Filter manufacturer 600.0 Dose tank capacity (gal)
A100 Filter model number 11.8 Dose tank volume (gal /in)
WIESER Manufacturer
Project: LOT 8 LUNDY'S NORTH
Transaction Number: Page 2 of'�
AT -GRADE PLAN VIEW
1/6 B Observation pipes (2 typical) A 9.00 ft
D B 100.00 ft
t' 1/6 B 16.67 ft
C 11.00 ft
W D 5.00 ft
E 2.00 ft
D L 110.00 ft
B W 21.00 ft
AxB 900.00 ft ^2
T L
�- Cap
Typical os. = Total aggregate cell A x B Slotted nt he lower
= Plowed area L x W 6 ", and anchored
4 j securely.
6"
T
AT -GRADE CROSS SECTION
Synthetic fabric cover 99 89 ft Finished grade
Lateral elevation
invert elev. 98.60 ft
.f-- Observation pipe
at aggregate toe
E
Surface contour F ---9 - 81 -
9810 ft C A 6 % Slope
and system
elevation D—+
® = 12 in. topsoil and subsoil plowed layer
over aggregate and tapered to toes. below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: LOT 8 LUNDY'S NORTH
Transaction Number. Page 3 of
1
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
f P I
IE X — I + sr2 024 Laterals & force main of PVC Sch 40
Last hole drilled next to end cap [per COMM Table 84.30 -5]
Holes driNed on the bottom of the lateral.
eguaAyspaced • = Turn-up wfball valve ordeanoutplug
Lateral Specifications
0.188 Orifice diameter (in) Center Lateral connection point
X 2.00 Orifice spacing (ft) 2 Number laterals
25 Orifices/lateral P 49.00 Lateral length (ft)
16.5 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
33.0 Sys. discharge rate (gpm) 150.00 Forcemain Length (ft)
16.32 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather - proof � — waning label and locking device
junction box
Final grade 4"
disconnect
Tank component is Atternate
properly vented outlet
location 18" min.
Electrical as per NEC 300 and s Approved outlet
Comm 16.28 WAC joint
Tank full M,
= Inche$ Gallons
JA
Provide 1/4"
. A 31.0 365.3 Alarm on weep hole or
�
cagy B 2.0 23.6 Pump on B antisiphon
E C 5.9 69.5 device.
o D 12.0 141.6 89.00 ft C
Totalsl 50.91 600.0 Pump off
D
I;
3' Bedding under tank �— 88.00 ft
GOULDS J Pump manufacturer LEVEL Alarm manufacturer
3871 [EP05] Pump model number DLV Alarm model number
Project: LOT 8 LUNDY'S NORTH
Transaction Number. Page 4 of
a
At -grade System Maintenance and Operation Specifications
Service Provider's Name UTGARD Phone 715 - 760 -0946
POWTS Regulator's Name ST. CROIX Phone 715 - 386 -4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 900.0 ft Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 m
Service Frequency
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Mound Inspect for ponding and seepage once every 3 years
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99).
Lateral Tum-up Detail
Finished • ............. MGrade
6 -8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral
g Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: LOT 8 LUNDY'S NORTH
Transaction Number: Page 5 of 17
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Ge neral
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD- 10570 -P (R. 06199) and SSWMP Pub. 9.6 (01/81)) and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundnc+ - -_. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At -grade and Pressure Distribution System
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the at-
grade be heavily mulched as protection from freezing_
Influent quality into the at -grade system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or
30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10` cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective components) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically dogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: LOT 8 LUNDY'S NORTH Transaction Number: Page 6 of
1,
E� Pump
E PO4 & EP05
Series
APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoptas• • Searingt► s: Upper and lower
S or tic enclosed design peciTically designed for the grade turbine oil f r9 for h" duty belt bearing
following uses: lubrication and efficient improved performance. r=%Ktion.
• Effluent systems heat transfer. ■Casing and Base; Rugged
• Homes Available for atttomatie and thermoplastic: design provides AGENCY LISTING
• Farms manual operation. Auto superior strength and corasion
• Heavy ut sum resistance. "Sutnda�as ""l1O'tien
W. Y P matic models irtchrde 0 "t 9 ttwW
• Water transfer Mechanical float Switch ■ Motor Housing- Cast iron
• Dewatering assembled and preset at the for efficient heat transfer. N" is tso soot it"Atnd.
factory. strength. and durability.
Sl'fCiFtCATlOt9S ■ Mote Cover: Themmoplastic
• Solids handling capability: FEATURES cover with irxegral handle and
�"`"" ,"".—
" maximum. ■ EPO4 Impeller. Thermoplas, float switch attachment points.
• Capacities: up to 60 GPM. tic nttcftarmc�al
semi• design ■Power Cable: Severe duty
Pump
• Total heads: up to 31 feat. � womet for ech rated oil and water resistant.
• Discharge size. 1'/r• NPT, sew Protect",
• Mechanical seal- carbon -
rotary/cetamit- sta0cinary,
BUNA-h elastomers.
• Temperature:
104°( ( 4t3•C) continuous
140•F (60°C) intermittent Mot" FEEL ... _ .. .. ... ......
• Fasteners,: 300 series to
Stainless steel.
• Capable of running 9 3p'�- an•�.,�, .. _ ! i s co�c s
dry without damage to {t
Components. 8 25 R
rA
23;,x._ "` ' — ..... ............:.. ... .. .
a
Motor.
• FPO4 ,
Single Phase: 0.4 HP
1 15 or 2 3 0 V. 60 Hz, 1550 ;
RPM, built in overload with s
automatic reset.
• EP05 Single phase: 0.5 HP,
115 V or 230V. 60 Hz, 1 550
RPM. built in overload with
automatic reset. 2 j ` EPO4
• Power tort 10 foot
standard length. 16/3 , 1
SJTW with three prong
grounding plug. Optional 20
too', 1 2rfclth, 1513 SJTW with 20 36 .. PM
three prang grounding Mug
(standard on EP05). 0 2 d 6 :; ,o rz rnA/n
CAPACITY
Gou lds P
t; NO Goulds Pv c ,_ D
,flRC +e•.,ud 2003 ) TT In du strl
eser; es
REC
EIV,�
Wisconsin Department of Com SAN 0 3 Z(§gIL VALUATION REPORT Page _� of 3
Division of Safety and Building ore s y h Com 85, Wis. Adm. Code Co un ty
r" T C� e
Attach complete site plan on paper not les i6l inche in size. Plan must J
include, but not limited to: vertical and horizontal referen M), direction and Parrmel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D
Please print all information. R 'ewed b Date
Pomona[ information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` �Q
Property Owner Property Location
Govt. Lot D 1/ S 1/4 S O�T3lJ N R / r� E 4 -
Property Owner's Mailing Add r ss Lot # I Block # Name CShW
� p
City State Zip Code Phone Number ❑ city ❑ villa e To Nearest Road
New Construction Use Residential / Number of bedrooms Code denied design flow rate 0Q GPD
❑ Replacement ❑ Public of � commerce Describe:
Parent material — Flood Plain eleva 'on if applicable /f1 ft.
General comments
and recommendations:
i
.s
F Boring # Boring i 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/ff;
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
9
C am - c � ��� i ✓`� n J t.
Ong # [] Boring J
o pit Ground surface elev 4�LL_L� ft. Depth to limiting factor 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
S (
2, ? -y � L r
3 q
S `�l LA - i. C
Effluent #1 = BOD > 30 < 220 rng/L and TSS >30 150 ` Effluert #2 = BOD <_ 30 mg/L and TSS < 30 mg/L
CST Name (Please Print)
Si ire CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address 10 Date Evaluation Conduc ed Telephone Number
1008 192nd Ave, New Richmond, WI 54017 A 'q s--1 715 - 246 -4516
I�
Property Owner Parcel ID # Page of
Boring # ❑ oring
Pit Ground surface elev. y ft. Depth to limiting factor 7o in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlif
in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
5 f Ib y/ F S
T7
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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 GPD/ff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Etf#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg& ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (RAM)
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Soil Test Plot Plan
Project Name Environmental Holdings LLP Shau
Address 70619th St.
Hudson Wi 54016 C M #226900
Lot 8 Subdivision Lundy's North Date 12/1/04
S 1/2 SE 1/4S 22 T 30 N /R W Township Richmond
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 97.5 *HRPSameasBenchmark
Alternate Benchmark Top of 1/2" Pipe @ 100.3'
Please note: soil test Scale is 1" = 40'
234' Property Line may not be suitable for unless otherwise
owners desired noted
building location, Soil
test was done to
satisfy zoning
requirements, please
verify system location
before excavating.
B -3
45'
6% Slope
30'
96'
B -1 95'
15'
40' 98'
B -2
Al .B.M.
B
121' Property Line
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06/28/05 TUE 08:06 FAX 715 386 4686 002
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer 7—, &1'k
Mailing Address
Property Address
(Verification required from Planning Ex-partment for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Loca '/. 5� v. Sec. ,22, T 30 N R 1 ° W, Town of
Property Lora n , � Q
�, f �Gn�
Subdivision ,Lot #
Certified Survey Map # / , Volume , Page #
Warranty Deed # D tP Volume �, Page #
Spec house ! 1 yesAio Lot lints identifiabl l yes i I no
SYSTEM MAINTENANCES
Improper 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 sooncr, if needed by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix County 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 wastewatcr disposal
system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources. State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and rcturned to the St. Croix County Zoning
Dep t within 30 days of th y expiration date.
NATURE OF APPLICANT
OWNER CERTMCATIO>!�
1/we certify that all stabetnents on this form are truc to the best of my /our knowledge. l /we am/are the owner(s) of the
property dcscribed above, by virtue of arranty deed recorded in Register of Deeds Office.
'5—' l.allj-D
SI AT RE OF APPLICANT DATE
*• * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department.
Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the ccrtifled survey map if
reference is made in the warranty deed.
- " 1 11111! 11111 VIII Illlf VIII VIII IIII 111111 Iill IIlI
State Bar of Wisconsin Form 1 -2003 * 9 1 5 0 6 3 1
WARRANTY DEED 9
Document Number Document Name BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between New Horizon Homes, Inc., a Wisconsin corporation 04/26/2010 11:00AM
( "Grantor," whether one or more), WARRANTY DEED
EXEMPT I
and Dousdas Pahl and Dies Pahl
( "Grantee," whether one or more). REC FEE: 11.00 TRANS FEE: 90.00
Grantor, for a valuable consideration, conveys to Grantee the following described real PAGES. 1
estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Recording Area
Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach
Name and Return Address
addendum)
Lot 8, Lundy's North, St. Croix County, Wisconsin�1�
As an additional consideration for the conveyance between Grantor and
Grantee herein, their heirs, successors and assigns, Grantee covenants and
agrees that New Horizon Homes, Inc., shall have the exclusive right to
construct any and all improvements and /or dwelling on said lot. 026 - 1290 -OMO
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: easements, restrictions and restrictions, if any, of record.
Dated j/r � z L U New Horizon Homes, Inw�
(SEAL) (SEAL)
* *Be rd J. Kopp, its p den
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) New Horizon Homes. Inc, a Wisconsin
cor oration by Bernard1J. Koop, its resident STATE OF )
authenticated on D 10 ) ss.
I Z�"_' G_ COUNTY }
*Kristins Offland L Personally came before me on ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above -named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Kristina O land Estree . k & O land Notary Public, State of
304 Locust Street. Huds n, WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged: Both are not necessary.)
NOTE: THIS IS p STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1.2003
• Type name below signatures. INFO -PRO° Legal Forms 800 -655 -2021 www.inloprotrms.com
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