HomeMy WebLinkAbout026-1073-40-000 F Wisconsin County: Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
430241 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:
Marek, Todd I Richmond Township 026- 1073 -40 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
lo S 3 & - ,P&) 25.30.18.385A10
TANK INFORMATION AW AIl - A06 L
TYPE MANUFACTURER CAPACITY ^ I H FS 1 b LEV.
Septic enncc mark
o�. � �'n s�hz�. vna✓t,�' a d � .SVt/ G trn�
Dosing t.
n c
Aeration Vj � �CJ Bldg. Sewer
Holding St/Ht Inlet t YrI
3' 0 •3
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic > / (,j 2v / uv ,.` � Dt) - ryw r 60 / 90` D /
Dosing � Z r � ll� s��Man. S� 3 . 3 _
Aeration Dist. Pipe o•
Holding Bot. System OS� dx
Final rade
PUMP /SIPHON INFORMATION S
Manufacturer Demand St Cover /
/
GPM 2 Ir l`5 �'Z 0 - 7.3
Model Number 0 I/V 0. v ^
TDH Lift Friction Loss System Head TDH Ft �� ,�,, / �J
Forcemain I Le? ) h , Dia., I Dist.toV� `�
SOIL ABSOR TION SYSTEM hJ 11 eQ wa e peT
BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth
DIMENSIONS 7s,—/ / j, 4 / 1---
SETBACK SYSTEM TO P/L W JBLDG WE L LAKE /STREAM L C G Manufacturer.
INFORMATION Type f System: / / CH . R OR Model Number.
O
DISTRIBUTION SYSTEM �. /
Header /Manifold Distribution x Hole Size
I x Hole Spacing Vent to Air Intak
�i Pipes) �� 1� (e�
Length Dia Lengt Dia Spacing f / l! 3
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 Bed/Trench Edges Topsoil I Yes ' No Yes 0 No
COMMENT (In ��code d,iscrepe�-n(cies, perrs'gn�,'s- pTssent, etc.) Inspection #1: �� / 7 / Inspection #2:11 / —7 / VU
Location: 13475`treet a R�hmbndl WI 1 54017 (NW 1/4 SW 1/4 25 T ON R18W) NA Lot 1 ra Parcel No: 25.30.18.385!A10
1.) Alt BM Description = ,I �(�,( Co yGt e �C S/� 6 ]`—� ' °�,► .G� "
2.) Bldg sewer length =� 11 I� �rt�/2(�tJ[( �/ � 1 ' -
- amount of cover = t 5�1,0� P yo V. /L�' �� �� [/•
to ( oc�.f
Plan revision Required? Yes No
< < -� - -- - - -- - -- --
Use other side for additional information. �_ � 03
SBD -6710 (R.3/97) Date Insepctor's Si nature Cart. No.
l
140th Avenue _
APPROVING AUTHORITY
TOWN OF RICHMOND
N W I N E I ST. CROIX COUNTY
ZONING
_ PLATTED AREA IS ZONED AND USED AS: AG -RES
N INTENDED ZONING AND USE: AG -RES
o AREAS
S I TOTAL AREA OF LAND TO BE PLATTED: 113.52 ACRES
BEARINGS ARE REFERENCED TO THE NORTH LINE OF T
L J SW 1/4 OF SECTION 25, T30N, R18W, WHICH IS
130th Avenue ASSUMED TO BEAR 589'52'26 "E.
MIN MAP C6NT�OURS AREIiOWN AT 2 FOOT INTERVALS
SEC. 25, T. 30 N., R.1 W.
TOWN OF RICHMOND, T. CROI COU TY, 1 l
NOT SCALE i I I "�' U -L ,4- / ED
Ivy !--- - - - - --
UNPL A TE L A ND,5 �A KWOOD L A NL
RUSTY F GUS0�11 x %
1611 I HWY�- 4 i
I J8/ HWY. 6 SPRI ' G LAKE F
NEW RICH N Wl: �ZMED A,G�RES
<; 21 5.1 215.00'
WEST 1 I O EIt? V i
2 SECTION 2 0*`T-
(AL UM. Mgl1'�UA�J�N
2. 7 A �l
c�
_ - \
Q _ Z Z
WES T LINE OF HE S 1 VIA- G- -
\ \
SECTION 25 - JO -1$ I) 6 \
f
I \
O \ O 1
(.4 - - - -- �j 53.42 2'��p( -
Ui I� w 1100 2+00 +OD
Safety and Buildings Utviston k_t,uttty
201 W. Washington Ave., P.O. Box 7162
Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
isconsin (608) 266 -3151 Ll 3 0 ;, LI I
Department of Commerce
Number D.
Sanitary Permit Application State Plan I. q — r(a^S.=
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different thpnmailing address)
pro l han
may be used for secondary purposes Privacy Law, s15.04(l)(m)
13 1 qO S
I. Application Information - Please Print All Information
Parcel ;t/ Lot # Block N
Property Owner's Na me ^_
J
Property Owner's M ailing Add re Property LocaCtio/n� , m 3YS- �]
Z - - 2— , 2 � 'k ; � v 'k ,Section �r
City, State � e Phone Number
4
on ) T�N; R rW
I Type of Building (check that apply) p,� �¢�P.ti/ Su� ame CSM Number
or 2 Family Dwelling - Number of Bedrooms
— r �>
❑Public /Commercial — Describe Use � i
7i State Owned - Describe Use X of / ' ❑City_ ❑VillagxeTownship of % (j
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
❑ ❑
El Transfer to New
List Previous Permit Number and Date Issued
B. Permit Renewal Permit Revision ❑ Change of
Before Expiration Plumber Owner
IV. Type of POWTS System: (C eck all that apply)
❑ Non - Pressurized In- Ground and > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal /Treatment Area Information: v
Design Flow (gpd) Design Soil Applic lion Rate( gpclsf] Dispersal Area Required (sf) Dispers Pr posed (sf) S stem Elevation ✓
4 nn
o.� ,�, J (J / 5a0� � Area 00 /��o / 7
V "1. Tank Info Capacity i Total Number
C
Manufacturer refab Site Steel Fiber Plastic
Gallons Gallons of Units u ' 2 Q� — /00
Concrete Constructed Glass
N ew Existing /
N g
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber /
�D J
VII. Responsibility Statement- 1, the undersi d, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumbe ' gam' MP /MPRS Number �Busin Phone umber
`Sk �ZAo00
Plumber's Addre ss (Street, City, State, Code)
VIII ounty /Department Use Only
.Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Da a Issued I ing ent Signa o Stamps)
Surcharge Fee) UO �/ / 63
11 Owner Given Reason for Denial b Q
IX. Conditions of Approval/Reasons for Disapproval L V It o
l S /L 2� ( 7/2S/ - 4 03) a" 01
A l l
rxaJ�L�t -ems--
ta h com le p } ans (to a Co ty only) for the sys on paper no less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03) l az 3.
PLOT PLAN
- PROJECT Todd Marek ADDRESS P.O. Box 228 New Richmond Wi 54017
NW i/4 SW 1 /4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/10/03 BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL sH Same as Benchmark
SYSTEM ELEVATION 105.7'
Property� ne =
1/4"
= O
19 a� �' I Wk
VA
, � e,
I
A.M. B -1 mg is to be e�I'
105 divert run -off way from
104.7' ❑ system
103' y
Tank is to be properly b e and
101 provided with lockdown v s with °-
approved warning label
0
-
cu
r
7% Slope ❑ B-2 m
M. * ❑
-3
Huffcutt mbo nk
Area 15' below System is to
remain undisturbed
Pro 4
yY1�9 v`
Bedro
o House
Well is to meet all setbacks found in Comm. 83
`iJ P y
� 3 - P - Aw,
l
Safety and Buildings
y 4003 N KINNEY COULEE RD
LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
V&6 onsin www.commerc .wis ons
Department of Commerce www•w
Jim Doyle, Governor
Cory L. Nettles, Secretary
July 25, 2003
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: 07/25/2005 Identification Numbers
Transaction ID No. 889048
SITE• Site ID No. 662443
Todd Marek Please refer to both identification numbers,
140th Street above, in all correspondence with the agency.
Town of Richmond
St Croix County
NW1 /4, SWIA, S25, T30N, R18W
FOR:
Description: Proposed Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 913097
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.
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
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems
VERSION 2.0" SBD- 10706 -P (N.01 /O1).
• Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,
excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are 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.
• 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.
• 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.
R N V�m Rw%
P P
SHAUN R BIRD Page 2 7/25/03
Owner Responsibilities:
• 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 per Comm 83.55, that is acceptable
to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
Note: Per Comm 83.21(2)(c)5, Wis. Adm. Code, if any part of the POWTS management plan specifies servicing or
maintenance at an interval of 12 months or less, the activity must be recorded with the deed for the property. If the
activity has not been recorded, a sanitary permit can not be issued.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely,
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm
jswim @commerce.state.wi.us WiSMART code: 2633'
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Cover Page
RECEIVED
Shaun Bird
Bird Plumbing Inc. SAFETY & BOGS DIV.
1008 192nd Ave
New Richmond Wi 54017
715 -246 -4516
Date: 7/10/03
Owner:Todd Marek
Location: NW1 /4 SW1 /4 S 25 T30 N,R 18W Richmond Lot 1
System type: Mound System
Manuals Used: Mound Component Manual version 2.0 (01/31)
Pressure Distribution Manual version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -9. Maintance and Contigency plan
10 -12 Soil test
Signature
L�
License number 22 00
GL1'� �`11'IIi\E Vi �•isjjii +rr {lLL
DIVISION OF SAVETY AND BUILDi NGS
*r- C ONDENCE
E
PLOT PLAN
PROJECT Todd Marek ADDRESS P.O. Box 228 New Richmond Wi 54017
NW 1/4 SW 1 /4S 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/10/03 BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 105.7'
Property Line
Scale = 1/4 = 10'
197'
Alt. B.M. 105' B-1 Grading is to be done to
104.7' ❑ divert run -off away from
system
103'
Tank is to be properly bedded and a ,
1 01 ' provided with lockdown covers with °-
approved warning labels
0
CD
r
7% Slope ❑ B-2
m
SB,.M. * [3
B -3
Huffcutt Combo tank
Area 15' below System is to
remain undisturbed
Pro 4
Bedroom
o House
Well is to meet all setbacks found in Comm. 83
v
• No
-Designer
Date
Non
-Woven oven Filter Fabric
4" observation Pipe Perforated �D;sIribulion Pipe
Below Filter Fabric
ASTM C -33 S a n d - \ - o
iH
Topsoli
—""-� E ` i
% Slope bed Of !�- 2 %2 Force Main \_Plowed
Lo er
Drain Rock From Fump Y
L)
'
Us
C ress Section Of A Mound S stem U F T
A Bed For The Absorption Area
G 1J
A
Ft.
J 1 Ft.�
K,® Ft.
L Ft.
L
4'Observotion Pipe- _ K
A 1 Moin
a -_- ------ - - - - ---- ------------- - - - - -- From Pump
W N t° — --�- -- — — — — — r. — -- — — —
3 �"
Distribution Bed Of /z - 2
Pipe
Drain Poch
I
40b6arvotion Pipe - LOCATED Permanent Marker
TH j TI{ 8 Fi¢.oM $ aTN Pipe or Rods
�o
tcuDS �TYP.}
Plan View Of Mound Ut►1n A Bed Far Tt►e Absorption Areo
PAGE OF
Perfora!eG Pipe Oelaii
:i End V
C FtrfOrpf�p /�.
+ PvL P'De
/ \L.i �� Kofes zoza:ea on 801:0m.
c os
rle- n ivc C7�
v :
+
t *, Pvc Force Main
7� ! F I RST iWLL ntzxT to COr1AtG }ron
PVC
Manifot PiQt
L S�/ c /t, cie:riaua,an
Pipe
X i
% Di5l ri bu tion P ipe Layou Ft.
n R Fj.
Ll
X Inches
} Inches
Signed: Hole Diameter �� finch
Lateral . Inch(es)
Li cense Number: Manifold Inches
Date: Force Main 2,_ Inches
# of holes /pipe
Invert Eievdtion of Laterals
ION AND S�EL�I LCAT IONS
SE PTIC TAN: E F�?MP CHAMBER CROSS SECT lU•
WEATHERPROOF Cl VENT FTP£ I .= MI2g- ABOVE GR°.i? JUNCTTON DDX APPROVED
F ' ,. MANHOLE COVER
s ��� FROM DQflI�, �.I�DC�+ DR i�ITH L.��DliI �
W/ WARNING PADL OCK 6
FRESH AIR INTAKE
WARNING iABE:.
FINISHF-D GRADE � _= MIN
CIF. Lf " c.%. *6% Rif1►Tsol► i = S. C- fS"MS1f•
E
s ,
GAS s
WATER TIG 4T SEALS : IGH'F k 4 VAPP4L�}Y��
SEAL ;j , JOINTS WITH
3 i 3 R �} ALM APPRQYEi1 PIPE
& _ ON 3° ONTO
APPROYEl) __T_ _ SOLID SOIL
PIPE 3' C �
()KTo 50L 10 _ � 6.Z FT . -- -- OFF
SOIL ?�C3MP OFF ELE1` - D i
BEDDING LINDER TANK
3 APFROV DD �'� (' ' C01�iCrZETE PAC
��
Sz'£CIFiCATZt}idS l r/
SEPTIC f DOSE 4 k . C� a, DOSES
?£R DA:_
TAI3lC LIRER: 27,SGAL-
GAL. I3DSE DLu ME
MAMJFACT IitiC `- ,--- =—
SEPTI FLf��tS
TANK SIZES_ DOSE '� S GAL- _ S�-= �'1
CA A
l r(C�iiS =
?�C� s 5 $ _ �Z - INCHES = ✓ GAL.
ALARM mANUFACTURER: ,�I------ - --- -�
MODEL 1+1[li#$ER: GAL-
INCHES S1�i1TCH 'APE: _- s-- Lf C S INCHES
?UHP t'IANUFAC'iU = D
_ INCHES
MODEL NUMBER : " ^ �, - e �C wij- 7 AS PER i LHR 25.23 WAC
SWITCH = FE: �--� C / M W I F: W' �
p G?ti F�im A LARM / /� FEET 6O
REQUIRL-D DISCHARGE RATS - _�-- --
FEET
EN �ETLTEEN p'�IMP OFf .AI+tD DiSTRTiON R _ FE£'T
VMTICAL DIFFER L4FPLY PRESSURE - '���� FEET
MINIMUM NE WORK S FT; 1QO FT- FRICTION
FACE _ J.� -�-�--
+ ✓ FEET FORCEMAIN X -' TO A• l DYNAm'C H A ." ."
i, I D �':3 DIAMETER
_..r... --
r 7 T
;v g
I DZME235 =DNS =i ?UK? TANK: LIQUID ��
D AT i- - f
i.sCESS"E ,DER
' S sGi`IE _
- 10TAL DYNAMIC HEAD/CAPACITY
PER MINUTE
HEAD CAPACITY CURVE EFFLUENT AND DEWATERIN -_ G
MODEL 152/153 r 152 153
MODEL
Q:: I
I Feet , Me Gal. L, ers 0 i. L iters
1
50 r" 5 -'— 1 5 I 69 '; 261 77 29
153 10 3.1 bt - 231 j 70 265
40 152 15 4.6 153 1 201 , 6 231 1
20 0 1
44 167 t 52 1 9 7
i I 25 7.6 34 29 42 159
30 g 1 23 87 I 33 ;125
a 8 �5 I T _
a5
3 5 -
_ 11 42
20 i 413 1 2.2
Ft.
1 3 8 .0
°
LO CK vc 1 - -! — ----
054508
4
1C
0 60 80 100
20 0
I 5 ,/4
GALLONS
LITERS 0 80 160 240 320 - 3 21/32
FLOW PER MINUTE
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS
i
B I
3 27/32
• Timed dosing panels available. e
• vailable and supplied with
Electrical alternators, for duplex systems, are a
an alarm.
• Variable level control switches are available for controlling single phase
systems.
• Double piggyback variable level float switches are available for variable -�- —
level long and short cycle controls. II
• Sealed Qwik -Box available for outdoor installations. See FM1420. — - I
Over 130 °F. (54 °C.) special quotation required.
12 tje
1521153 Series
ODELS Control Selection iI 1521153 M Model VottfPh Mo Amps Simplex D uplex
— 1 Zor3
W152 175 1 Non 8.5 i _I sK2ae4
BN 552 8.5 Included 2 or 3
115 1 Auto f
E-152 230 1 Non 4.3 1 2 or 3
BE152 230 115 1 1 Auto 4.3 Included Non 10.5 1 2or3 SELECTION GUIDE
2 or 3
N153
BN153 175 1 Auto t0.5 included 2 or 3 back variable level float switch or double piggyback variable level float
230 1 Non 5.3 1
E153 1. Single piggy
Be153 230 1 AM 5.3 in i 2 .0 3 switch. Refer to FM0477.
o CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak.
All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex
(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.
MAIL T0: P.O. BOX 16347
a Louisville, KY 40256 -0347 Manuiacturersoi. .
� M SHIP TO: 3649 Cane Run Road �!
Z 4® Louisville, KY 40211 - 1961 Q/1eUTYPUMaS SHOE �9
(502) 778 - 2731.1(800) 928 PUMP
http;/ /www.zoeller. coin
PUMP 1 FAX (502) 774 -3624
onnn 7nollpr Co All rights reserved.
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the mound is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below mound undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
10. Effluent Quality is not to excede the requirements found in Comm. 83
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, retill soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715 - 246 -4516
Pumper: Tom Mondor 715 - 246 -5148
St. Croix County Zoning 715 - 386 -4680
P age of
pOWTS OWNER'S MANUAL & MANAGEMEN 4PL s
SYSTEM SPECIFIC
FILE INFORMATION Septic Tank Capacity la mat ❑ NA
Owner ❑ NA
Septic Tank Manufacturer
Permit #. Effluent Filter Manufacturer �� ❑ NA
1, DESIGN PARAMETERS ❑ NA
❑ NA Effluent Filter Model
Number of Bedrooms = Pump Tank Capacity al ❑ NA
Number of Commercial Units p Tank Manufacturer O NA
(average) e,,.,0 NA
Estimated flow ( s al/day Pump Manufacturer
Estimated x 1 .5)
ga l/d a y ❑ NA
j Design flow (peak), ( Pump Model .�
Soil Application Rate aUda /ft� A
Monthly average` Pretreatment Unit ❑ peat Filter
Influent/Effluent Quality [I Sand/Grevel Filter
Fats. Oil & Grease (FOG) !!;30 mg/L ❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand
BODO 420 mg/L ❑ Disinfection ❑Other
Total Suspended Solids (T SS) 5150 m /L Manufacturer
❑ NA Monthly average" Dispersal Cell(s) ❑ in - ground (pressurized)
pretreated Effluent Quality AO mg/L ❑ In - ground (gravity) Qund
Biochemical Oxygen Demand (BODs) [j At-grade /
Total Suspended Solids (TSS) s30 cfu/ ❑ pri ine ❑Other
(geometric mean) 510 cfu1100m1
Fecal Colifo[m (g Values typical for domestic ( wastewater and
inch diameter
Maximum Effluent Particle Size Ya septic tank effluent
�* values typical for pretreated wastewater -
MAINTENANCE SCHEDULE Service Frequency
Service Event At least once every ❑ months ar(s) (Maximum 3 yrs.)
Inspect condition of tank(s)
) of tank volume
When combined sludge and scum equals one hird y ' 3 yrs.) Pump out contents of tanks) ❑ a
At least once every
Inspect dispersal cell(s) ❑ months ar(s)
At least once every
Clean effluent filter ar s ❑ NA
At least once every ❑months ( )
Inspect pump, pump controls alarm ❑months r(s) ❑ NA
3
Flush laterals and pressure test At least once every ❑months ❑ year(s) ❑ NA
Other At least once every
ohher At least once every
❑ months ❑ year(s) ❑ NA
NTE �
NANCE INSTRUCTIONS individu carrying one of the following licenses or
MAINTENANCE
inspections of tanks and dispersal cells shall be made by an indivld r broken
lun - ,tier Restricted ewer, S POWTS Inspector, POWfS Maintainer or certifications: Master Plumber, Master P to identify any missing
Servicing Operator. Tank inspections must incl ude a visual Inspection of the tank(s)
the volume of hardware, identify any cracks or leaks, m ce uThe dispersal cell( shalbe a ly inspected back up
pect ed to check the effluent levels
and to check or any -
or ponding of effluent on the ground surfs round surface. The ponding of effluent on the
in the observation pipes and to check for any pond of effluent on the g authority.
notification
ground surface may indicate a failing condition and requires the immediate ) of m °cef the volume, the
When the combined accumulation of sludge and scum in any tank equals one -third (y of in accordance with ch. NR
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed
113, Wisconsin Administrative Code. retreat ment components, and any
The servicing of effluent filters, mechanical or pressurized PO rformed by a certified POWi'S Maintainer.
WTS components, p
other maintenance or monitoring at intervals of 12 months or less shall be pe
A service report shall be provided to the local regulatory authority within 10 days of c ompletion of any service event.
ce of painting products or other
START UP AND OPERATION ) for the pre
hi h concentrations are eatment
and
For new construction, prior to use of PP /or age the dispersal cell(s). 9
chemicals that may impede the trea se a servicing operator prior to use.
b a p 9
removed y
detected have the contents of the ta nk(s)
' Page of
System staff up S hall not occu when soil conditions are frozen at the infiltrative sur powe Is restor the eXCeSS
During power outages pump tanks may fill above normal highwa
ter Levels. When
wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cels) and may result in the
or surface discharge of effl3uent To avoid this situation have the contents of the pump tank removed by a
backup
backup Servicing Operator prior tp restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to
Septage assist in manually operating the pump controls to restore normal levels within the pump tank
nks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,
Do not drive or park vehicles over ta
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; Clgar!ette 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.
ABANDONMMENT
� When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the
with
ch- Comm 83.33, Wisconsin Administrative Code:
system is property and safety abandoned in co mpliance i o Wings sealed.
• All piping to tanks and pits shall be disconnected and the abandoned pipe Pe
• The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
• After um in , all tanks and pits shall be excavated and removed or their covets removed and the void space
P P 9
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN a been or must be taken, to provide a code
cannot be repaired
the following measures hav If the POWTS fails and ca
s
compliant replacemen t system:
the location of a replacement soil
A suitable replace
ment area utilized for has been evaluated and may be hould not
absorption system. The replacement area should be protected from disturbance and compaction an s
be infringed upon by required setbacks from existing and proposed structure, lot lines and wells- Failure to
protect the replacement area will result r
n the need for a new soil and site evaluation to establish a suitable
re lacement area. Replacement systems must comply with the rules in effect at that time. sin POWTS
P ruin ad
vance
A suitable re lacement area is not available due to setback and/or so
it (imitations. Ba g
O P
'n tank m
a d lt resort to replace the failed POWT
ogY S.
technol a holdr g Y be installe as a as
d
e site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod an
suitable re
; site evaluation must be perform
ed to loco
te lacement area. If no replacement area is available a a P
oldin 9 tank y ma be installed as a last resort to replace the failed POVYTS.
nd and at -grade soil absorption systems may be reconstructed in place following removal of the biom at at
the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING»
EN
SEPTIC, PUMP AND OTHER TRF�ITMT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGE .
K UNDER ANY RE E NTER A SEPTIC, PUMP
E OF A PERSON PROM THE INTERIOR OF A MAY EB D F OR MPOSS gTM MAY
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name .I.0 f Name fi �, f✓
Phone � �--� -°
Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY +
Name Agency ��,
Phone J -`� L ��' Phone — J29fs— t�
is document meets
This document ryas drafted try the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. Th
the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(f) and 63- S4(1). (2) & (3), Wisconsin Administrative Code- Use of this document does GMw (
guarantee the performance of the POWTS.
Wiscongin Department of Industry, Pag 1 Of 3
Labor and Human Relations SOIL AND SITE E V A L U AT I�R EFRO R T 9
� de
COUNTY I
Division of Safety & Buildings
in accord with ILHR 83.05, is� o
�y :
\' St. Croix
Attach complete site plan on paper not less than 8 1/2x 11 inches in sizej.Ptda must irWtic�e)
PA EL I.D. #
ale D
not limited to vertical and horizontal reference point (BM), direction and % of-glope, sc or
dimensioned, north arrow, and location and distance to nearest road. 1 WED B d1 DAT
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATIG}Ft.': ST GF�p� j d
PROPERTY OWNER: PA'0P j''
R J C Development, Inc. GOVT�tp NW 1G4' �� /4,S25 T 30 ,N,R 18 for) W
PROPERTY OWNERS MAILING ADDRESS LOf .� ' 8L A i . NAME OR CSM #
1868 CTH. "C" 1 csm
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY (]VILLAGE F&IfOWN NEAREST ROAD
Somerset, WI. 54025 (715) 247 - 5721 Richmond 140 th. St.
I ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd/ft
Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft
Recommended infiltration surface elevation(s) 105.70' ft (as referred to site plan benchmark)
Additional design / site considerations system el. based on contour line of el. 104.70'
Parent material glacial drift Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem ❑ S �7 U ®S ❑ U IM S ❑ U KI S❑ U El FL] U ❑ S fr] U
SOIL DESCRIPTION REPORT
Boring # Horizon
Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -11 10yr2 /2 none L 2msbk mfr cs if .5 .6
2 11 -20 7.5yr4/4 none scl 2msbk mfr gw if (-4) .5
1 3 20 -53 7.5yr4/4 none sl 2msbk mfr gw na .5 .6
lev.
1 4 53 -80 5yr4/4 c2d 7.5yr5/6 scl M na na na np .2
Dep to
limiting
factor
53"
Remarks:
Boring #
1 —9 10yr2 /2 none L 2msbk mfr yw if .5 .6
2 2 —16 10yr4 /4 none sicl 2msbk mfr gw if .4 .5
3 6 -62 7.5yr4/4 none sl 2msbk mfr yw na .5 .6
Ground
elev. 4 2 -80 5yr4/4 none scl M na na na np .2
1 Q5 • fi
Depth to
limiting
factor
62"
V Remarks:
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave ew Richinon0i WI 54017
Signature: / Date: 5 -4 -2000 CST Number: m02298
I I - -
PROPERTY OWNER RJC Development, I ncSOIL DESCRIPTION REPORT Page 2 `of 3,
PARCEL I.D. # pending
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounclay Roots GPD /ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 0 -8 10yr2 /2 none 1 2msbk mfr cs if
2 8 -21 10yr4 /4 none sicl 2msbk mfr yw if .4 .5
Ground 3 21 -55 7.5yr4/4 none sl 2msbk mfr yw gw .5 .6
elev.
101. 8t. 4 55 -75 7.5yr4/4 c2d 7.5yr5/6 sl M na na. na .3 .4
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
F
Remarks:
Il SBD- 8330(8.05/92)
Y~ n . 4
STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTM2298 NW4SW4 S25 T30N - R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #1 -csm
N
1 " =40'
BM.= top of 1 Pvc pipe @ el. 100.00'
Alt. BM.= top of 1" pvc piep C el. 104.20'
F
�Aj
0
Gary L. Steel
5 -4 -2000
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNE HIP CERTIFICATION FORM
OwnerBuyer
Mailing Address O ,X17 Z� 6 - v 7 -" �, 2
Property Address I 0
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number 0 2 (a 1 0 1 -3
LEGAL DESCRIPTION 3
Properly Location r /., Sec�, . T 3 ON -R W, Town of PO
Subdivision , Lot #
Certified Survey Map # Volume Page #
Warranty Deed # Volume Z 3 `1 . Page
Spec house, yes ❑ no Lot lines identifiable yes ❑ no
SYSTEM MAINTENANCE
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 sooner, 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 Zoning Department a certification form, signed by the owner and by a
mastcrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary) , the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
da three year expiration date.
�Z A!=:— � )D g4
S1GNA11JRV OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the pr?pSoy described above, by virtue of a warranty deed recorded in Register of Deeds Office. n
v
9 G — NATURE OF APPLICANT DAtE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
J 2347 ° 265
733795
t ' STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between RJC Development, Inc.. a Wisconsin RECEIVED FOR RECORD
Corporation, 08/05/2003 09:30At1
Grantor, and Todd Mare k Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXERT #
the following described real estate in St. Croix County, State of Wisconsin
(if more space is needed, please attach addendum): REC FEE: 11.00
Part of the SWI /4 of SWIM and part of the NWl 14 of SWl14, all in TRANS FEE: 178.20
COPY FEE:
Section 25, Township 30 North, Range 18 West, St. Croix County, CC FEE:
Wisconsin, described as follows: Lot 1 of Certified Survey Map filed PAGES: 1
July 19, 2000, in Vol. 14, Page 3900, Doc. No. 626685, AND Lot 4 of
Certified Survey Map filed July 19, 2000, in Vol. 14, Page 3901, Doc. No.
626686.
Recording Area
Name a l ftfft OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, WI 54016
026- 1073 - 40-100 & 026 - 1073 -60 -200
Parcel Identification Number (PIN)
This is not homestead property
(is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of August 2003
RJC Development, Inc.
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., a Wis consin Corporation STATE OF )
by ) ss.
County )
authentic � day of August 2003
Personally came before me this day of
Kristi the above named
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Scats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Oglan
Hu dson, WI 54016 _ _ _ Notary Public, State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 2 - 1999
I�
M / 4r
ro °' � ♦o�
1C)H�tSON , y
� u 4 1 �3f ¢
w AMI.FdY. +z
VNIS. 0
.J * 'Q- Z =bb85
fSUp
t; J � M A P
ERTIFIED SURVEY �•�
® � A �.yrRS.ee 6 r r '
Located in part of the Southwest Quarter of the Southwest Quarter and part of the Northwest Quarter of the
Southwest Quarter oil in Section 25, Township 30 North, Range 18 West, Town of Richmond, St. Croix County,
Wisconsin.
Prepared for and at the request of:
OWNER:
RJC Development, Inc, l �
1868 C.T.H. C"
Somerset, WI 54025' e
Drafted by. Ty R. Dodge
WEST 114 CORNER I I UNPLATT LAND JUC 1 9
33' ( - £AST -WEST 1/4 LINE R NH Hr
SEC170N 25 -30 -1B � � �Q17 �
(FOUND ALUMINUM) � " - t'Olst�� ALSf1
COUNTY MONUMENT � " -- S89'52 2B E 5263.58 -- -�\ \ ` Cfo p, �
S89'52 26 E 248.00 tS
l� 215.00' S89'S2'26 "E� 5015.58' r
33.00' : _ K '
EAST 114 CORNER
al SEC1101V 25 -30 -18
�1 N' ( FOOUND ALUMINUM
�i W i �i ( 0 33 I oI L O T 1 o Z, COUNTY MAVUMENT)
a , co O O I
~i I n a l d g LEGEND
Q I ;
0101 ("' I �I � County Section Corner Monument
JI G: M l 'awn k � LO ; � i ��
_ of Record
I I
u (Mn W �i 'n (n � � � Z� °i � Set 1" x 24" Iron Pipe weighing
a minimum of 1.13 pounds per
" w
in 0 0 _' °I linear foot.
o g 0 g R= Recorded As
c o o ^I I • • • • • • • • • • • Denotes Building
' *� a` to ' �''' (100' from R — Setback Line
o W)
Ulna N I
°' E wI
_ LOTAA64a
.«+ y 'O 01
a E` `o d l j �>33.00'
`" ;c Q . m rn j I ' 215.00' LOT 1:
° E >' c w1 89'52'26 "W 248.00' TOTAL AREA:
vi o o M' j 114,081 SQ. FT./2.62 ACRES
I
0)'o °'~ ° > >i I ao ANT "A, AREA EXC. R -O -W:
o °: 98,901 SQ. FT. 2.27 ACRES
y 3 .a QI 10 L
`o o ra �w I U ---- LANDS LOT 2:
, a a w iLn DI TOTAL AREA:
103,442 SO. FT./2.37 ACRES
E o rn= Ni w i N( AREA EXC. R - O - W:
rn .w c �- � � o " . 93,780 SQ. FT. 2.15 ACRES
. o N W ° I ',g Ln W I o POINT B
a,
-o o F� "." in Z S89'52'28 "E 354.00'
c n v cwii � o i �� 321.00'
�` "'33.00':
Op m6 NI�Z�j) +N
N En v v "-I I I l m N 10
�' N LOT 2
m e ° I I a' I N N SOUTH LINE OF 7HE NW 114
`- N ' I O I N I OF THE SW 114
to) — — —
ao a I — ..._.. .. .. .. — .. — .. _.. _...
o - c al of �I I w I 3 NOR 7H LINE OF THE SW 114
• nm p QI NI 11 1HE SW 114
t `U �IK)jl ' to
Lij c °n x .r1 � w� i[) (N in U NP_LATTED_ LANDS
O o a ° Ia=1Ql �o I O �o OF (�WN_ER - - --
ZF-r+U �I�lal 0 'In
"?� h Z �r33.00': 321.01' to
JI Fi �i S89'55'25 "W 354.01' NORTH LINE OF THAT PROPERTY DESCRIBED
wi o 1 (33, � I IN A WARRANTY DEED RECORDED IN VOLUME
�>
W UNPL LANDS 1205 PAGE 534 IN THE REGISTER OF DEEDS
I EMEMOIX COUNTY, WISCONSIN.
c I ST. CROIX COUNTY
1 w Planninn Znron and Parks f own jttgR
111
tn
in
IUL 19 2000
IN SOUTHWEST CORNER
S£CTTON 25 -30 -18
JOB # A00049 (FOUND 314" IRON ROD) If not fecufueu wain 3U days of
Prepared by. `�, /�( approval date approval shall be
A & E 150 nulband void 150 NO TH W
LAND SURVEYING k CIVIL ENGINEERING
Phone No. (715) 246 -4319 GRAPHIC SCALE
109 East Third Street, P.O. Box 325 SCALE IN FEET: 1 inch = 150 feet
New Richmond, WI 54017 BEARINGS ARE REFERENCED TO THE WEST LINE OF THE
Sheet 1 of 2 SW 1/4 OF SECTION 25, TOWNSHIP 30 N., RANGE 18 W.
WHICH IS ASSUMED TO BEAR N00'25'35 "E.
Vol. 14 Page 3900