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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 405194 0 (ATTACH TO PERMIT) GENERAL INFORMATION State �Plan� ID � 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: Kizer, Tom Richmond Township 026- 1127 - 12-000 CST BM Elev: ( Insp. BM Elev: BM Description: Cf, WM OA+ . Wl TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z Benchmark Dosing ' ` w Alt. BM Aeration Bldg. Sewer 46 - S . s - f Holding St/Ht Inlet 1,30 gs-oSf St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > f r t2 a Dt Bottom Dosing Lt Y 570 f Header /Man. f CA 2 "� l�l•95� Aeration Dist. Pipe 2 • r Holding Bot. System .i0 01.35 ,o d .30 r Fin a Grade u �I PUMP /SIPHON INFORMATION (=j (Z *- Manufacturer Demand St Cover O 11 0 1 _ GP 3�3 5 I ,` O Model Number S�- � DH Lift Friction Loss System Head TDH �t ko�Se 2.cS .(c0 1. � Forcemain Length i Dia Dist to well (v S SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of T es PIT DIMENSIONS No. Of Pits Inside Dia. ILiquid Depth DIMENSIONS S I z t6 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI ufacturer: INFORMATION CHAMBE Type Of System: ` -' z f DS / 1/ ` tuber. DISTRIBUTION SYSTEM . P/L T 1 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake It Length Dia_� Length Dia Spacing SOIL COVER 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 Yes ! No [ ,JI Yes No 7 — COMMENTS: (Include co a discr a ties, persons present, etc.) Inspection #1: �� / 3 / OZ Inspection #2: 40 l,( -MS t Z l� ocatton' -1425 133rd venue New Richmond, WI 54017 (NE 1/4 SW 1/4 25 T30N R18W) R Ric o d Hills Lot 12 Parcel No: 25.30.18.822 1.) Alt BM Description = T�-••v 2.) Bldg sewer length = �. amount of cover = 3.) Contour = (cc .zs S 4. r i additional information. U� other side for Y es a e No `�Dat SBD - 6710 (R.3/97) Insepctor'sSignature Cert.No. � �� �aY Division and Buildings C� 201 W. Washington Ave., P.O. Box 7162 ^^ --II — � g VVimspe-onsin Madison, WI 53707 - 7162 Sine 5 .. 33 T� Oe artment of Commerce 7 --8 -Q Z sJ�3 S Permit Number Sanitary Permit Application Wis. dm. Code rso info v' ❑ Check if Revision In accord with Comm 83.21. , Pe D ma be used for sea Privacy . a15. State Plan I.D. Numbem I. Application Information - Please Print All Information Parcel Number 11 4W i property Owner's Name _ T, rn ST. CFZOIX COUNTY — zf I j 2: property Mcation property Owner's Mailing Address 1. S�T 0 N, R W E City, State Zip Code Phone Number Lot N her Block Number Subdivision Nam CSM Number II. Type of Building (check all that apply) N1 IJ4 1 ❑City 1 or 2 Family Dwelling - Number of Bedrooms (]village ❑ pubiidCo rcial - DescnIt Use � � wnship la 0 state _ a (t7t9 . ooR- Nearest Road Type of Permit: (Check only one box on line A numbering scheme for internal use). Complete line B if applicable) For County use � 1 New 2 ❑ Replacxmcnt system 3 ❑ Replacement of 6 ❑ Addition to Tank nniv B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)• --1a0 44 ❑Non - Pressurized In- Ground 2tAMound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑Recirculating 30 ❑ Other V. tment Area Information: sign Flow (gpd) Di Area Dispersal Area Soil Application Percolation Rate System Elevation Elevation Grade Required p Rate(Gals./Days/Sq.Ft•) LMr°./Inc h) IIevdon 60o ZOOip (o C) 0 6 l��`� Fib O Manufacturer Prefab Siu Steel Fiber Plastic VI. Tank Info Capacity in Total Number Concrete Constructed Glass Gallons Gallons of Tanks New Existing Tanks Talcs _ o r Holding Tank �a 5 lbsdng Chamber VII. Responsibility Statement - I, the undersigned ility for i of the POWTS shown on the attached plans. Plumber's Si MpJWRS Number Business Phone Number Plumber's Name (Print) n -2— / _ Plumber's Address (Street, City, State, e) I� ���/ � 0P lYlaYlcl S�Z� VIII. Count /De artment Use Only ure (No Stamps) Sanitary Permit Fee (includes Groundwater Date Issued Issuing Ag ent Si S' rgna Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse .Z S ZS Determination 1X. C of A provaUReasons for isapprov �pu�i Ct>v�CR. Cam(�Nd�4L� . ml ,,,p �� ._ Attach complete plod (to the Canty only) for the system on Papa' not less than Un x 11 inches in dze cR11�.�4R M 05/011 Tom Kizer PLOT PLAN ADDR 6 Park Ave New Richmond Wi 54017 . . W"1/4 SW 1/4S 25 /T 30 N/R 18 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 5/30/02 4 DATE BEDROOM _ CONVENTIONAL AT -GRA CONVENTIONAL LIFT HOLDING TANK )00( SEPTIC gallons LIFT TANK SIZE MOUND SEPTIC TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 IL # of chambers none BENCHMARK V.R.P. Top of I" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 101.5' Tank is to be properly 130th Ave bedded and provided with lockdown covers with approved warning labels Grading is to be Well is to meet all done to divert setbacks found in run -off away Comm. 83 from system System is to be installed tD along the 100.5' Contour m Alt. 101, Pro 4 B.M. B-2 Bedroom ❑ ❑ House B -1 Area 15' Below huffcutt System is to combo tank B - 3 remain g,M undisturbed 310' Property Line 1% 100' Slope J Scale = 1/4 = 10' ,E Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 Air W TDD #: (608) 264 -8777 isrconsin www.comnerce.state.wi.us /sb Department of Commerce www.wisco Scott McCallum, Governor Philip Edw. Albert, Secretary June 17, 2002 CUST ID No.226900 A777V.- 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: 06/17/2004 Identific rs SITE: Transaction ID N 5587 Site ED No. 645765 Tom Kizer Please refer to both identification numbers, 130TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County NE1 /4, SW1 /4, S25, T30N, R18W FOR: Description: Mound 600 Gpd. Object Type: POWT System Regulated Object ID No.: 855019 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: Correspondence Notes: • This plan action is subject to designer notes / comments on the plan. • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" Version 2.0 SBD- 10691 -P ( N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD - 10706 -P (N.01101). 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 O review shall relieve the designer of the responsibility for designing a safe building, structure, or component. ce��c R �t SEE SHAUN R BIRD Page 2 6/17/02 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 Thomas E Devereaux Plumbing / POWTS Reviewer H , Integrated Services WiSMART codei 7633' (715)634-3026, 7:45 am - 4:45 pm Mon. - Fri. tevereaux @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 5/30/02 Owner: Tom Kizer 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 ^�.T.S• E D Signature ERCE ��H or co M y p BUkL01% S License number 226900 F 5/30/02 GORR 7 s�� PLOT PLAN PROJECT Tom Kizer ADDR4 6 Park Ave New Richmond Wi 54017 NE 1/4 SW 1 /4S 25 /T 30 N/R 18 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /30/02 BEDROOM 4 CONVENTIONAL AT -GRA CONVENTIONAL LIFT HOLDING TANK MOUND )= 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 101.5' AL Tank is to be properly 130th Ave bedded and provided with lockdown covers with approved warning labels Grading is to be Well is to meet all done to divert setbacks found in run -off away Comm. 83 from system 0 System is to be installed CD along the 100.5' Contour 101 Pro 4 m Alt. Bedroom B.M. �B -2 House B -1 huffcutt Area 15' Below combo tank System is to B-3 remain B M undisturbed 310' Property Line 1% 100' ' slope Scale = 1 /4 11 = 10' Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric .,Distribution pips ♦STK C -33 Sand f ' Topsoil _ ~ _. G I T .., . r� f 7. Slope ( tied Of �� 2 2 force Main �� Drain Rock From Pump Layer 'D Cress Section Of A Mound ' Syslem Using E. r� A Bed For The Absorption Area F G A Ft. ti E 7_3Ft. J..5� Ft. ly'J,Z Ft. jk rn u-Ps wALat. L r A d7Observotion Pipe l - - - - -- 1 Force Main From Pump p Distribution Bed Of 7 — 2 %2 Pipe Drain Rock LL 4 Observation Pipe Permanent Morker Pipe or Rods Plan View Of Mound Using A Bed For The Absorption Area PAGE OF Perforated pipe Detail r 0 i End View )Perlcwotqu ; j PVC P-Pt Notes Located on Bottom. Are Equerry Spocee A A-'A'P j Br' + 4 S PVC Forte Main I l n AAST Mat& /d1i.XT t'e cww%c }►an l � { PVC Manifold Piet L� S D/� Distriptttion Pipe � Pf - 7 r 2 — L4 X g ? , � Distribution Pipe Layout A Ft. R R. X Inches Y _._:..,._ Inches s/ Signed: Ho le Diameter oZInch ZZ d 7 Lateral a Inch(es) Licens tmtber: Manifold Inches � Date Force Main " �L� Inches 0 of holes /pipe Invert Elevation of L aterals Ft. Maae Ut SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF t25' FROM DOOR. WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W! PADLOCK S FINISHED GRADE WARNING LABEL G " �+'.a. 4 MIN. sy° 18" IN y C.%. alKrWw► oa X . o . fire � t8 � M{ M• INLET � 1' WATER TIGHT SEALS GAS- TIGHT NAPPROVED FILTER - A SEAL ti JOINTS WITH APPROVED --t. -- ALM APPROVED PIPE PIPE 3' -�-- ONTO SOLID C ON SOLID SOIL SOIL PUMP OFF al d ELEV/0 • FT. -+- OFF D 3" APPROVED BEDDING UNDER TANK l77 RETE PAD SPECIFICATIONS ! SEPTIC ! DOSE TANK MANUFACTURER:`5;6 NUMBER DOSES PER DAY: TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING �� DOSE GAL. F LOWBAC K : GAL. ALARM MANUFACTURER: v - a &r S v CAPACITIES: A =& INCHES = GAL. MODEL NUMBER: B = .2 INCHES = GAL. SWITCH TYPE: rte- Q PUMP MANUFACTURER: ��D C " ._.... INCHES c GAL. MODEL NUMBER ZML D = INCHES = J GAL. SWITCH TYPE: - ---- -- REQUIRED DISCHARGE RATE 6PLM�PUMP 8 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . : FEET + MINIMUM NETWORK SUPPLY PR SURE . . FT. . . . . . . . FEET FEET FORCEMAIN X' FTll00FT. FRICTION FACTOR .' FEET TOTAL DYNAMIC HEAD = INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 7 IDTH DIAMETER LIQUID / DEPfiiT - i 5 " SIGNED: LICENSE NUMBER: zZ ©9 DATE 1/88 En gineering ! s i t : o . - 40 s Maeii ;>roiels 51 40M1 3lN48W S40Ai S44112 = 10. raft teal 3 S4oeJ Pais (4 Pale) - GP a15 .- Totd feae�) 10 14 1T �1 . Mark 49. ) 3.0 4.3 .&2 I29'P;Meo�iiwd (PttErrs /sec 3.8 25 1.3 .di3 O - e - 0ass 11 I 1/r Irr S 3/4' b 28bs. Sara• afrs' 18 Yi[iBS. (1C . - s nzn tee}. Per Card, as/3< 9m 2 aaff ill"#r�r�ros NAie Suess Stetl s lie 3. Ni fit - ,_ 5iai1 ` S�ei S. reserve the. make - IAatLnicei Seifacex _ � to qr � <� fir SkhSeei SedBad 'AiM i - iallaesliate.•. EarseeMrs itaiiessSeed ? 2{5C1*. - ®1998 Hydroa�a6c' Punps, AsMa�d Ohoo. AN Reexved I� FMROMATIC ° - Y=wA dharmea toW MWANdOr iil� i►�o/ iW A&A Olds 44105 Tek 411 -2W= rmc 419 -z814M WA Sie:vAV*WA*PwFm s� ors w �u>v►loi� at�s wig aounR�s ��— ar >re�t.��il��r�r�ie�io�r��e► �., �. ;� �. ,� w � .� �6 � +. �. . f �` �,� � t, ►�; �' �� ;� i 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 Shaun Bird #226900 5/30/02 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa ge of Flit E INFORMATION SYSTEM SPECIFICATIONS Owner Sew Tank Capacity -f S o NA Pem Septic Tank Mantes a NA EIMMUtt FEW Manufacturer o NA DESIGN PAtiA>igETERS Nth of Bedrooms NA Eflicetnt Filter Model f) a NA Ntunber of commercial Units Pump -Tank Capacity (.� a l 17 NA Es; mated flow (awme) Q ga pump Tank Manufacturer a NA Design flaw (peai4. ( x 1.5) Q Pump a NA Soft Rift Q Pump Model Q a NA InIluen VE QTY Morl" awleraw fitment Unit Fab, 05 & Grease (FOG) 530 mg/L 0 SarKVGmvd FAer o Peat Hker a Mil Aeration a wetland Modomical Oxygen Demand (BOD 420 mg& a Dkidbotion o Other Total SuqmxW Solids (TSS) s150 mg1l. Mamdachu- prefteated Effluent Quality Monthly average•• pisposd Ce*s) Biochemical Oxygen Demand (BO D S J 530 mg& a in- ground (graft) a bKjround (pressurized) nd Total Suspended Solids (TSS) 530 mg/L a Drl grade Fecal Cogform (geometric mean) 510` cfu/100m1 o a Other. . Maximum Effluent Particle Size K inch diameter varues tjobw for domestic (non-coamum:iao vnstmater and -• vakm typtcar f wwwwater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every o months years) (Maximum 3 yrs.) pump out contents of tank(s) When combined sludge and scum equals o�� (K) of tank volume At least once every a months year (Maximum 3 yrs.) inspect digersal cell(s) ,�- a months years) " Clean effluent faer !east ° every Inspect pump. pump controls & alarm At feast erica every o months years) o NA Flush re test At least once every o months s) a NA Flush Odwr. At least once every o months o year(s) ❑ NA od At least once every a months o year(s) a NA MAINTENANCE INSTRUCTIONS one the following menses or Inspections of tanks and dispersal cells shall be made by an individual cant' ng ohs: Maier Plumber. Master Plumber Restricted Sewer; POWTS Inspector: POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual won of the tames) 1 identify any missing or broken hardware. identify any cracks or lentos, measure the volume of oontbirnied sludge and scum and to check for any back up pot ng of effluent on the ground surface. The disPert:al 0011 (s) shall be visu* to check the effluent levels and to check for any P n9 of effluent on flte ground surface. The pondatg of effluent on this in the observation t and requkes the immediate notification of the kxNd regulatory autihority. ground surface may indicate a fading rend - rtion When the combined accumulation of sludge and scum in any tank equals one l*d (Yj or more of the tank volume. the entire contents of the tank shall be removed by a Septage Servicing Op and disposed of in accordance with ch. NR 113. Wisconsin Administrative Code- - The servic irng of effluent fitters. mechanical or pressurized pOWTS components. putt Components. and any other maintenance or mon at intervals of 12 months or less shall be performed by a eerti� er d POWTS Maintain. a within 10 days of completion of any service event. A service report shag be provided to the local regulatory au thority START UP AND OPERATION for the presence of Painting products or other For new oonstrudiat. prior to use of the POWTS check treatment tank( s ) s if !ugh concentrations are chemicals that may impede the treatment process ardor damage the di c4 s) detected have the contents of the tank(s) removed by a seplage Ong operator Prior to use. ' Y Page of System start up shad not occur when sod•corddilons are frozen at the infiltrative surface. Dunng power outages pump tanks may fill above aortal tktrwater level. When power Is restored the excess waste%vater will be discharged to the dispersal cell(s) In one large dose. overloadmg fie cis) and may result i the bac ,or surface (roctwMe of efnj=iL To avoid tads sduaflon have the contents of the pump tw* removed by a Septage g Operator prior loo restoring power b the effluent pump or contact a Plumber or POWTS Maintainer to assist i manua opera" the pump controls to restore normal levels within the pump tank.. Do not drive or park over tanks and dispersal cols. Do not drive or park over, or olvarwise disbiub or compact. the area within 15 feet down slope of any mound or atVrade said absbrption area. Reduction or elimination of the folowkmg from the wastewater wear may improve the pabrmanoe and prolong the lie of the PowM artloiodc� baby wipes; butt condoms cotton swabs a ; degs: dental Goss fir. fat faimida�cn dMin (sump pwW) water. fact and vegetable peeCmgs; gaisolne; greases herby meat scraps; moons; of OgAV products; per. sanitary . - and water saftener brine. ABANDONMMENT When the POINTS fans wKVor is permanently taken out of service the tolov tg steps shall to taken to insure that the sys i propmy and ' s afely abandoned in compliance with ch. Comm 83.33. Wisconsin Administrative Code: • Ad piping to tanks and pits shag be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shad be removed and property disposed of by a Septage Servicing Operator- • After pumping. a ll tanks OW pits shag be excavated and removed or their covers removed -and the void space f gW wdh son, gravel or another inert sold material. CONTINGENCY PLAN If the POINTS fads and cannot be repaired the following measures have been. or must be taken. to provide a code cAmpfiant replacement system: ❑ A sultabie naplaoenment has been evaluated and may be utdized for the location of a replacement sal absorption system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by recluked setbacks from exisling and proposed structure • Ict lines and wells Failure to protect the rlepfaoe<nnent area will result in the need for a new sod and site evaluation to establish a suitable replacement area, R systems must comply with the rules in effect at that time_ ❑ A suitable replacement area is not available due to setback and/or sod dmi ations. Bamng advances in POWTS technology a holding tank may be installed as a last resort to replace the faded POINTS. The site has not b een evaluated to idenMy a suitable replacement area Upon falure of the POINTS a sod and sfte evaluation must be performed to locate a suitable replacement area If no replacement area Is avalable a tank may be installed as a last resort to replace the faded POWTS. Mound and at -grade sod absorption system may be reoonstnxted in place fodowamg removal of the blomat at eve surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANIVOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POINTS IN ST POINTS MAINTAINER E Name Name Phone / Phone r— J SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY Name Plane /- 2 zz : This domed was diaftd by time imtadrs d Wa r�eeen Lana. Manq and Waushana CouriY Zan6g and Sanitaean - lids doh moos tha mi *,= r d dL Comm 83.22t2itbX1Xd)StQ and 83.WlL (2) >L (3). vYisoansht Ad a Cade. use d Mb doaanent does GMW (am) guarantee the Qetfonnanoe of the POWTS_ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 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. pendin Please print all i►jWid 'k1 joh.! R viewed by Date Personal information you provide may be used for : ,KA"d' purposes (Privacy LaW,'s. 15.04 (1) (m)). Z Property Owner a Property Location R J C Development, Inc, govt. Lot NE 1/4 SW 1/4 S 25 T 30 N R 18 K(or) W Property Owner's Mailing Address r; €l Lot At Block At Subd. Name or CSM# 1868 Cty Rd. C. 2: na Richmnnrl Hill-- City State Zip Code, -r phone Nutt e ' ity ❑ Village 91 Town Nearest Road New Richmond WI. 1 54017 C' )�9 T Richmond 130th. Ave. New Construction Use: ❑ Residential / N6 156f%f _ Code derived design flow rate 6f1Yl GPD ❑ Replacement ❑ Public or commercial = Hdscdille: - Parent material Cil aCi a 1 r1ri ft Flood Plain elevation if applicable na ft. General comments and recommendations: mound @ el. 101.50', based on contour line of el. 100.50' F 1 Boring # Boring Pit Ground surface elev. 100 7.0 ft. Depth to limiting factor 28 in. Soil A lication 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 - Eff#2 1 0 -11 10 r 3 2msbk DSH LJW if .5 .8 2 11 -19 10 r 4/4 none sici 2msbk mfr QW if .4 .6 3 19 -28 7.5 r 4/4 none scl 2msbk mfr (w n .4 .6 F Boring At 1 �� Boring 43 ® Pit Ground surface elev. _ • 70 ft. Depth to limiting factor in. —� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 I 'Eff 42 1 0 -10 10yr 3/3 none L 2msbk DSH 9w if .5 .8 2 10 -22 10 r 4/4 none sici 2msbk mfr w if .4 .6 3 22 -43 7.5 r 4/4 none sl 2msbk mfr .5 .9 4 -68 7.5 r 4 c2 7.5 r 5/6 sl M na na na .3 .5 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L CEi 2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature y ° CST Number Gar L. Steel � 298 Address Con cted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10 -15 -2000 715 - 246 -6200 F ' Property owner R J C Development Inc. Parcel ID# Qendin Page —9 of 3 Boring # ❑ Boring ® pit Ground surface elev. 100.40 ft. Depth to limiting factor +65 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EflW 1 0 -9 10 r 3 2 9 -22 0 r 4/4 none sicl 2msbk mfr if .4 .6 3 22-4157.5 r 4 none sl 2msb f .5 .9 4 45 -6 r 4 4 none sl M na na na .3 .5 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF 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. Soil Kplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = BOD, > 30:S 220 mg& and TSS >30 < 150 mg/L ' 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 (R.6r00) I , 1 r , STEEL'S SOIL SERVICE Gary L. Steel RJC Development, Inc. 1554 200th Ave. CSTM2298 NE4SW' S25- T30N -R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #12- Richmond Hills N 1 =40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 101.60' c 0 a n 20 ' a� ss s' 72-: Z.3 Gary L. Steel 10 -15 -2000 r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBBMBNT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address &C' e S << Properly Address (Verification required from Planning Department for new construction) City /State ► Parcel Identification Number /9, Z LEGAL DESCRIPTION Property Location .&Je r/4, 12tH /4, Sec. � T N om, Town of Subdivision Z C./. r►ti-On, f�/ �/ -S� . Lot # �. Certified Survey Map # , Volume , Page # Warranty Deed # � , Volume Page # 3 Spec house ❑ y no Lot lines identifiaV16 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 mastorplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -slte wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 �ys f the year e iration date. � 0 5I ATURE 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 pro a ribed a by virtue of a warranty deed recorded in Register of Deeds Office. SIGN TURF 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 reap if reference is made in the warranty deed STATE BAR WISCONSIN FORM 2- 1999 6 7 c3.4 0 6 Docuejem Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI This Deed, made between R Development, Il e., a Wisconsin Corporation, RECEIVED FOR RECORD — — - -- 05 -20 -2002 9:40 AN Grantor, and Thomas M. Kizer, Jr., and Heather J. Kizer, husband XEWT E WO and wife, EXEMPT t — — — — - -- REC FEE: 11.00 __- ..— . - - -. -- TRANS FEE: 74.10 COPY FEE: Grantee, CERT COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the PAGES: 1 following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot l , Plat of Richmond ' s in the Town of Richmond, St. Croix County, Name and Return Address P tsconsin. WESTCONSIN CREDIT UNION P.O. BOX 269 NEW RICHMOND, WI. 54017 026.1127 -12 -000 Parcel Identification Number (PIN) This is not _ _ homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. OE) (is not) Dated this /fi day of M — 2002 RJC D el in I c�. - -- • B : ohn H. Carlson, Preside AUTHENTICATION ACKNOWLEDGMENT Signature(s) — STATE OF WISCONSIN ) - - -.— )ss. St Croix — _ County ) authenticated this ^ _day of Personally carte before me this 1 S _ day of May _ 2002 the above named RJC Development, Inc., a W isconsin Corp oration, by Jo H. — Carlson, President TITLE: MEMBER STATE BAR OF WISCONSIN " "'••• (If not, to me known ' instrument � 1 4) He same. who executed the foregoir.; authorized by § 706.06, Wis. S[ats.) `�_ - � � a) •, THIS INSTRUMENT WAS DRAFTED BY " -- Attorn Kristine Ogland r — -- — Hudson, WI 54016 N m'Y P, lei ' coh n My Com a trZanenf.c(� not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.)' •' — �.��,) + Names orpersons signing in any capacity must be typed or printed below their signature. ''rq „�������,,,.•h larmat on Prorsw oryb Company, fora du Lac, Inn STATE BAR OF WISCONSIN B WARRANTY DEED FORM No. 2 -1999 . • • • . ' • LOT 29 Z.44 AC:KC J VC I TOTAL AREA: i o 92,560 SO. FT. I 30 N 2.12 ACRES I N89'52'55 "W r 364.80' I u I � U 41 9� �2„E Z � N10 5 68� 1• 3 5 I v W I I Q W 0 LOT 34 M o LOT 35 8 �p TOTAL AREA: N ►� TOTAL AREA: 0 �' Os N 0 0 94, 079 S0. FT 0 N 106, 765 SO. FT. p 2.16 ACRES z 2.45 ACRES T33 z ................... ............................... , I I I j I N _ T • • 363.97 N89'52 55 W � 0 N89'52'55 "W 364.38' / - - - - -- 334.34 - -- - -- 115.59 -- ' • ®, —': 30.04 - - - - - -- ' ' I / 31 H I - LOT 11 H w.c. I .... I — — -- 3 TOTAL AREA: 97,927 SO. FT. 1 . oq coo 2.25 ACRES N W LOT 12 N MIN. F.F.£. 1014,0 o TOTAL AREA: I in N .i ao 8J,663 S0. Fr it g �........ 1.92 ACRES w . �• N we 101'0.a � z 3T 13 N8954'22 "E 360.04' N89'55'11 "E 349.48' 12a.eo' MA MH LINE r SEE SHEET I LOT 9 r LOT 10 a • 4 i 1 � �, � z , ��- � D �, 3` �� �� ���z Iii At it WIC NCA�/ CAPA,MY HEAT) CAPACITY CURVE [* Mr�;7E r - r .IrNr aNl; ::_vraltt.7�u • MODEL 152/153 -' 50 Fee) r Metefs rill. titan -� -rr,•1 I;lws 153 'f 1.5 59 261 40 ti Zil 152.. lti 4.fi 201 g , 7;: /.6 SA 129 47 ;>it 0.7 Z i. C. 7.7 -- I -- 1 i Q� Ocl val 1 n. (,' 1.6m) "- i ht t ofsca 0 20 0 GO 80 100 GALLONS UlLkS 0 80 240 320 + �' ROW� M(NU CONSULT FACTORY FOR SPECIAL APPLICATIONS r,• • Timed dosing panels available. • E%t*al altemafors. for duplex systems, are available and supplied with an alarm • Vartable level COrtt I swife:Ites are available for controlling single phase • Dooubieuble pggytrack variable level Boat swltdles are available for variable _ l level brig and shod cycle controls. ! I ^ ll • Sealed Qwik -Box available for outdoor Installations. See FM1420. • Over 130 "F. (54 special quotatbn required, 1521153 Comrcl salaWon I / l "Nedd Yofb -Ph � aN152 Induced 2 or 3 E152 230 7 NM t 4.3 1 7 a 3 9Etti2 230 1 Auto 4_ Included 2 w 3 1m3 116 1 'Non 1 2F.3 eN1s3 ,ts 1 Awe 106 Includod 7or� SELEC7fON GUIDE Et53 _230 t Non 63 1 Y 2 a3 1. Siro piggy vwWm iuval Net wAch or double piggyback variable level float 6E153 230 1 Auto 200 wAch. Refer to FMO477. o cA N 2. gee 840712 for correct model of Electrical Altemewr E-Pak. Ail insW von of controls• pro"on device and Mftg Mould N cone bN a duarmeo 3, variable level control cwitch 10-0225 used as a control activator, specify dupwx (3) acemad davlcWt, AN etecvicW and *041y coda should bra follovwd Including the most ncard Wrlionat EUNrla Cods (NEC) and lM Occupational iahty and Waahh Act (08HAl, or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor Is engine4red into the design of every Zoeller pump. U" TO P.O. Bo( 111347 t • . l eaoz L 1417a. KY 102360347 ArarsAadu rcrs of.. G sw Ttk 904ti Gnv Ran, Raw Lf /e l.«,raala•xY�o2r1•r>ler l�aurrPu�acS,vcE smq nrtp Maww.ioNlN 1 n p l�yr • t {BOQI D ?MUTAP FAX (Sr7lJ 171 -3624 0 Copyright 2000 Zoeller Co. An rights reserved.