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HomeMy WebLinkAbout026-1127-13-000 r Wisconsin Departm ant of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division j INSPECTION REPORT Sanitary Permit No: 430633 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)]. 75 do Permit Holder's Name: City Village X Township Parcel Tax No: McDermid, Denise Richmond Township 026- 1127 -13 -000 CST BM Elev: Insp. BM Elev: BM Descriptio : t Section/Town/Range /Map No: S 25.30.18.823 TANK INFORMATION Or/ ELEVATION DATA . 3 �b 2.1 S g �f TYPE MANUFACTURER CAPACITY STATION BS HI FS 9 LEV. -5 E. Gam. 3 Co 42.E SZ Septic Benchma /vv d 3 d S /oZ. Dosing � Aft. BM Aeration 1 Bldg. Sewer Gv Holding SUHt Inlet 5 Cam/ y0 /47 0 /0. 1 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ✓� s` Septic i n Dt Bottom -7 Dosing Hea er an. 2 14 Aeration Dist. Pipe Holding Bot. System a• ��.Ss Final Grade �. S PUMP /SIPHON INFORMATION � f � 2 / Manufacturer Demand St Cover GPM Model Number T 9p TDH Lift Friction Loss System Head TDH Ft � Forcen�ain Len h t Dia. Dist. to Well SOIL ABSORPTION SYSTEM 3 3, g. Z BEDITRENCH Width Length No. Of Trenches PIT DIMENSI No. Of PI DIMENSIONS I ke SETBACK SYSTEM TO I P /L BLDG IWELL I LAKE /STREAM LEA HI Manufacturer: INFORMATION Typ 0 _yste CHAM OR - ���pm, Model Number: DISTRIRY-TLO N SYSTEM Header anifold Distribution x Hole Size x Hole Spacing Vent to r Int e Length Dia Z # Length Dia 2" �i 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 IV Bed/Trench Center Bed/Trench Edges Topsoil Yes L ] No , I Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:_ / /0 Inspection # / X /0 Location: 1421 133rd A nue� ew Ri hmond WI 54017 N 4 W 1/4 2 T30N R18W Richm nd Hllls of 13 Parcel No: 25.0.18.82 l °� L�ivZ.�/YL ` � Ilu� ( S 5 �1� 1.) Alt BM Description = 2 i 0 4 • ( 2.) Bldg sewer length = 35 I amou�ve� A � � tCwdi revis Plan Yes Use others de for additional ' �: ,L u information. i T _i_12 6_L _' l��e'!/I?��`. SBD -6710 (R.3/97) Date Insepctor s Si .lure Cart. No ' $afet}� end Coca � /) )�,i� n Av . 7 D 201 W. Washings S itary P ;t Number (to be filled in by Co.) Madison, 53707 — / 8 V v isconsin (60 261.6546�t0 3 Department of Commerce S e Man LD. Num =r Sanitary Permit Applica on 607 I.b�S. ►4 in accord with Comm al in 83.21, Wis. Adm. Code, personfo ion y &TPre")X COUNTY oject Address (if different than mailing address) maybe used for secondary purposes Privacy Law, x15. { OFFICE I nformatioa - Please Print All Information �Z 33 AJ& . 1. Application Parcel # Lot # Block # Property Owner's N Sae C 1� ✓ operty olio Property owner's Mailing Address _ l J. / Zip Code xtionc Phone Number S City, State j �(circl / �,,� s II. ype of Building (check all that app1Y) ? Subdivision Namc CSM or 2 Family Dwelling - Number of Bedrooms _ v _ 1 c t ❑ P1lbiiaComalercial - Describi Use ❑City ❑villa wosbip of r ❑ State -rn K .. _ 1 z - 6CTD Z III. of Permit: (Chee only one bozo ne Complete line B f a livable) 0 i � i A. Replacement C] other Modification [o Existing System ew System ❑ Replacement System ❑ TreatmenvHolding Tank Re y p ❑ Change of ❑ Permit Transfer to New U Previous Permit Number and Date Issued B. [] permit Renewal El Permit Revision plumber Owner Before Expiration IV. Ty of POK System: le ,.. Cheek sU that a I le soil ❑ At Grade g ❑ Si Pass Sand Filter ❑ Non - Pressurized In - Ground �Q Iviound > 24 in. of suitable soil ❑ Mound < 24 in. of suitab 0 i a Constructed Wetland ❑ Pressurized LO- GrOuDd ❑ Holding Tank ❑ Peat Filter ❑Aerobic Treatment Unit ❑Recirculating Sand Filter t less Pi ❑ Other (explain Reeirculatin Synthetic Media Filter ❑ l.eachia ❑ Gravel - Chamber ❑Drip Line � V. Dix ersalll'reatmeut Area Information: Dis ersal Area Required (st) Dispersal Area Proposed 00 S Elev ozv Design Flow (gpd) Design Appicatioa Rate(gpdsf) p r TJ r Z Manufacturer Prefab Site Steel Fiber Plastic VL Tank Info Capacity in Total Number Concrete Constructed Glass Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the waders assume responsibility for installation of the POWTS shown on the a ttac he d s Phone Numb Plumber' Name (Prins) Plumb rgoature MP/1 -z Number (L_ / 2 � 6 7 v .J = Yb 7 l Plumber's Address (Street, City, State, Z o o� VIII. �0'ntyl D ar iment Use Oal Sanitary Permit Fee includes Groundwater Date Issued 1 win gent Signature tam s) Approved ODisapproved Surcharge Fee) ' 2 0 -- Q Owner Given Reason for Denial J IX. Conditions of ApprovaVRessons for Disapproval 3 / ` � (�� l I ^ 1 w��u t v t,► t,t SYSTEM OWNER: �QaJG- O-V lCk 1 Septic tank, effluent filter ana dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances V I e plazas (ta the Co un ty only) for the system as paper OFF than til(2 s 11 laclres la size Attach complet SBD -6398 (R. 08/02) ��+' PLOT PLAN . - T Denise McDermid ADDRESS 603 E. Main St. Ellsworth Wi 54011 jiS 1/4 SW 1/4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/20/03 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND X00C SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE a WELL .H Same as Benchmark SYSTEM ELEVATION 99.8' Scale = 1/4" = 10' 133rd Ave Tank is to be proper c bedded an provided ith m lockdown overs with approved arniner, lab Is r Grading is to be CD done to divert 99, ❑ run -off away Pr 3 Huffcutt Combo ank 98.8' from system Be room 3 " Ho B -1 i B.M. ao Well is to meet all ❑ setbacks 15' below 2% Slope - 3 found in system is to Comm. 83 remain undisturbed Alt. B.M. 355' Property Line Top of 1" PVC Pipe Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Vhseonsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary December 23, 2003 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1 101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/23/2005 Identification Numbers Transaction ID No. 956288 SITE: Site ID No. 669584 Denise Mcdermid Please refer to both identification numbers, 133TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County SE1 /4, SW1 /4, S25, T30N, R18W Lot: 13, Subdivision: Richmond Hills FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 936607 Maintenance required; 450 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do by the department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • 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). • Per manual cited above, 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. COndih • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption APPKI area. chs. NR 811 & 812c D f"ARTMENT C • A Sanitary Permit must be obtained from the county where this project is located in accordance with the ON 4177TI requirements of See. 145.135 and 145.19, Wis. Stats. SEE CORREIE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the M N designated county official in accordance with the provisions of Sec. I45.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 12/23/03 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors Owner Responsibilities: - • Comm 83.52 Responsibilities. 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 8354(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of con struction/instalIation /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 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 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pill Monday - Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page g e �D�s D /V Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 12/20/03 Owner:Denise McDermid Location: SE1 /4 SW1 /4 S 25 T30 N,R 18W Lot 13 RichmondHills Richmond 133rd Ave 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 -14 Soil test Signature � License number 22690 �nnlly J VED F COMMERCE 1�1 GS •PONDE E II PLOT PLAN PROJECT Denise McDermid ADDRESS 603 E. Main St. Ellsworth Wi 54011 SE 1/4 SW 1/4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/20/03 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R Same as Benchmark SYSTEM ELEVATION 99.8' Scale = 1/4" = 10' 133rd Ave Tank is to be properly o bedded and provided with lockdown covers with .� approved warning labels CD Grading is to be done to divert 99 , B-2 run -off away Pro 3 Huffcutt Combo Tank 98.8' ❑ from system Bedroom House f B-1 98' B.M. Well is to meet all ❑ setbacks 2% Slope - 3 Area 15' below found in system is to Comm. 83 remain undisturbed Alt. B.M. 46 355' Property Line Top of 1" PVC Pipe r Designer No Date Non -Woven Filter Fabric 4" Observatio Pipe Perforated ,DisIribulion Pipe Below Filter Fabric AsTK C -33 Sand -` G 4" J e L % Slope bed Of 2 % Force Noin `\ Flowed �� I From PUMP layer Drain Rock / #D ' E. + i � Cress Section Of A Mou SY stem Using F A Bed For The Absorption Area G A Ft. ti yam' 6 5 Ft. I Ft. �l Ft. K Ft. L Ft. s L 4:'Observotion PiPe—,\ --K J E _ ^_ -------------------------- - - - - -- l W A + Force Win _° -- - - - - -- From PUMP --------------- - - - - -- L o Distribution L 0 ocK Pipe I \ "�,^ nt Marker r ation Pie ..�.t- Obte v P Rods Pion Vie w • f Mou nd U sing c in A Bed The Absorption Area l' Perforated Pip! Oetaii End Vies �Periorotea y + PvC a;pe o� a tta t.otated O 80"om. .t ` s�o Ar e Are EquattY 50 QCeo t ? " �' t PvC Force Moines FEAST 19o1.L NsKT re CertnsG�iot PVC M06fotd Pipe I S, f� p�� Oisi.;auatian Page 41'e- x-F -- 1 46 istr;bution Pipe Layout PSY Ft. �� , • R Fi. rO X Inches Y Inches Hole Diameter ,-6Inch Signed: Lateral Inch(es) License Number: Manifold Inches Date: Farce Main Inches # of holes /pipe Invert Elevation of Lateralsl�Ft... SECT" A ND SPECIFICAT S�pTIC TANK PUMP Ci# .MB'ER CROSS SE WF- ATKRPRWF APPROVED •, MxN. ABOVE GRADE JUNCTION BOX MAN14OLE COVER 4 „ Cl VENT F :" 4R WITH CONDUIT W1 PADLOCK 2 g + I'ROlS DOOR . WARNING LABEL FREsK AIR INTAKE x `14 riNISBED QaBADE n , 2Y 4 MCI %. Rya : , t$ MtiM• INLET GAS r —F TIGHT r . JOINTS V i WATER TIGHT S SEAL gpTPROY�tPE 1" 1 L? f.R ""'.. s AN 3 ONTO SOL,1II SOIL APPROVED C i t OFF P Qm SOLID SOIL LP OFF EL Ey •��', D API ED BEDDING UNDER TANI( NMETE PAD SP£CIFICA f / 9� S ?£R DAY: NU�+IL3Eg DOSE SEPTIC f pQSE ; CLUDIDIG FACTURE I105£ v0..�7i'tE IK CK: J GAL - TA,NLC MANU GAL. FI'D��'' . SEPTIC GAL- _� r . IKCHE DOSE S TAIiK SIZES 2 G r CAPACITIES: A GAL. ALA MAmuFAC' RER,: - �- -- GAL. MODEL NUMBE = � 1��� __ �KCT?!ES SHZTCH APE C� IHCIiES =/ ' _ _. — Pump MA"U � 0 '`��J/ Z LHR 15.23 WAC KODEL IiUMBFR U Ai'p MIRING AS PER SVITCH TYPE -�' PC33IP £ ' / FEET ° Z / GPM pIPE • - �.-5- FEET RE TREIj DISCHARGE xATE --- DISTRIBU - pUMP OFF AND" FEET vER'tI�L DFIFFEREN PRESSURE *FT. F R;CTI ©N FACTOR FEET M T FO ,"UM NETWORK S€1PPLY �- � FT /104 NAMIC BEAD = /�` ; G FEER.CI IN TOTAL D� DIAMETER ^FAN K : LENGTHD t3F P i.ZQi31 IN TER N AL 'D IMEN DA = £= LICENSE SIGNED: - :t &8 TOTAL DYNAMIC HFA /CAPACITY • PER MINUT HEAD CAP ITY CU RVE EFFLUENT AND DE ATERING cn MODEL 1 52/ 1 53 I MODEL 152 153 �C I 2 w 50 Feet Meters Gal. Liters Gol. Liters 5 1.5 1 69 261 77 291 153 10 3. i 61 2 1 70 265 12 40 152 15 4.6 53 201 61 231 °¢ 20 6.1 44 167 52 197 w x � 30 25 7.6 34 129 42 159 a 8 30 9.1 23 i 7 33 125 z o 35 I 10.7 -- -- 22 85 20 — 0 40 12.2 -- �– 11 42 – 13.4m) 4 I Lock Volve: X38.0 F;. X11 6m) 44.0 Ft. 014508 10 0 20 40 60 80 100 GALLONS 6 1 / 4 LITERS 0 80 160 240 320 3 27/32 4 5 8 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS e _ Timed dosing panels available. - OO 3 27/32 • 6 ' • Electrical alternators, for duplex systems, are available and supplied with an alarm. I • e for controlling single phase Variable level control switches are availabl systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available foroutdoor installations. See FM1420. I • Over 130 °F. (54 °C.) special quotation required. 12 1/a —� 152J153 Series 1521153 MODELS Control Selection ex Du l 5 1/a Model Voks_Ph Mode Amps Si mplex _� 2 l 3 N152 115 1 Non 845 1 SK2064 i Auto 8.5 Included 2 or 3 BN152 115 1 — E152 230 Nbn 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 2or3 3 SELECTION GUIDE BN15 115 1 Auto 10.5 Inducted 2 of 3 I { p E1 230 1 Non 5.3 1 1. Single piggyback variable level float switc or double i flack variable level float BE153 230 1 Aura 5.3 Included 2 or 3 switch. Refer to FM0477. o CAUTION 2. See FM0712 for correct model of Electrici�I Aftemator 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 d into the desi n of every Zoell r pump. reserve safety factor is engineered 9 For unusual conditions a rese _y MAIL To: P.O. sox 16347 ' Louisville, KY 40256 -0347 Mar, ufacturersof.. SHIP TO: 3649 Cane Run Road Q ` ® Louisville, KY 40211 -1961 /TYPUMP9 3 1116 CE /939 a (502) 778 - 2731.1(600) 928 -PUMP http: / /wwvvzoell er. c om FAX (502) 774.3624 © Copyright 2000 Zoeller Co. Alt 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 H Page of T PLA pC�WTS OWNER'S MANUAL & M T SPECIFICA EM I SYST TION C� /� al ❑ FILE INFO RMA � C -{• Septic TanK C , Owner c -� Septic Tank Manufacturer jj NA Permit #_ 3 3 d ❑ NA Effluent Flter Manufacturer DESIGN PARAMETERS — Effluent Filter Model ❑ NA ` � O NA al O NA Number of Bedrooms Pump Tank Capacity Number of Commercial Units _ Pump Tank Manufacturer ❑ NA aVda' ❑ NA Estimated flow (average) _� pu Manufacturer Estimated x 1.5) ,� aUd J"'� ❑ NA flow (Pear, ( j Pump Model Soil Applica Rate ! • aUda /ft= Monthly average' Pretreatment Unit E] peat Filter p SandiGrgvel t Quality Fitter influent/Effiuen (FOG) 530 mg/L ❑ Mechanical Aeration [3 Wetland Fats. Oil 8 G�se ( � O Other 52213 m9 Biochemical Oxygen Demand (BODs) ❑ Disinfection Total Suspended Solids (TSS) !050 m Manufacturer ❑ NA Monthly average" [ Dispersal Cell(s) [I In-ground (pressurized) Pretreated Effluent Quality �i0 mg/L ❑ In -ground (gravity) a' Mound emical Oxygen Demand (13005) [3 At-grade [3 Other B•ioch 530 mg/l- SS ine Suspended Solids (T SS) ❑ Ori Total Suspe 510 cfu1100m Fecal Coliform (geometric mean) values typical for domestic (non commerdaQ wastewater and Y inch diameter �� tank effluent. Y Maximum Effluent Particle Size .. values typicai for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event [3 month s7'Year(s) (Maximum 3 yam•) At least once every oats one-third (y) of tank volume Inspect condition of tank(s) When combined sludge and scum eq Maximum 3 yrs.) Pump out contents of tank c3 months ar(s) s) At least once every -� dispersal cell(s) / [3 mon ear(s) inspect At least once every . r(s) ❑ NA Clean effluent filter ❑ months least once every � ear(s) ❑ NA Inspect Pump, Pump controls 3 alarm At [3 months test At least once every � C] months 11 year(s) ❑ NA Flush laterals and pressure At least once every other At least once every months ❑ year(s) 0 NA Other. MAINTENANCE INSTRUCTIONS n one of the following licenses or di Dells shall be made by an individual carrying Inspector POWTS Maintainer, Septage Inspections of tanks and dispe Master Plumber Restricted Sewer; POWT s to identify any missing or broken certifications: Master Plumber; for any back up Servicing Operato re the v olume r. Tank inspections must include a visual inspection of the tank( inspected to check the effluent levels cracks or leaks, measulume ofcoms sled sludge y d s cum and and to check effluent on the hardware, identify any round surface. The dispersal cell t o round surface. The ponding or ponding of effluent on the g po nding of effluent on floe g reg ulatory authority - in the Observation pipes and to check for any 1� wires the immediate notification of th local re9 or more of the tank volume, the ground surface may indicate a failing condition and um equals one-third (K) with ch. NR sludge by a Septage Srator and disposed of in accordance When the co mbined accumulation of sludge an ervicing Operator d scum in any tank entire Contents of the tank shall be rem retreat4ment components, and any 113, Wisconsin Administrative Code. co mp onents, 'p p e rformed by by a certified POWTS Maintainer. The servicing of effluent filters �mechanical !is of 12 the orrlless shall b Pz service event 1 regulatory authority within 10 days of completion of any outer maintenance or monitnri 9 A service report shall be prrovided to the loca nce of painting products or other for the prese START AND OPERATION octal Ares . if high concentrations are For new construction, prior to use of e t r ea tment p o and/o damage the dispersal prior to use. chemicals that may impede the a a tank(s) emoved by a septage servicing Pe detected have the contents of the Y Page of I i - conditions are frozen at the infiltrative surface - System start up shall not occur vrhen is restored the excess r o utages pump tanks may fill above normal ovectoading the cell(s) and may result in the hrghwater levels. When Power Outing pow . ;ersal cells) in one large dose, wastewater will be discharg;t0 the d To avoid this situation have the contents of the pump tank removed by a backup or surface discharg e of effluent sp power to the effluent pump or contact a Plumber or POWTS Maintainer to Septage Servicing Operate 00"6 restoring tank assist in manually operating the Pump controls estore n ls to ormal levels within the pump I cells. Do not drive or park over, or otherwise disturb or compact, Do not drive or park vehicles over tanks and dispersa of any mound or at -grade soil absorption area. the area within 15 feet down slope Reduction or- elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wlPes; Cigarette butts; condoms; Cotton swabs; dec_ gasolin e dental , g floss: d des; meat disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings: gasoline scraps; medications; oil; Painting products: Pesticides; sanitary napkins; tampons; 'and water softener brine. ABANDONMENT tiY taken out of service the following steps shall lie taken to insure that the When the pOVVTS fails and/or is permanen system is property and safely abandoned in compliance with rtt_ Comm 83.33,1nln sealed. We Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe open 9 The contents of all tanks and P� shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space • fitted with soil, gravel of another inert solid material. CONTINGENCY PLAN aired .die following measures have been, or must be taken, to provide a code If the POVVTS fails and cannot be rep compliant replacement system: • A suitable replacement -area has be e n areacshoululd and may be utilized for the location of a be protected from d isturbance a d c ompaction and should not absorption system. The repscemen sec structure, lot lines and wells. Failure to be infringed upon by required setbacks from existing and new the r area will result in the need for a new�eiied snteffeval at time�blish a suitable torsi p comply with P must m P Y S nt systems dvances in POWT - Rep laceme Y ions. Barring a cement area soli li repla cement a P • A suitable replacement are a is be lied as a last resort to replace the failed POWTS. technology a holding tank may suitable replacement are IN a. Upon failure of the POTS a soil and XShe site has not been evaluated identify a s rep lacement area is available a p evaluation must be to locate a suitable replacement area_ If no holding tank may be installed as a last resort to replace the failed POWTS. removal of the biomat at y .Mound and at -grade soil absorption systems may be reconstructed i i Pwith theys effect at that time. e nfiltrative surface. Reconstructions of such systems must comp Y <<WARNING>> MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. SEPTIC, PUMP AND OTHER TREATMENT TANKS K UNDER ANY CIRCUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS MAINTAINER POVYTS INSTALLER Name Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Agency 7 Name �� Phone Phone �� �}`-- ThIs document meets Me staffs of the Green take q . Marquette and Waushara County Zoning and Sanitation ageftdes- This document was drafted by Code_ Use of this d does not the m i n i mu m req uirements of ch_ Comm 83- 22MCb)(1)(d)L (f) and 83.54(1), (2) 8 (3), Wisconsin Administrafnre GMW (ypt) guarantee the performance 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 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St 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. bendin Please print all inforw9g6n:; -r. I evi ad by Date Personal information you provide may be used for "nd@�V;k, po9es (Privacy Law, s. 15.04 (1) (m)). Property Owner %�.. Ptp party Location R J C Development, Inc r' _' -�' Govt. Lot NW 1 /4SW 1/4 S 25 T 30 N R 18 R(or) W Property Owner's Mailing Address I LaffA Block # Subd. Name or CSM# 1 n .Hills 1868 Ct Rd. C �� City State Zip Cod , Pho `N mf�er��;!: ' • - (jity ❑ Village K) Town Nearest Road New Richmondl WI I 540171,P' x'715 ) A 4ici= ` 4 Richmond i 140th. st. ER New Construction Use: ❑ Residential / Nwba(bf b@drooms, ,% Code derived design flow rate _ JD(1 GPD ❑ Replacement ❑ Public or commer6W iDk�Akie Parent material glacial drift Flood Plain elevation if applicable na ft. General comments and recommendations: mound el 99.80 based on contour line of el. 98.80 r Boring n Boring g Ground surface elev. 99.10 ft. Depth to limiting factor 44 in. Pit �� 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 1 0 -9 10 r 3/3 none L 2msbk mfr cs if .5 2 9 -22 110vr 4/4 none sic 2msbk myfr if -4 -6 3 22 -44 7.5 r 4/6 none JS na na na ❑2 Boring # E] Boring ® pit Ground surface elev. 99.1 ft. Depth to limiting factor 39 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 22 -39 7.5 r 4/4 none sl 2msbk mfr w na 4 39 -55 5 r 4/4 none scl M na. na na Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • -Effl ant #2 = BOD < mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel Z 02298 Address ate Evalu tion Con cted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 715 - 246 -6200 19 19 2000 t r Property Owner R J C Developme Inc. Parcel ID# pending Page 2 of 3 D Boring # ❑ Boring ® Pit Ground surface elev. 98.10 ft. Depth to limiting factor 47 in. Soil 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 'Eff#2 1 0 -10 10 r 3/3 none L 2msbk mfr cs if .5 .8 3 21 -47 7.5 r 4 none sl 2msbk mvfr crw na s .9 47-60 na na .0 none a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring E Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil 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 'Eff#2 Effluent #1 = BOD, > 30:S 220 mg/L 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 (86/00) STEEL'S SOIL SERVICE Gary L. Steel RJC Development, Inc. 1554 200th Ave. CSTM2298 WIWI S25- t30N - R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #13- Richmond Hills j !t. of 1 pvc pipe C el.100,QD� B1 = top of 1" pvc pipe C el. 98.40' q-f , 3° d el Gary L. Steel 10 -19 -2000 .............................. ........................... ......................... .............. ........ ...... ...... ... ...................................... ST CROIN CI(.'A-TP4 ;;D TANK M.All\"TL-I AND CERTIFICATION FOIRM . .. ..... . .. ... ...... .. . ......... z LA L t Y 1/:...._ . . . . . . . . (Verificaioti required tiot - n Planning Department for new constntchon ("'ityV tate Ilarcul Identification Numbfr T a on S /5 1 ", - 5 '--W Of PrOPC -:T,V Lo :4 ..3 La " ............ ._............- .._...._.......9 Ccrti.'ied Si-irt-.y Map , } { E P .. . .. ..... spec louse - 1:3 no IA)t lines idt,-ufifiabIeXYV0S l..l no V 'EIA, iTEVAICCT ImproPer rite and main your septic system could result in its premature .1ii lure to handle wastes. consiv .; of puzap i;r , out the spritic tank every three years or sooner, if needed by a Licensed DUMPey. What you Pur into th,e- system cat). 11 the riln:;Vian of the se ptic tuck as a treatment stage in the waste disposal systarn- The p:C0:N::.%y owner a1=03 to submit to SL Croix Zoning Depaitment a ceTtificatton form. signed by ttie.o-%%er.itnd by a Master olumbc-,:, iol.auey= dispos*# system, pilwibar, its or lit;cn8edpuwparVCrifYiu9WAI (1) the vu -silo LS in w.a per qQ. condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 fUl of Mudge. I/we, c Le underAi vi .,d have reav• the above requirements and agree to maintain the -private sewage disposai system with the; ,t5 ndards set fQria by the Departineut of Commerce and the Dep.attracut of Natural RegoLuces. State of 'Wisconsin. Cer statinj?'diat yoti• I'do system tas been maintained. ust be completed and returned to the St. Croix County Zoning, Officel 30 day", o Phr. eb:, 4tXP;.I:atiI'1 dac. SICIT'J: T J. v X1 D A11; 0WITi E' 47 (WC):• that an I�tatements on this form are true to the best of my (our) Ictiowled.P. I (we) am (are) Ilie Of the pt 1:3d above, b y virtun of a warranty. deed recorded w Register of Der-c1s Office TATS Any infornation that i ; rvds- .represented may result in the sanitary p ermit being revoked by • Zoning Ithi :.ude with 4 1) 1 1 applicati.; in - a , stamped warranty deed from the Register o Deeds otE cc a copy of the certified survey t%Iap if reference is made in the warmnry deed -- _.n N_ Z V I II C I - � . I t II �i II O C L 0 (0 0 0 I I - - - --- -u I- O l f') � C4 II c In � II Willi 11 11 I I'° Z I II - -- - - -� I --- II II II II I II II II II II II II I ® II II 0 I II II a II II -- -- -- - -- "- - --^ I( II I j II II II II I II II I i I II I I I ` „ I i I II Ii II - II II II i� I I zb 1 ��Ili w I I mz: El LL I II II 11 II II II II II II � II I I I I II I®2 IL� L-La I W � I I � I II t I I I I I N LI -v I I ii I I I' I 1.. I.0 1101"151 nL .. LEO£ Ilia ME IH4 C t` � T 0 i I U W 9 ,0- 11 IZ „1TI6 n s�l- x 9 E U') O O co m W I �i N I� = V fn w = CL t— �n n Ib II IS p z ' m I I g o O u b /51 C� SA o _ 6 — I 'v - o � MEIN OE6LM 51 51 5I9EM o u1 44 w II 6 9AOGV 0/0 0 13 3 1 Sassn1Jl 40 A a ze eEe 6 S - ed zl 0. v n0 "IZI w E ���n nZ I N _ � 9bl n 0 OIZ11 x- \ n� -Ib xIE01"IEI� \\ 110 -1b o \ q l / I / 0 1 / I / v- - - - - - - - -- OZO£ IMV u9",b „01-ILI pB-Ib „b-IlL „0-ILE J 2289P 611 727 Z+ {� KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD This Deed, made between RJC Development, Inc., a Wisconsin 06 /26/2083 12: 30PH Corporation, WARRANTY DEED EXEMPT # Grantor, and Denise K. McDermid EE: 1 TRANS 8.00 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area L W Lot 13, lat of Richmond Hills in the Town of Richmond, St. Croix County, Name and Return Address ' nsin. — &V q ? 026 - 1127 -13 -000 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this (CA 0� day of June 2003 JC Development, Inc. * + By: Roberta J. Ca , ice President AUTHENTICATION ACKNOWLEDGMENT Signature(s) RJC Development, Inc., a Wisconsin Corporation, STATE OF WISCONSIN ) by Roberta J. Carlson, Vice President ) ss. County ) authenticated 7Aday of June 2003 Personally came before me this day of the above named + Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 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 Protassionais company, Fad du Lac, WI WARRANTY DEED STATE BAR OF WISCONSIN ew- sss -zozi FORM No. 2 - 1999 ` I- f - - - - - - - - - - - OPERATION ADJA ►—i ........................ x I ", NOISES AND SME BE PRESENT ON M 0 f LOT 31 :t ° LOT 30 / x BENCHMARKS: ALL BENCHMARKS TOTAL AREA: W TOTAL AREA: 89, 1,73 50 FT. 9 0,315 FT 2.05 ACRES 2.07 ACRES x LOT 29 9 52'55'W N 309.00 x Sec Sip. � 10 of 4 6 Set LOT 32 LOT 33 O TOTAL AREA: TOTAL AREA: x V W 0 Set 80,161 SO. FT. .w W 1.1: 97, 663 So.. FT. w 1. 84 ACRES 2.24 ACRES V o N .0 Fou g W Buil Prol Den, � x � I � _� 01 - N89'52'55 - W - LOT 34 112.05' 04 Den( - Ns .x H. W. E. High 1:89'52'55 112.05' 3 _ ` g a / H. W. L. High -- :77.05 3® Sp• w F. F. E. Finis i _ • - -- 35.00 �`� �3 \0 �- x- ��g — —x Fenc 3 - •----- . ... . 31 ------ , 0) 0 LOT 13 O N EA: w nl 83,193 S0. FT. .n BEARINGS ARE R F I Z E 0 ~ : �' 1.91 ACRES ir) 40 ASSUMED LINE OF SECTION 2 ••�`• M /N. F.FE. 1024.4 ' '� � LOT 12 ASSUMED TO BEAR •� ` ° ►F,� O • �' .01 HORN AND VEF 961.,-m ST. CROIX COUNTY G Ilk \ JIL \ \ Drafted by. Joseph Iv Al 4