HomeMy WebLinkAbout026-1127-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
430116 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: s City Village X Township Parcel Tax No:
Hank, Ian Richmond Township 026- 1127 -14 -000
CST BM Elev: Insp. BM Elev: BM Des lion: / h Section/Town /Range /Map No:
/ 06 ' d /06-0 �✓� 1 �Y e' . 5 ►' W. 25.30.18.824
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS FS ELEV.
Septic Benchmark ' • /O
V r Alt. BM �,
Aeration J Bldg. Sewer �
Holding St/ t Inlet / s / 4v A , r .7�
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f
9�
Septic > 1 W Dt Bottom /• � O•
Dosing / / Bader/ an.
/02.
Aeration Dist. Pipe
Holding Bot. System / c7
Z .
Final Grade
PUMP /SIPHON INFORMATION 5 �'•
Manufacturer De St Cover 2.
'Dr
Model Number / q 0 14
TDH Lift < Friction L System e d TDH l/
Forcemain Le j y Dia. 2 n Dist. to W P 6T , �
SOIL ABSORPTION SYSTEM
BED/TRENCH Width 1 Length No. Of Tr��hhches�� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / fp2(,C
SETBACK SYSTEM TO P/LVV BLDG WELL LA /STREAM LEAC Manufacturer:
INFORMATION r R OR
Type Of System:
'� ' NIT Model Number:
DISTRIBUTION SYSTEM N �` /2 �a f
Header /Manipld Distribution / x Hole S e x Hole Spacing Vent to it Intake
Pipe(s) /1 /, 2 �/ � q h
Length Dia Z Lengt Dia Spacing 7
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only /PVC CO242'L.0
Depth Over y Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench I 'I cf Bed /Trench Edges Topsoil
CC T L Yes No
Center Yes Na
COMMENTS: (Include cdde discre encies, persons resent, etc.) Ins ection #1: / / Inspection #2:
P P P
Location: 1415 133rd Ave New Richmond, WI 54017 (NW 1/4 SW 1/4 25 T30N R18W) Richmond Hills of 1 O 1 �, Parcel No: 25.30. &. k
1.) Alt BM Description = sr' l(.�S -1-4� 14 uj
2.) Bldg sewer length = �' I
- amount of cover = w 2 f `�" -lJ' S QG�'
Plan revision Required? ti Yes No —Q 3 - - - �� - -- - - --
Use other side for additional information. �
SBD -6710 (R.3/97) Date Insepctor's i nature Cart. No.
MA, Saf€ty and Buildings Division County I n j x
201 W. Washington Ave., P.O. Box 7162
lseonsin Madison, WI 53707 - 7162 Sanitary ermit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 3D
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide < 91"5 - 3 ( = 7-r'a4g. ID .
may be used for secondary purposes Privacy Laif "- _ -Project Address (if different than mailing address)
I. Application Information - Please Print All Information k
Property Owner's Na me ` ` ZUO3 Parcel # Lot Block #
1
Property Owner's M ailing Address a "i' Property Location
Jam. 'k -'� 'k,Section
City, State ip Code Phone Number
A ircle
/^ a of B n (check all that appl J T �O N; R E o W
II.
P g PP y) CY+ S
Subdivision Name CS umber
1 or 2 Family Dwelling - Number of Be rooms S
❑ Public /Commercial - Describe
❑ State Owned - Describe Use IM ❑City ❑Village�Township of
4; 4 � 1 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) c>V, - 112-7 -- 14' 2
A.
ew System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply) A 5
❑ Non - Pressurized In- Ground A ound > 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:
Desi n Flow (gpd) Design Soil Application Rate( so Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation
A o G�
� '
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Seel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks I Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber J�
VII. Responsibility State nt - I, the undersigne sume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's nature MP /MPRS Number Business Phone Numb r
Plumber's Addre ss (Street, City, State, Z ode)
VIII. Cou7 artment Use Onl
ApproveDisapproved Sanitary Permit Fee (includes Groundwater ate Issued ss ' g Agent Signa a (No Stamps)
Surcharge Fee) 325---
Owner Given Reason for Denial
IX. Conditions of Approval /Reasons for Disapproval
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size
PLOT PLAN
,an Hank ADDRESS 5924 Beniamin St. Fridiv Mn 55432
X14 SW 1/4S 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
1 ,
RS Shaun Bird 226900 DATE5 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
Town Road SYSTEM ELEVATION 99.2'
Area 15' below grade to Tank is to be properly Scale = 1/4" = 10'
remain undisturbed bedded and provided with
lockdown covers with
97' approved warning labels
To have >42" of cover
2% 98'
Slope Huffcutt Combo
98.2'
B -3
Pro 4
❑ Bedroom
99 House
❑ B -2
Well is to meet all
setbacks found in 9 7
Comm. 83
B-1 Grading is to done to
divert run -off away
from system
B• Alt. B.M.
r
Safety and Buildings
2331 SAN LUIS PL STE 150
GREEN BAY WI 54304
TDD #: (608) 264-8777
,SCOnsn www.commerce.state.wi.us /sb
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
June 18, 2003
CUST ID No.226900 AT IN: 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: 06/18/2005 Identification Numbers
Transaction ID No. 875331
SITE: Site ID No. 660203
Ian Hankl Please refer to both identification numbers,
140TH St above, in all correspondence with the agency.
Town of Richmond
St Croix County
NW1 /4, SW1 /4, S25, T30N, R18W
Lot: 14, Subdivision: Richmond Hills
FOR:
Object Type: POWT System Regulated Object ID No.: 907018
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Conditi�
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. APPR(
The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF
Sulk
This plan action is subject to designer comments on the plan. OF SAFETY
Provide the homeowners with a user's manual on the operation and maintenance of this POWTS system.
# 1. Include each component manual by name, number, and date on the title page, used in the system design. SEE46 0RRESI
#2. Well must be located per the horizontal setbacks of Comm 83.43, Table 83.43 -1.
• • Access to the filter for cleaning must be provided per ss. Comm 84.25 (7) and (8),Wis. Adm. Code product
approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic
cleaning of the filter is required.
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 /instal lation/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 rovide a copy of this letter to the owner and an others who are responsible P PY Y for the P
installation operation or maintenance of the POWTS.
• SHAUN R BIRD Page 2 6/18/03
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Wesley C G be
Plumbing Plan Reviewer, Integrated Services WiSMART code: 7633
(920 )492 -5613 , M -r 7:00 - 16:30, F 7:00 - 11:00
wgrube@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Shaun Bird, Bird Plumbing Inc
. Cover Page RECEIVED JUN 0 2 2003
SAFETY & BLDGS: DIW
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 5/29/03
Owner: Ian Hankl
Location: NW1 /4 SW1 /4 S 25 T30 N,R 18W Lot 14 Richmond Hills Richmond
System type: Mound System
Manuals Used- ound Component Manual version 2.0 (01/31)
essure Distribution Manual version 2.0 (01/31)
Page# - - -- -
1. Cover Page finally
2. Mound Plot Plan WED
3. Mound Cross Section COMM CE
AND DINGS
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section 'OND NCE
6. Pump Curve
7 -9. Maintance and Contigency plan
10 -12 Soil test
Signature z
License number 4900
PLOT PLAN
PROJECT •Ian Hank ADDRESS 5924 Beniamin St. Fridiv Mn 55432
NW i/4 4 SW 1/4s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 5/29/03 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
Town Road SYSTEM ELEVATION 99.2'
Area 15' below grade to Tank is to be properly Scale = 1/4" = 10'
remain undisturbed bedded and provided with
lockdown covers with
97' approved warning labels
To have >42" of cover
2% 98'
Slope Huffcutt Combo
98.2'
B -3
Pro 4
❑ Bedroom
99 House
❑ B -2
Well is to meet all
setbacks found in
Comm. 83
B-1 Grading is to done to
divert run -off away
from system
L . BM. Alt. B.M.
v
r �
� Designer
No
Date.
Non -Woven Filter Fabric
4 Observation Pipe Perforated Distribution Pipe
Below Filter Fabric r :�
ASTt4 C -33 Sand
I F
„ Topsoi
E r
�'. Slope fled Of 2 % Force Main \Flow ed
I� 2 From Pump Layer
Drain Rock
f
Cress S Of A Mound S stem Using F
A Bed For �
The Absorption Area G
A Ft. `
s ` Ft.
7 Ft.
Ft.
.
L F t -
W = Ft.
L
Observation Pipe --,,\ K
n A Force Moin
° -------- - - - - -- ------------
- -- --- - - - - -- i
_ From Pump
W (� 7BDistribution ed 0f %2� Z 2�
Pipe
of Drain RocK
I
40bzervation Pipe Permanent Marker
Pipe or Rods
Pion View Of Mound Using A Bed For The Abs orption Area
PAGE OF
pertera!ed Dire Detail
End View
1
�Ftrta�citQ
PVC P.pe
^" Ca sa s rules LorWCO On 80"0"" I
° Are Egvatiy SPa =ee
F
� ' * PVC Fortz m ain--,
f �ifC i }!.pl �. ]I1R.Y,T TO �pAt1tG } iCf
l• 1
v/
` PVC
mcnafpid Pipe
/ C,�C CiSfreDUa til�
/1 \ Pipe
i
Distr Pipe La P ! �
R /
�L
f
i nc. hes
Signed:
Hole Diameter % Inch
Lateral Inch {es)
License Number: Manifold Inches_
Oato: Force Main Inches
of ho les % D i Pe- ;
Invert EievAtion of Lateral Ft.
�� j
SEPTIG gA�iK PUMP EliAMR
ER CRfl55 SECTION t,ND SPECIFICATIONS
CATIONS
APPROVED
y . CI SCENT PIPE 12" MZN. ABOVE GRADE � JUNCTION BOX MANHOLE COYER
> 2 5' FRO K DOOR, WINDOW OR \ -WITH CONDUIT Wl PADLOCK E
FRESH AIR INTAKE �wARNING LABEL
F;Nis GRADE MIN.
F ei,n. ZY�
y "c.z. oasERwac»a __ x. o. t8 °Mw�•
IBS IN fin * a
INLET -
GAS- ,
WATER 'TIGHT SEALS TIGHT rt VAppltAl�ED
A SEAL j JOINTS WWII
ALM APPROVED PIPE
s , 3' OHM
ON
APPROVED --�- _ SOLID SOIL
PIPE 3' f C j OFF
ORTD SOLID • , FT . -- —
SOIL Pump OFF ELF - ---- D
BEDDING 3- AppgOV ED UNDER TAN` CONCRETE PAD
SPECIFICATION
p� p PER DAY = ---- --
SEC TIC t DOSE r jIgSE$ DOSES
gACZURER :� r -- INCLUDING °y s
TANK MANU E y {y �M£ rN LU GAL-
' - DOS F LOWSAC It =
GAL . _..- .--- ------ ., -
TANK SI ZES: SEPTIC s .. - GAL . NCHES --!GAL
DOSE
y, ✓� CAPACITIES: -
riANUFAC2fi�3RER : '� ° " 2 INCHES = _ GAL. 8
ALA_ MODEL. NUMBE
SWITCli TYPE :'r r '> =�'.� C = A INCHES = ' e " GAL'
/ GAL-
PUrSP MAN{JFACTURER = "� '=- 13 INCHES
MODEL NU?48ER - , . 15.23 WAC
SWITCH TYPE._ ---` ,—"= == I LA
„p" � ALARM idIRZi3G AS PER
REQUIRED DISCHARGE RAT£_____ GPti Pill -iP R FEET
EEI�i pUt'4P OFF AND DISTRI PIP£ - - FEET
,4ERTICAL DIFFERENCE BETW PRESSUR - _ - ' - J - FEET
+ MINIMU1 NETWORK SUPPLY FT/10 FT FRICT FACTOR
NAM IC .
FEET FORCF.MA�N TOTAL DYNAi HEAD
/ "� - WIDTH * DIAMETER
(,Q� LENGTH " ---
IN
L DIMENSIONS OF FU M? °IAI�IK: LIQUI D `
DATE
LICENSE NUMBL -R:
SIGNED:
i /SB
101AL ✓YNAMIC HEAD /CAPACITY
PER MINUTE
FHE CAPA EFFLUENT AND CITY CURVE i
DEWATERING
MO 152/ 53 l MODEL 152 153
al —
I --
Co 1. I Liter` I
w Feet I Meters I Cui. Lters __ {
t _ E i 77 I 2Q? I
50 I 5 5 69
I 153 10 b1 i 231 70 265 I1,
I
a0 t5` 15 4.6 j 53 2G1 of 231
12 j 2 6.1 44 i 67 I 52 1 .97
20
I I 34 129 I 42 159
30 25 j 23 37 33 1 2
30 i 85
a 1 20 I I 40 I 12.2
f - - - - /it 6M)�44 F
� I Lock Voive: 3�S_� Ft.
4
I 10 ii i f
t
0 4 50 80 100
20 � e ,/a _.._
JALL ERS 320 3 27/ 2 4 5/3 ►I i
LITERS 8p 1 60 240
0
FLOW PER MINUTE l 3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS
G 3 27/ =2
Timed dosing panels available. lied with
Electrical alternators, for duplex systems, are available and supplied an alarm. j
Variable level control switches are available for controlling single phase i
systems.
• Double piggyback variable level float switches are available for variable -- 1
level long and short cycle controls.
I j
• Sealed Qwik -Box available for outdoor installations. See FM142 .
• Over 130 °F. (54 °C.) special quotation required. E
12 1/8 r-�
1521153 Series T
� ; lad ; l � i
l Selection i r -k= =a �` ' 5 1
Control
1 ^ 152/153 MODELS — 4 -- �,
sK
Mode Amps Simplex D uplex
Model i Vales -Ph 8 1 2 or 3 ! I - �z mba
I N152 115 1 Edon
A uto 8.5 Included I 2 or 3 — �
B 152 115 1 1 2 or 3
E152 230 1 Non 4.3
4.3 Included 2 or 3
BE 15 230 1 Auto 1 2 or 3 SELECTION GUIDE
N153 115 1 Non 10.5
Auto 10.5 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable Level float
BN153 115 1 i 2or3_�
E153 230 1 Non 5.3 I _
30
5.3 Included 2 cr 3 switch. Refer to FM0477.
2, See FM0712 for correct model of Electrical Alternator E-Pa .
SE153 2 1 Auto 3
o cAUTloN . Variable level control switch 10 -0225 used as a control activator, specify ty p ( )
A11 installation of controls, protection devices and sh should be done di a qualified 3 or (4) float system.
licensed electrician. All electrical and safety codes should ould f fo and Health Act (OSHA)-
recent National Electric Code (NEC) and the Occupational Safety
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
M l
AIL TO: P.O. BOX Manufacturersof..
— Louisville, KY 40256 -034
SHIP T0: 3649 Cane Run Road P sN�E /939
® Louisville, KY 40211 -1961 QLraUrr
Z O (502) 778
F � (5p1) 774-36 PUMP
htt p, - / /www.zoetler, corn
)nnn 7naller 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 with out 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
Page of
CATIONS AN
p0VVTS OWNER'S MANUAL & MANAG
EME. SYSTEM SPECIFIC 0 NA
I gal
f4LF- F
INFORMATION S Tank capacity ❑ NA
ON 0 NA
0 NA
I Manufacturer S Tank Manuf
owner -
Permit Effluent ❑ Filter Ma nufacturer 7 . 0 NA
❑ NA
ETE�RS ❑ Effluent Filter Model
WF_S.1GNPARAM � NA
❑
Number of Bedrooms j g NA pump Tank Capacity al 0 NA Number ❑ Number o f Commercial Units p Tank Manufacturer -------
. -'rf / alld
flaw (average) 'w Manufacturer ❑ NA
CC p mp Man
Estimated u
❑ NA
Design flow (Peak)- (Estimated Pretreatment p model
)pl Rate
Soil Af Unit
Estimated (avera s ed ge'
flow v 'a I led !x
� Onl
Design E5
I '( 'ma
App : tion Rate Monthly average* c , s Filter ci Peat Filter
r
fiuen W 0 ity
t Quality ❑ Wetland
Influent/Effluen Gr7 se (FOG) <30 mgfL mechanical Aeration
Oil & (BO OS) 5
Fats Oil& Grease (FOG) C3 Other
Oyy m (BO
n BOD �220 mgA_ [ 3 Di
D eman d
.
Bioche oxygen Demand
Total Sus S lids (TSS)
Sus Solids (TSS) _.�150 MEIL Manufacturer
Total SusP inch diameter In-g In-g
A Monthly average— F ls — r ; e — rsa l Cell(s) (pressurized)
— --------- ."AN Mon C1 round
Pretreated Effluent Quality [I round (gravity) 11 ound
Demand (SODS) _.-_�30 mg/L Cl At-grade ITM
Biochemical Oxygen Dema (TSS) : 5,3o mg/L ❑ ripfine cl other
Total Suspended Solid - c s mean) !004 cfu/100ml
f (me was t e water and
Fecal coliorm (geometr (non-comlner`030
Valves typical f or do
eo Y. eter
:= Pa r ticle se ptjC tank emuent- treate was tewater-
um E fflu e n t values typiclal for P
Maximum Effluent Particle Size
MAINTENANCE SCHEDULE
Service �FrequencY
�Z�M a) �J�
: ear (Maximut'n 3 yrs.)
Service Event [L3, r n on, �th s,;�
At least once every o f tank volume
_t condition o f tank(s) scum equals o ne-third (
lnspe ( When combin I I
rn tried sludge and s _yp
Pump out conten of tank(s) __ ❑ Monthslik-A _ar(s) (Max 3 yr's
At least once every ears
al cell(s) every months r( ) ------
Inspect dispers At least once ( / ;70 months ear(s) ❑ NA
Clean effluent filter At least once every I
Inspect PUMP pump Con & alarm At l once every ❑ months A-year(s) ❑ 0 1A
Flush laterals and pressure test At least once every ❑ months E3 year C1 NA
(s)
Other
❑ months ❑ year(,) ❑ NA
At least once every
other carrying one of the following licenses or
MA INTENANCE INSTRUCTIONS 1 cells shall be made by an individual pOWTS Maintainer, Septage
Sewer, pOvVTS inspeCtOr sing or broken
ins ns; of tanks and disper5a r pl Restricted Sew . of the tank(s) to identify any m15 . any back up
cefficatiOns: Master Plumber Mast m ust include a v isual inspection ; e and scu and to check fo
ServiCing Operator- Tank inspections re the v olume of combined sludg I t c h e ck the effluent levels
hardware, identify any crac or leaks, measure The dispersal cell(s) shall be visually inspect ec effluent on the
ing of effluent on the ground surface- ling of effluent on the ground surface- The ponding of effl
or pond , pipes and to check for any pond req uires the immediate no tification of the l regulatory authority -
in the observatio one-third (y or mor of the tank v olume, the
ground surface may indicate a failing condition d scum in any tank equals one-V d of in accordance with ch,
When the combined accumulation o f sludge an a Septage Servicing Op
entire contents Of the tank Shall be re moved by erator and dispose NR
nentS, and any
1 Wisconsin Administrative Code- nents, pretre,3ttment components, Maintainer-
echanical Of pressurized POWTS COMPO a certified P OWT
The servicing o f effluent filters, ril V mon o r less shall be Pcel by service event,
or monitoring at intervals Of days
Of corn pletion of any se
other maintenance to the local regu l a tory authority with 10
A Serviqe re port shall be provided for the p
e resence o f painting products or other
START Up AND OPERATION of the pOWTS check treatment tank(slf' o perator Pn rsal cell(s). if high concentrations are
For new c onstruclJon, prior to use the trea proce ss and damage the diSp . Or to use.
chemicals that may impede of the tank(s) remove b a se ptage servicing
detected have the contents
I
Page of
+ shall not occur when soil c Po
r levels. When onditions are frozen at the infiltrative surface- is restored t he excess
systern start U
power pump tanks may fill above normal highwate
During per+ outages l cells) in one arge l dose, overloading the cell(s) and may result in the
wastewaterwi be discharged to the disperse um tank removed by a
backup or surface discharge of effluent To avoid this situation have the contents a Plu bey or POWTS Maintainer to
Sept Servicing Operator prior -tp restoring power to the effluent pump or
assist in manually operating the pump controls to restore normal levels within the pump tank
D o five or p vehicles over tanks and dispersal Cells. Oo not drive or park ove, or otherwise disturb or compact,
the area within 15 feet dawn slope of any not d Pa mound or at - grade soil absorption are
t
Reduction or elimination of the fo llow i ng c butts; condoms; cotton yswabs; degreasers; dental floss; diapers:
a life
of the POWTS: antibiotics; baby
w ip e s; dg asotine; cease; herbicides; meat
disinfectants; fat; foundation draln (sump pump) water, fruit and vegetable peelings; g g
scraps; medications; oil; painting products; pesbcides-, sanitary napkins; tampons; and water softener brine_
A13ANDONOMENT taken out of service the following steps shall be taken to insure that the
When the POWTS fails and/or is permanently comp liance with ch_ Comm 83.33, Wisconsin Administrative Code:
system is properly and safety abandoned in comp openings sealed.
• All piping to tanks and pits shall be disconnected and the abandoned p a of Septa a Servicing Operator.
The contents of all tanks and pits shall be removed and properly
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space
filled with soil, gravel or another inert solid material.
CONTINGENCY PLAN
repaired the following measures have been, or must be taken, to provide a e
If the POWTS fails and cannot be
compliant replacement system:
A suitable replacement area has be area should be protected from disturbance a d compa and should not
absorption system. The replacem Se d structure, lot lines and wells. Failure to
be infringed upon by required setbacks from existing and propo
protect the replacement area will result in n eed
comply with t he soirules n ite effect at thatttime�blish a suitable S
replacement area- Replacement syste
* A suitable replacement area is not avail as a last re t replace the failed POWTS�g advances in P
technology a holding tank. may be installed n failure of the POWTS a soil and
The site has not been evaluated to identi fy a suitable replacement area. Up n
ment area. If no replacement area i
site evaluation must be performed to locate a suitable replace s available a
"holding tank may be installed as a last resort to replace the failed POWTS_
stems ma be reconstructed in place follow in( time.
removal of the biomat at
ound and at -grade soil absorption sy y with the rules in effect at that
the infiltrative surface. Recons�CUOns of such systems must comply
«WARNIN TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. ANY
SEPTIC, PUMP AND OTHER TREATMENT CIRCUMSTANCES. DEATH MAY
DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS MAINTAINER
POWTS INSTALLER'
f Name �c.�V
Name r
Phone'
Phone ,ate °° > ° r% t'�
MPER LOCAL REGULATORY AUTHORITY _
r/ r
SEPTAGE SERVICING OP ERATOR PU , �, ; , ,,�' .• —
.� Agency
Name �ldi'�' / �-
C Phone ��°
Phone ender. This document meets
Zoning and Sanitation a9
the staffs o ist
f the Green take. Marquette and Waushara County n9 d does not
This document was drafted by 2 )(�3(d) &(fl and 83.54(1 {2) 8 (3), W Adminrative Code. Use of this docu GtvnN (2/01) 83 )(b
the minimum requirements of ch. Gom
m (
guarantee the performance
of the POWTS-
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ 1 of
Division of Safety and Buildings
in accordance with Comm 85, Ws. 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 to n Oncq &slance to nearest road. De ndina
Please print all inforlpit!& ev' ed by ate r�
Personal information you provide may be used for setdhdayy purpose*riv Law, s. 15.
Property Owner _ 77 ' 7777 ' .- Prope Location
R J C De velopm ent, Inc. r f• ' ovt. Lot` NW 1 /4SW 1/4 S T N R K(or) W
Property Owner's Mailing Address _ r Lot #- :Block # Subd. Name or CSM#
1868-Cty. Rd. C
City State Zip Code Phon Number CU's �ti t' "I ❑ Village K) Town Nearest Road
' 6O
New Richmond WI 54 ( - 140th. st.
ER New Construction Use: ❑ Residential / Number o 4�_ Code derived design flow rate 600' GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material glacial drift Flood Plain elevation if applicable na ft.
General comments
and recommendations: mound @ el 99.20 based on contour line of el. 98.20'
Boring #
Boring
1 I pit Ground surface elev. 98.70 ft. Depth to limiting factor 32 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
L .5 .8
2 if
3 19 -32 7.5 r 4/4 none .4 .6
4 32-55 scl M na na na
2 Boring # Boring
P1 pit Ground surface elev. _ 98.70 ft Depth to limiting factor 38
❑ i Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary F if oots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -8 10 r 3/3 none cs .5 .8
2 8 -16 7.5 r 4/4, none
3 16 -38 7.5 r 4/4 ne na
na
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L nt #2 = BOD < 3 g/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 4 &L27gV 02298
Address Date Evaluation Condif0ed Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -19 -2000 715- 246 -6200
\ A
Property Owner R J C Developme Inc. parcel ID # pending Page 2 of 3
F Boring # ❑ Boring
3 ® pit Ground surface elev. 97 ft. Depth to limiting factor 24 in.
T Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2
1 2 none L s if .5 .8
2 12 -24 10 r 4/4 none sil 2msbk mfr if .5 .8
3 24 -32 10 r 4/2 2d7 r 5/6 sil M na ClW na .0 .2
4 na .6
5 9 -6 5yr 4/4 2 r 5/8 scl M na na na .0
F-1 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
F-1 ❑ ❑ Boring
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 > 30:5 220 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.
SBD4330 (R.6/00)
STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTML98 NW4SW4 S25- t30N -R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #14- Richmond Hills
4
/1 " =40'
/BM.- top of l" pvc pipe @ el. 1 00.00 ,
/Alt. BM.= top of 1" pvc pipe C el. 10 1.10 ,
E ;
/ - p
b s 3 �n5 �J"
30 s
c�Q
e
O
1 80 1,
Gary L. Steel
10 -19 -2000
ST CROIX COUNTY
SEMC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ! t) l , )
rl Mailing Address
Property Address 4
(Verification required from Planning Department for new construction)
City /S.tate Parcel Identification Number o z 6 Li 6
I
LEGAL DESCRIPTION
Property Location '/4, 6L) , /a, Sec.c �. T 3 � N -R W, Town of U
V� 1 t Lot #
Subdivision I�
Certified Survey Map # -�- . Volume . Page #
Warranty Deed # --; Z/ � s ( . Volume Z Z S 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
master plumber, 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.
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
days OPdre three expiration date.
SiGNKIXIE 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 owner(s) of
the pro rty described above, by virtue of a warranty deed recorded in Register of Deeds Office.
IGNATU�O�
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
l 2245P 407 - 7 956
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 05/19/2003 11:45AK
Corporation,
WARRANTY DEED
EXEMPT #
Grantor, and Ian Hank and Elizabeth A. Hank, husband and wife, REC FEE: 11.00
TRANS FEE: 81.30
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
c of 1 , Plat of Richmond Hills in the Town of Richmond, St. Croix County, Name and Return Address
sconsin.
i
026 - 1127 -14 -000
Parcel Identification Number (PIN)
This is not homestead property.
0K) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this L°� all- 'L� day of Joip �-�( 9 2003
RJC Development, Inc.
* + B : Roberta J. Ca Is , e President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., a Wisco Corporation, STATE OF WISCONSIN )
by Roberta J. Carlson, Vice President ) ss.
W'y County )
authenticated this 4-4ay of Ma 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 foregoir
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY +
Attorney Kristina Ogland Notary Public, State of Wisconsin
H udson, 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 Professionals company, Fond du Lac, W
STATE BAR OF WISCONSIN e00 -2021
WARRANTY DEED FORM No. 2 - 1999
2.08 ACRES
I w
x
F. F. E. 1006.0
N O 04 LOT 31 M O 30
04 N s N L T.
i + i TOTAL AREA: N TOTAL AREA:
I 89, IJJ SO. FT. 90, J15 SQ. FT.
W W i 2.05 A CRES
I � I 2.07 ACRES
I
— ..._..
Z I Z I N89'52'55 "W
— — 372.38' I i 309.00'
anent o
LOT n `° S3o �
0
TOTAL AREA: _N
LOT 32 LOT 33 281
91,979 SO. FT.
2.11 ACRES i 66 I i TOTAL AREA: W TOTAL AREA:
F.F.E. 1006.0 I • • I 80,161 SO. FT. 97,663 SO. FT.
• • • • • • �� i�� 1.84 ACRES ' 'N 2.24 ACRES
y
1 1
...................... ..
49.74' , • ® `� i
® S53'20'56 "W --
` . ( A — A -A ` -- N89'5255 W -
i 112.05'
N89'52'55 "W 112.05'
r
® 4 �! 58.01 - - -- --:77.05 3
S53 20'56 "W 3 i
• ` O \
3 -^ � -- --- -T - --' LOT 14 I 35.00'
` SO'h,
b i • • TOTAL AREA:
i
t w • 86,952 SO. FT .............. .....
wil . 3 2.00 ACRES 41
. • j
s .... • ' ' - MIN. F. F.E. 1024.4
"�• • � LOT 13
.....•'A��o LOT 15 ° ° v
00 C-4 0o N . TOTAL AREA:
�'•� TOTAL AREA: to 75' SETBACK • 83193 SO. F7
81,512 SO. FT. 4p 1.91 ACRES
1.87 ACRES k '' MIN. F.F.E. 1024
0 .
IV
1 O .
------- - - ----- 321.49 ------- 111 - � \ r
155.19' i ".17' 145.13' ' ~`�` 285.00' '
13054' 358.01
- -- - - - - -- S89 9 ,,r, - - - - -- \
— � \
UNPLA TTED LANDS a�nANO
� t