HomeMy WebLinkAbout026-1127-19-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Saiety and Building Division
INSPECTION REPORT Sanitary Permit No:
506353 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Marek, Todd R. I Richmond, Town of 026- 1127 -19 -000
CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No:
BM
/ 0 0 nj l (Zeyr 25.30.18.829
TANK INFORMATION 0 ELEVATION DATA
TYPE MANUFACTURER P CAPACITY STATION BS HI FS ELEV.
i
Septic Zb � Benchmark
Wy
Dosing Alt. BM
F; % le,� Co vtJL. 3 O
Awn Bldg. Sewer
Holding SUHt Inlet 'l pg C?7 3
TANK SETBACK INFORMATION SUHt Outlet
TANK TO I L WELL BLDG. vent to Air intake ROAD Dt Inlet
Septic ��� —� / t,A " ,� !Z 1 /s , / Dt Bottom
/ V �7 /0.5�, 3 9
Dosing , S i Header /Man.
G -3. Z( /6) •� y
Aeration Dist. Pipe
3.2 /OI.I
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade Z •2 /d 2
Manufacturer / _ o u` I1 S Demand St Cover 3. �/ /61
1 6� dl r
Model Number I
/ac 74
TDH Lift Friction Loss System Head TDH t
7• O.2� ,� � 01 �-t w.c— y8y Z
Forcemain Length Dia. Dist. to Well
Z"7 Z A� �- G o ruf r' �{ . Z /cry , z
SOIL ABSORPTION SYSTEM • Z-
BED /TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /� / R -- `-
�.
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Typ�Of,Syster}�: � Z 1 30 r� 1[� UNIT Model Number:
DISTRIBUTION SYSTEM SYSTEM N �V t
Header /Manifold Distribution i C / \ i x Hole Size �� x Hole Spacing Vep�to Air ake
Length Dia Length Dia Spacing Z L
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 1
Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center ] • 94 Bed /Trench Edges Topsoil , �� s I ! No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /! / Z / 67 Inspection #2:
f76 s3- �
Location: 1407 134th Avenue New Richmond, WI 54017 (NW 1/4 SW 1/4 25 T30N R18W) j? ichmond Hills L 19 Parcel No: 25.30.18.829
(1= , ,.. , G�.� ems. i, �1r2, rn a. �Je U
1.) Alt BM Description =
2.} Bldg sewer length L ("
- amount of cover = ( C• #Signat ,
3 4-o
Plan revision Required? inj Yes o Use other side for additional information. Date Cert. No.
SBD -6710 (R.3197)
e '
Safety and Buildings Division County
201 W. Washington Ave., P.O, x 7162 St. Croix
tiZc in Madison, WI 53 707 -71 Sanitary Permit Number (to be filled in by Co. )
mmerce - 4 t S 0 G ,3
Sanitary Permit Application tion Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate govemrrten l 6 -7
unit is required prior to obtaining a sanitary permit. Note: Application forms POWTS are Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provi may td°t�raacesdee5►
purpo in accordance with the Privacy Law, s. 15. 1 m , Stats. R C lr C 1 V 8 0 1 Avenue
I. Application Inform n - Print All Information 7
Property Owner's Name CO LU 0 C T 0 2 2 0 0 7 P 1# O 76
Todd Marak t Z 7• ' • 0 �'
Property Owner's Mailing Ad Pro rty Location
�" 9
P.O. box 228 5T• CROIX COUNTY •
Go .Lot sz
City, State Zip Code Phone N umber '/4, SW '/4, Section 25
New Richmond 54017 (Cl 0ne)
U. Type of Building (check all that apply) OIiC A� Lot # T 30 N; R 18 ❑ E R] W
2 1 or 2 Family Dwelling - Number of 4 19 Subdivision Name
( Richmond Hills
Block # ----
❑ Public/Commercial - Describe Use
1 City of
State Owned - Describe Use CSM Number ❑ Village of
❑✓ Town of Richmond
IIl. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. W1 New System Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain)
System
B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued
Renewal Before Plumber New Owner
Expiration
IV. Type of POWTS S stem/Com onent/Device: Check all that a
Non - Pressurized In- Ground Ll Pressurized In- Ground ✓ At -Grade Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Lj Pretreatment Device (explain)
V. DispersaliTrestment Area Information:
Design Flow (gpd) Design Soil Alcation Rate(gpdsf) Dispersal Area R fired (sf) Dispersal Area P sed (sf) System Elevation /
600 1 0.6 J 11000 7 1000 100.50
VI. Tank Info Capacity in Total # of Manufacturer Material
Gallons Gallons Units
New Tanks Existing Tanks
Septic or Holding Tank 1200 1200 1 Wieser Prefab Concrete
Dosing Chamber 800 1800 11 1 Wieser Prefab Concrete
VII. Responsibility Statement - 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) s Signature MP/MPRS Number Business Phone Number
Plumber'
Roger Nelson MP 226497 715 - 273.4444
Plumber's Address (Street, City, State, Zip Code)
122 East Summit Avenue Ellsworth, WI 54011
VIII, Coun evartment Use Onl
proved _ isapprov Permit Fee Date 7;d Issuing A ignature
_Owner en Reason Denial $ / 6 � � 16 l -7 R� V -J
IX. Condit�tpBpp�teasons for Disspproval(Pu go r
1. Septic tank, effluent lifter and ` i t., / �.v�4 C(3?.� , Lam/ 6
dispersal cell must all 5 /
p
as per management plan provided by pklttttier. w 1 kA.-
2. All setback requirements must be maintained , t
as code / tx /V
Attach to complete plans for the system and submioo the � j omty an& on paper not less than 8112 x IV inches in size rp
i
SBD -6398 (R. 01/07) Valid thru 01/09 45W h:4 6.66 61 S /tab 3 • 71
d2Ct� � 1
r
a
Todd Marek
• ' P.O. Box 228
New Richmond, WI 54017
NW %,SE%, S 25, T30 N, R 18 W N
Richmond Hills Lot # 19
Richmond Townsk p Upt G
St Croix County fflo
Scale I"= 40 ' --�
Weiser 1200800 thnA
BM #1= 100.00' top of survey iron 30 5. ?q
35' of 2 "force main y
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3a 7. 37' -5". p�a� � L 80 8
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Todd Marek
• ' P.O. Box 228
New Richmond, WI 54017
NW %,SE%, S25, T30N,R 18 W
Richmond Hills Lot # 19
Richmond Township
St. Cr o ix County
Scale I " =40'
Weiser 1200800 tank
BM #1 = 100.00' top of survey iron So SI ?q,'
35' of 2 "force main
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30 7. 3 7' S K / s r 7y L, «, Page 8 o 8
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code /�
�� . (. '
Attach complete site plan on paper not less than 8 1/2:x county ches in size. Plan must o )
include, but not limited to: vertical and horizontal refere int ), 'rection and Parcel I.D.
percent slope, scale or dimensions, north arrow, and loca ista to rest road.
Please print all infor Revi by Date
Personal information you provide may be used for secondary purposes (Pr s. 15.04 (1) (m)). 7/ 1 7 / 6 7
Property weer Property Location /
ryJ RECENE Govt. Lot (� 114 f 1/4 �T >,9 N R( $ E (or W
Property r s Mailing Address Z Block # Subd. Name or CS
, j 1310 > - L Z- � � 11Yq e, e-li City State Z'ip / CcVe Phone Number �❑ Village 4 Tnwn Nearest Road 1
e. 1 15 0 -7 �T. CR4IX COUNTY /2 C
New Construction Use: Resider la / Number of bedrooms .3 Code derived design flow rate S�) ?J �UrZ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General r
acr ndaations: s
e �{ s •ti T�> r.� ru . �.� .. mo
System Type �i�a ✓VI Ohs. rGY System Elevation
Ong # Boring
I pit Ground surface elev./O 49 j ft. Depth to limiting factor 3 4 . O in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. �J 'Eff#1 'E
d " 13 1 0 ,0.3 �- -_ -Z- (- AZ (/
133(0/U
3 6- 7 0 7 l s - h-► i
® Ong # ❑ Boring
j• Pit Ground surface elev. e ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munse Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z -1-3 s 6
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD 130 mg/1- TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
I
1008192nd Ave, New Richmond, WI 54017 �-� _ 0 715- 246 -4516
Property Owner _ Parcel ID # Page of
Boring # ❑ Boring
Eg pit Ground surface elev. ft., ; De+` sting factor (1 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description VS-re Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#11 'Eff#2
0 -, '
l 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
F] Boring # El 11 Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon 7epth 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 1220 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.
SS"330 (RAW)
i
Property Owner _ / Parcel ID # Q Page of
a Boring # ❑Boring G stin 0
pit Ground surface elev. J ft. a g factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description '`1$ re Consistence Boundary Roots GPDKf
E
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'ff#11 'Eff#2
- b
F-1 Boring # ❑Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
a pit Boring # Boring Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg& and TSS < 30 mg&
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 (RbNO)
Soil Test Plot Pla
Project Name Todd Marek Sh ird
Address P.O. Box 228 v
New Richmond Wi 54017 S #226900
Lot 1 9 Subdivision Richmond Hills Da a 9/ 10/07
N W 1/4 S W 1/4S 2 5 T 30 N /R18 W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
lk BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation TBD *HRpSameasBenchmark
134th Ave
Scale is 1" = 40'
unless otherwise
noted
100.5'
Drainage easement
10,13- 90'
99.5'
4% Slope 50'
5
B -3 50' B -1
50'
140th ST.
293' Property Line
307' Property Line B.M.*
Safety and Buildings
4003 N KINNEY COULEE RD
commercemi.gov LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www.commerce.wi.gov /sb/
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
September 28, 2007
CUST ID No. 226497 ATTN.• POWTS Inspector
ROGER D NELSON ZONING OFFICE
NELSON PLUMBING ST CROIX COUNTY SPIA
122 E SUMMIT AVE 1101 CARMICHAEL RD
ELLSWORTH WI 54011 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/28/2009 Identification Numbers
Transaction ID No. 1467855
SITE: Site ID No. 730824
Todd Marek Please refer to both identification numbers,
140"' Street above, in all correspondence with the agency.
Town of Richmond
St Croix County
NW1 /4, SWIA, S25, T30N, R18W
Lot: 19, Subdivision: Richmond Hills
FOR:
Description: Four Bedroom At -grade System / New construction
Object Type: POWTS Component Manual Regulated Object ID No.: 1154501
Maintenance required; 600 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual, SBD-
10573-P (R.6/99)
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 so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manual(s) referenced above.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
I
• The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic
or soil compaction in this area is prohibited.
• Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent
filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval
conditions.
• 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.
.ba..�.�. E.S
l
I I ncanQTnee.,� ., .,,,......__`_
ROGER D NELSON Page 2 9/28/2007
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• 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).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
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
1 � 0 Balance Due $ 0.00
Gerard M Swim
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633
jerry.swim@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
RESIDENTIAL AT -GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project Todd Marek 4 Bedroom
Owner Todd Marek
Address P. O. Box 228
New Richmond, WI 54017
Job Address: 140th Street
Legal Description NW 1/4, SW 1/4, S 25, T 30 N, R 18 W
Township Richmond County St Croix
Subdivision Name Richmond Hills Lot No. 19
Parcel ID Number
Plan Transaction Number
Index sheet Page 1
Calculations Page 2
At -grade drawings Page 3
Laterals and dose tank Page 4
Specifications Page 5
Management & contingency plan Page 6
Pump curve & specifications Page 7
Plot Plan Page 8
Designer Roger Nelson License Number MP 226497
Signature Phone Number 715 - 273 -4444
Date 09/25/07
Designed pursuant to:
At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 4.0 (04/03) aiVis 0 �, Y aia, Euii D;r.ris Page 1 of 8
LL Sr E CGR{�ES f;JIvCc
PRESSURIZED AT -GRADE DESIGN
At -grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
400.0 Estimated wastewater flow (gpd)
600.0 Design wastewater flow (gpd)
4.00 % Site slope
100.50 Contour elev. below lateral (ft)
36.00 Depth to limiting factor (in)
0.60 In -situ soil application rate (gpd /ft "2)
Distribution Cell Information
(1 or 2) 1 Influent wastewater quality
6.00 Linear loading rate gpd /ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
100.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) a Center or end lateral connection
1 Number of laterals
0.125 Orifice diameter (in) e.g. 0.188
Not a final
calculation 2.00 Estimated orifice spacing (ft)
2.00 Forcemain diameter (in)
2.14 Forcemain flow velocity (ft/sec)
35.00 Forcemain length (ft) y or n y Does forcemain drain back?
92.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
3 NA
` � 6.5 System head (ft) x 1.3 5.7 Forcemain drainback (gal)
/� �� 8.17 Vertical lift (ft) 45.0 5x Lateral void volume (gal)
0.35 Friction loss (ft) 50.7 Minimum dose volume (gal)
15.02 Total dynamic head (ft) 21.0 System demand (gpm)
Lateral Diameter Selection Gallons /Inch Calculator (optional)
Pipe diameter Design options Design choice Total Tank Capacity (gal)
Designer 1 in Total Working Liquid Depth (in)
must select 1.25 in Gal /in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x 1 12001 Septic tank capacity (gal)
Weiser Manufacturer
Effluent Filter Information Dose Tank Information
Zabel Filter manufacturer 800.0 Dose tank capacity (gal)
A100 Filter model number 22.2 Dose tank volume (gaVin)
Weiser Manufacturer
Project: Todd Marek 4 Bedroom
Transaction Number: Page 2 of 8
AT -GRADE PLAN VIEW
D —�
1/6 B Observation pipes (2 typical) A 10.00 ft
D B 100.00 ft
l �--
1/6 B 16.67 ft
�`— C 12.00 ft
W C D 5.00 ft
E 2.00 ft
L 110.00 ft
D B 40 W 22.00 ft
A x B 1000.00 ft^2
L
,_ Cap
Typical obs. pipe.
= Total aggregate cell A x B Slotted in the lower
s", and anchored
= Plowed area L x W
securely.
6"
AT -GRADE CROSS SECTION
Svnthetic fabric cover
102.29 ft Finished grade
Lateral elevation
invert elev. 101.00 ft '
�— Observation pipe
at aggregate toe
E
Surface contour 4 % Slope
ft C A
and system
100.50
elevation D
® = 12 in. topsoil and subsoil
over aggregate and tapered to toes. Plowed layer
below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: Todd Marek 4 Bedroom
Transaction Number: Page 3 of 8
: PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - End Connection
P
SIP
rHoles drilled next to end cap k X — �I Laterals 8c force main of PVC Sch 40
d on the bottom of the lateral (per COMM Table 84.30 -5)
ced ! = Turn- up w'ball valve orcleanoutplug
Lateral Specifications
0.125 Orifice diameter (in) End Lateral connection point
X 1.96 Orifice spacing (ft) 1 Number laterals
51 Orifices /lateral P 98.00 Lateral length (ft)
21.0 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
21.0 Sys. discharge rate (gpm) 35.00 Forcemain Length (ft)
15.02 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather -proof �— warning label and locking device
junction box
Final grade 4"
disconnect
Tank component is Aftemate
properly vented �� outlet
location 18" min.
Electrical as per NEC 300 and Approved outlet
Comm 16.28 WAC joint
Tank full
= Inches Gallons JA Provide 1/4"
A 21.8 482.9 Alarm on weep hole or
m B 2.0 44.4 B antisiphon
E C 2.3 50.7 Pump on device.
o D 10.0 222.0 92.83 ft C
Totals 1 36.1 800.0 — P_
Pump off
D
3" Bedding under tank .4 92.00 ft
Goulds Pump manufacturer IS. J. Electro System Alarm manufacturer —d� PE 41 Pump model number 101 HW Alarm model number
Project: Todd Marek 4 Bedroom
Transaction Number Page 4 of 8
At -grade System Maintenance and Operation Specifications
Service Provider's Name Nelson Plumbin Phone 715 - 273 -4444
POWTS Regulator's Name St. Croix County Zoning I Phone 715 - 384680
System Flow and Load Parameters
Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L
Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 1000.0 ft Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL
Service Frequency
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Mound Inspect for ponding and seepage once every 3 years
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
9 P
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99).
Lateral Turn -up Detail
Finished . .............� ...............
Grade
.
6 -8" Diameter Lawn . Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
.. .
Distribution . / . . . .
Lateral \�
Long Sweep 90 or Two
101.00 ft -D 45 Degree Bends Same
Diameter as Lateral
Project: Todd Marek 4 Bedroom
Transaction Number: Page 5 of 8
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD- 10570 -P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used
as POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fiter
shall be assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless
provisions are made to retain solids in the tank that may slough off the fiter when removed from its enclosure. If the filter is equipped
with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an
impending continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the
owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify
proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At -grade and Pressure Distribution System
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than
for vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface
within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February)
dictate that the at -grade be heavily mulched as protection from freezing.
Influent quality into the at -grade system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent
or 30 mg /L BOD5 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum
design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral
be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial
test when the system was installed to determine if orifice clogging has occurred and if orifice Leaning is required to maintain equal
distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and
any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Todd Marek 4 Bedroom Transaction Number: Page 6 of 8
L(6GOULDS RUMPS Submersible
Effluent Pump
PE
SPl33F1t,AT1ONS mom ffArMS
P _ General: General: ■ Corrosion resistant
• Discharge: 1'h" NPT • Slagle phase Construction.
• Temperature: 104°1' (4Q O • W Hertz ■ Cast iron body.
maximum, con"uoos when • 115 volts a Thermoplastic impeller and
fully submerged • Dint -in thermal overload pro- cover.
• Solids handling: 'h" mcdon with aulonlatic reset. ■ Upper sleeve and lower
maximum sphere. • Class B insuladon. heavy duty bail bearing
• Autorna k models include a • OiNiiled de$*. consouction.
APKJCATMUS float switch. • High strength carbon steel ■ Motor is permanently
Sp"y for the • Manual models available. shaft lubricated for extended
idlowing uses: • Pumping range: see PE31 Motor. service file.
• Mound Systems pedfiormanae Chart or arve. • .33 HP, 3000 RPM a Powered for corftp +u
• EffWAVDosing S vm PE31 Pump: • 12.0 Maubnum amps Oper ation.
• low Pressure Pipe Systems • Maximum G*adt)r 50 GPM d Pole design a AN ratin are within the
• Basement Draining • Maxhm m head: 25' TDH K41 Motor. ■ Quick g limits wrtd Pin motor.
• Heaver Duty Surtrp! PEati Pump: • .40 HP, 3400 RPM cord. 29 standard lengdl,
Dewatering • Maximum capacty— 60 GPM • 7.5 Maximum am" heavy duty 1 S)TW with
• Maximum head: 29' TDH • PSC design NEMA 5.1 SP, three prong,
PE51 Pump: PESt Motor: 11 S volt grounding plug.
• Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty,
• Maximum head: 37' TDH • 9.5 Maximum amps portable and compact.
rurer> as FEET
• PSC design ■ Medranial seal is carbon,
eo ceranK RM and stainless
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STATE BAR OF WISCONSIN FORM 2 - 1999
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between RJC Development, Inc.. A Wisconsin RECEIVED FOR RECORD
Corporation Grantor, 01116/2004 09:30AN
and Todd Marek
Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT i
the following described real estate in St. Croix County, State of Wisconsin REG FEE: 11.00
(if more space is needed, please attach addendum): TRANS FEE: 465.60
Lots 10, 19, 20, 46 and 48, Plat of Richmond Hills in the Town of COPY FEE:
CC FEE:
Richmond, St. Croix County, Wisconsin. PAGES: 1
Recording Area
Name and Return Addre s
KRISTIi A OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, WI 54016
026- 1127 - 10-000; 026- 1127 -19 -000
026- 1127 -20 -000: 026- 1127 -46 -000: 026- 1147 - 48-000
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of January 2004
RJC Development, Inc.
C
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., A Wisconsin Corporation STATE OF __ )
By: P IP U CAA (.C-. ) ss.
�� County )
authenticated this � day of January 2004
Personally came before me this day of
—_ the above named
* Kristin Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attomey Kristina Ogland
Hudson, WI 54016 Notary Public, State of _
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wl
STATE BAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 2 -1999
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
Mailing Address P O 2 2 N��-✓ C (- M o
Property Address l
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number D Z b J ( 2'7 / q 00
LEGAL DESCRIPTION
Property Location J 1 /4 , - 5 - �) '/4 , Sec. T N R W, Town of 2 (C K--� o ^1D
Subdivision /� (G ",,q n A << , Lot # .
Certified Survey Map # , Volume , Page #
/
Warranty Deed # 7.� (� Z , Volume 'Z , Page # ,3
Spec house �e no Lot lines identifiable (:?�p ifo
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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
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 Planning &
Zoning Department within 30 days of the three year expiration date.
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
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
A)
SIGNAT OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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Wis6)onsin Department ofCommerce SOIL EVALUATION REPORT Page of 3
r 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 C roi x
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 02- (,a
percent slope, scale or dimensions, north arrow, and Ioq$1oRpnd-dIstance to nearest road. /
I R iewed by Date
Please print all in nvi6n: ,
Personal information you provide may be used for purpos (Privacy Law, s. 1504 (1) (m)). 9 1 . ( Z
Property Owner FCr i%• ' Property Location /
R J C DeveloPment, Inc. Govt. L t NW 1/4 SW1/4 S 25 T 30 N R 18 k(or) W
Property Owner's Mailing Address is Lot # Block # Subd. Name or CSM#
City S to Zip Code ' .alone NumbeFokj Ci ❑ Village ® Town Nearest Road
MI N 140th. ST.
r — Richmond
[R New Construction Use: ❑ Residential ! Numbe) cdd�odIm f ",4`' Code derived design flow rate 600 GPD
❑ Replacement • ❑ Public or commercial - Descn'be:
Parent material ql ac•i a 1 drift Flood Plain elevation if applicable na ft.
General comments
and recommendations:
mound @ el. 99.90', based on contour line of el. 98.90'
F1-1 Boring # n Boring
Pit Ground surface elev. 99.30 ft. Depth to limiting factor 30 n.
- -�� 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
10 2/2 none L 2msbk DSH cs if .5 .8
9 -18 10 4/4 none sil 2msbk mfr 9w if .5 .8
none sl 2msbk mfr gW na .5 .9
7 5/8 scl M na na na .0 .0
F Boring # in.
Boring 99.30 39
pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff?
in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. `Eff#1 `Eff#2
_ n L 2msbk DSH cs if .5 .8
_ ?( 10 4/4 none sil 2msbk mfr 9W if .5 .8
is osq mvfr 9W na .7 1 .2
_ L' tone Re iduum np n
` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 and TSS < 30 mg/L
CST Name (Please Print) Signature ST Number
Gar L. Steel 02298
Address 4Data�.- nduct d Telephone Number
715- 246 -6200
1554 200th. Ave., New Richmond, WI. 54017 10 -20 -2000
It
Property Owner u .T C p6 C jMjept r InC. Parcel ID # PM8 Page �_ of 3
a Boring # ❑ Boring
Pit Ground surface elev. 98 ft. Depth to limiting factor 48 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
1
4 48 -60 7 5 ,
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # F1 Boring
El Pit Ground surface elev. ft. Depth to limiting factor 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
' Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS :5 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 (R6=)
t
• STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTM2298 NW'' SW' S25- t30N -R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #19- Richmond Hills
N
,l,-1 " =40'
� BM.= top of 1" pvcpipe @ el. 100.00'
/Alt. BM.= top of 1" pvc pipe el. 101.60'
0 5�
F
C.�
S
Gary L. Steel
10 -20 -2000
l