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026-1127-28-000
• tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ping Division INSPECTION REPORT Sanitary Permit No: 405188 0 RAI' INFORMATION (ATTACH TO PERMIT) State Plan ID No: ,ial information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. + — rfbUlr . b A • ,mit Holder's Name: City Village X Township Parcel Tax No: Marek, Todd Richmond Township 026 - 1127 -28 -000 CST BM Elev: Insp. BM Elev: BM Description: csO Icy ,a' P -- TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER grAPACITY STATION BS HI FS ELEV. Septic w � J � C Benchmark v � J �p, Z 'Z , W .0 Dosing r Alt. BM GJE�GrEj� 8"v I 1 B d . Se wer Aeration 9 r/3 oZ•tl Holding St/Ht Inlet )01. Oqt St/Ht Outlet TANK SETBACK INFORMATION 1 W •0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet -8b 18. TT t Septic f t Dt Bottom t;_ 56 23 / ,/o Dosing � r Header /Man. �•`� 4p � ,,I Aeration J Dist. Pipe - �oY Holding Bot. System -y5 Final Grade PUMP /SIPHON INFORMAT - � `f-�' (o �• 3� Manufacturer Demand St Cover D GPM 9t Model Number TDH Nif O Friction LQs,�, System Ha TD; S Ft ASS 3 • `t Forcemain Length Dia. Dist. to Well , SOIL ABSORPTION SYSTEM S - Z BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S Z ___\ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEAC G Man urer: INFORMATION Type Of System: S D ` y / SU( �^ CHA UN T R Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution �y /� x Hole Size q I x Hole Spacing / Vent to Air Intake Length � Length * Dia Spacing ►' � 3Z 2 1 -^ SOIL COVER x Pressure Systems Only xx Mound Or At - G rade Systems Only Depth Over Depth Over xx Depth of T77eded /Sodded Mulched xx Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Inspection #2: / Location: 1435134th Ave New Richmond, WI 54�0117 1/4 SW 1/4 25 T30N R18W) tic mond Hills W28 Parcel No: 25.30. 18.838 1.) Alt BM Description= 2.) Bldg sewer length= 2Qt - amount of cover = (b 3.) Contour = 00,q%f Plan revision Required? e No 12 2 o DZI Use other side for additional i R t� SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. re- - Safety and Buildings Division Count ,5� '' 201 W. Washington A P.O. Box 7162 7N w Madison, WI 53707 - 7162 Site Address 1* , 4consy n Dep artment of Commerce a s" z s-3 Sanitary Permit Number Sanitary Permit Appli cation 1/05 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Priva Law, s15. 1 m She plan I.D. N ber I. Application Information - Please Print All Information 7 5 le Parcel Number property :0woer's � Name Property Location Property Owner's Mailing A s 'J�T r 10 / o N. R, r =PhoneNumbec Lot N � be r Block Number City. State Zip ` Subdivision Name CSM Number H. Type of Building (check all that apply) Vol - S / 1 ,aJ ❑City 2 Family Dwelling - Number of Bedrooms, ^��"/� -� g ❑Vilisge Z. ❑ public/Commercial - Describe Use °"unship ❑ State Owned M W / " X 75 Nearest Road o-r\. Con -ia'LtAJ 91 vs �i 'l/ a Z� ' _ ! . D �� Sr+i+vd . III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 2 ❑ Replacement System f 6 ❑ Addition 3 ❑ Em:ber" w Tank stem Dace Issued B . ❑ Check if Sanitary Permit Previously Issued PN IV. Type of Permit: (Check all t scheme is for internal use) Npon - Pressurized In -Ground 47 C1 Sand Filter 5 ❑ Constructed Wetland 22 ❑ pressurized In- Ground Tank 48 ❑ Single Pass 51 ❑ Drip Line 4 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recircrhlating 30 Other V. D' tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area / Soil Application Percolation Race System Elevation Final Grade t) (Min./Inch) Elevation Required Proposed Rate(Gals./Days/Sq.F a - VI. Tank Info Capacity in Total Number Manufac r e Fiber Plastic Site Steel Glass Gallons Gallons of Tanks Concrete Constructed New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber J VII. Responsibility tatement I, the undersigned, responsibility for installation of the POW TS shown on the attached pleas. Number Plumber's S' MP/MPRS ' Business Phone Number Piumbe 's Name (Print) 6 7 Plumber's Address (Street, City, State, Z' V171 - 7 . 9 G VIII. /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Is em Signatu o Stamps) pproved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse y � Determination IX. Conditions of Approval/Reasons for Disapproval Sys�t v n ivts (a.,lii+� �t~ G57 - h AaC, W411 ��� y3 -` r V M/CIJ- OP ALI N C;l 3 UrLXNE12 - PRav size Attatt complete Plana (to We Cotmt� 7) for the s>>tem on papa' not kss than 8112 x 11 (aches ffi �m �,.,r�T hU.s Pte" 7 �c.v�vf-rr� � Pv�l Pl a�sP:�s�- sys�M �tc�.o,eIDiw a- ?�' IiaRm�� 1QRn -A';4R (R 05 /011 S( -446P ,6S• L Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 N TDD #: (608) 264.8777 www.commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary June 14, 2002 CUST ID No.226900 ATTN.- POWTS Inspector ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Ide N 7 5 7 Numbers PLAN APPROVAL EXPIRES: 06/14/2004 Transaction ID No. 757016 SITE: Site ID No. 646064 Todd Marek Please refer to both identification numbers, 130TH Ave above, in all correspondence with the 'agency. Town of Richmond St Croix County NE1 /4, SW1 /4, S25, T30N, R18W FOR: New mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 855882 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes P'O'V and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Condit chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. "PR The following conditions shall be met during construction or installation and prior to occupancy or use: p R7ME�N,T General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD - 106 - SEE ( N.01 /01) and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. Slats. • 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. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The bottom of the distribution cell shall be level per the Mound Component Manual. s SHAUN R BMD Page 2 6/14102 • The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • Provide frost protection per COMM 83.43(8)(c). • Holes must be drilled with a sharp bit and all burrs and foreign matter removed before installation. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer a safe building, structure or component. er of the responsibility for designing g, p � P Y � g 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 s i�s.4 copy of this letter to the owner and any others who are responsible for the installation, operation maintenance o the POWTS. Sincer , Fee Required $ 175.00 Fee Received $ 175.00 i Balance Due $ 0.00 c Patricia L Shando POWTS Plan Reviewer, Int' ed Services W SMART dude. 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 i 1 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 6/4/02 Owner: Todd Marerk System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# I.T.S. 1. Cover Page Onall 2. Mound Plot Plan CE 3. Mound Cross Section 7Y a ►NCS 4. Pipe Cross Section /Pipe Layout ONDE 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 26900 6/4/02 1 PLOT PLAN 'PROJECT Todd Marek ADD E SS P.O. Box 148 New Richmond Wi 54017 NW 1/4 SW 1 /4S 25 /T 30 N /R,r W TOWN Richmond COUNTY ST. CROIX 6/4/02 4 MPRS Shaun Bird 226900 ��� DATE BEDROOM CONVENTIONAL AT- GLADE CONVENTIONAL LIFT HOLDING TANK MOUND )= SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE 848 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of 1 " PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100_ ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATI 99 fir+ 130th Ave Scale = 1 /4 11 = 10' Tanks are to be properly bedded and provided with lockdown covers with G approved warning labels i, `7 T i I]T ° B - 2 s Weeks Pro 4 a - 13 ��'' Bedroom i House 3% Slope B -3 Area 15' Below B -1 stem is to Well is to meet all setbacks found in S Y 99 , remain Comm. 83 undisturbed 98' 97' Grading is to be done to divert run -off away from system * B.M. Alt. B.M. Property Line No Date 6 Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric Distribution pipe A) N G " Topsoil J i -= - = == r 1 ` 'L + 7. Slops ��•`�� . Bed or ij� 2 = Force Main Plowed Drain Rock From Pump Lo , Cress Section Of A Mound 'System Using - A Bed For 'The Absorption Area F I 0 Ft. J_ Ft. K j0 Ft. . L Q Ft. wpm Ft: L J 40bservolion Pipe -• .._.._..� —K r A N - - - - - -- -------- - - - - -- --------------- - - - - -- I force Main W 1 From Pump p Distribution Bed Of 2 %_ Pipe Drain Rock 4 Observation Pipe Permanent Marker Pipe or Rods Pion View Of Mound Using A Bed For The Absorption Area PAGE OF Perforated Pipe oetaif / En Pertoro +to i PVC P6pe e Notes t_oeaead Oa 8o+ +mn. 4` Are Eaudnr SpeCed fan vc.CJL f� rAAkp• �ro t/ t � SQ✓ a PVC Force Main 1I I FIASS xati NvxT pro Cannee }yen 1 , PVC Mordfald Pipe - P+pe Distribution Pipe Layout P 7f Ft R.. Ft. v2 Inches Inches�� - Signed: Hole Diameter / CAnch �� Lateral Inch(es) License Number: Manifold inches Date: `'Z' Force Main Inches # of holes / *I- Invert Elevation of Late Ft. �!j1MP r-§& =R C1tC WIN c ;. Vc iT 010r `T VC10 C AP t wtwrKCRlttpt�r � �►�MI�O�CO �OGIeeAi4 i� rAOa� o"o. { .:atvL"sOA1 sox 'yautllOt! tovtR strR +M�AKL � t GRAL1t i { r M'Pitl�, COIUD1itT �' ��' �` NRT�ZKt uAL ! • � j ill i *APPROVED 1 JOIN'S WIT" t - t, oY APMED PIPE 3' ONTO •c)r►P ••,,, ._..J Li SOLID *'SOIL .. 1 Ott G6mcittra 0 RIltit tXm OCAAM99 OU1.y t► T Awrt fAMA IAtTURCIt MA• tLiCM Jlta�ltOvAin w if _iAi`Cis) zus TAIL x i1li: --- c 7� 64LLOtJS OOSL VOL.WMi >� PNMpiI�.�'YA�SA: !iP_i:� s y �•�� IyCi.Ii0iN6 ��►tKf40V: N►btMi wuMLtR: �/' ............. rr►PUM948 A: aCNCC + Wi'�►c fRRAS 01 - C + Rauwrs OR out :'►OOi1. St�f1'�OeR: -� � D • � tsaiC •+it � •� .. OA1r�0iSt SWITCH 9'y►*t ..... rql�itr►YA OiiCKwR R bICTI: PUMP AWC ,I►�r�ltr► �1R !'O at ►M NrtT� t0 om 'JtP^I%ATC ollota t1k�TttAL OI► /4;Rtya itY iy • T: port ou P y :�u acTwoitK st. :u�t *+ttt :u r = 7 7 6 reppicTIOU w" ae '�'rwL Q y1w1AMiG Mtlld +� it T 4TEtW1ll. e:MtluiteNa TA1:.lK: 49N6Th .,..,? i w iQTN ..., -mm— i IQUI pcPTi4 ��;rc: ,. ,sum► u _ • • } ±ar�rsic VA ILI ,.� Su s1 4n . f l toed gic 0 r.>e (4 P " �p So 60. 70 1eralw _ Is _ GPM 1 13 17 25 Z8; 30 . 33 4:3 5 2 61 7 Nuts _ 129° f Max; 30 2 10.- d goNl (US t>4Plll1 a 3 S SZ it3 T9 1.3 Omw sI4" 1. it sa ttx tip �a 28 lbs. . � Ca .18/4 SM 20' stri. - s cszn _ 11atews of Cocico sska ca - - s" fooes`Crbn� spbF towN - '- - Ma�haekd 3eii Bei�'Ariud`S� ' = • - . - )t�wrc B�a�ms5leMra - coe�ed fm:leows . Oalsss stei -. W o w L. ®1948 HYDROMATIC® - nr I ` r • w • • 18� 0eodAt KWA4W kt419.21l.1042 Fmc4 9-2914M WASkwwLpwAd*wPM sou•cfflt>Es1NAaUMaMSMaom im Sg y � 1? a t, ♦��1 5. Or i Iii At LI'MMIC HEAVC.kPA.".11y H CAPACITY CURVE r Mlrr;lt f - f . ifNl' ANIi :;:71.:ItK1iG MODEL 152/153 l og P l: M. 1 50 _ Fe.el Melrrx Gol. 1..itere. ::rl ) Jv's 1.5 59 261 19 10 - -.... 1 U 3.1 5' 231 1 :� I ti 4.5 53 701 V L; 44 1 h7 c 30 _. 8 7;: /.b S^ C-3 _ _... 20 0.7 -- I C R.., hi•� � lU :ucN Vnlvr.: 3A.o (' 1.6m) It aisGOi 0 20 0 60 80 100 GALLONS UILHS I 0 80 240 320 MlNUrr •�- ---- -� CONSULT FACTORY FOR SPECIAL APPLICATIONS • Tnwd dosing panels available. • Eieatrical aNemators, for duplex systems, are available and supplied with `fil ' / an alarm • Variable level control awkhes are available for controlling single phase systems. I • Double piggyback variable level float switoes are avamwe for vadabie level long and short cycle Controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 "F. (54T.) sPecial quotation required. r ' 1321153 Series , r / N In"l K -tom G emtral ealeWon J; - Me" Yolb -Ah An M 11h J" DUPlex 1 i "i;5 1 Ncn._ 8.5 1 7nr BN152 113._ 1 END Included 2 er 3 E162 7.30 1 NM 43 1 2a� �t ut�*�v I V, rrxrs 9E162 230 1 AIAO Inckded 2 or 3 ty3 116 1 Non 1 20 0 SN133 115 1 Auto 110.5 Inckdw 2 a 3 SELECTION GUIDE E153 230 1 Non 61 1 2 or 3 1. back variable level Awt wAch or double pipflyback variable level float BE 1S3 - 230 t Auto ,' ed 2 or 3 v PReY sw�h. Refer to FM0477. o CA N 2. See FW712 for correct model of Electrical Aitemalor E-Pak. As moll" of txvnrola, ~00 devices and vAnny should "Oone qy a *Wffleo 3, variable lewl control switch 100225 used as a control sctiveior, specity duplex (3) Neeneed elecUlclan. AN electrical vW yaiely aodee thould be followed Including the most rrrant Nativnet Eleevte Cede (NEC) and the Occupations 9ofety and HUNK Ad (OSHA). or (4) float systern. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engirloered Into the design of every Zoeller pump. KUL To. RR Bo( low • • Lauuvdie, KY 10236-0341 1NewfrdW4!ro Or. . G SHf► TO: 3N9 CrH Rurr Rtxkl La *vyb• KY 40211.1961 etu P 4* as S,vcF /9.99 ntW // •�cdl room PL//t !O. / 60 21 776t27J1. 1(Wo 921-"P FAX (604 7 74 - 10 Copyright 2000 Zoeller Co. An rights reserved. 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 S C r oi x include, but not limited to: vertical and horizontal reference_pgint (BM), direction and Parcel I.D. 02,(��. 7 percent slope, scale or dimensions, north arrow, ar,�d ti6 tion pno dt*nce to nearest road. P endin g Please print al q, on. a ed by Date Personal information you provide may be used y, r 4343 ary purp4es sivacy Law, s. ".04 (1) (m)). W a 7 Property Owner i . Property Location R J C Development, Inc' " - ,,. GcvL.Lot NE 1/4 SWv4 S 25 T 30 N R 18 F[(or)W Property Owner's Mailing Address Lot # ` Block # Subd. Name or CSM# 1868 Ct . Rd. C na Richmond Hills City State Zip Code r one Num G [City ❑Village ElTown Nearest Road .ptd�'vG New Richmond WI.1 54017 11 247 -57 Richmond J New Construction Use: ❑ Residential / Numbei o#b�rb_o -44 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material g lacial drift Flood Plain elevation if applicable _ na ft. General comments and recommendations: mound @ el. 99.45', based on contour 1 ine of el. 98.45' ❑ Boring # Boring DC i Pit Ground surface elev. R S5 ft. Depth to limiting factor d in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -9 10 r 3/3 none L 2msbk DSH cs if .5 2 3 19 -30 7.5 r 4/4 none 4 30 -42 7.5 r 4/6 none F 2 2] # Boring Boring ® Pit Ground surface elev. 98 ft. Depth to limiting factor 4 6 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 0 -9 1 0yr 3/3 none L 2msbk n' 2 9 -18 10 r 4/4 none sicl 2msbk mfr w if *4 .6 3 18 -46 7.5 r 4/6 none sl 4 46 -70 7.5 r 4 d na n Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L E uent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gary L. Steel 2298 Address ate E "luatio nducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10 -13 -2000 715- 246 -6200 Property Owner R J C Developmen Inc Parcel ID# Pending Page 2 of F3 ] Boring # E3 Boring 4�+ Pit Ground surface elev. 9 7 . 15 ft. Depth to limiting factor 5 4 in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0- 2msbk DSH CS if .5 .8 2 9 10vr 4/4 none sicl 2msbk mfr •w if .4 .6 3 17-45 7,5yr 4/ none sl 2msbk mfr 4W if .5 .9 4 45 -54 7.5 r 4 none ms os mvfr 1.2 r 5 6 scl 2msbk na .4 .6 ❑ Boring # 11 E) ❑ 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 Boring # Ground surface elev. ft. Depth to limiting factor 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 I 'Eff#2 > = BOD < 30 and TSS < 30 'Effluent #1 - BOD > 30 < 220 mglL and TSS 30 < _ 150 mg/L ' Effluent #2 , _ mg/l_ _ 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 (86100) STEEL'S SOIL SERVICE Gary L. Steel RJC Develop Inc. 1554 200th Ave. CSTM2298 NE4SW4 S255pt30N-R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #28- Richmond Hills N 1"=40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 95.55' t n C� �a h 1 V � r N 1 o� a Gary L. Steel 10 -13 -2000 I STEEL'S SOIL SERVICE Gary L. Steel RJC Development, Inc. 1554 200th Ave. CSTM2298 NEISW4 S25 t30N - R18W New Richmond, WI 54017 MPRSW town of Richmond (715) 246 - 6200 lot #28- Richmond Hills N 1 " =40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 95.55' �a h �. w 1 zlz' 35r 2-91 33 rA kA VIIA", Gary L. Sbel 10 -13 -2)00 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / Mailing Address G,f3 Prop Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location � , -� V4, Se� T ' � N -R Town o Subdivision Lot # Certified Survey Map # Volume , Page # Warranty Deed # . Volume . Page # Spec ho us! yes ❑ no Lot lines identifiablVyes ❑ no STEM CE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastorplumber, joumeymanplumber, restrictedplumber or a licensedpumper 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 County Zoning Office within 30 stating that your septic system has been maintained must be completed and returned to the S t. Croix days of the three year expiration date. 4�4ZIL 71- SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of described above b virtue of a warra the property desc y deed recorded in Register of Deeds Office. ✓ DA SIGNATURE OF APPLICANT * * * * ** 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 r Maintenance and Contingency Plan for a Mound System 9 Y Y 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. 9 9 ,9 9 9 Y 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 an other failing components c is as needed. P Y 9 P Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St. Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 6/4/02 I POWTS OWNER'S MANUAL & MANAGEMENI PLAN f S YSTEM SpECIFIcanONS g 9INNIFORI A 0115WON s� Tank Capadw G at o NA r- -� Septic Tank Manufachm ❑ NA S EttNrerd Filter ifiNkUbdurer p NA I PARAME ©� Ef&wdFjWModel p NA * BedrooM Una pump -Tank Capac at O N of Conte {,�/ - � O Pump To* flow (WWOOO) _ NA Dew ( led x 1.5) �6 Model 0 0 NA P. Untl NA Sol A Mail ate• � Filter p Peat Filter F* Gt (FOG) 530 mgi[- p M Aeration 13 Wetland � OMw Demand (BODs) 5220 ' ❑ ❑ Total S Solids Rte') 5150 1Aaurufa ReusEied Mflt�tt Qual ❑ NA Monthly � 1 01 (g a y ) ❑ in-ground (pressurized) Wwd=n ai Oxygert Demand (BODE 13 At -grade p Other: Tow �� mean) � � oo"d p . Fecal K tr>ch diameter venues t� for domestic (n� ""�O118cOf Ow Maid mum Ef&Mt Particle Sim M w - MAINTENANCE SCHEDULE service Frequency Service Event p monk p year(s) (Maximum 3 yrs.) At least once every inspect cendihon of tank(s) When combined sludge and scum equals one -third (13) of tank volume Pump out intents of tank(s) p s) (Maximum 3 ym.) At least once every s) cell(s) O months 1 Inspect dispersal At least Once every � �efltuent fitter ❑ months--O ❑ NA Cl ► pump, !gyp Conti & alarm At lei o p mom r(s) ❑ NA inspect test � lead months E3 s) ❑ NA Flush s lab attd p test least once every Q months ❑ year(s) p HA atl At fast once every other. th f Icenses or i��(ANCE gaT�CTiONIS oe� strail be made by out Oft of �; S�ta9e i� of tanks Master plumber Rem Send: PO taO(S1 to identityY m>`9 back up spection of the C M T must include a irs volume f Co and sc um a d Check tits ideney pperat� or teaks. rnea�sure be vY t on the any hardware. rsal s hall be P of eftitren or check any P t the °B of the local r+e�l�Y authority in the may ircate a failing �diaon and requires (* a move of the Yank volume, the "twe ground r1bined l of sludge b she any Servi OP�a and disposed of in accordance �" When the entire Contents of the fit co and any 113. W Ad" or pressurized POWTS Compo a POWTS Maintainer_ The r ma 9 a ce or mt� a intervals of t2 months or teas 10 eomt of any service event oilier to the local reg+Wory authority - it be p� oche r sha ut�s or A setvi report the of painting P STAtTf UP AND OPERATID� use of the POWTS check trea tmen t {s) for e � s are high For new construction. . the treatment proms artdaor damage P to use servicing OPM deter have may contents of the tank(s) removed by septage System start up shall not occur when son are frozen at the infiltrative surface. DWg power owes pump tanks any fill above normal tughwater levels. When power Is restored the excess wastewater will be dbchatged to the dispersal cell(s) in one large dose. overloading the oell(s) and may result in the backup or surface discfarge of ' To avoid this situation have the contents of the pump tank removed by a Septage Sen* tg Operator' P�jo !'�o�t�'power to the ettkent pump or contact a Plumber or POWTS MaIntairw to assist In RUVWW opera&9 go lip Controls to restore normal levels within the plump tard"L Do not drive or park vd*Jes over tartkd and dispersal tags. Do not drive or park over. or otherwise disturb or compact. the area wVW 15 feet down dope of any mould or at-grade soft absorption area. Reduction of the fofiawdtrg item ilia vte+ivater stream may approve the perforrtanoe artd P We Of the POWM antibiotics; baby r - butf� . cotton swabs; degreased dental floss; dlapeM disinfectants: fat foundation � (swW Imo) water thrill and vegetable peelings: gasoline': gteas� herbicides: meat sCMW. n*ka i mr. at p Pte: ► "land water softener brine. AWhen t he POW PT TS lags and/or is permanently �et a out of service the folawhg steps shall tta taken to atstne that the vw>ert t systern is proper WW s abandoned o compliance with ch. Comm 83.33. Vlhsconsat Administrative Code: • An ptpatg to tanks and pits shall be disconnected and the abandoned pipe op~ sealid • The eonterts of a ll tanks and pits shad be removed and properly disposed of by a SephW S • After pumpkV. a ll tanks and pits shad be excavated and removal or them covets removed and the void space filed with sot gravel or anodw ktett sold material. CONTINGENCY PLAN measures have been. or must be taken. to provide a code if the POWI"S fails and cannot be repaired following cornpl replacement system: 13 A suitable tepla mnent'area has been evaluated and may utilized for the location of o r epl a ce m en t pac ion an d sal absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by r+egtn ed setbacks from ex*g and proposed structure. lot fines and wells. Palate o protect the replacement area wN result in the need for a new sod and site' evaluation to establish a suitable re pl ace m ent area. Replacement systems must Comply with the rules in effect at that torte. ❑ A suitable replacement any is not available due to setback and/or sod limitations. Battling advances in POWTS techrtoogy a holding tank may be installed as a last resort to replace the failed POWTS. s has trot been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and The its evaluation must be performed to locate a suitable replacement area. if no report area is available a t tank may be wed as a last resort to replace the faded POWTS. of the biomat at and atlpade sol systems may be lo face fallowing removal the L surface. Reconstructions of such systems must comply with the tubs in effect at that tune. «WARNING» SEPTIC, PUMP A ND OTHER TREATMENT TAN M AY CONTAIN LETHAL- GASSES AND/OR INSUFFICIENT OXYGEN. R ESULT. RESCUE OF�A PERSON FROM THE O THER INTERIOR OF A TANK MAY BE D IFFICULT OR IMPOSSIBLE MAY BLIMPOSSIBLE R ADD COMMENTS POWTS INSTALLER POW Its NIAlNTAINER Name case Name S ct.Ll ti , Fii Phone .T' —Z U ' / ` — /� Phone a � Z y`�f SEPTAGE SERVICING OPERATOR UM LOCAL T AUTHORITY FtE aW G ,,,ears This doacrnentvras craned Use stags dgc• mw take. Wrqueft and Waushua Cocmy� Zocdn� San>ta>i� Tl� dooms the mk*n-n cequlren.,M d dc. C,.. 83.2 VPXtXd" OW "j)• C4 & ( Wbw-sk adze Code- Use d I" do,""' dog not CL4W (fit) guarantee the petfamanas of ft POWTS. J va 1838PKE 579 STATE BAR OF WISCONSIN FORM 2. 1999 671 4 S 7 WARRANTY M fHLEEN H. WALSH DEED Document Number REGISTER O DEEDS Si". CR01X CO., WI This Deed, made between RJC Development, Inc., a Wisconsin RECEIVED FOR RECORD Corporation 02 -19 -2002 9:30 AN WARRANTY DEED Grantor, and Todd Marek, EXEMPT 8 CERT COPY FEE: COPY FEE: TRANSFER FEE: 163.20 RECORDING FEE: 11.00 Grantee. WILES: I 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 Lot 28 and Lot 32 Plat of Richmond Hills in the Town of Richmond, St. Name and Return Address Croix County, Wisconsin. 7 0 7 . ,a � 026.1127- 28,026 - 1127 -32 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.) ps not) Dated this 13.-W day of February 2002 WC De elo ,oenfgpnq r AUTHENTICATION , ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. �T. CJ2di ,C County ) authenticated this day of Personally came before me this / 7'Xz! day of February , 2002 the above named Y RJC Development, Inc., a Wisconsin Corporation by sod^ _ e i-row TITLE: MEMBER STATE BAR OF WISCONSIN it's (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 Attorney Kristine Ogland - rah Hudson, WI 016 Notary Public, StatQtB u„Isa, 15f pr1B11f My Commission is per manent. not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 9 ' Names of persons signing in any capacity must be typed or printed below their signature. a romue« Prof"Siomis comtw wt WARRANTY DEED STATE BAR OF WISCONSIN 900-555-102+ FORM No. 2 -1999 County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road std Hudson, WI 54016 -7710 (715)386 -4680 Fax(715)386 -4686 Attach complete plans for the system on paper not less than 8 -1/2 x 11 inches in size. 71 1 County Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Information Location: , ) Property Owner Name 1/4 �L�(14, Sec z� T N, R l,f E (oro Property Owner's Mailing Address Lot Number Block Number o' -� JUNl' City, State Zip Code Phone Numer Subdivision Name or CSM Number / "A � �ST. CROIX COUNTY 7 ZONIN If Type of Building: (check one) amity ❑Village of t a or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): 1✓ ❑ State -owned Nearest Ro d II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number (s) A) I r 2. ❑ Reconnection 3. ❑Non - plumbing . ❑Rejuvenation Sanitation B) Permit Number Date Issued ❑ State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground i /T�PAound ❑Sand Filter ❑Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Min. /inch) Elevation I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks 1s� ❑ ❑ ❑ ❑ 6 v ❑ ❑ ❑ ❑ ll. Responsibility Statement 1, the undersigned, assume responsibility for repair nnenction/rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A ricenseis required terralift repair of ion of non - plu mbing sanitation system. a (pri t) Plum nature (no stamps): Z MP /MPRS No. Business Phone Numb 6 M6 dress (Street, City, S ip Code) Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) roved Owner Given Initial Adverse Determination ns of Approval /Reasons for Disapproval: Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 \ CEIVED www. commerce.statemims/sb www.wisconsin.gov Department 14 2002 Scott McCallum, Governor W Philip Edw. Albert, Secretary ST. CROIX COUNTY ZONING OFFICE June 14, 2002 CUST ID No.226900 ATTN: POWTS Inspector ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/14/2004 Identification Numbers Transaction ID No. 757016 SITE: Site ID No. 646064 Todd Marek Please refer to both identification numbers 130TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County NE1 /4, SW1 /4, S25, T30N, R18W FOR: New mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 855882 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 /O1). _ • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The bottom of the distribution cell shall be level per the Mound Component Manual. SHAUN R BIRD Page 2 6/14/02 • The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Provide frost protection per COMM 83.43(8)(c). • Holes must be drilled with a sharp bit and all burrs and foreign matter removed before installation. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this 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 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 Bird Plumbing Shaun Bird ' I O --� O W CJ MATCH UNE ca SEE SHEET 1. � rr MA TCH SEE SHE i r N00'06'48 "E 591.55' r 3.99' i N00'13 ~ 297.56' 565. I - T' N co + I , I + I p � I • CD. � y rx, F� • y a c^ 0 + + + N00'23'32 "W - — 293.01 S00'35'07 "W . It + 293.01' i • 0 • i 1 O i 1 , I � I , � N I N 01 ci 1 CD 1 1 v i N N�o r cp OD �tia I mom a ? ^? 42 ci w c c y m W . I I Q 1 I ' 1 i 33' --- - - - - -- 293.00' ----- - - - - -- I N00'1333 "W ------- - - - - -- 293 -09 ------ - - - - -' • • 66.11 -- N' 2 5-5-W �0 — - e N00'13 586.01' • 0 w - - w N00'13'53 "W _ w 7't8 512 w "' 0 --197. -- - - - - -- .------- 181.00'- • - - - -- - ; - -- IaT-5�' - - - - - -- - - -- - - - - - -- i i N 48 i i __ .. �` � � rZ `� �� � , s- ��.