HomeMy WebLinkAbout026-1127-34-000 ,entofCommerce PRIVATE SEWAGE SYSTEM County: St. Croix
Division
` - ' INSPECTION REPORT Sanitary Permit No: 420353 0
.L INFORMATION (ATTACH TO PERMIT) State Plan ID No:
.formation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
,older•s Name: City Village X Township Parcel Tax No:
rek, Todd Richmond Township 026- 1127 -34 -000
F BM Elev: Insp. BM Elev: BM Description:
1 00.6 1 COI D W h , wa& a
�FORMATION EL VATION DATA MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 00 0 Benchmark �31n'4f' / Z aev
Dosing 7 & /.0
�D ( a /o U. p
Aeration (N �UQ Bldg. Sewer
Holding St/Ht Inlet
/u
TANK SETBACK INFORMATION St/Ht Outlet 1 �� g
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
1 -1 -13 ?,r. - t
Septic( / Dt Bottom
� 7 a �.'s� Pi s• ZS �s •�
Dosin g ` Header /Man.
tq� 3.
Aeration Dist. Piper
Holding Bot. System 3. F/ 9
,t
Final Grade
PUMP /SIPHON INFORMATION l •3
Manufacturer Demand St Cover;
GPM A
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Lengjk I Dia. Dist. to Well
SOIL ABSORPTION SYSTEM ¢ htue k-e0,.. 99• �ortt�uN)
BED/TRENCH Width Length No. Of Trenches T DIMENSI S No. f Pits Inside Dia. Liquid
DIMENSIONS 8 / -5 / G__ d- I
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L4,AgMNG Manufacturer:
INFORMATION ER OR
Type Of System: Z / 1 I /,j I---- CH U Model Number:
�T
DISTRIB S Y S TEM,�� b,
Header /Manifold IDistribution Hole x Size x Hole Spacing Vent to Air Intake
I r r Pipe(s) t s, 4
Length 4 Dia Z Length Dia 2 Spacing � 3 / f. Z T !n
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only &/,i+.
Depth Over -/_ (� Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center �¢� Bed/Trench Edges Topsoil Li
[] Yes [] No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: d P / b Inspection #2: A
Location: 1426 133rd Avenue New Richmond, WI 54017 (NW 1/4 SW 1/4 25 T30N R18W) Richm d II s Lot Parcel No: 25.30.18.84 "
1.) Alt BM Description = �� - P"� • �` w c� . � h - a'`" '�c2`"`J`
/'� � S
- � l
2.) Bldg sewer length - �a �jYj'f it-� �Yt� ,1'tO l � � � YGt /
- amount of cover = � to �e Tta Jf N ia�
3.) Contour Aejv"� 16u► -1 "
i� 0 rt' lit 2 l -e � v e
-
Plan revision uired? Yes I, No / / 7 I
Use other side for additional information. �- —
SBD -6710 (R.3197) Date Insepcto s Signature ( Cart. No.
PLOT PLAN
PROJXE T Todd Marek RESS P.O. Box 148 New Richmond Wi 54017
NE 1/4 SW 1/4s 25 /T 93008 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/20/02 BEDROOM 3
CONVENTIONAL AT -GR dE CONVENTIONAL LIFT HOLDING TANK
MOUND
)00( 1000 TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 848
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none /
BENCHMARK V.R.P. Top of 1" pvc Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ✓
❑ BOREHOLE (DWELL •H.R.P. NE corner of property ' � n
SYSTEM ELEVATION 5 , ra�7�/?/ -4ePte �
aj /00 � a4j t ie
_ B.M. #2
B.M. #1
192' Property Line 9 9 1 98
101, 100'
Area 15' below
system is to
Well is to remain
meet all i undisturbed
setbacks B-3
found in
Comm. 83
4%
Slope
Grading is to be
done to divert run-
off away from
system
Tanks are to be
properly bedded and B - 2� w
provided with
lockdown covers D'' °
CD
with approved
warning labels
Weeks ST �R
CD
Pro 3 l lo op d i
Bedroom o��
House
Town Road S = 1 /4 11 = 10'
01 163
Safety and Buildings Division 7 - --
201 W. Washington Ave., P.O. Box 7162
V Visconsin Madison, WI 53707 - 7162 Sine
Department of Commerce / �O 1531-V u '`
lieation Sanitary Permit Number
Salutary Pe rmit A pp
3
In accord with with comet 83.21, was. Aft. code. personal information yot prov e ❑Check if Revision �0 0
may be used for Law, si5. i m
L Application Information - Please Print AD Information State Plea I.D. Number
Z Owners ame Parcel Number
rw �O .3& - //a 7 Owner's Ad dress Address AEG i'�=ri tenon _ • S
- P. �)UGVIJTO
if �St • WZ T �� N B
code Lot N ` Block Number
City, Stine ZD
Subdivision Name Number
IL Type of Building (check all that apply) Deity
or 2 Family D -
Number of Bedrooms DVillage
❑ Public/Commercisl - Describe Use �
❑ Staoe Owned . lr � e'` Qal ' ,
vu l' k w -wa rlx 15 "7 / Nearest Rqad
III. Type of P ( only one boa on line A (numbering scheme for internal use). Complete line B if applicable)
A 2 ❑ Rat System 3 0 Replacement of 6 ❑ Addition to For Courtly use snag Ej
soem Task
B. ❑ Check if SanoituY Permit Previously Iss
Permit Number Date Issued
IV. Type of Permit: (Check all tIJA-app" scheme is for internal Use)
44 ❑ Non - Pressurized In -Ground it�tmo.. d 47 0 Sand Filter 50 O Constructed Wedand
22 Q p� hn Ground 41 Holding Tank 48 1] Single Pass 51 0 Drip Line
45 ❑ At-O ade 46 0 Aerobic Treatment Unit 490 Recircnlatin8 30 0 Odder
V. tment Area Information: Percolation Rate Sysoem Elevation Final Gradc
1Sa Flow (gpd) Dispersal Area Dispersal Area Soil Application
/ (11�tia./Ittch) /i ) Hevation
P`°posad(�/S(o) ��./ U
0, � m I I �)
i� VI. Talk Info Capacity in Total Number curer Prefab ate Stftl Fiber Plastic
Craiions GailoLS of Tanks Concrete Constructed Glass
FNW Fail w
Tanks Tardy
Sepeic or liold'mg Tatdc
D osing
VII. sliplifty Statement- I, the for instigation of the POVM Aown on the attad" plans.
Plumber's Name (Print) Phmtber's Mp/i�RS Number Business Phone Number
L Z Z 6 //J — /,�)
Plumber's Address (Stmt, City, 5 tW , � `l V
� � l TITS✓
V� ett Use )
Sanitary Permit Fee (incbxles Groundwater Date Issued Signa
Approved ❑Disapproved F
Q Owner Given Initial Adverse Suer a 3 �� � � !�
Determination )
IIC. ditions of pprova ons f Disapproval �J� �e w f'
!� J �� / l/'� __ 73Y .�s✓ Set
6o d.WavLe�
Ad OIT CWAIq env) to the SYACM m po act 1«. Ut inn z u bubw IDA1 b� �'►
SBD -6398 (R. 05101V
1 �
i
- ' TOTAL D YNAMIC HEADIWAM
u TE
HEAD _CAPACITY CURVE PER MIN
EFFLUENT AND D EWATER
MODEL 152/153
L" MODEL 152 153
W
LZ
50 Feet Meters Got. Liters Got. ta'ters
1 5 1.5 69 261 77 291
10 3.1 61 231 70 265
12 152
15 4.6 53 201 1 61 231
20 6.1 44 167 52 197
30 25 7.6 34 129 42 159
8 30 9.1 23 87 33 125
° 35 10.7 -- 22 85
a 20
0 40 12.2 -- -- 11 42
f- 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 FL (13.4m)
10 o1+aa
0
20 60 80 100
GALLONS 6 1/4
UTER5 O 60 160 240 320 _ 3 2132 4 5/8
FLOW PER M m
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS _
• Tuned dosing parWs avalal)le. `" r ® 3 27/32
• E el 2110TOO for duplex SyMm. are availaWe and supplied wM
an alarm.
• Vx We level control s mVm are avallable for contr mg sblgle 0=0
vWWS level Soat switches are avail" for variable
Level"and short cyde oorMI& '
• Sealed Qw&4kx avelable for odtdoor indanatkm. See FM1420. I
• Over i30'F. (WC) VK W q
t
12 1/a
nwwwK 1521'153 Sales •
1 5 1/e
Ni52 115 1 Volt+FPb Yoder F--bM6;N�ded
2 _or 3
°1
N152 Km &5 2ar
1 3 °0°
ON152 115 a. Aub &5 2w3 3
E 230 1 (fon 152 230 1 Aub 53 115 1 Nan 10.5 2 oor3 SELECTION GUIDE
BN153 115 1 Aub 10.5 Mcluded 2or3
E153 230 1 Non 5.3 1 2 a 3 1. Single piggyback vad" level bg swbch ordouble piggybo& variable level kM
aE153 230 1 1 Aub 1 &3 bduded 2 yw gd, Refer lo FM0477.
2. See FMO712 for wmlct model of Elecbicai Abmabr E*&
All b tdWA w of co &GK P dwtas and r+�s should be d ome by a *10 118111 3 Variable level oorgrol swileh 100225 used as a eonbol acFirrtor. sPedfy dupbx C3)
Nrmsed NoehlNos. All oloetrieal nd =ft 0 coda dw sf0� Homm Aet IOSH4 a (4)
lswst Natlonsl ElscYk Codo P�f
RESERVE POWERED DESIGN
For unusual conditions a resefve safely facltx is w0 ftred
into Vm of even► Zoeller PUMP.
ME T0: P.O.8Q1(1G?17
Uwimtfs;KY 40294W blow6cbrsrsaf..
SW Tar 3619CeweRwAbad �����,�,�
• Lotbuft KY 10211 -1961 k�•� +" S1r.M� I w
fa 7782731. I PM 92"U NP
mod ,„,, , �,1 P!!MP !O- FAx§M 774-M
0 Copyright 2000 Zoeller Co. All dgm reserved.
Safety and Buildings
NV I -sconsin - 10541N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 2648777
www.commerc i
www.wis .wisconsonsin goo .gov
Department of Commerce
Scott McCallum, Governor
Philip Edw. Albert, Secretary
August 15, 2002
CUST ID No.226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
�0 3�
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/15/2004 Identification Numbers
Transaction ID No. 774005
SITE: Site ID No. 648649
Todd Marek Richmond Hills Lot 34 Please refer to both identification numbers,
130TH Ave above, in all correspondence with the agency.
Town of Richmond, 54017
St Croix County NE1 /4, SW1 /4, S25, T30N, R18W Lot: 34,
FOR: New mound, 450 GPD
Object Type: POWT System Regulated Object ID No.: 863938 RO A
Bandit
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 A
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. p ENT
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 SEE CORRE
"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.01 101).
• 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. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
un official in accordance with the provisio 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.
SHAUN R BIRD Page 2 8/15/02
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).
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, operatio intenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
/ Balance Due $ 0.00
a Ic1a L Shan o
POWTS Plan Reviewer , Int ed 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
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715 - 246 -4516
Date: 7/20/02
Owner:
Lo tion: Lot 34 Richmond 1j.T - S,
System type: Mound System ton J�
Manuals Used: Mound Component Manual version 2.0 (01/31) 0 ED
Pressure Distribution Manual version 2.0 (01/31) of COM ERCE
Page# _
1. Cover Page S N
2. Mound Plot Plan .� f
3. Mound Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -9. Maintance and Contigency plan
10 - 12 Soil test
Signature
License number 226900
7/20/02
PLOT PLAN
PROJECT Todd Marek RESS P.O. Box 148 New Richmond Wi 54017
NE 1/4 SW 1 /4s 25 /T 93008 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/20/02 BEDROOM 3
CONVENTIONAL AT-GRAWE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 848
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none /
IL BENCHMARK V.R.P. Top of 1" pvc Pipe ASSUME ELEVATION 100' ✓
Filter Zabel A -100
❑ BOREHOLE O WELL *H NE corner of property
SYSTEM ELEVATION
ys
a, /DD • S
B.M. #2
B.M. #1
192' Property Line 99, 98t
101' 100'
1 Area 15' below )[3
Well is to system is to
remain
meet all undisturbed
setbacks n '
B -3
found in
Comm. 83
4%
Slope
Grading is to be
done to divert run-
off away from
system
Tanks are to be ^'
co
properly bedded and B - 2 ❑
provided with
lockdown covers D o
with approved
warning labels `
Sr
Weeks
Pro 3
Bedroom
House
Town Road Scale = 1/4' = 10'
r
Date D �1T4
4" Observation Pipe Perforated Non -Woven Filter Fabric
Below Filter Fabric /0) -0
Distribution Pip
ASS C -33 5 and 0 ,
Topsoil G-
� [ • ice. � Q /fib 5
Slope
/ fled Of 2 %2 Force Main ~
""-_F lowe d
Drain Rock From Pump layer
ID , `o
Cress ?Section Of A Mound - System Using , E. f ' y
A Bed For The Absorpti n-Area F
G
A Ft h j
I Ft.-
J 7 Ft.
... - K . Q Ft._
/ W S Ft:
J 40bservotion Pipe --�
JK_
a A
W V l� : - - -- ------- - - - - -- ----------- - - - - -- - -- i Force Main
t - - -._— - - - - - -- From Pump
° Distribution Bed Of %Z 2 %
d
Pipe Drain RocK
I �N
4 Observation Pipe Permanent Marker
Pipe or Rods
Plan View Of Mound Usinq A Bed For The Absorption Area
PAGE OF
r -
Perforoted pipe QetOO
�
i' End Yit_+
�Perforatsd
PVC P60t
/ , c
a t.L NOW Located On 8oltam.
_ Ars Equally Spae: :d
4-4 id
f ,r Q
r
A S! PVC Forte Man
j• f'IICST 1104.E jjSjVr 're Cann�+�
PVC
Manifold Pipe
LG fi OAin, IIislriovl�pn
Pipe
�lexf - �o
.�i
C.t. r 2 — "-PV oil Distribution Pipe Layout P Ft.
R R.
X 2 Inches
Y Inches
Signed: Hole Diameter �.�Inch
Lateral Z Inch (es)
License Number: Manifold " 7 Z. Inches z-l-(�
Date: „
Force Main Inches
# of holes /pipe`
Invert Elevation of Laterals "t.' -
t � �
`vCi►7t CAP / n �
wzArkcxi0t V N"
L l atA O CR. j .:s��G"sOsu •sDs i .aliltpvt0 r.OG1%trtJa
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• fit
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` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St . C r oix
include, but not limited to: vertical and horizontal rsf"666 potnt{@M), direction and Parcel I.D. Uc�6 / a-- — 3 —
percent slope, scale or dimensions, north arrgw , qn "Jon and distance to nearest road. p endin q
Please printlak iriforma n. le d by Date
Personal information you provide may be used farsecond f : Rrivacy 4aW s:\15.04 (1) (m)).
Property Owner Property Location
R J C Developm IriC:' _' 1'` ? !a Zi u% Go irt. Lot 1/4 $�n]I /4 S T 3 N R (or) W
Property Owner's Mailing Address J . f ` ;�C71 x r # Block # Subd. Name or CSM#
1868 Ct . Rd. C 1 " (%o(J' -Y 3 na Hills
" RiCbmond
City State Zip Cod f?horgM City ❑ Village :10 Town Nearest Road 140 ST y
New Ricbmondl WI 1 5401 ' 715 �6 t'' Richmond
130th. Ave.
(2� New Construction Use: ❑ Residential / Number o7b trtsom`s 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material glacial d i r f t Flood Plain elevation if applicable — ft.
General comments
and recommendations: mound @ el. 100.70', based on contour line of el. 99.70'
171 Boring #
Boring
Pit Ground surface elev. 1 0 O . 4 O tt. Depth to limiting factor � in.
Soil � Appiication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -10 10 r 3/3 if
2 10 -18 7.5 r 4/4 none sic 2m
3 18 -36 7.5 r 4/4 none sl 2csbk mfr ow - nA
4 36 -60 7.5 r 4/4 c2 7.5 r 5
a Boring # r] Boring 1 0 0. 4� 2 6
Pit Ground surface elev. Depth to limiting factor in. = PD/ftfl Horizon Depth Dominant Color Redox Description Texture Structure Consistence
Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -9 10 r 3/3 none 'S
2 .6
3 17 -26 7.5 r 4/41 none scl
4 26 -50 5 r 4/4 c2d7.5 r 5
' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ent #2 = BODA 30 mg/L and TSS S 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel � - 2 9 8
Address Date valuatio onducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -13 -2000 715- 246 -6200
' a
Property Owner R J C Developme Inc Parcel ID # pending Page 2 of _ 3
a Bor # Boring
❑
Pit Ground surface elev. 9 8 • 1 e ft. Depth to limiting factor 3 7 in. Soil Appl 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
10-10 3/3 none L •8
2 10 -2 1 4/4 none i •4�
3
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-1 Boring # ❑ Boring
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ligtion 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 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 (R.6Po0)
I
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave. RJC CSTM2298 NEI SW Development, I nc. New Richmond, WI 54017
MPRSW -3254 44 S25- T30N -R1 8W (715) 246 -6200
tbpnof Richmond
�. lot #34- Richmond Hills
N1 " =40'
BM.= top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of NE lot stake @ el. 92.70'
3
g
�y to
Gary L. Steel
10 -13 -2000
i
Safety and Buildings
10541N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
Visconsin www.commerc .wis ons
Department of Commerce RECEIVED www.wisconsin.gov
Scott McCallum, Governor
AUG 15 2002 Philip Edw. Albert, Secretary
ST. ZONING OFFICE Y
August 15, 2002
CUST ID No.226900 ATTN: PO KITS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/15/2004 Identification Numbers
Transaction ID No. 774005
SITE: Site ID No. 648649
Todd Marek Richmond Hills Lot 34 Please refer to both identification
130TH Ave numbers, above, in all
Town of Richmond, 54017 correspondence with the agency.
St Croix County NE1 /4, SW1 /4, S25, T30N, R1
Lot: 34,
FOR: New mound, 450 GPD
Object Type: POWT System Regulated Object ID No.: 863938
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.01/01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD- 10706 -P (N.01/01).
• 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
SHAUN R BIRD Page 2 8/15/02
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.
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).
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.
SHAUN R BIRD Page 3 8/15102
Sincerely, Fee Required $ 175.00
Fee Received $
175.00
Balance Due $ 0.00
Patricia L Shandorf
POWTS Plan Reviewer, Integrated Services
(715) 634 -7810, Fax: (715) 634 -5150 , M -F 7:45 am - WiSMART code: 7633
4:30 pm
pshandorf @commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
POWTS OWNER'S MANUAL &. MANAGEMENT PLAN Page of
(L.E INFORMATION SYSTEM SPECIFICATIONS
/ Septic Tank Ca P=W ai ❑ NA
O wner
p # 02 3 S Septic Tank Manu(ackm G NA
Effluent Fflber M� O NA
i PAtZAM tS 3 p NA Eta Fiker Model — DNA
Nw� - ❑ NA
of Comrne� units Pump -Tank CapacRy 1
flow O .3 p Pump Tank Manufacturer 4i a NA E3 NA
Estimated D fk„A► wed x 1.5)J - t7 NA
Solt R a if Pump Model pr,�rttent Unit
�entfEfllum t� tY p vet Filter 17 Peat Filter
Fats.- 01 & Grease (FOG)
=v& O M A O Wetland Biochemical Oxygen Demand (80%) mg I' 0 Disinfection O Other.
Total Suspended Solids (TSS) 5150 M�
plea Effluent Quality �A Monti�ly average s)
(B�s) �0 ffm& O In - gland (gravity) Cl in ground (Pressured) BiocherniCGI Oxygen Demand
Total Suspended Sol (TSS) 530 m91L 13 At-grade
Fecal C01ilmm (geometric mean) 510` ctuf100m1 O Drip- Other ,
Maximum Effluent Particle S•¢e
Y. inch diameter • Values typical ror domel (non4nnvnel vrastel and
Vs b for Wdmaod wasoawater.
MAINTENAMCE SCHEDULE Service Frequency
Service Event
tnspect onditiondition of tanks) At least once every E] months s) (Maximum 3 yrs.)
condition combined sludge and sewn equals one -third (Y of tank volume
contents of tank(s) a months s) (Maximum 3 yrs.)
. cefl(s) At least once every
At least once every ❑months s)
tt t3 months > r(s) ❑ NA
inspect p pump controls A alarm At feast once every s E3 NA
At least once every _-?E] months Yom( )
Flush l and pressure test At least once every O months E3 year(s) G NA
�.
At least once every [] months Cl year(s) ❑ NA
o�
MAKrEWWCE INSTRUCTIONS l cells shalt be made by a n in divid ua l one of the g licenses or
of tanks and Master Plumber Restricted Sewer. POWTS Inspector- POWTS M* taloer: Septage
Mastel inspections must lndcrde a visual inn the tams) to identifjt any missing broken
cracks a Teaks. measu
Servt�9 re the volume e of cornbifi skidge and sewn and to check for any back up
hadwame. identify any Cl e visuagy -o"�� to dledc the effluent levels
or pond'atg of of uent on the ground surface. The disposall o)n
in the obser the ground surface• The Ponce of lent on the
�ratan p and to c�lecic for any P of the local regulatory authority.
ground surface may indicate a failing cond and requires the imrnedlate nobs tank volume. the
When the combined accumulates of sludge and scum in any tank equals one-third (Y or more of the of in accordance with ch. NR
entire contents of the tank shall be removed by aP Servlan9 o pera t or an d disposed
113. Wisconsin Admin�trative Code. t � pceen �, and any
The servicing of effluent filters. mechanical POWTS �• certi POWTS Maita
event
Ical or pressurized niner.
other maintenance or the local regulatory mor>itoring at intervals of 12 months or less shaft be Performed
a within 10 days of completion of any service
A s report shall be provided to uthority
START UP AND OPERATION t tanks) for the presence of painting products or o (her
For new construc�n. prior to use of the POWTS check treatment ceI if high concentrations are
his that may impede the treatment process and/or damage the dispersal
servidm9 operator Prior to use.
detected have the contents of the tan k( s ) removed by
a septag e
Syste start up shall not occur when vXconditions are frozen at the infiltrative surface. Pam J Of
m w -
otastg power outages pump tanks may 0 above normal himgfmwaW levels. When power is restored the exces
was6ew" Vd be dbdoMed to the dilspe d cdl(s) in one la W dom overloading the odl(s) and may result in the
backup or sUrtave discharge of effl4wnt To avoid tat situation have the contents of the pump tank removed by a
Septa Servkirtg Operator prbr.tp restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to
assist in manually qmv tg the pump controls to restore normal levels within the plump tank
Do not drive or park vehicles over tanks and dispersal ceps. Do not drive or park over. or offunwise disturb or compact,
the area within 15 feet down stone of any mound or at -grade loll absorption amp.
Reduction or ektlmafion of the fiodowktg from the wastewater stream may improve the pefiomtance and prolong the Coe
of tte POWTS: antIlIotics; baby wipes; -cue bats: condomm. cotton swabs; degreases; denial Goss;
fat iotiriddtorrm draft pump) amber; kut and vegetable pee&W. gasoline; Weaw herbicides; meat
soaps: medlaltons: at oWnfing Pm&jctr Pte: sanit wy neiftir URWOW. - and water softener bins.
ABANDONMMENT
When the POWTS tats and/or is peamenenty.taken out of service the fodowtrrg steps shall tie taken to knsum that the
system is properly and safety abandoned in complance with dam. Comm 83.33. Wisconsin Mule Code:
• AN piping to tanks and pus shod be disconnected and the abandoned pipe s sealed.
• The contents of ad bwft and pits shall be removed and properly disposed of by a Septage ServkJng Operator.
• After pump hg. al tanks and pits dog be excavated and removed or their covers removed and the void space
Mod with sod. gravel or athotw kmxt solid math.
CONTINGENCY PLAN
if the POWTS fags and cannot be repaired the following measures have been. or must be taken. to provide a code
compliant replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the loc:adon of a replacement sal
absorption system. The replacement area should be protected from disturbance and compaction and should not
be infringed upon by required setbacks from existing and proposed structure. tot Ines and weds. Failure to
protect the replacement area will result in the need for a new soil and site' evaluation to establish a suitable
repiacenemt area. Replacement systems must comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the tailed POWTS.
The the has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sod and
site evaluation must be performed to locate a suitable replacement area ff no replacement area is available a
hoiding tank may be khsMW as a last resort to replace the faded POWTS.
Mound and at- -ade sod absorption systems may be in place foliowmg removal of the btomat at
the Mitratve surface. Reconstructions of such systems must comply with the rules In effect at that time
<<WARNING>>
SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN.
DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAMER,
Name
Name I
Phone 7/ f jo Phone Z J
SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY
Name �bM - icy S -/. C ` .s n f
Phone 6- S J `/ Phone 1 g 6— 6
This doasrmntwas drafted by use Stotts or the QMW t dW. MW*MVA and W=Nhwa County Zorft and Smaadw s9owi . Thds doa nwd meets
the mmhmn M* *Gnwft of cn. Cenan a3.=NXtX4" and 8 - M & Cat. *ftmwh A*ftft<<Wn con& use at ems doatM" does ,we
guarantee the Woramm or the POWTS. GLAN (2101)
Maintenance and Contingency Plan for a Mound System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the mound is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below mound undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
10. Effluent Quality is not to excede the requirements found in Comm. 83
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If mound fails, determine cause of failure, test another area or remove pipe and sewer
rock, retill soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715 - 246 -4516
Pumper: Tom Mondor 715 - 246 -5148
St. Croix County Zoning 715 - 386 -4680
Shaun Bird #226900
7/20/02
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
Mailing Address �' ��� 7
Property Address � t�
(Verification required from Planning Department for new construction)
City /State 71pic/ Parcel Identification Number
LEGAL DESCRIPTION
Property Location � 14 Se� , 'T W, Town
1�
Subdivision , Lot #`ZL
Certified Survey Map , Volume , Page #
Warrant Deed # e �� ,Volume /� �
) - - " Page #/
Y —
Spec house es ❑ no Lot lines identifiabl 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 wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
day thV) ree y r piration date.
V) / A4 F / ( '/
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) ce tify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
th pr rty desc ibed above, by virtue of a warranty deed recorded in Register of Deeds Office. n
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department.******
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
J 1J 177
STATE BAR OF WISCONSIN FORM 2- 1999 6 8 6 1 6 2
WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., NI
This Deed, made between RJC Deve Inc., a Wisconsin RECEIVED FOR RECORD
Corporation, 08 -06 -2002 9:45 AN
iWRRAIM DM
Grantor, and IT odd Marek EXDPT #
_ REC FEE: 11.00
TRANS FEE: 261.00
_. -- COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
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
Lots 22 33 an 34 Plat of Richmond Hills in the Town of Richmond, St. Name and Return Address
Croix County, consin. KRISTINA OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, W154016
026- 1127 -22, 026 - 1127 -33
ti, 026- 1127 -36
Parcel Identification Number (PIN)
This is not _ homestead property.
01) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this 2 4-14' day of Jul 2002
RJC D elo menqnc.
1R-- -- -
• • By; ho H. Carlson, President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc„ a Wisconsin Corporation, STATE OF WISCONSIN )
by John H. Carlson, President ) ss.
County )
authenticated this y of July 2002
�- Personally came before me this day of
the above named
• Kristins O land
TITLE: MEMBER STATE BAR OF WISCONSIN - --
(If not, _- to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
authorized by 4 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY • __ - _
Attorney Kristins Ogland Notary Public, State of Wisconsin
Rudion, 1 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. tntormaucn Proraaaionals eanp", FaW a Lae. ON
aooass2o2r
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 .1999
i
\. , ti� • " �� - - TOWN ROAD - - -
O �' • 0 S89'52'55 "E 360.62' M
- - -- 7 - - - - - - -- • / -- -------------------------------- - - - -,• I
8
- - -- -- - - " -" �\ . ....
s
LOT 28
MO rn TOTAL AREA: N I
N I
I 106, 274 S0. FT. I ,'
• • • • • . ' • • LOT 29 2.44 ACRES I O
I
TOTAL AREA: i � I
;° 92,560 SO. FT.
I 3� ^ 2.12 ACRES i 3
0) I
N N8952'55 "W
364.80' I in
O
59 I O
Z N� 33� 68 i Z I
o LOT M M s LOT 35 S
W � ,.; TOTAL AREA: I
�p TOTAL AREA: ;v N
0 94,079 SO FT. °o N 106 SO. FT. 68 ,
p 2.16 ACRES z 2.45 ACRES
T Z .. .. .......... ............................... i 33')
I I
1
I i I � i I
rn I
ri j I I
.•
N
N89'52'55 "W 363.97
N89'52'55 "W 364.38'
-
• , -'' 30.04 - -- -- ------ 334.34' - -- - --
-------- - -1 - -_ �_�_ -� • �� 2/ I
........ LOT 11
... .......... .... H w.c
. I
- 3 TOTAL AREA: ( I
- - - -- \ °•° 97 927 S4. FT 1 f 04 O
r) W
LOT 12 2.25 ACRES W N in
w o `� M /N. F.F.E. 1014
iv TOTAL AREA: i r
in G 83, 663 SO. FT. m �`. g i O
g 1 . ........ 1.92 ACRES . H.we tow � N I
2 1 I
)T 13 N I
I
I N
N89'54'22 "E 360.04' N89'55'11 'E 349.48' 228 -SW I
MA TRH LINE
SEE SHEET J. LOT 9 LOT 10