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HomeMy WebLinkAbout026-1130-28-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430471 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: Miller, Sam I Richmond Township 026- 1130 -28 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: , c, 1 25.30.18.888 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / (L?'. y, :c•c.c, 7. 1' lv7 # I �cf Dosing Alt. BM rN Aeration Bldg. Sewer Holding St/Ht Inlet 7.01 ioc, i3 TANK SETBACK INFORMATION St/Ht Outlet 7. 7_ "t TANK TO P/L WELL qBLDDG. Vent to Air Intake ROAD Dt Inlet Co Septic Dt Bottom �l. l rG. c� Dosing Header /Man. VA Aeration Dist. Pipe 5- 85 - 1 /0/ 29 Holding _� Bot. System PUMP /SIPHON INFORMATION Final Grade P T. � � Manufacturer Demand St Cover � Ll GPM �.lrC 3 d U'< 3 Model Number TDH Lift_ c Friction Loss System Head 7 - ead TDH Sq Ft / " - Z 1• _ Y•� ✓"�� llll'Z�Uwr /. G �� j�lr .ciC'.l Forcemain Length I Dia. I Dist. to Well /O 1 Z" Nlr SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenche PIT DIMENSIONS No. f Pits Insid Liquid e DIMENSIONS SETBACK SYSTEM TO P/L BLD ELL LAKE /STREAM L HI Manufacturer: INFORMATION C MBE Type Of System: UNIT Model Nu b DISTRIBUTION SYSTEM t7 cc 5�, ec- - Header /Manifold Distribution / 40 x Hole-Size c , x Hole Spacing Vent to Air Intake Length �•� Di t . L ngth 1 Dia f •S Spacing �O j �g 3 •� , SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center Bed/Trench Edges / Topsoil E-] Yes [, No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: A Location: 1371 140th Street New Richmond, WI 54017 (SW 1/4 NW 1/4 25 T30N R1 8W) Red Pine Corner Lot 28 Parcel No: 25.30.18.888 1.) Alt BM Description = 2.) Bldg sewer length = ° ` -7 - amount of cover = H•Q I It- Plan revision Required? Yes )(No G Use other side for additional information. L 7Y, SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safety and Buildings Division County N*i 201 W. Washington Ave., P.O. Box 7162 ( C_U S/�0���� Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 Sanitary Permit Application ate Plan I.D. Number In accord with Conn 83.2 1, Wis. Adm Code,-personal information you provide I Z Spa —�rS • �� ' may be used for secondary purposes Privacy Law, s15.04(1 xm) Project Address (if different than mailing address) 1. Application Information - Please Print All Information Property Owner's Name Parcel # Lot # Block SA rK M. I ( & A010 — Property Owner's Mailing Address Property Location A uk, Section Z S City, State / Zip Code Ph one � Numb1er v CJ S UJ I S D� 30 0 d�7 T � N; R 11. Type of Building (check all that apply) X I or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Pubbc/Commercial - Describe.Use !rm t0d 1 f i w ` 160• 00 RE" j ?( ° rN r_ ❑State Owned - Describe Use (rX9D' at, <1 C. 1 " D= 0 •S �2, ❑City_❑VillageVTownshipof 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) P Z f4 A O 2 -113 d - z — Gd u A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • C1 Permit Renewal 11 Permit Revision ❑Change of ❑Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. Type of POWTS System: Check all that apply) ` ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil 9mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: M cO ( L'r Design Flow (gpd) Design Soil Applicad te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Lf r d "fS'ti? `� y S O � y.1b / /00' V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New $xiating Tanks I Tanks Sc ptic or Holding Tank D ©O W C-- C C� Aerobic Treatment Unit Dosing Chamber VIL ResponsIbilIty Statement - 1, the undersigned, assume responsibility Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl l um iao 7 �r s Si t MP/MPRS Number Business Phone Number VIA I k •- �/I/l` - .0o kdl/ " Z Z so 3 ( (, L -'2 (. S - _ / I L7 Plumber's Address (Street, City, State, Zip ) (o � t.�+m,. t4 ,a a— k4 . bl ue s V11L County /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date issued s g Agent Signature o San ps) Surcharge Fee) 350 -- /O / 3 ` ❑Owner Given Reason for Denial � LX. Conditions of Approval/Reasous for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) -� .. a lyi • � � �' x d � / ,gyp ��� iii o 8 d •0 3 � 3 � -- 9 � C� � � S• � �'" J 1 v v o L CO PY • o Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www www•commerc .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary October 07, 2003 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/07/2005 Transaction ID No. 925644 SITE: Site ID No. 665939 Sam Miller Please refer to both identification numbers, 140TH St above, in all correspondence with the agency. Town of Richmond St Croix County SWIA, NW1 /4, S25, T30N, R18W Lot: 28, FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 923384 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes COnift and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in APPR chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. DEPARTMENT The following conditions shall be met during construction or installation and prior to occupancy or use: N OF General Approval Requirements: SEE CORRE • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stalls. • 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. Stat MICHAEL P MC DONELL Page 2 10/7/03 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of 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 Charles L Bratz POWTS Reviewer II , Integrated Services WSMART'code: 7633' (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi. us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Sam Miller 3 bedroom residential mound system Owner's Name: Sam Miller Owner's Address: P.O. Box 151 Trout Brook Road Hudson WI 54016 Pcl. Add.: XXXX 140th St. Legal Description: SW1 /4NW1 /4, Sec. 25, T.30N., R.18W. Township: Richmond County: St. Croix Subdivision Name: Red Pine Comer Lot Number: 28 Block Number: na Parcel I.D. Number: 026 - 1130 -28 -000 Plan Transaction No.: Page 1 Index and title oytD Page 2 Data entry OF RE CEIVED Page 3 Mound drawings r-r � Page 4 Lateral and dose tank Hq 9 200 Page 5 System maintenance specifications SpO SEA Page 6 Management and contingency plan G Page 7 Pump curve and specifications SAFETY & BLDGS D ' V ' Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike Mc Donell License Number: 225036 Date: 09/16/03 Phone Number: 715 - 386 -8692 c Signature: / Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information r or c R Residential or Commercial Design fill (D) calculations assume a ( ) n Note: Sand 9 300.00 Estimated Wastewater Flow ( gp d) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 2.00 Site Slope ( %) 100.00 Contour Line Elevation (ft) 45.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.001 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Does the forcemain drain back? F Y 94.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 6.00 Vertical Lift (ft) 81.16 5x Void Volume (gal) 0.41 Friction Loss (ft) 86.05 Minimum Dose Volume (gal) 12.91 Total Dynamic Head (ft) 24.72 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options _ choice 0.75 1.25 x _ 1.00 1.50 x _ x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 760.50 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 37.50 Total Working Liquid Depth (in) Wieser Concrete IManufacturer 20.28 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 760.50 Dose Tank Capacity (gal) JZabel IFilter Manufacturer 20.28 Dose Tank Volume (gal /in) IA100 Filter Model Number Wieser Concrete I Manufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View t 1/106• a J . • . • . . . . . . . . • ' • Observation Pipe — FK 5• t j : f'j:; :, : }C }; }ti ; .','•:; : • • .•t, t }. A W B - . . . -. . I L Mound Component Dimensions Down slope toe extension made. A 5.00 ft E [ AO.50 in H 1.00 ft K Al ft B 90.00 ft F in z 7.50 ft L ft D 6.00 in G ft J 5.07 ft W ft 450.00 (ft Dispersal Cell Area 1 1125.00 (ft) Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.29 (ft) ► .rrr r.... G H . 2 .rrrr�rrrr rrrrrrrr.. r rrrrr. r I I F : : 101.00 (ft) Lateral Dispersal�Cell 100.50 (ft) ........Invert Dispersal Cell D = = Elevation E=: = a 100.00 (ft) Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key m $, T Dispersal Cell See lateral details on 10 Topsoil Cap c °' 1.5 ft t .t.'.. t• Page 4 for number, rrrrr Subsoil Cap ; s ,:,ti;:'' size, and spacing of © t:n::- ASTM C33 Sand 14 Z ��a a�. •o :.: - • -.... F laterals. Laterals are ® ® Tilled Layer 0.5 ft ; tirypicai i_aterai� .:•r'; equally spaced from t.t.t.t.•.:�: .;ti•t• the distribution cell's Q r.: •:• Aggregate � c � :•:•:•:•:;:. ;•• ° �r•:. . —A centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 End Connection Lateral Layout Diagram Laterals Centered Over the A & B dimension �= Turn-up *.loallvalve orcleanoutplug P - - - --� All laterals are identical If- x —j I Holes drilled on the bottom of the lateral equally spaced Force main connection via tee or cross to manifold at any point. Laterals & force main of PVC Sch 40 (per COMM Table 84 30-5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.05 ft Lateral Length (P) 88.45 ft Orifices per Lateral 30 Lateral Spacing (S) 2.50 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 12.36 gpm Manifold Length 2.50 ft System Flow Rate 24.72 gpm Manifold Diameter 1.50 in Total Dynamic Head 12.91 ft Forcemain Velocity 2.52 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and ----► - Comm 16.28 WAC 4 in. min. Disconnect - :: Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 760.50 Gallons Volume 20.28 gal /inch A Weep hole or anti- Dimension Inches Gallons B 6 siphon device A 19.01 385.60 B 2.00 40.56 C Pump olf elevation (ft) C 4.49 90.98 1 95.00 D 12.00 243.36 D Total 37.501 760.50 Do, se tank elevation (ft) Y Bedding unZf tank. 94.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer jZoeller Pump Model Number Pump Must Deliver I 24.72 gpm at 12.91 ft TDH Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name E Jim Thompson #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715 - 386 -4680 Svstem Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freauencv Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 ears 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 mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished . •• ........ 0090000,00#0000 Grade \ , 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Sam Miller 3 bedroom residential mound system Page 5 of 9 Mound 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- 10691 -P (N.01/01) and SSWMP Publication 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, Stats. 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 fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 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 cleaning 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency 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 mound 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 removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sam Miller 3 bedroom residential mound system Page 6 of 9 HEAD /CAPACITY CURVE N Q W w � HEAD CAPACITY CURVE EFFLUENT MODELS 34 TOTAL DYNAMIC HEAD /CAPACITY PEH MINUTE 1 110 EFFLUENT AND DENATERING 32 t0 1W 45 170 64 tat 6E.11ES 67{9 _ 97 9B 137.139 137 IS 16.6 li :7N Ips 167 100 FT4. Ga. U94 Gd. LIn Gd'Lvs GK t.vt Gd -0}�. G Lt1 Od .tr > . C,. _ 1G — - ys: OK i Ltr4. Gl Ls.. 95- 152 40 16.1 5 0 212 72 I27J 104 304 106 401 al 2.111 al X}I 66 6 :.587 156 Safi .8 — 10 6 36 34 129 a6 - 174 - 231 79 360 100 676 61 201' I 31 al _ 26166 a �W 161 672 0 9 7 4 ST 1 2 X, 242 91 31 4 W SB t 667 145 5+9 6 — 20 5 67 25 9B 06 136 B2 010' 69 Z�—T— 6 ;616 140 673 �� ,4 8 JO )4 260 67 2'p aJ I� _ bd ,u IO3 60.1 80 A 14' U ua. 66 _ _ x0 ..� 6d 1hi iJ JW. 68 : 2x 121 �6Br 117 441 Js w •tz 19 -- — 46 u(. 46 1 65 1�0 — s 2&3 62 220 IC•6 :097 114 - 22 186 W 1624:' _ 21 B0: JJ Js 61 ID,'. w 219 w 2 W 1341 1 t �:0 3r9 —F70 W IQ7D 16 61; 1 I _ 4 .+b I m w 70 21.M 2 .' V 71 itS Y5 32? :0 6 _ T - 3J 114'.. 10 66 62 197 61 IO 2a6 , I 165 BO 24.:16!. _ — ---J 6 —T 6 °— _ ^ . -- — _ _ I 1 W - 45 1 7 0 2tl W 27.7 .121 2 6 07 140 5 100 S J0. 8' 163 t 10 .8200.,. � —� —'� _ it 66 -1 21 1r _ 7 � S r1 4 Lxu Vw.. 19.26' 2176' — 23' 26' 6d' 6r.• — pT 70� Its' Dt' 112' 4G_ EFFLUENT & DE:WATERING 10 „_ 165 _ Warning: Model 185 should not be subjected to less than 30 feet TDH. 8 25— 189 — Note: For Head Capacity on Model 112, industrial column P proof purnp, see FM 219. -�— T, • I 98 — S- 5 • 55, 7.59 13 139 ;,EWAGE & DEWATERING G ALL 3 IG 201 30 4G 50 60 1 70 60 SO ° °_ , , ,I,o 140 15° I60 i WARNING: Model 293 should riot be subjected LITE S j 80 160 240 320 4C0 460 S60 6+0 ° to less than 15 feet TDH. N Q d W 4 7 TOTAL DYNAMIC HEAD /CAVACII Y PER MINUTE 75 i SEWAGE AND DEWATE 22 1 _ — SERIES 262 266 26 7 2 _ 282_ 2 64 292 , 293 294 _ 295 70 _ FT. M Gal. Lb s. Gal. Urs. Ga l. LIla. Gal. Llra. Gel. LLs. Cal, 'J, s. G •�I. LOS. 1 Cal, Ltrs. Gal. Un. G U 20 5 1.52 90 341 120 464 12tl 484 128 4 170 492 1 68 t _140 530 _ 15a 712 2 652 65 t0 3.05 60 227 89_ b l 3 37 69 9 95 360 118 59 8 _12 r ^ __ 181 665 : '0` 776 - 15 1.57 22.5 BS 50 Itl9 Su 789 $0 189 W 238 - 115 511 1G6 401 130 492 16 625 _ , 85 7W - -- ' -- - - - - - -._ I__— —_ _ 18 60 —, t0 38 1U - 38 10 38 33 125 11 to , t 339 119 20 8.70 4 0 _ 5ti8 16, 6 3 6 25 7.62 — - -- - - -- —_ 6 288 c8 257 1 401 _ 1 3 6 Sts 53 St 0_ 30 9.14 _ .— _ .. _ ..— . — -- - 55 4 12.15 — ---� 3 w _: 1 _ 3: _ 121 458 4C 5 3 0 16 50 169 54 3S6 115 It5 a 7 I 50 15.21 —_ — __ — —_ _.. —_ —; __ - -_ — -- 50 W 18.25 _ - -- —. _ — i — —. —_- __ —__ _— 56 220 — 85 337 411 14 70 21.34 _ —_— __— II� ---. —. — - -._ — 2 95 45 Lock Velve 77 _ IB 2L5_ ' 2t.5'_ _26 ` - - 12 40 15 — 30 1 8 - 293 - - - -- 25 - - - 6 T20 -� -- 4 282 292 2 T 5 _ 262 266, 267, 268 - __- 284 i- 0 1 GALLONS 10 20 30 40 50 60 70 80 —r 90 100 110 120 130 140 1 150 160 170 180 190 200 210 227 230 '-ITERS 0 80 160 240 320 400 480 560 640 720 80) 860 r� a 6 S _ W � Q •� Z' SY c O A n c^ n` o p lz 0 3 P 7C, CL P Do ( r 0 � U o o �, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ � — of Division of Safety and Buildings in accordance with Cornet 85, Wis. Adm. Code -- County St. Croix Attach complete site plan on paper not less than B 112 x 11 inches in size. Plan must - - - - -- include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Fending percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - -- Please print all information. Reviewed by Date Personal information you provide maybe used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location Oakwood Land Development GovI. Lot SW 1 W v4 5 25 T 30 N R 18 XNor) Prope Owner's Mailing ddress Lot nck Subd. Name or CSM4 1611 HY. #10 N.E. 18 Red Pine 'Corner City State Zip Code Phone Number ❑ City ❑ Village C2 Town Nearest Road Spring Lake ar .55423 3 612 780 -4996 Ric hmond 140th st ® New Construction Use: ZCResidential / Number of bedroorns —4 -- Code derived design (low rate __ —_--EQQ— _— GPD ❑ Replacement ❑ Public or commercial - Describe: ___— __ —__— —._ -- ----- - - - - -- — g la cial drif ria ft. Parent material — Flood Plain elevation If - _— .______.____ General comments and recommendations: mound @ el. 101,00' based on contour line of el. 100.00' 3 Boring # Boring ® Pit Ground surface elev. _ 10 0.40 — ft. Depth to limiting factor �5 ... In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1. 'Eff#2 1 0 -13 1 2/2 none L 2msbk mfr (1W 2f 5 8 2 13 -26 10yr4/4 none sicl 2msbk mfr gw if .4 .6 3 26 - 45 7.5yr4/4 none scl 2msbk mfr g if .4 .6 4 45 - 60 S 4 4 c2d 7, 5 5 6 scl M na i �n Boring 1 1 Pit Ground surface aluv. C% - it. [; �,xh to G.miting faIXX; Soil Application Rate Horizon Depth Dominant Color Redox Description Texturo Structur© Corsistence Boundary Roots E*Eff# GPD /fF _— in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. - -_ 1 'Efi #2 1 0 -8 10•ar2 /2 none — L 2ms bk mfr. �w 2f .5 .8 2 8 -19 10yr4/4 none sic]. Iiisb: lafr 9:w _ if .4 .6 3 19-521 7.5yr4/4 none sl 2trsbk tnvfr gw ; 1 f .5 .9 --rt- 4 52 -75 5 - vr4 /4 none scl 2n mfi na na .4 .6 av _< 1-0 mg l tiluen; .ic 5 A) : :_ 30 rng 11 anu SS 30 mg/L CST Name (Please Print, Signature CST Number Gar L. Steel J 02298 Address Date Evaluation CoMucted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 11 -4 -2000 715 - 246 -6200 Property Owner Oakwood Land D evelopment Parcel ID # pendincT Page _ 2 of � 3 Boring ing # ❑ Boring [ Pit Ground surface elev. 99 . 60 ft. Depth to limiting fa ctor 51 ;n, Soil ApplicaUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsetl Qu. Sz. Cont. Color Gr. S z. Sh, 'Eff#1 �Etf#2 0 -12 1Oyr2/2 none L 2msbk mfr T'� 2f .5 .8 2 12 -29 1Oyr4/4 none sil 2msbk mfr 1f .5 .8 3 29 -51 7.5yr4/6 none is Osq mvfr qw na 1 7 1.2 4 51 -75 5yr4/4 c2p 7.5yr5/6 scl M na na na .0 .0 Boring # ❑Boring ❑ pi Ground surface elev. tt. Depth to limiting factor ,_�.. in. Soil ApplicatJon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I ❑ Boring Boring # elev. ft. Depth to limiting factor In. ❑ pit Ground surface e Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ' Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg& ' Effluent #2 ? BOD, < 30 mcyL and TSS < 30 mg/L The Department of Commerce is an equal opportuniry servicc 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. 58D433Q QL600) i c STEEL'S SOIL SERVICE Gar} L. Steel 1554 200th Ave. Oakwood Land Development CSTM2298 SWI S25- t30N -R18w New Richmond, WI .54017 MPRSW -3254 town of Richmond (715) 246 6200 lot #28 -Red Pine Corner N 1 " =40' BM. =top of mid -lot survey stake @ el. 100.00' Alt. BM.= top of NE lot stake @ el. 99.70' k, %dp , , t r, 7 J"- �yl z1 I � Gary L. Steel. I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St . Cr O1.X Attach complete site plan on paper not less than 8 Re ewed by Date 1/ -"Inc esSlze. Plan must include, but not limited to: vertical and horizontal [te n *L ce point'(BM), ction and parcel I.D. pending percent slope, scale or dimensions, north arro ^.a location and distarioe nearest road. ti' 1 Please print / $ �F �rfform , � o Personal information you provide may be used;ior secondary ti r � �cy Law, s. 15. (1) (m)). ' (2, 3 f o Property Owner Pgope Location Oakwood Land Development ` L' - GtOQ = Gb ut loot SW 1/4 NW 1/4 S 25 T 30 N R 18 for) W Prope Owner's Mailing Address TY I/o 1 Block # Subd. Name or CSM# HY. #10 N.E. �r1N na Red Pine 'Corner NIP�GUfFICi v, City State Zip Code ' Number City ❑ Village ® Town Nearest Road Spring Lake ar .55423 ( 61.2 7j 0 Richmond i 140th, st. ® New Construction Use: 9kResidential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material glacial drift Flood Plain elevation if applicable na ft. General comments and recommendations: mound @ el. 101.00' based on contour line of el. 100.00' 5-1 Boring # Boring ® pit Ground surface elev. 100.40 ft. Depth to limiting factor 45 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -13 10 2/2 none L 2msbk mfr qw 2f .5 8 2 13 -26 10yr4/4 none sicl 2msbk mfr gW if .4 .6 3 26 -45 7.5yr4/4 none scl 2msbk mfr gw if .4 .6 4 45 -60 5 4 4 c2d 7.5 5 6 scl M na na na ❑ Boring # Boring 2 Pit Ground surface elev. 100.40 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 1 0 -8 10yr2/2 none L 2msbk mfr CJW 2f .5 .8 2 8 -19 10yr4/4 none sicl 2msbk mfr gW if .4 .6 3 19 -52 7.5yr4/4 none sl 2msbk mvfr gw if .5 .9 4 52 -75 5yr4/4 none scl 2msbk mfi na na .4 .6 r Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = B < 30 mgA- and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel - 02298 Address Date Evaluation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 11 -4 -2000 715- 246 -6200 J Property Owner Oakwood Land D eVelOpitlent Parcel ID # pendinQ Page 2 of _3 3] Boring # ❑ Boring 3 [2 pit Ground surface elev. 99 ft. Depth to limiting factor 51 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 0 -12 10yr2/2 none L 2msbk mfr gw 2f .5 .8 2 12 -29 10yr4/4 none sil 2msbk mfr gW if .5 .8 3 29 -51 7.5yr4/6 none is Osg mvfr qw na .7 1.2 4 51 -75 5yr4/4 c2p 7.5yr5/6 scl M na na na .0 .0 F-1 Boring # E] E] ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff 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 GPDIff 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 5 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD- 8330(R-WW) s STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Oakwood Land Development New Richmond, WI 54017 MPRSW- -3254 �4�4 s25- t3o - R 18w (715) 246 -6200 town of Richmond lot #28 -Red Pine Corner N 1" =40' of mid -lot survey stake @ el. 1QQ__IIO' Ttf.B7M = top of NE lot stake @ el. 99.70' !� 3 0 r �0 /oa 7 � *7_ �C Gary L. Steel 11 -4 -2000 I I �J 0 ll u:i LJ t r� 1 , a �—� Lo O ` U Ln i = Z U C (b wQ o �� I (-) �O 7 � �o � 1YC F o ,, vI o U �- � C:) � � W Z Z O pp J O CG F� ILv w O 4 o Y _ Q Y �� 'L C- O �� O`�Q U > z ° � D Jcu1) c, V 00o ow �uw �r :D �: s N Vi 0- cn I O Nt`m � �c7N o� �1 �- O '^ J O M J f D LJ W O �' U O Lo U N V - m J O F- F V ) r Vl r �� u1 a C c. N e F- Q F Q j (1 LJ;E /� / (p O J fj I U _ = N F U i U ft1 I d' W Z W W In W {.L N J W--j� 0 0cr LLJ O=:L� U -" 0 ZI.- N 2 S V)� Z J O�$�3Ox mY U= a - i U - r E5 2 OQOOQWOOOw Zs Q zip U CS. DO U Y- 2 <U Y Z J� Q<tU s:'�. O zCG<L I Z Q Li z Z J L O 2 � O , V_ U I 1 i I J W i Z 0_ �� 4 O 0 UJ W II � cr 5 5 J J 1 b_ �1_. „� w Q J ui i 94. Q 1 N 11 j � 1 F- u 48 0 Ov — { i Q� P N E- L'm N Lot zg POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5,A4 m W L Lg Septic Tank Capacity �00d gal ❑ NA Permit # 1 Septic Tank Manufacturer SF C1 NA DESIGN PARAMETERS 1 Effluent Filter Manufacturer 21014 42 I / ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 4-160 ❑ NA Number of Public Facility Units N� NA Pump Tank Capacity 7;5 gal ❑ NA Estimated flow (average) t{ 5 0 g al/day Pump Tank Manufacturer wF t S E/L ❑ NA Design flow (peak), (Estimated x 1.5) SO gal/day Pump Manufacturer Z O ❑ NA Soil Application Rate al /da U /ft z Pump Model�(� ❑ NA r _ Standard Influen Effluent Quality Monthly v Pretreatment Unit � NA a t/ average* e Y Y 9 Fats, Oil & Grease (FOG) 530 mg /L K Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODO 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade V Mound Fecal Coliform (geometric mean) S10' cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y, in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 years) ❑ NA p y' �� P year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 3 Yea th(s) (Maximum 3 years) C1 NA Clean effluent filter At least once every: ❑ month(s) ❑ NA year(s) h(s) Inspect pump, pump controls & alarm At least once every: ❑ ❑ month(s) l NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once ever ❑ month(s) ❑ NA y' ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tan. inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondir,y of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113 Wisconsin Administrative Code. All other services, including but not limited to the 'servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer, A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. Page _ of __Z1_. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal.highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat: foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil painting products; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled witn soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails 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 location of a replacement soil 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, lot lines and wells. Failure to protect the replacement area wit! result in the need for a new soil and site evaluation to establish a suitable replacement 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 A technology a holding tank may be installed as a last resort to replace the failed POWTS, T alua a o ing any. b e ai a ��Df -(18 TTY � /�/� CoN57 - R ClC Dr�' Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative 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 AND /OR 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 MAINTAINER Name < Nia L L Name Phone (,/Z— (•S— Z - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s'r C ( V b ZD�Il�CI Phone 0_ <10SD This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d) &M and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Sf1- "n�I I;f G E,e._ Mailing Address 30A L . �s fi<</�sp• -. GtJ s G Property Address 1 3 71 I o rt- �^ 5 T� E ET (Verification required from Planning Department for new construction) City/State N Er,U 12.,,et W1. Parcel Identification Number LEGAL DESCRIPTION Property Location .s 4J ' /,, U /,, Sec. S T 30 N Town of k Aw zSubdivision K L C o N 0 Lot Certified Survey Map # fo y i 1 Z 3 , Volume S , Page # �3 Warranty Deed # 7 3 Z $ S , Volume z 33 Z . Page # 4 1 Spec house g yes ❑ no Lot lines identifiable yes ❑ no SYSTEM . ANCE 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, jourmeymanplumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as 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 St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE APPLICANT DATE •;: rOWNER CERTIFICATION i; certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro ribed a ve, by virtue of a warranty deed recorded in Register of Deeds Office. to /!o /d3 NA O PLICANT DATE •• + +•+ Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department." •+ Include with this application: a stamped warranty deed from the Register of Deeds office .a copy of the certified survey map if reference is made in the warranty deed l J 2332P 465 732165 STATE BAR OF WISCONSIN FORM 1 — 1998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Oakwood Land Development. Inc.. a 07/28/2003 08:30AH Corporation Grantor, and Sam E. Miller, a single pgrson , Grantee. Grantor, for a valuable consideration conveys to Grantee the following WARRANTY DEED described real estate in St. Croix County State of EXERT Y Wisconsin (the "Property "): REC FEE: 11.00 TRANS FEE: 508.50 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Miller 1406138th Avenue New Richmond, WI 54017 U 026 113016 00026 1130 28 000 Parcel Identification Number (PIN) 02u SS — 0 8 0 This is not homestead property. (is) (is not) Lots 16, 28 40, Red Pine Corner and Lots 46 and 55, Red Pine Corner First. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 1(>� day of (SEAL) (SEAL) . Oakwood L d'Deve , Inc. (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County authenticated this _ day of _ Personally came b f e me this day of fy the above named Gregory J. Peterson. as Vice President to me known to be the person who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledge the same. (If not, authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY �� �' Public, St t of Wisconsin Coldwell Banker Burnet 1301 Coulee Road yc�nmission is permanent. (If not, state expiration date: Hudson, WI 54016 Aq 2 - 41063 (Signatures may be authenticated or acknowledggd.B Both are not necessary.) Names of persons signing in any ca ac( must be ty ed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis. <i- S SE Q � NOTE: NO OIMVER OR I II _�_ WITH OR CHANGE THE 130th Avenue x, DRAINAGE AN L ' � D SOIL ES M MAP BUT IS NOT LIMITED TO SAC. 25, T,' .30 N R.18 `w. FILLING, OR TOWN EXCAVAl1N • OF RICHMOND, St CROIX COUNTY vN WATER DRAINAGE DIT 140T To WAU BERMS OR GRASS SEE LOT 26 MA1H C•L/NE Lary w I� S89'52'26 -E 330.00' i� LOT 27 el%ow sss 8 A 8 —.._. 152 ACRES $ N 6� S89'52'26'E Qi i n 330.00' 0o ,rn r I N d4l 00 LOT 28 4 -i • � 3 LQI ' : S 814 ow Sad! Fr, � 8 . to N $- 1.52 ACRES g JN Cq W I, I i J �• O C'4 I 7 W 10 330.00' LOT 29., o; r ri � - ,� � ���� � g � w•_ -- 1 S� ASS , , Abr g . ........... ............. p — L • r v I UNPLA T � m 52 26 E 205.67 -- - - - - -- �1 m 70;W ROAD �'„; I ----------------- _ �,A� " ��` •� i ! T r M 14 •:� j R J r i, N LO •' r `I n �► Judy Kahler 5 . 30, Subject: #430471 McDonald /Sam Miller Construct. - Plowing Location: Richmond, Lot 28 Red Pine Corner, 1371 140th St. Start: Tue 6/8/2004 12:00 PM End: Tue 6/8/2004 1:00 PM Recurrence: (none) He did not schedule a fina - when does he plan to complete ?? 1