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HomeMy WebLinkAbout026-1163-05-000 P Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 483970 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: Oeverin , Kenneth J. I Richmond, Town of 026- 1163 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: �] - ��� —Q 25.30.18.1255 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ,j /OVI� 3. /D/ 8 . 7 .i Dosing Alt. BM T 0.35 loo.gs Aeration /^. Bldg. Sewer Holding St/Ht Inlet / / % 93 T St/Ht Outlet TANK SETBACK INFORMATION -� TANK TO /L . BLDG. vent to Air Intak Dt Inlet Septic ' �; �/ 2 So r r� Dt Bottom '7 Dosing J 6 / Header /Man. g Aeration 3- t� Holding Bo ttom / . Syste a a V Final Grade PUMP /SIPHON INFORM TION ( -- r''. 4, j' �,�• ai ? -.� Gf %• v �j Manufacturer /' Demand St Cover — GPM C A �• Z / 0 , Model Number (l['�s � / Z (� 41 3 l TDH Lift Friction Loss ISystern Head TDH Ft Force gin Len th Dia. ,/ Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. pf Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 / Cp y A�� T t - SETBACK SYSTEM TO P/L BLDG W f l L/ K CHING anufacturer. INFORMATION HA R Type Of System: /Sj r �; (f Model Number: V� 3 ?, -- DISTRIBUTION SYSTEM 33 Q Header /Man o Distribution f x Hole Size x Hole Spacing vent to Air Intake Length Di 2 Length (� r Dia 2 Spacing e V / � K " G� SOIL COVER x Pressure Systems Only xx Moun r At -Grade S ems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mu lched Bed/french Center Bedrrrench Edges Topsail "(. Q Yes M No A Yes 7[gNo I'L COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 * I / ZZ' 7o PyInspection #2: / 2 -" f Location: 1416131st Ave New Richmond, WI 54017 (SW 1/4 SW 1/4 25 T30N R18W) - i0IMPO Lond t - Parcel No: 25.30.18.1255 1.) Alt BM Description = t n ��' 7� l ( 2.) Bldg sewer length = ?51 - amount of cover = 9 r > V2, "At i7L6et Plan revision Required? 0 Yes No �- Use other side for additional information. J L ?^� G '(UG lit SBD -6710 (R.3/97) Date Insepctor's Signatbre Cert. No. �Safety and Buildings Division Cody ox 201 W. Washington Ave., P.O. B 7162 '�`. 1 ?L Madison, WI 537072 Sanitary ermit Number (to be filled is by Co.) �3 / 7 Fba w - Traasaclon N Sanitary Permit Application in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1� unit is required prior to obtaining a sanitary permit. Note: Application forms for stat"wned POWTS are Projct e Address (if different than i {4 ) submitted to the Department of Commerce. Personal information you � i � / r es in accordance with the Privacy Law, s. 15. 1 m Stars. j L radon Information - Please Print All Wo do Parcel # Property Owner's Nano Kem, i� 0P� r � t r1 f r Warty Ovmaes Mailing P- perty' Location 02 La • /Aa 3 �0 -lc cJ � � ST. CROIX 7nN COUNTY � „� L1- vt. City, Zip Code c� y X14, Section � 4 , (circle ��� T3 L N� R,� E rW II, pe of Bnildfng ( "check ail that aPPly} Lot Subdi ion t or 2 Farnily Dwelling - Number of Bedm 6k,�— Bloc ❑ Public/Commercial - Describe Use � r--� ❑City of CSM Number ❑ Village of ❑ State Owned - Descn'b Use own of --Gr. M. Type of Permit: (Check only one box on Use A. Complete line B if applicable) CL A. �epace❑ Rlment System ❑ TreatmentBoldiag Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ P Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner Ti'. a of POWTS SystemiCom nentiDevice: (CheeU all that appl C1 Non - Pressurized In- Ground 13 Pressurized In- Oround -rrrade ❑ Mound >_ 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑Pretreatment Device (explain} V. DisperalIT vestment Area Information: I�spersal Area Propose (sf} m Elevation / Designy� / Des �i Appiicatio�Rate(gpdsfj Dislretsal Area R�lvi st) ,/ / �/ VL Tank Info Capacity in Total # of anacturer Gallons Gallons Units New Tsalts Existing Tanks / e,5 J + °Q _.. 7 — _. Septic or Holding Tank Dosing Chamber VII. Resp sibiNon� t) MP/MPRS Number Business Phone N r li Statement -1, the undenlgned, assume 11ity for I.Whtion of the POWTS shown on the attached Plana. -,Q - PI be' (Pri+r . Pltunbet's Si r Plumber's Address troet, City, State, Zip ode) d � , Reason f nw;hgip ent Use Oal A $e t to Iss Issu ing t Signature g Z //a ven ar M CoadiI0Sq" p>y�► >�easons for Disapproval J 411 c� , EUeJ _Ve t'� nee.. � owteawno� 1. Septic tank, effluent °filter and 3 � a s i a rtcQ , t o tdr . `� t . dispersal cell must all se Ic / Ml / as per management plan provided by plumber. Z All sedsotk tequirerrterrt; must be maintained + {� , j _ l' (a p as tt system sad aabmit to that % not � a SBDD -6398 (R. 01/07) Valid thru 01/09 j � �` �- t,). l � X04- t� P e-NA i PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 * SW '1/4 SW 1 /4S 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 96.9' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE WELL *H.R.P. Same as Benchmark Sca e = 1/4" = 10' _r L ot _.. Area 15' below sy tem is 12% Sloe to remain undistu bed e �'��l'° p �� Well is to meet all 95.5 B-3 __,� setbacks found in 96.9' Comm. 83 - 2 475' Property Line M in t­ g � B - is to be doh — pQ Alt. B.M. run -off away from s tem 1 Huffcutt Combo Tank y so r –Aq B.M.* Pro I B 1 use �'3 s� C v 150' 1 .Ave U" Property Line Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 Contact Through Relay tic sco n s i n wwv✓•commerce.wi.gov /sbJ www.wisconsin.gov epartment of Commerce Jim Doyle, Governor Aaron Olver, Secretary August 23, 2010 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/23/2012 Identifi 2848 Num bers Transaction ID Noo. . 18 1842848 SITE: Site ID No. 759373 Oevering Homes Please refer to both identification numbers, Lot 5 Hollow Pond above, in all correspondence with the agency. Town of Richmond St Croix County SWIA, SWIA, S25, T30N, R18W Lot: 5, Subdivision: Hollow Pond FOR: Description: Three Bedroom At -grade System / 12% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1277503 .Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, Version 2.0, SBD -10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. R O N The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condit No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APPR stats. DEPARTMENT t The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION Of SAFE1 Reminders 1 2 • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE CORRE; requirements of See. 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. I SHAUN R BIRD Page 2 8/23/2010 Owner Responsibilities: The current owner, and each subsequent owner, shall receive a copy of this letter including nstructions relating g to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 derard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMARTcode: 7633 jerry.swim @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. I 1 SHAUN R BIRD Page 2 8/23/2010 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to ro er use p p and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54 1 P PP . g P ( ) 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. I e t O a ard. n the event his soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the coup for P P h' maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 (ter M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4 :00 pm WJSM, coda: 7633 jerry.swirn@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. I I Cover Page g RECEIVED Shaun Bird AUG 16 2010 Bird Plumbing Inc SAFETY & BUILDINGS 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 8/11 A 0 Owner: Oevering Homes LLC Location:SW1 /4 SW1 /4 S25 T30 N,R18W Lot 5 Hollow Pond System type: At -Grade Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706 -P(N. 01/01) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section �� 4. Pipe Cross Section /Pipe Layout CO 5. Pump Chamber Cross Section , YAND 8� LDINGS 6. Pump Curve DENC� 7 -8. Maintance and Co ti ncy plan 9 -11. Soil test Shaun Bird Signature License numb 6900 I I At -grade System Sloping Site Cross Section and Plan View �, w ..,►. r, �+ +i• w ;. � .. � w.. T' ign '1"1 .!A!' sn. ..r r � .IR ... !nw � ...;. «l # .!t E E ► RE5.0 i �' 4 • rr r+ + , r ti. O A }-w }tir r;.:,rti{: i�' r' {r''f • r .. w { :' ��'titi } : � {; :':•.r�. 1 � r r �� r ti } '' { ; } r `Cs ;r'r ��ti } � } ��'} "��' ' Y ti } � � � � ti$ {.r ��rr�'�f�`; 1 F 0.5 L U� k-- 1/6 B �� W Z E -- - — -+ — Yn rr '�. r'r r � r r r r •. E B L Slope �� Plowed = Clean aggregate 0 = 4 in, sch. 40 pvc basal area '/z to 2 '/Z in. dia. observation pipe L r Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile G , t � With Cap Fabric �i�. Ft Lateral Invert Topsoil Cap . {� { 2' ��S�lSl���S� F ` r,�1 Ft Contour L e r ` D Plow Surface Slope Direction — -* GENERAL INSTALLATION: The at -grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x Vii is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the.plow depth to forma 1 /4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must placing the aggregate to minimize compaction of the plowed surface. After the topsoil the entire at -grade is seeded and mulched to promote vegetative growth, limit erosio from freezing. The observation pipes are perforated in the lower 6 inches and secured n 03 /051gj Page of Pressure Lateral Layout One Lateral -• End Manifold `-- Threaded Cleanout Lateral Turn -up --- ► Plug Force Main X ---� L Long Sweep 90 Bend Pressure System Construction Distribution Network S eci ications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC In. pipe. orifices are drilled perpendicular to Orifice Diameter In the pipe with a sharp drill bit and face down. L Orifice S acin Lateral turn -ups terminate with a threaded L Lateral Len th Ft 2 In. cleariout plug and are enclosed in a 6 -8 inch Force Main Diameter Ft. diameter lawn sprinkler valve box accessible Force Main Len th from finished grade. ••••• Grade ••• 's ••• ;Q ••••••• 6 -8 Inch Lawn Sprinkler Valve Box 03 /OS lgj Page of ,Septic-Dose Wank Cross Section And Pump Performance Specifications Pump Manufacturer r Tank Manufacturer pump Model Number Tank Model Number b 6 pa Manufacturer J � Total Tank Capacity ° Alarm Model Number t-, ✓ Max. Bury Depth Switch Type �.- Total Dynamic Head (TDH) - Feet Filter Manufacturer Elevation Head - 7' �1 Filter Model Number ' G Distal Pressure Network Loss Minimum Purnp Performance Required Force Main Loss - • GPM j Ft TDH Total ' Outlet Manhole Alin. 4" Above Grade With Manhole Min. 4" Above Grade Docking Device. Inlet Manhole C d L cking Device Securely Mounted C`0 6" Below Grade Sealed Watertight lbe� Weather -proof ju nction Box Ow -- F*Wshed Grade - -- -4'5� Vent Min. 12" ` Disconnect Above Grade - Means With Vent Cap putlet Filter - ----_y ----- - -- ''inlet Baffle - y inlet A , /4 ,: '<'' and Reserve Capacity �,�; Weep Switch Settings . Tank Volume = GPI B Hole e Ural. Dimension Inches Volume >e 6 f;: • (reserve) A? 0 2 S off Elevation C (alarm) B 2 ,; Y . Bottom (dose) C . -�" 7, � D ;. Elevation dead ) D 1 s : Ft pN: The septic /dose tank is bedded and back filled in accordan wmntah t ' G depth of bury as s ENERAL INSTALLA ,f the manufact Y manufacturer's product approval specifications. Maximum pec by Electrical service complies with NEC 300 and Comm be exceeded without prior approval. Manhole covers exposed to grade have an effective locking devic fitt and installed. Piping at the inlet and outlet is of approved mate mal,connected with 4 h 4 PVC to bridge the�tank laid on stable soil to prevent settling or sagging. The excavation and the sleeve is sealed watertight. 16.28. Page of oz /os U y 7l� �til iifS�! i Sy: K , LftaerJet 3100; a i 11 �- r � � r �� ■ i * F �� o �� .. jE F'F"L LENT PU M P , 9EH SERIES o a lgal .. S *aim 001 !it � Oki Mt tN ma on, um Wo W ' �4 tl9 gti{ Yt1bt:W SM NR _ MOM =0 met 4 ap V no im 70 8e 56 H at W v v 5tt ii161sY1� 591 MRV 'we '� �OMl Cgated (;act Iron v�qw- t txt moo Mawr p 4 ►000 aaoa so 1Rcluu ASS 3TCW- �3 shaft Sod N#ti�' carbon and ti c n Fsstenars _ S " O to 8loov wvA IAWW +a1 OAR H a s p 40 60 C436 ° u�w a�ca sn'aarr� L � �t � 7 . Pt y t � - m m,Ml,�.lili Goa d$ �prn 9964S�--Q7JOS , • Page Of P LAN p UAL & M - s��GIFR i°NS 0 m 0,0VVTs d �N�R'S 1Vt� ssvg� ranks• a ir.. Few NA 0 o NA � 6 3t� so p pump.'fank mr p IAA UtliCs Pump Ta�Ik f�+ ! 9A: ' mbar of �met� low 7C 1. ` PurctP model F ppMl � Pra6' � d Peet �" wetland cent QUO* CF0M -e.30 MOIL C] M t�isinfie� ° p O" Fats,01 3�Grew p ew MOIL 17 dow 4> ��� � � M t3lsAe CWCs) CI In-ground (pmasucb d) 1310dwa o w l Nlpatf►ly avemgo I" (9 � p Mound I]s} :r,.30 MOIL rade p Other= Syo ,�e tti�l 3ut�d } m 100ml d C3rY ne ray d {ra" °°r►+�"ardN, 'w.dr.ea >F me►ttrc Y Inch diOrnetat 1lal W uu* �,,yrgswiirl� magwaurn �Iplent Psrte Sao tYP't tar trwsre" , Ssrvt+co Froq � ZMaxlmu+ss 3 Yra•) YIUI{hfrERCts SCH�ULE h © rr'° nt (Y,) of tanK volume service �rrrrt At feast once every aqua n^ of tanKS when Combined sludge end scu+'n r(S) (makunurn 3 yrg -) fnspe� pn I:3 n� oonUb of tanK(s) At Yeast once every a mo r(s) Pump cs�(s) At kost once ®very J s) O NA tnspe4 WNW once every s} O NA t t1� At P. pucr<P a afeusr+ At leek anoe eve rdhs 0 yeads) DNA I PC tum test At wk once every p mor fl yaar(s} O NA Flumb h" t� At lest Dace every purr_ c one art tttie broke^ �CTtONS . be nud �` an irrd• �WTS i knk(*or. Idea r'S any ���i M PiW�+ber Restn s OO of the tBnK r an W � t>e1evels and sc pttnmt>ar: �; M * w%weedons must I he Vol of 00 oarrltsTned qr tnspee6l+d b ch°t�c,�, ent on 00 3etvid� my Or l nd The den to ttte 9 of ti's � 16 160flefy or PWA of �rtt one t for any �� � labs +� On Of mWe Of" wk � "� N and o Pipes �UOf►n tlir+es the Immediate in the OW a tt fl a scum in arty tank gq B d of to VAW with w WVJW mmbbo maven amt °f tw a Sepffi9� ter dng ant oc �"er'ts, em any SW be rode. urized PoWTS aomP°a�ts, pmtt�17' poWTS M' by a 113, SeM went vt " o f Them $welt . m �ani� � OntO or less ShW1 be a# cxm� a PCet[on ce or n�9 g1w ry authority within 1 d2P a r t be of psi+ pMdUO odwalmnomwe fitment lank S) � ="If high conc�+t�t� ar START LOP AIW t7PElZA � u� of gte POYY�S a the cbPete� For rte+ ��. 0 tment p rocess and/or clam � o° `� tW m*V i ,.moved b s the tree sS y a sePt3gB servEdn9 op bDr Pn� e 1ar� 9 the CS W ntw of th five surface— are frozen 2t the inter is Ow MOM cif noE owur when � - Cond it i o ns a npnnai byrdtiar i :ls. Vvtw3n t � W ks) and may fruit in the S Stott oc g tattles � pali(s) in vne large have their I Do&* f be d to to o Tu avoid this Sits lion pump or contsd e P , Faille. D o f �� pttr�r 5 nortnol kwels v -Min the c t � � OC flQltlp�t, S �ui�r � to P ww flea not dmre Of i all or vets ` m Wd ound or - fie a °rp� °n area rWM �d i not dnv�e ad` anY ; cove Pe pvkxg 00 15 feet SbPe stream P deft M US +' ��� deg Me of � Of to butts-, c°ndoms; cotton ' $ • tretb ; Reduce - ; {dby ,nr. stet; �r,,;t and vg9etabla P . Snd ,� 6rin�e of lire PO dtl�tt {awP P UMP ��ry napidns. tempo �� � pees' Steps go o � :a Cod � � �,,,, tttat the fotla es taken out o€ serYi � m 83.33, ar��, Add At3AMO aradlvr is . cornpj�c* with ch- Wings sealed �i 1 is POM1A�'t SOW ab a naected and tfie abandoned tY if f by a Sew �g OPa arnr Sysww AN p(t tot A tanks end be M vested and rern�d or awls s r � use . spates pits shag be Ate'e PLI, or MWOW inert ssaid maWda L fid WO Wit. must be toW, to pride a code i ling measures h been. «' . a m GOK POWTS pX,�and �� be am location of a r e,oemen't Sorg � l w tails � ent any has been evaluated and mDY�� i for tu b and COMA re to As t anew should ttbe! p sed sOruc got -GrV and watts. a sum � h e rept _ Th attaen'ran and existing a prvpo ,@VaillStiQ� CD establish 4 b wrP*m SO req iun set ft f or a new soil and 00 e w infringed upon by t st+eB.wB tuft In me need { with the rules in effect at that ttm sdv��s in POWTS must vamp y or so" tiM to S_ Barring � ��� a ,�ble flue w rt o replace the faded ��S- a i e ro led as a Oast n t of the POW A suAab l a holding be d er►bflr a su"dabie reP[aoernut area U Q ° �erit stag is avattaWe a has area- If no not bean. to a suitable rePlm the t>t evalustiW r must �t resort to repraaGe the PD folS tug- at in P 18I ng tank tntxy tai m may be � with the tufts m and aQt s of such sy comPlY the pHD(OR fNStIFF[t1ENT O%TOEN- C WN LETHAL- XS DEA1 K MAY fN©� iT7AIMA UNU�AMY f1L.TORIMPOSS ccYlfAt�1 AND OTHER 1'N TMEN� DtFFtC SE"C, PWMIP J► g *nC, pUMP OR OTN tZtOR OF ATANK fAAY' BE Re UL.r �VE.OF' A PERSON tsROtN E tt+tTE RES ABLIMONAL COMM .. _ POINT MlutitTER J tame �' r✓ g Oyy-{S INSTALLER Name n/ Ptione R0 ant f ULATORY A 1THfl Ph i�G SEPrAIGE SANG oPERaTOR AgencY Phone �- r"' moms minty Z and Sat Od � � Phone �m u'" tl stilt; am" i and 8 3 5W). ( (3) °rzsia arui>i s 'u taw few POINTS - VUW Z14AO 00 ,n 2M* I IS tL V isconsin Department of Commerce S �`A N REPORT Page of Division of Safety and Buildings nce h m S1. V'46. Adryu li'Gde County Attach complete site plan on paper not less than S 112 x es in size. Plan must include, but not limited to: vertical and horizontal referen point BM IeZR5NTY' Parcel I.D. percent slope, scale or dimensions, north arrow, and loca n an ZON tctWrtf road. o 2,6 - I 14 3- 05'- CM Please print all informati Re ewed by Date 1 (1) (m)). Personal information you provide may be used for secondary Purposes (Privacy Law, s. 1 /i���� Property Owner Property Location I . - _ 4 Govt. Lot - <,j 1/4sj1/4 S ;- ✓ T 3 �N R E (or Property Owner's Maili ddress g� Lot t� Block # Subd, me or CSM# 7 C7 fi �� �- jo A Yw city State Zip Code Phon umber ❑City ❑ illage T Nearest Road New Construction l)se. esidential ! Number of bedrooms Code derived design flow rate )70 - -- GPD ❑ Replacement ❑ P c or commercial - Describe: -- - - - - -- -- —� Parent material Flood Plain elevation if applicabl - - ft General oorniments ` and recommendations: � � _ _ '6 ct , / ✓ Air— I- f soliN # 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,'FP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff •Eff#2 # ❑ Boring Ground surface elev. - _�tt. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Co- 1 1 I YVI r I r 1 -3 L r s n . 2 6 Effluent #1 = BOO > 30 220 mg1L and TSS >30 150 mgt ` Effluent #2 = SOD ^ 30 ffK A- and TSS <- 30 mgA- Si CST Number CST Nam Pjumping, Inc Shaun Bird g 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715 -246 -4516 s Property Owner Parcel ID # Page of �] Boring 9 ,_ Boring ® # pit Ground surface elev. ft. Depth to limiting factor in• cal 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 12 ^' 2 .. i C 2 r ] � a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef'f#2 ❑ Borinng# ° Boring ❑ Pit Ground surface Bleu. ft. Depth to limiting factor !n- Sop �fio Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EtT#2 Effluent #1 = B00 > 30 220 mA and TSS >30 _< 150 mgll. ' Effluent #2 = BOD <_ 30 mgll and TSS < 30 ntglL 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. SOD4330OL6=) v ' Soil Test Plot Pla Project Name Ken Oevering Sha k d Address 838 Summer Pines Circle Hudson Wi 54016 M 0/25 #226900 Lot 5 Subdivision Hollow Pond Date i /05 S W 1/4 S W 1/4S 25 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 96.9' *HRPSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 96.6' 222 Property ine Scale = 1/4" = 10' unless otherwise noted 95.5' B -3 12% Slope 4 B -2 97.5' 25' 10' 100' 30' B -1 20' Alt.B.M. 30' 50' B.M. 150' 131St. Ave 475' Property Line 233' Property Line • 3 tt • I 1 ! RICHMOND HILLS LOT 15 LOT 14 LOT 13 WE 1315.51' 301.77' Q?t. 295.36' 222.30' 63. 4th- 1282.51' -- crown"* Easwr»ait t wAr lot 7.0" ZOO EXISTING Lori /�o �.w '�' ry o LOT 4 •^i ~ �` . 4 74M0 sq ff. t.80 acres c t . �, Eoee►rr�r►t q� 2_2 oatrs HIlE =tGZIQ O' Lore 2. 05 acres N$7`05 45 E Q I Na7 05745 "E 527.73' 02.E t • o ss LOT7 3 , 124 On sq. ft «� •E;, .:....... Lore 41 ? ?, 2. s4 wares � F LOT 9 0 ta?..M2 sa 89"s t6 S% ft. z „ y N Z." ddb 2.05 acres ev a •' at a -t0.� 0' 2 N Z i i ■� i N N n g � z � e w Q . ffr¢ 4 & 0 \ M �OI �IgIi I+ JI N l I rn l / ml I r•I \ ml I 1 �1 7 1�1 v sti k J Y 888 8888 88. 88 8 :i I / r /lASiu!!or /tis-wn«rrm? \ I '1<1 ZI ,W9911 A SSAMS vl �' ,low* ClUr r OI 3 a s s11 c soacu- r :o Z + � I I 1 17ry OI FtCY ,azzf I OV 1 �I "� F y � � 1 1` d ti t.pp'lu ). . mm QI E a� -- ti I Y� N o p pp l.`••.:: 8 �16QVLV1 • I i O lei UI +I n +rh I .....I..., 'e, A I Q2l4 I ' i3 W V gf m 1 to I I r o al I 3.. N o z i 1 \ ' �, z�f l 11 l ^I N1 N it �. I �'v a ��a 1 1. k o f .fLL ti II J 1 mss/ 1 {A, w V � ot� :p I ?i a r Yq �1 t � 11 �,. �� • O ❑ t' Vi C L YO•� JUL 0"Am" Jose, tl l' y> OI b Y D N OL .w'OLf �i 'i I .wrotf i I � I za•stY � Z 8 FLOOR''�� 1 a l E. i 3 �I WyI OII R NI I711�1 _ I — '. 1 lI C MIN Naha iw M M17 Li�KOpY -- an - - - 3 -- - il[s 35ad ft rvmn f e io5 i Z 105 i 'e , , g i 9. 6 p • -a± + s $�5 "b i q O Bb' 9 F 1. �M[V1 p S - F } $Q[ j 2 {y {ai {f }!y y y�gJj j, wYOi g 1N4 i S T. CROIX COUNTY I SEPTIC TANK MAINTENANCE AGREEMBNT AND I OY NStSH[p CERTIFICATION FORM 1 Owner/Buyer P r�� Mailing Address ftoperty Address (VejficW= requfted ftm VbMM9 DeparttafflA for now oowkacd•) ` d� G -gyp �3 � �i - � city /state Parcel identification Number 1 . I U9AL Property Location S �a , L V4, Sec • S T 3 ON R W, Tows of�! Subdivision ll -y' ,Lot # CerWed Survey Map # ---, Volume Page # Warranty Deed # Volume Page # Lot trines idl� no Spec b ouse yes ao ��//// I AND g TION bWWw =e=d of yaw w pw Mt= oocld restdt m its 7 fa11'te m lode wastzs. 1'�opar if neededt *a, licensed pub. Wbat you pat silo e of pumpit ant septic tank av ery three years the wastie disposal sysceat. C to r)*m ca affect tome fawfim of the sq * teak as a treat not stage • Order - re"d -bM� are SpeCiSded is §Cbmaas. 83.52(1) and in Chapter 12 - St. Croix C7aumRy Stay 11M property owner agrees to submit to St Cr0JX County Platcmin8 & yep tie aan- � the amt a master awb ja w7ww p1mber, re Wcwd plumber or a Hawoed pumper i f ), o tank is owner by coad&an and/or (2) aRer aid ( i M is op�8 �rastewadar disposal system p� , IM ti�an 113 foil of sludge: and agroe 'to the psivatis sewage disposal sysoaa with the �, the u�o d =*wd bare read the above :egt s of Natvsal Resovrom Stem of WiscowkL I, stsodazds set forth, herain as sat by the Dapavaaeat of Commerce and Ow Dam C rt,faca*on statmg that your t� ma� been od mast be complated mend to tome St. Crass County Ptaansng & wMn30 days of dw year r.s *xd-On date. oa this form are tree to the hest of my /our knowledge. Uwe wafers Ste own=($) of tae llwe = " y *a an slataruats Vroperty deseaibed above, try virtue of a watraazy deed recorded is Register of Deeds office. Number of bedrooms �� O I DATE GNA OF AP'PLICANT(S $P*OAA infornatiou #bat is 121 weased may result is the swtery peat bcmg revoked by &e Pbmi8 dude with theta apphcation a zec=W wagroty deed ftm the Regisder of Deeds office and a copy of ft mftfied survey map if resrax is made in the waaamty dead- (REV.08/05) I I U 2685P 179 �\ 778370 STATE BAR OF WISCONSIN FORM 1 -1998 KATHLEEN H. NALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO., NI Document Number I I RECEIVED FOR RECORD This Deed, made between Silver Lake Land. LLC, a Corporation 19/29/2004 08:25A11 Grantor, and Kenneth J. Oeverin4.--� . _. . - Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXEWT # described real estate in St. Croix County State of Wisconsin (the "Property REC FEE: 1 TRAMS FEE: 1272272. fa0 �C�03�tJ K 0 .� CC CO PY EE; b� PAGES: 1 Recording Area Name and Return Address 1. 'a TO: .urnet Title 11 i mnce Ave. S. }"i�,t Ilur F - :i; . NEN ;5431 026 1073 50 001 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Lots 1 through 11, Hollow Pond Addition, Town of Richmond, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except 4 Dated this tom' _ day of October 2004 (SEAL) (SEAL) Gregory J. Peterson, Presiden Silver Lake Land, LLC (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) State of Wisconsin, } ss. authenticated th�� E N � Y da Df ATZ I N A St. Croix County IVII fAHY Personally came before me this O day of STATE OF WISCONSIN Octobe r, 2004 the above named Gregory J. Peterson as President of Silver Lake Land. * LLC. a Corpolption to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the foregoing instrument (If not, and acknowledge he same. authorized by §706.06, Wis. Slats) - - - -. THIS INSTRUMENT WAS DRAFTED BY LcJ 0, Coldwell Banker Burnet Notary Public, State 6f Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is permanent. (If not, state expiration date: 3 -66215 C� ) (Signatures may be authenticated or acknowledged. Both are not necessary.) " Names of persons sig in any ca ac' must be kped or erinted below their signature. ow ----------- - - - --- lw © � 5 t M r . 1 t awn rrlr� 1 w 1 ri i71O� M srti srr w #+ bag .� Y 1 N �+ . low r ti _ _ RECEIVED Wisconsin Department ofComme FEB O 9 ,205QIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings S "rro 0mm 5, Wis. Adm. Code County St. Croix Attach complete site plan on pa r.not le W"4 Vfk il size. Plan must include, but not limited to` vertical and honzontal reference point (BM), direction and Paroel I.D. / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. FZ* A Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , JI Property Owner Property Location Greg Peterson Govt. Lot SW 1/4 SW 1/4 S 25 T 30 N R 18 E() W Property Owner's Mailing Address Lot # Block # Subd. ame CSM# 1611 Hwy 10 5 City State Zip Code Phone Number LFity [] Village - [IrTown Nearest Road Spring Lake Park I MN 1 55432 1 ( 7¢3 780 - 4996 140th Street E] New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Q Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable b4Ai ft. General comments These are massive soils wi a need for m ful ' el care s of stem being used by the and recommendations: stalling contractor. y commendation would also be o consi er a pressurized system, here the effluent be dosea over a entire sgb - ution area. Not required, hdrMUMHynded. This site is suitable for a below grade conventional system. I F-71 Boring # 0 Boring Pit Ground surface elev. 97.17 ft. Depth to limiting factor 90 in. Sal lication Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPD/1F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -7 10yr3 /3 sit 2msb mfr cw 2f .5 .8 2 7 -25 7.5w4/4 sl Om mfi cw 1 f .5 3 25 -90 7.5yr4/6 is Om mfi - - .5 .7 2 Boring # Boring 95.50 >90 Q Pit Ground surface elev. ft. Depth to limiting factor in. F*Eff#1 Rate Horizon Dep th Dominant Color Redox Description Texture Structure Consistence Boundary Roots DHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#2 1 0 - 10yr3 /3 sit 2msbk mfr cw 2f .8 2 11 -51 7,5 4/4 s1 Om u cw if 51 -90 7.5yr4/6 is Om tnfi - _ .7 ' Effluent #1 = BOO > 30 220 mglL and TSS >30 150 mg/L ' Effluent #2 = !Z 30 mg& and TSS < 30 mg1L CST Name (Please Print) Signature _ _ ...� ° CST Number Thomas C Nelson "° 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 7/3/03 715- 246 -2454 • I Property 2 y Owner Parcel ID # Page of 3 ❑ 3 Boring Boring g Pit Ground surface elev. 97.50 ft. Depth to limiting factor >91 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 'EfW 1 -12 1 2msbk mfr cw 2f .5 0 3/3 - sil .8 2 12-28 7.5 4/4 - sl Om mfi cvr if .5 3 28-91 7.5yr4/6 - Is Om mfi - .5 . ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'EM I F-1 Boring # Boring apit l 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 ' Effluent #1 = BOD, > 30:< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBil8330Tea (8.07/00) .0:Ll[j.0W 10N L. Q T 5 192 I 6' o 96' 214 I B3 j 94' 490'' TO I ]aI CO.RwE] 2% SLOPE I II3' B 2 85' 98' R O 33 A D - - BMI 100' LOT LIWEB SCALE I" = 40' 1 BMI TOP OF ISOF ]PIPE ]too � � Jr BM2 TOP O COWDVIT PIPE 99.42' BI 97.17' �^ B2 95.30' THOMAS 19ELSOF B3 97.50' 227387 ST. CROIX COUNTY WISCONSIN •` ti _ ''�, ZONING DEPARTMENT �\ t N t t p t p■ r���r. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 M emo to F From: Pam Quinn Date: 7/21 /2004 Re: On -Site Soil Report Verification for Lot 12 Hollow Pond Subdivision (SW % SW % Sec 25 Town of Richmond) On July 9, 2004 a site visit was conducted to evaluate soil conditions reported for Lot 12, 13 & 15 within this new subdivision. After making observations in test pits and subsequent review of all soil reports submitted for lots in Hollow Pond, it appears that the recommendations for installation of pressurized conventional (in- ground) systems may not be feasible. The weather was sunny, temperature in the 70's, with good light conditions for color determination and no precipitation for >24 hours. A sanitary permit was issued for this lot and excavation for the foundation had exposed soils that caused concern for installation of a conventional system. Test pits on lot 12 had been excavated at the approximate locations of B2 & B3 on the original soil report. At B3, the soil profile was similar to that reported, but redoximorphic features (iron deposits and high chroma concentrations) were observed at the irregular boundary between a sandy loam horizon and fine sands below, at approx. 60 inches. The fine sand horizon from 60 — 88" appears to be weathered sandstone, with extensive iron deposits throughout (2.5 YR 7/8) in a matrix of 10 YR 8/2. Bands of 7/5 YR 4/6 sandy loam were observed starting 6" below the textural change. A test pit near B2 showed massive sandy loam transitioning to fine sands at < 48 ", again with redox features along the textural change and much higher concentration of iron staining in the fine sands. Redox features at less than 48" would limit installation of a pressurized in -ground system. to less than 12 inches below grade. This would place the system on Lot 12 in silty clay loam soils with an application rate of 0.2 gpd/ft Recommendations for "pressurized conventional systems" would require a minimum of 2250 ft for a 3- bedroom house, 3000 ft for a 4- bedroom system. Due to Dept. of Commerce code changes, effective as of 2/1/04, massive sandy loams now have a soil application rate of 0.2 gpd/ft . On many lots these soils were encountered in a third horizon at depths of less than 24 inches from the surface. Pressurized pipe, not a dosed system using leaching chambers, would be needed to achieve even distribution of wastewater throughout these soils. Costs for design and installation of an in- ground pressurized system should be compared to a traditional mound system, the latter having the option of being reconstructed if a failure occurs. The existing tested areas for all lots within Hollow Pond are not large enough for installation of a 3,000 square foot system and another equal area for replacement. Additional soil evaluations will be required and the replacement areas will have to be preserved from any construction activity for sites proposing to use this POWTS option. Mound systems for lots in Hollow Pond would require designs with lower loading rates where soils exhibit platy structure in the upper horizons and/or have <0.3 soil application rates within 12 inches of the surface. These long, narrow systems would, however, fit within the existing tested areas provided on the original soil reports. Sanitary permit applications for conventional POWTS will not be approved for these lots based upon this on -site determination unless the following items are included: 1. Additional soil test pits have been evaluated to provide both primary and future replacement areas. 2. Documentation that redox features are >36" below any proposed system elevation. 3. The soil application rate used for sizing the system extends a minimum of 6 inches below the proposed system elevation. For example, if the system is 18 inches deep and a massive sandy loam begins at 19 ", a soil application rate of 0.2 gpd/ft would be required for sizing the system. 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