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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: - 479459 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 , Ken I Richmond, Town of 026- 1163 -07 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: �6D G 25.30.18.1257 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J t, / Benchmark 6 1 p � �� D*Holding i ` / Alt. BM n - 110 P Bldg. Sewer St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet So Septic C6 y+ A* 3-6 ' ' Dt Bottom V. S Dosing �, 1 n _ 36 1 31 Header /Man. 17 Aeration Dist. Pipe CT7 Holding Bot. System y4 94' '01, PUMP /SIPHON INFORMATION Final Grade Z -� 9�s t4 Manufacturer 7 ^ , f r- GPM nd St Cover r, / C) 4 ZOO e,, � � C.oJ Model Number ! ` C -71�� a Gf c� / z TDH L Friction Lo�s� System dead TDH , + 4i + Forcemain Length 5 D+/ Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /6 (3ec SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: ` INFORMATION CHAMBER OR Type Of S stem: z UNIT Model Number 1 54 ' c /5/� A f r. DISTRIBUTION SYSTEM /TIC /l/i� �V Header /Manifold Distribution x Hol Size I x Hole Spacing Vent to Air Intake \ Pipe(s) Z- // Length DO Length � Dia Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center y Bed/Trench Edges ` Topsoil 1 Yes W No es j' JI No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /Q / Z5 1 d Inspection #2: / / Location: 1415 131st Av ue New Richmond, WI 54017 (SW 1/4 SW 1/4 25 T30N R18W) Hollow Pond Lot 7 Parcel o 225.3. 8.1257 1.) Alt BM Description i 2.) Bldg sewer length = 3$ 4ig�nnat ./ d - amount of cover = + 5 Plan revision Required? Yes No S Use other side for additional inform on. __I__—: Z ! ___ __ SBD -6710 (R.3/97) Date Cart. No. I Cotmry �- Safety and Buildings Division. W -ton Ave., P.O. Box 7162 t be fill in by CO.) .20, W umber ( o adison, Wl 53707-7162 ons Sanitary Permit N C 1�Cn (608) 266 -3151 7 J ■ Department of Commerce Plan I.D. Numbet _ n PECE �n you p �ll 1 Sanitary Permit P rovide n ) In accord with Comm 83.21, Wis. Adm- vacy al proj ct Address (if different than mailing nQuic slo � 1)(m) may be used for secondary Purpo Pri */V/'5 / 3 1 �� Information - Please J , �. Application P rint All �7. +�;RCi!X ��` � � "� Lot Block# ?CtVtNG 0 - RCE P 1# property Owner's Name ✓ Property Location property owner Is Address �J y � � Section Phone Number i e) Zip q , City, Stale r / q, }X17 N, R E r W j t cLS 5v Subdivision Name CSM . 1-17 11. T Pe of Building (check all that apply) `1 Ok r 2 Family Dwelling - Number of Bedrooms 7 ❑ Public/Commercial - Describe Use ❑City_ ❑village hip of ❑ State Owned - Describe Use app licable) II1. Type o Permit: (Check only one box on line A. Complete line B if a lacement Only ❑ other Modification to Existing System ❑ Treatment/Holding Tank Rep A. ew System El Rep lacement System List Previous Permit Number and Date issued ❑ Change of ❑ Permit Transfer to New S. ❑ Permit Renewal erm it Revision Plumber owner Before Expiration ❑ Single Pass Sand Filter ❑ IV. T e of POWTS S ten: Check all that a 1 _ 5 - 11 0 Non - Pressurized In- Grod Sand F un 11 Mound ? 24 in. of suitable soil ❑Mound < r in. of suitable sot Holding Tank ❑Peat Filter ❑ Aerobic Treatment Uni ❑ Rectrculating ilter Constructed Wetland ❑ Pressurized in- Ground [I Holding Pipe C] Other (explain) L Chamber ❑ Recirculating Synthetic MediaFiluer ❑Lea ❑ Drip Line p (sf) System Elevation % Di al Area Required (s Dispe Area Prof V. Dis ersallTreatment Area Information- / Floe Design esgn Soil Application Rate( (gPd Site Steel Fiber Plastic Prefab Glass Total Number Manufacturia Concrete Constructed VI. Tank Info Capacity in Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber for installation of the YOWTS sh °w n on the attached P ns- me responsibility Business phone Number VII. Responsibility staternent 1, the undersign N4P/MPRS Number r' ature L Z_ b t' z Plum Name (Print) Plumbe�_ City, State e s - 217 umber's Address (Sriver, ty, . ✓ Iss - t Si o includes Groundwater Date Is VIII. oun /De artlnentUseOn Sanitary Permit Fee ( � pproved ❑ D' prov Surcharge Fee) t ' ❑ R ial W U bLUJJ t col rovaUReasonsforDisapproval _3� Jl 'I (Y1,J4 5 f f IX. Conditions of App U u 0 tM1� Q- Ot.J Aalk' SYSM OWNER: 0.G 'Woe tank effluent cR �r and dispersal cei n nu ne ,p; lc�s_ ,ainta GOB -d�� 1 Ot� f� - � �\ , /l, SV as p er management p'ar � rovirr �7 ; r plu if 2. All setback requ!re^ ;� : ;Host oe namtaif}od as Per applicable code i ordinances. to the County only) for the system on Paper not less than 8111 x 11 inches rr sys Attach complete Plans SBD -6398 (R. 01103) PLOT PLAN PROJECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 SW 1/4 SW 1 14S 25 /T 30 - N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 95.9' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none hk BENCHMARK V.R.P. Top of Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark Pro 3 Bedroom Tank is to be properly House bedded and provided with lockdown covers with approved warning labels 377' To 140th St. Property Huffcutt Combo Tank Area 15' below system Line is to remain 5% Slope undisturbed B -1 95 B -2 412' Property Line 96' B -3 Grading is to done to B M * divert run -off away from system Alt. B.M. is top of Survey Iron Well is to meet @ 96.7' all setbacks found in Comm. Property Line 83 "' ""+ �° -► Property Line PLAT PLAN PROJECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 SW 1/4 SW 1145 25 tT 30 ' NIR 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 95.9' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 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 Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H.R.P. SameasBenchmark Pro 3 Bedroom Tank is to be properly House bedded and provided with lockdown covers with approved warning labels 377' To 140th St. Property Huffcutt Combo Tank Area 15' below system Line is to remain 5% Slope undisturbed B -1 95 B -2 95.9' 412' Property Line 96' B -3 Grading is to done to * divert run -off away B. M. from system Alt. B.M. is top of Survey Iron Well is to meet @ 96.7' all setbacks found in Comm. Property Line 83 Property Line Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons ' n w ww.coe.wi.gov/s / www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary September 14, 2005 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 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/14/2007 Identification Numbers Transaction ID No. 1193713 SITE: Site ID No. 704492 Ken Oevering Please refer to both identification numbers, 140"' Street above, in all correspondence With the ,agency. Town of Richmond St Croix County SW1 /4, SWIA, S25, T30N, R18W Lot: 7, Subdivision: Hollow Pond FOR: Description: Three Bedroom At -Grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1039534 Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System: At -grade Component Manual, SBD- 10570 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the approved plans, and with publication SBD - 10570 -P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite � `"' Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD- 10573 -P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods DE N OF FT of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". , , P RTM �J J SEE CORREB • 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. • 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. Stats. • Inspection of the POWTS 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 • Comm 83.22(7) A copy of the approved plans s, pecifications 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 W Balance Due $ 0.00 L j Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@connnerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 L AiL > 5 B >_ 5 PV �TUP W-- UPS" : r -, AJI #-- ba sr&tSar te9 LATF -M EA SrA6Eti ��D a�t�vnT►ars WELL A_ O _ o 1 /6B i (/6 E3 1/2B A : Ft. L _ / {. [ EL L Of kz A&GEC C-64TC ftPQabv�a SYM-cl�.�r,. Fabric � Distribution Laire�al ��.-- Soil Cover STM61CMV_b observation --- -.� j pi,b Eb L.AVE2 ? 5 A -� 5 t- reds Unit with a ' on o� iTisconsia-a A S plan View and Cross S8Ct1 sl op ing Site Slagle absorption Area on a P g Page Of Distribution Pipe Detail For Lateral Network = TufkM -UP (up tkftlT) PVC Forte Main PVC Distribution Pipe P * Last Hole Should Be Next To TuR�i - P Ft. Hole Diameter -13ol- Inch X Inches Lateral Diameter _—�- Inch(es) Y inches Force Main Diameter Inches 0 Of Holes /Pipe 7 Invert Elevation Of Laterals Ft. Signed: License Humber: Date: SEPTIC TANK PUMP C1 fiFR CRC}SS SECTION SPECIFICATIONS y GRAD £ W£A HERPRWF APPROVED VENT PIPE 2" MIN. ABO E jUNCTION BOX wr mDow OR W ITH CONDUIT MANHOLE COVER ` FROM DOOR, W / PAD LOCK � Fg£S� "iR IIdTAiCE - �Lrro 4; 4IA&KI�tG iABEL ` Ott HIN - f IN} l GRADE --- ZY �: t8 �s�• ism- - T INLE GAS { • W W,&T£R "1 IGHT S E,ALS "T TIGHT - A SEAL ,R3li�tt5 s ALM APPROYM PIP£ N 10 SOIL APPROVE0 ' SOL r � P 3 SOLID Q C. F Tr Xv SOT D 3 - APPROV ED - SEDDI NG UNDER TA.3+I1C CoNc ETE PAD S PECI F ICA.TI ONS �}fBEP DQS t''ER ;JAY : . SEPTIC f DOSE /1 E DI3 i A38K MANUrACTUP.ER : , _ice___ DOSE v {3 HE I N LU 7 , J SAL - �c szas: s EPT ;C FLT 3.��T �L. nos£ a IES � I�PACIIIE:S A GAL. AIA IKANUFACc = ' U 8 = 2 INCHES MODEL HUH$£R: 1.— T1J�'`, -- � j IIBCf ES = q� C'L- SwI.TCH TYPE: tJ C — = /��L- FACIIJ'Rr-R= II = �. INCHES P4114P MOD Ntfi'i8£R : -- I�St}DEI, � I LiiR 15.23 WAC S WITCH 'TYPE= ar Z A.; 14 W'R 1 12 IIJG A5 PFR .,,AR �1 a1 ,I1lP � FEET RATE -- ' - - � b � � FEET REQLiIRED DISCHARGE I�'TI� PIP£ ptJKP O FF ANA DISTR _ ----- FEET vf2TICAL DIFFERENCE $E'1' TEEN . - ` £ g IC'TIOK FACTOR • ?�.aI T`110Q FT- �, DYNAMIC HEAD � f FEET + �jjNlifim NETWORK S€S igm x /. 31F TOTA FEET FORC�MR �j D IAMETER pU MP TANK: LF,14GTH INTERNAL DIMENSIONS F ? ZQi}ID iFCEI�S` �MBKR - -- S IGNED = ;,188 r- TOTAL DYNAMIC HEAD /CAPACITY ° PER MINUTE HEAD CA °ACITY CURVE EFFLUENT AND cEwATERINC ^ LO MODEL 152/153 MODEL 152 153 W� W Feet Meters Goi. Liters Got. Liters 50 5 1.5 69 ( 261 77 291 153 10 I 3.1 61 231 70 1 265 40 15 4.6 53 201 1 61 231 12 152 o � 2� . 6.1 I 44 1 67 52 19 z 25 7.6 34 129 42 159 v 30 i 125 ' 30 9.1 23 87 1 33 a 8 I z 1 --- 22 ; 85 o Q 20 ?0 i 12.2 -- -- 11 { 42 I ock dolve: 38.D (1t.Sm)I44.0 Ft. (13.4m) 4 ou5m 10 I 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 - 3 5/e --f FLOW PER MINUTE I 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS I s 3 27r2 • Timed dosing panels available. z e and supp lied with ► - • Electrical alternators, for duplex systems, are availabl an alarm. I • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. iI • Sealed Qwik -Box available for outdoor installations. See FM1420, l i Over 130 °F. (54 °C.) special quotation required. 1 1521153 Series" 'tFT Contro Sen I ) u tir 1521153 MODELS le o i — 1 J 5 AMPS Simplex Duplex I Model Voris Ph Mode 1 2 or 3 I N152 115 1 Non 8.5 2or3 t { BN152 115 1 Auto 8.5 Inducted ; 4.3 1 2 or 3 E152 230 1 Non 4 lud 2 or 3 N o n 115 1 on .3 Inced UBE1 1 215 1 10.5 1 2or3 SELECTION GUIDE @N15 3 115 1 Auto 10.5 Included 2 or 3 1153 230 1 Non 5.3 1 i 2 or 3 1. Single piggyback vanable level float switch or double piggyback variable level t 81153 230 1 A to 5.3 included 2 or 3 Switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. n cauziorl ng should be done by a qualified 3. Variable lovel control switch 1 0 - 0225 used as a control activator, speafij duplex ( ) Au installation of controls, protection devices and wiri licensed electrician. All eladncal and safety codes should be followed including the most. or (4) float system. recent National Electric Code ( NEC) endthe Occupational Safety and Health Ad (OSHA)• RESERVE POWERED DESIGN e ver y Zoelle For unusual Conditions a reserve safety factor is engineered into the design of a ry p ump. MAIL TO: P.0- BOX 16347 Louisville, KY 40256-0347 Amdufachrrersof . L , SHIP T0: 3649 Cane Run Road ��J Q Louisville, KY 40211 -1961 QlLd[/TYPiiMas �dCE l� nmff I 0 (502) 7'8 (800) 928 -PUMP FA X X (502) (502) 774 -3624 ht1pY1wwwz0eller.com p Copyright 2000 Zoeller Co. All rights reserved. E14T PLAN Rage of . VVTS, 0Wt4ER'S MANUAL & - SPECIFICATIONS PO SYST at 0 NA $eptic tank Capa NA Fir E iNFORMAT geptic Tank Manufa� finer a r ✓ (3 NA Pence Effluent Filter M darer � °l 0 -0 0 NA S 0 NA Efuent Ftter Model � 0 al 0 NA DESIGN PAF Tank Capaw number ofSedroans Pump- I NA Numbe! Units �� �(d pump Tank Man �l (e✓ ❑ Nk Esoed flow (a�refage) J""� aVd Pumpn ! j'Z ❑ NA mat estimated x 1 -s} pump Model Deogn flow (P� aVd preb eabn ent Unit 0 peat Filter Son APP °n Monthly ZVO navel F n p Welland Ir�ituentJEt#lu t Quarry w (FOG) -<30 mgr• p ecthectjor Ae1 CI Other. Fats, Oil G BODs} �p mgr. ❑ D gnfection BioctieMICA o Demand ( So m 2 Manufacturer Tots[ Suspendd Solids (TSS) average'- Dispersal Cetl(s) ❑ [n.ground (pressurized) Effluent QuafrtY Mo�O mg/L L3 In (gravl<YJ c) mound Pry emand (8005) foD g D Other. Btochem n pe 0 mgr ne noacomrne�dan `"ra't°"ater are Total Suspended Solids +CFA 10 4 �/l00mr for ao s t Fecal CoAform (geometric mean) inch diameter - v �"�� e�iuent seP uar for pfc�� ri,15�water. Maxiraunt Effluent partite Size .. values tyP Service Frequency F,WNTENANCE SCHEDULE r (s) (Maximum 3 yrs.) p months Service Event At least once every ,� of tank volume and scum equals one-th (K) lnspe� GondWon of tank(s) y�hen combined sludge �Cyear(s) (hf[aydmum 3 yrsI p months J pump out contents of tank(s) At least once every r(s) Inspe� tsar, celt(s) D months . dupe At feast once every s ) 0 NA Q months yea Cl O NA Ch.-an effluent fitter every s amp conu'o� &alarm At least once 11 months ) NA pump. p At least once every Q m o n ths I7 year(s) and pressure test mon:3 rs) c3 NA Flush h laterals AL Least once every ths 1 other: At least Once every pt,er pal b licenses or INSTRUCTIONS an Indrvidual carry one °f the foll Maintainer, Sepla9e MJUNTENANCE INSTR rat cells s hall be made by r pOW'TS lnspecw pOY t any missing or broken tnspe of tanks anQ Master plumber Resits Sevfe e rdntiiy for any ad up ins:. Master Dumber, must inclu a visual inspec6an of the tanks? to m and m check t levels ed sludge and scu check the effluen Sw kw O . ator. Tank ins asur the volume of oom] visua[ty went on the hardware. IdenSfy any emcks or leaks, rrre The diispersW celi(s) shall be autfiorrty round surface- of effluent o the ground surface The po or pond'; of effluent on the g far any porting tion of the local feg ulatory and to C' � ce rn an y and wires the lrnmedlate notifica re of the tank v olum or moe, the in the obss"Son Pipes tank equals one -third (YQ arcs ' ch. NR ground surface may indreate a farfinB a and d in any disposed of in acr�rd mbined accuMulation of sty by a Septage Servicing operator and dispos When the Coof the tank shall be rem vents: and any entire a onen. p ent cempo istrative Code. P ressurized pOYYTS cornP ts retreat �fied pOWTS Maintalnet• 113, WWWritin Admin n �anical or p rfortned by SetYice event. The Sonricing of went filters, at intervals of 92 months or iess shall be p? o f completion of any other malydenance or monito d d to the local regulatory authority ucts or other min 1 ¢ate A setY� report shall �be prrnrt painting prod for the Pr'�ce of STARTUP AND OPERA7'1DN POWTS check treatment tank(S ersal eell(s). if high ooncentretions are lion, prior to use of ro(�SS a ndlor damage the ra disp prior to use - ch new Im�e the treatm removed by ent P a septage servicing opeto P cheer W K S) deteaed have the contents of the tan ( ) Page of _ infiltra surface. - e inf n at tti start up Shall not occur when soil condrt�ons are froze v hen power is testoted the excess S � #�' hvrater levels. System above nomhat K3 m result i ou Pump tan � [ s in one a dose. overloading the c (s} and ay n the Drlring P�'r� C 3 tank removed a Wi be discharged to the dispel w3stewateC d.&u_ rge of ttiuent To avo e id this situation have the contents of the pump backup ori polder to the effluent pump g Operator Prior to tom or r�ntact a Plirrr�ec or ('OYVTS Maintainer to tar ik. rfta!]tlallY purtlp cant - ols to restore normal levels YMhin the Pump ate d cis cells_ Do not drive Or park over, or otherwise disturb or compact, Do not drive or park vehi� �p tanks an of any tnotind or at -grade soil absorpron area_ the area rvifhin 15 fit down s lope from the rv orrrlartce and prolong the ffie astew2ter stream may improve the perf Reduction or- efimination of the f0ffOwin3 butts; condoms; tton .swabs; degreasers; dental floss; diapers, Of the POYYTS: antibtotic�:'v�Ipt d water, fruit and vegetable peelings; gasoline; grease; herbicides; meat disinfectan&. fat fr►urida�ort draltt (surnp PUMP) . saaps; rnedlc ours; c�ti painting prvduc W. pesticides; sanitary napkins, sampans; and water softener brine_ ABANDOWMENT taken out of service the fotlovAng steps shalt Fte taken to Insure that the When the POWTS fans andfor is permanent y dministrative Code system is property and safely abandoned in comp ranee with ch_ Comm 83.33, t+ilrscOr►sin A nin s sealed_ , Ali piping to tanks and pits shall -be disconnected and the abandoned pipe ope g The contents of an tanks and pits shall be removed and property dispos and th v oid of by a Sepfage Servi v oid space Operator_ After pit�7 plea. all tanks and pitts Shan be excavated and removed or their covers removed fitted with son, gravel or another inert solid materiaL CON71MGENCY PLAN measures have bee". or must be taken, to provide a code if the POWCS fails and cannot be repaired the following compliant replacement systenti i p A suitable r,eplaoerr►ent�area has been evaluated and may be utilized for the location al' a replacement soil absorption system- The replacement area should be protect propo structu lot lines and wean td not Failure e to be infringed upon by required setbacks from existing and propo protect the replacement area Wig result in the need for a new soil and site °evacuation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time_ 0 A suitable replacement area i s not as a last r esort o rr place soil the failed POINTSns advances in POWTS technology a holding tank may r lacement area. Upon failure of the POWTS a sodand The site has not been evaluated to identify a suitable rep site evaluation must be performed to late a suitable replacement area if no replacement area is available a oldrng tank may be installed as a last resort to replace the failed POWT - S. Q d and at-grade sor7 aInosPtxon systems may be reconstructed in place following removal of the biomat at fiitrati3re surface. Reconstructions of such systems must comply with the rules in effect at that time <<WARNIN©> TMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. SEPTIC PUMP I P AD OTHER TRF�► _ DO HOT ENTER A E A PERSON FROM THE INTERIOR OF A T MAY MAY BE DIFFICULT OR IMPOSSIBLE. RESULT. RES ADDITIONAL. COMMENTS I P05KT51NSTALLER pOVVTS fitlA NTAINER game L �t c Name a ,, � Phone Phone - 1 J SEPTAGE SERVICING OPERATOR PUMPS LOCAL REGULATORY THORITY Name j /yam Agency llf n i Phone ,�.��"" Jl Phone � meis The docrrmer4 was &aft ad tr y, go stags of the Green lake. Mariiuette and Wasrstiara Cnty ou Zoning and Sanitatiotr gggndPS_ This doarme�t the minimum regvrrerfler+ts of dt Comm 83_22(2?(b)(t](d)�(t) and 83.56{1). (2) & (3). Wisconsin ,4dminlstrat+ve Cede [fse of tt>TS doarment dues not GMVY (1101) guarantee the performance of the POW T& Property Owner _ Boring Parcel ID # / Page of .// Is Boring # it Ground surface elev.� 1 ft. Depth to limiting factor in. -- go - ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO in. Muns Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -3 r J �? e r ,3 b / I , qS�7 i �IV . ❑Boring # ❑Boring ❑ Soil lication Rate Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Cola 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 mgA- ' 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. SBD -8330 (8.6100) Property Owner _ Parcel ID # / Page of Boring # Boring FN .// .pit Ground surface elev. f ft. 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 `) ) C ' / tom e 6 -3 ,-.� m 1 - I 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 ❑ Pit Ground surface elev. ft. Depth in 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 mgA- ' 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. SB"330 (a.60) Soil Test Plot Plan Project Name Ken Oevering Sha it Address 838 Summer Pines Circle j Hudson Wi 54016 TM #226900 Lot 7 Subdivision Hollow Pond Date 917/05 S W 1/4 S W 1/4S 2 5 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 Fence Post System Elevation 95.9' *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted 377' To 140th St. Property Line 5% Slope B -1 95 B -2 412 Property Line 96 B -3 B. M. Alt. B.M. 967 Top of Survey iron Property Line Property Line ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ' I I N/ M N N N a ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road AN , .. '•ter -� `.:. Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 M emo to 'e 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. Cc: Greg Peterson, Subdivision Developer Oevering Builders, owner Leroy Jansky, Regional Wastewater Specialist Tom Nelson, CST #227387 County Safety and Buildings Division l 201 W. Washington Ave., P.O. Box 7162 jo Madison on, WI 53707 —, Sanitary Permit umber (to be fill in by Co.) F N onsi (608) -31 'T 5 Department of Commerce to Plan I.D. Number Sanitary Permit Application al information you provide /,VI fferent than mailing address) In accord with Comm 83.21, Wis, Adm. Code, person s15.04 1 m lect Address (if dt may be used for secondary purposes Privacy La in ()( 6+ A I. Application Information - Please Print All Information Block # t. [, azcel # of # property Owner's a S P D) o Q! b"i ST. CROIX COUNTY roperty Pro perty owner's Ma A ess G OFFICE f J 1A, 1 14, 'ectiod Zip Code Phone Number -7 J City, State / ircl ne) I � l R/ -&E o W II. yp e of Building (check all that ap ) br a5 Subdivisi nName CSM ber Family Dwelling - Number of Bedroo q + 1 a ty._❑Vill wns of ❑ publidCommercial- Describe Us \ ❑ State owned - Describe Use III. Type Permit: (Check only one box on line A Complete line B if appl a ❑ other Modification to Existing System A. stem Replacement System ❑ tment/Holding Tank R acement Only ❑ permit Revision ❑Chang f ❑ rmit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Renewal er Plumber Before Expiration IV of POWFS S ys t em: Check all that a 1 > 24 in. of suitable soil ❑ < 24 in. of suitable soil ❑ At- ❑Single Pass Sand Filter ressurized In- Ground ❑ Mound p _ Peat Fi ❑ Aerobic Treatment Unit [] Recirc ulating Sand Filter Constructed Wetland ❑ pressurized In- and [I Holding Holding Tank I in ri Ctta -less Pipe ❑ Other (explain) Recirculating Synthetic [03 D ine c Media Filter S tem Elevatio V. Dis ersal/ Treatment Area I formation: Di mal Area Required (sf) Dispersal Area Proposed (sf) Ys � 7 7 Design Fl ow (gpd) Design Soil Application Ra � Site S 1 Fiber Plastic Manufacturer Prefab Glass Capacity in i umb Concrete Constructed VI. Tank Info Gallons Gallons of U ts New Existing Ar in � Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber ume responsibility for installation of the POWTS shown ° e attach ess Phone Number J VII ,Responsibility Statement- 1, the undersign MP/MPRs Number afore t7 Plumber' J L 1/ Plum Ys ame (P r' C Plumber's Address (Stree City ty, State, Zip e � Lz- 1 47 Dat I Issuin t Signa VIII. Court /De artment Use On l Sanitazy permit Fee (includes Groundwater Approved isapproved Surcharge Fee) �jn� 60 'Cl g ssu 05 Reaso or � 1X. Conditions of Approval/Reaso for Disapproval 3) SYSTEM OWNER: I. `SapAic tirlk, Mar and diaparsal cell must all bs *tea / msak-ad as per Manage" Pis^ pr °`nd°d by Pk"nb�' T. AN SS&N c requftrnerft must be mWrdW ned M W appkOWS code / ordinances. Coun only) for the system on paper not Tess than 81/2 X I I inches in size Attach complete plans ( to the �' y SBD -6398 (R. 01/03) PLOT AN PROJECT Ken Oeverina ESS 83 OT Pines Circle Hudson Wi 54016 SW 1/4 SW 114S 25 /T 30 8 TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/6/05 BEDROOM 3 CONVENTIONAL M IN- GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE NK SIZE HOLDING TANK E LOAD RATE .2 ABSORPTION AREA 2363 # of ambers 76 BENCHMARK V.R.P. p of conduit ASSUME ELEVATION 1 Filter Zabel A -100 ❑ BOREHOLE O WELL H.R.P Same as Benchmark SYSTEM ELEVATION 98.0/9 9/97.8/97.7 Well is to meet all Plans Designed Using setbacks required by Conventional Powts WDNR Manual Version 2.0 pro 3 t ST 0 1 Property Line bedroom B-2 house 168' 4-3' 119' Cells with >3' Spacing B -3 Vent �I%Slope B.M. > 6» Standard Biodiffuser 108' #2 of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Lon g 11" en - 3 411 Grade at System Elevation 40 31' B.M. #1 107' 8' 21 Property Line I zw I JN/8 AN PROJECT Ken Oeverina SS 83&Summer Pines Circle Hudson Wi 54016 SW 1/4 SW 1/4s 25 '/T 30 TOWN R ichmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 3 CONVENTIONAL XXX IN- GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SI LOAD RATE .2 ABSORPTION AREA 2363 # f chambers 76 ,BENCHMARK V.R.P. op of conduit ASSUME ELEVATI 100° Filter Zabel A -100 ❑ BOREHOLE O WE *H.R.P. SameasBenchmark SYSTEM ELEVATION 8.0/97.9/97.8/97.7 Well is to meet all Plans Design e Using setbacks required by Convention owts WDNR Manual V ion 2.0 pro 25 ST 30' Property Line be om B -2 h se 168' 4 -3' X 119' Cells with >3' Spacin B -3 Vent 1% Slope B.M. 108' #2 > 691 Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11 en 40' 3 4" Grade at System Elevation B.M. #1 31' 10' 107' 8' 21' Property Line RECE'VE Wisconsin Department of 01L DEVALUATION REPORT Page I of 3 Division of Safety and Buildings . Fe 9 : 2dO �. accordance wlith Com 85, Wis. Adm. Code Counl St. Croix Attach complete ��� site plan on noVq$C1 ch size. Plan must include, but not liimitedto: i andtw l� ' 1 ), direction and Parcel I.D. percent open 0 Z — - O — sl scale or dimens' �rH3 don and distance to nearest road. �o / �0 3 7 OGx PI"W print ON M*"mftn. 'wed by Date Personal information ou provide may be used for y p y second purposes (Privacy Law, s. 75.04 (i) (m)). • 1� Property Owner Property. Location Greg Peterson Govt. Lot SW 1/4 SW 1/4 S 25 T 30 N R 18 E( a Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1611 Hwy 10 7 W,oiica Pv,,j City State Zip Code Phone Number []City village ■ Town Nearest Road Spring Lake Park I MN 1 55432 1 ( 7¢3- 780 -4996 140th Stmt ■ New Construction Use[D Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD ® Replacement ® Public or commensal - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable MA- ft. General comments These are massive soils tem being} e and recommendations: stalling contractor. M recommendation would also be to consider a pressurized system, the effluent can be dose over en ire in upon area. of require , ded. This site is suitable for a below grade conventional system....scl' with 1/4" bands of cl D Boring % h de � - 0k El # Q Pit Ground surface elev. 99.57 ft. Depth to limiting factor 8 in. 1' Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence undary Roots GPD/IP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EWI •Eff#2 1 0 -10 10yr2/1 - A 2msbk mfr cs 2f .5 .8 2 10 -24 1 4/4 - sicl 2msbk mfr cs if .4 .6 3 24 -52 7.5yr5/6 is lmsb cs _ • 7 1.2 4 52 -59 7.5yr5/6 I Om mfi cs - 3 .7 5 59 -82 7.5yr5/6 - is lmsbk mvfr - - .7 1.2 d )� Boring # � 11 Boring 100.30 >88 E] (} I 2 :l pit Ground surface elev. ft. Depth to limiting factor in. Sal R Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr2 /1 sil 2msbk mfr cs 2f .5 .8 2 1 10 -24 1 4/4 - sicl k mfr cs I f .4 .6 3 24-50 7.5yr5/6 sl Om mfi cs _ •5 4 50 - 88 7.5yr5/6 is Om mfi - - 5 7 * Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg& * Effluent #2 = BOD t 30 mg/- and TSS < 30 mg/L CST Name (Please Print) — — Sig " - -- -� CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 7/3/03 715 -246 -2454 Pe terson P 2 of 3 Property Owner ��,�,�, Parcel ID # age 3 Borin # '°" ""' " g Q Pit Ground surface elev. 97.86 ft. Depth to limiting factor � in. Sod Appiketion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 1 0 -10 10yr2 /1 - sil 2msbk mfr cs 2f .5 .8 2 10-28 1 4/4 sicl 2ms mfr cs 1 f .4 .6 3 28 -36 7.5yr5/6 Om mfi cs _ 11 71/ 4 36-60 7.5yr5/6 - / s Osg ml cs - .7 1.2 5 60- 0 10yr6 /3 c2d5yr5 /8 scl* OM mfi cw - .0 .0 6 70 -86 7.5yr5/6 - Is 1 msbk mvfr - - .7 1.2 ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soft 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 •Ef'f#2 Boring F # Bori � pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon. Depth. . Dominant Color Redox Description Texture . Structure . Consistence . Boundary . Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Efffi"2 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 rig& 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- 9330Tea (R.07M) I� OIL �cOW rowv IL O E 7 N o l 2 -"028 ■ -SCALE I' = 40' OP OF COWD IT PIPE UQ' BM2 OP OF COWD IT PIPE 99.92' 99.91 ?' B2 100.30' A397-86 B3 107' ■ 168' M2 108' B1 ■ S4' 31' MI E LOT CO WE8 96 981, 100' TSOMA,.S WMLSOW 21173117 U � 2685 P 179 � 7'7g37Pi STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WAL.SH WARRANTY DEED REGISTER OF DEEDS ST. CROIK CO., III Document Number RECEIVED FOR RECORD This Deed, made between Silver Lake Land. LLC. a Corporation 10/29/2004 08:25AH Grantor, and Kenneth J. Oeverina..ai. — . 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: 11.00 COPY FEE: 1272.00 : (),.nt a PAGEESS�:: : 1 Recording Area Name and Return Address TO: -urnct Title r I'; since Ave. S. i MN -;5435 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 `* Dated this >- , day of October 2004 (SEAL) (SEAL) Gregory J. Peterson, Presiden Silver Lake Land, LLC (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ) ss. authenticated m D,W ATZ I N A St. Croix County J. Personally came before me this � day of STATE OF WISCONSIN Oct , 2004 the above named Greoory J. Peterson as President of Silver Lake Lgnd. LL a tion' to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person F who executed the fgregoing instrument (if not, and ackn wledge he same. authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY s/cJ ^n0~- Coidweil Banker Burnet Notary Public, State i6f Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission is permanent. (if not state expiration date: (Sigma 5 I () ) (Signatures may be authenticated or acknowledged. { Both are not necessary.) Names of persons sIgning signing in any capacity must be typed or printed below their signature. I I W ` ° N087p'S5 "E I N I " w I y 42 9-69 - . N s N • , _ I m I N00'05'55 "E N Z o o . w o° 32701' ► ;o �' % y p Loy A I I c� r O +� h i l SQ 9 CD > > I F ] N p n Q N x ? I 0 m fn h �O i��'1� p I W A w h N12 33, � C IF 5 .22' 8 H. o to l a � . ,c y '° � ?� ` 1 • > II� o 00 4 o Dx 0 14 0 O y N 000 c N00'05'55 "E aaoo' : t LA � �� '° G' o r 3 7.01 y a ti� C, w w: W tv 0, �I , A H 'o ^�f 'U' 33' II ti o O m y� rq to Y �O Cb N00'05'55 "E 411.00' M N).06 o46•F r i(b w� 327.01' 83.99' A O vPr v Z I� �i 11 ' n y � $• o "i Ito to 0 o a y 0 II O 4 A 6 6' b � �► O O O y O y{fg o, I .1 33.00' — 1135.06'— _ v 327.01' 377.13' 430.92 I I n S00'05'55 "W 1168.06' g cn D rn C 1- 1 1;0 I East line of the SW-114 of the SW -114 ` M Ir' Ir ID I I� I Ir \ Ka `o ► 1 I< IF 111 I Ip 1 I 10 1 N N a i"� Irn 01010 o IcnIC'j I I°' \ j� 1 00 �- � I °I \ RICHMOND HILLS I� Im I \ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address �� �°�^ ✓' �"� Property Address r 5 (Verification required from Planning & Zoning Department for new const on.) City /State Parcel Identification Number 6 2� ` /1 3 — ?S-7 — d 6 LEGAL DESCRIPTION �( �/ i J `U 1/ , Sed. T w N RdW, Town of Property Location la , Subdivision 11 O,(� , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house >yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property desc ibed bove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. 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. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Co Plan Option #1. system fails, determine cause of failure, use alternate area and install new in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 i - - - -J ------------- - - - - - - - - - -,. C 9 ''t r r � Ier �a, o : ? - F Y r ET Wd7T =01 700E 7T 'oaQ ZB ZTT£SSTL: ON XUA 0 S3WOH ONI83ABO: WO8J Is 1 �g V RLS NEE c 16 f r M' •, O"0 - � P ,... VAL. T Td WdbT :OT POOZ VT 'DaQ ZBZT TESSTZ : 'ON Xtld 071 S3WOH ON183A30: W083 Parcel #: 026- 1163 -07 -000. 09/08/2005 10:26 AM PAGE 1 OF 1 Alt. Parcel #: 25.30.18.1257 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/07/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner KENNETH J OEVERING O - OEVERING, KENNETH J 838 SUMMER PINES CIR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1415 131ST AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.940 Plat: 10/03- HOLLOW POND 026/04 LOTS 1/16 g p SEC 25 T30N R18W PT SW SW BEING HOLLOW Block/Condo Bldg: LOT 07 POND ('04) LOT 7 (2.940AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 25- 30N -18W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 10/29/2004 778370 2685/179 WD 05107/2004 761870 10/03 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/2112005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.940 32,100 0 32,100 NO Totals for 2005: General Property 2.940 32,100 0 32,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 337l /pShb11tl76yN x�vsaaoendelcrsl�su &MNn NUM -- - A{rl9NlYldS X11/ `dna� 6uq/nsuo0 •3•N0 /.{b'MHJ /H «9/ � j M0770H NOSR 3d 93219 =Nlld (7NOd 0 31 J0lV7d AY N1PV173Yd aNV73 /�r3nWS WEk079430 A E " � N J ZZ W O OO�aU w P UF a p N zis�a[ O C� O g •�W 1-3 L ZF O� < � W c � .C. �� <g 1W � � 2�'�VI O n ma O J U o E � J m 2� y a , t..W`r U�� pa � Ia�c�'°� t Him � Q?O LS b y ~" °m� #w�`II v ! 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