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HomeMy WebLinkAbout026-1163-11-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 488252 0 GENERAL INFORMATION 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 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 17 1Q. — �� 25.30.18.1261 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z G4 - T.1 � Septic it F;(4 -- Benchmark er Dosing Alt. BM Bldg. Sewer 7` Z gZ Holding St/Ht Inlet B.c7 1�•Co TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet W Septic Dt Bottom - 7 � ZT. Z'9 -� 12 • b S7- (c Dosing 7 g Z d i Header /Man. Aeration Dist. Pipe 1. • ` 01 Holding Bot. System e PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cove�r `.> GPM % Model Number ra 11 YErf- 7- t!a r 2 TDH Lift Friction Loss System Head TDH Ft Forcemain Length / Dia. r r Dist. to Well N I 1 SOIL ABSORPTION SYSTEM BEDITRENCH Width , Length No. Of Tre has PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /� �b Q \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION ` CHAMBER OR Type Of System: ♦ UNIT N N . Model Number. DISTRIBUTION SYSTEM (d /� Header/Manifold Distribution r � x Hole Size i I x Hole Spacing Verftto Air Intake Lengt Dia Lengt Dia 1 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S ded xx Mulched Bed/Trench Center Bed/Trench Edges To soil g p ( "' Yes E] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / 1 3 / d Inspection #2: Location: 1403 131st Ave New Richmon WI 54017 (SW 1/4 SW 1/4 25 T30N R18 W) Hollow Pond Lot 11 C�'SRcicel No: 25.30.18.1261 1.) Alt BM Description = 1 4 V 2.) Bldg sewer length = Zj - amount of cover = 3 ✓ °G " I � S 6 V Plan revision Required? E Yes No Use other side for additional information. F J , J SBD -6710 (R.3/97) Date 14 t lnsepctor�s nature Cart. No. Safety and Buildings Division County L 201 W. Washington Ave., P.O. Box 7162 _<� ) Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 VV isco -/?SrZ Z Department of Commerce Sanitary Permit Application State PI T.D. Nuu�ber m In accord with Com 83.21, Wis. Adm. Code, personal inform �`/ S may be used for secondary purposes Privacy Law, s 15. (I)(m E C E I V E D Pro ect Address (if different than ling mai address) T. Application Information — please Print nfo atio k 1�6 3 131 ov� Property Owner's Name / 43 P el # Block # �J ST. CROIX COUNTY Property Owner's Mailing Address U OQ Pr ert Location Section ity, state Zi Code Phone Number ✓v 5 0 JCJ N; 1 Eo �i / Z (j' T. pe of Building (check all that apply) ry k cis �,t�Iovw• ily Dwelling — Number of Bedroo G y� p /� �— Subdiv" ion Name CSM her ❑ PubliclCommercial — Describe Use C� ❑ State Owned — Describe Use �� / ❑City ❑Villa wnship o M. Type o ermit: (Check only one box on line A. Complete line B if applicable) 0 21P x/63 A ' stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal ❑Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. a of POWTS S stem Check all that a ly 0 d U ❑ Non Pressurized In- Ground ❑ Mound ?:24 in. of suitable soil ❑ Mound <24 in. of suitable soil t -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. Dis ersal/Treatment Area Information: D i Flow (gpd) Design Soil Application Rate(gpdsfa Dispersal Area Required (sf) Dis ersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw E daring t ` t Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber - VII. Responsibility Statement- 1, the nn ned, assume responsibility for insWia of the POWTS shown on the attached plans. Plum er's Name (Print) P s Signature Business Phone N her 7—)� L J Plumber's Addr (Street, Ci , Sta Code) CJ un /Department Use Onl pproved ❑ Di pp Sanitary Permit flee (includes Groundwater Tss Issuin t Signature Stamps Surcharge Fee) 0 ' Z)d d / O ❑ O on for � IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3) 1. Septic tank, effluent filter and dispersal ceN must all kLe servir;es /maintained n per management plan provided by plumber. ! J 2. AN setback requirements must be maintairod salt per applcable code I ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches In size a ,F f %. eabe. ` SBD -6398 (R. 01/03) ��, � VvLt Pc;, b l 1 i PLOT PLAN PROJECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 'SW 1/4 SW 1/43 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 96.7' 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 hL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA -100 ❑ BOREHOLE WELL * H. R. P. Same as Benchmark 131 st Ave Property Line (not to scale) Scale = 1/4" = 10' Tank is to be properly bedded and provided with lockdown Pro 3 covers with Bedroom approved House warning labels Alt. B.M. Huffcutt Combo Tank Well is to meet all setback found 43. in Comm. 83 -1 170' 8% Slope Grading is to be _ done to divert Area 15' below system run -off away is to remain from system undisturbed B -2 %e-0 97' 96' 95' k:: im 96.7' Property Line . PRO PLOT PLAN JECT Ken Oeverina ADDRESS 838 Summer Pines Circle Hudson Wi 54016 I x `SW 1/4 SW 114s 25 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 96.7' 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 ZabelA -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 131 st Ave Property Line (not to scale) Scale = 1/4" = 10 Tank is to be properly bedded and provided with lockdown Pro 3 covers with Bedroom approved House warning labels Alt. B.M. Huffcutt Combo Tank Well is to meet all setback found in Comm. 83 M. B -1 170' 8% Slope Grading is to be B-3 done to divert Area 15' below system run -off away is to remain from system undisturbed B -2 97' 95' 96' 96.7' Property Line I Safety and Buildings 141 NW BARSTOW ST FL 4TH commerce.wi.gov WAUKESHA WI 53188 -3789 TDD #: (608) 264 -8777 It isconsin www. www.comm Wsco o v Department of Commerce wisconsin.gv Jim Doyle, Governor Mary P. Burke, Secretary June 26, 2006 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: 06/26/2008 Identification Numbers Transaction ID No. 1284373 SITE: Site ID No. 714562 Ken Devering Please refer to both identification numbers, 131 ST Avenue above, in all correspondence with the agency. Town of Richmond, 54017 St Croix County SW1 /4, SW1 /4, S25, T30N, R18W Lot: 11, Subdivision: Hollowpond FOR: Description: At- grade, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1082006 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99) 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 the component manual(s) referenced above. 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: 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 of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". (NOTE: The At -Grade Component Manual does not allow for utilization of the Versn 2 Pressure Distribution Component Manual.) �...+� C1" J, �. In the event this soil absorption system or any of its component parts malfuncti s so as`!� fa lth hazard, the property owner must follow the contingency plan as described in the approved pl In add a owner must comply with the operation, maintenance and monitoring duties as described in sec II oft at -grade component manual. A copy of this information must be given to the owner upon co m of the project. J/ 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. SHAUN R BIRD Page 2 6/26/2006 r A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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. i • 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. 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 Julia Lewis- Osborne POWTS Reviewer 2, Integrated Services WSMART code: 7633 (262) 548 -8638, Fax: (262) 548 -8614 julia.lewis @wisconsin.gov t Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 6/12/06 Owner:Ken Oevering Location:SW1 /4 SW1 /4 S 25 T30 N,R18W Lot 11 Hollow Pond Richmond System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section * -GOVE� 4. Pipe Cross Section /Pipe Layout 3u1A 1 Z0 5. Pump Chamber Cross Section EN & 5U 0"I'S 6. Pump Curve $A� 7 -8. Maintance and Contigency plan 9 -11. Soil test R�c��vEp Shaun Bird p4 16 2006 Signature License number 2 0 v 4 9 r J Z 51 r 2 - ��Ttif�i�- UPS" EA kf Dts r ten, #S Li%r AL 5�'gSt�Z�D o�.,Cvr�rtort WiE ___-_. >5 !/ $ 1 fd2 $ L�` L =/ F{, CELL of kz p, pQRajF- a S- rm - ramt - Fabric Distribution Lateral SM8tL1tr,-b +observation----- -_, � �--- Soil Cover Well CO- t jj j Yt6vV�D - aYE� > 5 t A plan V3.cv a&nd Crass Section of wis,consx,a At- grad+a Ultc with a Single Absorption Area on a Sloping. Site L1L£ nFcSE- �t��ic� rte Page Of Distribution Pipe i3et3il For Lateral getwork TuRH -UP �CLUtrtt�est _ PVC Force Hain T.._. _ PVC Distribution Pipe - P ---- ' Last Hole Should Be Next To TURQ- up Ft_ Hale €3iameter ' ( P � Inch X �. Inches Lateral Diameter �_ Inch(es) �1-.. -- y inches Force Main Diameter �-' Inches �� # Of Hales /Pipe Invert Elevation Of Laterals 7, 2— Ft. Sinned: License Humber: Date: r CRASS SECTION AND SP ECIF ICATIONS SEPTIC TANK � P#3Mp C#.AMBER WEATHERPROOF APPROVED u �= CI vl:NT PIPE }Z" 14IN. A BOVE G RADE: JUNCTION BOX WIN 4R WITH CONDUIT MANHOLE COV ER io` rROK DOOR, fit! PADL CK & FRES1= A.IR INTAKE WAFAING LABEL CAZ GRADE B L ,� _„ „� 4" MIN- ♦+Q `=a i a INLET r ' a GAS � � ATE TIGHT SFALS � TIGHT. ■ �tpfE A SEAL. ` AL M APPROVED i PIPE O s g - _ ON SiR.; IL APPROVED � PIPE 3` C FF omm SOLID, SOIL PUMP OFF EL£V - _ -- D BEDDING U�+fiDF.€Z TANY' 3 a APPROVED CONCRETE PAS S PFC Z F ICATI 0?4 S 1 S. sl ER DOSES ?ER #7A`f = g EpTlc ! D rRli; NUFACTE = C mr "a GAL- Tf '' I3C3SE Sl {3 .0 E F LtWBACK. G AL. � j T12nx SIZES: SEPTIC GAL. - _ }3flS£ CAPACITIF.S= A _ CAL. 1SA JFACTf3RER 8 = INCHES 3 �--- ALA HpDEI. Ntilf$£1L SNITCH TYPE: sr C = 3 INCHES L- // GAL. PUMP MAWrACTUR£ft : L� % f� D = L _ � IHCH£S — MODEL. NumBER : ' P I L.HR 26 - wxc SWITCH TYPE= g ALARM WIRING AS � Gad - Primp F_ FEET REQUIRED DISCHARGE RATE DISTRIBUION PIPE . ERYICAL DIFFERENCE $£ EEN pUl�'FP OFF AND - T _ - - --"''� fEM V SSURE - . FR ICTION FACTOR ' FEET ± MINrMUM NETWORK SUPPLY PR � T1 to g � FT. :IC BEAD = A f �_ F� ET FflRC�� X �'�� y . TOTAL DYE` � pUtii TANK- L,EIIGl% INTER14AL D114ENSIONS flE L DAZE_ -- i.ICE1vSEH = SIGNED. _ ,too Sent By: HP LaserJet 3100; 1 715 552 8827 May -5 -06 2:56PM; Page 2/3 9EH SERIES SUMP/EFFLUENT PUMP 11.65 8.95 0 Specifications INK CA = 4ninc ►f E9ilYt�KO sum PAL MLCIL Ow �sns IL 81 ups 9► Iltii p MUM f if IF At fU Oki am i1121116 9E m woo um V10 115 314 13.0 1000 70 64 55 41 32 133 20 24 9.11 x 11.61 x 9.94 984-0M 509340 W= 4r -0 230 34 6.5 1000 70 64 55 41 32 13.9 20` 24 911 x 1164 x L94 IN 509358 U1 o 4 115 314 13.0 1000 70 64 55 41 32 13.9 217 27 9.11 x 11.64 x 9.94 9W 5099@0 ULM Ara 230 3% 6S UDO 70 64 55 41 32 13.9 27 V 9.11 %11.64x9.94 Go oaus DutyR1W— 'LObejwe gsvA o pwWzeraudcoNmmsdoyubnpauttnyaerunwMinMe raWPft hmwinos' FLOW- LITERS /HOUR Construction 0 1000 2000 3000 Motor Housing Foxy Coated Cast Iron Impeller Material Poly Carbonate 10 Im ll r Typ C losed Van — 301 Volute 7 s Power Cord SJTW-A 20 a Mechanical Shaft Seat Nitrite with carbon and ceramic faces 0 Fasteners _ _ _ Stainless Steel = to Shaft S tainlem. Steel 2.5 Bearings ! Upper Sleeve and Lower Ball Bearings 0 20 40 60 so FLOW- GALLONS /yINUTE PU MP PERFORMANCE CURVE S SW Little Giant Pump Co. -- S 115V 6042 PO Box 12810.ONd oma CW OK 73157 Phone- 40S.W.2511 • Fax: 405.228.1550 F�mr91: cusrooexser.icaQlftttKluiat_eom www.LittleGiantPump.com in Form 995235 -07/03 POWTS OWNER'S MANUAL & MAN AGEME PLAN Page of SYSTEM SPECIFtCAMNS Fri s= It�iF Septic Tank Capacity I07JL7 a NA septi Mantr er cL. n NA Permit#- Effluent Filter 6 e, ❑ NA OESiGK PAR T NA Effluenf Ff(ferMode! �I v NA Number of 00*00ms Pump _Tank Capadty 63 a a[ O Na Number of c4amlel'dw Units al(d R Tank Manufacturer 0 NA Esd[r� t� (aveWar) aUd `- Pump Manufat ,` , tZ PIA (Tn MW (pe�3K}. ( x 753 Pump M al/d ode) Rabe p Unit Soil +'WPB" Monthly average; raYel F 0 Peat FVW irrfluea�� Quality G} Sao mg/L p iVlectranical Aeration D wetland Fats,r afl S Grease � Disinfecfio ❑Other. sh ems 5220 atg2 O oxygen Demand (13O�s} 0 DW n Infectio Total Susper dad Solids CrSS) 5150 m IL Monthly average" Dispersal Celts) 0 In - ground (pressurbed) Pry EMMt Quality Oxygen Demand 530 mg1L i7 1 .ground (gravitY) 0 Mound Bloc heroical (SODS) ride p Omer_ ded Solids (TSS) 530 m9n- Q Orr ne Total Sus 570` cfufloomi Fecal 0011farm (geometric meanj values r Vld for doh (rnon oort�ne � Y inch diameter septic tam went Ma�drnum Effluent Particle Size values typical for Pretreated w+stewaxe� fiWNTENMCE SCHEDULE Service Frequency See Event nths 0 y ears) (Ma)imum► 3 yrs.) rvic inspect condition of tank(s) At feast once every equals one -third (Y,) of tank volume When combined sludge and scu e4 Maximum 3 yrs.j Pump out contents of tank(s) nths o years) At )east once every inspect dispersal cell(s) At least once every onths . II year(s) Clean Bffluent filter nths D year(s) NA Inspect PurnP, pump controls 8. atarn•+ At least once every ' thS El years) 0 NA Flush iatetais and pyre test At least once revery NA At least once every Q months fl year(5) D osffen 13 months 0 years) a NA ocher_ At least once every &AA NTE aA[dCE INSTRUCTIONS ri be made by an ind "nrldual canYin9 one of the tollow Q licenses ar inspecrons of tanks and dispersal cells shall r, POY1r'i S I nspecWr Pbw'TS Maintainer. So~ � Master Plumber: Master Plumber Restricted So" Inspections of the tank do lde�Y any �9 or broken Tan Serwkkv operator. is ctions must include a visual Inspection check the effluent levels g of e hardware. �ti{y any cracks or leaks, measure the volume of combined sludge and scum and t shack ter any back UP c or pondirf on the ground surtaoe- The dispersal cell shall be nd surface- ace- Insp ected Ponding of effluent on the for any ponding of effluent on tl a ground surface. . in the observation PIPOS and do check req uires the immediate notification of the Iota) rr9gulatorY authority ground surface may indicate a failing Condition and req or more of the tank volume, the When the combined aaarmulation of sludge and scum in any tank equals m and isposed of in axocdanoe with ch. NR enflrE OW" of the tank shall be removed by a Septage Setvidng OPera 113, WWWfleM Administrative Code. onents, prelr3eat nt components: and any The serf Wmg of effluent Mters. mechanit� or pre ssurized Pt31AlTS comp a WA fWd POWTS Maintainer . othermaintenanoe or Monitor at within of 12 months or {ass shalt b by ipt[on of a service event. A shall be provided to the lxal regulatory authority within 10 days of camp any START UP AND OPERA710N the resence of painting ps�u� or other For new �. prior to use of the POWrS dleck.treatrrlenttink($) f er or P s and/or damage #fie dispsal cell(s). if high concentrations ate cherni�s tfiat may impede the treatment proces liar to use. d0ded have the contents of the tank($) removed by ' s septage servicing operator P _ Page or System start up shalt not rrr When sowconditions are frozen at the infttrative surface. {M above normal highwWer levels- When power is restored the e=ess During per outages t�F rani s m one a dose, overloading the c�etf(s) and may result in the to the crmpersaf cWs) �3 ,fir veil! be discharged - of the tank removed a dtsd►arge of etticrent To avoid this srhration have the canter•tts F�fx by backup or contact a Plumber or POWTS miner to _ gyp~ - wing • pQyYet to the effluent pump S%ftgre Servicing Operator in mart opes�ru} the P UM P eontrnis to restore normal l eve l s within the pump lank. a.�st rk over or othetwise Graf ub or compact, . an its t Do n drive ar pa . . vehicles over Do not &M or park d or at -grade srn'1 absorption area- - the area wiaM 15 feet down sbpe of any ntoclnd ter stream may improv the perfommice and prolong Uw life Reduction orerirninaWn of Me fni(awing from the wastexra of the POWTS: anUbbWS; .ma - otgatede butts; condoms; cotton swabs; degreasers; dentaf floss; diapers. disinfectants: fat: foutida6on draft (sump P=P) rater, fruit and vegetable peetui9s= gasarrte; 9 herbicides; meat medlcationsi Olt painting pioducW pestrades; sanitary napkins. tampons: and water softener brine. ABANDOttMEN shall t>!e taken to insure drat the When the p YTS falls an is perrnanently.taken out of service the foilovAng steps system is properly and safely abandoned in comprrance with ch- Comm 83.33, Wisconsin Admh9shstive Code: All piping W mks and pits Shall be disconnected and the abandoned pipe openings seakxL Th contents of an tanks an d pits shall be removed and properly disposed of by a Septage Servicing Operator_ s after pumping, all tanks - pits shaff be excavated and removed or their covers removed-and the void spate Sled with soli, grave!' or another inert solid material. CONTINGENCY PLAN If the POWTS fads and cannot be repaired the following measures have been, or roust be taken, to provide a code compliant rrepWernent system_ 0 A suitable riepracemenrarea 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 e>CiSting and proposed structure, tot lines and wefts_ Failure to protect the replacement area will result in the need for a new soif and site `evaluation to establish a suitable replacement area- Repiacement systems must comply with the rules in effect at that time- 0 A suitable replacement area is not aysilable due to setback andlor soil limitations- Barring advances in POyVTS' ,// technology a holding tank may be installed as a last resort to replace the failed POWTS- -yhe site has not been. evaluated tro identify a suitable replacement area. Upon failure of the POWTS a soil -and ` ! site evaluation must be performed to locate a suitable replacement area if no replacement area is available a at th Recons holding tank may be installed as a last resort to replace the failed POWi'S- wld and at -grade soli absorption systems may be reconstructed in place fotloming removal of the time- at Me Infiltrative surface., Reconstructions of such systems must comply with the rules in effect at tirrne <<VVARNIN4G>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAfN LETHAL GASSES ANDIOR iNSUFFIC ENT OXYGEX DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CSRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSOI'+I FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIr ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name J «. u ,� Phone Phone ?r - 2-1 %o -- � SEPTAGE SERVICING OPERATOR JPUMP&P LOCAL REGULATORY AU HOMY Name 7 Agency This document was drafted by the MM of the cf rpan Lake. Marquette and Waushara County Zoning and Saniaifion ag&WbL This doamrA meets tft mk*nwn rvquun3rtnetns cf cn. Conran 2M 83..54(1 ). (z) $ (3). Wisconsin A6mk9strafive Code Use of u* doc=ent inks Trot guarantee the performance of the POW S. CtuW (?JOt1 r r � trEC :zontal ED Y Wisconsin Department ommer�e ) OIL EVLUQO kO T P age of 3 Division of Safety and Bui ings - r d�nce �Nis..pm. Code S . CR wit Comm 85, nty S C rb c c Attach complete site pla on pa 6 inches in size. Plan must include, but not limited t reference point (BM), direction and Parcel I.D. 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o 246 - 16 3 - f / - J 1l information. Re 'wed by Date Please print a Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location /t Govt. Lot - <,4-J 1 /4sj 1/4 S 4 J T 3 D N R E (or Property Owner's Maili ddress Lot # Block # Subd. me or CSNM 3 3 °- rw rr�- City State Zip Code P1 TD City ❑ illage T Nearest Road UbJ"�A' A New Construction Use. esidential / Number of bedrooms Code derived design flow rate r 7�, )� - -- GPD ❑ Replacement ❑ c or commercial - Describe: - _ - - - - -- - -- Parent material - Flood Plain elevation if applicable ft General comments and recommendations: G Boring F—/1 # p Boring 7 pit Ground surface elev. / 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 'Etf#2 a ® Borin # 0 Borin � i( Ground surface elev. ' `� ft. Depth to limiting factor J _ in. Application Rate Horizon Depth !!l l �� ��� Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -J / / Zm Z 1z- (� spy Z w I 3 04 0 1© ry /� --- -- t' I 2rr�s� lc r►-, �v w Effluent #1 = BOO > 30 220 mg(L and TSS >30 150 ' Effluent #2 = BOD <_ 30 mglL and TSS < 30 CST Nam (R p ture CST Numb Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 5- 246 -4516 1008 192nd Ave, New Richmond, WI 54017 - _ b ,.- 71 Property Owner _ Parcel ID # Page of [a] Boring # ❑ Boring pit Ground surface elev. /)3 ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence / LBoundar Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eif#2 1 0 ~) s/ z ,- Z / 0 y -3g S/ r ❑Boring # ❑Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in Sal Applicatiori Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munse" Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I E] Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appication 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 _ > 150 ' Effluent #2 = BOD < 30 mg& and TSS 130 mg/L Effluent #1 - BOD > 30 _220 mglL and TSS 30 < _ mg/L s _ 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 (RAW S Soil Test Plot Plan "Project Name Ken Oevering Sha ird Address 838 Summer Pines Circle Hudson Wi 54016 S #226900 Lot 11 Subdivision Hollow Pond Date �'l0/25/05 S W 1/4 S W 1/4S 25 T 30 N /R W Township—Richmond B ing Q Well PL Property Line County ST. CROIX BM VRp Assume Elevation 100 ft. Top of 1/2" pipe em Elevation 97.2' *HRPSame as Benchmark Alternate Benchmark—Top of 1/2" pipe C 100.0' 131 st. Ave Scale = 1/4" = 10' unless otherwise noted 140th St. A1t.B.M. 10' B -1 35' 40' B.M. 8% Slope 170' 85' \0'B 50' B -3 97' 95' 215' Property Line 1 2 5 0 V 43&x` r �-- - 21 •219.9 to do a i • ■ W in LAOrg 1C4 Lo acres t f An t 4 a 1 62J 235 • a i i r 77; RECEI�IE� Wisconsin Department of Comme �Eg Q 9 A IL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 89, Wis. Adm. Code qty St. Croix ST. CROIX COUNT Attach complete site plan on p not ie I @ F11 in size. Plan must include but not limited to: vertical ; direction and Parcel l:D. percent slope; scale or dimensions, north arrow, and- location and distance to nearest road. Ple"o prinfa/l. infofmadon. R viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)): O �� Property Owner Property Location Greg Peterson Govt. Lot SW 1/4 SW 1/4 S 25 T 30 N R 18 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1611 Hwy 10 11 Hollow Pond City State Zip Code Phone Number ity QVIlage ■ Town Nearest Road Spring Lake Park I N1N 1 55432 1 7¢3 780 - 4996 140th Street Richmond Q New Construction Use(D Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable it General and recommendations: * ions: with cont' ds of Om sl This site is s wta le for mound system ue to scl Om at 18 m borin �- 4o Ce' /Rat. E l ®Boring W r °` cQesi Boring #.. �� _ — . Pit Ground surface elev. 99.93 ft. Depth to limiting factor >86 in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/[F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * Eff#1 * E 1 0 -10 10yr3 /2 A 2msbk mfr aw 2f .5 .8 2 10 -20 1 4/6 Sid lmsbk mfr cw if .2 .3 3 20 -41 7.5yr4/6 Is lmsbk mvfr cw - .7 1.2 4 41-49 10yr5/6 s Osg ml Cw - 1.2 5 49 -86 10yr5/6 *s *Osg *ml - - 3 5 F Boring # D Boring 98.93 >88 El pit Ground surface elev. ft. Depth to limiting factor in. Soil 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 -8 10yr3 /2 - sil 2msbk mfr aw 2f .5 .8 2 8 -13 1 4/6 - sicl lmsbk mfr cw If 2 3 3 13 -25 7.5yr4/6 is lmsbk mvfr cw _ 7 1.2 4 25-88 7.5yr4/6 sl Om mfi - . Z * Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 150 mg/L *Effluent #2 = .= _ 5 j e < 30 mg/L and TSS < 30 mg/L 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 OILILOW POND LOT 1.1 Ww LOT COXWEB I I 199 344' 2 ?' B2 3q BM BMI TOR OF COWID UXT 100.00' BBi2 TO -lp OF ,COFDTJIW 99.23' B 19 B2 98.93' S% B3 9.6.SS' SCALE I" = 30' S ORE Ss 3 M,I BI THOMA0 WX3L00W ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ' M ti N u ■ — r���r, ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 p•°" ""� 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 ' /4 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 1 r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OV NNTERSHIP CERTIFICATION FORM Owner/Buyer e v Mailing Address 0 3 S e Address n . tructi P m' — (jl�cation required from Planning &Zoning Department for new cons ) Pro Parcel Identification Number Z!� P C i ty /State R Z (o LEGAL DESCRIPTION �1 Q l� / T a , Sec. �` 32J 11 � i1 W, Town of Property Locatiotl - / , t I Lot # bdivr � ' � ,� '` Su sron �--' Volume Page:# Certified Survey Map # ' Warranty Deed # Volume ______._ -- Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature fail a lr handle was at you put into maintenance consists of pumping out the septic tank every three years or sooner, if needed, by Pea the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance fu responsibilities are specified in §Comm• 8352(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. owner s to submit to St Croix County Planning & Zoning Department a certification form, signed by the The property agree v that (1) the on -site owner and by a master plumber, journeyman plumber, restricted plumber or a license pu umpenfy m necessary), septic tank is wastewater disposal system is in proper operating condition and/or (2) after inspection pumping ( less than 113 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 Cotntnerce 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. of m /our knowledge. Uwe am/= the owners) of the I/we certify that all statements on this form are true to the best y prope described above, by virtue of a warranty deed recorded in Register of Deeds Office_ 4 SIGNATURE APPLICANTS) DATE * An y information that is misrepresented may result in the sanitary permit being revoked by the Planning & Dning Npatuneni. * # � 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) U 2685P 179 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH ♦ ' WARRANTY DEED REGISTER OF DEEDS ST. CROIR GO., WI Document Number RECEIVED FOR RECORD This Deed, made between Silver Lake Land. LLC. a Corporation 10/29/2004 08:25AK Grantor, and Kenneth J. Oevering. # ._- Grantee. WARRANTY DEED Grantor, for a valuable consideration conveys to Grantee the following EXW # described real estate in St. Croix County State of Wisconsin (the "Property"): .. ): RANS 1272.00 y CCCCPFEE: ck wk-s, PAGES: 1 Recording Area Name and Return Address _ ..j.:N TO: urn et Title 75 50 France Ave. S. 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 4 Dated this day of October 2004 (SEAL) (SEAL) Gregory J. Peterson, Presiders Silver Lake Land, LLC (SEAL) (SEAL) s AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ) ss. authenticated to v lq NY da of ATZ I N A St. Croix County �J- Personally came before me this day of STATE OF WISCONSI O ctober 2004 the above named Gregory J. Peterson as President of Silver Lake Land. I-C., a Corposation to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the foregoing instrument and ackn vvledge a same. (If not, _ authorized by §706.06, Wis. State) THIS INSTRUMENT WAS DRAFTED BY jLcJ a30�— Coldweil Banker Burnet Notary Public, State j6f Wisconsin 1301 Coulee Road Hudson, WI 54016 My commission Is permanent. (If not, state expiration date: 5 (Sigma 1 (� ) (Signatures may be authenticated or acknowledged. [S 1 / Both are not necessary.) " Names of persons sIqnIn2 in any caocU must be ed or Brinted below their signature. Parcel #: 026- 1163 -11 -000 06/29/2006 04:34 PM PAGE 1 OF 1 r ' Alt. Parcel #: 25.30.18.1261 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 " 1403 131ST AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DI ST I S SP 1700 WITC Legal Description: Acres: 2.100 Plat: 10/03- HOLLOW POND 026/04 LOTS 1/16 SEC 25 T30N R18W PT SW SW BEING HOLLOW Block/Condo Bldg: LOT 11 POND ('04) LOT 11 (2.100AC) 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 05/07/2004 761870 10/03 PLAT 2006 SUMMARY Bill #: Fair Market Value: Assessed with: I 0 Valuations: Last Changed: 06/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.100 29,300 0 29,300 NO Totals for 2006: General Property 2.100 29,300 0 29,300 Woodland 0.000 0 0 Totals for 2005: General Property 2.100 29,300 0 29,300 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 FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12 ISE �f t. MV VWU �w I O i N d j - --- - -- -- - -- --- ---.- i -- FROM .OEVERING HOMES LLC FAX NO. :7155311262 Dec. 14 2004 10:14PM P11 Ail ow" Am Q D 8 ` Bell. How an N r ..,....__- ---- -- .- .- - -• -�. N SI N 1 . - r w -