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HomeMy WebLinkAbout026-1288-02-000 Wiscon& i Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499172 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: Marek, Todd I Richmond, Town of 026- 1288 -02 -000 CST BM Elev: Insp. BM Elev: BM Descri ti _ Section/Town /Range/Map No: d 0.. a Nw 26.30.18.1445 TANK IN ORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Aj t4) Septic /n Benchmark Q � ` r7 Dosing i / Alt. BM , . I [� � . U (N Aeration Bld oe�iver 1 Holding St/Ht Inlet TANK SET SUHt Outlet SETBACK INFORMATION �1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / _ 7 Dt Botto 15-1 / S(� N Q Dosing Header/ an. �� Q� r Aeration Dist. Pipe, / , 2r C2 - z- Holding Bot. System �R PUMP /SIPHON INFORMATION Final Grade a( Manufacturer / Demand t Cover - / 1 I n. /O C(/1J GPM l J Model Number 3 <- Q TDH Lift 2 Friction os� System a Forcemain L th _ Dia. y Di t. to Well I / r SOIL ABSORPTION SYSTEM jA&z BED/TRENCH Width Length / No. Of Trenches PIT D IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ( 10 1 3 SETBACK SYSTEM TO P/L BLD WE LAKE /STREAM ACHING Man erX INFORMATION CHAMBER O Yidb Type f System: I ` r�1 UNIT Model l DISTRIBUTION SYSTEM ytl Header/Manifold Distribution 1 x Hole Size x Hole Sp90N rq�� 1 Pipes) Length � D�a Length Dia Spacing � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center [ Bed/Trench Edges Topsoil H Yes Q No 0 Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1388 134th Ave. New Richmond, WI 54017 (SE 1/4 SE 1/4 26 T30N R18W) Stone Run Est, s of 2 Parcel No: 26.30.18.1445 T` ' o� I►�al�(�I QQ ceue�� a/u - �vzr 1.) Alt BM Description = {� 3 2.j Bldg sewer length = 3o _ 0 _ �7 L Q O i �„ , _ „ _�- - amount of cover = '7 4 1 &)' 7 '� E �►'� Vl� w�- n 1 (!J'I n- `� 57p64- Plan revision Required? N Yes No '� 1�1 6 7 Use other side for additional information. � - 1 C� l0 S L4 Date Insepctor's Sign ture Cert. No. SBD -6710 (R.3/97) I Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 i seonsin Madison, WI 53707 — 7162 Sanitary Permit Number to be filled in by Co.) Department of Commerce (608) 266 -3151 I 1 Sanitary Permit Application State Plan LD. Number d � PP ._ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information — Please Print All Information Property Owner's Name kR�I Parcel # Lot # Z Block # f ODD I)IA-k ,rte K Property Owner's Mailing Address Property Location O / _O (, � d 2 2 SEP 1 5 2006 /�r Z City, State t Zip Code Phone Number °' —��" Section ire V w /LiC.Gr�O� W( ✓ [ 0 / ✓� � D T�DN; R / / V Eo le rQ)!/ ) TY T. Type of Building (check all that apply) �/f �y *t"br 2 Family Dwelling — Number of Bedrooms 3 1 (� e- r J ' & 1wL) Subdivision Name � CSM Number ❑ Public/Commercial — Describe Use P S f a ­;iE ❑ State Owned — Describe Use ❑City_ ❑Village Wownship of &C f r/ to A/O Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Perin it Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) ,[j, C9 Non — Pressurized In- Ground ❑ Mound > 24 of suitable soil ❑ Mound < 24 in. of suitab e soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In -Gro d ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ ecirculating Sand Filter ❑ W `� Recirculating Synthetic Media Filter 1&6aching Chamber ❑ Li Grav 1 -less Pipe ❑Other explain) 3 Y• �h S n V. Dispersal/Treat ent Area Information: % V 1A 99 Desi n F (gpd) Design Soil Applicatior (gp dsf) ispersal Area Required (sf) Dtspersal Elevation 7 /��� a(,t�GIC VI. Tank Info Capacity in Total N ber Manufacturer Prefab ite Steel Fiber Plastic Gallons Ions Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tak ,/ Aerobic Treatment Unit !` Dosing Chamber �) �7 _.. 3- VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er' Signature MP /MPRSNumber Business Phone Number C� X 40 - 2 z 6 y`� T /s 5�� Plum er's Ad (Street, City, State, Zip C (Tde) VIII. C unt v /De awn — ent Use Onl pproved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued suing Age Signa re (N tat ps) ` Surcharge Fee) p El Owner Denial Owner G iven Reason f I / ` _ oV . l(�J�Gc IX. Conditions ofAppro Re n for isapproval l SYSTEM OWNER: /It / W 1 Septic tank, effluent filter and x,01' vh 71�1� dispersal cell must all be serviced / maintained as ent Ian provided b Plumber. All setback requirements must be maintained as per applica a code /o d'nances. A ch co lete plans (to the C i6nty only) for thoystcm on pager not less than 8112 x 11 inches in size MdJ171 .-n111Y vim_ SBD -6398 (R. 01/03) PLO r1 f°P 16 7 c c. �a&A R gi Is s vi CemQ� PLO P,�,JA) I ' ` D F 4.1 An C r - K- Got Z P z L �a &A Ito 8 gi A p 4f s� Co�n�� COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must adend to a point no greater must eidend at least than 6" Below Finished Grade 4" Above Finished Grade . 510 Coverwith W&A N 00r YI� — 514 ko- C4 IP Locking Device �N 64x (typical) � hed Grade N /Z .M�N.frhv�'+'► ui LwJ6r 56 We-12- _ Min. 23" 30 FI" >�2 Access Opening i O P- iN5� UL Min. 23" Access Opening „ P) PC J� Oulat Effluent Filter j 11 /7W lf��ovc S�'E union ?I PC 3 Pr � �� p/v`Ta SOL /D SOiC_ Inlet Baffle Pump rn with Pdy 3 �'''`° °r Two Co Se tic Tank ✓✓ ,9 P P P (4 o�q �i1� &n a&Vs M /4) SPECIFICATIONS f� TANK MFR: �Xy r DOSES PER DAY: TANK SIZE: SEPTIC GAL. DOSE VOLUME: 7" r( Z GAL. DOSE GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: CAPACITIES: A= Z �✓'r ACHES = GAL. MODEL # ,w /O Switch type: B = — 2 — INCHES = GAL. PUMP MFR: ou Gd C = -7 INCHES = JW Z GAL. MODEL #: Pz 4 / SWITCH TYPE: /y/ D = INCHES = / Z 3 GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) Iven / 6.4 - L - VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ / �i FT. MIN UM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + -G FT. 6 -7 I FT. OF FORCEMAIN x Z. T. 1100 FT. FRICTION FACTOR ...... _ +--2---12N-FT. �— TOTAL DYNAMIC HEAD (TDH) INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH MP/MPRS SIGNATURE: X, LICENSE NUMBER: APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 HGOULDS PULPS Submersible Q ��eff Effluent Pum BUT 1#19 4 PE INLVEW P UMP SPECIFICATIONS MOTOR FEATURES Pump — General; General: ■ Corrosion resistant • Discharge: 1'h" NPT • Single phase construction. • Temperature: 104 °F (40 °C) ' 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload pro- cover. • Solids handling:' /," tection with automatic reset t Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing APPLICATIONS Automatic models include a • 011- filied design. construction, float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the ' Manual models available. shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 votes operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. �. ■ Quick disconnect ......• Heavy Duty Sump/ PE41 Pump: • ,40 HP, 3400 RPM p ower p Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts 16� c o Vy duty rd length, • Maximum head: 29' TDH • PSC design hea or duty volt grounding PE51 Pump: PE51 Motor. plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact. METERS FEET 'PSC design ■ Mechanical seal is carbon, 40 7 — _ ceramic, BUNA and stainless PE51 I j I - I MODELS: PE31, PE41, PE51 steel. 35 HP:.33, .40, .50 ■ Stainless steel fasteners, i I i • I 10 i• 2 GAM I ' I i i I I AGENCY LISTINGS 30 •PB4 i 1 _ I. I �, I i 1 FT � O i l l I, I I I' , �•i Q I I I k z � ZS i I I I I I ! IC s 20 I • • -. F "` �- I I I Tested to UL 778 and I I ; CSA 22.2 108 Standards 0 15 r BY Canadian Sbn&v& Azuda6on rile #U811se it I I 10 Gourds Pumps iS ISO 9001 Registered ; J. II'I j� I -- i il.j. 5 + li •� i Ali , I I II i l i' , J ' ' I • I .� 1 I I o °oil. to "III 20 30 40 50 60 70 GPM 8o 0 5 1 0 15 m Goulds Pumps 2004 ITT Water Technology, in E Effective June, 7004 ITT Industries po l ck4 �' b 77 3 g STANDARD CHAMBER 1? 52° Quick4 Standard Chamber 48 " (EFFECTIVE LENGTH) p e B B 12" © 6" 34" E VIEW SECTION VIEW MultiPort End Cap A I 16" 12" 34" SIDE VIEW TOP VIEW FRONT VIEW s t , INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY (a) The stmctural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( 'Uhitsj, when installed end operated In a loachfield of an onslte septc system In accedence wkh Infiffratoes instructions, is warranted to the original pur;haeer ('HOldefi against defective materials and worivnanstYp fe one year from the date that The septic permit is issued for Its septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date That installation of the septic system commences. To -.c' its warranty rignts, Holder must ratify Infiltrator In writing at its Corporate Headquarters in Old Saybrook, CorxwfioA within fifteen 05) days of the alleged detect. Infiltrator will supply replecernent Units for Units determined by Infierator to be covered by this Umfted warranty. . . Infiltrator§ liability specifically excludes the cost of removal and/or installation of the Units. Q THE UNI WAR AND REMEDIES WA S^ M SUBPARAGRAPH (N EXCLUSIVE ARE THERE ARE NO OT WARRANTIES WITH RESPECT T T SYSTEMS INC TO THE UNITS, , I LUDING DING NC NO IMPUF� WARRANTIES OF MERCHANTABILITY FITNESS OR FOR A PARTICULAR LAR PURPOSE. (c) Thi ext end to incidentals Umit Warranty shall be void If army pert of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does .Pu not , consequential, special a nhdnect damages. Infiltrator Shall not be liable for peneeles or Iiqukleted damages, Including loss of Environmental Onsite Wastewater Solutions production and profits, labor and materiels, overhead casts, or other losses or expenses Incurred by the Holder or any third parry. Specifically excluded from Umited Warranty coverage are damage to the Units due to ordinary weer and tee , alteration, accident, misuse, abuse or neglect of the Units; the Urds being subladed to vehicle traffic or other conditions which are not permitted by the Installation Instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth In the Installation Instructions; the placement of Improper materials into the system containing The Units; failure of Old Saybrook, CT 06475 The Units or the septic system roper due to knp eithp or nnproper sizing, excessive water usage, Improper grease disposal, or improper operation; a any other event not caused by Infiltrator. This Limited Warranty shelf be void ff the Holder fails to comply with all of the terms set forth In this Limited 860- 577 -7000 •FAX 860 - 577 -7001 Warranty. �f Further, h no event shall Infiltrator be responsible for any Ines a damage to the Holder, the Units. or ary third parry resulting from installation or ship- 800 rnenL a mom arty product Iiabgiry dakns of Holder or any thnd party For this Limited Warranty to apply, the Units must be Installed In accordance with ad/ site conditkns reWdrad M state and local codes; all other applicable laws; and Infifirator's Installation Instructions. (d) No representative of Infiltrate has the authority to change or extend this U rafted Warranty. No warranty applies to any perry other than the origi- nal Holier. The above represents the Standard Unified Warranty offered by Infiltrator. A limited number of states and counties have different warranty require- ments. Any puchaser of Units should contact Infiloata's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a COPY of the applicable warranty, and should carefully read that warranty prior to the purchase of units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark In Mexico. Contour, Contour Swivel Connection, Microl-eaching, PoyTuff, SnapLock, ChamberSpacer, PosiLock, OuickCut, OuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiftrator Systems Inc. Printed in U.S.A. Q011203HP -0 LI RECEVED JAN 0 Wisconsin Department of Commerce SATION REPORT Page of Division of Safaty and Buildings ST. CROIX Adm. Code County, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Revi by Date Please print all information. ed Personal information you provide may be used for secondary purposes (Privacy Law, s. t 5.04 (1) (m)). 0 Property Owner Property Location �-, Govt. Lot 1/4 r1/4 S N R E( ) Property Owner's Ma' ' Address Lot # Block # Subd. Name or CSM# City tate Zip Code Phone Number [:I city E3 Village Town Nearest Road New Construrlion Us Residential / Number of bedrooms - Code derived design flaw rate GPD ❑ Replacement Public or commercial - Describe: - - - - - -- - -- `— Parent material - - 'Y-6 1 Fl Plain elevation if applicable General comments ! ! / d and recom lions Sl /� . Qi ✓c� ' D • 7 � 40 ti Bo FP Boring # Pit ring Ground surface elev. Vft- Dep to limiting factor U in. lication Rate Horizon Depti Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z z - I->: 3 U -/ -- - /In - ' ? s s Ong # FjiBoring it Ground surface elev. ' ( *ft. Depth to limiting factor in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f * in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EtT#1 Eff#2 Effluent #1 = BOD > 30 <_ 220 mg/L and TSS >30 -` 1 nt #2 = SOD < 30 mg/L and TSS < 30 mg/L ignature CST Number CST Name (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number � 715- 246 -45 Address Date Evaluation Conducted p 1008 192nd Ave, New Richmond, WI 54017 _ I S T CO UNTY PLANNING &. ZONING FAx MFmo DATE: J 2, 0/ 6 S To:S Code Administrati FAX NUMBER (o - 7 ) - - 3(-1 715 -386 -4680 Land Informati FROM 4/W Planning FAX NUMBER 715 - 386 -4686 715 -386- 4 R roperty PHONE NUMBER:, e - 386 -4677 Re ling NUMBER OF PAGES, INCLUDING COVER SHEET: la 71 6 -4675 RE: �-o-T-s 2 3 1 - �- c � -.o �e- OK d" 46 OA i ST. CROIX COUNTY GOVERNMENT CENTER 1 1 CARMICHAEL ROAD, HUDSON W/ 54016 715386 FAX PZ @CO.SA CROI US W WW.CO.SAINT- CROIX.W Property Owner _ Parcel ID # Page of Boring #' Boring it Ground surface elev. ft. Depth to limiting factor Z 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 2 L L Z� s 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 GPFM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff l 'Ef1#2 F Boring # ❑ C1 Pit Boring Ground surface elev. ft. Depth to {uniting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/N 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 1 30 mg/L and TSS 1 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. seD4330 M-6=) I ` Soil Test Plot Plan Project Name. Bryan Schaefer Sha ird Address 1336 140th St. New Richmond Wi 54017 M #226900 Lot 2 Subdivision Stone Run Estates Dat /1 /04 NE 1/4 SE 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 99.1 /98.7/98.3 *HRPSameasBenchmark Alternate Benchmark Top of survey iron @ 997 Alt. B.M. M. 167' Property Line 75' A Scale is 1" = 40' B -1 5 unless otherwise Ks 30' noted 6% Slope 120 45' 100' B -2 494' B -3 Property Line 102' 10' roperty ine — - N00'16'12"E 988.28' — 418' — v \ / OC \\ 1 ' I a 1 \ \ o o Ul - 1 012 0 En 418' \ ' I I � -° =— — —0 t0 l— Ln j L4 0 L-j } � .: /� '"' ' -x i� / O ►.a v ,905 rZ001 � ; /' / / lo I N CO ✓ —pp : g66 • o gog cn u, / co r ' f ` i / , / v V CD lot- N OD / U / / � / • /v I / / 418 / \ ( / / n to c / I v , to lZ5 �,J I \� I N `o / v 1� ' ry L '' 00 I / 406.28' I I r / ,' r / ......rrr • ��� „Q w \ 19 ` 9 0 I 9 <D - I . ` 9 cu) 'Eosem en t �' ,� 3 Cif ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - �� Mailing Address Q D Z 2 � Property Address , tf E (Verification required from Planning & Zoning Department for new construction.) City /State �� Parcel Identification Number o- L o r 7— C.T r✓j F LEGAL DESCRIPTION D 26, /a Property Location /y �' 1 /a , � ' /4 , Sec. T _ R /5W, Town of �Ct�ls�,tA /2-u Subdivision �j�/f/ � 7 7 f� S , Lot # — L Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house es 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms /4� no F/// 6 6 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) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1,9* Septic Tank Capacity ' Z, -D ai ❑ NA Permit # Septic Tank Manufacturer (J�� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 6� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 41--y ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 0-V a l ❑ NA I Estimated flow (average) g al/day Pump Tank Manufacturer T.{J12� ❑ NA Design flow (peak), (Estimated x 1.5) 4"T gal/day Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model PE 2q ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit XN A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 1 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) /�� A Biochemical Oxygen Demand (BOD 530 mg /L \/ IS In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L [OVA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510' c 1 00m ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: E3 NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA ever 9 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: - ® y (Maximum 3 years) [I NA Clean effluent filter At least once every: 13 mo nth(s) ❑ NA ® year(s) Inspect pump, pump controls & alarm At least once every: ?' ❑ month(s) ❑ NA B year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 'M year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of, combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services including ut not limited to the serv filters mechanical or p ressurized components,. retreatment g of effluent p p units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page Z of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent: To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve .the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • enin sealed All piping to tanks and pits shall be disconnected and the abandoned pipe openings , • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the PO fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaceme system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to 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 holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name o IZ N CL SON Name Phone ' 7 1 5 - - Z 7 3 _ ll( Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 712 ? ? c' This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code, Parcel #: 026- 1288 -02 -000 09/18/2006 08:43 AM PAGE 1 OF 1 Alt. Parcel #: 26.30.18.1445 026 - TOWN OF RICHMOND Current L ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/12/2005 00 0 Tax Address Owner(s): O = Current Owner, C = Current Co -Owner O - TODD MAREK CONSTRUCTION TODD MAREK CONSTRUCTION PO BOX 228 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 1388 134TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.040 Plat: 10 /077 -STONE RUN ESTATES LOTS 1 -11 026/05 SEC 26 T30N R18W PT NE SE STONE RUN Block/Condo Bldg: LOT 002 ESTATES LOT 2 (2.040AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 30N -18W NE SE Notes: Parcel History: Date Doc # Vol /Page Type 02/27/2006 819409 WD 09/12/2005 806196 10/077 PLAT 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/22/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.040 29,000 0 29,000 NO 02 Totals for 2006: General Property 2.040 29,000 0 29,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 819409 �'' KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIX CO.. VI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 82/27/2006 03:38PN VARRANTY DEED THIS DEED, made between 6 -G Corporation, a Minnesota EXEWT # Corporation, Grantor, and Todd Marek Construction, Inc., a Wisconsin Corporation, Grantee. TR 246.00 Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 1 Lots 2 and 3, Stone Run Estates, St. Croix County, Wisconsin. Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2n St. — Suite 115 2 Exceptions to warranties: Hudson WI 54016 Easements, restrictions and rights -of -way of record, if any. 496245 026 - 1077 -30 -200 Parcel identification Number (PIN) This is not homestead property. Dated this 24th day F ary,, JJ � 6 -G Corpoli atiq inne Corporation B B * J040. Brunner, President/Treasurer, 6 -G Corporation, a * Ke to J. Kelly ice- s nt/Secretary, 6 -G Corporation, Mit{esota Corporation, President/Treasurer a Minnesota rporatio ice- President/Secreta * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) oar VII ST. CROIX COUNTY. ) ss. authenticated this 24th day of Februaryl Personally came before me this February 24, 2006 the NojeL O , n s`1(1 above named John J. Brunner, President/Treasurer, 6 -G * Corporation, A Minnesota Corporation and Kevin J. Kelly, Vice- President/Secretary, 6 -G Corporation, A Minnesota TITLE: MEMBER STATE BAR O CONSIN Corporation to me known to be the person(s) who executed the (If not, foregoing ins ent and acknowledged the same. authorized by § 706.06, Wis. Slats.) c All THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Peterson, Fram & Bergman — Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 3/11/2007 *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 819409 1 of 1 Sep .07 06 08:54p Todd Marek 17152469341 p.4 w MINARY PLAT OF STONE RUN ESTATES (a County Pvan 114 of the Southeast 114 of Sect;o, 25; Township 30 North, Range 18 West, Town of R:07MOnG, ot 2 of c Certi,ied Suriey Mop eccrded in Volume 9 Page 2551 rn the St. Croix County Register ' of Deeds Of ice. I I I I I LOT 1 I \ CER /, "Et7 SU RVEY ' PJA tML Uti!E 9 PAGE 2452 \•� 999. 41 171" 17.1' ♦ t67' r t ( 1 \ \\ 8 �\ �\ ♦ ♦ i :: / IJ gal } \ ���1 It i \ \ \ r �� ♦ \\ 128:20.1 sq\ ft. r t 9 �,La ! y `a a,o .1 t i ! r 4 - S ; Q 131,549 S ^fr• ! of \ : 89,821 s ft 89,821♦s ft. 88,955`•sq. 3.02 acr sl q ' l q- •3. J / +;! 1 1 2.06 acres 2.06 aces X 2.04 occes / �• / ^ I i a E0 I !l ...... .`.` l .. �. ,.\ �.. �.� ..j� \ 1 74 X77® ! �O�! L I \ �\ ` \♦ ♦ \ y \ / ♦ f 1Q't ,067 sq. i ft. f� !! !/ JI I - ! ! RI, / �/ 1a5' ! ies' v `. eras `. va ' ` o' _ \ A \ I I ! ! 1... .......1 .:...............t..... ��_ .......:...I..... .... ... ..1.,..`. � 9 i / era, ♦ p \ C \ \ �0 — f Lf l \T� I \' O \ I 1 !9 \ \� _ ro / 90,6h9 sq. ft. ° (] _ 77,33 �sq. ft. `+ 77,330 sq. ft. f `t 77,330 sq. lft. i '� 7 ,33 sq. ft `+ 9 2.09 ve Nl 1.7.8 acres 1.78 acres !/ 1.�8 ecre i 1.78 ,acres 1 / y l r / J � ai _ 185' 185' . 77• 10 209' / �'� �� _ ��� ~Itts �` '�\ �I � ', �\`: ` \.\ I '\ •\ / !! //� "� ' 077. "��,a�l }Ill \ Ofl �T 3 No —! l R�� L� ♦\ `�\ ♦� \ I QT�4 J r f — ��' ' ' IL'I ♦♦ c RTIF /ED SURRVEY MArrt CERTIFIED SURI/EY MAP I/OLU6f� 9 P ?AGE 2551 I i!OLUME 113 Al GE 3620 r7 2?j I _ j t to Statc, County and To IM lot size, access top Contact the St. Crair county I hereby certify that this map wcz prepared by me or under my direct supervision, ' advice. 'hat It la true and correct to the best of my knowledge end that i om a Euly Registered Land Surveyor unde.• the laws of the State of Wlscons( , 68 DANM. WSE SPECIFIED. DODGE. REGISTERED UCENSED SURVEYOR NO. 2484 ,B'. -E AREA) UNLrSS O1HER .. .. DATE