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HomeMy WebLinkAbout026-1167-22-000 Wiscon"sn Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr 'X Safety and Building Division INSPECTION REPORT Sanitary Permit 46345 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: Glen Johnson Construction I Richmond, Town of 026- 1167 -22 -000 CST BM Elev:. Insp. BM Elev: BM Description: �., Section/Town /Range /Map No: /Xi 1 8 # GS 1 27.30.18.1324 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Al Benchmark ,^ / , I 14-10 f Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet /0 35 7S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic s / Dt Bottom 74+ Dosing Header /Man. Aeration Dist Pipe , „ q,� Holding Bot. System , 3,' Final Grade q •7 PUMP /SIPHON IN ATION / 47 Manufactu Demand St Cover � 1 P / 5. C� Mo I Number TD ift Friction Loss ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ; Length / No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �{ ltT� a eVV _ --�� I J SETBACK SYSTEM TO Q CJ P/L BLDG 1 WELL LAKE /STREAM LEACHING Manufacturer: r t INFORMATION CHAMBER OR l Type Of Syst 6 �J i' , /� UNIT Model Number: J G` I A L04:__1 1 60 DISTRIBUTION SYSTEM AWL ZO erLcL, 4o Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air talk! t Length / Dia T Length Dia Spacing e SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth o xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil -1 Yes 1 1 No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1 / Inspection #2: Location: 1377 126th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 27 T30N R1 8W) Lundy's�Preserve Lot 22 Parcel No: 27.30.18.1324 1.) Alt BM Description = C ► k 4 , 2.) Bldg sewer length = Z4 6 - amount of cover = If Plan revision Required? Yes No Use other side for additional Information. __ -- Date insepctor's Sign re Cert. No. SBD -6710 (R.3/97) 1 Q, I S 4N v7 4 � � b b 1 a , p - -- Safety an W I1 =viclnn County -- T 201 W, Washin ton �! /�j t� Madison WI 53 atutary Permit Number (to be filled in by Co.) \ Vis cons i n Department of Commerce (,8) 266 -3151 s/ � Sanitary Permit Applic io State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal info mation kF IC i P may be used for secondary purposes Privacy Law, F �CE Project Address (i different than mailing address) I I. Application Information - Please Print All Information 1Z,,", Property Owner's Na me Parce # /l Block Property Owner's M ailing Address Property Location a 61 . cab &� �� City, State Zip Code � Phone Number I � i Z� T / 3 Q N; R E oCWJ II. Type of Building (check all that apply) (circle/ "1 or 2 Family Dwelling - Number of Bedrooms 4LAr Lyi eTi Subdivision Name CSM Number ❑ Public /Commercial - Describe Use i J State Owned - Describe Use —_� T � ❑City_ ❑village ownship of _ C4 o._ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. �y New System ❑ Replacement System r I Y+t Y p y ❑ Treatment/Holding Tank Replacement Only I ❑Other Modification to Existing System B • ❑ Permit Renewal Permit Revision ❑ Change of _ ❑ Permit Transfer to New j List Previous Permit Number and Date Issued Before Expiration Plumber Owner it N. T ype of POWTS System: (Check all that app p S ' i Xlon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < .. in- of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Cham Drip Line ❑ Gravel -less Pi Other (explain) V. Dispersa /Treatment Area Information: 3 I Design Flow (gpd) Design Soil Application Ra so IN Irsal Area Required (st) Dis ton z VI. Tank Info Capacity in To Number Manufacturer Prefab Site Steel Fiber C Plastic r Gallons Gallons of Units Concrete Constructed Glass New Existing _ Tanks Tanks i Septic or Holding Tank - Aerobic Treatment Unit ! r ! Dosing Chamber V II . Responsibility Statem - 1 , the undersign assu responsibility for iuskaflation of the POWTS shown on the attached plans. Plumber's Na me (Prinz) Plumber's Si gnature MP PRS Number Business Phone Number ! Plumber's Addre ss (Street, City, State, Zip Code) /d : 5 e__ L�� VIII. o n I u t /De artme Use Only pproved El Disapproved Sanitary Permit Fee (includes Groundwater pate Issued Owner G iven Reason fo r Denial suing Agett Sign re { S ' ps) ` Surcharge Fee) � _ ❑ IX. Conditions of Approval /Reasons for Disapproval r�s �Y ( r4 �44, L S45 A ttach complete plans (to the tounty onl Por the system on paper not less than 8112 ,x 1 c 4 ZI1T)_A10Q /D n t m 2\ (r►1� Y �' (/yt s cl�.(o O of Wisconsin Department of Commerce EVALUATI ORT Page Division of Safety and Buildings in accordance Con Y I e - � , C' Attach complete site plan on paper not less than 131/2 x 1 inches in size. Plan must ` Include, bu not limited to: vertical and horizontal referen ' point ( d r c n and parcel I.D. percent slope, scale or dimensions, north arrow, and I on an n t q@�oad. Please print all informa 'on. ST. CRO'XCO Reviewed by Date Personal information you provide may be used for secondary p P� (#tFtR4 )(m)). Property Owner Prope n Govt Lot / 1/4 Q S T N R E (or) Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# _G gog 0 7 Z- vA r� City State Zip Code Phone Number ❑ City ❑ Village ($Town Nearest Road d 5c, n, i t. , jt ii9l i ( ) , C " New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate S`r��l o GPD Replacement Public or commercial - Describe: Parent material T� Flood Plain elevation if applicable Z// ft General comments and recommendations: S ,pA -e /r v Boring Boring # © [� pit Ground surface elev. v ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -1 L 0 (3 ! S�` �- tr. - Z 1 1 ® Boring # Boring 1 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 o -(� pc - K313 Z- 1 1 - 1 3 16- �' C C — � 13 2-m . a ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L. ' Effluent #2 = BOD 1 30 mg/- and TSS 1 30 mg/L CST Wne (Please S' ture CST Number _ �S' O Address Date Evaluation Conducted Telephone Number I Property Owner �rJ� �L-5�n Parcel ID # Page of F Boring# ❑ Boring Ground surface face elev. �5L ft. Depth to limiting factor � in. �;i !cation Rate Pit GPDlfF Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. rr 'Eff #1 'E1f F —1 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 'Etf#2 ❑ a Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil !cation Rate ffA Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots •E GPD •Eft#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Effluent #1 = BOD, > 30 1 220 mg& and TSS >30 <_ 150 mglL ' Effluent #2 = BOD, 130 mglL and TSS 130 mg1L 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. r PAGE E O F 3 NAME' LOT# 6/l LEGAL DESCRIPT ION41C /a4- 1 /a,SZ-?Tl ,N ,R>�< - E(OR)w SCALE: I " BM I ELEVATION ��Q • U BM I DESCRIPTION DUG BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION ZZ, 5� SYSTEM TYPE 6 N` I S N � � SIGNATURE -�_ - -•�' DATE M i l ' g 1 p SR I .................�� 1 A \ 1 '�• y / IE r� �u�b R � ��ar �/ cs � s0,Zrr�N J " � I I 3• O I r.. I I s', S0022 58 368.13 °� I � I � H N m to SO1 2! E 406.62 N. SAC 500 "2'58 ° E 491.47 I n r I STANDARD CHAMBER Quick4 Standard Chamber - -- - 4a" - -- (EFFECTIVE LENGTH) e I r� ito I 4 te j 1 in I - -- 34" - -- SIDE VIEW SECTION VIEW MultiPort End Cap — - -, 12" 1 �_ i J'r \ SIDE VIEW TOP VIEW FRONT VIEW ,} Quick4 Standard'-ChamberyNominalPS ecifications� �{ MuitiPort Intl Cad Nominal Specihcatwo .° r r: ; Size (W x`L x H) "' 34'x 16 12" Effective Length 48" Invert Height - 8" or 1.25" Invert Height g^ FILTR R SY - STfiM i l STANDARD LIM WARa (n} he svvctural .1"nety of ea b C,hembw, end Plate, wedge and othe n,cass v n ant laofwa f by k f7iralp ('IJnits °1. when x stallee and operated n a leachfietd of an ensile snptic system In aocordance win I. 1t ator', lost uc,ons, s wo railed to Ir,P - qu,pl Purcx,aser 1 "Flrrdar) against aatac!ke r rater a and w x ><vt.slriri frx ram F3ar Iron, ihn data th t Ihu sepl'". f w. nil is issued fo u e sysle i cur tannq the Li peer ded, horwevcr, th If a soptil permtl I. not ragti oil M aPP+reatte law, thew l PwIud will both o r. , ell al 1. r tanauo al l n spl " s epllnlrncisI To o m 6e its wertany nqh! Hold, oust ol'fy I ifiarat 1 r at is C oo ate rr +a t.t[ rs - uW '+aybetoa u.r BLliGUI nn kaeen (7 G) . • d ry of the vlpgoily ed defa'!p1.. Infilt t. 11 supply ter 2Cnn¢ 1 U n - of Un I d Irxn,iwd tN nl1aato: to be wowed by 1111. L nire7 W manly ; rat it at s ,ial. f—1 kcafry a Uudas The coal of eernovig and/or installation of Inc un R WARR r - LAVE) WA I REME SUBPARAGRAPH (,tl ARE E 'I 1 01 ARE RI OT WAHRAN ?IES WITH RESPEC? T SYSTEMS INC o 7 HE Ll der INU UITING N IJ IMPLIED WARRANTIES OF kAEfiCHAtJTAII:LIT'ir Y OR OR tT N1.�; cOR A PAl9TICU'JW PURPO$[- I t 1 iris Limnpt W ranty shall ba vJid If any part of the than xr ,,Al n t .,nularturad y ary )w oth>.r than Infiltrator 'fhe t tr I Yyananty toes "71 extend to In 1*1131 '.ul9 jde�rtiai, special or iindi t damage.:. In t its snail not be fai la for pot a los a� liqu,datul dar:ae�s rnr.luding Vasa of Environn►entaf Onsite Wastewater SOJUf10RS pfrxludion and profits, tabor and m"lcariais, ovedksad Costs. or other losses o exparrs2s i ,;,,teed by (:v3 Holder or any third Carly Spaciffzaky e.cluded tram t rifed'Marmnly ccmerage are damage to the Units duo to ordinary wear and fear, allarali n, ace,der 1, rrvsuse, abuse w negierl of the Jolla: Etta J.i Is being scb0cted hi vehicle traffic or other conditions wkch are not parrr;ttn,l by the installation irutruolrorm fames to nlantan d's 6 Business Park Road • P.O. Box 768 n. nirl ground orw ,, set forth in lho installation instruction l; the placernell of impnPe nafmia!s into the system roMarrnng trio Ur,,ts, tailors of ,hi+. I.Mits or the WAIT; System drre to improper airptg er imPmprx s;zinq erwssive wets s age, Improper gmase disposal, or impronw, operation; any other event rt ur Old Saybrook, CT 06475 o caused by Ink9lator Rvs Limited Warranty sha, be �6d If the tW leer fails m WrIpy with ak o/ the tarots set ,onh n Ih,s Llmiled uvav- n;y. 860- 577 -7000 • FAX 860- 577 -7001 Furth Udunt er, in no even, - ,A total alt - oa resfx>nskde Iw ary fuss or damage ro Ina Holder. Ina Units. or any er- party r can sranaliur. or ship 800 _4436 mans, or HIT, any p reta 1, d' Iter1 ul Holder pr any It ild Perry ", this Limited Warrant' to itil the u W nits meet be indllr)d Y3 &Ceenan� With all cafe conditions required oy slate and local codes; all other arrttlicable taws, and k,fimakn's instariallcn instructions. (0 No IrProsar,latwe of Infiltralcr haw the auGtonty to mange or axlrrld Ines L,nfod Wena,ty. No warranty applies to any Many other than the origi- nal Holder. fine above tepee =sits the Slantlard Lunnad Warranty offered M k3fitirata • A kmdorl number of states and colrdles !rave A9feranr warranty require alerts, Any pumnaser of Unl1s shouts Contact Mtiltratc!r'S G3rWhIll, Heladrluanars in Oka Saybrook, GonnrcWut, prior to such purchase, to oblain a copy of the appical warranty, and snored Carefully read that waranty prior to Itle OurcraI .J units, u,S'. Patents 4,759.8fit; 5,(117,0-01; 5,758,488: 5,336,017; 5A01,176; 5.n0l,a,5f3; 5,511,903; o,71G,1ti3; 5,588,778; 5,839,fk44 Canadian Patents: 1,329.9, Cther patents pending. 9a61trator, Equalizer and Sido trader are registered trademarks of '.ini'llrator Sy.7lenls Inc. infiltrator fs a registered trallerrwrK in Fran,:e. IntiNrator Systems Inc. is a registered trademark in Mexico. Contour, Contour Swivel Ccrlrtection, MicfoLeaching. PotyTutf, Snaplock, ChamberSpacer, Posit_ock, QuickCul, Quk;kPlay RFCYCLEOPAPER and QUil are tzade+narks cf Infiltrator Systems 1110 2003 lnfilUator Systems Inc. Printed in 'J,S,A. nnI 19R' &IP_r1 r •• m'n D a 1,1 �x�� 7ON ANJ v�LLl:1LC .� ;k `TANK ; . UMP ��:A,.RZF_ CROS 4" Cl VENT PIPE ' 12" ifN. ABOVE GRADE b WEATHERPROOF ?:25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE -------- �---�� WITH CONDUIT MANHOLE COVER FINISHED GRADE WARhIhG 4" CI RISER 7 - MIN. 18" IN. B" MAX. +�++ NLET 1 1 WATER TIGHT SEALS GAS• , TIGHT : pPROVED A SE JOINTS WITH PPROVED - ALM APPROVED PIPE IPE 3' .. a ON 3' ONTO ITO SOLID SOLID SOIL OI L PUMP OFF ELEV. FT. - C �--- RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE 'y`ANK MANUFACTURER; Ke NUMBER LOSES PER DAY: " 5 IZES: SEPTIC GAL, DOSE Vo:l;ME INCLUDING DOSE .,._ GAL. FLOw9ACK: L GAL ALARM MANUFACTURER: L lawl... CAPACITIES; A x ,� INCHES 9 AL. MODEL NUMBER: sj 1. y Z INCHES x 30� GAL. SWITCH TYPE; 1�Z ....e.r s rr...,.....,.. 8 .�..�.. .�,.....,.�.� PUMP MANUFACTURER; oc C = $ INCHES = Y GAL. MODEL NJMBER SWITCH TYPE: dw1wr"r D = � INCHES = _ _GAL. REQUIRED DISCHARGE RATE ^ k GPM PUMP S ALA WIRING AS PER ILHR 16.23 WAC 'VE , ER L P F AND DISTRIBUTION PIPE .0 FEET FICA DIFFERENCE BETWEEN PUMP GF N + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . FEET + — 4e, FEET F ORCEMAIN X ji,igg,FT /10 FT. FRICTION FACTOR . Lxz,. FEET TOTAL DYNAMIC HEAD = _ ZLXI FEET !NTERNAL DIMENSIONS OF PUMP TANK: LENGTH - W DIAMETER LIQUID 1�'EP'I'IT "e 1 r SIGNED: �.- r6+ " / ' LICENSE NUMBER: ,r? -7f f0 DATE: 1/88 �GOULDS PUMPS • Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high all EPOS Impeller: Thermoplas- 8 Bearings: Upper and lower Spetifcaly designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. E Casing and Base: Rugged • Homes Available for momatic and t1wrnopiabbc design provides AGENCY FISTING • Farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matk models include resistance. 41' CoadW Suww 6 Assod•tfon • Water transfer Medtawtical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and p reset at the for efficient heat transfer, in T' or "C ".) factory. strength, and duraWity. SPECIFI E Motor Cover: Thermoplastic Goulds Pumps is lso coot Aeglstwed. • Solids handling capability: FEATURES cover with Integral handle and 'A" maximum. float swatch attachment points. • to cities: u to 60 GPM. E EPO4 Impeller: Thermopias- E Power table: Severe duty • Total heads: up tc 31 feet. pump o vanes for mechanical rated oil and water resistant. • Discharge size: 1'/j' NPT, seal protection. • Mechanical seal: carbon - rota rykeram ic- station ry, BUNA -N elastomers. ,, Temperature: 104°F (40°C) continuous 1401 (60 intermittent METERS FEET Fasteners: • stainless steel. series Capable of running 9 30 —► .—sG i .. . dry without damage to a \ *2.5 rr components. 2s Motor: • EPO4 Single hase: 0.4 HP, 6 M - -- 115 or 2 3 0 V 60 Hz, 1550 ._ RPM, built in overload with s automatic reset. O t5 ....,., , w......_ _.__. __.,.._.._ ...- ...... � • EP05 , Single phase: 0.5 HP +- 4 g EPOS 115 V, 60 Hz, 1550 RPM, 3 t o built in overload with automatic reset. 2 EPO4 • Power cord: 10 foot s ; standard length. 16/3 r SJTOW with three prong grounding plug, Optional 10 0 0 0 10 2 3 0 as so GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EPOS). 0 a 4 6 8 to 12 m'/h CAw►CIrr Goulds Pu m 1080 Goulds Pumps ITT Industries Effective February. 2000 83871 i y' Safer and Buildings Division F201 W. Washin 8 ton A Madisonqr ns�/1 Department of Commerce d (608) 2 313 t��'� ani Permtt Number (to be riled in by Co.) Sanitary Permit y Number In accord with Co 3 4 3 t A tat Ian I.D. MAY 0 4 20 nn Y Comm 83.21, Wis. Adm. Code, rsotral i Pe u provide may be used for secondary idary purposes Privacy Law, s15. (I)( ) $ T . CROIX CO roject ddress (if different titan mailing address) A I, - F lteation Jud pP ormation _ Pl ease Print All Information /2 / Property Owner's Na me Parcel # Lot X Block N �)�/ / Pro Owner's M �Z4 / (,7- 22-60b as Pent ailing Address Property Location Ciry, State Zip k, u Sec' on Code � � s P Phone Nu r ,�•-.— l I� (circle j II. Type of Building (check all that a. T N• R PI x) , _ E E o& 1 or 2 Family Dwelling - Number of Bedrooms Ne J � J Subdivision Name CSM Number ❑ Public /Commercial - Describe Use _ — �a 7 State Owned - Describe Use .. v //� �//�� ❑City _ ❑Vitt ge r ownship ofe�42�1f-j III. Type of Permit: (Check only one box on line A. Co lete li B if applicable) • A ' New System Y ❑Replacement System ❑ Treatmen o ing Tank Replacement Only ❑ O er odificarion to E stirs ys �B • Q Permit Renewal ❑Permit Revision ❑ Change of ❑ Permit Transfer to New Lts[ evi s m i ate Issued f ' Before Expiration Plumber caner IV. T of POWTS S stem: (Check all that a 1 ) Non - Pressurized In- Ground J Mound > 24 in. of suitable I L Mound < 2 of suitable soil At -Grade il ❑ Single Pass Sand Filter i ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holdin Tank ❑ Peat Filter Aerobic Treatment Unit J Recircul and Filter i � L ❑ Recirculating Synthetic Media Filter eachingChambe Drip Line ❑ Gravel -les ipe ❑ Other (explain) ,,,` V. Xs rsal /Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf ispersal Area Required Or) Dispersal ea Proposed (sf) System E evasion a S V . Tank Info Capacity in Total Nu r Manufacturer Pr Site Steei Fsber plastic Gallons Gallnrs I of nits Co i ncr Constructed Glass New Existing i Tanks Tanks Septic or Holding Tank -- rl. - Aerobic Treatment Unit Dosing Chamber el VII. Responsibility Statement- I , the undersign assume responsibility for anon of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si na re M>i /. PRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) r` VIII. Count /De artment Use Onl Approved is ved Sanitary Permit Fee (includes Groundwater Date issu Issuin gent S12na (N tamps) Surcharge Fee) Q Owner ' n Reas Mal 3 � t5 S 05 IX. Conditions of Approval/Reasons for Disapproval (� I 3� GJ• Ije. - ✓hv6d' Sv(, 6tJv�0 -`_ I1'�C .�Palr� � YSTEM OWNER: � V } 1 S�fank effluent otter and PG �" n e owe 64ar aJL- dispersal cell must all t>e rv' / I as per management plan provided by pkunber. 2. AN seiMck requirements must be r nahMM n W sppi c" cc* / noes. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size 93AWO MVZY8, ' t>nt taf6t 1nw�e ilrisi_atgs$ , P ,F!sF�r F..ha+sciESb al wws lb0o sift*" tp as i ldy 1 i 5 Q �us � l ao� I Tk � A A. c01 ef c; ,/ D L<rG GAG 1- !r /J v s r' u s D G S � 1 600 a� - U t � a'1 o.. ��� • " FILE iNFOR TION POWTS OWNER'S MANUAL & MANAGEMENT e PLAN Page of MA. _ _ L SYSTEM SPECtFfCA'flONS Owner z �^ Septic Tank Capacity al 13 NA Permit Septic Tank Manufacturer LI ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a p NA Number of Bedrooms ❑ NA Effluent Filter Model A 4r© ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) lf�t9 g al/day Pump Tank Manufacturer ❑ NA se,• Design flow (peak), (Estimated x 1 .fQ g al/day Pump Manufacturer `�,' � 13 NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg /L ❑ NA ❑ Mechanical Aeration CI Wetland Total Suspended Solids (TSS) 1 5150 mg /L CI Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Calls) ❑ NA Biochemical Oxygen Demand (1301) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 mont ear(a s! (Maximum 3 years) ❑ NA 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 ever hs) (Maximum 8 ears) ❑ NA y .� Wyearlg) y Clean effluent filter At least once every: months) ❑ NA yearls) Inspect pump, pump controls & alarm At least once every: ,-- ❑ month(s) C3 NA _ ❑ year(a) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ monthls) ❑ NA At least once every: ❑ 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. 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IS)Ileo lesJ9dslp 941 of peBsegoslp aq IIIM J91eMelseM ss9oxe 941 p9 Jols9J sl J9M U04M 'SIaA9I J 91eMyBl4 IewJ4U 9Aoge lit; Aew sjuel dwnd seBelno J9Mod BUUna •9oepns 9Alleul! ;w 041 Is uazOJ; eJ suo11!puo0 110s usyM sn000 1 ou 11 do lsel w9isAS •esn of Joud JoleJado BuimAJas eBeldas a Aq peno4AJeJ (s IMI 841 10 slualuoa 041 OAe4 p910e4Op aJe suo1le 4614 ;i '(2)1100 lessedslp 941 eBewep Jo /pue sse 1U9w1e9J1 0 419padwl A ew 1041 8l001w040 J9410 Jo slonposd Sul3ulRd ;o 6ouseoi 041 Jo; (s)�u wewlean 10043 S,LMOd 0 41 ;o esn of solid 'uoilonijawo Mau Job N011VV3d0 GNV do "VIS ;o aged tRECEIVED JUN 0 1 2004 Lundy's Preserve Comments: ST. CROIX COUNTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning, she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size, and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 5/28/04 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code � County Attach complete site plan on paper not less than 8 1/2 x 11 nches!`l�b�t� include, but not limited to: vertical and horizontal reference ' int ( � nd Parcel I.D. r Z percent slope, scale or dimensions, north arrow, and �ti n d distance to n ea rest road. 1� (07 Please print all 5.04 ( 1 info"t JUN O 1 2 00 4 Reviewed by Date . Personal information you provide may be used for seconds pu es rivacy Law, , s. 1 ) (m)) � �'{ A 5 Property Owner r cation r o 0 1/4 '�/4 S T N R E (o W Property Owner's ailing Address Lot # I Block # tj6d. Name or CSM# S � City State Zip Code Phone Number O City ❑ Village wn Nearest R 9. t? ;G/ _ /Y11i9v C� New Construction Use. Residential / Number of bedrooms Code derived design flow rate �Q GPD ❑ Replacement Pub lic �orr commercial - D scribe: f ! - - - -- -- -- Parent material 14/ Flood Plain elevation if applicable �- ft. General comments / 9 j and recommendations: S,�-S �P. e (�/(/ `J ` z ° ` q �• t7 fif/JJQ! , s Bori Ground surface elev. �� ft. Depth to limiting factor Pit in Soil 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 I - r a Bori ng # E] nng 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. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Q -i 0.-3� rocl r CS (o Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 ' Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L CST Number CST Name (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number Address Date Evaluation Conducted 1008 192nd Ave, New Richmond, WI 54017G` 715- 246 -4516 2 2.- Property Owner Parcel ID # Page of 51 Boring # Boring Pi Ground surface elev. Depth to limiting factor aC in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPW in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 0 -/0 3 — S ! of c o-) c s am . ! Z-0 F d- Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E Boring # El Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil iaation Rate. Horizon Depth Dominant Color Redox Description. Texture Stnxxure 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 1150 mg& ' Effluent #2 = SOD, 130 mg& 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. seae330 ptAm) Soil Test Plot Pl Jhn_ , ,.Project Name Environmental Holding L.L.P. d A ddress 706 19th St. S. Hudson Wi 54016 TM #226900 Lot 22 Subdivision Lundy's Preserve Date 5/24/04 N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 92.0/91.0 *HRpSameasBenchmark Alternate Benchmark Top of Survey Iron @ 96.0' 368' Property Line AL 94' 96' 92' Scale is 1" = 40' B -2 unless otherwise 3 noted s ' 12% Please note:Soil test Slo e was done to satisfy -3 county zoning requirement. Soil test may not be suitable for owners 15 desired building location. B -1 35' 40 Alt. B.M. 286' Property Line 120' B *M. r ST CROIX COUNTY SEPTIC: TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerrB uyer -� .�� Mailing :Address Property Address 77 / .5� (Verification required from Planning Department for new construction) City /State CJT-- Parcel Identification Number 6 Z C — // (o 7 — z z --aid LE GAL DESCRIPTION Property Location IN � ' /�, JUE 1 4, Sec. , T 0 N -R I t W, Town of _ sx,\, Subdivision L-- k e— t Q, , Lot # �� P114 Cert! ap , Volume lb ,Page # _ Z Warranty Deed Volume Z(et1 �-- , No # 5 D 7 Spec house 0 ycs C no . Lot lines identifiable Cyes C] no SYSTEM MAINTFNAN F Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance colsists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can afrect the furction of the septic tank as n treatment stage in the waste disposal system, The property owner agrees to subs it to St. Croix Zoning Department a certification form, signed by the ow -rer and b, mastcrplumber, joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system: is in proper operating condition and/or ( 2) after insricetion and pumping (if necessary), the septic tank is less than 1/3 full of sludge Uwe, the undersigned have read the above requ,temcnts and agree to maintain the private sewage disposal system with the siandar set forth, herein, as set by the Department of C'ornmerce and the Department of Natural Resources, Stoic of Wisconsin. Certtficac;or, staling !ha ur sc tj system s been n,autiair: ;i1 ;�tttst be completed and returned to the St. ('roix. County Zoning Office with r days of tee ' car xpirat n data SIGNATURE 0 PLICANT A Imo // DATL OWNF.,R ERTIFICATION i (we) cc Iha 11 statements on il,is form are imc to the best of my (our) knowledge. I (we) am (are) the ownen,$) of the pro desc ibe ab c, by virtue of a »arraniy deed recorded in Register of Deeds Office. SIGNATURE 0 PALICANT q f -2 � /A'� DATE •• "'• Any information that is mis- represcnicd Rlay resu in the sanitary permit being revoked by the Zoning Department. •'••'• •• Include with this application: a stamped warranty deed from the Register of Deeds office a 'co of the certified surv m if pY y a reference is made in the warrant P y d eed Parcel #: 026- 1167 -22 -000 05/09/2005 09:37 AM PAGE 1 OF 1 Alt. Parcel #: 27.30.18.1324 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 06/29/2004 00 0 Tax Address: Owner(s): * = Current Owner * GLEN JOHNSON CONSTRUCTION INC GLEN JOHNSON CONSTRUCTION INC PO BOX 809 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1377 126TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.927 Plat: 10 /12- LUNDY'S PRESERVE 026/04 LOTS 1/33 SEC 27 T30N R18W PT NW NE BEING LUNDY'S Block/Condo Bldg: LOT 22 PRESERVE ('04) LOT 22 (1.927AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 27- 30N -18W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 08/17/2004 771942 2639/526 AFF 07/07/2004 768132 2611/507 WD 07/01/2004 767568 2607/589 WD 06/29/2004 767300 10/12 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/10/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 s R '$' iftiffiltifitt ltitftfitltiillii�sifii� _ s i�i! ��� �1"s �i;.',;;:; If L LILM RX J6 Ir °;.0 -; D{ EEjtiEE�I {ii�lEli�EiD�jEiit�l�lii�ER�I; �•, I I 3f O.Z. f • �lEE 1 � , — i�r�.oilt!�'• '�.ai ♦ L a� �� r �i 1� ,t ��� ��� . �. ;1 a� E !` to — I t is 11ts ouo soi • liia.i..i *.��' t���j� x • :ii "iii � '. pii�'�' � �j �<♦�,'11��a� ;: �� �� F � Eiil1lll10lt fill IIIillll11 I;j1x il row- !!! M w1/r • 1t/r . 1 nwt May gram 34LW � i • r • � � �� "v � • rr +f r � � , a i M ii>t >silis'T , 2 U 2611 P 50? It STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROI X CO.. WI This Deed, made between Environmental Holding RECEIVED FOR RECORD Company, LLC 07/07/2004 01:20PH Grantor, WARRANTY DEED and Glen Johnson Construction EXENPI A REC FEE: 11.00 TRANS FEE: 969.60 Grantee. COPY FEE: C FEE: Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Lots 12, 13, 16, 17, 18, 19, 22, 23, Lundy's Preserve, Town of Richmond Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 Partof 026 - 1078 -10 -000 Partof 026- 1078 -30 -000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Date his 30th day of June 2004 * Bi 1 Sherman * Jeff Warren Environmental Holding Company, LLC Envirionmental Holding Company, LLC * * AUTHENTICATI ACKNOWLEDGMENT 0 -(1 1 Y F(Nls�/ STATE OF WISCONSIN ) Signature(s) 0, ) ss. St. Croix County. ) authenticated this day o Personally came before me this — 30th day of FAI June 2004 the above named Bill Sherman and Jeff Warren TITLE: MEMBER STATE BAR OF Wh 1 If not, 1C ( to me known to be the person s who executed authorized by §706.06, Wis. Stats.) the foregoi g i ment d a ed th same. THIS INSTRUMENT WAS DRAFTED BY *Kav Pglm Michael H. Forecki, Attorney Notary Pdl5lic, State of Wisconsin Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date: ( Signatures may be authenticated or acknowled ed. Both are not necessary.) December 12 2004 . "Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 ttorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire W154701 -7928 Phone: (715) 835 -3029 Fax: (715) 835 -4112 Michael F. Forecki T4632009.ZFX Produced with ZipForm TM by RE FormeNst, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -gW5