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026-1294-24-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506344 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: Smith, Gerald J. I Richmond, Town of 026- 1294 -24 -000 CST BM Elev: Insp. BM Elev: BM Description: �^ Section/Town /Range /Map No: 6() e / �' ` ( G - 28.30.18.1506 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3, Benchmark Z ZJA% ��Z• J� Dosing 4-S &Ono Alt. POD o / C &.:n,4- 6 � to Bldg. Sewer ' ,7 $R . 7 Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 5 ! r Dt Bottom 2 •7 _ lb 5$ S . F 7 � z � Z l Ss Dosing r r r Header /Man. 7 Z5 -97 2- -- 4. g5. 7 Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 1 5 .1 C 17 3 Manufacturer 0vL 5 GPM Demand St Cover 7 - . 4 0 1. 5(0 7 Model Number Pe -3 7U TDH Lift, Friction LL ss System H T H , 7 ,( Ft �� � "i Forcemain Length ' Dia. Z - Dist. to Well r SOIL ABSORPTION SYSTEM BED /TRENCH Width , Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ? -3 f \_ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR r•�d-i (° Type Of System: UNIT /a / �/g gl r Model Numbg,L � � - 4 Gj DISTRIBUTION SYSTEM vial[,, T /$ dL ( /6 - k 1,5 = </s A�,� Header /Manifold Distribution x Hole Size x Hole Spacing Vepi to Air Intake Pipe(s) \ \ ` \ Length Dia Length Dia Spacing w SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over j Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Z. �� Bed/Trench Edges Topsoil Yes es No Y 7No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1139 134th Avenue� WI 54017 (NE 1/4 SW 1/4 T30N R18W) Richmond Acres Lot f 24 Parcel No: 28.30.18.1506 1.) Alt BM Description 2.) Bldg sewer length = Z+ - amount of cover = r Plan revision Required? ❑ Yes (1 No Use other side for additional information. U , 7 Date Ins ctor's S' ature Cert. No. SBD -6710 (R.3/97) $ 3B r RECEIVED IM A T im Co11'1Rme'1'Ce.wwov Safety dBu@f*1011940 County 0 201 W. Was ngton Ave., P.O. Box 7162 - C �a Madi n, W 1 . 't iDepartiment scon�� ST5 �ROI�L;OU� \TY Sanitary Permit Number (to be 111edinbyCo.) of Commerce 50 ? Sanitary Permit Application State Transaotio In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental , unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary / � u oses in accordance with the Privacy Law, s. 15.04(l m , Slats. / 4) / (jy / T�li" I. Application Information - Please Print All Information / l Property Owner's Name Parcel # 6 e t , ,< 14 T Sm ,th t�h.no� A� ���- ��C tip -da Property Owner's Mailing Address /� Property Location `° D / 7 " 1 �1 V � � Govt. Lot City, State Zip Code Phone Number A!� 2 ,� / ? �j c /4, ..5� /4, Section 0 rig S Y 3 3 0 ��- .3 y'y� � a T 3 0 N; R _L� circle on�' / W 1 II. Type of Building (check all that apply) Lot # E o \� X 1 or 2 Family Dwelling - Number of Bedrooms A /7/ Subdivision Name Name Block # LL t C- /y) �'L RC S ❑ Public /Commercial - Describe Use R ,G 9 Mo �C � ❑ City of ❑ ❑ CSM Number Village of State Owned - Describe Use p II Town of 44 a 1 Ill. Type of ermit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. Permit Renewal ❑Permit Revision Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Owner 5-0t(/ 2 / D IV. T e of POWTS System/Component/Device: Check all that a 1 / G Non - Pressurized In- Ground k At -Grade ❑ Mot > 24 in. of'sua < 24 n. of suit le s I / /� Z t El Holding Tank El Other Dispersal Component (explain e(/ ex lain) V. Dis ersallfreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation NS A . S VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Z o v New Tanks Existing Tanks �• � `/ a U cn H � � C7 C. Septic or Holding Tank Dosing Chamber O [po (3 / VII. Responsibility Statement- 1, the undersigned, as a responsibility f i stallation of OWTS sho the attached plans. Z y Plumb 's Name (Print) P m r' ignature M P Number Business Phone Number u ber's Address (Street, City, State, Zip ode) VIII Count /De artment Use O Approved ❑ Disapproved Permit Fee Date I sue suing Agent gnatu ❑ Owner Given Reason for Denial $ V� /� D L�?i %�-"' L /C✓ IX itions of Approval/Reasons for Disapproval c> �- 7 /5/° °�� Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 Jul 05 07 07:10a WATERS EDGE CONSTRUCTION 7157724435 p.2 Jul 05 07 06:20a CeCe Tesky 7158661126 P -1 "* REVISED PLOT PLAN 130h are f . P Garage ( Proposed 3 t g bodnxm d or Sch 40 maw•• +ameoo� Scale 1" = 40 eu aep6e �'r* ° = BerM%n Brk - EL EV 100' 3%Mwe" Top of nail in wooden post - also HRF ■ = Soil Borings Wth Bac khoe �2" brae rten = No wail at trrne of evaluation Y t T . ' Gerald J SrNih ASO ick4 Gambns Lot 24, Rldyncnd Acres NE 1/4 - SW 114 - S28 - T30N - R18W is 31W Mh ad�nSM Z Town of Richmond Parcel 4 0265-11 2U24 00 3 x s�ope� PAGE! of 1 42 Ck t r , GRAVITY CONVENTIONAL DESIGN Index and Title Sheet Owner Name: Gerald J. Smith, Richmond Acres LLC Address: 11160 190 Ave NW Elk River, MN 55330 P • fi' Legal Description: NE % - SW % - S28 – T30N – R18W Township: Richmond County: St. Croix ff.'s` ('s• Subdivision Name: Richmond Acres Lot #: 24 SCA yo v'' sok Yo • Parcel ID #: 026 - 1294 -24 -000 r,w: n Index Sheet Page 1 m. '1 1 Site Plan Page 2 Gh.-" q's vs- Cell Cross Section Page 3 inJ 4"Or Maintenance and Contingency Page 4 Page 5 ij Page 6 Page 7 Page 8 1 Designer: Nvt r a Signature: License #: �' h one: 715 -6 Date: 06/20/07 Designed pursuant to: In Ground Soil Absorption Manual for POWTS SBD- 10705 -P (N.01/01) REVISED PLOT PLAN 134th Ave Propowd J a Mr (Y) ° Gamp Proposed 3 he&oom dweik v 96. 4" Sch 40 986 t> ee%w IWOM00OW Scale 1" = 40' M ampUc o = BendMWk - FEIN/. 1 W 396 slopa 11 Top of nail in wooden post - also HRF '� ■ ■ = Soil Borings With Baddhoe ■ - = No well at time of evaluation '� • Gerald J Smith 45 CA" 4 a amI ms Lot 24, Rldhnond. Aaes 15i"eachcen South property I NE 1/4 - SW 1/4 - S28 - T30N - R18W >1arhofd Town of Richmond Parcel # 026 - 1294 - 24000 3 % Sbpe PAGE 1 of 1 i Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical �E p S •= Turn -up wilball valve or 4(-X----+1+,)2 Laterals & force main of PVC Sch 40 oleangutplug perCOMMTable84. / 30 -5 / HolesdtiNedt{Athe ` t"op eP /e.ZhM GVe 5A A1 1 1 - I n AI A OM (, C`Cloc.4 / 1 Lea o �S 6 rDn7 Nat C C - Z r- 0U. fit renp% Pyle" QJ3 Ad /C." Number of Laterals Orifice Diameter 5 in Lateral Diameter in Orifice Spacing (X) ft Lateral Length (P) ft Orifices per Lateral Lateral Spacing (S) 3a ft Orifice Density ft /orifice �y7 ►n of ce- Lateral Flow Rate „ ' gpm Manifold Length v () ft System Flow Rate o gpm Manifold Diameter in Total Dynamic Head ft Forcemain Velocity D ft/sec SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS LocUing Cover wall Weather Proof Junction Box . warning label. Access Elear cal as per NEC 700 and - opening, not lop of cover. Comm 18.28 WAC vent Pipe most extend at least 4' >_ 12 above grads soave finnhw grade. Acteaa opemn9. trot lop I Maximum Cover over Tank of Cover, must extend to a past no greater than E below finished grade. 23' Min. Open" aa y E� Alternate outlet 1� ff%M Idt:atl0n i rl Fares Main Otaraaeler zr min. Open" a —•� * me Main Length / r7[ Appr BtfBdktg < to Ifir A sewer particle am@ Weep now or and elution dance. C wnp at tOwr ?L' 0 ~ oeee TTaak 0-. LbJ Oed and bacdo material comply tank aocordif5 to manaderfiean spsasaedors gllCilOr tank as ttsesrarY to negate + r Note: All pipe and vent comply Comm 8a. Tank Manufacturer. Doses Per Day: `�j Tank Si", Septic i Gallons GPO! *eHa6mv. albns Pump �Qi,1,1 Ga�ll�ojns�r Backtlow. U t� saltine Gallons Per Inch: 1 l r i =D Total Dose Volume: Uquid Level: Required GPM: Q Q Pump Manufacturer. L l an l Dimensions I Inches Gallons Q A �- Pump Model: 1 C14 g a Alarm Manufact ST C e- C e Alarm Model: Total Vertical Difference between pump off and distribution pipe Minimum Required Suppiv Pressure (0 for dosed conventional) S, eet of force main x friction factor/ 100 - �t.L ✓ ° Total Dynamic Head ii .1 II �. i CD E 0 0 �. o �i y IH yr 0 0 \ it I U - .0 al CT 0 0 cu I A4 L\ 0 - 0 4 o C* 4-1 JP C4 N - a -2 ? - 1 c 0 /< \ � � c 1� III it . V GO U � w T4-4 0 C*j *PfLolov C r c. f ;A f- dl d6-t ro 4S by �o P I -A e e Pa / Wisconsin Department of Commerce SO EV AT N E T Pa g J of —Y Division of Safety and Buildings in accordance with Comm 85. e C S.D. 02 I.D. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Include, but not limited to: vertical and horizontal reference point (BM), direction and P percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �� Please print all Informatlon. viowe b _ Date Personal Information you provide may be used for s condaR r; s' c � s. 15.0 (1) (m)). / 3 Q� Property Owner Prope Localio G S 200 Govt. of N E 1/4 W 1/4 S T N R E (or Property Owner's Mailing A drgti Lot # Biock # S bd. Name or CSM# 'T CROIX COUN Y(� ,[, AC C ity State Zip Code ja Number ❑ Village � Town Nearest Road IC JGv� w'►1 � L New Construction Use: �&Resldentlal /Number of bedrooms Code derived design flow rate � S _, GPD ❑ Replacement .L❑ Public or commercial • Describe: _ -- Parent material — �, `. �^ 5 L--1 .` _ _ Flood Plain e:evation if applicable _ h• General comments 1 and recommendations: �S U 3 S 3 Tre 7) FD r e a eJA4 F; a Boring # Boring so [ Pit Ground surface elev. q &, Lt� ft. Depth to limiting factor _ (n. Soil Application R....; 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 aYR3 f s W- w - . g ❑ / ® Boring # Boring p(I Ground surface elev. ��, I D eti ft. Depth to limiting factor in Soil lication Ralo 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 a to >- K Y ' Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) ignature CST Number 1,r 1 "S D to Evaluation Conducted Telephone Number Ti (p LA Property Owner �Zl� � — Percel ID # _ Page _ of -- 3 Boring # ❑ Boring 9 �. Pit Ground surface elev. _` 7 g. ft. Depth to limiting factor_ in. Soil App lication RBIs 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 I 'Eff #2 1 Cw It ' - 3 - I y ``f,I L v rslfr I 1V 1 I e V Boring # ❑ Boring q t Pit Ground surface elev. _ / �! h. Depth to limiting factor ! !,Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff #1 'Eff#2 b -12 / b 3 --.. ) - 1t -off D Haa�H 6 T.. G ter/ � 7. J • k 1 8-16 7. -$l 1" k .- F-1 Boring # ❑ Boring ❑ pit Ground surface elev. _ h. Depth to limiting factor (n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 130 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266.3151 or TTY 608.264 -8777. SBD•I1J0 (R.bVOr 3 Y AU -aea.— Yoacre-� (�bBhn a (Top C 50 a �a•i�� �a .t, 9 i a s T 00 - - tA CA •E I ter �� 22 . 1 23 2448 N tg 2.41 acres ° 2.43 acres g iO 104, 860 sq. ft. 106, 032 sq. ft. L. B. 0. 964.0 L. B. 0. 964.0 jaw w ff ......... ... .......... �.. �a0 96.2 Ol $ I /V 001.00 I g2 7-1 21.00 . -0.02 .07' c,7 7' S89'49'16 283.02' C15 9658 — ' r~ WT C16 , I � I 84' 74 PORARY CUL DE- (� I EASEMENT (TO BE REt /OI (� oz UPON EX7EN.90N OF 'NE io .. ..........,.... o z Q Cl CS °i I � V 24 25 acre.- 40 96, 768 sq. f . r` J4, 517 sq ft.. 964.5 96.E O S7 962 8 2 4,0,93 r S 7g�28 55 W S79 g #55 "W 165•�' o cr PELKE PLUMBING Fax:715- 672 -5267 Oct 12 '05 14:02 P.02 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer Mailing Address _ G l 3 5 f o kc \a `'`) ` l S ° l-•J .f Property Address r (Verification required from Planning & Zuning Dcpaftmcnt for new construction.) City /State Pa �`��^�� �✓ Parcel Identification Number _ tea 6 — LEGAL DESCRIPTION Property Location — —'A , ' /4 , Sec. T 3 0 N R Z W. Town of / . ��.-� Subdivision � �c /� � , Lot # 4 ` Certified Survey Map # , Volume , Page # 2 Warranty Deed # - �7 q Y , Volume o Page # 3 Spec house no Lot lines identifiable (9) no S](STEM MAINTENANCE D OWNER CERTIFICA17O 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 Nncti= 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 pbrmbet, joumeytnaa 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 Nil 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. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu r of bedroo 7 SIG OF APPLICANTS) 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 trap if reference is made in the warranty deed. (REV. 08/05) ` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page __Lof�/ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Gerald J. Smith Tank Manufacturer Skaw ❑ NA Permit # 6DO ,3y� X Septic ❑ Dose ❑ Holding Vol. 1000 gal DESIGN PARAMETERS Tank Manufact r �kGw X NA Number of Bedrooms 3 ❑ NA ❑ Septic Dose ❑ Holding Vol. gal Number of Public Facility Units ❑ NA Effluent Filter Manufacturer BEST ❑ NA Estimated (average) flow 300 g al/day Effluent Filter Model GF10 Design (peak) flow = (Estimated x 1.5) 450 g 6l/day Pump Manufacturer ❑ NA In Situ Soil Application Rate .5 aVda /ft2 Pump Model Standard Influent/Effluent Quality Monthly average' Pretreatment Unit X NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD5) 220 mg/L X NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) !150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BODO <30 mg/L Dispersal Cell(s) w14QL - kA � ❑ NA Total Suspended Solids TSS <30 mg/L ❑ NA X In- Ground (gravity) ❑ In- Ground (pressurized) P ( ) 9/ (9 Y) (P ) Fecal Coliform (geometric mean) 1510 cfu/100m1 ❑ At -Grade ❑ Mound Maximum Effluent Particle Size 36 in dia. ❑ NA ❑ Drip -Line ❑ Other: 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 ❑ month(s) (Maximum 3 years) ❑ NA X year(s Pump out contents of tank(s) X When combined sludge and scum equals one-third ( %) of tank volume ❑ NA ❑ When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA X year(s) Clean effluent filter At least once every: 1 . 1 ❑ month(s) ❑ NA X year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) X NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) X NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year($) 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 (pumper). 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 a 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 treatment tank equals one -third (X) 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 but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 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 (12/02) Page of START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • 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 POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement 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 Norm Arndt Name Phone 715- 353 -2263 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name St. Croix County Zoning Phone Phone 715 - 386 -4674 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter [RGOULDS PUMPS Submersible Effluent Pump PE �1•UENi PUMP SPECIRCATIONS MOTOR FEATURES Pump — General: General: in Corrosion resistant • Discharge. 1'h* NPT • Single phase construction. • Temperature: 104-F (40 PQ • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • BuNn thermal mrerload pro- cover. • Solids handling: 'k" tenon with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil -filled design. construction. APPLICATIONS float switch. • High strength carbon steel IN 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 m Powered for contincontinuous n • PE31 Pump. 12.0 Maximum amps o°n the • ow Pressure Effluent/Dosing e Systems • Maximum capacity. 50 GPM • Shaded POle design AN ra world limits of the motor. • Basement Draining • Maximum head: 25' TDH PE41 Motor m di' conned power • Heavy Duty Sump) PE41 Pump: • .40 HP, 3400 RPM • 7.5 Maximum am °Dnd' 20' standard ' Dewateting • Maximum capacity: 60 GPM Ps heavy 16/3 SJTW with • Maximum head: 29' TDH • PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor: 115 volt grounding plug. • Maximum capacity. 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compacL • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless . . - -- . -- . + - i = Y - } Mooehs reap. rear, MI steel. - } _ _ - } steel } ...... - -� - -- - ■stainless fasteners. 35 _ 10 - -t —+ ' - L .. ._ _.p.._.p_Y.. ._., _.. , _, --- . _ r 2 GPM _____ __ _1.___._ YUSTINGS C� * U s, j i M Tested 1n u.77$ and } 20 __,___ r � �222 j _ I _ .. Y - By Cam" Vaud ids Amdadw - N -' -r - - 15 We#UO" 10 t God6ro lslsogm l gis eel 5 : + 0 0 0 10 20 30 40 50 60 70 GPM 80 0 5 10 15 ma/h Goulds Pumps CAPACITY o aooi ends PWVWS Z3�.> ITT Industries .y It I commerce .Wl.gov Safety and Buildings Division County i ' 201 W. Washington Ave., P.O. Box 7162 �L �f Q�t X `+ O c Madison, WI 53707 -7162 Sanitary Pe umber (to]� filled in b y Department of Commerce 5— Sanitary Permit Application State Transaction Number In accordance with s. Comm. 8321(2), Wis. Adm. Code, submission of this form to the appropriate ental NA unit is required prior to obtaining a sanitary permit. Note: Application forms for st POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. e.. I. Application Information - Please Print All Information Prope Owner's Name t z_6- i ?_9 4 z4-000 l # � � I�; chm�nd� l s LL 7 Property Owner's Mailing Addre J ul, P perty Location 1(00 ii�Q Av 14 /5U ROIX COUNffY vt. Lot City, State Zip Code P one Number L 1 y., Section 2 — Ik IZtV21 MN 'j 53 3p 1 rgag (circle on T 3o N; REo P V n. Type of Building (check all that apply) 2 Lot # 1 or 2 Family Dwelling - Number of Bedrooms 3 t Subdi ' ron 3 a?- Block # lJ►tfl^Qn� �11 r/J ❑ Public/Commercial -Describe Use City of 11 State Owned - Describe Use & f�,d"� ' / CSM Number El Village of , p� Town of III. Type of Permit: (Check only one box on line A. Complete fine B if applicable) A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replaceme my ❑ Other Modification to Existing System (explain) B. El Permit Renewal 11 Permit Revision El Change of Plumber ❑Perm' ransfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl A Non- Pressurized In- Ground Pressurized In- Ground At -Grade ❑ Mo `d >_ 24 in. of suitable soil ❑ Mound < 24 in. of s�u it u ❑ Holding Tank El Other Dispersa omponent (explain) ` etreatment Device (explain) " r / V. Dis ersal/Treatment Area Inform (/ Design Flow (gpd) Design Soil Application ftq Dispersal Are equired (sf) Dispers Area Proposed (sf) in Elevation O 3 VI. Tank Info Capacity in T& # of of , to Gallons lOns Units New Tanks Existing Tanks c a Septic or4IeldiwgTank 1000 / (0� / 1.��1 J Dosing Chamber V j _ + ® y ^1 � ( !1 VII. Responsibility Statement I, the undersigned, ass a responsibility for ins lation o POWTS shown on the attached plans. Plumber's Name (Print) Signature 'A RS Number Business Phone Number No(om Arad+ ° �. - 2�� 15453 Plumber's Address (Street, City, State, Zip Code ) i N+6 Pi e - 1Z61. QA�(1Q_r 1i l 5448 ? 5 VIII. un /De artment Use Onl pproved El Disapproved Permit Date I sued Iss ' g Agent Signa El Owner Given Reason fo enial $ yJ � 0 IX. Conditions of Approval/Reasons r Disapproval SYSTEM OWNER: ( MA 1 Septic tank, effluent filter and ad a rt�Sit. -�� /Gtr a4 dispersal cell must all be serviced / maintained d�,� as per management plan provided by plumber. c o om ete tans or the system and submit to the County on paper not less t 81/2 x/411 inc es in size ,,,,, as per applicable cod inaRce � � ^. /�_ 74�j �Q1'GO'1N SBD -6398 (R. 01/07) Valid thru 01/09 w A v 4 GRAVITY CONVENTIONAL DESIGN Index and Title Sheet Owner Name: Gerald J. Smith, Richmond Acres LLC Address: 11160 190 Ave NW Elk River, MN 55330 Legal Description: NE ' /4 - SW '/4 - S28 — T30N — R1 8W Township: Richmond County: St. Croix Subdivision Name: Richmond Acres Lot #: 24 Parcel ID #: 026- 1294 -24 -000 Index Sheet Page 1 Site Plan Page 2 Cell Cross Section Page 3 Maintenance and Contingency Page 4 Page 5 Page 6 Page 7 Page 8 • C! . Designer: CeCe Tesky, e� 10 ' '�SS, o 4 ,� , Signature: 'w License #: 265824 Phone: 715 - 868 -0126 Date: 06/20/07 Designed pursuant to: In Ground Soil Absorption Manual for POWTS SBD- 10705 -P (N.01/01) o a- 5; 7 � � Combination Tank Component Cross Section Approved Manhole Covers With Wanking Labels and Locking Device / 4" Min. Above Fi+ Weather Proof .function Box Electric per NEC 300 8t COMM. 4" Sch. 40 Vent PR I 1628 WAC > or =to 12" Above Final Grade 99 Discoullect v Alternate outlet Location W /Approved 4" Sleeve Inlet Approved Force Main Diam. Effluent Filter Baffle/? < or = to 118" Weep Hole or Anti Siphon Devioe Particle Size A B Pump Off Elev. LL C Tank Mfr. D / � Dose Tank Elev- Vertic al Diffeaence Betwom Pump off and Distribution Pipe = ). L 7 *mu / h ( Required Supply Pressure ....... ............................... _ S A• 0 y / FT. of Force Main Friction Factad100'FI ..., • / 1 b0 Total Dynamic Head .................... �1 Number of Doses ... _ Per Da}y Gat. Perimy #of Doses Volume of Backftow ............... .4 ?... ¢ .................. = _ZO Gal. �' _.... Total Dose Volume ............................ .........................._.... = Gal. Pump Tank Capacity Gallons Dimensions Inches Gallons j Pub Tanis Volnne GaNwh A a� 3 7 r S S /' % / v B 0 Pump Mfr C Pump Model S w C D� / /G, 3 9 lviininlum D' = PM D �— 4 v Z SS j . y Alarm Mfr. " �Totat= 7 Almm Model W Bed. Tank per COMM. 83.45(5) Anchor Tank as ueoesmy to negate buoyant forces per CM" 83.43(8)(g,). C O cr; r y y y yO • • ° .. g c� {b H Oil If cr co CL • C CD u , I rA m O 9 K C et- ae Oy p '�7 � ♦� 1 � \ -, M a� If � II II t'j N d • PLOT PLAN 134th Ave � c J t2V � n 0 c � J rr LL 1 99. 7 Pro Gara e BM2 I, a i d , a imp Proposed 3 bedroom dwelling 101.57 1000 GPI10 �Ya 4" Sch 40 4 % Slope septic tank with outlet fitter building sewer Scale 1" = 40' = Benchmark2 - ELEV. 99.49' �( Top of iron pipe - also HRP 45 Quick Immbers = Soil Borin Wth Backhoe Pit to be verified 15 in each cell by CST = No Well at time of evaluation South env fine Gerald J Smith is >IW south of drainfieW Lot 24, Rlchmond Acres rm r NE 1/4 - SW 1/4 - S28 - T30N - R18W Town of Richmond Qt" -IT f `" Parcel # 026 - 129424 -000 `- AA- 7 1 0 7 PAGE 2 of 4 - }v Pa in d 4&�U d ahem +V lines . SHEET NUMBER-43 , 43 `A�' N y Join heel 35) s s LL O S8 t r O LO r 1 1M ' Pr s , cn O O O O N '« a 4 0 T+ 0 0 C (Jana shee/ S 1) 1 335 000 FEET 0 0 rs y- aY k papoaa aaoux aau Sagl lnq `saraas anrlaadsaa atwg4 ;o �Fa :. !0 ants uasaadaa ss a iaasa sauo a o aU !tins sa oad uaDaad ut ssa out Jo a 4 pg. p q4 4 I. Ig 4 9 u4 I Ilq�i.ltUius ansit xalduxoa sail ul silos o pus o2urluUS airy maj u pus sa2pla So Bad" � � Jul ssuma2uulsap autos ul OsIU aau Matti •papoaa Daoux - salsgns SaAuia `uoaaad I°n Sr tos a aa9 m S asd XaA P ut' `S02 i MOaasu - OS •S ou}l u O Si [� II I . i. q4 q I p p. M AIDA `SlIOU31 uO aau SIUO UI03 silos srtusup pus 02TIU j put SAUmD21G1u1uap U silos °`' �_ 8 � i t Dili sadols loot anuauoa put sapla ptoaqSlaluaapoux Iluuxs maj u aau 2uiddutu uo si Sluourmoa Ilos o2iq uuS aril Inq � faun aduas •aauurtgl sl Ilosgns altl„ - LUu -putt atgl uo silos as9lil JO suor4lSOd •lansa.� put puss si awful aDUjxns aril Inq �s dax Xq Aq ululaapun silos 1114 Smuol pus silos t,ruxuup Slututu su paglaasap Duo atil of aslt -qr `silos willo luaaaad 9E put `Luuol 411s o luaaaad gg `tuuol Ills o2tl4utS luaaaad pp lnogt si xaldima sitiy uxoal a2uta put adulis ul atl ' re •1isUmino tanta$ put puns ao gill tutol Spuus 2utSjaapun IsoW sauivaoux punoa2 So sa* i xa sl a u us ua uII as is u Af umm aUUO silos asa Isado a ivaaaad o; l fi P� u4 p 4 .P II. g p 3 I. u1 I tit 9 uleor,-,7 •azis ur saaDU OOi 0 4 OT uxoal auua pus adUgs ul aUln jioi uxu -2aaal aau suaau lsolAI •141ap isrDti2 pallid put sauruaotu dno.12 put,gpoom :T--all Ilun A ., "uux - an pua uo axe xaldtuoD sigl ui silos atiy •papoaa °sadols pooS to aolauj luslaoduxr us st `sa �o son waaaad SZ ol ZI Ixalducoa oWiiuV o2m3ueS — ZQaS SttUraadsa `uoisoaa $uliioaluoD •u4 •ioi dnoa.� puUlpoom ! I Ilun SIltlgtdvO •luatu sl II s41U3tU pus `sluo `u103 of pali Jul - a2tutux pooh So saolDSj luslaoduxl aau lualuoD aallUiu li4211s sr uorsoaa So pauzUil aril �?, -on. xuu2ao put u4I14 2ulululucuux put uolsoaa 2ui110aluoD •sapra So sadols loo :1w •sauld allum put paa of palms 11am aau xalduxoa stgl ui `uxnlualsgns Snsaq `uoaaad to sU _ u sadols daals laogS •uaoa So lunotut palltull u of palms papnlaui osiV s�fUma�uursap ul silos' . ulo axe pus `sassU12 put `sltuIlt `sluo of palms llam aau So suaaU tiuius put stlou31 uo silos not Silos asagy •pO4Un14inD aau xalduxoa sltil So ssaau lsoN So staau axe $ulddutu ui Ilos snt aup - aagut aDujans aril ul salias attl , aalluux 3luu2ao So lualuoa aril paanpaa suit put aluaola su paglaasap algoad aul svq lios stet -alap of Mill pasnuD suit uoisoaa saDuld Isom uI •aluaa 02;i of OT uioaj a2uua put aduigs ul are 4jcl0 -pour sl uorsoaa So pauzuti aril put `tunipatu si Ijoung axe stain lsoN •saumioux puno s put; •luaaaad Zi uuiil aaoux axe sadols aaatim sitiy -sadols tuaaaad 9 ot ti �lueol it s u 9 0 suaaU gguuxs autos put spuod put silos lam ;o suaaU rrutus Suutu axe papnlaul osIV •sllowl So slsaaa aril uo silos paultap Ataood lugmauxos atgl puu silos `.fat .9113nV12 put Sputs 3O sUaaU 11VIUS put 3taluI satlaul 0S glam x1aluaapoux aql uutil paulUap a u�t of 01 xaSlGl aaul xns 31atp U anuq 4tu4 s.f1Rma219U1tap ul 'Silos aou2syAI put u009a3 asau al? sit -dot silos Sutuz axe 2ulddtui ur silos asatil tilrm papnlaul plaU Al2uoa4s of plat trz �lalul satiaui OT o4 9 awful 9aujans Kasp u anuit xaiduxoo -iaoil 0 atll put `plan S12uoals sl uoziaotl t eiu Dia sltil ui silos aul saDugd ur put `1114 tuuol .9puus tislppaa -�ua4 asatoa luaaaad 9i of 0 si uoz fit ui �filaud pauxao� IUu4 Ilosgns s sUil lros o�rlu� aril lsoux ul •tuuol 4u211 ao uxuol dpuus sl uoziaoil 'ally `saauld Auuux ut `osly 'puns aaoux �Ilg2lts utuluOD puu •uxtot Snuaq ao uxuoi SPUUS Ansati sl uozuoq IS aus qsu papoaa aaoux Diu �fag4 4nq `sala rla aS anadsaa alau4 to ' uesoaq -qnf anrluluasaadaa su paglaasap sauo au4 of auptuis salgoad iislBUa3 31aup a0 umoaq tisiSua2 31aup `pal aAml xalduxoD sltil ul silos o2quV puu 02equUS arty dV arty - 4;)i1l4 sailDUl 9g of 9i 91 allum Mills 91 11 `um •so2pla put slloutl So slatd xanuOD 'Pap a uo Bluoux ssau3lDrtil ui sagaur 01 of 0� tuoa3 sa2uUa umtos oily saa, -tuoa oslu sr Inq `sAuma2uuluap ul st Ilos o2quV arty •p13U SiBuoals Digs sadols looj ansauoa S1111211S uo put sa2pla puoaq .ftaluaa ! auxnt0n Aq sluaux2uaj asatoD luaaaad _ins -pour uo si Ilos o2Ui4uuS au4 �Iluaaua2 Inq `AJUn adtas OT Inoqu ! slow maj ! alqutal ! saluld 3 1a1u4 lnoc -puut Dill uo silos asDiil JO SU011lsod •lanu.12 pus puts 3116 of 2upluaaq anlsS'UlLu : tut,ol fpuUS Sq urttaapun silos till Atutol puU silos t,ltuUup sluiutu (9 /1 Uxq) paa 11simollas : satiout 09 04 w alltl `silos aotilo luaDaad qF, puU `m-eol Ills o luaaaad Sig -Aiepunoq - Ali; `tuuol Ills o2t,ilutS luaaaad 09 Inoqu si atriiiio_a slay Xntm aUala 'plat Al2wals ! atunlon gq slto< su lno lint put puUS a0 gill UIU01 Apuus ul i sluaux2ual asauoa luaaaad 01 hogs : slooa 30 - aapun aril ul put- luauxrpas Allrs ur slurem pauxaol silos maj : alqulaj : aanlanals �f�laolg atin2m 0 4 ; asaliy azts ur sagas phi of pi uxoa1 a�uUa puu adt s ul -qns tunxpatu - 4Uam ! uxUOl �fpuus �fnuati autn2aaai Diu suaxe IsoW •Illap lumv12 pallid p jddnoa ui . (9 /v uxo,) Pa-1 tisimoita f ! satiaul : P9 01 0 - oux uo am xalduxoa sig4 ul silos alit' *pap as ldols �fatpunoq SAwA Iuaaaad tit o; 9 'xalilmoa o�nuV o�eilue —yS at,ala ! plDt d Buoals : atunton Aq sluatu ioi - 2ual asauoa luaDaad 9i lnoqu 'slow uom R o puutpoom : i 41un SIlilgsdUO quauxa2Uuu p o - uxoD ! spad to sawej uo sum puUs Dug „ nut saol;ml luslaoduu aau lualuoa aalluux Drut210 put 114114 UOA put 411s paluoaun autos ! suxlg Avia Mill 2ulurtlum -tu puu uolsoaa 2uriioaluoO •uaoD So lunotuu Stioltd ulul ! alqural ! aanlanals A3j;)oiq auln palm pa4lluli U puU `Onvilu `slto of pallns si Ilos sitiy - 2utgns tunipatu almapotu : uxsol fnualq 1105 •aadul aoujans aill ui (T jXq,) umoaq tisippaa `. satiaut 0£ oI vg I99all aallutu Dius$ao to lualuoa aril paanpaa suit puU aluao •,Satpunoq aUin2aaal auala 944 - raalap O} u4114 pasnuD stq uoisoaa stair Isoux ul 'aluia ! plaU St2mals `. atunion Sq sluau .dual alUa -pour sl uoisoaa So pat,ztq aq4 put `tunipaux si jtoung asauw luaDaad 9i lnoqu : slow uouxuxoa 'aaal 99 NISid00SIM `AINfIOO XIOUD *IS PLOT PLAN 134th Ave I f r- I F�� I I I a 2 (\ I 1 r ss. Proposed 3 bedroom dwelling V t 101.57 10009 aHon8karv. 4" Sch 4 % Slope septic tank with outlet fitter building se Scale 1" = 40' = Benchmark2 - ELEV. 99.49' Top of iron pipe - also HRP 45 Quick 4 hambers �, o Pit to be verified 15 in each cell ] / = SOII Borings 1NIth Bacldioe by CST i ,. . � = �' = No wtgl at tlrl1e of evaluation wiS Sou, propert One Gerald J Smith 'rrn t is >150' south of drainfieki Lot 24, Richmond Acres NE 1/4 - SW 1/4 - S28 - T30N - R18W AdjU Town of Richmond Parcel # 026 - 1294 - 244000 PAGE 2 of 4 Wisconsin Department of commerce SOIL EVALUATION REPORT Page -I_ of 1— Divislon of Safety and Buildings in acc ( rdance with mm 85, Wis. Adm. Code County y / Attach complete site plan on paper not less tha 81/2 �rtE"Molan must S_! • ~ Include, but not limited to: vertical and horizontz I reference point (BM), direction an I Parcel I.D. t0 - percent slope, scale or dimensions, north arrow and lo cation and istance to nearest road. Please print all / for InTlan. - 9 2006 ad Date Personal information you provide may be used for se ndaryff Yn6 5,15.04 1) (m)). ( O Property Owner U Y Prope Location ered A r A1- Govt. Lot 1/4 1/4 S T 3o N R IS E ( W Property Owner's Mailing A dress Lot # Block # Su . ame or CSM# 9 " Ao`. N a r�� o IF 2 ►� 0►- s Ci State Zip Code Phone Number ❑ City ❑ Village (Town Nearest oao IK. P , %*X w►N 5330 ( ) - VVV t,, w• a (, New Construction Use: Residential / Number of bedrooms Code derived design flow rate ^ _ _ GPD ❑ Replacement y ❑ Public or commercial - Describe: Parent material �- ` .. 1,3� C` s h Flood Plain e:evation if applicable tt• General comments = S 5+ 3 -'fir r 4�^'S e,!; � F P �► t.ln -�-e and recommendations X96 t "�;`( � 55,61' 7 V (fl1K. v%,0r0 k F I ' F+ S�T��. ' a (96. � T (4Y,96') f 5 dl ee- Ae ,:Q � 'f : 3 ( 95,9 0 , 'r, ( q yl . Sig F-11 Boring # Boring c �. pit Ground surface elev. ' S� tt. Depth to limiting factor l b _ 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 I 0-ID 10101 5 L af5hW- r' y - aw d a 4P 40 r Cw IF `l 3 s o --s •7 /- to FA-1 Boring # D Boring Pit Ground surface elev. ft. Depth to limiting factor S In. Soil plication 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 -i � 0 -- SL a F5b vA r' aw a� 1 ► 0 oZ la» yg 75 1 A M t`Ieat_ M b k Fr C w i r _J S ' Effluent #1 = SOD > 30,5 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD _< 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Signature ��) , CST Number U a.r k 7 Address Date Evaluation Conducted Telephone NumC Property Owner Boring # C1 Boring Parcel ID # _ Page of _ © - I Pit Ground surface elev. I —f ft. Depth to limiting factor ° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure gC onsi st ence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 sl L a•o a� "1 `I R Boring # ,p❑ Boring po pit Ground surface elev. I0/ , 57 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. S I •Etf#t I •Eff#2 6-1 -11 I M P- 3 11 L a F31w- YA ;v- a w 1 �,Sy2Y 1w� w► w `P .? -ysy(.tY 5 C�F u- hnrtr 1J Boring # ❑ Boring ❑ Pit Ground surface elev. __ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD < 30 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. 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U +:IPrr N . Y f ,, �•I� rnro++lhnewllr tlt�ytCnovxl6r �' omsral � :.;:�:'. "� ��G"y..d.1�StA'0.S"4uT �•' 41 t 1 I A, fINW,, 40 rple � raaY'r6 »:r .�;r. - -- -• r A C Q INS Cb Vj } / r i �,.._ , , v rr , „ - i V' , r , / _ r „ / Q`f T l 4 AD'" t Wisconsin Department of Commerce St-la VALUATION REPORT Page �_ of Division of Safety and Buildings D as r i GG ounry .S't !' Attach complete site plan on paper not le han 1/2 x 11 i ches i 4e.QzmLtl�D C O I Include, but not limited to: vertical and horizontal reference int (BM), direction and arrel I.D. percent slope, scale or dimensions, north arrow, and location and disa �@ toipegre t(� d��'^ .' I11 ,, " �db Date Please print all informatiof�. / ,r Personal information you provide may be used for secondary purposIs (PHIly. �aflbi Property Owner C L ZON t IL2fcation G e rod cl 7Y . S N1 r n Govt. Lot F 1/451]1/4 S p$ T30 N R E (or Property Owner's Mailing Add re Blo Lot # ck # Subd. Name or CSM# 1 1/1 0 0 - 90 e. N W a a.1' 'O F �fc m c ret City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road �1K R. % 1 0R MN 30 1 ( ) - $ p;C.VN a r4 A I I3y vL New Construction Use: T� Residential / Number of bedrooms Code derived design flow rate — SQ _— GPD ❑ Replacement ❑ Pubic or commercial - Describe: Parent material U -W F j I l! / _ Flood Plain e;evaGon if applicable ^ - -- ft. General comments 2 5 t �-t ar, to 1F 75 r r 54,.s I i o � w+ O u r c¢ S -{ 4-t 01.7a t and recommendations: 5S . 6 If wee Ga�Z.�aL�CS�- On lol`� �0�� Boring # 5 1 Boring Q � f Pit Ground surface elev. l ft. Depth to limiting factor 7 S _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U-IU IOY2 3 /a, - -- L a m5 10-Iei Iom - sb rrnJr Gf I ,�S YY\ S C I O F Boring # Boring Q g r s� �� Pit Ground surface elev. _ 7 ft. Depth to I miring 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 - I D IZ 34 - h s I m �7r � F , g a d5 .75yg 4 1c L I m; r I 15 y G1 B5 -50 75YiL I- VII Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please P Signature CST Nur ber C;LCA 1,7 t Ct.V hG� a d �', M S Date Evaluation Conducted Telephone Number L v r ' �' e� W v1 r -CAS ,] IS a N$ ,3-588 '50 � - �v�n,�� Parcel ID # _- .-- --"' -- Page °f Ger t `� in. Soil lica Rate Property Owner Depth to limiting factor — GPDIff Boring # Ground surface elev. ❑ Boring lQ y ff. Consistence Boundary Ro •Eff#2 � Pit Texture Structure •Eff#1 Redox Description Gr. Sz. Sh. Horizon Depth Dominant Color Munsell Qu. Sz. Cont. Color m j Y' r factor _ - -- in. Soil lication Rate fl. Structure Consistence Boundary -E 0 Boring Depth to limiting Roots GPDItf ❑ Pit a goring # Ground surface elev. -_— � •Eff#2 Texture Redox Descrip tion Gr. Sz. Sh. Horizon Depth Dominant Color Qu Sz Cont. Color In. Munsell factor _._ -- in ' Soil A lication Rate Depth to limiting GPDfff n # Boring s urface surface elev. _ _ ff' Boundary .E ROOD 2 Bori Consistence �1 •Eff# ❑Pit Texture Structure Dominant Color Redox Description Gr. Sz. Sh. Horizon Denth Munsell ()U. Sz. Cont. Color > 30 _ 220 mglL and TSS >30 <_ M mglL • Effluent #2 = BOD ` 30 mg1L and TSS <_ 30 mgll • Effluent #1 = BOD6 < n an alternate format, please ortunity service p and employer If you need assistaan0ce264 ac services or The Department of Commerce is an equal opp contact the department at 608 - 266 -3151 or TT ' need material t SBD•833 (0..60) �u I �e �o h , , 5-t•a..r N '/y s w j sue. a� N � s 1 i� d _ - i - Top 5E_ c vrrvcv� 1 s o c v c , gm a T "p `r a', 3 '%j 39 i _ S O _ + v � 1 CO i ,� I '� _ _ _ - - - -- - -- - _ - -- - -- _ __ _ -- __ __ __ _ _ _ _ __ __ - __ _. __. __ ___ __ __ _ - re �e r� i " .'► ►-fit -, N E '� ,Sw i j S cc, p e" �' N P, LL) 6ce,Ic ` qo� t hL� Y p � �°�� IN /7 oc PPS �d o o ` 6 , � -P, r Ic � % v M bo E I 3; .. n C- o . v o r. q' C ut 3q �o� 3B RUG- Lle -d0d� 11:43 FROM:•JEO CONSULT NG GROUP 715 -3830 T0:2487B39 P1001/001 . pRELIMINARY PLAT OF RICHMOND ACRES cA cur 10.Y'N N rQ/1 wl rl. 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Psfes T�t/ � •]r L a Mn I 1 .. i m ?.2,4 acre 1 ol - 7 1 1 F 1;, •r 17 acres ' 1 46 % y , 7� wa 2.79 ocro; I k ' -} 88 a�rda. . ,11. t 3 vas f.74 oCres `� µak 1 1 1.94 /eS r I t N�a� MFLA, kd., `I,Id arcs 1 y':D7 r %8 NaPrr �� Il.p I.li tic o1*,r, p` L yY ti r � xw wArn 1� ck aAt�' v yy np G'L2 - �i' j ' .,., . `a. a8s , _ rr•M' ocrs. I I - 99 14A p brort 1 4 e• ! 1 I„ • • wx J• \ ^ w_LI�C d P�+rCa L.J • 1 t e5S' . Rn ¢LI ��t :^'1'I c w..J'""P. (.� « '°" E MI o .•� ,r / ` r_..r^� ?,�1! acres g . 3 r'Z'.e�rmw y 4 l � it wwwi w w QM 'A«+M+rt 1 �o u...+ r• ww � w t �tl I ,o.s..a awq ww+ � y l , J r' f ^► / A• / !/ _• •} �� ... +NM w�:q - - I 1 ,�.'.w�.,« Mw.w1.. •h'•.,...•_. ,_1 - •..... Jt7J ,r t ^..� I WhIl 611Aw.r .e N CIO. ,G �....�m ti' V:NIU 4 — Iln, 1 • f 1N« .N ",a •�� ✓� f E 7 C.MAI:« HNI LM I VMoYtlI 6111 IV/• /,iY[01 I�C�AI 1� • w..w wM lu.we, , w .Awaw ia�'in �y'+.,. �e� ' 7OClC'' '�'"'• bw;Yy lns LM NW I1trVC 1 »A aCr'BS 'U I. LAA• . �hl lyl nn �. qt Il+IH y t P LL ' ',�, +,u Rwn I�Ie e�. A I «IA I� "' _._ — �, / 1 I °R�..•' I �(/ h=l I r + a"r^�, yw.,y s , i� , N +I1.2 � 1 �. , I / I py • 1f I $ III 1 1 d .. .. otwan warwl nM p ywww_}x i�a'.a�n•+4. �.P of . W _ '•� _ ,_�!}'� A,�. " ' �.i..titi..«.. « «;k «� v 11K •Mnq.11 +ww + ftru � "°• r r ' c aws w Y s O.A ST 2f CHLIII' � t AO 6GA C � M W IM:... i aar i.IWr,a 4nu Cw+Y► rYrr 0 Jrm eoAlrarryLA wr. w+ IM 1 WA.PV• �?•'/` n+d+ Isi, �/IrNw YV/ avtro+aLSr+aauao-, r„sel puma a a t ""*.' q,t,.r• waut:.w mAlra�ar..Lw I w... �,r 'I�iYi • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa t Of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Gerald J. Smith Tank Manufacturer "S4e q W fC I ❑ NA Permit # 5?-- X Septic ❑ Dose ❑ Holding Vol. 1000 gal DESIGN PARAMETERS �Manufacturer to jo X NA Number of Bedrooms 3 ❑ NA p'Septic ;4ose ❑ Holding Vol. &Wft1a gal Number of Public Facility Units ❑ NA Effluent Filter Manufacturer BEST ❑ NA Estimated (average) flow 300 al/da Effluent Filter Model GF1 Design (peak) flow = (Estimated x 1.5) 450 al/da Pump Manufacturer 6� U ids ❑ NA In Situ Soil Application Rate .5 al/da /ft2 Pump Model W60 3 ! J L St andard nwaim+. Monthly average" Pretreatment Unit X NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Fitter ❑ Peat Fitter Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BODs) <30 mg/L Dispersal Cell(s) ❑ NA Total Suspended Solids (TSS) <_30 mg/L NA X In- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) <10 cfu/100m ❑ At -Grade ❑ Mound Maximum Effluent Particle Size in dia. ❑ NA ❑ Drip -Line ❑ Other: 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 ❑ month(s) (Maximum 3 years) ❑ NA X ear(s) Pump out contents of tank(s) X When combined sludge and scum equals one-third (16) of tank volume ❑ NA ❑ When the high water alarm is activated Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA X year(s) Clean effluent fitter At least once every: 1 . 1 ❑ month(s) ❑ NA X year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) X NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) X NA ❑ 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 (pumper). 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 a 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 treatment tank equals one -third (X) 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 but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of _ <12 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 (12/02) 2 -�/ START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • 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 POWTS fails an rauaoL -be— repaired - -€tom rovide a code compliant repla system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption C ystem. The replacement area should be protected from disturbance and compaction and should not be infringed upon by equired setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will esult in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mu omply with the rules in effect at that time. El As uita a no 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. .,e 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 Norm Arndt Name Phone 715 353 - 2263 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name St. Croix County Zoning Phone Phone 715 - 386- 4-64+ y(QYO This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter Parcel #: 026 - 1294 -24 -000 07/05/2007 09:17 AM PAGE 1 OF 1 Alt. Parcel #: 28.30.18.1506 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/10/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - RICHMOND ACRES LLC RICHMOND ACRES LLC 11160 190TH AVE NW ELK RIVER MN 55330 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 1139 134TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.400 Plat: 10/086- RICHMOND ACRES LOTS 3 -49 026/05 SEC 28 T30N R18W PT NE SW RICHMOND ACRES Block/Condo Bldg: LOT 024 LOT 24 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 28- 30N -18W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 11/10/2005 811739 10/086 PLAT 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/22/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.400 30,200 0 30,200 NO Totals for 2007: General Property 2.400 30,200 0 30,200 Woodland 0.000 0 0 Totals for 2006: General Property 2.400 30,200 0 30,200 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 < 796 64 1 U 2 8 1 `I P 5 3 1 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIR Co., WI DOCUMENT NO. WARRANTY DEED RECEIVED FOR RECORD 06/03/2005 12:00Ph WARRANTY DEED EXEMPT # This Deed, made between David A. Ball and Kimberly A. Ball, husband REC FEE- 13.00 and wife and Dennis F. Ball and Nancy A. Ball, husband and wife, TRANS FEE: 3185.40 Grantors, and Gerald J. Smith, a married person, Grantee, COPY FEE: WITNESSETH, That the said Grantors, for a valuable consideration CC FEE: convey to Grantee the following described real estate in St. Croix PAGES: 2 County, State of Wisconsin:: RETURN TO: Parcel 1: The East Half of the East Half of the Southwest Quarter Loberg Law Office (E' /. 359 West Main Street /E' /2 Ellsworth, WI 54011 /SW' /.) of Section Twenty Eight (28), Township Thirty (30) North, PID #026 - 1082 -40 -000 Range Eighteen (18) West, Town of Richmond, St. Croix County, 026 - 1082 -70 -100 Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 026- 1082 -95 -000 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being 026- 1083 -10 -000 part of the Southwest Quarter of the Southeast Quarter (SW'/./SE%) and part of the Southeast Quarter of the Southwest Quarter (SE' /. /SW'/.), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West. Parcel 2: The West Half of the Southeast Quarter (V1/' /2 /SE %) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: 1. Lot One (1) of Certified Survey Map filed April 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW'/./SE %) and part of the Southeast Quarter of the Southwest Quarter (SE' /. /SW'/.), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast Quarter (SW' /JSE %) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 3_ Commencing at the Southwest corner of Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89'59'15" West 20.00 feet; thence NO'01'41" East 262.00 feet; thence S89'59'15" East 224.00 feet; thence SO'01'41" West 15.00 feet; thence N89'59'15" West 209.00 feet; thence SO'01'41" West 242.00 feet to the point of beginning; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter (NW/✓SE'/.) of said Section 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginning. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants and conditions and will warrant and defend the same. U 2814 P 532 Dated �th�is 1166th day of May 2005- <-�12i"' "!I� d - �(/"`^ (SEAL) r SEAL) David A. Ball / Kimberi A. B i2 -Y'W�/� e/ R Q' (SEAL) (SEAL) Dennis F. Ball Naficy A. BaIr AUTHENTICATION ACKNOWLEDGMENT Signature(s) n�= i�.6�r/y: STATE OF MINNESOTA } ) ss. authen ted this ay of COUNTY OF 20 Personally came before me this 16th day of May, 2005 the above named David A. Ball Kimberly A. Ball and Dennis F. Ball and TITLE: MEMBER STATE BAR OF WISCONSIN Nancy A. Ball to me known to be the persons (If not, who executed the foregoing instrument an authorized by §706.06, Wis. Stats.) ackno the same THIS INSTRUMENT WAS DRAFTED BY LOBERG LAW OFFICE Notary Public County,MN My Robert L. Lobers] Commission is permanent. _.) (Signatures may be authenticated or acknowledged. Both are not necessary) (if not, state expiration date: .20 )b / SST1042 Notary