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HomeMy WebLinkAbout026-1175-04-000 Jisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488031 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Miller Homes of Hudson, LLC I Richmond, Town of 026- 1175 -04 -000 CST BM Elev: Insp, BM Elev: BM Description: Section/Town /Range /Map No: / oe (a{Yl ► G 5 ( 30.30.18.1404 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER w,5 CAPACITY STATION BS HI FS ELEV. Septic 3 Benchmark - I 9 ra o ILA �Z S Alt. BM` f c. Co�a�, y,o5 io3 i� Aeration Bldg. Se er � 7.7 /Da•Z`t Holding St/Ht Inlet +� g, "76 9q . 3 I 9 7g �q TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 17 i / J� 3, � 7 75 � Dt Bottom Dosing Header /Man. Ir B 3 � Aeration Dist. Pipe * 7,T 7 99 ' r,* Holding Bot. System !� '�g• /6 , 15 57 tG Final Grade f �j, Za a Z • 91 PUMP /SIPHON INFORMATION Manufacturer Demand St Cove GPM Model Number 11 4 1p q9 • �/ TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - 3 / C"i Z. t fe wc, SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: II /" UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 4 Pipe(s) \ \ \ c3 C.1 Length 5 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of x Seeded /Sodded ] xx Mulched I i i Bed/Trench Center S b 5 Bed/Trench Edges Topsoil \ Yes No +ti Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 918 131st Avenue New Richmond, WI 54017 (SW 1/4 SW 1/4 30 T30N R1 8W) / Willow ever East Lot 4 Parcel No: 30.30.18.1404 1.) Alt BM Description = jz' I �` 2.) Bldg sewer length = Z - amount of cover = I Plan revision Required? 1 Yes No 'Z , L� pt Use other side for additional information. _ ----- -- - - Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) Col'T merGe.vvi.gov Safety and Build' County t „ I ats x .O. B x 7162 1 —7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce gj d 3 Sanitary Permit p a ion State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, sub fission ¢ h riate ovemmental �-- unit is required prior to obtaining a sanitary permit. Not AppltC�toN'forms�or owned OWTS are Project Address (if differentthan nailin address) submitted to the Department of Commerce. Personal info ation ou to Mr secondary C? t 9 t 3 I s� v p urposes in accordance with the Privacy Law, s. 15.04(1)(m) s. / /h /l� ✓� 1. Application information — Please Pri I mation /Y / � E ' Lh of Property Owner's Name / Parcel # ✓ 4 we 0 2C, -U 7 Property Owner's Mailing Address Property Location r Govt. Lot City, State Zip Code Phone Number G ) (� y, y,, Section 3 C7 circle one -S � � � �� � 7 T 3 I ) N; R � � E 1. Type of Building (check all that apply) 3�E Lot # or 2 Family Dwelling - Number of Bedrooms - P�w.� Subdivision Name Block # W � � � �r.�J � , IJ �✓ ��� ❑ Public /Commercial — Describe Use Z iSS II 11 City of El State Owned — Describe Use LA-J 23 }Z3 C --l ee' CSM Number ❑ Village of own of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ac stem ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) Chan g e of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued F1 ` B. Permit Renewal ermi[ Revision r ' l Before Expiration Owner _/4 _1 ., t C�- IV. Type of POWTS System/Component/Device: Check all that apply) 2 — uV 1 2 Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) c to I IBC ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requir (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o U == New Tanks Existing Tanks o` o k �� Iftt✓ U n y n w C7 ii Septic or Holding Tank Dosing Chamber t VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number t � V1ti -�o xm`� 7 ite D- 2 -1 2 S' P lumber's Address (Street, City, State, Zip Code) Vill. County/ e artment Use Onl Approved 11 Di p Permit Fee Date Iss ed Issuing A Signature ❑ O tven Reas for Denial $ /z a o(� IX. ConditimThWIMAW.easons for Disappr \ 1. Septic tank, etlhtent ftRer a n d 3 dispersal cell must all be services / maintained �,� �'a .'� "� K a.�`"�u►� -`' as per management plan provided by plumber. 2 AN setback requirements must be mairutakued Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 1 "31AWO M3'TSYZ b9nif. nib" I ,• t�,,:Y• ? t - lnli' • : Y G::'9r si i W i((ouw R: var srt'" y ,., - T F °f LO Sfax. �'�: s ; s u 2e. �✓a w DEC 1 1 y � g -) CR OUNTY gT. OIX C ., B 3� � o L 12 sv'a f o v � LY 13 PN fo o \ n ti COPY v f L i kow R', oar Usrt" Q . Vt1 14 a /o Sfa * 11 A- : TY►; S ;s u G1✓A �.t.J B :• p g -► OU N 1' �;(Q B3 � o L To V- v ` c 4 l ka7) h IV 2055 Wisconsin Department of Comm SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on pW not less than 8Y: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 026- 1175 -04 -000 Please print all information. Revi , ed By Date Personal information you provide arWrivacy s. 15.04 (1) (m)). Property Owner 1L.JJ Property Location Miller Homes Of Huds4Address DEC Govt. Lot SW 1/4 S4114 S 30 T 30 N R 18 W Property Owner's Mailing tot # Block # Subd. Name or CSM# P.O. Box 10 4 Willow River East City St a Zi o one Number _J City _f Village Town Nearest Road Hudson 531 -0714 Richmond 1 131St Street V1 New Construction Use: 0 Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. System elev. = 97.25'. Boring # I Boring 0 Pit Ground Surface elev. 103.61 ft. Depth to limiting factor >122" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.6 1.0 2 12 -24 10yr4/4 none gr sl 1 msbk mfr cw 2f,1 me 0.4 0.6 3 24-40 10yr5/4 none sil 2msbk mfr cw lfm 0.6 0.8 4 40-46 10yr5/4 f2d 7.5yr5/8 sil 2msbk mfr aw lfm 0.6 0.8 5 46 -122 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 3L ' I Z Comm. 85.30(3)(a)2 applied to discount redox. features reported in H#4. Boring # I Boring !1 Pit Ground Surface elev. 102.03 ft. Depth to limiting factor >125" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -12 10yr3/3 none sl 2fsbk mvfr as 2fm,1 c 0.6 1.0 2 12 -32 10yr4/4 none sl 1 msbk mfr cw 2f,1 me 0.4 0.6 3 32-46 10yr5/4 f2d 7.5yr5/8 sil 2msbk mfr aw 1fm 0.6 0.8 4 46 -56 7.5yr4/6 none Is 0 sg ml gw - 0.7 1.6 5 56 -125 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 ILHR C m. 85.30(3 applied to discount redox. features reported in H#3. " Effluent #1 = BOD > 30 220 mg /L a d TSS >30 < 15 mg /L uent #2 = BOD <30 mg /L and TSS <30 mg /L s m CST Name (Please Print) Signatur • Number u be r so 3602 K. Thompson p Address A.C.E. Soil & Site Evaluations , Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceol W1 54020 12/5/2006 715 - 248 -7767 III -_ - - - - -- ' • Sor % edalua�caCby W , QenC,. Wtp, Teo o("/4� Asswrne e/ el erg _ /OD . co, ,SOr �Qdct/ua� 'cn �,� • " 3 1 L ) " � z0 SS 1° 0 30 T 1� �' S� .Gr�ox Co c,J�•, & 3 •a r•dttz r � l 83 '`b_ , btdroom re6l Ex��s�5� i, zsro 6 2 cL , Rasidu,a Ca�L 0 ry x31 St. 3W3 A '7 - /g37� OWNERS COUNTY PLAT .— a D VEE N WILLOW RIVER EAST NEWRICHMONU. W soon W or+ A LOCATED IN PART OF THE SW1 /4 OF THE SW1 /4 OF SECTION 30 AND IN PART OF THE NW1 /4 OF THE NW1 /4 OF SURVEYOR SECTION 31, ALL IN T30N, R1 8W, TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN. EOWINC. IIANUM 8 � NORTIOMUSUR`kVING,INC. ml 5 655AI1W/ , 1P.O. RO%r•1 ? c RODF3tP5 W , I5e023 ry N l �\SCONS�i i ItVGVI .. .0 U4`II,BB� !'� +s vZ _ aY � ✓ U a+ N89`40'55"E 1442 08' s' � , uE ervwlry lvmF bhro. rHE Swu svnra ac s5crlo ��SUtNNEy.. 'o h 3 1 ry "u DRA /NALF fASfMf - N rtobry •s ue b. LOT ACRES a 113 so LOT1 t 8BACRES �. LOT 8 - 61,88] 1. gCRE3 ir, —NAZE EASEMEM DETAIL 4 3N5 aN It -i NACR ES q il CNI �1YSJi 1 ^ +14rr \, 2.09 ACR ES 9w.bb 9001 -W x ;• I {�b Y S t LOT 22 LOO ACRES 69,963 sq. n. i k' LOT 2 n ' l! ! A `c + L•t "�, 2d2 ACRES + F ___ - -- .. ul m spew m p'� 1 N Br{N Uw. _ - c, LOT E � 1.62 ACREn .tea � 9 aoSiCu ]01151 r ,8 9 )� rvBpls�lw e rF Uv O LOT 21 _ -- -- ACRES N Sw I in p ol� S6 zo�c.wan.. / .' AR A.:a - u �I k �ONOINc a,y f m LOTS fi 1t ut lH —ACRES , �� /�� / LOT 9 `C —ACRES o Z LOT 20 j, I.puY: d ISR ACRE 5 \ t h .bss . E Lv +r W / 1 YY u C. L0 19 ., ea � ACREB ,293 sa.n 2 _yBl LOT ARE y z9 ACREE OT8 I`R 110.395 sq�n. _ U RCrwr+rvOr[ . _ 2.11 ACRES a ` 91,]]8 S9 n . - .f LOT 18 Y `nbr t i ,.: a s , �A n m LOT 11 _ ACRES N 130TH es „y, �. m 81.]53 s0 x:' ._ .. _ D . a AVENUE LOT 17 ]' J LOT 13 ak 'r 1.5]ACRES �'.• B3,OB1Nh P� s � ; u r LOT 12 "1F \ \ � \ ” LEGEND ags - Y LOT 16 9 1 � ` % �vr: . - ss sn�ct ov E�'+ �1 P o !l wrvvnt++.na Tq ACRES � 2 T D1 ea sg �• n ,�, � ]9,1X3 sa. n. I " � 1 �� - NINr, i Ss RC4 11 8 .Eh rv.uE2. t0 ACRE5 rvOrt a mE 42 to rvu LovII TEMPORARY CULDE.SAC DETAIL -. - rEAtrvUwrvry,w twtu O .. `Tr '� 1 A9 EVtv1l Z I LO T15 w P. uw ha 1w10-w rhry r«r 2', 2.21 ACRES tvzr 2ENdNUwN ELEw.TNa� ]O a 0 99N PPE j• 1 95,eal sa. x.,.' / LOCATION SKETCH i 3 . � A ND SIRE I �1 1 ra:N S v 6 � a 1 G y N i / /+ e' +s �4r e � rvnre ecc[ssB[stnlcl ON t6 ��✓S� \� \ J rnE rcl.ss rRON rur*EO raw B9Nx „ I V yP F //f vnrnv lrnbu* y _ 30 LOT zz PLAT { nor u,u sateNU Ox D OT] Cl­ 1.I,CP_4.3. `fi y � r 1nvFrvrvr. nn u n v,nte — __ NOt ml �: 31 i 1315T $TREE' I •bw T R LOT9 - LOTS COUrv1Y,N1 - - a:E:`a,N SEC. 30 6 31, T30N, R1 SW BorAOroB A9wa �` P uorslMENa oc bECOBn SCALE IN FEET V = 100' 168 0 1m zoo SHEET / OF 2 SHEETS INOrrE00vNMUPUnrvEn .I IAR— Safety and Buildings Division County 201 W. Washington Ave., P.O. B ® .5 T - . C✓ O I X ` adison L Sanitary Permit Number (to be filled in by Co.) /SCOif stWn 8 ' Department of Commerce fate Plan I.D. Number Sanitary Permit p tio> 2005 In accord with Comm 83.21, Wis. Adm. Code, na 'nf ton vide oject Address (if different than maaddress) may be used for secondary purposes Pri La •04(lXm) �IXCCuNv 'J (sT 1. Application Information - Please Print All Informatio NELtJ RIc,N tN � D P.—Ara-, Lot Block b Property Owner's Name J _ SAM ( LL 2 /„ L L p Property Locg Property Owner's Mailing Addr .0J- �A& 3 — / Section 3 � City, State Zip C�od / e Phone Number -'� vySO lq S71>�40 �1f 38'F'Z7r°g T ,30 N; ES Eo e taW II. Type of Building (check a at apply) � � �' k � J4. n Subdivision Name CSMNu ❑ 1 or 2 Family Dwelling - Number o rooms U/ . 40uJ ❑ Public/Commercial - Describe Use w s fir. [City ❑Village ownshi of ❑ State Owned - Describe Use 4 6 Q LIB S III. Type of Permit: (Check only one box il lac A. Complete line B if applicab ❑Other Modification to Existing System - A. New System ❑ Replacement System ❑ Treatment/Holding Tank R acement Only t List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision hange of emit Transfer o New Before Expiration Plu wrier 1 % [V. T of POWTS s ys t em: Check all that a I 2 - .s �•.I s w.t Non - Prcssuri�ed in -Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of U suitable soil ❑ nit ❑Recirculating Sand Filter ❑ Grade [3 Single Pass Sand Filter ❑ Constructed and El Pressurized in -Ground ❑ Holding Tan ❑ t Filter ❑ Aerobic Treatment Un Recirculating ynthetic Media Filter Leachin Chamber rip Line Gravel -less Pipe' ❑ Other(cxplain) V. Dis rsal/Treatment Area Information: Dispersal Area Req (sf) Dispersal Area Pro sea (sf) System Elevation / Design Flow (gpd) Design Soil Application Rate(gpdst) p � Q ' Z / /7 Z .00 Manufac er Prefab Site Steel Fiber Plastic VI. Tank Info Capacity to Total umber Concrete Constructed Glass Gallons Gallons of Units I New Existing D 1 1 Tanks Tanks $optic or Folding Tank an ' w d 1 tr Aerobic Treatment Unit Dosing Chamber hown oa the attached plans. VII. Responsibility Statement - 1, the ersigned, assume responsibility for installation of the PO Business Phone Number Plu tier's Signa MP/MPRS Number p ; b Name (� / n i t) I "t ., Z L S 3 �o 7/ S ' 7 �e d . 2-7 2. d � -UO K C V 1r l l Plumber's Address (Street, City, State, Zip ode) 0-?o � �m-r/ (L , kJ @�• v hJ.S OI/� W � fo VIII. Count /De artment Use Only Date Issued Issu' Agent Si mater No s Sanitary Permit F (includes Groundwater Approved 11 Di Surcharge Fee) 00 �Z XZ 05 ❑ O r Giv Reaso or Denial IX. Conditions of Approval /Reasons for Disapproval 3> A J5 � - SYSTEM OWNER: � ,. I "*C W*,. malt MW CO MU@t 81 t>• NrVICai / Il�tta I n as.wr plant/ n Ma k d P`t�nnl�X-� �' J -se_ a'. c�•� �J +�^,� -1° ,,, Q•� psr,lppNeabt. coda 10 dl WIC du I,t l� Qm � for the system on paper not less tlua 81R x It inches fa size Attach complete pram (to the County only) SBD -6398 (R. 01/03) e-Q VAotk to Am wj,"; t4" or. Lf I D � 3 1 Q e o o' a- IX 42 �'T'RSAtc. NF S JA 5 c k ck i 2. w - U� Z - ro e :F.@L Nca_ �c � � = i ��/ Oa• /yI /C�E2 No mom` S m I LLe2 W /LLo w 'R( l)b,t E4-.j7' D �f i 3 -- wEL� -- M a� 12So �►4� SZ" I o1L FI LTE d' B' !� a- 3 X 92 x '1',2 r NF S °tl - ��,� 3 - L1.4 rH •✓ s .mil N =� 4. -7b G� v ''A - rj Tt ,1M. TO P (�'r` ST�.k� 1E 1= 100,00 �, tK 2 - o c a- o Srt � 1- 0 T P �.�� � I L I.o D RECEIVED I OCT 14 2004 ST. CROIX COUNTY ZONING OFFICE OWNERS - COUNTY PLAT WILLOW RIVER EAST St33P0 AVENUE NEwwcwA0N0. vn 5n5t, xct�,w LOCATED IN PART OF THE SW1/4 THE SECTION 30 AND IN PART OF THE OF THE NW i/4 OF / SECTION 31, ALL IN T30N, N, R1 SW, , TOWN OF RICHMOND, ST. CROIX COUNTY, , WISCONSIN. , SURVEYOR 1 N o�NC. EIANUSn o e TNUNO5UnvEYWG, iNC. 9 BSBAMM 95'1 P.0.00 %ia o F POBEPIS.MSa033 a � p I 91MPQIRD UNU G 88 g R {QA w.. m N09 °40'55 "E 1442.08' 1 " \ •:\ - rvn -� -' w iosro aoy, m LOT5 I - \ `\ i� •b' F n. aCPE S m,mwr m eno LOT I LOT 1 ts. pVES 1� \ .B�a0PE3 E _ 91,3.S p. n. f LOT] Q os. ..1_ .................... \ 21 nES 91f7fiL ^.tll'701.SP.tlf:_ 1 I \ \\ i , 1 , " D R I I 3 P ONDI N ^AREA' Y � aw L 22 aCPE aro,wtw vt `. I iOT 2 � Y IWis.ev. -ovn __ -f IaS4n 11 h, , r. lei �� \ �•, y q � -o s 6 yrns —.—. —_ • �Qi E03 aCPE9. d \ � � ® � 4�.- r = -'�- Ef �.p' -I� ,'7 n. u Imo• tm -aroo �. L0T3 w �y ......... .................... T ....... o LOT 4 r /: G � 1 \\ 0 e: min .azn•... ,.N N el.t 1 ay nE5 ...LO UrEn ~ V LOT 20 ® >, i.fey •9 �o tno9taoos Nq . LOT E �. 1 • —E. � \ �'• 8Ev LOT Io ' 1 8 _ / 5 �` .ccss x 8 4 _130TTfAVE ssnioxw - ---- ---- --- - -- LOT 11 /® LOTiE \ \v/ a A ND T V LEGE LOT 12 ` %� LOT 16 f POND/NC, un'.cn + °��P % - �j O "" n i1R£A' III a .ccsa l ine wx I " ;:..sa i g ss ,uacBEh rare - r � ' • s ro �,� r. n m "� 1 � � :•� '/ P� �!, /' ____ rrta%9's°muEw.rtwrw Z i f /, Lro - Lw.En , rmar vss xr rEssn 15 zs uorz:' 6 .^/' // eExnuu«Etnnnx T1 / acPES / /' LOCATION SKETCH ............ .wrcxow.rsEtwrxL . a — ~. — —.' �' •/ y6 / s �iu�., 30 wx.xs.on>.r ..Krrssrrwnarm °x. rows 1111T J? s / � atts9nrs osmoaawssESmrN. snww.s..nsn / 31 G�6•�' '�/ / ,� / �"� mss � "runssxnxxo netenx rossx.E newu n.tn.c SEC. W d 31, T3ON, Rt BW / u�,lrav[NneEeccgm \ wnarrtxoronnrmr8rwnr SCALE IN FEET 1 - l W �N 0 1N M SHEET 1 OF 2 SHEETS Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Cam' Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must s � include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north am w. and t� se iewand9ie crest road. ` n Please print al irwoAft - I V E D R by Date Personal information you Provide may be used for dnuy Purposes (Privacy Law. s.1 O j1) (m))• Z' �, p p P go Su l Lot NLj 114 114 T d N R U E( W Property Owner's Mailing Address J 0 N I N G OFF ICE Block # Sltrd a CSMIf qly pate zip Code Phone Number ❑ City ❑ Vine T Road J ) �✓ New Construction Use: Residential i Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pu bliic or commercial - Describe: - -- -- Parent material © a-t?.cJ C.� Flood elevation if applicable l�J i3 ft. Gerwal comments and ninsixiations: e e- # On c 9 Pit Ground surface W I R Depth to smiting factor G &l Rate . Sol Application Horizon Depth Dominard Color Redox Description Texture Structure Consistence Boundary Roots GPQff In. Munsd flu. Sz. Cont. Color Gr. S7- Sh. '1 'Eff#2 312 3 _ J A4)" Z Cv •t 1 �. Pit Ground surface elev. 1 - % ft. Depth to lhWM factor in. Son ik aeon Role Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD01? In. Munses (lu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 TRIM a m S -2 m , s/ �L 1 sb� �'r w r , 2 l ox ' r /� S s I n c+, r) , 7 /• Z CA efliwt #1= WD 30 <_ 220 mg& andISS >30 5r� ' Eftmit #2 = BM 1 30 mglL and TSS <_ 30 mglL CST ( r CST Number ` s r✓ r Telephone Number Address r /` Date Evaluation Conducted propert owner Parcel 1 # Page of Boring * 0 Boft Pit Ground surface elev. � R Depth to g facia'� in - SoU Rate Horizon Depth Dominant Color Redox Description Texdre Structure Consistence Boundary Roots GPD/If In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •Eif#2 - T - O-/) , P 3) z -- 'Z m ' v � K S — . 8 2 / - _ Fr - "Z 3 nn Boring F ❑ Pit Ground surface elev. R Depth to limiting factor in. Soli Application Rate Horizon Depth Dortuinant Color Redox Description Texture Structure Consistence Boundary Roots GPD/N In. Munsell Qu Sz. Cont. Color Gr. Sz. Sh. •Efi#'i •Etr#2 i F Bodng # ❑ �9 ❑ Pit Grour)d arface elev. R Depth to WnMV factor in Sod Rate Horizon Depth DMIlnent Color Redox Desm"ort. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell OU. Sr- Cont. Color Gr. Sz. Sh. •EW •Etf#2 • Effluent #1 = BOD, > 30 _< 220 mg& and MS >30 < 150 nV& ' Effluent #2 = BOD. 1 30 nQ& and TSS 130 mglt. 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- 2648777. ssauwc L&W) . J Bir� Soil Test Plot Plan Project Name David Railsback Shaun Address 845 133rd Ave I ) New Richmond Wi 54017 CS #226900 Lot 4 Subdivision Date 1 /12/02 SW /NW 1/4SW/NW1/43 30/31 T 30 N/R 18 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 103.0/99.9' *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement 301'Property Line * Alt. B. � 35' \. 10% lope , 20' B -1 80 ' - - 30' 40' a B -3 107' 207' Property Line I, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Ro k 1 1 Property Address 4 7 ( 1-31-s7 c ---_ VE (Verification required fr om Planning & Zoning Department for new construction.) City /State 6fX i2l W/ Parcel Identification Number cam J ?S -vop 02G.- Io'T / — 7o — o 0 cv LEGAL DESCRIPTION Property Location S W '/o , s ' A - ) '/a , Sec. 3 ° , T N R 1 2 &Town of 2 : c I, AA o n Q Subdivision W t LL-0 wJ , Lot # Certified Survey Map # 7 7 1'3 7 y , Volume 1 D , Page # YO Warranty Deed # 7 �' 2- , Volume Z 7 Z , Page # z 5 Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as alreatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SI A 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 map if reference is made in the warranty deed. (REV. 08/05) U, 2 7 2 6 P 2 5 4 - 7 8 .4 atfi a State Barbf Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED - ST. CROIX CO., WI Document Number Document Name RECEI YED FOR RECORD 01/05/2005 01:00PH WARRANTY DEED THIS DEED, made between David H. Railsback a /k/a David H. Railsback II and EXEMPT # Arla J. Railsback husband and wife ( "Grantor," whether one or more), REG FEE: 11.00 and Miller Homes of Hudson LLC, a Wisconsin Limited Liability Company TRANS FEE: 2115.00 ( "Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Lots 2, 3, 4, 6, 8, 10, 12, 19, 21 and 22, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. 0_26- 1088 -95- 000:026- 1091 - -000 Parcel Identification Number (PIN) This is not homestead propert}. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated December 30 2004 (SEAL) (SEAL) * * David H. Railsback (SEAL) (SE * *Arla J. Railsb k AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback and Aria J. Railsback husband and wife STATE OF ) authenticated ori D ember 30 2004 ) ss. ff COUNTY ) �2m I * Krishna Oeland Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland - Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 * Type name below signatures. INFO -PROT" Legal Forms 800- 655 -2021 www.infoproforms.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa Z -- LE INFORMATION SYSTEM SPECIFICATIONS Owner 5ttwll M� 0#X ���,�, /��,� me / / Septic Tank Capacity L, .5 P � s O al C N:: i Permit A i Septic Tank Manufacturer wCl S � ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2,Q Jg E ❑ NA 1 Number of Bedrooms ❑ NA Effluent Filter Model 0 N { Number of Public Facility Units I X NA Pump Tank Capacity al Z NA Estimated flow (average) Y SD g al/day Pump Tank Manufacturer J W NA Design flow (peak), (Estimated x 1.5) (O p O g al/day Pump Manufacturer WIN Soil Application Rate al /da /ftz Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit Z'NA j Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) C NA Biochemical Oxygen Demand (BOD S30 mg /L In - Ground (gravity) 0 In - Ground (pressurized Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade 0 Mound Fecal Coliform (geometric mean) 510' cfu /100ml ❑ Drip -Line 0 Other: i Maximum Effluent Particle Size Y in dia. ❑ NA Other: C N:: Other. Other, ❑NAI Values typical for domestic wastewater and septic tank effluent. Other: C NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ ear(sl(s) (Maximum 3 years) C NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume C NA • Inspect dispersal cell(s) At least once every: 3 ❑ year(g)month (Maximum 3 years) ❑ NA • month(s) Clean effluent fifter At least once every: / — Z- jg ear(s) ❑' N ❑ month(s) C N Inspect pump, pump controls & alarm At least once every: ❑ year(s) C r Flush ❑ month(s) laterals and pressure test At least once every: ❑ year(s) J Other ❑ 1 At least once every: ear ❑ month(s) NA � ❑y ) Other 7 N MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifica; ohs Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tangy 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 pond inc; of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immedi 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 dispoged 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. l ; UP AND OPERATION Page o f 7/ For new construction, prior, to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels, When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent, To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • 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. / T r/ alua b e ai e ���� 1l f3 lT�� �t� /�/�1✓ �NS`lR(IC� 6uj ❑ 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 les O K� �� Name Phone lS " I lea - L J Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S C Phone d Phone (0— (O (D Th This document was drafted in compliance with Chapter Comm 8 3.22(2)(b)(1)(d) &(f) and 83.6401, (2) & (3), Wisconsin Administrative Code. elf! W , LLOW RIYER EAC.Tt LOT , M I �•- a M' n LET T �, � 11S„yt:7 h 21t•,aCN6 �FE 6 c m EA I E 1h� `t n n' r f 106.1T: 7q. 1 "itl'7 1 �!\ //�� /) ,' y'� '.. t t ►,lG l li7A RYTAlR xMlnR t•! e in t J 4 i Q s� J � - T 3 2 L.crr 0 + . Qt ACR V CY ^•D r -4owm WI It J7:1.T 17V � 0.'v::, t•t77: i ,,'i� � Gw 1 t71' SD � '�� � '' •� I ` ACAJF. '�' p� LOT 0 C=W-r' ;n:STK'C4,. a !':,770 W R' Al �•r.r — i I• . t 5 .'. .CST T? r /� ,) nrr•F� LOT 13 s • �" LOT 1 G 7 v' - 3 -OT 12 4 y1 1Ci1 y I d k . • :,y �.... , „�� „ y ,�t r�� i \ / ` / n �� r J r . ` 101.54 nu It �{ „', c, .7Y A.I It iK s��� _ ta 07 •. a �' A : ', :%;(�,�� , . /'+�.��% �' , /* C• 4 9.1 uAC1LL 3% fir o1aK / 7; t. ick4 rM STANDARD CHAMBER I 52" - Quick4 Standard Chamber _ - 48' _– FFECTIVE LENGTH; I ll s I LL -A or 1 - 31 "- - -- -- -- - SIDE VIEW SECTION VIEW MultiPort End Cap i -- — - I _ t 34" - - ;II' ` „I! `.'. TOP VIEW FRONT VIEW ` Quick4 Standard Chamber�Nomin'al Specifications NlultiPort End Cap Nominal Specifications Size (WxLxH) Wx 52 "x12" S ize(WxLxH) 34 "x16 "x12" Effective Length + r 48" ; Wert Height 8” or 1.25" Invert Height 8" 1 i a� INFILTRATOR SYSTEMS, INC.. STA NDARD LIMITED W ARRANTY ,.rll r ,rt r hlo h h:. i � iv Period II! � I 1 ;y l 11 I f,)r L nil ^d la vl•11 L. 'i i- r IN .Il, O A let ARF 1 OR I I I N N SYSTEMS INC � (' Intl I C VJgl tngti nLS OF MEr�(:HAMARII Ifl' 0717 I.IIUf .�� I G ! CSI :1 C lt', i .. SCI „I i ,,.. .��. ^I e 1 rur rp _ ,1I ;r, .. Environmental Onsite Wastewater Solutions 1; •r o rt a11. Jr r, n dl ens wl I J1 a 1 6 BUisiness Park Road " P.O. BOX �6 r i .Ih -, ...d61xJn r51n lc (. ,. 11 tJ DIpGO nt?n1 nl Iprr , r �, Old Saybrook, CT 0647,5 - P 860 577 -7000 • FAX 860 5 i 7 -700' ! I , 1 II 800- 221 -4436 I I I ... 1 . 1 ,r �I. t ', I -rJ I r , I - •' 1 I ,r I -. C I ' 1 , I.IE � 70 1 v11 „ t — J - 5 5 11 , n aS7 OO f_SF t O I oefents nenciing Si,1q`A .r ler ffi9 rp, Su:.'P,d Irarleme:ks of Inflltrato Svsi ms i "% 11:P. r r, _ :'l; r� Ir' ^b. rdl bVS,('I'1g Irr, r Vnnco Cn it,iur. Contour Swivel Connection tv1�r rnl r dr.! "1, �. d Spar r n..r n rJ ..: Ju '.k Fin,, aErrueo one =a fclnar�s of Inhltrntr Scsteme Inc 7 2003 Infiltrate Sys ,ms Inc. I'•L i iI - - , Polylok PL-525 Should you feel it necessary to add additional support to the PL -525 fi lter, use a six -inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The extontion pipe needs to be anchored to the fi lter housing with one or two #1.0 X 112" SS screws. i � e - Anchor 1 -2 Stainless steel screws through housing and into pipe. Use #10 X 112" 6" Schedule 40 Pipe Pipe rests on bottom of tank - - -- W ►flow R'. uar �S"f"" wfi'� y 7"o P of lo7 sfak+ /11�� : ��: s ; s u 2e c`✓a u Q WI F,l : /DO.c1o' �� � m� a.� 5. f Zr - 6,3/ , o zS � c T ti� _ u o i 71 z� �o r J 'a