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HomeMy WebLinkAbout026-1286-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION AVOORT Sanitary Permit No: (ATTACH TO PERMIT) 488206 0 GENERAL INFORMATION State Plan ID No Personal informatio0ou 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: Sunset Rid 2e LLC I Richmond, Town of 026- 1286 -01 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CST BM Elev: 7 ov AIM t GS 34.30.18.1423 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 's CAPACITY STATION BS HI FS ELEV. Septic z',, _- Benchmark F.M.41 loco 0 z_ Dosing Alt. BM :! I. Co N.�ioo G�DO of r o.,�� ; Bldg. Sewer of ing St/Ht Inlet St /Ht Outlet TANK SETBACK INFORMATION Vent o Air nae ROAD Dt I ep lc � b q�' o om osing a I 7 Z 1 H eader/Man. �✓ . . Le eron Nib- . Z is ipe Z Holding o . ys em 3.3 9$ • � �t lna ra e PUMP /SIPHON INFORMATION I • / � O anu ac urer Uenriana st cover GPM Ftb Co Z m odel um er ZS t0 Ca&A-o,�l' 3 3 7'9-7 I UN l nc io oss y em ea 11 •`i 1 0. 47 1i•7 rcem l rr ! � 3o A "SOIL ABSORPTION SYSTEM Z.o EmIgm U1 "C 11.� rr!"DIVIENMONS NO. 01 PRS 111bluu uld. [qulu Uuplll DIMENSIONS � + . INFORMATION -7 j CHAMBER OR A�l1 //� n (1�,^ _ ` ^ A- UNIT Pipe(s) s I/ Length \1 2 g Dia Length D Dia Spacing Z� a IJ x Pressure Systems Only xx Mound Or At -Grade Systems Only Bed/Trench Center / • C Bed/Trench Edges \ Topsoil 7 �� -'fts' � � No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � / — (. j in C Inspection #2: / / Location: 1202 124th Ave New Richmond, WI ( 54017 (W 1/2 SW 1/4 34 T30N R18W) Sunset Ridge Lot 1 �,. ,�` Parcel No: 34.30.18.1423 O� �Jn dtq'� �o✓� ��tJs 1.) Alt BM Description 6 %a: &'s = 2.) Bldg sewer length = ;js 1 41- 62� �� - amount of cover = I•- L{ d ►ti. Plan revision Required? ]Yes No '� �� 7 Use other side for additional information. a / - L te - - - - -Ins s S t - - - -- — -J SBD -6710 (R.3/97) i Safety and Buil ings Division County 201 W. Washingto ., P.O. Box 7162 e filled in by Co.) Madison, .3 07 7162 Sanitary Permit Number (to b (6 26 - qg g 2� Department of Commerce Sanitary Permit App St Plan LD. Number 1 In accord with Comm 83.2 1, Wis. Adm. Code, perso may be used for secondary purposes Privac T aw, s1 ,o}ect Address (if difYeren mailing Tress) *'! Lo Z /2 J 1. Application Information - Please Print All Informatio 3 0 20 06 AY Parcel # Lot # Block # Property Owner's Name L-1 ST. CROIX COUNTY J`� —' 5, -e- roperty cati Property Owner's Mailing Address 0 j J w `l , W % SW %., Section City, State Zip Code hone Number oc ire Al b �N, E 4f 11. Type of Building (check all that apply) S Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedroom S L.t- rl, ❑ Public/Commercial - Describe Use ❑City_ ❑Villag%;E<ownshipof C ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Q - " z A. nZeforeMpiration tem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued enewal ❑ Permit Revision El Change of ❑ Permit Transfer to New Plumber Owner IV. Type of POWTS System: Check all that appl ❑ El Non - Pressurized In- Ground El Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil t -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) V. Dis ersaUTreatment Area Information: 0 Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) ispersal Area Proposed (sf) ystem Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Unit W (�wE>�LI /(_Ido Concrete Constructed Glass New Existing 1 4 ftv Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit noses c hamber X 3 v VIT. Responsibility Statement- I, the undersi assume responsibility for instaltation of the POWTS shown on the attached plans Plumber's Name (Print) Plumb ignature MPrMPRS Number Business Phone Number -Z z,- , �: Plumber's Address (Street, City, State, `Lip de) VIII. County/Department Use Onl Sanitary Permit Fee (i eludes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑Disapproved Surcharge Fee) 55U- 0 . en Reason for enial JV IX. Conditions o pp ov val SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than S 2 x 11 inches in size SBD -6398 (R. 01 /03) • PLOT PLAN PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W 1/2 SW 1/4s 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 98.7' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none Ilk BENCHMARK V.R.P. Top Of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE WELL * H. R. P. Same as Benchmark B.M.* 317' Property Line Scale = 1/4" = 10' 98 �, 91 B -1 Area 15' below system is to remain undisturbed B - 3 5% Slope Grading is to done to divert run -off away from system B -2 Well is to meet all Huffcutt Combo Tank setbacks found in Comm. 83 Tank is to be properly bedded and provided with lockdown covers with Pro 3 approved warning labels Bedroom House 120th St cop 342' Property Line A Safety and Buildings C01111t1 @CC @.WI. OV 141 NW BARSTOW ST FL 4TH g WAUKESHA WI 53188 -3789 TDD #: (608) 2648777 i scons i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 25, 2006 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/25/2008 Identification Numbers Transaction ID No. 1270480 SITE: Site ID No. 713090 Sunset Ridge LLC Please refer to both identification numbers, 120TH Street above, in all correspondence with the agency. Town of Richmond, 54017 St Croix County W1 /2, SW1/4, S34, T3N, R18W Lot: 1, Subdivision: Sunset Ridge FOR: Description: At- Grade, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1076437 Maintenance required; 450 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the approved plans, and with publication SBD - 10570-P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems ". The pressure network is to be constructed in accordance with publications SBD - 10573 -P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and th(: sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks fortST -SAS (01/81) In the event this soil absorption system or any of its component parts malfunctions so as to crcA health hazard, the owner must follow the contingency p lan as described in the approved plans. In additio property g Y p PP P k ? owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the at-krade component manual. A copy of this information must be given to the owner upon completion of the project. I Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. I SHAUN R BIRD Page 2 5/25/2006 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operarion. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Julia Lewis- Osborne POWTS Reviewer 2, Integrated Services WiSMART cede: 7633 (262) 548 -8638, Fax: (262) 548 -8614 julia.lewis@wisconsin.gov Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 5/11/06 w r: n t Ridge LL O ne Su se dge C Location:W1 /2 SW1 /4 S 34T30 N,R18W Lot 1 Sunset Ridge Richmond System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81) Page# 1. Cover Page RECE QED 2. At -Grade Plot Plan MAY a1006 3. At -Grade Cross Section tii,Jf.l)INGS 4. Pipe Cross Section /Pipe Layout SAFETY t 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature i g License nu r 226900 ; c s PLOT PLAN PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W 1/2 SW 1/4s 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 98.7' BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B.M.* 317' Property Line AL Scale= 1/4 = 10 98' 98.7' 9, B -1 Area 15' below system is to remain undisturbed B -3 5% Slope Grading is to done to divert run -off away from system B -2 Well is to meet all Huffcutt Combo Tank setbacks found in Comm. 83 Tank is to be properly bedded and provided with lockdown covers with Pro 3 approved warning labels Bedroom House 120th St 342' Property Line > 5' B EA k-- ltSTR�`iT ;ewi L�4T�[LJkL STl�6tz o�9.`��c�ar: v�ttc 0 - > 5' {/6 E3 (12B }_ _ $ F$. CELL o lz Z %2 AtSf :ttE�#�T ptPQa.burLa SYmTjiEnc. Fabric i Distribution Later ©l STAI 110 - tr-b Observation---- r ,�: � if t �� /, I � �5oit Cover 1 eli �, j fl.bvtil�D i.nYER pier, View and Cress Se ction Of w iscarksi-rx Ac-grade, unit with a Single Absorption Area on a sloping, Site C,IGWA 0M Page Of oistribution Pipe Det=ail For Lateral Metwork TuRM -uP (CLERNou -- - PVC Force Hain PVC 'Distribution Pipe P , * Last hole Should Be Next To rww- up l P ' 0 0 Ft, tlol a Diam Inch X Inches Lateral diameter � ` Inch {es} Y Inches force Main Diameter d 72 - Inches # Of Holes /Wipe J Invert E evatian Of Laterals fit. - Signed: License der: Bate: s SEC-1104 AND SPE pUMP CHAMBER CRO! CIF ICATIt�NS SEPTIC TANK wEA.TWRP�RWF APFROV ED AgUVE GRADE j- 014CTION BOX HOLE COYER w == CI t�ENT PZPE I4dINp0 4#t WITH C ONDUIT �/ gp,DLt3Cif I: y `Rt1M D4flR, WAS ;XG LABEL FRESH` ° IR IXTAiCt' t - ^• .��""• ; r . ¢ ri o ., 4 " KIN- GRADE i A xt INLET —T— GAS- ' p fiED WATER 'TIGHT S � SEAL, � I �E3I�1�PE ALM LT f K '" $ : ON 3�I IL APPROVED ' c : PIPE 3 c = FF tiles SMID SOIL PUMP OFF ELEV - -- D 3 APPROVED BEDDOIRG UNDER 'TfNY, CONCRETE FAD Sp£CIFICfiT DUS £S F£R DAY: DOSE I+R1i'fBE� �.. ---- SEPTIC I I - :- NC �y3I3+� . 5 TANK MANU 13{35E �lf3LCJi'IE FLCIWBACK 4x SIZES: SEPTIC �_.._..�.- c, 1. GAL. b �' TA GAL- - � . 3 IiiiC&ES = DOS£ CA PACITIES: A - 6AL. cs s = _ 'INC - _ MjkNuFAC�ER,: 1 A � Mi1DELM$ER': !1 �GAL- S TYPE: e'er � � C SWITCH = �- � IITCI�ES � /17GAL a t'✓ f pump MA�F NtT!#BF.R � I �g I6.2 SWITCH 3 WAC MODES ��_ � /� y r ' �''� w�R As PER � o � ALA � (� f EET gE IRED DI GL RATE '6G. -TI ON PIPE —'-- � pUt4P OFF AND D ISTIzIBD - 7X/3 ll� FEET glMTICAL DIF� of p RESSUBE - - PgIC'T FACTOR - - - FEET MINII"I`jm k£ �'F1 III g - FT - p££T FflRC�� X . � ��3TAL OY�I£ M� � j) �.3 9 0 - DIAMETER - d � - WIDTH 0 INT£RNAE D114ENSIDI+I5 fl pljl4p TANK'. 1_ 1{}ij lD LICENSE NU14BER SIGNED'- _ il$8 Sent By: HP LaserJet 3100; 1 715 552 8827 may -b -ub 'L:bwm; rage els Zlj 9 EH SERIES SUMP /EFFLUENT PUMP 11.65 0 Specifications 11918 Shut 119110119c IEA SSUCE Q9IM MW ►St H&CM OWN I• K n 9► 11BS Sk.1x) AMPAA1At11 s it i s fu FLT ow I1sIx96 9[H - 011 509330 UV= 41 115 Im 134 1000 70 54 55 41 32 119 20 24 111 x11b4x &94 984-4 509340 b41CSA 4 230 314 &5 1000 70 Zia 55 41 32 13.8 W 2t 111 01b4xfl94 04)&R'S 509350 U GA 4 0 115 314 134 1000 70 64 55 41 32 138 211' 27 9.11 x 11.64 x 8.94 *H-CA 9 SDgy60 ,L,% 4^0 230 34 6.5 1000 70 54 55 4 1_ 32 13.0 20 27 111 x11.64x934 Cap owsDetyPAW —'Lift GistWaswawpmpsalonAedtonftw sd *asbnpuftyarenmwiftt�eWeShshe0 9s1a>he+t awls. FLOW- LITERS /HOUR Construction 0 1000 2000 3000 Motor Housing Epoxy Coated Cast Iron Impeller Material Poly Carbonate a0 l0 Im eller Closed Van _ Volute ...... --- - - - -•- ABS W -s W Power Card _ g H w_A L20_ Mechanical Shaft Seal Nitrite with carbon and ceramic faces 5 w Fasteners Stainless Steel ^ - . . z to = Shaft 1 St Steel e -5 Bearings - — - -- — Upper Sleeve and Lower 0 D ... i Ba ll Bearings 0 20 40 60 80 FLOW P UMP PERFORMANCE GALLONS/.MIN CURVE Little G iant Plump Co. 115V 60HZ l 1'4) Box 12070 - (Mokom Cky, OK 73157 Phone: 405.947.2511 -Fax: 405.22 &1550 E -oaaB: caslwoenerviae�llttleglaetco® www.LittleCxianti"Ump.com 43 Form 945235 -07103 Page of _ _ _ ENT PLAN pOWTS OWNER'S MANUAL & MANA sPE PYtcAT10NS SYST a i d NA FILE INF(yAYlG1N Septic p[ Tank t'�Pty NA Owner optic Tank Manufac Effluent Filter Manufacturer � E3 NA Petrrdt�_ -- p NA Ott PRAM [1 NA Effluent Ftfber Motft:t fl NA i1urowof 8edtnoms Pump-Tw* Caps* NA Humbef 'of t.",omme1'� u nits alld PumP Tank Manger LL. ted 00W a"Mloe) ggday PUTP Martufadi uW t i G cl Model Design Dow (P�� � . al/d Pretn-aWtent U nit - p Pe F ift er Rate Soil APP Monthly average dvei FOW lnft�� Quality (FO G) �o mg/i e p MedtanIcal Aeration EJ Wedand Fats,. Off b Grease � s�4 rn gll- ❑ Drsinfe� r maherr sk scat Oxygen Demand (SODS) Total Suspet d so,ads CT.SS) 5150 m JL µ Monthly average" Dispe�s and {gstavi<Y) Q In -ground (pressurized) ❑ ln-g p Mound Pr+etn �tlerlt Quality O0� s3o mg/L rade ❑ Other- Biodremice oxygen Demand (8 -.00 mg/L ne Total Suspended Solids (TSS) 5� D` cfu/10Omi [I Dri ,ieasberras.r �+1 Fecal l Sul Tn (geometric mean) values '� i � 3a inchdiameter seP� � Ma>amurn Effluent P84cle Sire values �� h IICE SCHEDULE Service Freque L7I C months s) (Maxjmu:n 3 yrs.) service Event of tank volume A2 Least once every equ are -third (X,) Inspe Co didon of tank(s) When combined sludge and scorn e4 Pump out contents of tanks) At least once every �� p months KS) (Maximum 3 Yis -? p rrconths r(s) inspect disper� CI At least once every I• s) O NA Clean e ffl uen t fmr At least once every ❑months Q NA Inspect pump, Pump controls atarn+ Q months s} At least once every Flush taberels and pres test At least once every Q months © year(s) O NA Otsw p months a year(s) 0 NA At least -oonce every onfer= one of the faloYVtrtig licenses or t� MNrENI►NCE INSTRUCTIONS t b made by an individual canyhV a POWTS stainer. Sepme dlgPers3l cells s2�ai Sewer POWTS inspe or broken ice of tanks and : Malabar Plumber: master plumber Restrvisu on of the WK S) W idex�y any missing any back up S 9 Mr• Tank insQedions m ume of combined ust indude a visual Irsspecti a and scum and m + tevew packs or teaks. measure -the vol sludg th check the effl t on the uent har+d+*, ide�Y any, surface Oe_ The dispersal aeli(s) shall be visually the of of tl or poeding of effluent on the g for any ponding of effluent on tale ground sur ulatorY authority and t o check uir0s the lrnmedfat a nc f affon o f the local leg in the observation pipes cpndi5on and req (Yr more of the tank''0lume, the ground surface may . a f2uTing min any tank equals t}ne- ftiird (? of in accordVcs W"h Ch NR When the combined a=mulation of sludge and scu operator and s#�Ao� of the tank shall be removed a SePth9� $ervicing t3pera entire conter>ss r t camPonenK and MY 113, yy to Adrrlirdstrafine Code ppWTS Mai nths or ntalner anical ar pressurized PQY>n'S co mponents. p�� The Ong of effluent filters, mech firmed by a selri� he local regulatory authority evict athernWnWanae or monitoring at intervals �2 mo less shad 1 d o f compief<On of any sers�e t to t whin 1Q days A roducts Ol atfier START UP AND CPERA71ON treamient tank45) far the. presence parnGng P For OSW oonsb . Prior tea use - ttte POW-S check cells if High COWWWWS ale a ent pror�ess and/or damage the dispel � ri to use_ cherl�s that may • rm !o the treatm rerrwved by a septage servicing pperatDr P defected have the contents of the tank(s) - j sfari up strap not occur when soil conditions are frozen: at the - infiltrative surface. hem tored th e eXCM ages purnp tan[cs May t*Z above nomtai hnghwaier levels. When power is res D�wili be discharged to #w drs coil (S) in one large dose, overloading the ce8 {s) and may result in the is d i e t To avoid this s&m ion have the content of the pmV tank removed by a s SepFage S nQ PW�-m r In$ P� to the effluent pump or contact a Piurnt or FOW TS [Ka7ata'arer to assist in Inalulaw open` the PUMP caontrt�is to restore normal levels within the pump tank. Do not d ve or park ve*jes ow lab and dls�1 �. Do not drive or Park over, or otherwise disturb or compact the arena wrffr� 45 feet down sbpe of any mound or at -grade soil absorption area. Reduction tK � of the �Ilo�ng from lire wa stewater stream may improve file periorrrrartce and prolong the &e of the POW & antibto6Cs; „, Pte; dgarette butts; condoms, cotton swabs; degreasers: dental floss; diapers; dskd6cWnft,f3t JWndatlon divan (SUMP P=P) Water- flair and vegetable getable gasoline; gtt~aW t"Nc ides; meat of rig products: pesticides, sanitary napkins: tampons: - and wafer softener brine. scram ffmcoastions; ABANOONIOMENT service the follo4virtg steps shall i� taken to Insure that the vtherr the POWTS falls andfor is pwrnanentty- aken out of service system is pmperty -nd* abandoned in comprrance with ch. Comm 83.33, Wrseonsin Adminlatra6 Code: All pWg to tanks and pits shaft be disconnected and the abandoned pipe openings seaisd- The consents of all tanks and Pft shall be removed and property disposed of by a Septage Servicing Operator. After pumping, all tanks and pd5 shall be excavated and removed or their covers removed -and the void space jilted with soli. gravel or another inert solid material - CONWIGENCY PLAN if the POWjS farts and cannot be repaired the followtrig measures have been, or must be i`akm to provide a code compliant rreptacwnent system 0 A suitable ; repWXMent'anea has been evaluated and may be utib:ed for the location of a replacement soil absorption system- The replacement area should be protected from disturbance and compaction and should not be �� upon SeWacks from e�sting and proposed structure, Iot 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 damply with the rules in effect at that tine_ O A suitable replacement area is not avatlabie due to setback .and/or soil limitations- Barring advances in POWTS technology a holding tank may be instdiied as a last resort to replace the faded POWTS_ e site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil.and site evaluation must file perforroed to rotate 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 absorpt systems may be reconstructed in place fofbw'ng removal of the biarrnat at the ln5tfrat3ive surface. Reconsbuedws of such systems trust comply with the rules in effect at that time. <<WARNfN G>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CO NTAIN LE i 4AL GASSES AND/OR WSUFFIC[ENIT OXYGEN. 00 NOT ENTER A SEPTIC, BtJIUIP 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 INSTALL / ER a POWTS MAINTAINER Name ��t Gr ne/GJr � dame ` Pllorne r . / V� �� /C�7 Phone SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHOR ' Name Agency � • , � � C �'% Phone L/,f . G Phone ' This dood -nt v as dratted W ttre i1 fE of the QMW faire. Maniuette and Waushara County Zoning and Sanitation 89=t - This da=Wlt meets nee n*fimm requ renumb of dL Comm 83?2(Z)(b)(1)(d)4f) acrd 83- & (3), Wisconsin Admhifstrafi Code Use of this dacrnment dress trot g um oft ft pwfaunanoe of tt>e POWS. G&4W (?101) i Wisconsin Department of commerce SOIL. E. VALID REPORT Page of Division of Safety and Buildings in accordance with Coma E1,5: Wis. Adm. ounty ��• � f Attach complete site plan on paper not less than 8 112 x 1 inch (q! Lf q include, but not limited to: vertical and horizontal reference point 1 , rMand Parcel I.D. percent slope, scale or dimensions, north arrow, and locat 3nand distance to nearest road. APR 2 0 2005 Re ewed by Date Please print all informati n. _ Personal information you provide maybe used for secondary pu es (Pr ve -.y Law, s. 15.04 (1) (m)). Property Owner T. L ratio yy ZONIN 0 FI E 1/ 1,11/4 S T (� N R E (o W CID __. Property Owner's Mailing Address Lot # Block # •Name or CSMtk $ CAY, State zip Code Phone Number city ® Village own N est Road 7/jj 7A New Construction Use: esidential / Number of bedrooms p Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: ___ — - - - - -�1 - - - -- - -- _ Parent material -�- _ 'Q -_ __ Flood Plain elevation if applicable _ ft• General comments ! V and recommendations: l s A91 Boring E] . Boring ���� # TT it Ground surface elev. t E -= -v f Depth to Limiting factor , Soil tcation Rate Horizon Depth Dominant Color Redox Description 'cxture Structure Consistence Boundary Roots +E GPD Eff#2 in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. ry S��� "1r, S _ - r�r►.. " _ Boring # p Boring �.� in /fK it Ground surface elev. L ✓ � — t. Depth to limiting factor Soil lication Rate P on De Dominant Color Redox Description _ Taxture Structure Consistence Boundary Roots 1 -- * i Hors p •Eff#1 Eff#2 in. Munsell Qu. Sz. Cont. Color _ G r. Sz. Sh. - Iq fo 3/ _ a r m (-r c r .._ _ ) m 'Effluent #1 = BOO > 30 =220 rn9IL and TSS >30 < 5 : ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mgll e CST Number CST Name (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird Address gate Evaluation Conducted Telephone Number 715- 246 -4516 1008 192nd Ave, New Richmond, WI 54017 ..—,� ..j I e Property Owner Parcel ID # _ -- Page of F31 Boring # C] Boring G it Ground surface elev :i ft. Dep ?l; t( niting factor in, Soil ication Rate Horizon Depth Dominant Color Redox Description Texture !Ctur — _ - onsistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color __. >h. 'Elf #1 'Eff#2 r / m S m>� * r y -ham , ` •02 , F-1 Boring # ❑Boring ❑ pit Ground surface elev. ft. Dept :o iimifing factor in. r Soil 8eplication Rate Horizon Depth Dominant Color Redox Description Texture !- tr acture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Colo C-? -3z. Sh. 'Efl#1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Dep i c li miting factor in. ❑ pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture 'Aluctire Consistence Boundary Roots GPD/fF in. Munsell Qu, Sz. Cont. Gold r. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, <_ 30 mg/L 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 depar*ment at 608 266 - 3151 or TTY 608 - 264 - 8777. SBD4330 Soil Test Plot Plan Protect Name Sunset Ridge LLC Sha ird j Address 838 Summer Pines Circle ..� Hudson Wi 54016 C#k #226900 Lot 1 Subdivision Sunset Ridge Date L4115105 W 1/2 S W 1/4S 34 T 30 N /R18 W Township Richmond [] Boring 0 Well PL Property Line ✓ County ST. CROIX BM r VRP Assume Elevation 100 ft. Top of Survey Nail /iron System Elevation 98.7' *HRPSame as Benchmark 317' Pro2erty Line 40' B.M. Scale is 1" = 40' 30' unless otherwise noted B -1 5% Slope B -3 100' 0 ' 98' 30' 99' B-2 342' Property Line ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L Mailing Address J: c- n^- ✓� �� ` lJ V Property Address �a / _ 9 (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 0 7 6 - LEGAL DESCRIPTION �� Property Location 6-c r/ , �Q r /a , Sec. , T N R [ _ W , Town of Lot # Subdivision Certified Survey Map # -------- ` , Volumes //,, , Page# Warranty Deed # L 0 Volume ' 2- 6 4V , Page # Spec hous ye 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 a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the Qwner(s) of the prope cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. sg,o� S NATURE O PPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 2660? 306 77494rb STATE BAR OF WISCONSIN FORM I - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIK CO.. WI This Deed, made between Herman W. Keller, Sr., Herman W. RECEIVED FOR RECORD Keller Jr and Karen M. Keller, husband and wife 09/21/2004 10:25AK Grantor, and Sunset Ridge, LLC Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin REC FEE: 13.00 (the "Property") (if more space is needed, please attach addendum): TRANS FEE: 1440.00 See attached Exhibit A COPY FEE: CC FEE: PAGES: 2 Recording Area Estreen & Ogland' 304 locust Street Hudson, W154016 Together with all appurtenant rights, title and interests. 026- 1098 -20 -000: 026- 1098 - 30-000 Parcel Identification Number (PIN) This is homestead property (is) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any,, of record. Dated this day of V 41 2004 * Herman W. Keller, Sr. * Herman W. Keller, Jr. * K ren M. Keller AUTHENTICATION ACKNOWLEDGMENT Signature(s) Herman W. Keller, Sr., Herman W. Keller, Jr. STATE OF WISCONSIN ) and Karen M. Keller, husband and wife ) ss. ST. CROIX County ) authenticated this ? da of V_ _� '2004 Personally came before me this day of 2004 the above named Herman W. Keller, Sr., Herman W. Keller, Jr. and Karen * Kristin Ogland M. Keller, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland, Estreen & Ogland 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. )nfonnation Professionals Co., Fond du Lac, wl SPATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 1 -1999 U 2660P 307 EXHIBIT A Located in part of the northwest quarter of the southwest quarter, and the southwest quarter of the southwest quarter of Section 34, Township 30 North, Range 18 West, Town of Richmbnd, County St. Croix, State of Wisconsin described as follows: Commencing at the southwest comer of said Section 34; Thence North 00 degrees 08 minutes 04 seconds East along the West line of the southwest quarter of said Section 34 a distance of 484.68 feet to the POINT OF BEGINNING; Thence contiue North 00 degrees 08 minutes 04 seconds East along said West line of the southwest quarter 2157.27 feet to the West quarter comer of said Section 34; Thence North 89 degrees 50 minutes 54 seconds East along the North line of the southwest quarter of said Section 34 a distance of 1018.75 feet; Thence South 00 degrees 08 minutes 04 seconds West on a line parallel with the West line of the southwest quarter of said Section 34 a distance of 2007.79 feet; Thence North 89 degrees 59 minutes 59 seconds West 694.55 feet; Thence South 00 degrees 08 minutes 04 seconds West along a line parallel wdh said West line of the southwest quarter 164.50 feet to the northeasterly corner of a Certified Survey Map recorded in Volume 5, Page 1400; Thence North 87 degrees 49 minutes 24 secons West along the northerly line of said Certified Survey Map 324.40 feet to the POINT OF BEGINNING and there terminating. St. Croix County, Wisconsin. FLA*r OP - �5 - u IN Located in part of the Northwest Quarter of th of Southwest Quarter of the Southwest Quar Range 18 West, Town of Richmond, County of St. Or OIX, - Ut 1 I ---- - - - - -- -- P �A 1 Jew I i I C I N I T Y MA P s.v,s I I O" is 130TH AVE. - + MW 114 i N£ 114 i` 1 � 3S L _ — — — \ i + i , Et — I AM 2 C. T. H. \ L. VM7 R. a \' n 746 m .m. 1.900 Gem i 7 Ls.a f OL 1 * wao I IL w ` i