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HomeMy WebLinkAbout026-1286-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division - F Sanitary Permit No: INSPECTION REPORT 479500 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: Sunset Ridge LLC I Richmond, Town of OZ� -- 1, - 05 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 6a IM 1 GS 1 34.30.18. 1 Y ' 7 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4 Benchmark Dosing ` �j � � Alt. BM / Bldg. Sewer Holding St/Ht Inlet ' 91 -.. w...,., _ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ' 2:5 / V / i — Dt Bottom ' 4 r - 7, <9 Dosing ?Zc J 1 f I _ Header /Man. 3 b T q 3 1 Aeration Dist. Pipe 2 ' Q 9 Cl Holding Bot. System .3 7 y 8 , Z Final Grade PUMP /SIPHON INFORMATION ' �c° 160 ' � Ol`� Manufacturer Demand St Cover _ / G/ �f GPM 1 .. L +...I S'3 !� Model Number TDH Lift / I ( Fricti a Los 7 System Head` Co TD g Ft Forcemain Length t Dia. Zit Dist. to well ` SOIL ABSORPTION SYSTEM � BED/TRENCH Width r Length / No. "Trenc s PI T DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (10 7S SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of S stem. CHAMBER OR YP ) I /� UNIT Model Number: ej DISTRIBUTION SYSTEM t.J Header /Manifold i I Distribution (2_) r x Hole Size / I x Hole Spacing Vent to Air Inta Z Pipes) 7Z Z ✓ P, 6 wti Length_ Dia Length Dia Spacin Z Z SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of [7odded xx Mulched Bed /Trench Center 2-- -7 Bed/Trench Edges \ Topsoil [ �—, es No ' u es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 ( 0 / Z / 05 P Inspection #2: Location: New Richmond WI 54017 (W 1/2 SW 1/4 5 T30N R18W) Sunset Ridge Lot 5+�'�.:� Parc No: 34.30.18. 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = 7 4Z Plan revision Required? Yes . No I Use other side for additional information. __ a Date insepcto s ignture Cert. No. SBD -6710 (R.3/97) li I Z — —' Safety and Buildings Division County 1 201 W. Washington Ave. Madison, Wl 707E V itatY ebsnitNLu /m- b�erGt(to be filled in by Co.) F\ VS�O�S�� (6 26 3 51� Tf 1 S o Commerce t ate Pi LD umber — Department f �? ;� t1. U yl 0 � r- IRIS Sanitary Permit' th vide ect A dress 0 different an mailing address) In accord with Comm 83.21, Wis. Adm. Code, Personal' ide nf s '. f CROIX CO � /741 may be used for secondary purposes E / -7 / 9 tion Information Pl – ease Print All Information �/ d. / L- U I. Applies ► LOt # Block # azcel # 5 p Owner's Name P `- L'L el ' Se7t - / r- r C Property do P Owner's Mailing Address ,S( ti Section 6 Phone Zip Code City, S Number I !� lZ �(ct rc�e) JT T lJ N: r , apply) T � t Subdivision Name CSM Numbs all that pp . ) II. Type of Building (check � s . i .� 1 or 2 Family Dwelling - Number of Bedrooms - t' b— ❑ PublidCommercial - Describe Use ❑CiryVillago ownship of ❑ State Owned- Describe Use 11I. Type of Permit: (Check only one box on line A. Complete line B if ap p licable) Only ❑ Other Modification to Existing System A ❑ Replacement System ❑ Trestment/Holding Tank Rep ew System List Previous Permit Number and Date Issued El of ❑ Permit Transfer to New B. ❑Permit Renewal ❑ P Revision Plumber Owner Before Expiration = . 0 IV. T e of pOS S stem: Check all that a 1 X < 24 in. of suitable soil ❑ At-Grade Si Pass Sand Filter ❑ Non - Pressurized In- Ground ound ? 24 in. of suitable soil ❑ Mound ❑ ❑Aerobic Treatment Unit ❑ Rec Sa>'�d� Filter ❑ Pressurized In -Ground C3 Holding Tank El Feat Filter Consmicmd Wetland ❑ ❑Other (explain) Chamber ❑ Drip Line ❑ Gra vel -less Pipe Recirculating Synthetic Media Filter ❑ Leaching g Proposed System Elevation, Di ersaa Requre id (sf) Design Flow (gpd) Design Soil AM- Dispersal �� Prop V- Dis ersalflreatment Area Information: J plication Rate(gpdsfl ! Are sP -0 J 7 / � L� fab Site Steel Fiber Plastic J - Manufacturer Constructed Glass Capacity in Total Number n ` I rete VI. Tank Info dons Gallons ofUni �,� nc F� New -� Tanks Tanks Septic or Holding Tank Aerobic Treatment unit Dosing Chamber i nstallation of the YOWTS Show" un the attained Plans for i ume responsibility MRS N mbe ji B Phone Number ! f ) J VII. Responsibility Statement I, � Plumbers afore 7— Plumbeer's Name (Print) Pl s Address (Street, City, State., Zi 9.7 � o Stamps) ent Use On Date Issued Issuing Agent Signature M VIII. Coun /D- Sanitary Permit Fee (dudes Groundwatex Approved ❑ Disapp ved Surcharge Fee) ` ilJ' [ lLS f / . 2� / en Reason or Denial � D(, Conditio of Ap r l SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / llumbea a per management plan provided by p 2. All setback requirements must be maintained app licable code /ordinances. csini� as per app nn a ernotlessthan Attach complete plans ( the County only) for the system P P SBD -6398 (R. 01/03) PLOT PLAN PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W 112 SW 114S 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 98.4' .9' Sand Lift BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron /Nail ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B. M. * Property Line Scale = 1/4" = 10' Area 15' below system is to remain 120th St. 941 undisturbed 9 '97.5 961 97.5 B-1 14% Slope Well is to meet all setbacks found in Comm. 83 -3 Grading is to be done to divert run- off away from system Tank is to be properly bedded and provided with lockdown covers B- with approved warning labels Huffcutt Combo Tank 526' Property Pro 3 Line Bedroom House OPI C Safety and Buildings i 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i scons i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 23, 2005 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: 09/23/2007 Identification Numbers Transaction ID No. 1198146 SITE: Site ID No. 704922 Sunset Ridge LLC Please refer to both identification numbers, 120th Street above, in all correspondence with the agenc Town of Richmond St Croix County W1 /2, SW1/4, S34, T30N, R18W Lot: 5, Subdivision: Sunset Ridge FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1041237 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0; SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99), Biofilter. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD- 10573 -P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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 POWTS 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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. • Comm 83.22(7) - A copy of the ! qpproved plans, specificatio and t his left ,s I - ite durin construction and open to inspection by authorized representatives of the 'f` iRrmay include local inspectors. U 011 [loll 11 � [ I __ SHAUN R BIRD Page 2 9/23/2005 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm W SMART code: 7633' jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page s IeA r6' ° � o Shaun Bird Bird Plumbing Inc. �s 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/13/05 Owner:Sunset Ridge LLC Location:W1 /2 SW1 /4 S34 T30 N,R18 W Lot 5 Sunset Ridge Richmond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual VeFsi ) Pa 9 e# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature License number 16900 a�i Or L)1 of SAFFY ANC ML € s i 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 98.4' .9' Sand Lift BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron/Nail ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE WELL *H.R.P. Same as Benchmark O B. M. * Property Line Scale = 1/4" = 10' Area 15' below system is to remain 120th St. 94 , undisturbed 98'97.5 P6' 8 ' 97.5 B-1 14% Slope Well is to meet all setbacks found in Comm. 83 B -3 Grading is to be done to divert run- off away from system Tank is to be properly bedded and provided with lockdown covers B-2 with approved warning labels Huffcutt Combo Tank 526' Pro 3 Property Bedroom Line House Designer PO Date Non -Woven Filter Fabric 4 Observation Pipe Perforated ,D;stribulion. Pi pe Below Filter Fabric �' ASTK C -33 Sand {H % Slope 4f Force Noin \_Flowed Bed Of 2 % Drain Rock From Pump Layer ID Cress Section Of A Mound S sttm using F $ ' A Bed For The Absorption Area G 5 A 6 Ft. h —�---- g ­ 7 Ft. I Ft.. 3 Ft. Ft. _ L % Ft. le L : �Observotion Pipe -� Force Main - - - - - -- - - - - -- ----- - - - - -- From Pump �S t • �2 o Distribution Bed Of /2 I — �.e t o 0 Pipe Drain RocK I 4 Observation Pipe ,�C.& Permonent Morktr '6G''`�" P i pe or Rods Plan View Of Mound Usin A Bed For The Absorption Areo PAGE:.. —OF_ Perforo'ed PiPe O"" / Ilk End Vier �PertorOtsG PYG P,pt Myles LOCOted On Botaon+. Are E406 SAO"O all t7c CiG !� ! ' ,( +� r � � PvC Force M OOR y a FlitsT 140LL i4 re CanntC }rcn i PVC Manifold Pipe 5'f o -e, Oist.inu� an \ Pipe Distribu Pipe Loyovt Q Ica Ft. R �' R. c X � inc�+es Y °`! Inches Hole Diameter 5 nch Signed: Lateral '� _ Ineh(es) License Humber: Manifold Inches Date: Force Main Inches # of holes /pipe Invert Elevation of Lateralsff-,j Ft.— SEPTIC TANK r �3MF C[,RMB CROSS 5£C� I0 ADD g SPECIr ICATIQttS WEATH£ItP�f APPROVED , III . ABpv E GRADE j T NCT 1N BOX MMHOLE COM ER +1 G► VZNT PIPE WITH CDND WINDOW 4R WJ PP,ALtICK & 3.6 FRO�4 D44k. " TR INTAKE WAR�tiI�d LASE' MIN- FRIESI � � r i d £I�3 GRAD£ zY� INLET C S- c -" TIGHT, jollas V WATER TIGHT SEALS A SEAL � '• S OVER P P£ P i LT E.R - -- ALM 3' ONTO s oN smic SOIL APPROVED PIPE 3' C FF Ono SOLID pump OFF EL �Jl SOIL BEDDING UNDER TANY- �� CONCRETE FAO f 3%t APPRC3Y / r / � C-lx / � SPECIFICATIt3PF5 y `[• DOSES ?F DAY sETZC Dass GAS. - TA�iK MANUFAGT� T3�E Vol I�IE pNypy�SACIt�' TANK SIZES: SEPTIC = .� INCfiES = 6 GAL_ JOSE S c CAPACZTT'E A MANUFACT 8 —L. AIARn ��F MBER'z C ;NCH tom- /�;���� �L M t3DEL NU MBER = � ,� ES = _ SWITCH _ Pump "Awl. P CT;JRF.R = l� J � - 14- 16.23 WAC MODEL NUKBER= " WyRlrfG AS .PER ; °J SWTTCti TYPE GPK aump FEET FIP£ o �� ££T R EQUTRSD DISCHARGE g�+iTE DZSTgTB T i FEET pIIMp OFF AND :.,.a;FEET VEg'�ICAL DIFFEg£3�tCE BET�r - 'Fg ;C'TIDN 'FACTS � H NIt4i3i N1aRK SUPPLY pRESSO FT> IO Q FT. NA MIC tiEAD / I y FEET FORCV'9H X .`---� TOTAL D�. / DIAiK T ;, DIKENSIONS ?,jK {} TANK: LEN - OID Ci LIQU'�� it I NT£R 1�A gAT� �------� i,ICF.NS£ SIGNED= _ f. TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT - GE IrIATERING Ln HEAD CAPACITY CURVE �. MODEL 152/153 MODEL 152 153 Feet Meters Goi. Lifers Gol. I Liters 50 G 1.5 69 1 201 77 291 J 153 10 3.1 61 231 70 1 265 15 4.6 53 201 61 231 40 12 152 6.1 I 44 I i67 { 52 197 ` %.6 34 30 129 42 159 i L `—' 30 9.1 I 2� 87 33 I 125 8 10 7 l 22 85 O 35 i ; i 42 I Q 20 40 12.2 I -- i __ 1 _ i 0 ock Volve: 38.0 t. (1 1.6m) 1 44.0 Ft. (I3.4m) r or <soe 4 Mop 10 I 0 20 4 60 80 100 GALLONS 4 5 j8�{ LITERS 80 160 240 320 3 27/32 I I FLOW PER MINUTE i 1 ; 27/32 LT FACTORY FOR SPECIAL APPLICATIONS CONSU G' i 3 2 1/32 • Timed dosing panels available. with . Electrical alternators, for duplex systems, are available and supplied an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available foroutdoor installations. See FM1420. • Over 130 °F. (54 °C•) Special quotation required. I 15?J153 Series Control Selection 15y153 MODELS Model 1 volts -ph Mode Am s Sim lex I 2 Du o l r 3 e: 8.5 1 sK2oe+ N152 115 1 Non 8.5 included 2or3 13N152 115 1 Auto 2 or 3 E152 230 1 Non 4 . 3 1 2 or Auto Included BEt52 230 t �' 1 2or3 SELECTION GUIDE N153 115 t Non 10.5 Auto 2 or 3 10.5 included back variable level float switch or double piggyback variable level float BN153 115 1 5.3 1 i 2 or 3 1. Single piggy E153 230 1 Non BE153 230 1 Auto 5.3 indudea 2 or 3 switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. d 3 o CAUTION q ualified All i of controls, protection devices and wi uld be f ollowed Including ffia most. 3 o V loat systm. of switch 10 -0225 used as a control activator, specify ( licensed electrician. AD electrical and safety codes sho ( 4 ) recent National Ell:ctric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40256-0347 Manufacturersof.. SHIP TO: 3649 Cane Run Road C O Louisville, KY 40211 -1961 jjvau Peas S vcf /939 Q' ® (502) 778 - 2731.1(800) 928 -PUMP � ��lY // �• o fAX ( 502) 774.3624 htiol'iew.zoelter.c om Copyright 2000 Zoe ller Co. All rights reserved, © • ENT PLAN Page of _ S OVKN�R'S MANUAL & MANA SPE IFICA►TfONS POWT SYSTEM al 0 NA =[t.E INFOEtME►TION Septic Tank CaPac�Y to rer septic Tank Manufa ❑ NA owner Perrnfl �- Effluent Filter Manufacturer p NA Effluent Filter Model .l DESIGN PARS ❑ v at ❑ NA ro pfns Pump-Tank Capacity NA Numb o f erciai Units sUd p Tank Manufacturer ❑ � Num `. avefage) Pump Man ❑ ufacturer �, Esdmabed flow � �-� aVd ✓f �' x 1.5) Design flow (P� ' (Estimated y [� al/da I t 2 Pump Mod Unit �� e Probva Filter [3 Peat Filter Son APP� Monthly average' O Sandlert3vel ❑ Wetland Influent/Effluent Quardy OG) S30 mg/- O Mechanical Aeration ❑ Other. Fam"Oil l� Grease (F 5220 mgn- C3 Disinfection mica► Oxygen Demand (BODs) Manufacturer BiocheTotat Susp� Oisp ded Solids (YSS) 51 m real cell(s) ressurized) Monthly average" e cavity) ❑ ( -ground (p Effluent Quality [3 In�round (9 rid meted SiO mgn• [3 At-grade ❑ Other_ P BODs) ema ( 1L Biochemical Oxygen D SS) 530 mg [3 Qri the tsr and Total Suspended Solids r sari) 510' cfull OOmt id for d (non oom�rdaq �st� Fecal Coliform (geometric Yalu e�uent Y inchdiameter trBl for vR� wasewa ated ter. t Maximum Effluent Particle Size values typ CE SCHEDULE Service Frequency Maximum 3 yrs•t NAN ar(s) tA►t[�'rE Event c3 months Service once every ird me At least oafs one-th (� ) of tank volu When combined sludge and scum equals Maximum 3 yrs•) inspect oonditton of tank(s) ❑month ea s) ( - Pump out contents of tank(s) At feast once every ❑ months . ar(s) inspect dispersal aell(s) At Least once every s) ❑ NA ❑ months Clean effluent filter At least once every s ) ❑ NA con &alarm ❑months inspect Pump, Pump n At least once every ❑ months [3 years) E3 1A Flush laterals and p test At feast once every C3 months ❑ year(s) p NA om At least Once every oc+ licenses or MA1riTENANGE INSTRUCTIONS ying one of the fctlS j�ntainer, Seplage its shale be made by an individual car Sewer POW'rS InsPe�°r. POWTSany missing or broken Inspections o f and dispersal Ce Restri s to identify fo any back up Master Plumber: Master plumbe on of tfie tank(} m and to check t levels certiflc,aWns: ns must include a visual i.nspecti slu a and s the effluen led S Operator. Z•> o ks, measure the volume of combined ally ins hardware, Identify any The disper� cell(s) shall be pondin9 of effluent on the round surface- riding of effluent on ft ground surface* i of effluent On the g for any Po v ol um e, pipes and to check wires the Immediate notit�5on of the fora ulatory authority or Pond in the obser lice indicate a fairing condition and reg oafs one -third (Y) or more of the tank e, the with ch NR ground surface n a and scorn in any tank equals of in acco rdance mulation of studs b a Septage Servicing Operator and disposed When the combined aocu and any entire contents of the tank shall be removed Y retreat #ment Components, 113, Wisconsin Administrative Code orients, P a 006 , d PUWTS Maintainer- • .n of effluent filters, mechanIC3 or pressurized POWTS comp event The sernci g da of completion of any service r monitoring at intervals of 12 months or less shal n 0� ys Hance o authority mafnte regulatory other � to the local fegu rY A servIC* repoet shall -be prov+ pai nting products or other treatment ta nk( for the Presence of pal trations are START UP AND OPERATION et52t1 cell(s). if high ooncen For new eonbtruc�n. Pdor to use o #the Pp S an d /or damage the dis p e rsal prior to use- chemi e the treatment Proces a septM8 servicing Pe cals that may impel removed by detected have the contents of the tanks) _._ Page of '^ t'conditians are frozen at the infiltrative surface - System start up shall not occur when soil- is restored ttie excess o uts ac es pump tanks may flit above n ormal highwater levels. When power result in the may D`r ,,, ra eraterw be disahmVed to the disPe� in one large dose, ceil(sj con o the C um tank removed by a discharge of effluent To avoid this situation have the o r' �ntad a P umber or POVYTS [�tntainer to back Q pp �- prior -to niSW� Power to the effluent pump Septa9 manually operating pip over, or otherwise corttro[s to restore nomtaf fevers within the pumF ash in and dispersal cells. Do not drive or pant disbirb or compact, D not drive or park vehicles Over tanks - the area within IS feet down slope of any mound or at -grade soil absorption area. prolong the fife from the wastewater stream may improve t h e Performance and P g Reduction or.el'anlnation of the following tte butts; condoms; cotton swabs; degreasers; dental floss: dtaPers: of the POWTS: antibiotics; baby wiP water; fruit atxi vegetable peer gasoline; grease; herbicides; meat drsinfedariis: tab fourida6on drain {sump P P} medtcons; o0. tenting products; pesticides; sanitary napkins; tam p o ns: and water softener brine. ABANDO taken out of service the following steps shall be taken to Insure that the When the POWTS fails andlot is p doned n c omp fiance with ch_ Comm 83.33, WLsconsin Administrative Code: system Is properly and safety abandoned in c p nings sealed_ . All piping to tanks and pits shall be disconnected and the abandoned Fe oPe oved and property disposed of by a Septag a Servici pefa O for. The contents of aft tanks and pits shall be rem oved and the void space After pumping, all tanks and pits shalt be excavated and removed or their covers rem filled vkh Solt, gravel or another inert solid material. CONTINGENCY PLAN e following measures have been, or must be taken. to provide a code If the POWYS fails and cannot be repaired compliant replacement system- soil ❑ A suitable replacement - area has be arre be protected from d for isturbance loca nd compaction and should not absorption system. The rep struc from existing and proposed structure, lot lines and wells- Failure to be infringed upon by required setbacks protect the replacement area will resu ems mus comply with the ' t rules in effect at that tim tablish a suitable e. replacement area- Replacement sys ❑ A suitable replacement area is not as a fast resort to r eplace the failed POWTSng advances in POWYS technology a holding tank may b e The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sorl.an /evaluation must be perform }ovat a suitable replacement area. if no replacement area is available a � hojdinq k may be installed as a last resort to replace the failed POINTS_ removal of the biomat at _at -grade soil absorption systems may be reconstructed in place following the infiltrative surface. RecorrstruotiOns of such systems must comply with the rules in effect at that time_ <<WARNING>> SEPTIC, PUMP AND OTHER TR EATME NT O ER TREATMENT CO ANK UNDER ANY CIRCUMSTANCES. INSUFF OXYGEN MSTTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIB ADDITIONAL COMMENTS POVYTS INSTALLER pOWTS MAINTAINER Name n/ J Name Phone 7) j Phone L LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR UIV►PER ` Name ' �,l Agency , �C7 r^ l ?hone i7 Phone / �� This document meets This dowamu was dratted by the staffs of the Green Lake, Marquette and Waus hara County Zoning and Sanitation agencies. went does not the minimum requirements of cif Comm 83.22M(b)tt)(d) &(f1 and 83.54(!). (2) & (3). Wisconsin Adrnklls tative Cede Use of C+)s data GMW (0 guarantee the performance of the r OWTS. FROM ,OEVERING HOMES LLC FAX NO. :7152460745 Sep. 15 2005 09:14AM P2 Wlsowadr=geparonentotc:ommerce SOIL EVALUATION REPORT Page d Mob" of Safely and euhd fts in socordende wilhh Cumr 1 115. NAs. Adm. Cade AUaCh OorWate site plan on paper not Ion than 8112 x 11 inches it, sire. Man must Indude. but nol Waited to: vertical end hodiontal reference poinx Pts'}. dkedion and Paroet I.P. potent slope. scale or dimenslone, north arrow, and I*Mdw and " a wnce to nearest toad. Data Please ptllnt all intomatron- rteviewed by ft fpnsl WWft V" You Wovift rneY be wed to - -Rde WWI WI (ft •r -:r t.aw. s. 15.04 0) (m ))• PfY Owns? C o f I Property Location t / ,S ., Y V GovL Lot JA/ t{ W1g S T30 N R ( E t PwpeAy Owner's MBANIg Address •) Lot 0 f11� rr . Name or CSMM r Stone code t�rnber � t�ly Q vtltage N � �� Nave CwAft c lan U" fiat t Nuff#m of bedrooms Code derryed &31P now rank (3PD [� M"Wer"ent . Pubk or carer wCW - i]esctfbe :. parerrtrtraterlel �, �1. — . -- Flood Plain ele Wn K appticabte , . A General oat e sand / and reoorrtrrrendations: 1 :: �z L OU . hi ( Grotxrd sumacs elev. * • _ f . Oepth 10 ikrtllirt(i facer i m Role ""M Poo Dominant COW Reft 0850"on �'ffaeRee SbuGhfya Cartsistance Boundary Rants GPM fn. Mtemel tau. f3z. Cant Cale► tar. Sz. Sh. V101 'E1fM2 5 T Arz fh Gtofind sudwe elev. r' _. t. D90 to kff*B fad" .•._• —.(/ in. $pt Rate hlorizan Deptit Dominant Re* Description Tsxwm Swum" Consistence Boundary ROM GPD F in. Munselt ou. sz. Cont. Cola Gr. Sz. Sh. - 1 M1 . t nwet 01 a t30O > 30:5 220 fro& end US 230 +• EllfueM 02 r SOD �5 3D melt and TSS 130 mplL CST N" rem Pdm CST trum6er Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Tolephons Number 1008 192nd Ave, New Richmond, WI 54 -- ......V 715- 246 -4516 .FROM ;OEVERING HOMES LLC FAX NO. :7152460745 Sep. 15 2005 09:14AM P3 par Ot Parcel ID 0 n * ❑ Gmundsuetaaaew►. ` 8. �fl:4 :knifing fader 3s In. Rate IS.�J It • - Boundeiy Rods G Dominant Color T11" xluro Co+utstsn� Hwbw Doo • HMI •EItp2 in. Munss9 Cont. COW .. - nii 3 4 " F-1 Q � ❑pit Ground suAaeae 61w, _ R, Oepti a GY+ainp faes0n Seel Role Holton 000 Dominant Retdox DestsWW Too" . :4r x "s Coto wwM Boundary Roots GPOIN fn Munaa9 pu. 8z. Cont•Calor C; . 3x Sh. •E11Nt •Elf Bon�O d ❑ F > ❑ Pk Ground suAaeeelw. A. Dept �Y�ri9nghdor to . _ 309 Flw6n DOM DominantColm Redox Dna"on. TeaAUne - .4v a" Ca isivence Boundary Root+ In. Munse9 Qu. Sz. Cont. Color 3%. Sk 'm 'ow EMlueat S1 s 800 > 30 220 m4+1 and TSS >30 < ISo oV& • Effluent ill = 801%130 nV& and TSS 130 rn9 L The Department of Commerce is an equal oppomistity service provider sad employer. if you need assistance to access services or need material in an altcnudt formak please contact the dc;:trtment at 608-266.3151 or 608461.8777. �fop�tasn FROM `OEVERING HOMES LLC FAX NO. :7152460745 Sep. 15 2005 09:14AM P4 Soil Test Plot Plan o)eet Name Sunset Ridge LLC Sh ' d Address 838 Summer Pines Circle Hudson Wi 54016 #226900 Lot 5 Subdivision Sunset Ridge _ pate 4/15/05 W 1/2 S W 1 /4S 34 T 3 0 N/R18 W Township Richmond 0 Boring () Well PL Property Line County ST. CROIX ` BM or VRP Assume Elevation 100 ft. Top of survey Nallnron System Elevation 98.5' *HRP as Be nchmark * B.M. 188'EWrty Line 94' 90' 9 Scale is 1" _ 40' 98 , unless otherwise B -1 14°la Slope noted 30' 40' 95' B -3 10 26' property line Wisconsin Department of Commerce (c) 90NG S RT Page of Divisioi, of Safety and Buildings r 1 ti i, Wis. Adm. Code ounty Attach complete site p lan on paper not less e: it "Plgn/ftu 005 include, but not limited to: vertical and horiz int (� A ;, direct n``�an arr�l I.D. I r dimensions, north atio and Ji:ta rce n Date t n s to pe sca e o ST. Please print ao ZONING OFFICE e �ewed by Personal information you provide maybe used for secondary purposes (Pr w V Law, S. 15.04 (1) (m)). ZT S Property Owner Property Location L4- � t �Z � - Govt. Lot W 1! �/4 S � T� C) N R � E (o W it I Property Owner's Mailing Address Lot # Block # Name or CSM# City State Zip Code Phone Number ❑ City ® Village own N est Road New Construction Use: esidential /Number of bedrooms _ -__N Code derived design flow rate '�� GPD ❑ Replacements Public or commercial -Describe: _ . __ - - -- - -- - - - - -- - -- _ Parent material __ _ -_._ Flood Plain elevation if applicable _ ft• General comments and recommendations: $- Ott r F_/1 ❑ Boring Boring # ~� it Ground surface elev. ` - f . Depth to limiting factor min• Soil lication Rate Honor Depth Dominant Color Redox Description r t exture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - Jl� 46� r' Baring # Bonng ® Pit Ground surface elev. " �_ t. Depth to limiting factor V in. Soil Application Rate - - Horizon Depth Dominant Color Redox Description _ T3xture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 tlertt #1 BOD > 30 ntgll = and TSS >30 < 5 - ' Effluent #2 = BOD _< 30 mg/L and TSS < 30 nx Eifl < _ 220 - CST Number CST N" (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird ` Date Evaluation Conducted Telephone Number Address 715- 246 -4516 1008 192nd Ave, New Richmond, WI 540 ��-- `j Property Owner _ Parcel ID # _ __ Page of F,_31 Boring # ❑Boring pit Ground surface elev. � ft. Dept: s c irviting factor � n. Soil - Application Rate Horizon Depth Dominant Color Redox Description Texture 'n cture ° Consistence Boundary Roots GPO/ff in. Munsell Qu. Sz. Cont. Color T _?�3h. 'Eff#1 'Eff#2 0 -II gy �s a O 7 S ! s ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Dept o limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture ': tr re Consistence Boundary Roots GPD/ff° in. Munsell Qu. Sz. Cont. Color s_! 3z. Sh. `Eff#1 'Eff#2 Boring El Boring # Ground surface elev. ft. Dept.- ali mitingfactor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture 'tuctire Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color 8z. Sh. 'Eff#1 'Eff#2 ` Effluent #1 = BOD > 30 < 220 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 aid employer. If you need assistance to access services or need material in an alternate format, please contact the derar*ment at 608- 266 -3151 or TTY 608 -264 -8777. SBW330 (RAW) Soil Test Plot Plan Project Name Sunset Ridge LLC Shaun Address 838 Summer Pines Circle Hudson Wi 54016 CS 22 00 Lot 5 Subdivision Sunset Ridge Date 4/ 5/05 W 1/2 S W 1 /4S 34 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Nail /Iron System Elevation 98.5' *HRPSameasBenchmark B.M. 188' Property Line 94' 90' 9 ' Scale is 1" = 40' 98' unless otherwise 30' B-1 40' 14% Slope noted 0 ' 95' B -3 10' B 26' property line 2 g ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ��- n SQL 2 � /--, /.— c Mailing Address �'/! _� / l ' spa/ Property Address erific n required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPT ?� Property Location `'y '/ , ` S � i� ,Sec. `� � > T L J N R W, Town of Subdivision -S� /► S , Lot # Certified Survey Map # q , Volume , Page # Warranty Deed # / Volume 2 6 6 0 , Page # 3o C Spec hous yes no Lot lines identifiable (!F) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improp Y Improper use and maintenance of our 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 1 owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumpe r verifying y g that ( ) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11 Iva If Ad ., .,VA :.W --�� d — N j l` � � „ S7tl Sib � yy w R r w a m t�srs fil NC .` V • f FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12 mu Ira I ' i .n u z a II J - gig - Arm E © j p d • a - --- -- ---- - -- - - - -- --- t ---�- Y - r— _' U 2660P 306 STATE BAR OF WISCONSIN FORM I - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX 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 0 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 t' 304 Locust Street Hudson, W1,54016 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 2-q * * , day of v 2004 w. * 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 v 7 da of t/ ' 2004 Personally came before me this day of 2004 the above named Herman W. Keller, Sr., He W. Keller, Jr. and Karen * Kristina 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. Stats.) 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 acknow(edged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du lac, W I STATE BAR OF WISCONSIN 800 - 655 -2021 WARRANTY DEED FORM No. I -1999 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 contius 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 with 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. ft M aw - - -- / Aj ' - West auwfar Lbo � f - - - -- M 34 rsww CWOWV40 Ndf r vt 4 . M ocree 1.OM 92,469 sq-ft W' radius temporary . cu4—de —s*c easement to tre extinguished upon rood extension qL BtAdIng Setback E / 373.12' 1 - 1 10.00' 7 , l& 2 _ .� _ oeitt A Bu— ~Setback 20 N ne��3s•3rw -= / 76 .241 sq. ft. m 1 uta- ioo74 }t. 1 21 4% c es ."4 o