HomeMy WebLinkAbout026-1286-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
• 487929 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: Village X Township Parcel Tax No:
City
Sunset Ridge LLC Richmond, Town of
C) Z(o- 1 7 - &P . 67 - &0
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/61 (j -- I G S T 34.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic s Benchmark
/ 0110
Dosing ` Alt. BM
06
Relation
/ Bldg. Sewer 5 /Do , sq
Holding SVHt Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet `—
J da._ �
Septic S r o f Dt Bottom 9 s •
] Z 3
11.7
Dosing - 5 1 C) 3 6 l Header /Man. 3_ G 1
Aeration Dist. Pipe
3 , 1b
Holding Bot. System fa Z' Z D
Final Grade T
PUMP /SIPH INF ORMATION 4z I 6q , v5
Manufacturer De St Cover �\ 2
-7 C3 1 r
Model Number ,, ` [�z_ 24.3 o� � / OZ Z,
TDH Lift Friction Loss lJ System ead TDH Ft
7,$_> 1. 3
Forcemain Length Dia. Z , r Dist. to well , /A
5h/ 1 o
'V Q —
SOIL ABSORPTION SYSTEM
BED/TRENCH Width I Length No. Of Tr ches PIT DIMENSIONS No. Of its Inside Dia. Liquid Depth
DIMENSIONS /Z) 70
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer:
CHAMBER OR
INFORMATION T e O S tem: / a /. � A UNIT
Yp Ys /V Model Number.
ti 1 o
DISTRIBUTION SYSTEM
Header /M ifold t Distribution 0 i 1 x Hole Size +I x Hole Spacing It to Air Intake
J
�
Pipes) 1'9 � /
Length Dia � Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulch
Bed/Trench Center 2 . 6.5 Bed/Trench Edges � Topsoil � �` , No s No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /b / Z I / Inspection #2: / /
Location: 1240 121st Street New Richmond, WI 54017 (W 1/2 SW 1/4 34 T30N R1 8W) Sunset Ridge Lot 7 Parcel No: 34.30.18.
1. Alt BM Description = 6.- 1 ��
�J�/� G�a►:.ng a— ��.7 6 ''� �'�`
P
2.) Bldg sewer length=
- amount of cover = /
5
Plan revision Required? Yes ), No
3
Use other side for additional information.
Date 4nses a Cert. No.
SBD -6710 (R.3/97)
- J
Safety and Buildings Division County I l
201 W_ Washi
v �� f Madiso WI P f E D Sanitary Permit Number (to be filled in by Co.)
08)2 6 �s`� �g °(
' Department of Commerce
State Plan I.D. Number
1 Sanitary Per App � I '' I? `
In accord with Com 8321, Wis. Adm. C anon you provide 2) 0 � — �W s ' 10
m
may be used for secondary purposes Privacy Law, s (�rt) . „ Project Address (if different than mailing address)
, ti'�.LiN1
I. Application Information - Please Print All Information
S-f
Property Owner's Name - Parcel # Lot # Block #
k I-
Property Owner's Mailing Address '" Property cati
I - � �w 1V� r' p' ' c ' /., 5u ,. Section 3
City, State ) Zip ( CodZPhn e Number
� [ N; E r II4_1 e of Building (check all that apply) S Subdivision Name CSM Number
2 Family Dwelling - Number of Bedrooms S4- �.
❑ Public /Commercial - Describe Use
❑City_❑Villag sh p of
❑ state Owned - Describe Use
III. Type Permit: (Check only one box on tine A. Complete line B if applicable)
A. stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. El Permit Renewal El Permit Revision ❑ Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply)
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil At-Grade ❑ Single Pass Sand Filter El
Constructed Wetland El Pressurized In- Ground El Holding Tank L1 Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter 11
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVfreatment Area Information: O 0
i Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area uired (sf) Dis ersal Area Proposed sf) yste El evation
in Total Number Manufacturer Prefab Site Steel Fiber Plastic
VI. Tank Info Capacity Concrete Constructed Glass
Gallons Gallons of Units 4 Ft._644 4_1170 [/
New Existing`.
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersign a nine responsibility for installation of the POWTS shown on the attached plans.
Plumber' Name (Print) Plumber's ature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip
VIII. Coun /De artment Use
Approved ❑Disapproved � Onl Sanitary Permit Fee (i Ludes Groundwater Date Issued Lssui Agent Signature (No Stamps)
Surcharge Fee) � /2_ 5- El
! { IX. Conditions pr6v 3 ' s
SYSTEM WNER:
1 Septic tank, effluent filter and at- lt -^�°
dispersal cell must all be serviced ! maintained Q0.—
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 Siff x 11 inches in sin
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 102.7' 3
. b. BEDROOM
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 ABSORPTION AREA 900 # of chambers
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
316' Property Line Tank is to be properly
bedded and provided
with lockdown covers
with approved warning
labels
Well is to meet all
101 ' '7 103'Huffcutt Combo Tank setbacks found in
' Comm. 83
r _
Pro 3
Bedroo
7% Slope B - 3 House
120th St.
B.M.
Grading is to be done to divert run -off
B -2 away from system
X11
Area 15'
below system
314' Property Line is to remain
undisturbed
Scale = 1/4" = 10'
A r Safety and Buildings
4003 N KINNEY COULEE RD
f' commerce.wi.gov LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
'
isconsin www.commerce.wi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
October 04 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 Identification Numbers
PLAN APPROVAL EXPIRES: 10/04/2007
Transaction ID No. 1200719
SITE: Site ID No. 705527
Sunset Ridge LLC Please refer to both identification numbers,
120TH Street above, in all corres ondence with the agency.
Town of Richmond
St Croix County
WI/2, SW1 /4, S34, T30N, R18W
Lot: 7, Subdivision: Sunset Ridge
FOR:
Description: Three Bedroom At -Grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 1043119
Maintenance required; 450 GPD Flow rate; 45 in Soil minimum depth to limiting factor from original grade;
System: At -grade Component Manual, SBD- 10570 -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:
Reminders
• 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/or the sizing methods
of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". CO31dtfl
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. A A
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and DE RTMENT 0
dispersal are prohibited. N OF TE
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption SEE CORRES
area. chs. NR 811 & 812c
• 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.
SHAUN R BIRD Page 2 10/4/2005
• 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. Stat
• Comm 83.22 A copy of the approved plans, s ecifications and this letter shall be on -site during construction
and open to inspection by authorized representatives of the Department, which ma include local ins ectors.
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.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
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
Charles L Bratz
POWTS Reviewer II, Integrated Services WiSMART code: 7633
(608)789-7893, 7:45 am - 4:30 pm Monday - Friday
cbratz@conimerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
t � ,
RFC EIV�,D
SEP 2 8 2005
• SAFETY BUIL DINGS
Cover Page
g
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 9 /24/05
Owner:Sunset Ridge LLC
Location:W1 /2 SW1 /4 S34 T30 N,R18W Lot 7 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
2. At -Grade Plot Plan
3. At -Grade Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pum p Chamber Cross Section
6. Pump Curve
7 -8. Maintance and Contigency I n
9 -11. Soil test
D
Shaun Bird COP- cE
Signature ; ° Wa . arcs
License number 22690 ONOENcr
III
PLOT PLAN
PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016
M, 1/2 SW 1/4s 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 102.7' 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 ABSORPTION AREA 900 # of chambers
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
316' Property Line Tank is to be properly
bedded and provided
with lockdown covers
with approved warning
labels
Well is to meet all
101, setbacks found in
102.7' 1 03 , Huffcutt Combo Tank Comm. 83
-1
Pro 3
Bedroo
7% Slope B - 3 House
120th St.
B.M.
Grading is to be done to divert run -off
away from system
B -2
Area 15'
below system
314' Property Line is to remain
undisturbed
Scale = 1/4" = 10'
L
> rJr B
?:
PVC Fomi-mm
: 5 1 �-- 2 1TUR11'- UPS
t-- Dt.Grf %s...tTtoa LA•t�[.t,1+►L } '
w A SrABMI ZED o1 �ht�a:s WELL
OL
Ir >5 1
I/G B PI /6B
i i /2B
A
/ AGGRE,G
I�TE,
L = CELL O F k
fit i Z Z
vj--t .
RP4R,d%EED 57 �1T1}E'1'1c. Fabric � Distribution Lateral
Soil Cover
S TRJ 1611 -b Observat on --'
Wel -� Z " •
Ir v
r i .6 wlE D L OE.K
?5 A
�2` • > 5'
giari View and Cross Section o£ ldisa 051" At- &VAde Unit with a
Single Absorption Area on a Sloping Site
Ur- ;NsE.
S,r��a RE.
page Of
Distribution Pipe Detail for Lateral Metwork
Ac ce ss'
TURN -up (GLERT40ur)
_ - PVC
j
F ce Mai n
PvC distribution Pipe
P
* Last Mole should Be Next To
ruRN• 0
® Hole Diameter
P D Ft.
X Z. Inches Lateral Diameter 2 -- Inches)
y , Inches Force Main Diameter 2— Inches
I
# Of Holes /Pipe
Invert Elevation Of Laterals�
I
Signed-
License dumber:
Date:
I
I
u CHA MBER CROSS SECT aO X AND SPEC ICA'TIONS
-UMP
SEPTIC TANK € CHA
�£ATNE#�P�F
,, MIN- ABOV GRADE F .I FATHI RPR F APPROVED
u„ G VENT PIPE I �INj}OS,� 4R MANBO'LE COVER
FROM DOC #,�Z'Tf� C€�I�I3LiFT W/ PADLOCK F
FRES "[R INTAKE WAPAING LABEL
GRADE '''" g' „
FiN t7 t i � _,��,..., MIN.
_ j a
I NLET
GAS -
WAT£R TIGHT SEALS � 113- ; `' jollas 1iIT1i SEAL
ALM APPROVED PIPE
B ' ON 3 �,IID SOIL
APPROVED �-
PIPE 3` C
wo 54LIO - 2T T . - --
SOIL pump 0 ELF - D
3 A OYED BEDDING UNDER TP-Ny-
;; CONCRETE PAD
SPyCIF CAT
�� PFtI3'f BER
f}SES
?£R i)AY
D
SEPTIC f D as E
TANK I''�ANUFAC'I�RER: 3fl5E O E Zt�tCLUDZNG L� t GAL -
t K
TANK SIZES: SEPTIC —� GAL. PLO �ZNCHFS = SAL.
DOSE s 3 , ES A
TI .
. � CA
PACT L.
AL,ARI"L MANUFAC'I3RER? Lit'. -� B = INCHES =
MODEL NUMBER' � � � � GAL.
fl
_ HE _...... ---
SWITC
PUMP MANUFACTURER = D
_ A- - = IpCi�£S
MODEL NU : - !'3 _,re,w -t PER
I LHR 16.23 WAC
Fi TYPE= " ; :AR14 WIRING
o FE
FEET - ,/; a {�tiP £ A
L
ET
REQL�-IRED DISCHARGE RATE �- TI ON pSP£ - -�' (o � FEET
BETWEEN PUMP OFF AND DTSTRIB _ FEET
VERTICA3, I)IFFEREIdCE RE j0L3 -FT- . FRICTION FACTOR - ' -- ---- FEET
+ MINI N£TW V FpRCEriA� £ / 3-=- TOTAL DP I£ --
FEE r- /�
INTERNAL DIMENSIONS OE
PIJ M r T LENGTH - `_... ---
DA
LICENSE NUM$ w
SIGNED* _
i188
TOTAL DYNAMIC HEAD /CAPACITY
PER MINUTE
HEAD CAPACITY CURVE EFFL AND DEWATERING
U MODEL 152/153 MODEL I 152 153
cr_ W 1—
� ii 5O Feet Meters G,l. Liters Gal. Liters
5 1.5 69 261 77 291
153 10 3.1 I 61 231 70 1 265
12 40 152 15 4.6 53 201 61 231
o i 20 6.1 44 167 52 197
_ 2� 7.8 34 129 42 159
U
30 _ I
I
30 9.1 23 87
33 125
Z 8
ra J5 10.7 — 22 85
20 40 12.2 I i —_ 1 42
ack Valve: 38.0 = . {11.6m)f4 Ft. (t3.4m)i
4 u�osae
10
0 20 40 60 80 100
GALLONS
LITERS 0 80 160 240 320 _ 3 27/32
I
FLOW PER MINUTE I I
.9 3 27/32
t
CONSULT FACTORY FOR SPECIAL APPLICATIONS
3 27/32
I
•Timed dosing panels available. t
• plied with
Electrical alternators, for duplex systems, are available and sup
an alarm. I
• Variable level control switches are available for controlling single phase
systems.
Doub le piggyback back va
viable level float switches are available for variable ---- i
• p 99Y
level long and short cycle controls.
. Sealed Qwik -Box available for outdoor installations. See FM1420. t t
• Over 130 °F. (54 °C.) special quotation required. L I �
i/e I ,
1521153 Series' 1 t
p R
1521153 M DELS Convo Sele -on 1/8
Am s simplex Du lex
Model yofts•Fh mode a.5 t 2 or 3
N152 115 1 Non —L sKZOe+
8.5 included 2 or 3 t I
aN152 t15 1 Auto 2or3
E152 230 1 Non 4.3 1
Bn2301 Auto 43 Included 2 or 3
E15 10.5 1 2or3
SELECTION GUIDE
N153 Non variable level float
BN15Auto 10.5 i EE1 Non 5.3 1. Single piggyback vanable Level float switch or double piggyba a E t5 Aura 5.3 ded switch. Refer to FM0477.
2. See FM0712 for correct model of Electical Alternator E -Pak. du lex 3
O CAUTION
. Variable level control switch 10 -0225 used as a control activator, specify p ( )
All installation of controls, protection devises and wiring 3
ng should be done by a qualified of (4) float system.
recgri ed ficna E All electrical and dthee Oc ational Safety fo m ost
an Health Act [OSHA)
• ode n P
' Electnc C (NEC) i )
recent Naponal
RESERVE POWERED DESIGN ever Zoeller pump.
to the design of y p
factor is engineered In 9
For unus c onditions a reserve safety 9
MAIL TO: P.O. BOX 16347 -
Louisville, KY 40256 -0347 Manufacluersof
` SHIP T0: 3649 Cane Run Road ��
O ® Louisville, KY 40211 -1961 Qveu Awlpf 5 pN /Ifflys
Cf r
ham; //wwwsoeUer com
PUMP LO. (502) 778-2731.1 2 7 3 PUMP
624
p Copyright 2000 Zoeller Co. All rights reserved.
MAN & MANAGEM
UAL E14T PLAN Page of —
PowTS overt F s EG[F1CAT10NS
SYSTEM SP J w 0 NA
. INFORMA ION X41 Septic Tanis CapacrtY
NA Ft� er ` Septic Tank Manufacturer
,f
Pennfl Effluent Filter Manufac*ut er 13
Efliuenf F(ter Model —11�Z O lVA
OESIGN PARS Cl NA ❑ NA
Number of Bedrooms Pump-Tank CV3CItY
Number o f Commercial Units p Tank Manufacturer NA atfda /
❑ NA'
Ell"ated flow ( avefage) at/d Pump Manutafxurer ❑
1_5
Design flow (Peakf, ( x mated ) atld a /its Pump Model
�� pre trnent Unit
$O II APPti Monthly average p Sani/Gravel Fitter D Peat Filter
wetland
tnfluentlEfttuent Quai - rty S 30 mg/L O Mechanical Aer ?on ❑
Fats.. Oil 4 Grease (FOG) y.20 mg/L on ❑ Other_
I oxygen Demand (BODs) ❑ Disinf tur
Biodw ded Solids {TSS) 5150 +�� Manufacturer
Total Suspen cast
Mont Cecgr in-ground average " Dispe c3 [n-g ressurized)
Pretreated Effluent QuaidY ❑
Fecal Co .ground (gravity) p Mound
GODS) S30 mg1L .grade
en Demand ( 530 mg / ❑Other_
B ioch em ical o i Suspended Solids (TSS) 1' ❑ Dn 'ne
(g eometri c mean) 510` diam v l� for d 00a'ca 'dao �- "'
litorm (9 y ;nchd iamter �"� �
5e � Wk efftueat
Maximum Effluent particle Size
values types ro Pretreated waste+rate�
MAINTENANCE SCHEDULE Service Frequency
Service Event ❑months ear(s) (Ma)imum 3 y1
At least once every oafs one - third (y,) of tank volume
inspect condr6on of tank(s) When combined sludge and scum c Maximum 3 yrs.)
contents of tank(s) N ❑ months earls)
Pump out At least once every ar(s) ci
Inspect dispersal cell(s) At least once every months .
e ffl ue nt filter eve
" ❑months s) E3 NA
once Clean feast on every
At
um controls & alarm ❑ months s) O NA
inspect pump. P P At least once every
❑ year(s) [I NA
rBSSU test
re ❑ months e
Flush taterats and P At least once every
❑ s) O NA
O 9W- Once every
C3 m onths Year(
At feast
odwr_
maY indicate a Ma n one of the following licenses or
mMMTENMCE INSTRUCTIONS lira shaft be made by an individual carrYi I n s pector 9 POw�'S lutamtainer, Septage
lnspedlon of tanks and dispersal st Restricted Sewer pO of the tank(S) t0 identify any rKmsmg or broken
cer dfWfio ns: Master Plumber: ster Plumber for any back up
Tank inspections
$ Operator. Tan must induce a visual tnsper sperm to check the effluent levels
cracks or leaks, measure the volume of oomb[rsed slud and and to sheds
hardware, identify any The dispersal cell(s) shall be vts Y nding
o r ponding of effluent effluent on the
fluent on the ground surfac e- round surface . The Po
for any ponding of effluent on the g ficetion of the 10001 regulatory autho
in the observation Pipes and to C h ec k for and requires the immediate noti tank
d surfa volume. the
ground failing equals one - third (K) or more of the NR
sl and scum in any tank eq for and diseased of in accondancx with Ch- When the combined accumulation of ove a Septage Servicing Open
entire contend of the tank shall be removed �' retreatr�ment components; and MY
113, Wi=sin AdministratWe Code onents, P pOWTS Maintainer.
rformed by a ceftifted
Th e SorVic in of effluent filters, meclnanicai or '� mo the orless shall be Pe service event
Th 9 of compie�on of any
Other maintenance or monitoring at irate IOC r ulatory authority within 10 days
loss re9
to
the -
�be •� .
shalt P o ther
I I A SetYlQe reed Of
START UP AND OPERATION treatment tank(s)
for th Presence o f painting products
to use of the PDVy rS cheer.
er5al cell(s). if high conoEntmbonS aJe
For new oonsttvtion, per s anchor damage the dis a o Prior to use_
chemicals that may impede the beatmeni Process by a septage servicing t�
detected hate the oontents of the tank(s) - -
/'L+ t ♦ I
Page of
conditions are frozen at the infiltrative surface.
Sy stem sort up shalt not occur when scn1, is restored Me extress
fill above nom highwater levels. When power is
may result in the
During povmr o utages Pump tanks MA Y celt(s� in one large dose, overloading the ced( )
�� „ be discharged to the dc rim tank removed a
bac4P or surface d'csdtarge of efttuent To avoid this situation have the co contact a Plumber or POWTS Maintainer to
Serge Servidng pPemt3or prW-t0 restoring power to the effluent pump
assist In r ervici y oPerabng pip oon� to restore normal levels Within the pump tank
r park vehldeS over tanks and dispersal cells. Do not drive or park over or otherwise ds�burb or compact,
Do not drive o pa mound or at-grade Sot? absorption area.
the am within 15 feet down slope of arty
rom the wastewater stream may improve the performance and prolong the Reduction or- el"unination of the fnl((Ax g f. tte butts; condoms; cotton swabs; deArea�: dental
floss. pers; ffe
of the POWT& antrb babY WPW- .d 9 water, fruit and vegetable peelings; gaso grease;" herbicides; meat
disinfecc� ants; fat: fourida�n drain {sump
p ump) .des: sanitary napkins: tampons; and water softener brine.
scraps, medications: of gainting products; peg
ABANDONMENT rrtiy talker Cod
out of service the following steps shalt he taken to insure that the
When the POWTS falls and/or is perrtt fiance with ch. Comm 83.33, Wisconsin Administrat e:
system is properly and safety abandoned in camp o p en ings; sealed-
•
A li p ipi n g to tanks and pits shall -be disconnected and the aband po of by Septage $ervicing Operator.
The contents of all tanks and pits shall be removed and properly
After pumping, all tanks and Pits shall be excavated and removed or their covers removed and the void space
filled with soli, gravel or another inert solid material.
CONTINGENCY PLAN th following measures have been, or must be taken, to provide a code
if the POWTS fans and cannot be repaired
compliant replacement system'
Q A suitable replacement -area has been evaluated and may be utilized for the location of a replacement s
absorption system. The replacement area should be protected from disturban lot Fines and we compactio a and ure sh ould Id not
be infringed upon by requiter/ setbacks from existing and proposed struure, ct
toted the replacement area Will result in the need f or avY th the in at that time
replacement area_ Replace establish a suitable evaluation to
p ms must co p y
[r►ent syste
Q A suitable replacement area is not available due to setback and/or soil limitations_ gaming advances in POWTS
,
technology a holding tank may be installed as a last resort to replace the fatted Ppu1(TS_
a suitable replacement area Upon failure of the POWTS a sod.and
T he site has not been evaluated to identify .
Site evaluation must be petfortn� to locate a suitable replacement area_ if no replacement area is available a
holding tank may be installed as a last resort to replace the failed POWTS. Mound an6 at -grade sor7 absorption systems may be reoonstruGted in place following removal °thatt time.
at the rules
the infiftratiWe surface. Reconstructions of such systems must comply
« MI=NT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN.
SEPTIC, PUMP AND OTHER TRF1► ANY CIRCUMSTANCES. DEATH MAY
DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER
RESULT. "RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE
ADD COMMENTS
i
PUWTS r MA I NT A INER POWTS INSTALLER
Name. .,�1 Namcc
Phone l �, r l �p Phone I
SEPTAGE SERVICING OPERATOR PUMPS
LOCAL REGULATORY AUTHORITY
i49enc Y 7�
o
Name F ill"
Y Y' r j
Phone I '> �j( 1 6
Phone �"� This document crests
r uetfe and Waushara County Zaning end Sanitation agertrles-
3Tis oowmerrt was drart+ad by the staffs of the Green LAM Matq Ccde Use of this domment does not
the minimum requuements of ct� Comm 83 22C1)(b}ftHdj� {� 83.Sd(1}. (2) 8 (3). Wisconsin AQmtn m G#AW(21pt)
guarantee the performance of the POWTS.
Wisconsin Department of Commerce SOIL. EVALUATION REPORT Page of
Division of Safety and Buildings
ina a hC mri EREMV my
Attach complete site plan on paper not less than 8 1 x i it i size. Plan must
include, but not limited to: vertical and horizontal refere h'), direction and reel I.D.
percent slope, scale or dimensions, north arrow, and Iocat Ji - -,A?Ro 2effel U15-
evi ed by Date
Please prinf all information ST. CRO 7
Personal information you provide may be used for secondary purpos (Pr w 44.� )�Y �( O �Q 2
property Owner y
!' t 1 f Govt. Lot W 1/ S A S T3 N R E (o 6V�
! r ,
Property Owner's Mailing Address fn ./ Lot # Block # ( .Marne or CSM#
Q State zip Code Phone Number [l City ' ❑ Village own es� oad
New Construction Use: esidential / Number of bedrooms _._� Code derived design flow rate �� GPD
❑ Replacement Public or commercial -Describe: _., -- - - -- - -- - - -- - - --
Parent materia Z __ _.___ Flood Plain elevation if applicable
General comments
and recommendations:
5
Boring j
Boring # p ' I t . Depth to limiting factor n.
it Ground surface elev. � Soil ApjAcation Rate
Horizon Depth Dominant Color Redox Desaiption _ exture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
ik:
&zing #
E] Boring
it Ground surface elev. D/ l
1 / . t. Depth to limiting factor - - -�� Sal Application Rate
Horizon Depth Dominant Color Redox Description Taxture Structure Consistence Boundary Roots 'Eff#1 GPD/f'
Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
0 �D a YY) r C S r j (7
j i'" L r
AQ ,5 Y
I b
Effluent #1 = BOO > 30 < 220 mglL and TSS >30:S 5. r ' Effluent #2 = BOD C 30 mg/L and TSS < 30 mglL
CST Number
CST Name (Please Print) 226900
Bird Plumbing, Inc. Shaun Bird
Date Evaluation Conducted Telephone Number
Address
1008 192nd Ave, New Richmond, WI 5401 ���— 715- 246 -4516
Property Owner _ Parcel ID # _ _— Page -- of
F3_1 Boring # E] Boring
it Ground surface elev. D ft. Deplt; .c limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture ature Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color _ , : >.__. 3h. `Eff#1 *Eff#2
S1 a MIA r irY) 4,--' C s o
t Sj a,rn
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft Dept- o limiting factor in. Soil 8Wication Rate
Horizon Depth Dominant Color Redox Description Texture ! : is re Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color C: 3z. Sh. *Etf#1 'Eff#2
Boring
a Boring # Ground surface elev. ft. Dep' - i v li °niting factor in.
❑ Pit Soil Apaication Rate
Horizon Depth Dominant Color Redox Description. Texture "I t UGijre Consistence. Boundary Roots GPD/ff•
in. Munsell Qu. Sz. Cont. Color :r. Sz. 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 nVL
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 deparment at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (RAM)
Soil Test Plot Plan
Project Name Sunset Ridge LLC Shaun rd
Address 838 Summer Pines Circle
Hudson Wi 54016 CS #226900
Lot 7 Subdivision Sunset Ridge Date 4A 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 102.7' *HRPSameasBenchmark
316' Property Line
Scale is 1" = 40'
unless otherwise
noted
10 B -1
B -3
100'
7% Slope
0 '
.M.
55 ' B -2 /45'
101 -
103'
314' Property Line
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
C
OWNERSHIP CERTIFICATION
FORM
OwnerBuyer
Mailing Address Y3
O ) g� 1 01 b
'F ti � n.e��i�c.0 �-��� ! /�•� -�
Property Address L "D sfi
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location 1 / ,J , Se.3, T_30 RL&W, Town of /Z 11
• Lot # n
Subdivisio /I LC'� . � � , _�.
I Vr-
Certified Survey Map # , Volume , Page # _
Warranty Deed # 4_:H` L o , Volume Z(a f, , Page # _ 3OG
Spec house (& no Lot lines identifiable 5yesno
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.
n
The property owner agrees to submit to 5t. Croix County Planning & Zoning Department a certification form, signed by th e
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 113 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.
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. 08105)
l
FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11
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FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12
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STATE BAR OF WISCONSIN FORM 1 - 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 19:25AK
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: 13.80
(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, W1
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.
ct
Dated this - _t day of V41 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.
M ST. CROIX County )
authenticated this 121?da of 2004
Personally came before me this day of
2004 the above named
Herman W. Keller, Sr., Herman 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. Slats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina 0gland, 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. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 1 -1999
U 2660P 30? .--
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 libe 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 comer 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.
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