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HomeMy WebLinkAbout026-1172-03-000 : County St Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 463374 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: Marek, Todd Richmond, Town of 026- 1172 -03 -000 CST BM Elev: Insp. BM Elev: BM Description: 5 "(J Sectionfrown /Range /Map No: I ,b (�VV"- CST �� 35.30.18.1364 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. O qp . O CIS o Septic C � Benchmark kJ e�ti- 1 zop Dosing Alt. BM A� Bldg. Sewer 43 b 5 Holding St/Ht Inlet SVHt Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ \ Septic iC / A �s 75 Dt Bottom I z �� - 7 c l . � Dosing L4 5 j 7 5' t 75 1 Header /Man. 2 i5G� � y5 � 7 Aeration Dist. Pipe Z.55 ti 7.y5 a , Bot. System 3 . Holding �� 7 �x,,,.l' ZS .7 0� PUMP /SIPHON INFORMATION Final Grade 1 1 55 `fg 1 4 5 Manufacturer Demand St Cover 3.1% 1% GPM b Model Number I �` o Ca o� 3 y5 �b o TDH Lift Fricti 0 Lo 0 System Head � T Z �t r � Forcemain Length i Dia. is Dist. to Well Z(c Z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenche PIT D ENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Ci 7 \ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: b U / A' UNIT Model Number: \ DISTRIBUTION SYSTEM Iv Header /Manifold r Distribution / \ / x Hole Siz I x Hole Spacing Venvex t��o tal�e �ILI Pipe(s) 0563 / �' \��/� 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 Mulched Bed /Trench Center Bed/Trench Edges Topsoil � � I 4 es No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 / 6 6 Inspection #2: Location: 1286 138th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 35 T30N R18W) Sunset 1 w Hollow Lot 3 Parcel No: 35.30.18.1364 1.) Alt BM Description = F, � n I ��� Z ����� Ivl O r II 2.) Bldg sewer length - amount of cover = ; Plan revision Required? Yes XINO Use other side for additional information. Date Insepctor's nature Cert. No. SBD -6710 (R.3/97) L Safety and Buildings Division County ' ZO1 W. Washington Ave., P.O. Box 716 _5 C An Madison, Madison, WI 53 ,� IE� Sa 'lacy Permit Number (to be filled in by Co.) aLf Department of Commerce L/ `� (608 66 3�{ \I (� 3 3 10 05 Stat Plan I. D. Number ((2 3 z / � Sanitar Permit �p� In accord with Comm 83,21, Wis, Adm, Code, personal infOrmat ptfdJide 9 ff 7 � St may be used for secondary purposes Privacy Law, sl. .04( (m) GROIXCCVN� Proje Ad ess (if different than m address) gT. FIG I. Application Information - Please Print All Information b / (3 Q ` 6 I Property owner's Na me Parcel N Lot X lr oM Property Owner's M ailing Address Property Location j� � ' /4. �• t /a,Section City, State /may Zip Code Phone Number l(, O A/ D �C.� - 71.E `+'77 0 (ce ti /1) � T � N; Rjel e) E o 1 II. Type of Building (check all that apply) Subdivision Name CSM Number 9 1 or. 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use /(f Q C. LO t-I.J ❑State Owned - Describe Use ❑City — ❑Village gTownship of 2 /C# N0 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) QQ A. New System ❑ Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modi teanon to Exis g System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner . ) - I A 4 I n 44 t tt a t IV. T e of POWTS System: (Check all that appl X - O ❑ Non - Pressurized In- Ground XMound > 24 in. of suitable soil E Mound < 24 in. of suitable soil ❑ At -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 Pipe ❑ Otl r (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Applicat i Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro osed (so System Elevation �o 6 • 0 S a (OG 1P 1 1 6 S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units A --. /ac onerete ConsOUcted Glass New Existing Tanks Taaks `� r Septic or Holding Tank 2_ v Aerobic Treatment Unit Dosing Chamber � VII. Responsibility Statement- I, the u ndersigned, as sume responsibility for installation of the POWTS shown on the attached plans. Plu ber's Na tine (Print) " -qro Plumber's Si gnature MP /1`4IaR8 Number Business Phone Number - 7 Z Z b 9 � yes" Z . 5�f� P umber's Addre�Street, City, State, Zip Cc VIII. Count /De artment Use Onl K Approved ❑ d Sanitary Permit Fe includes Groundwater Date Issued Issuing A ent Signature No Stamps) Surcharge Pee) ❑ Owner Given Reasot Denial O ` % - — mr _A LX. Conditions p r 1/ 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 81/2 x 11 inches in size SBD -6398 (R. 01/03) Todd Marek P.O. Box 228 New Richmond, WI 54017 NE' /.,NE' /4,S35,T30N,R 18 W Richmond Township St. Croix County Scale I" = 40' Weiser 1200/800 Tank BM = 100.00' Top of steel fence post BM 2 = 95.00' Top of survey iron 30' of 2" Force main roo N t* AV c 6 `4- � d a3 \ y , q 4 C9e1 rw� C �ri ✓ G W �C� ti C � � cdrova. h�o..s �• M y , o wfcL R O Page 8 of 8 Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w ,a,nnn, commer isco sin.go / Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 01, 2005 CUST ID No.226497 ATTN. POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 'CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2007 Identification Numbers Transaction ID No. 1123265 SITE: Site ID No. 696476 Todd Marek Please refer to both identification numbers, 138TH St above, in all correspondence with the agency. Town of Richmond St Croix County NE1 /4, NE1 /4, S35, T30N, R18W Lot: 3, Subdivision: Sunset Hollow FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1011198 Maintenance required; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD- 10691 -P (N.O1 /01); 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. P ( ), P P q No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, CON ( # stats. The following conditions shall be met during construction or installation and prior to occupancy or use: P P" R D A Fl Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORI2E "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption 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. • 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. Stat ROGER D NELSON Page 2 4/1/2005 • Comm 83.22(7) 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. 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 $ 17500 Balance Due $ 0.00 C L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz @commerce. state. wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 RF �Fi MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Todd Marek 4 bedroom Mound system Owner's Name: Todd Marek Owner's Address: P. O. Box 228 New Richmond, WI 54017 Job address: 138 th Street Legal Description: NE 1/4, NE 1/4, S 35, T 30, N R 18 W Township: Richmond County: St. Croix Subdivision Name: Sunset Hollow Lot Number: 3 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan R Page 7 Pump curve and specifications` Page 8 Plot Plan OF C OYMERDE .LDiNGS SPOND Designer: Roger Nelson License Number: MP 226497 Date: 03/28 05 Phone Number: 715 - 273 -4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01101), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) _R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <= 36 inches. 600.00 Design Flow (gpd) _ 4.00 Site Slope ( %) ~~ 9 6.00 Contour Line Elevation (ft) 40.0 Depth to Limiting Factor (in) -- In -situ Soil Application Rate (gpd/fe) Distribution Cell Information 67.00 Dispersal Cell Length Along Contour (ft) = 8.96 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution I Y Press Disribution Information network? Enter Y or N (c or e) ( e Center or End Manifold 2.99 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. t � - 0. - 12 5 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimate Orifice Spacing (ft) = 11.77 ft /orifice 2.0 Forcemain Diameter (in) 30.0 Forcemain Length (ft) Does the forcemain drain back? L 8 2.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 14.17 Vertical Lift (ft) 40.03 5x Void Volume (gal) 0.30 Friction Loss (ft) 44.92 Minimum Dose Volume (gal) 20.97 Total Dynamic Head (ft) 21.01 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Select in. dia. options c hoice dia. options c hoice 0.75 1.25 x -- 1.00 x x 1.50 x x � 1.25 x ~ � 2.00 l 1.50 x 3.00 �^ - 2.00 x _ - 3.00 x i Gallonslinch Calculator (optional) Treatment Tank Information r - � Total Tank Capacity (gal) 1200.0 - 1 Septic Ta nk Capacity (gal) _ Total Working Liquid Depth (in) We ser 800- 325 - 84561 Manufacturer gaUin (enter result in cell B49) Dose T ank Information ! Effluent F i lt er In formation 80 0.001 Dose Tank Capacity (gal) Zabel 1-800- 2 21 -5742 Filter Manufacturer 2 224 Dose Tank Volume (gal /in) }A1 Filter Model Number jweiser !Manufacturer Project: Todd Marek 4 bedroom Mound system Page 2 of 8 Mound Plan View t 1l - B Observation Pipe .. J FK . . . rj A W :1 B 4 1�J I �-- L Mound Component Dimensions A 8-.N ft E 10.30 in H 1.00 ft K aft ft B 67.00 ft F 9.00 in 1 7.19 ft L ft D 6.00 in G 0.50 ft J 4.69 ft W 600.32 (fe) Dispersal Cell Area 1 1081.90 (fe) Basal Area Available 8.96 (gpd/ft) Linear Loading Rate 1 6.70 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.25 (ft) —� � ,rfrrrrr,�. 2 rirrrrrf,. j Z F :: € 97.00 (ft) Lateral Dispersal Cell 96.50 (ft)— — Invert Dispersal Cell :D t Elevation ... ............ ... .. ............ . 4 4 96.00 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key $. "r Dispersal Cell See lateral details on Topsoil Cap 1.5 ft Page 4 for number, size, _ S ub so il Ca ff /!� 2 . ,f.r•�tirtir•r•r•:tirtir6r i 5 •r• t•r•r and spacing of laterals. © p ti. «,s r•r r r : } r f•r Laterals are equall Z ti fti =~ L _ ti ,ti ;titti f ti : F 4 Y ASTM C33 Sand E ® Tilled Layer v m 0.5 ft fsr Typical Lateral j�r�. spaced from the C ~•~•~• ••~• ••••~•~•~• r•r•t r•r•r•r t•r•r•r distribution cell's ti•ti•ti ti••.•� •ti••.•ti•ti•'.•'.•ti• 5 r•r•r•• Aggregate o r•r•r•r•t•r•r•r • r; r•t centerline in the 0 — A distribution cell (AxB). Project: Todd Marek 4 bedroom Mound system Page 3 of 8 End Connection Lateral Layout Diagram Centel the w rals owl tM A do B dMnension •- Turn -up wrbmil vslw or ofon nout pi up AN are dentical (< X —� I Halos drMOd on the bottom of the iatoral $ oqu*% spaced lator(� Table P VC -s� 40 s c meadon via toe or oross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) �> -4-09 ft Lateral Length (P) 7 Y 65.44 ft Orifices per Lateral 17 Lateral Spacing (S) 2.99 ft Orifice Density 11.77 ft /orifice Lateral Flow Rate 7.00 gpm Manifold Length 5.97 ft System Flow Rate 21.01 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.97 ft Forcemain Velocity 2.15 ftisec Dose Tank Information Looting cover With warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC 4 in. min. Disconnect __._„___,_,_ Tank component is properly vented Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer X 2 in- Ca i 800.00 Gallons _t Volume 22.24 9 al/inch A Weep hob or anti - Dim Inches Gallons B siphon device A 21.95 488.20 C B _ . 02 2.00 44.48 � P ump off elevation (R C 2 44.92 82.83 D 10 # 222.40 D Total 35.97 800.00 I Dose tank elevation ft 3" Bedding un r tank. 82 - Alarm Manuaaacturer i S. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer L M�rers Pump Model Number ME40 Pump Must Deliver 21.01 gpm at 20.97 ft TDH Project: Todd Marek 4 bedroom Mound system Page 4 of 8 1 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effecthve locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather Installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be Immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Todd Marek 4 bedroom Mound system Page 6 of 8 - 7 . J � M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 W 30 t3 .t ► 25 Z s 2 GJ. 7 rr l 6 15 Q O 4 0 F- 10 2 5 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE �l.ol G PM ` 1101 Myers Parkway. Ashland, Ohio 44806 -1923 419/288-1144 FAX 419/289-6658 Telex 86-7443 K3326 7/91 Printed in U.S.A. ...... c..� ..,.... —. .,..,,,, .,yes .,InL ♦ r ir% r- ---7 ..ess_i Todd Marek P.O. Box 228 New Richmond, WI 54017 NE %.,NE%,S35,T30N,R18W Richmond Township St. Croix County Scale 1" = 40' Weiser 1200/800 Tank BM = 100.00' Top of steel fence post BM 2 = 95.00' Top of survey iron 30' of 2" Force main N Lo-' g �2- Norm Pro�s�.t L.� c� e 8 G Arw�C /i ri ✓ L w cc � y PrC J h �. rU a drowa. t � wECL n ,5aa 74 po .r �, L . ;� Page 8 of 8 Wisconsin Department of Commerce I ION REPORT Page__of Division of Safety and Buildings an h mm 85, Wis. Ad .Code County Attach complete site plan on paper not less th n 8 vvv inrte�irY6 Plan must include, but not limited to: vertical and horizon I reference point ►►wff�� fiat lion d Parcel I.D. percent slope, scale or dimensions, north arro , and iorland distance to ne rest road. o KUIX I Re, wed by Date Please print all nfora�VI�1G OFFICE q. Q S -- Personal information you provide maybe used for secondary purposes (Privacy Law, s. ... (t) (m)). Property Owner, Property Location ` Govt. Lot eSubd. 114 S_5 T So N R E (o W Property Own�Mailing Address 19j"b— p Lot # Bme or C SM# , .mac �=ef�ol Lac/ City to Zip Code Phone Number 0 City ❑ `Allage X3own Nearest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate _ GPD ❑ Replacement Public or commer l - escribe: --- - - - - -- - - -- — Parent materia �llL� �Ii4. Lh Flood Plain elevation if applicable //2!E - - -- - - -- ft. General continents and recommendations: e / Fl Borng # Boring it Ground surface elev. �I n • Depth to limiting factor Y Soil t lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfFfi 'Eff#2 Z I Boring # Boring - A Pit Ground surface elev /_� / ft. Depth to limiting factor Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efta1 •Eff#2 - 1 u -Z, C v s' 2, )4-2,0 / "j 0-1111 , S ---� J'b L,� 6- 7 41 J r i • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < mglL ' Effluent #2 = BOD < 30 mg/1- and TSS < 30 rng/L CST Number CST Name (Pleaw Print) ignature Bird Plumbing, Inc. Shaun Bird 22690() Date Evaluation Conducted Telephona Number Address 715 -2�6 -4516 1008 192nd Ave, New Richmond, WI 54017 r_� Property Owner _ Parcel ID # Page of Boring # Boring / V it Ground surface elev. 4(a r! ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtk in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 4 , - f Z_ —2 �' ' L ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. ' Sz , Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD- > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/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 department at 608- 266 -3151 or TTY 608 -264 -8777. SSD -8330 (R.6(00) Soil Test Plot Pla Project Name Todd Marek S d Address P.O. Box 228 New Richmond Wi 54017 STM #226900 Lot 3 Subdivision Sunset Hollow Date 10/29/04 NE 1/4 NE 1/4S 35 T 30 N /R W Township Richmond FJ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence P ost System Elevation *HRPSame as Benchmark enchmark Top of Survey Iron @ 95.0' ' 288' Property Line 1 B. B- 35' 1' 0' Scale is 1" = 40' unless otherwise loo B -3 noted 4% Stop B -2 6 95' 275' Property Line 138th St. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �L P try " W R — 4 ( (_ - C- Mailing Address 6d Property Address 2. f J ? 4 S (Verification required from Planning Department for new construction) D i fo /0q /0 0� City /State Parcel Identification Number 9 io `e9 I,o 000 LEGAL DESCRIPTION P Property Location �'/4, � -� '/4, Sec. , T 3 -R W, Town of ' &O' -m, /V o Subdivision CTv cc--e 'U , Lot # Certified Survey Map # , Volume age # Warranty Deed # :� - 7 2 35 , Volume 7O , Page # Spec house Dyes O no Lot lines identifiable .la yes O no SYSTEM MAINTENANCE 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 systerr. can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by z master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal systen- 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 standard: set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatior stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF AP LICANT DATE OWNER CERTIFICATION 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 AP LICA DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with,this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i1. 2640 P 621 77aI35 KATHLEEN H. VALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST CROIX CO.. VI • RECEIVED FOR RECORD This Deed, made between RJC Development. Inc.. 08/19/2084 10:30AN Grantor, and Todd Marek, VARRANTY DEED Grantee. EXEIPT # 3 Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: COPY FEE: (if more space is needed, please attach addendum): CC FEE: Lots 2(D4, 8 and 12, Plat of Sunset Hollow in the Town of Richmond, PAGES: 1 St. Croix County, Wisconsin. This deed is being given to correct the actual lots that were conveyed from Grantor to Grantee in Doc. No. 761627. Recording Area Name and Return Address V� 026- 1099 -10 -000. 026 -1099- 60-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of August , 2004 Jj�' AUTHENTICATION CKNOWLEDGMENT Signature(s) _ STATE OF ) — j c ) ss. ,i Cis county ) authenticated this day of _ �vTreC „�� vb ` 1 C Personally came before me this y of P S,r August , 2004 the above named �$C Todd Marek, O{ at e TITLE: MEMBER STATE BAR OF NSIN (If not, _ to me own to be the person(!) executed the foregoing authorized by § 706.06, Wis. Slats.) instru n a d ackno edge e. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hud W I 54016 Notary Public, Stite of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) j L —Z ) • 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. 2 -1999 sa9• ` 307.85' 0 g N76'1I'39'� N ' 8 Eosem nt 8 � �'�9ys� � g S89'49'1 5 "E 279.72 M :LOT6 H. W.E. _ sM•�'1s'�' T . n 0 rn 1019.0' �� 112.95' N� 71, 002 Sq. ft. g 8 1.63 ocres Sd9'4 616' V OD 0 LOT 2 I w S89'49'1 5 "E 0 a N h ° 79, sq. 060 ft. ° -N 275.00' 1.81 acres in L.B.O.- 1023.0' � v ° S89'49'1 5 "E 288.24' Z o o LOT 7 ° iVT 76 Ord o 00 ° o — 74, 251 sq. ft. $ g .• OD 1 v 1. .70 acres ni rn ot) Z S89'49'15 "E SaO. O LOTS N o v 275.00' Ln w o 79, 319 sq. ft. 0 190.00' 190.00' w 1.82 acres ° z � �+ S89'49'15 "E 288.63' ( LOT 8 LOT 9 78,851 sq. ft. Z 78, 851 sq. ft. �, ( 1.81 acres o 1.81 ocres D v Z a CA oo D OD o s Lin N LOT 4 I ' p 79,426 sq. ft. v x ° 1.82 acres ° ............................ I I �J 33' .33' — N89 0 49 ' 1 5 � , 190.00 --- 10.00 ' ° 289.02' N89'49'1S 580.01 - 1287H- A VEME . - ...... - - °_1ga44• 230.00' S89'49'1 5 "E 935.12' NW70'45'r ' z 230.00' l�+y J b /����' I I �- RECEIVED 1372 Wisconsin Department of Coi imerceNOV 13 2003 SC IL EVALUATION REPORT Page I of 3 Division of Safety and Buildin s d wit Comm 85, Wis. Adm. Code Steel Soil Service ST. CRd« County Attach complete site pla on papeaa%hS d18FJUI inches i size. Plan must St. Croix include, but not limited to. and nonzonto reference point M), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. eviewe Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). < `oZ `v 6 Y Property Owner Property Location R.J.C. Development, Inc. Govt. Lot na NE 19 NE 19 S 35 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1868 CT Hwy " C " 3 na Sunset Hollow City State Zip Code Phone Number J City _j Village a Town Nearest Road Somerset I WI 1 54025 651 - 488 - 3051 Richmond 130Th Ave 16 New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement I Public or commercial - Describe: Parent material Benches and large drainageways of ground moraines. Flood plain elevation, if applicable na General comments and recommendations:, Mound design, system elevation 102.00 ft based on contour line elevation 101.00 ft. Minimum 42 of > 3 u S J�STM C33 sand. 6- k.-a- ad _ 4,;C 9L1 Sk&i;l M4- Id [�J ftring # I Boring ✓ Am Pit Ground Surface elev. 101.50 ft. Depth to limiting factor 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/2 none sit 2msbk mfr gw 2f .5 .8 2 16-40 10yr4/4 none sicl 2msbk mfr gw 1f .4 .6 3 40-60 7.5yr414 none sl /scl 2msbk mfr gw na .4 1.6 4 60 -96 5yr4/4 c2d7.5yr5/6 sl /scl om mfr na na .0 .0 Boring # I Boring 0 Pit Ground Surface elev. 101.50 ft. Depth to limiting factor 45 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2msbk mfr gw 2f .5 .8 2 10 -23 10yr4/4 none sicl 2msbk dfr gw 1f .4 .6 3 23-45 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 45 -55 10yr8/2 c2d7.5yr5/6 sand stone residumm mfr na na .0 .0 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = B00 S30 mg /L and TSS <30 mg /L CST Name (Please Prin Signature: CST Number David J. Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54l 11/10/2003 715 246 - 5085 Property Owner R.J.C. Development, Inc. Parcel ID # Pending �,��, 2 of 3 Boring # Boring ( �b �� 77 M Pit Ground Surface elev. 100.10 ft. Depth to limiting factor 26 m• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 13 -16 10yr4/4 none sicl 2msbk mfr cs 1 of .4 .6 3 16 - 10yr4/4 none sil 2msbk dfr gw 1vf .4 .6 4 26 -60 5yr4/4 none scl om mfr na na .0 .0 F—I Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # I Boring ` J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 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 and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST- POWTSM RJC Development Co. New Richmond,WI 54017 L1c #248956 NE1 /4,NE1 /4,S35,T30N,R18W Bus.(715) 246 -6200 Town of Richmond, St. Croix Co. Fax.(715) 246 -9372 Sunset Hollow, Lot 3 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1 = 40' ♦ = Benchmark Ele. 100.00Ft Top of 1/2" pvc pipe • = Alt Benchmark Ele. 99.90Ft Top of 1/2" pvc pipe ❑ = Borings Boring Elevations BI = 101.50Ft B2 = 101.50Ft B3 = 100.1OFt B4 = OO.00Ft 75� Ai 4 Z� az 6a � 1 60' 37' <-o� Af Q I \ \ \ z 71,002 . sq. ft. 1.63 acres I I 1 \ \\ \ LOT N .79,060 sq. ft. - N / / r 275 / 1.81 acres i / SLOT 7� \ ►\ o 288' = \ 1 N ' r - 74,251 sq. ft. 1 � 1.70 acres \ \ \ \ o ^ LOT 3 _: \ 190 275 190 \\ 0 N \79,J19 sq. ft. --- \ X1.82 acres ,- / 78, 8 51 sq. ft._ 78, 851 sq. > 1.81 acres — `1.81 acres U N I l / N 79,426 sq. ft. ( / ------ - - - - -- 1-7.82 acres' — — _ i .......... . . ._._� ------ - - - - -- L i - � L, --190' =� ---. 190' X 322' ` � \ ( ` - - � 646 _ `-f �DpOSED _ __ �_ 128TH --- -A ' \ 968' i / J 230' \ ' 230' — � 230' ��� - - -\ r�l� �� \ --.., I \ \ a do �"1 1-1 \ 70 7 � t \ .�