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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisidn I ,e INSPECTION REPORT Sanitary Permit No: 479245 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 I Richmond, Town of 026- 1172 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: C l' • Z 36.30.18.1365 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 . Benchmark Dosing O QD owe 4 � ` f G - qJ F Sewer / J ' S cam/ , Holding / St/Ht Inlet b St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L J WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 10z' 7 ,2 7 7 ' -7 I _ Dt Bottom 15 74 Dosing ) � � Header /Man. a z� z� Z `7 Aeration Dist. Pipe Holding Bot. System q(o , 3,4 PUMP /SIPHON INFORMATION Final Grade � 4 7 3 2 5 Manufacturer GPM nd St C �r . 0� (` ZS �ov Model Number ,10c%,-- , j' �� b �� J . D TDH Lift Friction Loss System Head TDH Ft /3.OZ . 4 Forcemain Length i Dia. it I Dist.toWell SOIL ABSORPTION SYSTEM BED/TRENCH Width ! Length ) No. 0 Trerye}�es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS l 7 9 ` SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. .` INFORMATION e Of S CHAMBER OR Type Yy§� I G �i / , //A . UNIT Model Number. DISTRIBUTION SYSTEM /va Header /Manifold ' it Distribution 43-3 )J x Hole Size G I x Hole Spacing Vent to Air Intake /L Pip s P g O �'� V cd G e 1 1-ength � ' `' � Dia S acin SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched BedlTrench Center ' Bed/Trench Edges Topsoil ` es [] No Yes [�� No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 7 / 7-7 6 S In pection #2: (E — 7, Location: 1282 138th S treet New ichmond, I�-5-,4017 (NE 1/4 NE 1/4 1/4 36 T30N RI 8W) Sunset Hollow low L Lot 4 Parcel No: 36.30.18.1365 An 1.) Alt BM Description = °F' �v a'r` �� " J (� 2.) Bldg sewer length = Z`) f - amount of cover Plan revision Required? I Yes o Use other side for additional informat' Date msepct. ignat Cart. No. SBD -6710 (R.3/97) S89 5"E 288.24' q z o "~ nument of Record ° ni t o ( cn » e oo "Set 1 -1 f4 x 18 Rebar Ln (weighing 4.303 lbs. per linear foot) 0 Found 1" Iron Pipe p C 5 � LOT 3 """ """""" Building Setback Line (100' W e 79,319 sq. ft. e from Right —of —way) I C L 1.82 ocres i' iz Approx. Driveway Location I -� Ir Denotes 12' Utility Easement I I L.B.O. Minimum Elevation of I m S89'49'1 5"E 288.63' Lowest Building Opening 10 V v I H.W.E. 25 —Year High Water Elevation I D 1 0 (24 —hour Storm Event) 1 z (� Z v )QOp, Benchmark — Top of Iron !W G 1 ° Monument as noted CD J LOT 4 : hi I - cr 79, 426 sq. ft. ALL OTHER LOT 0�E 11" x o 18" IRON PIPE , 1.82 acres o 'FOO'T iAFr ` I 3 , N89'49'15 "W— , 289.02' - 128 r= o_ 230.00 . "� ��� �: �ua�• S89041 auvyo'ssT.,; °a 230.00' � ..................... ..................... ¢,w x7Y t d I� ' s I r LOT 14 z rf 121,901 sq. ft. c„ o Vj q b p " o r 2.80 ocres o W �1 , o �,, o� L.B.O. -99B0 C LOT ` 35' � 121,901 s 2.80 oc Drainage Casement H. W.E. = 8 I 994.0' . S8 4 9 9 1 230.00' 230.00 N89'41 993.67 I LOT 2 C.S.M. I CURVE TABLE Safety and Buildings Division County ME Nvi m 201 W. Washington "., P,0. Box 7162 St. Croix C O� ,� Madison, WI 707 - 71 Sanitary Permit Number (to be filled in by Co.) Department of Co mmerce (608) 2613.3151 7 c; Z !1 C Sanitary Permit Application C' e Plan I.D. Number / Z q z In accord with Comm 83.21, Wis. Adm. Code, personal information you p vide �� T f` may be used for secondary purposes Privacy Law, s15.04(lxm)V/�/ Proje&Wddre 7 318th r ent than mailing address) I. Application Information — Please Print All Information iy> /� Street Property Owner's Name / FF ' �aTCel # Lot # Block # J Todd Marek C 4 Property Owner's Mailing Address Pro Location � P. O. Box 228 NE ,� NE 1 /4, Section 35 City, State Zip Code Phone Number New Richmond, WI 54017 30 1 g(circle one) T N; R r � II. Type of Building (check all that apply) a �` D S�r/ Subdivision Name CSM Number 1 or 2 Family Dwelling —Number of Bedrooms 4 Public /Commercial — Describe Use Sunset Hollow / r � ❑ State Owned — Describe Use s f ° �.t' to �_ 6� C erW� rJr [ bCity ❑village Brownship of Richmond III. Type of Permit: (Check only one box on line A. Complete line B if applicable) — — A. ❑' New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl r ❑ Non — Pressurized In - Ground ❑ Mound > 24 in. of suitable soil © 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 Cl Gravel -less Pipe ❑ Other (explain) / V. Dispersal/Treat ent Area Information: r Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R 'red (sf) Dispersal Area Propo System Elevation 600 0.6 600 �� 600 j 96.50' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing /) I Tanks Tanks f Septic or Holding Tank 1200 1200 1 Wieser x Aerobic Treatment Unit I Dosing Chamber 800 1 1800 11 1 Wieser x VII. Responsibility Statement- I, the undersigned, assume re;ponsilolity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum s Signature MP/MPRS Number Business Phone Number Roger Nelson MP226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip C 122 East Summit Avenue Ellsworth, WI 54011 VIII. oun /De artment Use Onl Approved ❑ Di a Sanitary Permit Fee (includes Groundwater Date su Issuing ent Signa e o S Surcharge Fee) � -7 C ❑Owne Reasonfor C' Denial �J IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3 J RJA1 - MJS�'5' ' L at.a�. „ns� r•c� t. Septic tank, effluent filter and AC Vfo�e - o� ✓�_ dispersal cell must all be services / maintained as per management plan provided by plumber. I - � t 2. AN setback requirements must be maintained y) G pv� 1'c� 1 a ✓< S i n S�G,e . �r C. e. 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) s Todd Marek P.O. Box 228 New Richmond, WI 54017 NE 4, NE 4, S35,T34N,R18W 1 Sunset Hollow Lot # 4 Richmond Township St. Croix County Scale 1 " = 40' Weiser 12001800 tank BM #1= 100.00' top of steel fence post BM #2 = 95.20' top of survey iron 100' of 2 "force main y 9 Q• r L 17 o�..T r v �. ' 0 0 4 �G�iIYlM1 4. t YOU U B u n 3 Dr.U c.Ja � 0 Eve't Page 8 of 8 I -C Todd Marek P.O. Box 228 New Richmond, WI 54017 NE %,NE%, S35, T30N,R18W 1 • Sunset Hollow Lot # 4 Richmond Township St. Croix County Scale 1 " = 40' Weiser 12001800 tank BM #1 = 100.00' top of steel fence post BM #2 = 95.20' top of survey iron 100' of 2 "force main M +I-2 Lot 3 ' L o t �l d si-0,14= ys *a 6 J v` 2„ r ' 00 �1 �/ousc i J � U � 3 Or.'ve �✓ � O wEt1, i Page 8of8 Ale., K c Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.w www.coe.wi.gov/s isco n sin.go / Department of Commerce iscosin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 02 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: 06/02/2007 Identification Numbers Transaction ID No. 1142932 SITE: Site ID No. 699441 Marek Lot 4 Please refer to both identification numbers, 138TH Street above, in all correspondence with the agency. Town of Richmond St Croix County NE1 /4, NE1 /4, S35, T30N, R18W Lot: 4, Subdivision: Sunset Hollow FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1021523 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Cla , d stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Approval Requirements: ON OF f F 1 e • This system is to be constructed and located to accordance with the enclosed approved plans an d with the - "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) SEE COR RI and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (0 1/8 1) • 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 i ROGER D NELSON Page 2 6/2/2005 • 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. i Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 e4 e 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@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 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: 138th Street Legal Description: NE 114, NE 1/4, S 35, T 30, N R 18 W Township: Richmond County: St. Croix Subdivision Name: Sunset Hollow Lot Number: 4 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings PF( Page 4 Lateral and dose tank Page 5 System maintenance specifications '• syri 3 1 2005 Page 6 Management and contingency plan Page 7 Pump curve and specifications S AFETY & BU' LDINGS Page 8 Plot Plan f EY 4 C O'VATRCC � JI ACS ozw��.wc Designer: Roger Nelson License Number: MP 226497 Date: 05/26/05 Phone Number: 715 - 273 -4444 Signature: Alo �/a L1 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04103) Pagel 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) 10.00 Site Slope ( %) 95.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 67.001 Dispersal Cell Length Along Contour (ft) = 8.96 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 2.99 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimated Orifice Spacing (ft) = 11.77 ft /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 78.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 18.17 Vertical Lift (ft) 40.03 5x Void Volume (gal) 1.00 Friction Loss (ft) 56.34 Minimum Dose Volume (gal) O 25.67 Total Dynamic Head (ft) 21.01 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in dia. options choice U 0.75 1.25 x 1.00 x x 1.50 x x 1.25 x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 IManufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) JZabel 1-800-221-574:fl Filter Manufacturer 22.241 Dose Tank Volume (gal /in) IA100 I Filter Model Number Weiser = Manufacturer Project: Todd Marek 4 bedroom Mound system Page 2 of 8 Mound Plan View t 1/106: ::0; J Observation Pipe — .......,... . . . . . . . . .'.'. K. � ,. . ti ,.,,. • ,,,,,,,,,,,,, ti•ti , ti , ti ,.,..,,., ... . W .B . . . . . . . - r . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L Mound Component Dimensions A 8.96 ft E 28.75 in H 1.00 ft K Aft ft B 67.00 ft F 9.00 in z 15.63 ft L ft D 18.00 in G 0.50 ft J 6.35 ft W 600.32 (ft Dispersal Cell Area 1647.24 (ft Basal Area Available 8.96 (gpd /ft) Linear Loading Rate 6.70 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.25 (ft) G H Er:rrrr err 2::rrrrr�,. rr. �rrr :r::r:::rJTJ'rrr::rrr�+rrrrr.. _ ..... ..... F : Dispersal Cell 97.00 (ft) La teral 96.50 (ft) —► — Invert Dispersal Cell :: 3 t Elevation E . ::::::::::::: D :.:. . • • .:.:.: .... .: . :•:•:•. 4 4 95.00 (ft) Contour Elevation 10.0 % Site Slope Geotextile Fabric Cover Shading Key o. Dispersal Cell See lateral details on 1❑ _ Topsoil Cap c Q- 1.5 ft ti•ti••.•ti••.•ti•ti• •ti•ti• Page 4 for number, size, Subsoil Cap 0 5 r �f; �r and spacing of laterals. ©0 ASTM C33 Sand 1° r __ r�.�• Laterals are equally Tilled Layer d 0.5 ft Typical Lateral tii'•: spaced from the • ��f•• r•• r•� �r•f•• distribution cell's �5 r•:•:., Aggregate c :•::•....:•:.:.:;:•:.: • centerline in the 0 A * distribution cell (AxB). Project: Todd Marek 4 bedroom Mound system Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •= Turn -up vWball valve or oleanoutplug e P ' All laterals are identical IE X _4I Holes drilled on the bottom of the lateral equallg spaced S Laterals & Force main of PVC Sch 40 S (per COMM Table 84.30 -5) Force main connection via tee or cross 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) 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 25.67 ft Forcemain Velocity 2.15 fUsec Dose Tank Information Locking 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 _ 2 in. Cap acityl 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.44 476.78 B 2.00 44.48 C P ump off elevation (ft) C 2.53 56.34 � 78.83 D 10.00 222.40 D Total 35.971 800.00 J Do se tank elevation 8. 3" Bedding un er tank. 78.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer G uld Pump Model Number P Pump Must Deliver 21.01 gpm at 25.67 ft TDH Project: Todd Marek 4 bedroom Mound system Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name I nstalled by Nelson Plumbing Phone 715 - 273 -4444 POWTS Regulator's Name St. Croix County Zoning I Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600.32 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mounidl Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade 6 -8" Diameter Lawn • • Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Todd Marek 4 bedroom Mound system Page 5 of 8 I Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01181)] 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 effective 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, Stats. 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter 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. Continuency 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 � PUMPS Submersible Effluent Pump PE SPECIFICATIONS MOTOR FEATURES Pump — General: General: a Corrosion resistant • Discharge: 1 NPT • Single phase construction. • Temperature: 104 (4M • 60 Hertz ■ Cast Iron body. maximum, continuous when • 115 volts • Thermoplastic impeller and fully submerged. • Buift -in then overbad pro- cover, • Solids handling: '/" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ba;l bearing APPLICATIONS • Automatic models include a • OiWilled design. construction. float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual modeis available. shaft. lubricated for extended fotlowing uses; •Pumping range; see service life. PE31 Motor: • Mound Systems performance &.art or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capadty: 50 GPM • Shaded pole design ■ AN ratings are within the • Basement Draining Maximum head: 25' TDH worldng limits of the motor. 9 PE41 Motor • Heavy Duty Sumps P>c41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 6o GPM • 7.5 Maximum amps cord, 20' standard length, • Maximum head: 29' TDH • PSC design heavy duty 1613 S1TW with NEMA 5 -15P, three prong, PES1 Pump: PE51 Motor. 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. METERS FEET • PSC design ■ Mechanical seal is carbon, 40 ---- ceramic, BONA and stainless MODELS: PE31, PEW. PESt steel. i { 3s �+h .33 A5,— ■ Stainless steel fasteners. x 7. 10 - d - -► � 1 F7 2 GPM cX s• 4 7 _ T j = 25 ,-,- CM us +J Tested to UL 778 and 0 221108 Siandlardll; 15 t t - �' ' - - h J. ••r••.F..� ByGfl�lill S ICIDII011 H F .. -.1 + - . 10 r ,.._r f ? . GOWN Pumps is ISO 9001 Regkoer�d 00 10 ` 2 30 40 50 60 ' 70 GPM 80 // 0 5 10 is rn GOIjICIS Qtlfll}75 2 / • O 1 UAACITY 0 2002 GOU14ds Pumps �+ P� Effective SPE31/4 1 V1l November, 2002 t7 <& ITT Industries i BPE31 J4 F RECEIVE T ) W isconsin Department of Comme L O N REPORT Page of Division of Safety and Buildings r 10 i In accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on pa >er noEii"iA 4i'� 5� Y inches n size. Plan must include, but not limited to: verti I and hdtI260frt&r point (BM), direction and Parcel I.D. percent slope, scale or dimensio w, an ocatlon and distance to nearest road. 72 O Q� Please print all information. Review y Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). Q Property Owner � { � � Property Location Govt. Lot 114 1 /4 S T sa N R E (o LW Property Own Mailing Address Lot # Block # Sutxi. Name or CSM# ) f- d, ,St�C 7-Z-'7 rlo��� City to Zip Code Phone Number ❑ City C3 Village Town Nearest Road ew Construction Use: Residential / Number of bedrooms Code derived design flow rate l GPD ❑ Replacement Public or c:ommer Describe: Parent material / �%in. ? Flood Plain elevation if applicable General comments and recommendations: Boring M ng # pit Ground surface elev. `� ' Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOIN In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 / © Boring # Boring Pit Ground surface elev.� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. C ont. Color Gr Sz. Sh. 'Eff#1 'Eff#2 1 -z �- - 7 • Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Si Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 715- 246 -4516 I Property Owner _ Parcel ID # Page of Boring Boring # it Ground surface elev. � 17 Depth to limiting factor i� 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 C — 1 D 3 3 1 1— --�— ..� ,� . li 0 b- ,3 !/ 'n'// /�4 , a Boring # Boring ❑ ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont Color Gr. Sz` Sh. 'Eff #1 I 'Eff#2 E Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtfF 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. I SB"330 (rt.6=) I I v f Soil Test Plot Plan Project Name Todd Marek Sha it Address P.O. Box 228 New Richmond Wi 54017 #226900 Lot 4 Subdivision Sunset Hollow Date 10/29/04 NE 1/4 NE 1 /4S 35 T 30 N /R W Township Richmond Boring Q Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation *HRPSame as Benchmark Alt Benchmark Top of Survey Iron @ 95.2' 289' Property Line 5 B.M. B -1 90' 5' Scale is 1" = 40' 40' 95' unless otherwise 10% noted Slope 45' -3 93' 96' 275' Property Line 138th St. Jun 09 05 05:16p Todd Marek 17152469341 p.1 06/09/2005 10:35 FAX 715 273 0444 NELSON - PLUMBING oo� /vut ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND � yf OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address d gz>x 2z g A) e L,J r. 0 G✓�' S� Property Address ( Verification required from Planning Department for new construction) - City /State Parcel Identification Number LEGAL DESCRIPTION o � z / � 02 //7Z -- 0 - rxb Property Location � ' /,, �'h, Sec. S T C �1 -R a W, Town of Subdivision � n S P j //0 lJ , Lot #. Certified Survey Map # . Volume . , Page # Warranty Deed # — 7 72 .3 Volume -z Page # Spec house yes D no Lot lines identifiable Ayes O no SYSTEM MAINTENANCE Improper use and maintenauccof your septic system could result in its premature failure to handle wastes. Proper maintenancx; consists of pumping out the septic tank every three years or sooner, if needed by a licensed pamper. What you put into the system 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 a master plumber, journeyman plumber, restricted plumber or a licensed pumperverifying 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 standard: 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 Zoning Office within 30 da s of, three ea expiration date. / ZY�Z SIGNATURE OF APPLICANT DATE OWNER CERT)<'FICATION 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 pro erty desc i ed above, by virtue of a warranty deed recorded in Register of Deeds Office. / /OS SIGNATURE OF APPLICANT DATE *• "r« 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 ncc warranty deed 2640t 621 772135 WALSH 1 l STATE BAR OF WISCONSIN FORM 2 - 1999 REGIST R H. OF DEEDS REGISTEEDS Document Number WARRANTY DEED ST. CROIX CO.. WI RECEIVED FOR RECORD This Deed, made between RJC Development, Inc.. 08/19/2004 10:30A11 Grantor, WARRANTY DEED and Todd Marek. EXEMPT # 3 Grantee. 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: (if more space is needed, please attach addendum): COPY FEE: CC FEE. Lots 2, 3, 4, 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 026- 1099 -10- 000: 026 - 1499 -60-M 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 1 2004 q� 1 * * AUTHENTICATION CKNOWLEDGMENT Signature(s) _ STATE OF ) — — ) ss. County ) authenticated this day of .�, eC Personally came before me this y of P S,r August 2004 the above named �gC Todd Mamk, * 0 _ TITLE: MEMBER STATE BAR OF WI§MNSIN (If not, _ to me own to be the person(s) executed the foregoing authorized by § 706.06, Wis. Slats.) instru n a d ackno edge me. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, W I 54016 Notary Public, Stite of MY Commission is per anent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 1 Z —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 600-655 -2021 WARRANTY DEED FORM No. 2 -1999 Parcel.#: 026- 1172 -04 -000 06/13/2005 08:20 AM PA 1 OF 1 Alt. Parcel #: 35.30.18.1365 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/27/2004 00 0 Tax Address: Owner(s): * = Current Owner * MAREK, TODD TODD MAREK PO BOX 228 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1282 138TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.820 Plat: 10/02- SUNSET HOLLOW 026/04 LOTS 1/17 SEC 35 T30N R18W PT NE NE BEING SUNSET Block/Condo Bldg: LOT 04 HOLLOW ('04) LOT 4 (1.820AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 35- 30N -18W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 08/19/2004 772135 2640/621 WD 01/16/2004 751924 2493/129 WD 10/2912003 745128 17/4640 GSM 07/18/2003 730816 2319/598 TD more... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/11/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED 1373 Wisconsin Department of Co erceN O V 1 3 2003 S L EVALUATION REPORT P age 1 of 3 Division of Safety and Buildin i a r wit Comm 85, Wis. Adm. Code Steel Soil Service ST. CROi3C � County Attach complete site plan n paper WWRGafift Q�inches ' ,size. Plan must St. Croix include, but not limited to: re rence pomt (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Pending Please print all infonnation, eviewe y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). g D 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 " 4 na I Sunset Hollow City State Zip Code Phone Number J City J Village 16 Town Nearest Road Somerset I WI 1 54025 1 651 - 488 - 3051 Richmond 1 130Th Ave 16 New Construction Use: sM Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe na Parent material Benches and large drainageways of ground moraines. Flood plain elevation, if applicable na General comments n l' l and recommendations: Mound design, system elevation ft based on contour line elevation 97.60 ft. Minimum 1 /of ASTM C33 sand. .� cr u�-4 >3 -� 1 r'M , ;7� -��oY Ca„ t� a t�da- 0"-- to Boring # J Boring 16 Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 00 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 2 10 -24 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 24 -48 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 48 -100 10yr4/4 none sl 2msbk mfr na na .5 .9 Fil Boring # Boring f Pit Ground Surface elev. 98.60 ft. Depth to limiting factor 43 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -11 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 11 -26 10yr4/4 none sicl 2msbk dfr gw lvf .4 .6 3 26-43 7.5yr4/4 none sl 2msbk dfr gw na .5 .9 4 43-60 7.5yr4/4 none sl /scl om mfr na na .0 .0 F * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L " Effluent #2 = BOD S30 mg /L and TSS s30 mg/L CST Name (Please Print) �— Signature CST Number David J. Steel / 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 11/10/2003 715- 246 -5085 Property Owner R.J.C. Development, Inc. Parcel ID # Pending Page 2 of 3 ] Boring # J Boring 1+' Pit Ground Surface elev. 95.80 ft. Depth to limiting factor — 43 — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 10 -27 10yr4/4 none sicl 2msbk dfr gw 1vf .4 .6 3 27-43 7.5yr4/4 none sicl 2msbk dfr gw na .4 .6 4 43 -96 7.5yr4/4 c2d7.5yr5/6 WIN om mfr na na .0 .0 F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # J Boring I 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 Lic. #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 4 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. 99.9017t Top of 1/2" pvc pipe ❑ = Borings Boring Elevations B 1 = 99.60Ft B2 = 9 .6017t B3 = 9 .80Ft B4 = OOFt q7' BZ 8/ C l i • g S, �D�i� �/� 'SAarb �/1 h�•4- z 280 \ �►. �� „� - O I = \ �� w 71,002 sq. ft. 10 °o `\ 1.63 ' acres `\ \ N -79,060 sq. ft. � ' N l / r 275 / X 1.81 acres i / - ( ;SLOT 7 ° o 1 288' Iry - r - 74,251 sq. ft. 1.70 acres \ \ \ 275' \ \ O N \79, 319 sq. ft. , I + \ 190 \ \ \\ °�-° �\ `1.82 acres \ 1 \\ Nl N, - 8 __ _ h -_ SOT 9 ;� _ — - - • 78, 851 sq. ft._ `� _ 78,851 sq. i 1..81 acres , 1.81 acres .,LOS", - _ 79, sq. _ft. r / ------ - - - -•- /-1.82 acres' ------- - - - --- - --- _ --- - - - - -- 289'x- Li 33'33' L,- - l9w --- 190' / • �- / / X 322' \ \ ( - - - 646' - - D - - 9sa 128TH -- -A l �' ~' 230 '230' 230' Cn 0CA K m0 v o �, = d o G 3 � � _ T (n x z to z O A ;CJ W O • P,r N O C 0 V pJ n N _ O 3 (,,J ? � � O { m m ' x, o o N C N ro N 3 N —I C W N O' n o a ^t o CL 00 n S CD F En 3 v, o C CA G N CO N d N z D D > a coo OV 3 N cn i�3 CD CD 0 0 N p G 0 �E 0 „ c y In fn f/J o_ ovo� � e� N N 0 z N 0 N cQ y ~ A � V N D D o o _O o � � N 1V CL CL cn CD C O1 C L m � - 0 3 N CD Q Z 3 N � N .. � y co Z — q co W m W cn (D m o z a 3 A O " z w 3 m � N N A A � D a 0 CL m S' o C z O 3 c O" a � W N o' v o CD o 0 CL t Qz m 4J � V .j `J 1 O LN 0 ^ CD < z o O tv CD � C)