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HomeMy WebLinkAbout026-1139-03-000 +,Jconsiri Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514918 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 R. I Richmond, Town of 026- 1139 -03 -000 CST BM Elev: Insp. BM Elev: escription: Section/Town /Range /Map No: r app ,6r11 G - r 36.30.18.998 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURERS CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1 66 6 / od Dosing Alt. B Gb�bo P� Say �•� Goa�,�, 3. /aj �� Aerakron ` la � � Bldg. Sewer �� ^ � • �` r; `1 .J Holding I SUHt Inlet 7 , sz 5 • p4 TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet Septic � 7146 Dt Bottom Dosing ' !� 714 I 2.7 7 I _ Header /Man. 7 ,O Aeration Dist. Pipe 4:5 9� 7 7, 75 Holding Bot. System • 9 Final Grade PUMP /SIPHON INFORMATION • 17 Manufacturer / e L .0s G Pm f �and St Cover _ 2 • � /a /' 6 Model Number PE At l 51 TDH Lift Friction Loss System He d TDH Ft $ q 5.710 2 . �it�" Forcemain Length Dia. Z // Dist. to Well toy 1- J Y SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Tres PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /60 3 ' ( %-- 1 --- 1-- 1__% SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer 47 ,` INFORMATION Type Of System: �1 � CHAMBER OR ll i G pl�vQw�•bh 5^T 5 �� /�� UNIT Model Number: �JI DISTRIBUTION SYSTEM Q by j 4L Z6 -Z64- 25 z 75 Header /Manifold istribution x Hole Size x Hole Spacing Vent to r In e P u Pipes) `. . `�� 3. Ia.w. LD ia T Length Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ., Depth Over / Depth Over j xx Depth of xx Seeded /Sodded xx Mulch Bed/Trench Center Bed/Trench Edges `� Topsoil �.� Yes E] No Yes 0 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1269 140th Street New Richmond, WI 54017 (SW 114 NW 1/4 36 T30N R18W) TT;orey Pines Lot 3 Parc No: 36.30.18.998 1.) Alt BM Description= �'' 1�•t� ��� +" ► J� w 2.) Bldg sewer length 1 - amount of cover = I/ L--J e fe,,45 -- - -- - - $ Z7 -- - Use revis Re q u ired? s de for add tional information. o SBD -6710 (R.3/97) Date Insepctor' Signatu Cert. No. " commerce.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 l K ] Madison, WI 53707 -7162 Sanitary Permit Number (to a filled in by Co.) s consin rit of Caanmeros �� Sanitary Permit Applicatio State. Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropr me O a' / - b 4 unit is required prior to obtaining a sanitary permit. Note: Application forms -owned PO roject Address (if different than ailing address) submitted to the Department of Commerce. Personal information you provide may be u econda r �� p urposes in accordance with the Privacy Law, s. 15.04 l m , Slats. Q , 1. Application Information - Please Print All Informatio Property Owner' Name RECEIV Parcel # b'D d Z - l - 4 - � - c - o Property ner's Mailing AdcTress JUN 2 5 2008 Property Location / ��� Govt. Lot City, Stale ^ 1 Zip Code ft OTOUNTY Section ,V (circle one T N; R1Eo(q II. Type of Building (check all that apply) Lot # _.. _ d_iyiiiQn Natne I or 2 Family Dwelling- Number of Bedrooms _ ...__ .. 5� I- ❑ Public/Commercial - Describe Us Block ❑ City of CSM N ❑ State Owned - Describe Use umber ❑ Village of 3 6;4c.416 c�J 15�'L5+"Z �- Town �� Ill. Type of Permit: (Check o ly one box on line A. Complete line B if applicable) A. XNew System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem /Coin onent/Device: Check all that appl 0-jNon- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank Other mspersal Component (explain) ❑ Pretreatment Device (explain) V. DispersahTreatipent Area Information: f Design Flow(gpd)4 Design Soil App licatio Rate( sf) Dispersal Area (s0 le spe I roposed System Elevation , ✓/ `/ 7S" tW /C/f 96 VI. Tank Info Capacity in Total # of ufacturer w Gallons Gallons Units v o _ New Tanks Existing Tanks " Septic or Holding Tank t ZA/ l Dosing Chamber ,wry ! 1 VII. Responsibility Statement- I, the undersigned, assume r esponslbility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /NH4&Number Business Phone Number ,cJ z6 �� Y" plumber's A06ress (Street, City, State, Zip Code) VIII-County/Department Use Onl Approved ❑ isapprovmxi Permit Fee Date ued Issuing ent Signatur caner Giv eason for Denm [S � 51) - 1 IX. Conditig easons for Disapproval 1. Sept tank, cellfthtent G must all be stmtrvlces! maMitaNtlad �� P��� � �c� � $s per management plan pmvidsd by per• t'7:► (� jyt,3 j 1 et I 5O a S 2, AN ntbaak ft**e Menu must be nglktt*W o refFon system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 - j 1 � t .., ,.. . �,�arrigl11t6T J`.. (14 . � k k - - _ -. � .�fin��l)�'' S td �'i5af,: � "�r =; ": ',`a t' iY� i:b OM +e'�'3�6rn vti k , ., :tr�..ry,o �u �� .��e�t5z ;;C �+ .� I rra-9C-1K A, 4Z ki Iv� LCD VA, t ps �plj t v ECOPY p ID lo ok 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85 „Wis. Adm. Code County r �` Attach complete site plan on paper not less than 81/2 x 11 inches in size. P mu `f include, but not limited to: vertical and horizontal reference BM recti an Parcel I.D. Pe 9►Z/ _ /��C� O 2� rcent slope, scale or dimensions north arrow, and location ad. , Please print all information. rd b Date Personal information you provide may be used for seconds .04 (1) m)). I V Property Owner roperty l- cation -7 o �� A. Lot (,J 1/4 /4 S G T (� N R �E (or Prope Owner's Mailing Address # I Er# I Subd. Name or CSM# D, ,% o r City State Zip Code Phon = F I City El Village Nearest Road Ip tt v �� a1 5 ( i G fK 9 S New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable 1y114 ft. Genl and era on rec ommendations: -r:7 °K �/ /-, 4 ��7 S' rn 3° /eui�/ JZ� A l System Type eO iLL/P�d� System Elevation F 7 1 Boring # El 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. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 4 9 3 tt Fa-1 ❑Boring Boring # Pit Ground surface elev. ! ft. Depth to limiting factor — i'-w'= 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 L s i. 1 L L' s A- 4 - -, r Effluent #1 = BOD > 30 < 220 mg/L A TSS 30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - - CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ��� d — 715- 246 -4516 I Property Owner _ Parcel ID # Page of � Boring # ❑ Bonng /) F Pit Ground surface elev.. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7j S rY1 N l ti Z le 1 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 E Boring # Boring Cl Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I '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. sBD -Salo (R.W00) ` S 4 Property Owner _ Parcel ID # Page of ❑ Boring 91 51 2 Boring # j /J�� v Pit Ground surface elev. � 'ft. Depth to limiting factor / y y 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 - 13 49 3 1-z 2y_1 Y 2- 13 C < / 1 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 I •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' - ♦ Effluent #1 - BOD > 30 < 220 mglL and TSS >30 < 150 mglL Effluent #2 - - BOD < 30 mgll and TSS _< 30 mglL 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. SOD3330 (8.6/00) a Soil Test Plot Plan Project Name Todd Marek Sha . ird Address P.O. Box 228 ;' New Richmond Wi 54017 M #226900 Lot 3 Subdivision Torey Pines Date 6/20/08 S W 1/4 N W 1/4S 36 T 30 N/R 1 8 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" Pipe System Elevation 97.0/96.7/96.4 *HRpSameasBenchmark Property Line Scale is 1" = 40' unless otherwise noted 70' Pockets of US found in 3rd Install system upslope as horizon, no massive sl found in much as possible! 3rd horizon, B -2 B -1 60' 35' Pro 4 102' 100' Bedroom 20' ,� 140th St. B.M. House 101' ' 50' B -3 100' 5% Slope Do 63E�59S F' <e �� X06, �1 _.�_ 1Y.11RE.eoY '.NRTAIIL�.id -n•. ""' lgY.4LLR M ". �....- MMWM.t TOR:�itM�S' t_ OY t �rawraatl 1 frx fi [ ° wrBW.rOWrY(7FD.8T. Y. �a I . J.'t�11LMt1 -. RNPAM : fE%s5ll ft - u�tttltYarllctl Ma1p�oA.tiq l�zlFNa' f 1 ttav ArmMt h 1 r Mlee�elf M YWIN/I/IItlD Rillt °3s . +Rrem. 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( p1"�IIEN fEt IR t�C x09Af iT7:OW tpf 6Gff ••• M pIIRA4 NYI ax 0" InResn•wnra *t next t3 ui[ ,III � �'"fY y�d,.�L {frr, i11� _ :1NnilNrtMl�Vndnp 1t'I�I ?�� F tMLYMf41if i7n4Wf Ynt�q�r °y,`. t. ^TF ' Tra COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must extend to a point no greater must extend at least than 6" Below Finished 4Gra/de 4' Above Finished G ade Cover with IYvgA'lF� �K GI�F y � —qla � 10 Locking Device T b �, J'64y PP�'� CH (typical) Finished Grade t DUI LU //vIr r �... Saw � Min. 23" > 3b Pr >4y ' Access Opening i O P— LAS lm Min. 23" Access Opening Ouh:t Effluent Filter W /TH �'o✓C Union �,2cYEA /O6 3 Pr. Inlet Baffle i21�'1 p/�%Ta SOS /a S`O /C� i P p t� 3 ,Sar►d o r ra vr. w i;�h c!en�er 2 •• /outer y�iah QdyPs Two Compartment Septic/Pump Tank C 4 o * r u on ov�side GC IBS) SPECIFICATIONS TANK MFR: DOSES PER DAY: TANK SIZE: SEPTIC ZV GAL. DOSE VOLUME: l �`t Z GAL. DOSE O - D GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: A'2CW - t! CAPACITIES: A = 2.,3, 3NCHES = GAL. MODEL # Switch type: rOA-+ B = 2 ^ INCHES = V GAL. PUMP MFR: _� L� C = INCHES= GAL. MODEL M Lz SWITCH TYPE: D = INCHES = Z 3. b GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ ! FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + 0 FT. 2 O FT. OF FORCEMAIN x _�FT. /100 FT. FRICTION FACTOR ...... _ + FT. TOTAL DYNAMIC HEAD (TDH = FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPTH MP/MPRS SIGNATURE: LICENSE NUMBER: APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 'HGOULDS PUMPS Submersible Effluent Pump PE ENLUpT pUMP SPECIFICATIONS MOTOR FEATURES Pump — General; General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104 °F (40 • 60 Hertz ■ Cast iron body. maximum, continuous when ' 115 and 230 volts a Thermoplastic impeller and fully submerged. • Built -in thermal overload pro - cover. • Solids handling: t /2" tection with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing APPLI • Automatic models include a • 011-filled design construction. float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available, shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the f • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. \ • Heavy Duty Sump/ PE41 Pump: • •40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design heavy duty 16/3 SJTW with PE51 Pump: PE51 Motor. 115 or 230 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact. METERS FEET ' PSC design ■ Mechanical seal is carbon, 40 i r - I ^� _ ceramic, BUNA and stainless PE51 I I I I - I I MODELS: PE31, PE41, PE51 steel, 35 _ I I I ! I III HR. •33• •40. so ■ Stainless steel fasteners. p _ I -► 2 GPM I I ; i ' I AGENCY LISTING 30 , e4tl - i S 1 FT ! i 25 Ck v c 20 Tested to UL 7 I 78 and CSA 222108 standards By Canadian Standards AZedation !! i r I i I. I. I . :i_. I. i r- t- , I I r I File #L 3859 II !I • 1 i i I I i I I I I I' G0LI1d9 PWPS is ISO 9001 Registered• L , �. o oil 0 10 20 ' 30 40 50 60 70 80 GPM 0 5 10 15 m Goulds P umps ® 2004 iTr Water Technology. Inc. CAPACITY Effective BP 31 /41 ,une' 2004 ITT Industries r 4,?��G� 4 r C 0 ,n1 �y STANDARD CHAMBER 52" Quick4 Standard Chamber 46" (EFFECTIVE LENGTH) E) 12" 6" I 34" SIDE VIEW SECTION VIEW MultiPort End Cap P 16". 12" -34' SIDE VIEW T P VIEW / 0/d / FRONT VIEW ^ Z r7 NC. STANDARD LIMITE I la) in of chamber, and plate, wedge and other arxxescy manufactured by Infi ( "Unsus "), when hatafed and operated In of en In armrdence with IrMltrator's InstnwYbns, Is warranted to the original purchaser rFkkWI agai defective 5 �� the date at the septic permit IS iaeued for the Septic system Containing th te UMlts: provided. h, that M a septic Perm w rat rcpt red by applicable law, the warranty period will begin upon the date that Installation of the septic system carmreraes. To exercise its warranty rights, Fickler must notify Infiltrator In writing at kit Corporate Headquarters In Old Saybrook, Connecticut bill Wn fifteen (15) days of the alleged defect. Inlitret« wit supply replacement Units for Units determined by Infiltrator to be coAmed by this Limited Warranty. . • Infiltrators liability specifically excludes the coat of removal and or Installation of the units. O (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRAI MES WITH RESPECT a To THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR ETINESS FOR A PARTCULAR PURPOSE. SYSTEMS INC (c) This Limited Warranty shell be void a any part of the chamber system is manufactured by anyone other then mraw.. The united Warranty dose not extend to ncid1K" caeegLrsntial, apeclel or k dkect demhagee. Infiltrator shelf not be fable for peneltlea or iquldated damages, Including loss of Sir ivi GlUflellta Onalte Wastmtw SolWomr pmduotlan and proft labor end metedels, wednead costs, «other losM or expenses incurred by the Holder or any third party. Spedficeiy the Units the exclude #= being ,meted to sae � or other Eldon `, am not p � Inatai Lw�' . i'� to the 6 Business Park Road • P.O. Box 768 mlwrxm grand covers eat form in t h e Installation Instructions; are plawhent of inpoper materials No the system conteInIng th unite; fawn, Of Old Saybrook, CT 06475 the Units or tha septic system due to Improper ailing or Improper siting, excessive water usage, Improper grease dispowt, or hum ern operation; « warran any other event not carread by Infiltrator This Limited Whinny well be Vold If the Folder fella to carob with al of Me tee ad forth In alit lilted 860 577 - 7000 •FAX 860 - 577 - 7001 Further, In no event Shell Infiltrator be responsible for any low or carnage to the Fickler, the Units, or a third party resulting from Installation or ship. p A ment, «from any product lability aama of Hodar «any thm pang•. F« Ws Lnritau warranty b aptly, the Units must be Installed n acco dame 800 - 221 - 4436 With al site conditions required by state and acel oocea: all otihar appllcade Iewe; end Intlllretarb Installation Instructions. (d) No representative of Infiltrator has tie authority to change or extend this Linked Wartany. No womanly apples to any party other Men the origl- naf Holder. The above represents tis Standard United Warranty offered by Indicator. A Witted number of atatep and oorxdlea heve different werrenly MWM- mems. Any purchaser of Units 90-Ad contact InfiltrO r'e Corporate Headquarters In Old Saybrook, C rMcdc ut, prior to such purchase, to obtain a copy of the applicable warranty, and ahauid carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,611,903; 6,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Skfewrknder are registered trademarks of Infiltrator Systems Inc. Inlghator Is a registered "clernlvk in France. Infiltrator Systems Inc. is a registered trademark in Mexk:o. Contour, Contour Swivel ConnaCllon, Miomtaeohlrg, P*Tuff, SnapLock, ChemberSpecer, POSILOCk, QuickCut, Ouk kPlay "NC1'CLE17 PAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiffrator Systems Inc. Printed in U.SA Q011203HP -0 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — f> o /V 4 D Mailing Address P � X 2 AJ C�l.J lX4 Li Da- to Property Address IL (Verification required from Planmink & Zoning Department for new cons City /State Parcel Identification Number O Z 6 , ; Q 3 0 0 0 LEGAL DESCRIPTION Property Location � 4 J '/, , AJ k/ '/4 , Sec. , T 3 6 N R /gW, Town of C' Q Subdivisio q pot (\ S , Lot #. Certified Survey Map # 47Z9' Volume , Page # Warranty Deed # A! , Volume , Page # Spec house Oe no Lot lines identifiable C") no SYSTEM MAINTENANCE AND OWNER CERTIFICATION ll..// Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 �r %uia 6 /moo SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Numb of Bedrooms Design Flow - Peak (gpd) L v�p Estimated Flow - Average (gpd) v70 Septic Tank Capacity (al) ? Z 01 Soil Absorption Component. Size (ft 1 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) C O 5 Maximum Influent Particle Size (in) 1/8 Maximum BOD (m /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge 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 an 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. 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. i 2 I Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. p Lif_ T PI, 9 (� 7/s- - 414�rj Co Aj C +E 715 6`� 2 I 3 11lllf {!I{I IIIII !{Ill {III{ {1111 {II{ IIl11{ 4111 {I!f 8 6 6 7 1 9 1 State Bar of Wisconsin Form 2 -2003 866719 WARRANTY DEED U V KATHLEEN H. WALSH DocumentNumber Document Name REGISTER OF DEEDS ST. CROIX CO., W1 RECEIVED FOR RECORD 01/04/2008 01:00PM THIS DEED, made between Gregory M. Collins and Erin M. Collins, husband and WARRANTY DEED wife EXEMPT t ( "Grantor," whether one or more), REC FEE: 11.00 and Todd Marek a married Gerson TRANS FEE: 90.00 PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Na1E and Val. Estreen interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is 304 Locust Street needed, please attach addendum): Lot 3, Torey Pines. St. Croix County, Wisconsin Hudson, WI 54016 tFA 026 -1139 -03-000 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 (SEAL) ' Z (SEAL) * *Gregory M. C ins (SEAL) - -�—'^� (SEAL) * *Erin M. Collins AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gregory M. Collins and Erin M. Collins, h usband and wif STATE OF ) authenticated on I ) ss. COUNTY ) *Kristina O land Personally came before me on TITLE: MEMBER STA E BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 Type name below signatures. INFO -PRO"' Legal Fonns 800 -655 -2021 www.infopmfbrms.com 1 of 1 r 1llfgtCOns`Department of Commerce SOIL EVALUATION REPORT Page 1 of -3.. Divisyion of Safety and Buildings i in accordanoe with Comm 85, V& Adm. Code County Attach complete site plan an paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print aM 'infbrnaticlf by Personal Information you provide may be used ror,econQarec s`�s.o4 ( (m)). Gf// K I , 03 Property Owner C` ' y' ' Location ; • _ „, �j t3o�it -L fief 1/4 1/4 S T N R E (or) No t, Property Owner's Mailing Address Lot Block # Subd. Nam or CW City stele M4 Code ax Ydlage QTown Nearest Road cA [A New Construction Use ls� Residential I Numb"of YP Code derived deep flow rate WS GPD ❑ Replacement ❑ Public or commercial - Dee: Parent material Flood Plain elevation if cattle General oarrvnents Sys �'►'� ° l .t. v. 460 9y. oo tow - c" 43. 570 v3 and recommendations 14 r►f• e Z I •c v - p g.sla Low- �r4z.00j3 �,u �� � I ����Crn�,�aw�- r^ or J 3 © Ewng # Pit t r ® Ground surface elev. � arrrtirtg factor �1 d in. Sol App Role Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munson Qu. Sz. Cont Color Gr. Sz. Sh. *rmn I 'E= ma ' ty 3 3� taYry /G L. C' G r ' Z Boring # I Boring 11a Pit Ground surface elev. n- qiQ ft. Depth to Igniting facer in. Son Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EW1 '8f#2 0 to r 3 1 Z /k- r to S: m S Z& 3rnzbe Aiv C / c nsa c�0 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mgL and TfSS < 30 rngill- CST Nam (Please Print) Signature CST Number Address Data Evaluation Condu led Telephone Number ,l, _S S yoz .S 0 -z S -ad 71,S - - z / s Property owner -Id='M 5 i Parcel ID # Ga Page — of F-31 Boring # ❑ Boring Pit Ground surface elev. 9 S (e CS ft. Depth to limiting factor -- y�' -- in. Soil Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color "Eff#1 -811#2 1 0- 5 e5 , o / r S' alaL " i C5 — - 1. S , W, C - . F Boring # F1 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sctl ic"im Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. F g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft? in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 '0102 Effluent #1 = BOO > 30 220 mglL and TSS >30:5 150 mglt. • Effluent #2 = BOO < 30 mgll. and TSS _< 30 mgll 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. SOD4U30 (ROM) r ROM RW C \ `. 1V 3',O 330o-0-4-y- 297' i 0 OT J 2.2 AQ�E� IS2� ACRE i� \ ON RTHE � �- =•- �� � -- -- 297' / 1 j \ LC THE _ , /MIN FIFE / / l \ (2 / � r• I �� = 1011.00 \, 41f ION .4 AC ) 1 \ �� LOT123 p 100' / / ,L .. _ .. �� .. ,. �� L... i . Z .. AC -E (D ,-' STORM WATER �� `� i , p 200 OD ,� RETENTION AREA �� 1 42.0 ACRS) H.W.L. = 1009.0 \� 297 I 1 1 31 T 66' 1 x1005.81 340' • STORM WATER i /� RETENTION AR MIN FFE • i H.W.L. = 1006.0 = 1008.00 / N w W (1.4 ACRES) _ 2. I / /340' PAGE 3 OF NAME 5 LOT# _�> LEGAL DESCRIPTION5W ' /eklu <,S3(oT2 S E (or)(0 SCALE: I "= yd BM I ELEVATION BM I DESCRIPTION r u i A (9 d p: A.,- L,)( j-(a _ BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION ()& r q �.OV Go -, e r Q3 So ALTERNATE ELEVATION UPp• qZ •� k,-u r CONTOUR ELEVATION gl.CQ 94.OU q7, 6c) U O o G u VV o C 9,2 tp I0a q.v SIGNATURE i / = ��� DATE PAGE 3 OF NAME S LOT# -!:> LEGAL DESCRIPTION5W ' /4Uu`J/4,S3(vTag,N,RI S E (or)(0 SCALE: F'= ( a BM 1 ELEVATION C) BM 1 DESCRIPTION h ce , - n (9 a P A L-)I hta �, t' BM 2 ELEVATION ql'q 7 I 3 BM 2 DESCRIPTION fvp o � SYSTEM ELEVATION UPPtr ALTERNATE ELEVATION u -r qZ ,5 D CONTOUR ELEVATION qy.OU ., 94.00 3 GO I d3 a o � Q+a SIGNATURE DATE