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HomeMy WebLinkAbout026-1149-26-000 WiscVnsin Depallment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515179 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- 1149 -26 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: ( ob I) f , !� ��,�/ 1=, P- 36.30.18.1126 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic // f Benchmark v � J �Z Dosing Alt. BM c 2,> i 2 7 Aeration . ; /'? Y PHt g. h" �• �/ . � Holding jI Inlet (.�D r0 •fe jU C St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f / / Septic f . i (`' Dt ttom (.it _ Y lkv t" v 1 • ✓YGct,., -....r Dosing f r-, p7 Header /Man. 5 r , (, 2 d 7 l Aeration : "' Dist. Pipe 1 �k;__ Holding Bot. System 911, ys Final Grade PUMP /SIPHON INFORMATION' t „ ,,.: Manufacturer Demand St over y GPM Model Number lj� •� /5 / I 01-{ I Li C ft , r Friction Loss System. H ad T Ft W r Forcemain Le / Dia. r � Dist. to Weild A l SOIL ABSORPTION SYSTEM R l�e.Cl BED/TRENCH Width / Len t No. Of Trenches PIT DIMEN.SIONS No. O its Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG WE L LAKE /STREAM LEACHIN "a Manufacturer. INFORMATION . ^” C R OR Type Of System r / I /'`�� Model Number: DISTRIBUTION SY EM Header /MarJlif Id Distribution ' f x Hole Size x Hole Spacing ent o Air InIke ,I / 11 Pipe(s)(' (1 Len 9 th Dia Length Dia '2 Spacing SOIL 6OVER x Pressure Systems Only xx Moun At Gratems Only Depth Over Depth Over xx Depth of c� t t, xx Seeded /Sodded xx Mulched t: - Bed/Trench Center ✓/� Bed/Trench Edges Topsoil I U — a Yes E] No Yes L No I �- r , COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: I / / 4et Inspection #2: – Location: 1274 142nd Street New Richmond, WI 54017 (SW 1/4 NW 1/4 36 T30N R18W) Torey Pines II Lot 26 Parcel No: 36..30.18.1126 611.R2, evy*vt 1.) Alt BM Description may' YYIG "nit 4Lr' t ` "�' ' '� 2.) Bldg sewer length = - amount of cover an revision Required? ❑ Yes [?No other side for additional information. —— Date Insepctor's Signature Cert. No. 710 (8.3197) V Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix VIISConsin M adison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (fig) 266-3151 5 7 Sanitary Permit Application P Plan I.D. Number 1 .J �2 75 7 In accord with Comm 83.21, Wis. Adm. Code, personal information you ., maybe used for secondary purposes Privacy Law, s 15.04(1 xm) _..- ltoject Address (if diffe mailing address) I. Application Information — Please Print All Information 142nd Street /Z 7-41 Property Owner's Na RECEIVED. Lot# Block# Todd Marek 26 Property owner's Mailing Address OCT 2 6 2009 Property Location PO Box 228 SW N W City, State Zip Code % Y., Section 36 PLAN I ffi M ' 0 r' FHCE New Richmond, WI 54017 T 30 N; R 1 8(crrcle one) H. Type of Building (check all that apply) t3 k �,; ✓ Subdivision Name CSM Number 01 or 2 Family Dwelling - Number of Bedrooms 4 w---_ Pubiic/Commeroial - Describe Use TOrey Pines ❑ State Owned - Describe use 1�4 f QC ity�] v illage �fownship of Richmond III. Type of Permit: (Cheek only one box on line A. Complete line B if applicable) ., 9 9 - Z A. ® New System ❑ Replacement system Q TreatmenUHolding Tank Replacement Only 0 Other Modification to Existing System B. 0 Permit Renewal ❑ Permit Revision ❑ Change of 0 Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner SV A. Type ofPOWTS System: Check all that a pply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil © At- Grade ❑ Single Pass Sand Filter 0 Constructed Wetland ❑ Pressurized In -Ground 13 Holding Tank E3 Peat Filter [3 Aerobic Treatment u;7b Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 11 Drip Line ® Gravel -less Pipe ❑ Other (explain) V. DistImalfIrreatment Area Information: Design Flow ( Design Soil Appli ' Rate(gp dsf) Dispersal Area (sf) Dispersal Area �O (sf) System Elevation 600 0.6 1000 1000 �/ 96' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ,Q & C /� Concrete Consbucted Glass N OW Existing T anks Tanks '2 UCt5 � s f�' to T so* or Holding Tom 1200 1200 Wieser x AoroWc Treatment Unit DosimChambex 800 1 800 Wieser Ix VII. Responsibility Statement- I, the undeas%ped, onnae respondbility for Installation of the POWPS shown on the attached plans. Plumber's Name (Print) Plumber's Si re MP/MPRS Number Business Phone Number Roger Nelson MP 226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zi Code) 122 East Summit Avenue Ellsworth, WI 54011 VIII, oun /De partment Use Only pproved ❑ sapprov Sanitary Permit Fee (includes Groundwater 7dz Issuing ignature (N Surcharge Fee) / / ❑ en R eason for Denial {p (� _ I b IX. Conditions of Approval/Reasons for Disapproval 3) f 2 � � �C� /A� G�IO jJ � t neW SYSTEM OWNER: IV 'r ��`` ,1 I. Septic tank, effluent titter and' � � W . Mr... AtAC-.& dispersal cell must all be servk:es / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained p t ��" as per applicable code f OrdlrWRces. Attach complete plain (to the County only) for the systems on paper ant ku than 81l1 x 11 hashes In stn SBD -6398 (R. 01/03) 6'tz c. lot line B1 BM B 7%8 Slope 104 94 96 30 of 2 force main Wieser 0 0 1200/800 z o 4" PVC 0 CD rt 1 (D y�\ 4 Bedroom W House Garage Todd Marek �� Driveway PO Box 228 j i \� _ ��� LOT �� - - -- - -- \ (2.33 ACR 89 E 330 _00' _ \ 3-- - 297 -- _ ---, 490 f LOT 25 �OT \ �- - -,• \ �� 2.3 ACRES ,/' ►� n I j (2.3 ACRES) / $ Z i A !sw ACREr 297' - I I �� �� LOT 24 ACRES � �• � � , /MIN FIFE �� / f �� ` •� �� = 1011.00 j LQT, 3 �\ �\ 418' (1.4 ACRES) Vol / y ` LOT 23 --/STORM WATER �. i ' 2.0 ACMES RETENTION AREA �2.0 ACRS) H.W.L. = 1009.0 \� I i i ' 317' ' x1005.81 3 � / 1 12f�' ---y MIN FIFE � = 1008.00, i / /� i -� - LOT,22 w 1.4 A 2 ES) _ _ ` Lpt 1 = . 7 .4 x i - . R 'J` / .94 / � / �� � � ' � � .. 1 000 . . / X340' / .� .� (1.. A ES)/ Safety and Buildings PO BOX 7162 commerce .Wl.gov MADISON WI 53707 -7162 Contact Through Relay i sco n s i n www•commer isco sin.go www.wisconsin.gov Department of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary October 21, 2009 CUST ID No. 226497 A7TN: 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: 10/21/2011 SITE• Identification Numbers Todd Marek - Dwelling Transaction ID No. 1724957 142 Street Site ID No. 752229 Town of Richmond, 54017 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SW1 /4, NW1 /4, S36, T30N, R18W Lot: 26, Subdivision: Torey Pines FOR: Description: At -Grade Object Type: POWTS Component Manual Regulated Object ID No.: 1244330 Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P.lv requirements. Con � WMA S: No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, A I ( stats. D P ME DIVI I E SA The following conditions shall be met during construction or installation and prior to occupancy or use: => The north arrow shown on the SOIL EVALUATION REPORT plot plan and the north arrow shown SE` C; R on page 8 do not coincide. The SOIL EVALUATION REPORT plot plan appears to be correct. 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. 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. r ROGER D NELSON Page 2 10/21/2009 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. Sincer Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 P et I age Private Sewa&PlanR er , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0600 - 1430 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi.' ov/ SB/ SB- BuildingContractorProgram,htmi RESMENTIAL. AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Todd Mark 4 bedroom Y _� Owner Todd Marek v» Address P. O. Box 228 New Richmond, WI 54017 Job Address: 142th Street Legal Description SW 1/4, NW 1/4, S 36, T 30 N, ft 18 W Township Richmond County St. Croix Subdivision Name Torey Pines Lot No. 26 Parcel ID Number Plan Transaction Number Index sheet Page 1 ;n Calculations Page 2°� • T. �' At -grade drawings Page 3 Laterals and dose tank Page 4 -,� Specifications Page 5 Management & contingency plan Page 6 -FT Pump curve & specifications P 7 \ L� °tf1UC� \C lot Plan Page SPL;<<�D i Designer Roger Nelson Lioense Number MP 226497 Signature &/"i ., y/ Phone Number 715 - 2734444 Date 10101/09 Designed pursuant to: At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) Version 4.0 (04103) Page 1 of 8 PRESSURIZED AT -GRADE DESIGN At -grade Design Worksheet - Sloping Site Flows and Slte Data Enby. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 7.00 % Site slope 96.00 Contour elev. below lateral (ft) 36.00 Depth to limiting factor (in) O.40 In -situ soil application rate (gpd/ft"2) Distribution Cep InfOr nation (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 100.001 Aggregate length (ft) Pressure OloWbutlon Data Entry (c or e) a Center or end lateral connection 1 Number of laterals 0.156 Oriflc•.e diameter (in) e.g. 0.188 Not a gnat calculation 2,00 Estimated orifice spacing (ft) 2.001 Forc amain diameter (in) 2.801 Forcemain flow velocity (ft/sec) -- -0 Fordeemain length (ft) y or n Does forcemain drain back? -- U-001 Pump tank elevation (ft) y or n y Are laterals at highest point? NA 4.55 System head (ft) x 1.3 4.9 Forcemain drainbacc (gal) 9.67 Vertical Itft (ft) 80.0 5x Lateral void volume (gal) O.49 Friction loss (ft) 1 84.91 Minimum dose volume (gal) 14.71 Total dynamic head (ft) 27.4 System demand (gpm) Lateral Diameter Selection ttlal&x"V nch Calculator (optional) I dramecx dwice Total Tank Capacity (gal) Designer t In Total Working Liquid Depth (in) must select 1.25 in GaVin (enter result in cell G46) one lateral 1.5 in diameter 2 In x Troobnent Tank Inkwmadon 3 in x 1200 Septic tank capacity (gat) Wieser Manufacturer Eftent FBtaer In Doss Tank informatlon 1 Filter manufacturer 800.0 Dose tank capacity (gal) 1 Fitter model number 22.21 Doge tank volume (gaVn) Wieser Manufacturer Project: Todd Marek 4 bedroom Transaction Number: Page 2 of 8 I i AT -GRADE PLAN VIEW 1/8 Observation Pips (2 typical) A 10.00 ft D B 100.00 ft 116 B 16.67 ft W Tr -.4,— C 12.00 ft D 5.00 ft E 2.00 ft L 110.00 ft D B W1 22 : 00 ft A x B 1000.00 f A2 i L E--, Cap Total Typical in t Plo hal aggregate cell A x SOW in the lower C � = Plowed area L x W s", and anchored securely. 8• AT -GRADE CROSS SECTION Svnthedc fabric cover 97.63 ft Finished grade Lateral elevatio invert elev. r 96.50 ft •' : : .i—.— Observation Pipe at aggregate we E 7 % Slope Surface contour 96.00 ft C "A a. and system elevation D ® =12 in. topsoil and subsoil Plowed iayer over aggregate and tapered to toes. below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Todd Marek 4 bedroom Transaction Number. p� PRESSURE DISTRIBUTION AND DOSE TANK Latmi Diagram - End Connection P Last hole dlrilled next to end cap X Laterals & foroe main of PVC Soh 40 Holes driNr:d on the bottom of the lateral (per COMM Table 84.300 equapyspaoed • + Turn- upwiibaliwhrowoloonoutplup Lateral Specifications 0.156 Ori lc:e diameter (in) End Lateran connection point X 1.96 Orifice spacing (ft) 1 Number laterals 51 Orifxms/laterall P 98.00 Lateral length (ft) 27.4 Lat discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Foroemain diameter (in) 27.4 Sys. discharge rate (gpm) 30.00 Forcemain Length (ft) 14.71 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with weathsr -proof warning MW and bdcirig device Final grade ire box disoonnsat 4' Tank Component is Afternale properly ye oum kmation 16" min. Electrical as per NEC 300 and Apps outlet Comm 16.28 WAC Tank tuN Inches Gallons JA provide 114" A 20.2 448.7 Alarm on weep hole or 8 2.0 44.4 Pump on g dev C 3.8 84.9 D 10.0 222.0 86. ft C Totah 36.Oi 800.0 D Z—V'Saing under to 86.00 ft Goulds Pump manufacturer IS. J. Elsctro System I Alarm manufacturer PE 41 Pump model number 1101 MW Alarm model number Project: Todd Mark 4 bedroom Transaction Number. Page 4 of 8 At-crude, Svste,_Maintenance and Ooara n SM! ic_dga Service Provider's Name Nelson Plumbing Phone 715 - 273-4444 POWTS Regulator's Name St,Croi Coun Zoning Phone 715 - 3864680 SyMan Flow and Load Parmneters 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 1000.0 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Conform >10E4 cfu/100 mL Serviee Freauency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter 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 ears Mound Inspect for ponding and seepage once every 3 rs Other 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 st -grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. AN gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is aocomplished with a mold board or chi" plow. 5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope We will be protected from compaction. 7. AN other construction detaNs are as per the at -grade component manual SBD- 10570 -P (R. 6199). LLaferai Turn -un Dotail Finished ............... Grade """""` Ur Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Sail Valve Distribution Lateral .., �-- ----- Long Sweep 90 or Two 96.50 It — 45 Degree Bends Same Diameter as Lateral Project: Todd Marek 4 bedroom Transaction Number Page 5 of 8 At -grade System Management Plan lourou nrrt to Comm 83.54, Vft. Adm. Code Stel This system shah be operated in accordance with Comm 8244 Wit. Adze. Cods, and shall maintained in accordance ugh its' component manuals 1SSD- 10570 -P (R. 06199) and SSWMP Pub. 9.6 (01181)) and local or state rubs pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present shed could cam death. Septic and pump tank aborWoriment shall be In accordance with Comm 83.33, Wit. Adm. Cods when the semis are no longer used so POWTS components. Septic or pump tank manhole users, ecom rhos and covers should be' sp a m r for wetsr tglift 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 fare must be replaced. Exposed access openings greater than &4ndies In diameter shad be secured by an effective looking device to prevent accidental or unauthorized w trry into a tank or component. Soodc TM* The septic tank shag be maintained by an Individual oertfbd to service septic tank* under s. 281.48, Slats. The owlents of the septic tarok shall be disposed of in accordance with fit 113, Wis. Adm. Code. The operating condition of the septic took and outlet filler shall be assessed at %W once every 3 years by Inspection. The outlet filter shag be cleaned as necessary to ensure proper operation. The toter cartridge should not be removed unless provisions are made to retain solids In the tank that may sough off the titer when removed frog► its enclosure. If the MW is equipped with an scram, the fitter *hall be serviced if the alarm Is activated continuously. Intermittent fUter alarms may Indicate surge lbws or an hnpendkg continuous sbmm. The septic tank OW have Its contents removed when the volume of skrdge and scum In the tank exceeds 1/3 the clinic volume of the tank. If the contents W the tank are not removed at the time of a triennial assessment, maintenance personnel shed advise the owner of when the neon service needs to be ps buried to nm**W less than n mdrmun scum and sludge accumulation lation in the tank. The addition of biological or chemical addeves to enhance septic: tank pwkmhanoe is generally not required. However, IF such products are used they shelf be approved for septic tank use by the Department of Commerce. Puma tank The pump (doskg) tank shell be inspected at bast once every 3 years. Ad writches, alarms, and pumps shall bole 1 1 to verily proper operation. If an elflusrt filer Is Installed within the tank It *hall be Inspected +zed serviced as necessary. No tress or shrubs should be planted on the at•Srods. Plantings may be made around the st grade's perimeter, and the st grade shad be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on tie at -grads is not recwnmwx ell since soil compaction may hinder aeration of the krditradw surface within the mound and snow compaction In the winter wig promote frost penetration. Cold woother installations (Ocl Ober- February) dkdals that the at- Wade be heavily mulched as protection from freezing. Influsrt quality Into tie at -grade system may not exceed 220 mgA. BOD5,150 mg& TSS, and 30 nglL FOG for septic tank etfiuent or 30 ff*t BOOS, 30 nV& TSS, 10 n & FO% solid 10' clW100 mt. for highly treated often t. Inlbsnt flow may not axcsed m odm urn deep flow specitled in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each bterel, and 4 is recommended that each lateral be flushed of accunwlated solids at Meet once every 18 months. When a pressure test is perfomod it should be compared to the knkm test when the system was installed to determine N onifios clogging has occurred and tl orifice cleaning is required to makntakh equal dbdlbutlah within the dispersal pg. Observation pipes within the dispersal cell shag be checked for oft" pondkg. Pondkg levels shag be reported to the owner, and arty levsb above 4 inches considered as an impending hydraulic fours requiring addWW, more frequent montenkg. CorWr oanav Plan If the septic tank or any of Its commponena become detective the tank or component shag be repaired or replooed to keep the system In proper operating condition. If the dosing tank, pump, pump controls, alarm or related wkkg becomes defective the detective eomponw*&) shag be knmodately repoked or fo~ with a component of the same or equal pe *wmnoe. t the stgrade cormpaeM fags to sootpt wastewater or begins to discharge w astewaler to to ground skufaos, it will be repaired or replaced in its' present location by Increasing bassi area If toe lookage occurs or by renovating the biologically dogged absorption and dispersal media, Installing new piping, aid r apt acng other components as deemed necessary to bring to system Ito 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 Transaction Number. Page 6 of 8 [ VGOIJLDS PUMPS Submersible Effluent Pump PE 5�lO V.An= mom PiA"M • � 7 • 115 vft i �� hPON ad • 0u" do i mi a abad pm. cover. • Saft;=;"'A• wow WO ­0 100C ■ uppersbMaad lows mard I sphere. • am 8 wAuladon, heavy duty beal bee " • AuN n a* niodeb WKk de a • 0t3AMad desigm aor wadi n. APPLIGTI MS float sysdch. • High $oaigth anbon steel • MM is parnaw * for the • MantW modals avai ft- Owk k6kated for aftnded MMM • S pa se service WO. larl. wt e or asve. @.33 HP, 3000 RPM ■ Mwemd for CNOVANs • Ellkwood sj�ms Pal Pwnp: • �3.a mw6oxn am" • Law P pipe Stems • Mao hum repsdtX SO GPM • 9ww Pala design • � are wilt�n the • 6ssarknt graining • Maodrmrra head: 2S' TDH K41 Motor brrple attist motor. • liewy 0" sww P6 Pww & . 40 HP, 3000 RPM • c� 2w Stamm bn^ • Ms *FM he nN • PK design a W" d" 1 43 SITW widr PESI NH}AA S-t Sf, tlree preeg, • Msxi w fir, 70 GPM *.50 HP, 3400 RPM . omplo w n s �. • Moxky ni Maxi: 37' MH • &S MM*Mw 6 • PSC design • Midw*W seal a carbon, Mamas 0 aranric, 6lNrl► and staiaias ?. :._ ....._,... ...._, • Stainless ad 1 swft S- GPM AORKYusnum Ft 7- A. C� us ij } .. r s.. ,.. U 7 ...T.. 1 - ..:z.r.�.. 0 • •. ' "'FYq '� --P..4. p .�. .F..H.. .. :.l: • + }.p.:�.. 0 � M to 20 30 40 - SO- 60, O GPI1A 80 / a C ?OT S 9 0 s 10 1s C>ar0lds PlM11Fl6 CAMM 2M God" 2 ?• <31TT industries North lot line o B1 BM B 7% Slope ? /0, 94 95 96 30' of 2" force main L, Wieser 1200/800 z m � o 4" PVC = o c� CD 4 Bedroom Well House Garage Todd Marek Driveway PO Box 228 New Richmond, WI 54017 Torey Pines Lot # 26 SW 1/4, NW 1/4, S36, T 30 N, R 18 W Richmond Township St. Croix County 2.252 Acres BM= 100.00' Top of survey iron Scale 1 " = 40' �-- 40 -o„ ---� a 9 10 9 abed Iaails puZK r z Wisconsin Department of Commerce S PAID L EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ^ County 5Y C � i Attach complete site plan on paper not less than 8 1/2 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. Opp 6'' r o 6 Please print all information. viewed Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ��+✓� ` V (/ Property Owner 1: IV Property Location / d �� /� REG G Y Govt. Lot J� 1/4 1 A S 3 �j T 3 0 N R � E (o Property Owner's Mailing Address no(J Lot # Block # Subd. Name or CSM# 42. Z Z- OCj 0 52 26 - or �� JZ City� State Zi Code Phone pF% e ING c ❑Village Nearest Road J7 1 NF' & ZON O ❑ City I' � Construction Us esidential / Number of bedrooms Code derived design flow rate GPD ❑ Replaoement Public or commercial - Describe: Parent material �'e Flood Plain elevation if applicable ' A 1 14Z ft. General comments and recommendations: System Type System Elevation 7 a Boring # ❑ Boring pit Ground surface elev. � &J 3 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description aGr. ucture Consistence Boundary Roots GPD/tt' in. Munsell Qu. Sz. Cont. Color Sz. Sh. •Eff#1 - Eff#2 D -0 107, 3/L ej 2 _ `�� r /-' v Ong # Boring ® J n Pit Ground surface elew —311t. 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 ,ti- - Z s -3 • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ��� 715 - 246 -4516 I Property Owner Parcel ID # Page of FS] Boring Boring # C L Pit Ground surface elev, ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �3fv Via° l F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. - "go — ilApplicabon 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 Boring E Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth 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 mg/L and TSS >30 < 150 mglL '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 -8330 (RAM) Property Owner — Parcel ID # Page of El Boring # ❑Boring Pit Ground surface elev, C:/ 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 'L Z 1U r - - //7 J ^ N - Boring ❑ g Boring 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 GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring Ground surface elev. ft. Depth to Limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg& 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 -8330 (R.6100) Soil Test Plot Plan Project Name Todd Marek Shaun Bird y / Address P.O. Box 228 New Richmond Wi 54017 CSTM 26900 Lot 26 Subdivision Torey Pines Date 9f 28 /09 S W 1/4 N W 1/4S 36 T 30 N /R W Township Richmond F] Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRpSameasBenchmark B.M. 490' Property Line Ac 70' Scale is 1" = 40' unless otherwise noted 6• _ 15 B -1 50' 40' B -2 B -3 55' 96' 142nd St. 7% Slope 5 ' 94' 200' Property Line - - -- -- fir- �N° •- n �� �, -.;; � �5 LOT 28 t � \ �O- 2.152 ACRES (93,744 SO. FT.) lD I \y \ ? E�vAnoN-1oso.ss \ — _ N 89°51'34" E 490.37' N 0 9'57 ! 10' EV\ 164:25 8e I 33' 1 33' I 30' DRAINAGE / I EASEMENT N _ S LOT 28 2.252 ACRES (98,076 SO. FT.) I I I :2.002 ACF MIS N 89°51'34" E 490.39 341.; N 89 z 2.002 ACI z o LOT 27 2.252 ACRES (98,081 SQ. FT.) OD m L cn Z $ I N l MIN FFE C CD N 89°51'34" E 490.42 to E�VATION- 1029.12 J N 89° 3`Z7 I - � I w L L , !D a' y .252 ACRE (98 85 SO_ FT.) � - 1 :2.002 ACF MIN ELEVWn0N f 490.4.4' I N 89 °: N O ! 3 o LOT 25 L� o ° 2.252 ACRES (98,091 SQ. FT.) ' -- 2.002 AC MIN N 89 E 490.47' N 89°5 336.E ElVATION= 1020.89 PD a LOT 24 • — 2.019 ACRES (87,966 SO. FT.) LOT 16 ' ! 2.613 ACRES (113.802 SO. FT.1 �'d Ti+E69bZSTLT i{aiew ppol dSb : -O 60 6 des ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7 I Ate 5-� Mailing Address PO / dX 2 2 F N C 0 m ei t_J 0 l/ s l 7 Property Address 409 A 7 R �'�=� .S (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number d 0e) LEGAL DESCRIPTION Property Location ' /4 , !V (ilk ' /4 , Sec. , T 30 N R / e W, Town of k -AJ O Subdivisio y &tir- s �l , Lot # b Certified Survey Map # , Volume , Page # Warranty Deed # q �Q� , Volume , Page # Spec house ay�p no Lot lines identifiable y� no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. 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. Uwe, 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. Uwe 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 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) (!IIII (IIII l 1111 !IIII IIIlI VIII Illf Ill!!! IIII flll State Bar of Wisconsin Form ] -2003 9 0 4 8 5 7 1 WARRANTY DEED 904857 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Croix Custom Homes, Inc., a Wisconsin corporation 10J05/2009 11 :10AM WARRANTY DEED ( "Grantor," whether one or more), EXEMPT 0 and Todd Marek, a married person REC FEE: 11.00 ( "Grantee," whether one or more). TRANS FEE: 91.50 Grantor, for a valuable consideration, conveys to Grantee the following described real PAGES: 1 estate, together with the rents, profits, fixtures and other appurtenant interests, in St Recording Area Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach Name and Return Address addendum): Lot 26, Torey Pines 11, St. Croix County, Wisconsin KRISTINA OGLAND ESTREEN & OGLAND E' 304 Locust Hudson, WI 54016 026 -1149 -26-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated IO A" 1 r � Croix Custom Homes, Inc. (SEAL) C _ ms s- (SEAL) * s (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Croix Custom Homes, Inc., a Wisconsin corporation, by JC'hAAs­� t3- 14-urr+ STATE OF ) ) ss. authenticated on COUNTY ) I -- Personally came before me on , *Kristina Op-land the above -named TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED. BY: Notary Public, State of Kristina Ogland, Estreen & O¢land My Commission (is permanent) (expires: ) 304 Locust Street, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. INFO -PRO Legal Forms 800.855 -2021 www.infbproforms.com 1 of 1 Viisoortslri Department of Commerce SOIL EVALUATION REPORT Page of 3 Uvisl6n of Safety and Buildings M in accordance with Comm 85, Weis. Adm. Code minty C Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must v� C 1 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. Q (( — Z� — Please print all information. Re ' b Date Pesorw Info g matkn you provide may be used for secondary purposes (P�cy Law. s. 1504 (1) (m)). Property Owner ~ -. _ Property Location . Ame LLC Govt. Lot 3L 1/4 NJU� 1/4 S 3(Q T 3Q N R E (ore Property Owner's Mailing Address Lot # I Block It FSubd. Name or CSM# Pe _ pirW City State Zip Code Phone Number ❑ City _; ❑ Vdlage Town Neartst Road Pal INtil 10 1 U1 6 ) (� 2C�'1 Q� c� vn l `40 SE . ]..New Construction Use: & Residential I Number of bedrooms 3 - Code derived design flow rate 4 UU GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 41' it A_ 6 ✓ Flood Plain elevation If appii mbie General comments c��s { p� U , v r �/ I22 U ��-- and recommendations: `[ U - 7' I� l 2 2 Z ('If 11 P /-eV 99.5° Qu4-s1de nee Boring # ❑ Boring ® pit Ground surface,etev. /DCJ� Z U ft. Depth to timiti ctor in. • - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munseil Qu. Sz. Cont Color Gr. Si. Sh. 'EfI#1 0 002 I O -!O 10 31 Silr cS 10 I O cl Iq 5 4 Zm 5bk m r c S - q I LE Boring # ❑ Boring 2 pit Ground surface elev. /1*10' 6 o ft Depth to limiting factor 3 CD in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fN In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 g i I Zrrlobk m r c I vf . g 2 1 - (p )Q H Zm m4 - q 0 7 t) 4 r y I -# 5L Zrnsbk m Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number r Ad Schv k r 25• Address Date Evaluation Conducted Telephone Number 2113 <�o` S�. Some, Z _ �- / /-ate 0-115) -yoo� r Property Owner N 1n 1n��C'�I wf rl, LL Parcel ID . # Page of 4 ❑ M B# Boring sq " =" '®`Pit Ground surface elev. ' d R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Si. ConE diAw Gt Sz Sh. •Eff#1 'Eff#2 I 0 0 - Z 40 ID — 51 CI r ct) tp 3 - 3 C �.5 ;41q SL 2nn5bk, � - - 5 7] 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/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F Boring # Boring ❑ ❑ Pif - Ground surface elev. it. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 • Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/4 and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to acceis services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD8330 (807100) Property Owner Nne3 ke` LLC- Parcel ID # Page ' _ L of 3 Boring # ; � Ground surface elev. R Depth to limiting factor �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 •Eff#2 2 -h �r cS 1 J 9 14 -- S i L! 2 r LS �P 3 C2P1.5 Iq SL ZIP b 9 a Boring Boring # ❑ ❑ Pit Ground surface elev. R Depth to limiting factor in. Soli Application Rate Horizon Depth . Dominant Color Redox Description . Texture _Structure Consistence Boundary Roots GPDlft In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPDtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 • Effluent #1 = BOD > 30 220 mg& and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/4 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. SBD 330 (807100) PAGE 3 OF 3 w SO % IVc `4 3 6 f NAME hn. LOT# Z LEGAL DE SCRIPT ION � ,S � T � N_R. g E(or� SCALE: I" " BM I ELEVATION /dc). U BM I DESCRIPTION , p 6 h-4 -'� 4 - BM 2 ELEVATION � ' f s ec, 3 � BM 2 DESCRIPTION o I uc �' �' SYSTEM ELEVATION / 60 ' a - y ALTERNATE ELEVATION A114 CONTOUR ELEVATION co ur r a a I SIGNATURE l GZ DATE