HomeMy WebLinkAbout026-1149-27-000 visconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 420653 0
GENERAL INFORMATION (ATTACH TO PERMIT) State P�lan ID No:
T Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 1
Permit Holder's Name: City Village X Township Parcel Tax No:
Marek, Todd I Richmond Township 026 - 1149 -27 -000
CST BM Elev: Insp. BM Elev: BM Description.
/ OD . oo v S�� �•
TANK INFORMATION ELEVATON DAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark s v � / /
I Z Sv / T-S7 - C) My y DO • c)
Dosing � tt Alt. BM ST / �--
Aeration Bldg. Sewer 3 C.
2 /dibncl
Holding °� St/Ht Inlet
St/Ht Outlet 7
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Se tic > Dt Bottom
p Sr't 3' r lo. to �/ • 3
Dosing Header /Map y
7 a• <5 0 Zd
Aeration Dist. Pipe
Holding Bot. Syst m
3 15 r po • 9
PUMP /SIPHON INFORMATION Final Grade / LI 7 Manufacturer Demand St Cover
(� GPM
Model Number "7 12-
S7— l
TDH Lift Friction Loss System Head TDH Ft
- 7 T I.o I q-
Forcemain Length -f Dia. Z Dist. to Well
(V ,
S /— " �j
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth
DIMENSIONS /O / / Z / / &d �_
SETBACK SYSTEM TO ! P/V JBLDG WELL LAKE /STREAM L CHIN Manufacturer:
INFORMATION Ty Of System: CHA OR
i Model Number:
DISTRIBUTION SY EM (V v C
Hea er /Mapifold Distribution x Hole Size p x Hole Spa�ing Vent/ tg 1- Pipes) ` 4 S /3Z q a ength ` Dia Length I ZD
Dia Z Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over 0 - Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center �d Bed/Trench Edges Topsoil
/ [� Yes [l No [] Yes
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�/ /t „^Imection #2:_ /
Location: 1278 142th St New Richmond, WI 54017 (NW 114 NW 1/4 36 T30N R18W) Torey Pines Lot 27 Parcel No: 36.30.18.1127
1.) Alt BM Description
2.) Bldg sewer length �f �'(.� ,pr,�y �Y" (,tom �u%1►"f�uvd� (�Q(
- amount of cover t a U
3 ) Q q. — too
Plan revision Required? =I Yes 't: No r
& � �, �3 i '),
Use other side for additional information. 1 __J
SBD -6710 (R.3/97)
Date Insepctor's �gnature Cert. No.
/' f j / 3
r
4 �
A Safety and Buildings Division County
1*1
gt P.O. Box 7082 201 W. Washin on Ave., sconsin Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 261 -6546 Z0 (V S
Sanitary Application Permit A State Plan I.D. Number
In accord with Comm 83.21 Wis. Adm. * %2J =T.,.ts. 1'
Code, personal information you provide
may be used for secondary purposes Privacy Law, sI5.04(I)(m) Project Address (if difLolntffifn mailing address)
At IzIB' 1 't2- I. Application Information — Please Print All Information 624 — 111{q - 2:�- CW (. 112 7)
Property Owner's�� �� � Parcel # � Lot # Block #
7
Property Owner's Mailing Address Property Location
L z
City, State Zip Code Phone Number ��'' �"`� ��• Section QJ ,2AJ 15Y61 - (cirel
II. Type of Building (check all that apply) acS pat Su, wvt T N;
f Subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedrooms
❑ Public/Commercial — Describe Use
❑ State Owned — Describe Use []City ❑ age oymshi f
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ys ep y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. El 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 0 Y, 12 1
❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil t -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
?4 6 t% -. -.15 Z
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units W/ Z.bs -Q -/� �/ �,-J Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank S
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, agume responsibility for installation of the POWTS shown on the attached plans.
Plumber' ame (Print) Plumber's re MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip e) OF
VIII. County e artment Use Onl
! �fflEl Disapproved Fss nitary Permit Fee (includes Groundwater Date Issued Is sui Agent Signatur (No Stamps)
rc harge Fee) -_ .
❑ Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
-k "Lo ( ,M � � =ate J1 tv o,u�- S
p
tx
(A ttach complete plans (to the County only) for the system on paper not less thin 81/2 z 11 11sches in size
SBD -6398 (R. 08/02)
/PRSShaun Marek PLOT PLAN (�e- I - #
ADDRESS P.O. Box 228 New Richmond Wi 54017
1 /4S 36 /T 30 N/R 18 W TOWN Richmond
COUNTY ST. CROIX
r d 226900 1/8/03
DATE BEDROOM 4
CONVENTIONAL AT -GRADE X)O(
CONVENTIONAL IONAL LIFT HOLDING TANK
MOUND _ SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE
DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE -5 ABSORPTION AREA 1210
# of chambers none
BENCHMARK V.R.P. Top of Survey Iron
ASSUME ELEVATION 100' Filter
❑BOREHOLE Q WELL 'H,R.P. Same as Benchmark Zabel A -100
SYSTEM ELEVATION 104.2'
B.M. Property Line
Scale , = 1/4" = 10'
� Area 15' Below
System is to
103' remain
undisturbed Well is to
meet all
104' setbacks
found in
105, Comm. 83
B -2
3% Grading is to be done �.
Slope to divert run -off o
away from system o
0
-
m
B -3 �
C
Huffctgt Comt o Tank
A
Tank is to be properly
bedded and provided with
�<110ckdown covers with
o approved warn' labels
0
Pro 4
Bedroom
r House
Pro Town Road
I
4 Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
*isco www.w
nsin
w ww.commerce.s tate ml- us/ s b
isconin.gov
Department of Commerce .lames Doyle, Governor
Corry L. Nettles, Secretary
January 14, 2003
CUST ID No.226900 ATTN: POVYTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL Identification Numbers
PLAN APPROVAL EXPIRES: 01/14/2005 Transaction ID No. 827036
Site ID No. 654857
SITE: Please refer to both identification numbers,
Todd Marek Torey Pines Lot 27 above, in all correspondence with the agency.
140TH St
Town of Richmond
St Croix County NW1 /4, NW1 /4, S36, T30N, R18W Lot: 27
FOR: New at grade system, 600 GPD
Object Type: POWT System Regulated Object ID No.: 887849
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P.O
n C�11t t'` It
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Conditions: NO r
• This system is to be constructed and located in accordance with the enclosed approved plans and with the "At 0 - RTMENT
Grade Component Manual, SBD- 10570 -P (R.6/99)" and SSWMP Publication 9.6, Design Of Pressurized 0
OF SAFE
Distribution Networks For Septic Tank- Soil Absorption Systems. G
• In the event this soil absorption system malfunctions so as to create a health hazard, the property owner . SEE GORR
follow the contingency plan as described in the approved plans. In addition, the owner must insure that the
operation, maintenance and monitoring duties as described the At Grade Component Manual are complied
Reminder
• The orientation of the at grade system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual.
• Surface water drainage shall be diverted away from the system area.
• Materials shall conform to the requirements of COMM 84.
• Maintain well and waterline set backs per COMM 83.43(8)(1).
• Insulate building sewer per COMM 82.30(11)(c).
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.
SHAUN R BIRD Page 2 1/14/03
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.
S J Fee Required $ 175.00
Fee Received $ 175.00
" Balance Due $ 0.0 0
Sha�rrdorf
POWTS Plan Reviewer, Integrated Services WiSMART`code: 7.633
(715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm
pshandorf@commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 1 / - `�
i O er: T�c,ar� cF
L cation: Lot 27 Torey Pines
S Ys type: At -Grade
Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99)
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-
SAS (01/81)
Pa 9 e# .T.S.
1. Cover Page arl
2. At -Grade Plot Plan D
F CO,4 cRCE
3. At -Grade Cross Section Y AN cs
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section SPONDEN
6. Pump urve
p BZ -7o3�
7 -9. , Maintance and Contigency plan
10 -12 Soil test
Shaun Bird
Signature
License number 26900
1/8/03
/ 3
PLOT PLAN
PROJECT Todd Marek ADDRESS P.O. Box 228 New Richmond Wi 54017
NW ' 1/4 NW 1/4s 36 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 1/8/03 BEDROOM 4
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE
LOAD RATE •5 ABSORPTION AREA 1210 # of chambers none
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION loo' Filter Zabel A -100
❑ BOREHOLE (E)WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 104.2'
B. M. ' Property Line Scale = 1/4 = 10'
Area 15' Below
System is to
remain Well is to
103' undisturbed meet all
setbacks
104' found in
Comm. 83
105'
B -2
Grading is to be done
Slope divert run -off °-
Slope away from system
0
CD
r
B -3 ro
Huffcutt Combo Tank
Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
0
- B -1
v
0
Pro 4
CD
Bedroom
House
CD Pro Town Road
- - - -- - - - -- -- — J
TOTAL DYNAMIC HEAD /CAPACITY
HEAD .CAPACITY CURVE PER MINUTE
EFFLUENT AND DEWATERING
MIDDIL T 1
MODEL 152 153
uj 171
n�
50 Feet Meters Gol. liters Gal. Liters
153 5 t.5 69 261 77 291
12 40 10 3.1 61 231 70 265
152 15 4.6 53 201 61 231
20 6.1 44 167 52 197
v 30 25 7.6 34 129 42 159
8 30 9.1 23 87 33 125
o _
a 20
35 10.7 -- — 22 85
0 40 12.2 -- E44EFI. 42
4 \ • Sr1 Lock Volve: 38.0 Ft. (11.645) (13.445)
10 01450
0
20 40 60 80 100
GALLONS 6 1/4
LITERS D 80 160 240 320
3 27/32 4 5/8
FLOW PER MINUTE
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS _
• Timed dosing Panels WAa&— R ® 3 27/32
• Electrical alternahn, for duplex system, am available and Suppled wdh
an alarm.
• Variable level WnW switdtes are available for conhaing single phase
System-
r
• Doutie piggyback vale Petrel W swilches are availaible for variable
level long and short cue eontrols. �
• Sealed Qwk_f3ox avg&e far outdoor ift"aWns. See FM1420.
• Over 130 °F. (WC.) special Wolation required.
1
ISM53 Series' a 1/8
WAubs .B 8
Mode Yob 5 1/8
N152 115 6.5 1 2or3
BN152 115 - 8.5 bduded 2a3 f
E152 230 4.3 1 2or3
W152 230 4.3 rndided 2or3
N153 2or3 sELECTM GUIDE
tt5 10.5 1 8N153 115 10.5 b doded 2 or 3
E153 290 5.3 1 2 « 3 1. ogle piggyback variable level Wat 90111011 a double Plggy� variable level flow BE153 230 51 tndudad 2 or 3 wAbh. Refer
b FM0477.
a CAUTION 2. See FW712 for cared model of Elecfrieei Alternator E -Pak.
AM inotdoon o f co n t ro l s , fi devices and wiring should be done by a q MWAd 3. Variable k-trel a)i*d swk h io-0M used as a amW acWabr. seedy duplex (3)
r9con tildi a " B p&qwd1the0cwPAw31 SAW and Heakh Ad (05114 or (4) float system.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller PUMP.
M41L 70: P.Q BOX 16117
Loth^ KY 40256.0347 Aterxfaduerad. .
Sir To. 3619 Can Run Road
t Lnursok KY 40211.1961 �„fe£r4urr v%� l933
p;,r/M4w,vzoeUerc«r'
)'LIMP M. f
/� 77�nXM774,
® Copyright 2000 Zoeller Go. All rights reserved.
Maintenance and Contingency Plan for a At -Grade System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Dose Chamber is to be pumped at the same time as the septic tank.
3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
4. Once every 3 years the At -Grade is to be inspected via the inspections pipes in the at-
grade. The laterals are to be inspected via the cleanouts.
5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
6. Pump and electrical components are to be checked at the time of the pumping.
7. Owner agrees to leave the area 15' below at -grade undisturbed.
8. The owner agrees to save this plan.
9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is
not be driven over.
Contingency Plan
1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if
needed, then bypass pump float and try pump without float. If this works, float is bad,
replace float. If pump still does not work, check power at the pump with a electrical device
such as a hair dryer. If no power, check breaker inside house ind call a electrician. If there is
power, then pump is bad and needs to be replaced by a plumber.
2. If At -Grade fails, determine cause of failure, test another area or remove pipe and sewer
rock, retill soil, install new mound system.
3. Replace any other failing components as needed.
Important Phone Numbers
Plumber: Shaun Bird 715- 246 -4516
Pumper: Tom Mondor 715 -246 -5148
St. Croix County Zoning 715 - 386 -4680
Shaun Bird
#226900
i
DESIGN PARANIFTSIS u:nKm i-ow u KA
Number of Bedrooms q103N Fwd Fier Model p E3 NA
Number of com mevchd Units Pump Tank CaPadfy 6� ❑ NA
Eked flow (ahnerage) PUMP T=* Manufachm O NA
Deslign flow (pet, (Estimated x 1.5) . kwoMamdicturer 0 NA
Sol! App6cadon Rate .S� gaVdayffl Pump M ❑ NA
InfluenuEf fluent CQaanty Mond* evecaW Pretreatment Unit
Fats, on & Grease (FOG) 530 mg/L 3 Sandlarqvel Filter ❑ Peat Filter
Bks;hemical Oxygen Demand (BOO 6220 mg& 0 Medwrdcal Aeration O Wetland
Total Suspended Solids (M) 5150 a Disinfec oon DOOM
Manufacturer
Pretrea6ed Effluent Quality - , 4 - .kNA Monthly average— k ❑ I. nramd� ❑ to -ground (pressurized) )
Bkdmm d Oxygen Demand (13013,) 530 mg/L ❑ Mound
Total Suspended Solids (TSS) 530 m9lL
Fecal Conform (geometric mean) s10` du/100mi 1 13 O. other:
Maximum Effluent Particle Size Ye inch diameter vases typal for domestic (nol- aommadatl waswwater and
sapic to* emoenL
!� vakws typical for pretreated waswwrater-
MAINTENANCE SCHEDULE
Service Event service Frequency
Inspect condition of lank(s) At least once every .3 O months r(s) (Ma)imum 3 yrs.)
Pump out contents of tank(s) when combined sludge and scum equals one-third (Y,) of tank volume
inspect dispersal ceps) At least once every 3 O months years) (Maximum 3 yrs.)
Clean effluent filer At least once every f 0 months years)
inspect pump . pump controls & alarm At least once every 13 months s) O NA
Flush laterals and pr essure test At least once every t3 months s) (3 NA
Ofirer. At least once every O months 13 year(s) 0 NA
txfier At least once every E3 months 13 year(s) 13 NA
MAINTENANCE INSTRUCTIONS
Inspeof m of tanks and dispersal cells shall be male by an individual canyltg one of the following licenses or
cep Master Phnnber; Master Plumber Restricted Sewer. POWTS Inspector: POWTSS Malnteftw. Septage
Servicing operator Tank inspections must include a visual Inspection of the to *s) to identify any missing or broken
hardware. identify any cracks or leaks. measure the volume of combbwd sludge and scum and to check for any back up
or pond'stg of effluent on the ground surface. The dispersal cdks) shall be vim/ Inspected lo dnedc the effluent levels
in the observation pipes and to check for any porndng of effluent on the Wound surface- The pondurg of effluent on the
ground surface may indicate a fang condition and requires the Immediate notilkadwn of the local regulatory aufhoft.
When the combined accumulation of sludge and scrum In any tank equals one -flnld (l.) or more of the tank volume. the
entire contents of the tank shall be removed by a Septage_ Servicing Operator and disposed of in accor with ch. NR
113. Wisconsin Administrative Code.
The servicing of effluent filters. mechanical or pressurized POWTS components. pretreaWnetnt components. and any
other maintenance or mond6oring at intervals of 12 months or)ess shall be performed by a c�ert�d POWTS Maintainer_
A ser vIT report shall be provided to the local regulatory auft* within 10 days of completion of any service event
START UP AND OPERATION
For new construction. prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemicals that may impede the treatment process and/or damage the dispersal ce#(s). If high concentrations are
detected have the contents of the tank(s) removed by a septage servidig operator prior to use.
y ` Page Of
System start up shall not occur when soilconditions are frozen at the infiltrative surface.
During powder outages punk tanks may fill above normal highwater levels. When power is restored ti e excess
wastewater will be discharged to the del cell(s) in one large dose, overloading the call(s) and may result in the
bac or agfaoe dischagge of eftl�e rL To avoid this situation have the contents of the pump tank removed by a
SepbW Servicing Operator pdior-lo reidoft power to the effluent pump or contact a Plumber or POWYS Maintainer to
assist In mantially Ong the plump controls to restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over. or otherwise disturb or compact.
the area within 15 feet dawn slope of any mound or at - grade sod abs6q)doon area.
Reduction or elimination of the following fiiom the wastewater stream may Improve the perlonniance and prolong the Me .
of the POWTS: wNhAcK bob y u%xW - coar . elle btitts< corndoms; cotton swabs; degteat aM dented Goss; drapeers;
fat fo
drsinfec : ts� dtah (sump m
p!p) walla: and vegetable peelings: gasoRK grease; herbicides; meat
medications; of P p per: sankary - aund water sullener brine.
ABANDONjWENT
When the POWr$ falls andlor is permanently-taken out of service the following steps shag to taken to Insure that the
system is property acid safely abandoned M compliance with ch. Comm 83.33, Wiiseonsin AdMirktrative Code:
• Ad piping to tanks and pits shall be disconnected and the abandoned pipe openings sued.
• The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
• Alter pumping, all tanks and pits shad be excavated and removed or their covers removed and the void space
Ned with sod, gravel or another Inert sold material.
CONTINGENCY PLAN
If the POWTS fads and cannot be repaired the following measures have been, or must be taken, to provide a code
compliant replacement system:
• A suitable nent'area has been evaluated and may be utilized for the location of a replacement sod
absorption system. The replacement area should be protected from disturbance and compaction and should not
be u ktged upon by required setbacks from extsfirig and proposed structure, tot tines acid weds. Facture to
protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable
replacement area. Replacement systems must comply with the rules in effect at that tine_
• A suitable replacement area is not avadabie due to setback andlor sal limitations. Ba mriq advances in POWTS
technology a holding tank may be installed as a last resort to replace the faded POWTS.
"It—The she has not been evaluated to identify a suite l* repaoement area. Upon faiilue of the POWTS a sod and
/
site evaluation mast be pe rk mned to locate a suitWe replacement area. if no replacement area is available a
holding tank may be installed as a last resort to replace the failed POWTS.
nd and atVrade sod absorption systems may be reconstructed in place following removal of the Momat at
/76 the Iifdtrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDiOR INSUFFICIENT OXYGEN.
00 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDiTIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAIMER
Name F' `r
Phone _ _ f Phone c
SEPTAGE SERVICING OPERATOR L OCAL REGULATORY AUT HORITY
Name n,✓ D Agency
Phone ? s r� Phone J
This document was *a ted 4y uw starts 01`910 Q"n take. L%Muette eta W aushm County Zo ft and Srudta M Wader. This dwmw t treats
the Ind *nun mquktnerds of eh. Corm 83.22(MXtxd)&M and 83.Si(1). (2) & (3). wraeotwn Adtt a Code. Use of tlds doeuinent does trot
guarantee the pwomu m of the POWTS. GMW (2101)
Wisconsin Department of Commerce ' SOIL EVALUATION REPORT Page � of Z
Division of Safety and Buildings
in accordance with Comm 5 i s, 6dm, Code �ounty
Attach complete site plan on paper not less than 8 1/2 x 11 i irf�i
es Fe ra g Wf- D �� J
include, but not limited to: vertical and horizontal reference int (BM), direction and D arcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. p 2 - 6 - 1 I - 2 - " 8-2
Please print all informatio J A N 0 2 ?_ Review by Date
Personal information you provide may be used for secondary purpos (Priv 1 ( —1W3 I� 3
Property Owner ZON ftOM11j9ation
Govt. Lot 1/4 /// •S T3Q N R E ( W
Property sMailing Address 2 Z '? Lot _# Blodc # Subd. Name or CSM#
a
City State , Zip Code Phone Number ❑ City ❑ Village own Nearest Road
�&'jj - IU2) SYol 7 1 ( )
Construction Use esidential /Number of bedrooms Code derived design flow rate GPD
❑ Replacement P Pubs r merclal - Describe:
Parent material �/ Flood Plain elevation if applicable 'A R
General and recommendations: /D
a Boring # Boring
Pit Ground surface elev. /Oj. / 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
0 -1 , iii � J- 's 'Y
Borg # Boring
Pit Ground surface elev. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 •Eff#2
U` o P l L ,w
�•- p , s -- (� , U
• Effluent #1 = BOD > 30 < 220 mg1L and 30 < 150 mg& • Effluent #2 = BOD < 30 mgA- and TSS < 30 mgA-
Name (Please prutt) Signature Number
1 1 2 Z 70 �0
►3� r�
Address Date Evaluation Conducted Telephone Number
Iaj
Property Owner _ Parcel ID # Page of
Boring # r ❑ Boring L/7
Pit Ground surface elev. /'� ft. Depth to limiting factor � in. Still Application Rate
Horizon I 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
Q -171 31 - -- , 1, , ,s - 8
Z z s � - i
Z� ,s
F 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. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2
Boring # ❑ Boring
❑ Pit Ground surface slay. ft. Depth to limiting tailor in.
Sod Application Rate
Horfzon 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
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgll ` Effluent #2 = BOD < 30 mg/L and TSS 5 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.
seaeaw(RAW)
Soil Test F' r- ian
Project Name Todd Marek Shaun Bird
j
Address P.O. Box 228
New Richmond Wi 54017 CSTM #x,26900
Lot 27 Subdivision Tory Pines D -te 12/30/02
N W 1/4 N W 1/4S 36 T 30 N /13 W Township Richmond
FJ Boring 0 Well PL Property Line Co ST. CROIX
L BM or VRP Assume Elevation 100 ft.. To Iron
System Elevation 104.2' *HRP" nchmark
Alt. BM = Top of Steel : llo t @ 103.0'
B.M. 2 1'roperty Liiie
Alt
.M.
0 '
40' B -2 104 105'
3%
Slope
120'
f
20' �
25'
B -1 0
a�
0
Pro Road
Wisconsin Dep&tmnt of Commerce SOIL EVALUATION REPORT Page of 3
Division 61 Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County � . Cr^o i x
Attach PaP� P on complete site plan not less than 81/2 x 11 inches In size. Plan must
P
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.
Please print all information Reviewed by Date
Personal Inforrnation you provide may be used for seco purposes (Privacy law. s. 15.04 (1) (m)).
Property Owner Property Location
mer LLC Govt. Lot IV 1/4 N u ,) 114 S 3 T 3(j N R E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
3�4 Pe�,id , .. 21 _ _. _ f P�r�es
City State Zip Code Phone Number []City ❑ Village 0rown Nearest Road
6 LoCod M N I 55 ( - 1l ) - 1
EL New Construction Use: Residential / Number of bedrooms 3-4 .. Code derived design to y 50 GPD
❑ Replacement i ❑ Public or commercial - Describe:
Parent material + i I I Flood Plain elevation if appli ble lU "I A - 9 ft.
General comments �� rn elc L l . 10 o —1 if
and recommendations: s ° �' - t, �v 0
�o✓i ��� �f� 2
FT] Boring # ❑7l Boring
Pit Ground surface.elev. q d ft Depth to limiting factor 2t� 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 'Eff#2
h -2 1p Z st I 2rmr ok C's
I 5 $
N -2c1 Iq 5 i c.l k n4 ` cS _ 4 tp
a
Boring # r❑r Boring
2 l� Pit Ground surface elev. 1 9 9 wl� ft. Depth to )'im)Gng factor 2 5
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 •Eff#2
r Z — P I 2r6a& r4r C 3 I v 5 $
2 -ZS 4� �t l y s� �► bk m�� c - 4 , (P
3 - (o ,f)h c - 7.5 O 5 ,�, big ice; - cE
Effluent #1 = BOD > < 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
Address Dale Evaluation Conducted Telephone Number
0115)2 7 -4008
•
i
Property Owner Arr)e 1 n e5+men + , LLL Parcel ID # Page Z - of
J ? F Boring # ❑Boring Ground surface elev. fL Depth to limiting factor 5(P in.
Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Str uchue Consistence Boundary Roots GPD/ft
.._..
In. Munsell Cori Cobr Gr. Sz Sh. •Eff#1 •Eff#2
1'0 r — Vii' 1... Z rn o'b�' r )v c S 1 \j �' S
Z
7- -2-Z 1 S cl c 5
3
Z% .S m -S q m-�
Boring # ❑ Boring
❑ pit Ground surface elev. R Depth to limiting factor In. Soil Application Rate
Horizon Depth . Dominant Color . Redox Description - .. _. Texture _Sbucture Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
a Boring # ❑ Boring -
❑ Pif • Ground surface elev. ft. Depth to limiting factor in.
Sal 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 •01#2
• Effluent #1 = BOO, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 13013 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 access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R07100)
PAGE 3 OF
NA S TOT# � 7 7-L T DES(:RIP'T'ION XV� Y ,S 3 6 T 30 ,N,R, E(or3
SCALE: V
BM I ELEVATION X60• o
BM 1 DESCRIPTION -f—
BM 2 ELEVATION U
BM 2 DESCRIPTIO
SYSTEM ELEVATION loo y a
ALTERNATE ELEVATION �c
CONTOUR ELEVATION
e w,) i
i
I
SIGNATURE DATE 7 2
ST CROIX COUNTY
SEPTIC TANK mmm?,NANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer `
Mailing Address fJ
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
I
LEGAL ' DESCRIPTION /
1 b , N- W, Town of
propertyLocation k m/4 m/,, Sec
Subdivision /,zA Lot #
61 9
Certified Survey Map # __. Volume _ , Page -
Warranty Deed # � CID I . Volume 20 (off , Page # �
Spec ho uses ❑ no Lot lines identifiable es ❑ no
SYSTEM MAIN7CENANCE ture failure to bandlewastes. Proper maintenance
Improper use and mainteaanceof your septic system could result in ixs prema What you put into the system
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper.
can affect the fimction of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Crow Zoning Department a certification form, signed by the owner and by a
master plumber, journeyu plumb z, restrmetedplumber or a licensedpumper verifying that (1) the on -site wastmmterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 fun of sludge.
ed have read the above requirements and agree to maintain the private sewage disposal system with the standards
Uwe, the undersigned
set forth, herein, as set by the 'Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
Office within 30
stating that your c system has been maintained must be completed and returned to the St. Croix County Zoning
expiration date.
l /
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that an statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(b) of
p d above, by virtue of a warranty deed recorded in Register of Deeds Office. / /'
( 1b 10
SIGNATURE F APPLICANT DATE
* * * * ** Any information that is m is- 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 deed
a copy of the certified survey map if reference is made in the warranty
i
J 2 0 6 3 4 8 4
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., MI
Document Number RECEIVED FOR RECORD
This Deed, made between Ames Investment Corporation, LLC, a 12/04/2002 10:30AH
Minne Lim Liability Company EXEWT ti
REC FEE: 11.00
Grantor, and Todd Marek Construction, Inc. TRANS FEE: 233.10
COPY FEE:
CERT COPY FEE:
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Name and Return Address
Lot 27 28 and 29, Plat of Torey Pines II in the Town of Richmond, St.
Croix County, Wisconsin.
026 - 1101 -80 -050
Parcel Identification Number (PIN)
This is not homestead property.
QE) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this _� day of Dec ember 2002
Amen e t nt Corpora on, LLC
s -- • C�� �J
t s
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) y_ STATE YOFIS ONSIN `) ss.
---- �-f - -- County �
authenticated this day of
- --- Personally came before me this _ day of
December 2002 the above named
Ames Investm Cor oration, a innesota Limited
Liability Company l✓7
TITLE: MEMBER STATE BAR OF WISCONSIN
(lf not, ROGER D to me know to be a pets (s) who executed the foregoing
instru d n ged the same.
authorized by § 706.06, Wis. Stats.
t
THIS INSTRUMENT WAS DRAFTED BY +
Attor Kristina Oglan Notary Pu , .late of Wisconsin
Hud WI 54016 _ — My forrurission is permane . (If not, state expiration data :
(Signatures may be authenticated or acknowledged. Both are not necessary.)
' Names of persons signing in any capacity must be typed or printed below their sigvdlc. information Proressfonais Company, Fond du Lac. wi
STATE BAR OF WISCONSIN 000-855 -202
WARRANTY DEED FORM No. 2 - 1999
)REV ODUH[E@ �
L@U 2 ON
I MOLD 14 P@. 000
N89°5
66.4
SWSWIWE 636.97- 8"A11oN= 1030._5
)4 cy PCA_4 _ STORM WATER
53 u7 i PO�nIG� RETENTION AREA i
---- - - - - -- o LOT 30 H.W.E. = •1031.0
o
2.630 ACRES (114,570 SO. FT.)
w
�o
^ MIN FIFE = 1033.00
S 86 °54'18' E 511.87'
W 6 MAI
N
'eui[ N PaHlig ° w LOT 29
.---- - - - - -- 2.152 ACRES (93,744 SO. FT.) ; I
ELEVAnON =1050.98 -
N 89 E 490.37'
I 33' 13 31
• I
S LOT 28
J4 9 PRA4
2 .252 ACRES (98,076 SO. Fr.)
N 89°51'34" E 490.39'
i I
N LOT 27 _ o
0 2.252 ACRES (98,081 SO. FT.) N
Z $ FBI
v O
N 89 E 490.42' ELEVATION =103125 0D •
l
w 8 LOT 26
m $ 2.252 ACRES (98,086 SO. FT.)
BENCH MARK
TOP OF IRON PIPE
_ _ ELEVATION =1028.11 '
N 89 E 490.44' 0
rn