HomeMy WebLinkAbout032-2181-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count St. C r o ix
Safety arxf Building Division
INSPECTION REPORT Sanitary Permit No
(ATTACH TO PERMIT) 463314 0
GENERAL INFORMATION 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:
AHRH Properties LLC I Somerset, Town of
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
q (B . (o " 2, C5 ( 01.31.19.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
.3
Septic Benchmark
t �
Dosing Alt. BM
AETiitfaTl ,n / Bldg. Sewer 1 b . % q - 7.
i
Holding F � — SUHt Inlet 1
11.i3 �V - 1 75
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic i Z.5 / � Dt Bottom
Dosing 26 / � Header /Man. 7, p � 166 zS
Aeration Dist. Pipe eq b6 Z'S
Holding Bot. System 1 ��CJ� r �
S n�
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM ` .5J 160 ` G 3 `
j I ; J
Model Number co 40 100.
TDH Li Friction Loss ISystem Head TDH
.13 2. z4 (P-
Forcemain Len gth ii Dia. /I Dist. to Well �� /
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Lengt / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 5 I� �_ \ ` \
N
V
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: \
INFORMATION I CHAMBER OR
Type Of System: �� S v l 1 �J , rA-- UNIT Model Number: \
e
DISTRIBUTION SYSTEM
Header /Manifad �� FDistr I � x H 7 x Hole Spacing � I V?n)to Ai Intake
) I �� � \ 1 i/ i ] 2. VX "^
L Dia Hole Size � h + f V
is �� Spacing Z ,I
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center / I Bed /Trench Edges \ Topsoil , (�(
tom• ' _\e s No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 5 / / (D / &5 nspection #2: / /
Location: 2314 96th Street Somerset, WI 54025 (SW 1/4 SE 1/4 1 T31 R1 9W) Woodlawn Meadows Lot 21 Parcel No: 01.31.19.
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1.) Alt BM Description = _ 0, PIotj
2.) Bldg sewer length = 2Z I J p� � L P I ow
- amount of cover = � ke �
Plan revision Required? Yes J�`�" C Uj ( ,✓:'Z Z/ 5
Use other side for additional information. J �(J'� J
Date Insepctor's nature Cent No
SBD -6710 (R.3/97)
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FROM NORTHLAND PLUMBING, INC. FAX NO. : 715-643-2520 Feb. 10 2005 04:30PM P2
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RE
Safe yxnd Me uildings D
ton Ave,, p_). i1 7; r,:?
n 08) l'i
'son, W1 $3707 Sjijju Permit iry Pert N , lo tw filled in by I V C 0 0 W hingt
0
j,� 6 266-315 1
o,,
(608)266
pe ent of Com erces6l. "; ,,
piplication sale om tjo
�ta Plan I
Number
S3 a Ani
// 0 571(- 1 EAWS t 1
in accord with Comm 93.21, Wis. Adill. Code, personal informAdon you pro••Idt, A ddress (:rlifferent than nilliling addre4s)
may be used for secondary purposes Privacy L-3%v. S15AWO(m) j A
- FApplil-C-on — Information - Pha Print All 1-f-11-2tioll s-1.
p Owner's Na me Parcel i I,ot # Block #
propc Lo
0,oprty Own - Address
A,Section
P
P " 4p-c� Location
Cit State - Z ip Codc Phone Number : � 4 I L I T� R
11, Type of Building (check all that apply) CS, Subdivision Name CSM Number
- Number of Bedrooms
I or 2 Family Dwelling -4
�J sI
Public/Conimercial - Describe Use . ....... 7-..
%( owlisrilip Of
JCIIY !'�Viflage
State Owned - Descrit)e Use
Ill. T of PeritrAR: (Check only one box on line A. Complete line B if
0 Replacement System C Treacment/Holding T;trLk Jz laccfacmonly ter oiici
A. New System Oh Mdf o n In Existing System
List Previous Permit Number and Date Issued
B. Permit Rcticwzl :� Pcrmii Revision 0 clialige of ❑ P fra% fer to Ncw
Before FxDirjuion Plumber Owner
TV. Type KP �WT-5 Sy -ML, (Check -4F
�!'
71 �4ur, - Pressurized In-(;round ❑ MourKI > 24 in. of suitable soil
XMound < 2•; in of 5ill';ihic --ji l Single Pass Sand Filler
ComLructcd Wcdand Pressurized In-Gi•tlund . j Holding Tank Cl Peal Filter Ae - ! - rcaLment 1,)nit
Recirculating Sand Filter
I-) ,
Recirculating Synthetic Media Filter 0 Leaching piarnbcf CJ Drip Lin; G ru v
,. tl-1css Pir,>d OU1er ke
lr
V. Dispersad/Treatent Area InforTna * Y V! C ID MkAk
, 4� UWP--,* 6 5
:]
Design Flow (gpd) Design Soil Applicatio Dispersal Area Requited Or) Dsp ersal Arcs Proposed (st) SyslcmE
el
1 Steel Fiber
r Plastic
N umber Manulactur";
V Tan 0 V-ilpilt:iry In 1 T Nu efab Site
Iq ME
! - -ucted Glass
Gal G flons of Urtits r-Uncrelc I Consu
Existing q W
Exisit
Tanks TVW
Septic or Holding 7ar*
F7 k1nil
1 � -CTII
Dosing haraber
VII, Res Statement 1, the undersigned, amnuttle res pocisibility for 311.11. it'll a dI
Plu De 5 V' IN (Pfino
WD hr attached plans:
,
Plumber's Si cur PAAJ--�s �'Jum USMCSF. Phone Number
y ,7
Pluny6er's Addre ss (Str Cj6. State. Zip ISM
x- ap
Y'llk,"' County /De painment Use Only
Sanitary Permit Fee (includes r,(C;:'Y VMC lssuf�t /-SSUIng 9C SiXII3 re (' PS)
12�11;lproyecj Disapproyed Surcharge Fee)
61d
❑ 0--rigann Reason for Denies
LX. Conditions f Disa
of �PDrov ons or pro P
%YSTEM0WNM- (� PeW' j
I p ic ank, effluent filter and 6 V CgT
dispersal cell must all be serviced / main ained
A p Inai id�fg�men p an provided by plumber.
2. Atieffau Must be maintained 4 () 1, ltrk I
as per applicable code/ordinances
0:�
UAIP-h -Plele *AAJtD the C-ilEity Oojy) lllf2 I L Lnch-A dllill.
;;;Z _D/ Alt,
Safety and Buildings Division Counry
201 W. Washington Ave., P.O. Box 7162 7 - / L" ` x
Nv isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Cc )
De artment of Commerce (608) 266-3151
Sanitary Permit Application State Plan 1 D Number
In accord with Cornm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15,040)(m) Project Address (if different than mailing address)
i
I. Application Information - Please Print All Information O�
Property Owner's Na me Parcel !/ Lot p Block p
Property Owner's M ailing Address operty Locati
"4, A,secoon
�
City .
. State Zip Code P
.) (ci
l r rcl e)
T N; R_'E ( r _ W 7
II. Type of Building (check all that apply)
t l or 2 Family Dwelling - Number of Bedrooms — Subdivision Name y CSM Number
❑
Public/Commercial - Describe Use
❑ State Owned - Describe Use `_]Cir)_[VillageV'Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System ❑ Replacement System g p y 8 Y
❑ Treatment/Holdin Tank Replacement ON J Other Modification to Existing System
B. Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit
Transfer to New List: Previous Permit Number and Date Issued
Before Expiration Plumber Owner
rV. Type of POWTS System: (Check all,that appl _
Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter
Constructed Wetland Pressurized In- Ground Holding Tank El Peat Filter Aerooic " reatment Unit Recirculating Sand Filter
I
Li Recirculating Synthetic Media Filter ❑ Leaching Chamber [I Drip Line ❑ Gravel -less Pi,x JI Other (explain)
V. Dis ersaUTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Req rsal Area Proposed (so System Elevation
V1. Tank Info Capacity in I Total Number 1 1 Manufacturer T Prefab Site Steel Fiber Plastic
Gallons Gallons of Unix Concrete Constructed i Glass
New Existing
Tanks Tanks
Septic or Holding Tuck
Aerobic Treatment Unit
Dosing Chamber
I VII. Responsibility Statement- I, the undersigned, assum responsibility for LpqalJatio n of the PO«"TS shown on the attached plans.
PI u ber's Na me (Print) I Plumber's Sign M A/ PRS Number Business Phone Number
7/s e6
Plu is Addre ss (Street, C4, State. Zip Code9 1 ' /
72 s
VIII. Countv /De artment lise Onl __
Sanitary Permit Fee (includes Groundwater ? Date Issued Issuing Agent Signature (No Stamps)
Approved Disapproved Surcharge Fee)
❑ Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
I I
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Attach complete plans (to the County only) for the system on paper not less than BlR x 11 inches in size t
SBD -6398 (R. 01/03) €
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Safety and Buildings
commerce.wi. OV 141 NW BARSTOW ST FL 4TH
g WAUKESHA WI 53188 -3789
TDD #: (608) 264 -8777
www. commerce.wi.gov /sb/
isconsin www.wisconsin.gov
tl
epartment of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
January 31, 2005
CUST ID No.224617 ATTN: POWTS Inspector
LYLE J MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
E1556 STATE ROAD 64 1101 CARMICHAEL RD
BOYCEVILLE WI 54725 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 01/31/2007 Identification Numbers
Transaction ID No. 1105433
SITE: Site ID No. 694482
Ahrh Properties LLC Please refer to both identification numbers,
County Road H above, in all correspondence with the agency.
Town of Somerset
St Croix County
SW 1/4, SE 1/4, S1, T31N, R19W
Lot: 21,
FOR:
Description: Mound, 3 Bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1002609
Maintenance required; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version
2.0, SBD - 10706 -P (N.01 101)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD -
p Y
10706 -P (N.01/01).
In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the
property owner must follow the contingency plan as described in the approved plans. In addition, the owner must
comply with the operation, maintenance and monitoring duties as described in section VIII of the rrynd component
manual. A copy of this information must be given to the owner upon completion of the prc jeqE:^
et
All holding /treatment tanks are to comply with Comm. 84.25(7)(a). Q
Maintenance information must be given to the owner of the tank explaining that perip clean1 i the filter is
required. Access to the filter for cleaning must be provided per Comm 84 product apv onditions.
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
LYLE J MYERS Page 2 1/31/2005
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
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.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 2 83.52 A POWTS that is not maintained in accordance with the approved management plan or as
() PP g P
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county
for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)
utilized in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
r Fee Received $ 175.00
Balance Due $ 0.00
Julia A Lewis- Osborne
POWTS Reviewer 2, Integrated Services WiSMART code: 7633
(262) 548 -8638, Fax: (262) 548 -8614
jlewis@comtnerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Mound System Cover Page pg 1 of 6
RECEIVE
N MEN
NESEE BORGNE 'E JAN 2 7 200
SAFE & BUILD
Project Name: AHRH Properties LLC
GS
Owner's Name AHRH Properties LLC
Owners Address 404 S. Green Avenue
New Richmond, WI 54017
Legal Description sw , W y,, SE 7 �/, Secr� T 31 N, R F 19 Fw 'w
Township Somerset
County Saint Croix
Subdivision Woodland Meadows
Lot# 21
Parcel ID# Pending
Table of Contents
pg-
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Ma
total # of pages: 6
Designer Name: Lyle J. Myers
MP /License #: I.D.# 224617
Date: 1117/05
Ph. #: 7156432520
Signature:
t
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01)
per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N O'NQ1)
'� � �<.11 I s
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715- 643 -6068 email: 3ba@3badvisem .com
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: AHRH Properties LLC
Site Con Design of Entire Fill
Project Type: 1 or 2 Family D_welM __ _� Cell depth at upslope edge (D): 19.0 in.
% Slope: 7 % Cell depth at downslope edge (E): 23.2 in.
# of Bedrooms: 3 Distribution cell depth (F): 9.5 in.
Depth to limiting factor: 17 in. Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: 0.4 gal /ft /day End slope width (K): 10.7 ft.
Effluent quality Eff #1 • Fill length (L): 111.4 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 7.2 ft.
Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 12.3 ft.
Fill Width (W): 24.5 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal /day Basal area required: 1125 ft
Distribution cell width (A): 5.00 ft Basal area available: 1557 ft
Distribution cell length (B): _ 90 _ - _ 01 ft
Area of Distribution Cell: 450.0 ft Observation Pipes
Contour Elevation of Mound: 98.00 ft Location from end of cell (Z): 15 ft
System Elevation of Mound: 99.58 ft
Final Grade of Mound: 101.38 ft
Mound Plan View
Observation Pipes
T B k—K
I Tilled ArearFill Material
L rI
Mound Cross Section
Final Grade Observation Pipe
Synthetic Fabric F �,: G
Distribution Cell
System Elevation s a �,
Cover Material Lateral 0
Fill Material E invert
s.
Tilled Area
Slope Forcemain System
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(g)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3 of s
Pressure Distribution Calculations
Project Name: AHRH Properties LLC
Lateral Layout Lateral /Manifold Design
Lateral elevation: 100 .1 ft Lateral diameter: �� � In.
Rows of Laterals: 2 - Lateral spacing (S): � ft
Manifold type: [ Center ]w Lateral to cell edge: 1 ft
Ce
Orifice diameter:
0.125 • In. Lateral discharge rate: 9.47 gpm
# of Laterals: 4 System discharge rate: 37.90 gpm
Distal Pressure: 5 ft Manifold diameter: i 2 W In.
Lateral Length: 44 ft Manifold length: 3 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 23.73 Inches Forcemain length: 75 ft
Orifices per lateral: 23 Forcemain diameter: 12 w I In.
Avg. ft /Orifice: 4.89 ft Friction loss in forcemain: 2.240 ft
Lateral Side View
Manifold
Lateral � Lateral
x x x x x x x x x 7 r x 7 r x x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Length Turn -up w /ball valve or cleanout plug
n nT
S
0 0
Orifices on bottom of
lateral equally spaced PVC laterals and forcemain to comply with
specifications per Comm 84.30(2)(e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean -out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimum may be used in
Long Sweep 90 place of 3/8" bar
Lateral
or two 45's 3/8" Bar
Mound System Page 4 of 6
Septic, Pump and Dose Tank
Project: AHRH Properties LLC
Tank Information Dosage Volume
Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? Q Yes O No
Pump tank size /model: W1000 /650 -MR Lateral void volume: 18.8 gal
Pump tank gal /inch: 17 Dosage to absorbtion Cell: 90.0 gal
Actual Pump Tank Volume: 646 gal Forcemain volume: 13.1 gal
Tank bottom elevation (inside): 86 ft Total dosage: 103.1 gal
Septic tank size /model: W1000 /650 -MR
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point? y
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ( "D" to lateral) 13.42 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter. Opening to terminate at or above grade. Friction TOSS In fOrcemaln: 2.24 ft
Pressure loss from filter: � ft
Total dynamic head (TDH): 22.16 ft
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4 Inch ' With Warning Label
Finished A Reserve 21.9 372.9
Minimum
Grade g Pump off to Alarm 2.0 34.0
Alternate C Total Dosage 6.1 103.1
Outlet
Location Elect. per Comm D Effluent depth for pump 8.0 136.0
_J
For ein 16.28 and Total Capacity: 38.0 646.0
NEC 300
Weep Hole A
or Anti -
Siphon B
Device FLOW- LIT /HO R
C 0 1000 2000 3000
D 30 10
N
w 7.5 W
� 20 i
i
5 �
a ca
a a
Pump must be capable of: 37.9 GPM = 10
2.5
and head pressure of: 22.2 Feet
0 0
0 20 40 60 8o
Little Giant FLOW- GALLONS /MINUTE
9EH PUMP PERFORMANCE CURVE
115V 60HZ
Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and /or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 113 of the usable tank volume may be occupied
by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump /dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
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sconsinDepartof}nm� RECE VA County St.Croix
Wisconsin OfiC UATION REPORT page 1 of 3
Division of Safety and Bulkimgs
In acxpS�lan�e yritk�C "p, W Adm. Code
1,; ; i
Attach complete site plan on paper not I than 81/2 x 11 inches in size. Ian must
include, but not limited to: vertical and h rizontpl e qq ga y ( NtJ dire ion and Parcel I.D. Pending
percent slope, scale or dimensions, no arrmV ��"1�}0,CIstance nearest road.
Please prin IM n ormetion. z by a Date
Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). I
Property Owner Property Location
1:1 El
AHRH Properties LLC Govt. Lot SW 1/4 SE 1/4 S 1 T 31 N R 19
Property Owner's Mailing Address Lot # Block # E d. ;Narne or CS M#
404 SGreen Avenue 21 - Woodland Meadows
City State Zip Code Phone Number ay [ Village wn Nearest Road
New Richmond I Wl 1 54017 ( 715- 222 -0169 CTH
E] New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
11 Replacement D Public or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable N-A ft.
General comments Site suitable for a mound system
and recommendations:
Boring # 0 Boring
El Pit Ground surface elev. 9(! 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. 'Effff1 "Eff#2
1 0-8 10yr3 /2 sil lmsbk mfr cw lm 4 .6
2 8 -18 10 4/4 sil 2msbk mfr cw lm '4� -�°
3 18 -26 10yr4 /4 f2f5yr5 /8 sic] lmsbk mfr cw - 2 .3
4 26 -76 7.5yr4/4 fsl Om dvh _ _ 5
F21 Boring# 11 Boring 'l
El pit Ground surface elev. 9 ft. Depth 1)
ate
Horizon Depth Dominant Color Redox Description Texture Sti
in. Munsell Qu. Sz. Cont Color Gr. / y !
1 0 -7 10yr3 /2 sil 2n. r q I
2 7 -17 10 4/4 sil 2m U "t
3 ( 10yr4/4 f2f5yr5 /8 sicl lm, 'C !
4 23-42 7.5yr4/4 - fsl Or. o
• Effluent #1 = BOD > 30::,220 mg/L and TSS >30 150 mg/L ` Effluent #2 = D < 30 mg/L and TSS < 30 ng/L
CST Name (Please Print) Signature CST Number
Thomas C. Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 11/17/04 715- 246 -2454
AHRH Prope LLC Pendin Page of
❑
3 Boring # G Boring r 2�0
a Pit Ground surface elev. � f 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
1 0 -7 10yr3/2 - sil 1 p mfr as lm .4 .6
2 7 -13 10 4/4 - A lmsbk mfr cw Im .4 .6
3 13 -20 10yr414 - sicl 2msbk mfr cw _ .4 .6
4 X29 10yr4 /4 f2f5v /8 sicl lmsbk mfr cw - .2 .3
5 29 -50 7.5yr4/4 - fsl Om dvh - - •2 •5
Boring # Boring
F Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - EfW
F-1 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/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I "Eff#2
' Effluent #1 = BOD > 30 < 220 mg/- and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg&
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- 8330PeA (RAC /00)
I
Woodland Meadows
Scale, �' y
8M 1 Top of conduit 100.00 Lot 21
SM2 Top o conduit 6 uit 97.
81".86
82 56.56'
83 85.21'
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Thomas Nelson
z 227387
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer AtI R 14 I)Uh E M es 6 4r — ,
Mailing Address J S. 6 Kee--A Ave A-1E4'-s (R cet{ tlla OJ&
Property Address �3 S ✓
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location sw '/4, S E ' /., Sec. , T 3 r N - R - Z - LW, Town of Sa
Subdivision W v o bCA4b A.*.-o o w S , Lot # 2(
Certified Survey Map # , Volume . Page #
Warranty Deed # , Volume Page # '2-1 D
Spec house 05 yes ❑ no Lot lines identifiable K yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failuie 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. '
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed 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 fqrth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of thr, a ear expiration date.
1 Z /o �jo5 �-
SIGRWOWOF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro a bed above, by virtue of a warranty deed recorded in Register of Deeds Office. X
SIdR7fUF& OF APPLICANT DATE
* * * *, ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
U, 2 7 16 P 2 10 782676 I'
KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX Co., WI
RECEIVED FOR RECORD
Document Number Document Name 12/16/2004 11: 50AN
WARRANTY DEED
EXEMPT #
THIS DEED, made between Gregory L. Nelson and Linda K. Nelson REC FEE: 11.08
( "Grantor," whether one or more), TRANS FEE: 2013.00
and AHRH Properties. LLC, a Wisconsin Limited Liability Comaany COPY FEE:
("Grantee," whether one or more). CC FEE:
PAGES:. 1
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is I ✓
needed, please attach addendum): Name and Return Address
West Half of Southeast Quarter (W %2 of SE Y4) of Section 1, Township 31 North, -dTZrW ft,7 7 - 7 77,E_ S u�4►�
Range 19 West, St. Croix County, Wisconsin. 6 F /b1 i N/-e S e I`,4
f1' s
,�n �1
032 - 1002 -10- 000:032 -1002- 20-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, ifany.
Dated December 16, 2004
L) c/
(SEAL)
(SEA
* *G gory Nelson
(SEA (SEAL)
* Lin a K. Nelson
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gregory L. Nelson and Linda K. Nelson,
husband and wife STATE OF )
authentica d ZDecen4k*r 16 2004 ) ss.
i COUNTY )
*Kristin land Personally came before me on
TITLE: MEMBER STATE 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 Oeland Notary Public, State of
Hudson. WI 54016 My Commission (is permanent) (expires: )
(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. 2-2003
* Type name below signatures. INFO -PROTM Legal Forms 800 -855 -2021 www.infoprofbrms.com
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