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026-1077-70-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579047 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: Hillard, Darrell Richmond, Town of 026-1077-70-100 CST BM Elev: Insp. BM Elev: BM Description: n Section/Town/Range/Map No: 6L 6 I 26.30.18.407C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z . 51. /6Z• 6Z / a a Septic Benchmark Eu; 5 /L~d S~ last. 9 /66 ez•-L, 3C3-- •7v~d Alt. Bpu Goy, 7. I7 g S, 3 R, u" Ala Bldg. Sewe St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Ja. Z- <7Z TANK TO P/L r WELL BLDG. Ventto Intake ROAD Dt Inlet /~~ZS 9I Z7 afw.~ Septic S4 Z I Dt Bottom /7.r 1 $-7, Dosing I 15 LIB' i Header/Man. 2-7-9 7 -7, 4 Aeration 77 Dist. Pipe z'7s 99. 7Y Holding Bot. System PUMP/SIPHON INFORMATION Final Grade /•-/I 16b. 7f Manufacturer C /I5 P Demand St -VU-4 a 7/.7 S •35 Model Number 6.,1 Epas 36 - jr „ s 9 ac ✓ti ~-b v TDH lift Friction Loss' System HeadsS TDH ' Forcemain Length Dia. / Dist. to Well I ~O~ Z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 (0 1 / „ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type 9f SysteJJ"": / Z UNIT Model Number: 4-1 C~fa.dLA. g DISTRIBUTION SYSTEM aj Header/Manifold Distribution 1 , f x Hole Size x Hole Spacing C/ Veryf)to Air Intake Length Dia \ Length /61' 749 Dia Z Spacing 3 Z /(p ru a SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only No Mulched s No Depth Over De th Over 1XX Dep Bed/Trench Center /74f Bed/Treen h Edges` Top oilh of I P4-- xx Seeded/Sodded Yes D _ s COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / -7q/ Inspection #2: Location: 1322 140th Str t New Richmond, WI 54017 (SE 1/4 SEE 1/4 26 T30N R1 8W) NA Lot G~/~ ~r arcel No: 26.30.18.407C 1.) Alt BM Description reA-, ! g¢~ 2.) Bldg sewer length = / s ;~n 5 X01'"" ^ J("ZL - amount of cover = G^ J\ V w~~ ~'f a GG.~,,~s 4- Le ~~S a~ Plan revision Required? vm Yes No - GS j, Use other side for additional information. Date Insepctor's gnature Cert. No. SBD-671 0 (R.3/97) W LL County Safety and Buildings Division St. Croix / m n Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P A 10 It $ p~ 2 i 153707-7162 t f 7 AUA 0 6 2016 State Transaction Number Sanitary Pei ,p ri 2581984 In accordance with SPS 383.21(2), Wis. Adm.®((ropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-ow ed POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordancewith the Privacy Law, s. 15.04 1 m , Stats. 1322- ! LJ.V\ , 5+", L Application Information - Plea nt All Information ! Property Owner's Name / Parcel # Darrell or Jill Hillard 026-1077-70-100 Property Owner's Mailing Address Property Location 1322 140th St. Govt. Lot ~~7 G City, State Zip Code Phone Number SE Section26 New Richmond Wi. 715-246-3678 (circle one) T30 N; R18 E or W II. Type of Building (check all that apply) Lot 1 or 2 Family Dwelling - Number of Bedrooms '4 Subdivision Name Block # ❑ Public/Commercial -Describe Use ❑ City of ❑ State owned - Describe use / CSM Number L 6 Z % 7 ❑ V illage of X 11z ~(fownof Richmond (era III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Z, A. ❑ New System OCRe lacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) P P ❑ B. Permit Renewal ❑ Permit Revision Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Iss ❑ Before Expiration Owner A 9 IV. Type of POWTS S stem/Com oneat/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground [*At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of table oil ❑ Holding Tank ❑ Other Dispersal Component (expl in) ❑ Pretreatment Device (explain) V. Dis ersairrreat nt Area Information: Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Required (s Dispersal Area posed sf) System Elevati 600 -6 1000 0 / 10 n 99. VI. Tank Info Capacity in Total # of Man acturer Gallons Gallons Units o ° y h New Tanks Existing Tanks ` o d P -U p 2 61 n Z J c v y A is 8 a. Septic or Holding Tank 1250 eks X Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for in llation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum is Sigma MP/MPRS Number Business Phone Number _ Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code) 927 150th St Roberts Wi. 54023 VHI-County/Department Use Only ing A t Signur Approved sapprov Permit Fee DQate Issu Issu at n Reason for al '67.5. 11 ~ ~ 15 IX. Condi easons for Disapproval t 5 - ro hFc/l 1. MIT"Itox ers:il at;ll al b services iiy. p I'maintained CL r t- i A- (.i1 * es per rnanag@n @nt plia prgvit ed ay lumbg~. / Mo* , . > bm n per q*kW * 0* I Vd , Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6348 (R. 11/11) o ' to a ~ O fsa 0 r, a .y 0. ~ ~X x ~ X U L .o S o o ~ L d h y s' h h o v o y ° y y v~ hb r~ o n"1 O. Q+ n +d. trj 77: OL M W tl ~ 4, A O ~j e e //I ~ fy cr\i ~ O Q 32, L C ti v N ~ N ~ L ~ V tl boy b l ,ti LL ~ ~O o'~~ ~ W tia o ~ 1 y 3 ~ ~ o y L~i~~ x v O C ~ ° ~ ~ h Off' y o cy b O ni 10 b O O O ti 'r O II M a~i cd > y v~~ N v `°v,oo W o 0 A M v, Q >s, Q ~p oGi Q °rnrno~ ~ E° O e it II II o O ~ W W CYt CCU v~ A., ~ h O QI O 0 0 wy II r.. r u 11; CLI c W x to ~ Y ~ II A U C 0 2 otiptxrtirDIVISION OF INDUSTRY SERVICES ~~ti~ roe 10541N RANCH ROAD HAYWARD WI 54843 3 Contact Through Relay http://dsps.wi.gov/programs/industry-services P $ www.wisconsin.gov s Scott Walker, Governor Dave Ross, Secretary August 03, 2015 CUST ID No. 224059 ATTN.• POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/03/2017 Identification Numbers Transaction ID No. 2581984 SITE: Site ID No. 815484 Darrell Hillard Please refer to both identification numbers, Town of Richmond above, in all correspondence with the agency. St Croix County SE1/4, SE1/4, S26, T30N, R18W Lot: 4, FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1548974 Maintenance required; Replacement system; 600 low rate; 39 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; 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 any component manual(s) referenced above. 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: The Weeks 1200 gallon septic tank is actually rated for 1260 gallons so does fit in this application. 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 Industry Services 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 conceming 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. I' KEITH E STONER Page 2 8/3/2015 Sincerely, Fee Required $ 250.00 4AWor This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSNIART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson, Knudtson Plumbing (Plans Mailed To) KEITH E STONER Page 2 8/3/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. v When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-50-)5, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson, Knudtson Plumbing (Plans Mailed To) I I see I test Del cd,111-111, RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Darrell and Jill Hillard Replacement Mound Owner Darrel and Jill Hillard Address 1322 140th St. New Richmond WI 54017 715-246-3678 Legal Description Part of the SE1/4-SE1/4 Sec. 26 T30N-R18W Township Richmond County St. Croix r0b1pITInNALLY Subdivision Name Csm Vol. 13 Pg. 3620 Lot No. 4 APPROVED _ ~ A~ D PROFESSIONAL SERVICES Parcel ID Number 026-1077-70-100 DIVISION OF INDUSTRY SERVICE- Plan Transaction Number Index sheet e Calculations F ESpONpENCE At-grade drawings Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump curve & specifications Page 7 Plot Plan Page 8 %Wl Designer Keith E. Stoner- * : • 't License Number Designer# 1575-007 STONER D-1575 i _ } Signature Phone Number IS. Date 07/22/15 0FSIQN~ ~ttlt10esigned pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07), and both SSWMP Publication 9.6 Dbsign of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (03112) Page 1 of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 6.00 % Site slope 99.00 Contour elev. below lateral (ft) 39.00 Depth to limiting factor (in) 0.60 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 9.00 Linear loading rate gpd/ft 9.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 112.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) a Center or end lateral connection 1 Number of laterals 8.156 Orifice diameter (in) e.g. 0.25 Not a final calculation 2.00 Estimated orifice spacing (ft) 2.00 Forcemain diameter (in) 3.13 Forcemain flow velocity (ft/sec) 175.00 Forcemain length (ft) y or n Does forcemain drain back? 86.00 Pump tank elevation (ft) y or n Are laterals at highest point? 4.55 System head (ft) x 1.3 NA 12.83 Vertical lift (ft) 28.5 Forcemain drainback (gal) 3.52 Friction loss (ft) 89.5 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 118.0 Minimum dose volume (gal) 20.90 Total dynamic head (ft) 30.6 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gal/in (enter result in cell G46) one lateral 1.5 in diameter 2 in x x Treatment Tank Information 3 in x 1200 Septic tank capacity (gal) Weeks Concrete Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok Filter manufacturer 750.4 Dose tank capacity (gal) PL-525 Filter model number F20.31 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Darrell and Jill Hillard Replacement Mound Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW -f ~D7D1 1/613 Observation pipes (2 typical) A 9.00 ft B 112.00 ft 1/6 B 18.67 ft W C 11.00 ft C D 5.00 ft E 2.00 ft D ~ L 122.00 ft B W 21.00 ft A x B 1000.00 ft^2 -L Cap = Total aggregate cell A x B Typical obs. pipe. Slotted in the lower 6", and = Plowed area L x W anchored securely. IR 6" AT-GRADE CROSS SECTION Svnthetic fabric cover 100.83 ft Finished grade Lateral elevation invert elev. 9950 ft ' Observation pipe F/S at aggregate toe E 6 % Slope Surface contour 99.00 ft C A and system elevation D = 12 in. topsoil and subsoil 'Plowed layer over aggregate and tapered to toes. below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Darrell and Jill Hillard Replacement Mound Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End Connection P Last hole dlrilled next to end cap lE X Laterals & for** main of PVC Sch 40 Holes drilled on the W torn of the Imetal per SPS Table 384.30-6 equallgspatced • = Turn-up wdballvslveorcleanoutplug Lateral Specifications 0.156 Orifice diameter (in) End Lateral connection point x 1.96 Orifice spacing (ft) 1 Number laterals 57 Orifices/lateral P 109.76 Lateral length (ft) 30.6 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 30.6 Sys. discharge rate (gpm) 175.00 Forcemain length (ft) 20.9 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device Final grade junction box 4,. disconnect Tank component is Alternate properly vented , outlet location 18" min. Electrical as per NEC 300 and SPS 316.300 WAC Approved Tank full outlet joint = Inches Gallons A Provide 1/4" 0 .c A 21.2 429.4 Alarm on weep hole or m B 2.0 40.6 B antisiphon E C 5.8 118.0 Pump on device. o D 8.0 162.4 86.67 ft C Totals 37.0 750.4 Pump off D 3" Bedding under tank 86.00 ft Goulds Pump manufacturer SJE Rhombus Alarm manufacturer 005 Pump model number Tank Alert 1 Alarm model number Project: Darrell and Jill Hillard Replacement Mound Transaction Number: Page 4 of 8 At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforrn >10E4 cfu/100 mL Service Freguencv Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel 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 toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished . • • • • • • • • • • • • • • • • • • • • • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution 99.50 ft Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Darrell and Jill Hillard Replacement Mound Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10854-P (N. 03107), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BODS 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu1100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Darrell and Jill Hillard Replaceme Transaction Number: Page 6 of 8 Page 7 of 8 XGOULDS PUMPS Submersible Effluent Pump _ EP04 49- 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■ Casing and Base; Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation, Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. a Canadian SwwdardsAsmdation • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS i Motor Cover. Thermoplastic corm ftr ps is ISO soot % *Wed • Solids handling capability: FEATURES cover with integral handle and 'la" maximum. E EP04 Impeller: Thermoplas- float switch attachment points. • Capacities: up to 60 GPM. tic Semi-open design with E Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1'/z" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40`C) continuous 140"F (60cC) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. 9 30.11 • Capable of running sGPM dry without damage to 8 2.5 FT components. 25~ o Motor: • EP04 Single phase: 0.4 HP, u 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with c 5- 15 automatic reset. J - • EP05 Single phase: 0.5 HP, 4 E 05" 115 V or 230V, 60 Hz, 1550 3 10 PM, built in overload with , automatic reset. z EP04 • Power cord: 10 foot s - - - standard length, 16/3 1 SJTOW with three prong - grounding plug. Optional 20 0 00.. , 10 20 40 50 GPM foot length, 16/3 SJTV1! with 30 three prong grounding plug (standard on EP05). 0 2 4 6 a 10 12 m,/h CAPACITY Goulds Pumps Ef 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 :4; i w 0 00 NO ti a, ~ o PQ 0 y 0.,, x X ~ x U o a' a 3 ~ ~ g r e o V ry n o h ~s At ~ n y M U h ~ M R1 ,u y ~ alr O ti L N ~ ~ p0 b0 b ~ O O ~N U W i~Q @ fy ON oot~a ° " o~ b O N b O c m 0 C! A o> o °0 00 r: o -o C05 4 n ~o,rn~F u ~ ,ti ;L a1 II II II ~ O N IF a g $ a ~ o II A v II ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1322 140th St located at: SE V411 SE V4, Section 26 , Town 30 N, Range 18 W, Town of Richmond , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 8-5-15 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Weeks Age of Tank (if known): - 92, Permit number (if own) Keith Knudtson (License P umber Signature) (Print Name) 648443 (Title) (License Number) MP/MPRS 08-05-2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Darrell Hillard Mailing Address Property Address 1322 140th St. (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond Wi. 54015 026-1077-70-100 Parcel Identification Number LEGAL DESCRIPTION Property Location SE '/4 , SE I/4 ,Sec. 26 , T 30 N R 18 W, Town of Richmond Subdivision Plat: Lot # Certified Survey Map # Volume 13 , Page # 13 Warranty Deed # (before 2007)Volume Page # Spec house DyesElno Lot lines identifiable Dyes[]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 §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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. Uwe certify that all statements on is 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 anty deed recorded in Register of Deeds Office. Num 7f bedrooms 4 6 SIGNATURE OF APPLICANT(S) DATE E ***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. 04/12) RECEIVED JUL 14 2015 P A JL q -71 Dowanswof c~t~on0f&ft"GWdGAUNTY SOIL EV RT Page l of -3 COMMUNITY DEVELOPMENiracmdancewth Comm 95. Wis. Ad"L Code A430 corrapte* ste plan on paper not less um 8112 x 11 indres in sizQ. Pion must Co r ty S--/. ' irdnde, but not a a im ve acal and trsramlat re~enoe poi:,t (Btu. drecr and peroergstope. wale ordknerrslons. naih am& &..W kma ion and dis w=%D ne=W mad. _ p 7 7 70 pd Please Print aD ir*WAMNOM by Date Pasand Orwnf;on you plav7du bo used To.soconaaer purposes tg yrs■., s lsA4 t+l (e+)t Owner Properly Locabon 1 I,, f r con Lot : sE 11a f~ 11d T 30 N R /P E tO Owner's Ma ' Lot # Bbdc # Sltid Nicene ar t azz ~yo - r~• y - cay Slate Zp Code PhonB 1 D /o CRY ❑ Viiage Errw1 -Nieaest tea/ ~!i n ri S o t 7/~ G- 6 7f rn/e~ v S71• New Carostrr~cton use 13 Residential Nhrnber of besjrooms code delved design tow rate _ Gov app C~~t ❑ Pubic or . - Des~e. Paert nraberiat . ~ Flood Pain de agon iFappic~e GenweW and reewwwwWpom lkfl4xl- fst r irn~~n~ 1y-r~s+++ , lr9S'` -eAl It l3+ot6g # ❑ Borirg ' . Pit Groundsiafaceele+r.Q# DepUtbim~rgfactor~ir. DqM Sol Appkeson Rate tio®on, Don>e~k P4xl c Desaipion Texprre Structure C.or rce Boundary Roots - GpW CAL Sz C.anE tabu Gr. sz Sh. t 't2 V/Z - - - 2 ,6 - BJ~`•' 2 zge r ✓ Tr r t❑~ g«:rs LI Pit Ground surtaEe elev. - f Z. _ {t DSPlh sa 6rrl V factor YO n FloriaDrr Deth Depth Doerer Redorc Desv"M Terre Shuck" Cans ence Sol GPnff Rate ir> dtrsei Qu Sa Cant color Cr.SzSh gay p q 4rd tS 'M 'Ef 2 L - _ - z w - 2k 6 D- - 2 sc , 0 ,-I m E: 3 xe r v E rent #T = 8t7D > 30 <?2D mglL and TSS >30 < 1'50 mgd ' Ebert # = 806: 3D nv L ad _c, 30 nak CST Now (Plesee~ Ppng - -A g CST Number 'O Address Dale FtraMaaton cardurfied T s y p/ ekOU* Ntrrt w ~ .eo GG~.v ~ ~1~_.~ /[.d - ,,rssr>r ,r i o 2 C~1Z 7>s = y/6 ~ooo pmpmyownw. Y - t'arcat~ _ A-4-- 102 7 -7a 10W " page 2 of 3 Soi i2a/e Hmbm dopdh om*mtcow Rodw p lamas SNKM CaeMORcB Bmadwy . Rmb GPDR Lt Munad CAL SL OWL Cdor Qr S`z. SIL ~tasS 'M Z _ 7.s i Ls s - ~o7r' `Z - ,r/tY tee{ E]0 Q pit Gmundstrfaosdw R, 0401oboymfactor to 5oi Amft*m Rate" 1bximon 6W& Pomkm*Cdm Ae Ia cDeocsln . Tie S me Consideaoa 8amday Raab Gpoff kL IWrmd CkL Sz Cast cdw (fir. Sz. SIL +M TIM { ! Bdigit ❑ 8aiW t._J ❑ pa da~wiaoeals+r. pap& yt 0 facom k ftplCMon RaOe Dapm- Dart ~19" 3oi DesaQiuTeam C~enDS Y Route im flu. Sz Cad: Clot f St OL • SIW" #i WD,> 30_220 nwg& wWTSS ~Wj m RV & • MJent= = 800,= 30 u#L wW TWj 30 n#L Tlfe DR=Imm ofCo xop is an Cgo810 ty 3ety+ia prtvtiidec and ano"m Hym new as a to access wrvicm or wd mumW m an aftmft fob puss coma file &pWhnft at 6g-256.3151 ar TTY M&2648719_ . P ~ f' j ~ t ° I) II ' ~ 11 lr rt 1 t !{Eyr ( f \\V ` X V A i q ~1 '1 it 41 \ Y Nz~ e LN ^ w W v e V i o v ~ Iv 0 o li 1 1 r N~'II(► Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT #1313 Page 1 of :L in accordance with SPS 385, Wis. Adm. Code Keith E. Stoner Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. -70-0 Please print all information. 026-10 Rev' By Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). Property Owner Property Location Darrell Hillard Govt. Lot SE1/4, 1/ , S26, T30N, R18W Property Owner's Mailing Address Lot # Block # Subd. Na or CSM# 1322 140th St. 4 Csm Vol. 13 Pg. 3620 City State Zip Code Phone Number City ❑ Village ® Town Nearest Road New Richmond WI 54017 Richmond Same ❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ❑ Public or commercial - Describe: Parent material Sandy Loam to Loamy Till Flood plain elevation, if applicable Na ft. General comments Re-verification boring to determine extent of weak fine to medium (structure type incomplete) parting to massive sl described by Cst and recommendations: in B#1. Shovel pit to a depth of 30" found no massive soils with a weak to moderate medium sub-angular blocky observed. F 1-1 Boring # ❑ Boring ® Pit Ground surface elev. 98.34 ft. Depth to limiting factor >30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 5YR3/2 sl 2msbk mvfr Cs 3f-m 0.6 1.0 2 5-22 5YR4/4 sl 1-2msbk mvfr gs 3f 0.4 0.7 3 22-30 5YR4/4 Is 0s9 ml 2f 0.7 1.6 Hand dug boring for soil structure verification. * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * E u #2 = BODS < 30 mg/L and TSS s30 mg/L CST Name (Please Print) Signature: CST Number Keith E. Stoner 224059 Address Keith E. Stoner Aate;Ei-'--t',n Conducted Telephone Number 23220 Wood Creek rd. Siren, WI 54872 7/22/2015 715-653-2324 SBD-8330 MOM) RECEIVED JUL 2 7 2015 ST. CROIX COUNTY "'OMMUNITY DEVELOPMENT y a°i °o °o N 0 0 0 1 C7 Oq ' N N a' I ° ° ° 0 N O O A 'O ~ C ~ N ` O O~ L Op C3) 0 3 = E U N w N Y N N° N N= c 3 NNN m O C m N C 0= L R L 7 N m- O--0 ° o o cca E ri ~aYY ° NL E° m Na v a~ a° a 3 ° 3° c _ a o iv (D f; o - - o 5, Q- C7 L N N _N C N O O C 7 O U Y N M N 7 m m° a .2 O' N L x OvE Ec~ 2 TNp~ i U 2.2 E C N> p m U y C is 4-cN.--a7 c0 3c m~ o>~oo°c°m2E2-2°°0 > om ac o 0(n EL ° u) M ° N m N C ~7 .tea Z u7 U L > N.L.+ NN a 07 N N U) cN > -O O 2 m N - a7 am) C 03 NN may N> m,o c ~Nw c z E m'0 U(m= o oNEY L °a w ° _ - 3 - - a7 3 a7 - 0 c U. c °oE mO QO a o>pYN-o-° V) o- O N O O N C` p L T O- OU d 0 0 m 7 N - C O a. Y T C- _ O C L Y L Q U N ~i ML N O N m U N 3 am a= E c 3 3 r7 z iii a~o W E0 o z a co 07 w a m N F- (n O Z d ° c v o Fz- 07 rn c 0) a) N Y U N 7 O (n cr N O O • Ai L c N N d 0 c 2 O - o o `7 Q a O Z F- z z o N co ~a E a R o y _ c CL u~) a m ` m .M-- ! 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S 0 '0 15 '0 C*4 co M U N M O N N fp U^ O N N m U ~ • O O N of of m O Z C Y a- In Z C Y 0- I U • C. d V p E c c r A vat oU)0 f 1 r ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner f! Property Address o !r City/State ,mss X i. ,0 Legal Description: Lot Block Subdivision/CSM # /a/a, Sec,G, TZN-Re!!r6, Town of PIN # Q!!;7- 47 ?o SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer _ /~z 4.j Size ST/PC 7 Setback from: House4~_ Well 0 P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: .-G--~4 Type of system: Wid Length Number of Trenches Setback from: House _ Well v /L _ Vent to fresh air intake y ELEVATIONS: Elevation Description of benchmark ~ AO'V Description of alternate benchmark c Elevation -G-- 97, 73 Building Sewer ST/HT Inlet V ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System V) 7=) 60 ( ) i Final Grade Date of installation zkap- ermit number State plan number Plumber's signature icense number Date i►2• Inspector K~,.+~.• Complete plot plan Or ~e P,~~~ ~~~~,'~~s Bw~ ram„ h,w~ t NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN W hv~ ? ~s i i INDICATE NORTH ARROW I / Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No... ST. IX Personal information you provice may be used for secondary purposes (Privacy La S.15.04 (1)(m)]. 338911 Perrp~t glE{e,'s' '~xAEL El Cit YC lffi Town of: State Plan ID No.: CST BttCCM Elev.: Insp. BM Elev.: BM Description: PlU Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0.67 Dosing a2r 3-~ Aeration Bldg. Sewer 07,13 g,s [Holding St /Ht Inlet 3.q CI&-10- TANK SETBACK INFORMATION St/ Ht Outlet, .S~ Vent TANK TO P/ L WELL BLDG. Air ito ntake ROAD Dt Inlet Septic > $O' 0713 f NA Dt Bottom Dosing NA Header/ Man. ~z S Aeration NA Dist. Pipe 3.9 7 Holding Bot. System g;}g 9Z• PUMP / SIPHON INFORMATION Final Grade 5,0 95,6 Manufacturer Demand 46 , 2Z Model Number GPM 7DH Lift Frl Ss TDH Ft Force nTS-inTLength Dia. Dist. To Well SOIL ABSORPTION SYSTEM &W H Width I Length No f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5(.. 74' DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf~~t re SETBACK f~ INFORMATION yPem CHAMBER Numbeu System: 1(6- 02~, OR UNIT Mo el Cy" DISTRIBUTION SYSTEM Header / anifold C~ u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length CR-- Dia. l Length Dia. Spacing a 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 Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) 14_40 -7'Z3_94 LOCATION: RICHMOND 26.30.18,SE,SE 1322 140TH STREET - LOT 4 e4 sza reM o l~•~. D Ln L-- & aJ ~1~. .~o~.e- w s~,e~ Co~oL+m ~~R~o 2o~e¢ se• .~Jl g ~0 , r Plan revision required? ❑ Yes *ANo Use other side for additional information. III 1 C!U SBD-6710 (R.3/97) Date Inspector's Signature Cert. No t ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E ; E mm.. P i t 3 € 3 z 2 x ¢ S f i S - c c 3 ~ t 33 Division SANITARY PERMIT APPLICATION 201 safety W. and B Washin ngtton on Avenue Visconsin with I P O Box 7302 Department of Commerce accord LHR 83.05, WIS. Adm. Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County 1 than 81/2 x 11 inches in size. G,"M 44 • See reverse side for instructions for completing this application State Sanitary Permit Number Personal information you provide may be used for secondary purposes ❑ Check if revision tto previous app ica►ion [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEAS PRINT ALL INF RMATION Pro erty Owner me roperty Location 54 14 1/4, S~ T;:FQ , N, R E (049~) O'f ~f .E Property Own s ailing Address Lot Number Block Number C)ate s~ Zip C de Phone Nu er Subdivision Na a Numb l (lam® fl) ? - ~ D 2= i 3 . ~jtvZU II. TYPE F BUILDING: (check one) ❑ State Owned 0 ty Neare ad VI t age Public 591 or 2 Family Dwelling - No. of bedrooms Town OF 111. BUILDING USE: (If building type is public, check all that apply) arcel Tax Number(s) 4 ~6 -/07~-moo-/d o 1 ❑ Apartment/ Condo Z6.3D• 14R. 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. sa New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an - System System Tank Only ______________Existing system ________Existlng System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12jj55eepage Trench 22 ❑ In-Ground Pressure i / ( 42 C] Pit Privy 13 [1 Seepage Pit c~ X S(~ . ZS 3 ❑ Vault Privy 14 ❑ System-In-Fill r a ,~A ay. VI. ABSORPTION SYSTEM INF MATION: J~jGk w-ber5 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade f~ Q Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation vl 5~7 Feet Feet VII. TANK Ca in gacct gallons Total # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted T nks Tanks eptic Tank o o ing Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plu is Name: (Pr ) Plu r Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plum is Ad ress (Street, Sty, State, Zip Code): /yt r•- dD IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issuin Agent Si nature (No Stamps) [Approved ❑OwnerGiven Initial 7,7- 00// Pb Surcharge Pee) lei 1 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1 _ A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in.the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning,your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only.. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 112 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. . The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ID " f _ lll~ lo- 17 l~ r r s 40 Wisconsir.Departmertt of Commerce SOIL AND SITE EVALUATION Div~illiuxt of Safety and Buildings Page of Bumn of Integrated Services in accordance ft~HR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 1 n size. Planlnust County include; but not limited to: vertical and horizontal (B ir~tion and e r per;nt slope, scale or dimensions, north arrow, and I and di¢ tWd rest road. Parc I.D. # art;~ Oro," 664L" ~y z ~r r, APPLICANT INFORMATION - Please prim A- 4 infor abi , 09 f R ewes by Date Personal information you provide may be used for secondary (Privy T fv1S604 (1) (m) j Cl i Property Owner ING OFF, ro ation j loo 1/4 _ 1/4,S T o,N,R E (or W Property Owner's Mailing Address c ! lock Su . Name M# ,.t Ztj Y L`cC t~' 6 cO3- Uc I I; 3&z City to Zippbde Phone Number Village Town ❑ City Nearest ❑ lipao New Construction Use: lehesidential / Number of bedrooms Addition to existing building ❑ Replacement / ❑ Public or commercial - Describe: Code derived daily flow 6 ~D gpd Recommended design loading rate : 7 bed, gpd/ft2 trench, gpd/ft2 Absorption area required S$ bed, ft2_2 trench, ft2 c~ Maximum design loading rate e2 bed, gp trench, gpd/f12 Recommended infiltration surface elevation(s) Q ]~i- 0Q / &4d el rft (as referred site plan benchmark) Additional design/site considerations rn `T a J011~- Parent material /v /,"!e Hood plain elevation, if applicable A2 l ft S = Suitable for system Conventional Mound In-Ground Pressure TAT-G.3rade System in Fill Holding Tank U unsuitable for system I to S0 u s❑ u W s❑ u ❑ u ❑ s u ❑ s Btu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I~ '~3 z CS ►7 Ground o- , Y b r nn 14- S, elev. 9 6~ft. - ~ s i w ~i~ ~ ~ ~ ~ Depth to limiting n. 5"s Remarks: i Boring # 0- 10Y1- 112- A4r--9- kyl ImAK i3 _'S: '6' Ground -u / ~l J4 , /.~I~ft' , Depth to limiting fact . / a. Remarks: CST Name (Please Print) S nature Telephone No. 'S k~ - 6 - Address , Date CST Number SOIL DESCRIPTION REPORT • PROPERTY OWNER~~~ Page yof PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench J' ;1 Gold 40LI) elev 7-ft. ~.ri N N Depth to limiting 7 faL ~ gtoS,. n. Remarks: Boring # J D 5 a 3 4- •6 k., 41 - 4eed)t~ Ground S 11 S' i elev. Depth to limiting 7) f~ctgi ~i-n. Remarks: Horizon Depth Dominant Color Mottles Structure GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # V, Mfy- L Ground u}- 9 rift. Depth to limiting fa for 7 '0 in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) Soil Test Plot Plan Project Name Mike Reed Shaun Bir Address 1112 County Road G New Richmond Wi 54017 STM #226900 Lot Subdivision Date 2/6/99 SE 1/4SE 1/4526 T 30 N/R 18 W Township Richmond Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Wood Corner Post System Elevation 90.9/89.5 * H R p Same as Benchmark Alter BM Top of Wood Post @ 99.6 " KB.M. 140th St. B.M. 5 Acre Parcel 95' 5' B-4 30' B-2 5% Slope Rep A Pri A B-3 80' 80' 0 0, BP m CD House r B-5 15' 15' B-1 00 )S-9q ftN` r~ !~0 2 L.tS _ 20.41 acre s 23 q-g _eCERTIFs~ RVEY MAP Located in part of the Southeast Quarter of the outheast Quarter of Section 26, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. EAST 114 CORNER-•-g Prepared for and at the request of: SEC. 26-30-18 % Bridget Bauvals (ALUM. CO. MON.) 1394 130th Avenue ml New Richmond, N 54017 M \ OWNER: 1 Margaret A. Brown LOT 2 Drafted by. Krleti A. Eylandt CERTIFIED SURVEY MAP 3• LEGEND ' VOLUME 9 PAGE 2551 I `.~I I County Section Corner Monument of Record NORTH LINE OF THE SE l o' • Set 1" x 24" Iron Pipe weighing 114 OF THE SE 114 NI I a minimum of 1.13 pounds per linear foot. S89'40'1 5"E 675.01' O Found 1" Iron Pipe ii 642.01' , i LOT 4 33.001- i u N TOTAL AREA: i o °1 S'1 -1~ I $ 218,025 SQ. FT. i °o I °o ° °7 w • j 5.01 ACRES ' nMi N N U RONAID F. ~tl N 7 c AREA EXCLUD. R.O.W.: MIM I z °a' JOHNSON I 207,366 SQ. FT. 40 U c 0c ' a 8-1106 AMERY. 4.76 ACRES I I z a E ai WIS. N89'40'15"W 675.01' I I c~ g ` a 0 <qN J~•1 1~~ i\'_--- -----642.01=---- i I .012 N O SU R \ 1 I y o o ~~~IQt4'itlws I j 33.00' ° ON I I I \ I co cp I 1 I 4) 0 u;>o QjNI M I u I I I N1J.11 ° v a ~I NI N I I : (AAA I I ( WI V a`~ ` o I W I j : c I I 1 3 I V )l E c o d r)I .-I ZI I el gl u,.2 cs L H I =)I aI w I 00 I ^ cn 03 Co oI o, °'I N I LOT 5 : o N00 I o l oI 0 La" ~t I I I `'I OI ° 'a v Fi mI r- TOTAL AREA: I nI N (7) C c m 4- ~I of C' I I I 674,033 SQ. FT. z: <I .°c ° ° c~~i >I oz I r' -ol 15.47 ACRES M. 3 I I F-I ZI 03 ON I I U• '*m1m31 I OI ~i E! 'c 11 I ' CO. AREA EXCLUD. R.O.W.: a: i. Ui I ao iol I ~I o v; c~i N I 620,251 SQ. FT. w: o rn ca 03 rn a 0; i I I 14.24 ACRES u I I I Z. I $I Ll tc- L v I I I 9; I I (A ei c° x I BARN m: I I I W O o a° I I 2 ZF-.aU SIOLO I ( O-2 CC~1 ~ WELL I I I E SHED 1 CENTERLIN ►i i j W~"~~ ~ I I I I I N I I I I DRIVEWAY HOUSE 1 I I I J Ci z~ 33, cn c~ SOUTH 114 CORNER . °f ; I I W 1 ! I M R.O.W. 130th / • \3 I SEC. 26-30-18 (FND 1 IRON PIPE) Avenue L N89'j 00"W _ 642.01 k S89'37'32'E 1931.64_M - _ N89_37_32_W 675.01'~,~ ----N89'37'32"W 2606.65'------- - 33 CENTERLINE 130TH AVENUE 133 130th Avenue SOUTH LINE OF THE SE 114 OF SECTION 26 I I UNPLATTED LANDS Joe 199009 200 0 200 NO TH Prepared by. A & E GRAPHIC SCALE LAND SURVEYING do CIVIL ENGINEERING SCALE IN FEET: 1 Inch = 200 feet Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE 109 East Third Street, P.O. Box 325 SE 1/4 OF SECTION 26, TOWNSHIP 30 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR N89'37'32"W. 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Property Address 1 3,---7o2 / ~fo 7`l1- (Verification required from Planning Department for new construction)- City/State 641 Gc-o/r Parcel Identification Number LEGAL DESCRIPTION Property Locations ''/4, Sec., Td N-Rff W, Town of /1~G/mod Subdivision Lot # Certified Survey Map # ol --6- ,Volume Page # Warranty Deed # W Y~f , Volume a , Page # ~l Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE 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. 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the t ee ear expir ' date. J 3/ If SIGNATURE OF 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 property des ribed ove, by vi 'A of a warranty deed recorded in Register of Deeds Office. SIG A URE 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 VOL 1425PAGE lis 6,427~J0 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Margaret A. Brown, Grantor, and Michael 05-07-1999 3:00 PM R. Reed and Bridget A. Beauvais, joint tenants, Grantee. WARRANTY DEED Witnesseth, That the said Grantor, for a valuable consideration conveys EXEMPT N to Grantee the following described real estate in St. Croix County, State CERT COPY FEE: of Wisconsin: COPY FEE: TRANSFER FEE: 30.00 RECORDING FEE: 10.00 PAGES: 1 I Recording Area Name and Return Address BAKKE NORMAN, S.C. P.O. BOX 50 NEW RICHMOND, WI 54017 026-1077-70-100 (Parcel Identification Number) Lot 4 of Certified Survey Map filed March 29, 1999, in Volume 13 on page 3620 as Document No. 600287, being a part of the Southeast Quarter of the Southeast Quarter (SE-1/4 of SE-1/4) of Section 26, Township 30 North, Range 18 West. This is not homestead property. Together with all and singular hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this (DV, day of May, 1999. 'Margar . Brown AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this (0' day of May, 1999 the above named Margaret A. Brown to me known to be the authenticated this day of person(s) who executed the foregoing instrument and acknowledge the same. signature signature type or print name type or print name CAS L U AJet TITLE: MEMBER STATE BAR OF WISCONSIN Nota Public St. Croix County, Wisconsin. (If not, sion is permanent. (If not, state expiration date: authorized by§706.06, Wis. Stats.) 6 aUw.) THIS INSTRUMENT WAS DRAFTED BY ~(rllile;gf.pgrso signing in any capacity should be typed or Timothy J. Scott panted below their ignatures. BAKKE NORMAN, S.C. (Signatures may be authenticated or acknowledged. Both are p K' necessary.) s Information Professionals Company Fond du Lac, Wisconsin 800-655-2021 G00A87 CERTIFIED SURVEY MAP Located in part of the Southeast Quarter of the Southeast Quarter of Section 26, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. Prepared for and at the request of: SEC. 26-30-18 0RNER--~ ilk T Bridget Bouvols (ALUM. CO. MON.) ' % 1394 130th Avenue 00001 New Richmond, WI 54017 N: 1 OWNER: Margaret A. Brown LOT 2 1 Drafted by. Kristi A. E&ndt CERTIFIED SURVEY MAP _ _ 3 I LEGEND: VOLUME -9 PAGE 2551 I ~I I i c~ ~ ~ County Section Corner Monument of Record NORTH LINE OF THE SE En • Set 1" x 24" Iron Pipe weighing 114 OF THE SE 114 (N~ a minimum of 1.13 pounds per ` linear foot. S89'40'15"E 675.01' 9 1999 ip 2 O Found 1" Iron Pipe 642.01' 13 MAR / i . 1(pVLEEN H. WA M Reg N LOT 4 33.00'=/ ( Cio1xCA WIs S 0 v7 a 4•. ~ Cs n V~.(- o ~ r,, I TOTAL AREA: 'a U 0) o r % ~/2 9l ° 218,025 SQ. FT. i ~o°' M (S 0 TNT, fs+ I N 5.01 ACRES C N o o JC`N~l~^N AREA EXCLUD ROW z ' v 207,366 SQ. FT. - I =c N v o AR4f E;Y, 4.76 ACRES ' I I'r o o u o WIS. ( r<L N89'40'15"W 675.01' o r _ N G Dm +a/er(9 y0 -----642.01'----- ° E c tvO Su R`l~' Opp'`' ' 1 I I U; co fo Aa6Dnr►t19:^,'t.► i 33.00'-~~~ 4 I I 1 1 I b 3 3 c a) 0 °ca~ I I I I M N a~;0a a_M ' f 11 I I INII-1 > o QI I N I WI va MI LO N I I I I I V a~ . 0 a } I ►7 0 „..o o w~ a:! Wi cn, E y Ld c71 r~ •o.• I C', o MI D I QI , rh : d r I ~ `-1 O zl v_,._ c I DI a_ I 0D QI 3oC o; `nW~ ; LOT 5 :30°00 ( ~IMtnl\ -'1 04 0 C °'U o WI W' d N I I I O ~ 0 4) D 0' ~i I I ' TOTAL AREA MIN F= Uj o cv 1' o wi >I ° i i 674,033 SQ. FT. M -1 a N o t>1 z I r` 0 15.47 ACRES Ir-I zl N ym.~ I n 0: d CooIw 3I 1 01 ~ m P ` 1 I co AREA EXCLUD. R.O.W.: Q: oo to I I U a rn ca a) ~I I 'Ct W o u N 620,251 SQ. FT. Ld: 00) 0) r I r-i 2 o a 14.24 ACRES 0: N oI 0- C Z: 0 x_ 0 0 V'I W o y o I I ct O a.o i BARN m• i I z o; ^ :Zt IL z to- ° U SILO V co I Q: SHED 100' ( I 1~ WELL W ~o j I I CENTERLINE ' I I I I N 1 I •I. I , • . DRIVEWAY HOUSE • 1 I 1 O W 2 SOUTH 114 CORNER 1 i I ' 1 f1' I 33 n R.O.W. 130th I 3 I I SEC. 26-30-18 1 / / / o I / (FND 1 " IRON PIPE) 11 / / ail Avenue I / o L N89'43'00"W _.01' S89'37'32"E 1931.64' M _M N89'37'32"W 675.01'____~-, ----N89'37'32"W 2606.65'--- I33 33I - - - CENTERLINE 130TH AVENUE I , 130th Avenue SOUTH LINE OF THE SE 114 OF SEC77ON 26 UNPLATTED LANDS I I I JOB #99009 200 0 200 NO TH Prepared by. A 8C E GRAPHIC SCALE LAND SURVEYING & CIVIL ENGINEERING SCALE IN FEET: 1 inch = 200 feet Phone No. (715) 246-4319 BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE 109 East Third Street, P.O. Box 325 SE 1 /4 OF SECTION 26, TOWNSHIP 30 N., RANGE 18 W. New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR N89'37'32"W. Sheet 1 of 2 VOLUME 13 PAGE 3620 a CERTIFIED SURVEY MAP Located in part of the Southeast Quarter of the Southeast Quarter of Section 26, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. SURVEYOR'S CERTIFICATE I, Ronald E. Johnson, a Registered Wisconsin Land Surveyor, hereby certify that by l;he direction of Margaret A. Brown, I have surveyed, divided and mapped part of the Southeast Quarter of the Southeast Quarter of. Section 26, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin, being that land described in a Termination of Decedent's Property Interest recorded in the Register of Deeds Office in said County in volume 1030, page 27, described, by metes and bounds as .requi red SLa(--e Statute 236.34, as follows: Beginning at the southeast corner of said Section 26; thence, on an assumed bearing along the south line of the Southeast Quarter of said Section 26, North 89 degrees 37 minutes 32 seconds West a distance of 675.01 feet; thencp., along the east line of Lot 3 of a Certified Survey Map recorded in said Register of Deeds Office in Volume 9 page 2551, North Oft degrees 37 minutes 46 seconds East a distance of 1321.30 feet to the north line of the Southeast Quarter of the Southeast Quari:er of said Section 26; thence, along last said north line, this a]so being the south line of Lot'2 of last said Map, South 89 degrees 40 minutes 1.5 seconds Fast a distance of 675.01 feet to the east line of the Southeast Quarter of the Southeast Quarter of said Section 26; thence, along last- said east line, South 00 degrees- 37 minutes 46 seconds West a distance of1321.84 feet to the point of beginning. Containing 892,058 square feet (20.48 acres). Subject to right-of-way for 130th Avenue (a Town Road) along the most southerly line and 140t:h Street (a Town Road) along the easterly line of the above described property. Also subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundaries surveyed and described; that I have complied with the provisions of.Chapter 236.34 of the Wisconsin Statutes and the Subdivision Ordinance of the County of St. Croix and the Town of Richmond in surveying and mapping the same. A Ronald E. nson Reg. No. 11.86 Date A & E Land Surveying Telephone # (715) 246-4319 P. O. Box 325 New Richmond, WT 5401.7 y RONALD F. JOti1.4cr" t J + y 5- 1 1 c~~ ~ Ai,.^. K'! : Y. A r W!3. v' r 00 ♦i 9 ....o•'••~. fvo U) ;a ;rl --i m =a -s m _ aae ";Vx • ~ 8 ~ • ° ti tyT~ MD Mr E: ey (n V, S ►-+cn s Sheet 2 of 2 VOLUME 13 PAGE 3620