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HomeMy WebLinkAbout030-2153-01-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: City Village Township City Wide Development TOWN OF SAINT JOSEPH CST BM Elev: I Insp. BM Ele v: BM Description: e0 .0 DO -o CSr f,m::k- i TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ©oD lb 0,74 Dosing �t Aerati Hold TANK SETBACK INFORMATION TANK TO P/L AV was t WELL BLDG. Vent to Air Intake ROAD Septic 1 Dosing t < < Aeratio Holding PUMP/SIPHON INFORMATION man 4�Y, -3) Manufacturer De d G P M Hol2 Model Number �3 TDH Lift Friction Loss \ - System Head O TDH - Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651240 State Plan ID No: Parcel Tax No: 030-2153-01-000 Section/Town/Range/Map No: 20.30.19.3071 STATION BS HI FS ELEV. Benchmark � � f � f D .0 Alt. BM Bldg. Sewer O St/Ht Inlet St/Ht Outlet Dt Inlet f Dt Bottom t.qo %-301 Header/an. pq _� 1 3 Dist. Pipe 3r7, 10 5'3a t Bot. System cQ I 0 4'. (0c) final Grrw < < l 6 Oct lZ- coi- r � St Coveg- [+eX r COK,J-00(V, 1 6t Ad9.q-0 �,p bo-9 BED NSIONS Width C� Length No. On2- PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 57 �. s SETBACK SYSTEM TO P/L B DG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION ce. CHAMBER OR �aJ Type Of S yp y stem: } 5D' � UNIT Model Number: DO DISTRIBUTION SYSTEM Header/Manifold ,JJ 1 01 2 t1 Length `�l Dia Distribution Pipe(s) � , l7 Length Dia Spacing - x Hole Size, I Z `b x Hole Spacing 2 t-f Vent to Air Intake 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 discrepencies, persons present, etc.) Location: 499 146TH AVE Inspection #1: (n 1, ?L.bVJ_-5.j Inspection #2: toilz 12.023 I 141 FeN4. 1.) Alt BM Description = 2.) Bldg sewer length `� ,��O.� a 'Vex+ 4- aA4moun of cover = 42- �' 8'�I 1 R G•40 `tom C�L Plan revision Required? ❑ Yes X No Use other side for additional information. SB -6710 (R.3/97) Date i Insepctor's Signature t� Cert. No. - � A&, . �L �, �te� . 3 • D r1Sass &A -p- y-fr w�a�+�.ks a 2-p Ft StsS s+� �W#.X ► k --v �A aAm r.1�mo:J �° • R County FD) F \Vj E Industry Services Division t �3 ,. 4822 Madison Yards Way Zvi Madison, W1 53705 Sanitary Permit Number (to be filled in by Co.) -, `r p 51 S JUL 21 2023 P.O. Box 7162 1_ Madison, W1 53707-7162 z State Transaction Number ��; il7la ."_r)_iefth;At Application In accordance with SPS 383.21(2), Wis. Adin. Code, submission of this fon-ii to the appropriate governmental unit 3 0a. is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m)., Stats. 1. Application Information - Please Print All Information Property Owner's Name Parcel # c I 4y I \)JO r�% uj-dcel P6, �_rll Property Owner's Mailing Address Property Location Govt. Lot City, State Zip Code Phone Ntimber 70 0 -1 . C �_ 1/4) 1/4 Section It. Type of Building (check all, that apply). Lot # T N R lq..E 40 or 2 Family Dwelling - Number of Bedrooms Subdivision Name k Block # P .1 om ublic/Conimercial - Describe Use 7City of E]State Owned - Describe Use CSM Number Village of own of 5f 05trk f[L. Type of POWTS Permit: ,(Check. either "New" or "Replacement',' andother applicable on- line A. Check one box �on line B. Complete line C.ii A. ystern ew System Replacement Systein E]Other Modification to Existing System (explain) FlAdditional Pretreatment Unit (explain) B. 01 (Ii ng,,,ank In -Ground at -Grade Wound Individtical Site Design Other Type (explain) (conventional) 2 L4 C. QRenewal Before [:]Revision DChange of Plumber Dransfer to New Owner1.1st Previous Permit Number and Date Isstied Expiration iv.,,jjispersau,u-,reatme11t Area ana. ianKiniormation: D X5-t VivulAACQUI -4"ZV- 1.-0 ( Ix j Desi n Flow (gpd) Design Soil Application Rate(gpd/so Dispersal Area Required (so Dispersal Area Proposed (so System Elevation ,,ram Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units '0 2U 4-J New Tanks Existing Tanks 4�- 0 a. U to 0%,FLIV V1 a11K WIPA NJ = r= = 0 DoshigChainber V. Responsibility Statement- 1, the undei-signed'Vassun nsil)ility fol? installation of the POWTS shop n. owthe. a ttac lied. -plans. timbe Pkwiher's Name (Print) P1 ;7nature MP/MPRS Number Business Phone Number V, z OO 1 7/� r Y P55niber's Address (Street, Cit , State, Zip de) r It - Cf 2?Al LIT 3 Z., V1. County/Department Use Only Approved oved Permit Fee Date Issued Issuing Agent Signature IV iven Re i for Denial Conditions o(Ap Approval Disappr-qv-al 3� A t l �. �, {� �� V s `� SYSTEM OWNER ire C4��Co 1. Septic tank, effluent filter and dispersal cell >? S(2? C,-" LA— ws �&qu,,4 & must be serviced / maintained as per ALL LA,& management plan provided by plumber, ikr�,4r qffu6z 2. All setback requirements must be maintained 6 � /L41 err-- as per applicable Code / ordinances. 6,t- Attach to complete plans for the systev awl submit to the County only on paper not less titan 8 1/2 X 11 i[ICIICS in site .qnT)_A,_1()1q M M/? I 1 System PLOT PLAN PROJECT Citv Wide Develooment ADDRESS 404 La Grandeur Road. Somerset WI 54025 SE 1/4 NE 1 /4 s 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 105.5' DATE 7/5/23 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT MOLDING TANK MOUND xxx SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 546Gallon HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone kk BENCHMARK V.R.P. Top of 3/4" Pipe . ASSUMEELEVATION goo Filter Lifetime BOREHOLE (D WELL * H. R- p, same as benchmark [_N COPY Scale 1 "=40' Area 15' Below Mound is to remain undisturbed Well is to meet all WDNR Setbacks �-1 1061 B - 2 -- 104.5' 1044 80th 1 02' Grading to be done to divert runoff away from system Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 July 21, 2023 CUST ID NO.: 226900 SHAUN R BIRD 1432 120TH ST NEW RICHMOND, WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/21 /2025 MUNICIPALITY: TOWN OF ST. JOSEPH ST. CROIX COUNTY SITE: CITY WIDE DEVELOPMENT 499 146TH AVE SOMERSET, WI 54025 SETA NEIA S20 T30 N,R 19W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 26" Maintenance Required: Effluent Filter O�QART)4 =w Phone: 608-266-2112 Web: http://dsl2s.wi.gov Email: dsns�cr�,wisconsin:.ov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-072301465-C Application No.: DIS-072330644 Site ID No.: SIT-118386 Please refer to all identification numbers in each correspondence with the Department. Mound Component Manual - Version 2.1 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: The building sewer shall be installed/insulated per SPS 382.30(11)(c) Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. The dispersal cell site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the dispersal cell site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval and Wis. Admin. Code § SPS 383.54 1 . • 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. 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. 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. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Elizabeth Rudnicki Division of Industry Services Phone: 608400-3186 Email: elizabeth.rudnlckl@wisconsln.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Ex ected: $0.00 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 07/05/2023 Owner: City Wide Development Location: S E 1 /4 N E 114 S20 T 30 N, R 19W 146th Ave, St. Joseph Manuals Used: Mound Component Manual Version 2.1 (May 2022-27) Pressure Distribution Manual Version 2.1 (May 2022-27) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil test /Y Shaun Bird Signature 'X/Y License number 22 900 Page 1 of 9 System PLOT PLAN PROJECT Citv Wide Develooment ADDRESS 404 La Grandeur Road. Somerset WI 54025 SE 1/4 NE 1 /4 s 20 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 105.5' DATE 7/5/23 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT MOLDING TANK MOUND xxx SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE 646Gallon HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone kk BENCHMARK V.R.P. Top of 3/4" Pipe . ASSUMEELEVATION goo Filter Lifetime BOREHOLE (D WELL * H. R- p, same as benchmark 146th Ave Scale 1 "=40' p' 40' 80` Pro 3 Bedroom House Wieser Combo Septic Well is to meet all WDNR Setbacks 10% Slope B•3 Area 15' Below Mound is to remain undisturbed 2801 B - 2 150' -- 104.5' 10 4' 80th S 1 02' B . M . * Grading to be done to divert runoff away from system Mound System Cross Section and Plan View v r ♦• L 4 v v f• r r •�� < �z���3 ? �� �}3 �� �•z �r�� r�� ?%��_ ��•�� �� ,���� � � �z'g;fir ��� ��� rr � �x� ��� s � 14,3i��_�ii� i�i{ �t4 .t � l fti.�it r Dimension I Feet I J K L `JV Z Slot Topsoil ASTM C-33 -- aggregate r 4 in. sch. 40 �- Clean can aggr pvc • a dia. Ca Material sand fill z/Z to 2 '/ in. observation pipe . M r• ,t, t `�1ti1ti11��111�11►1►1� �.... . ��:::tiiti�ti��i�ti�itiitiiiiiiiiii :►witiiiiiiiti��y,.►�.•... . •.�titti»��ti1.1ti111b1_�1111rti11111►1►`ti11�111111��11ir`.`�.w.-����_ _ Id��.t Contour Plowed Surface ftWI, Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Fxisting vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or Plowing maynot proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire chisel plow,g p • rolled between the alms of the hands. ASTM C-33 quality sand is placed Immediately when a sample is ro p after plowing. Sand is pl aced with a tracked machine keeping 12 or more inches of sand under the tracks or a backhoe. Special care must be used when placing sand of less than one foot is placed overhead by p thickness to minimize compactionp of the lowed surface. After the topsoil cap is placed, the entire mound and mulched to promote vegetative growth, limit erosion and protect from freezing. The is seeded a p g observationpipes i es are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page of Pressure Lateral Layout Two Laterals -- End Manifold Man Force Main ded gout g ng Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40. PVC pipe. . Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleano Lit lug and are enclosed in a 6-8 inch p diameter lawn sprinkler valve box accessible from finished grade. Page A ___ of _1___ 03/05 lgj go Ormar1ce �CX Yc ions -dose �r�. ��o� s ection And Puny � Perf ....•.�...�.� pw,n Manufacturor _ PPuntPr .. Prank 'Manufadurer 1 � ' 1 , , ._..__......._..__..........�...�..- �- Number r .._..w•__.�w_-1 't"ank. N Udel Nummbar .� _.........�._...._._.. Alarm an,�facturex C.1 Total Tw* Capacity . Model odel Number -�- Max. duty nth � Alarrri ..�.�. switch 'T'ype - --9 Filter Manufacturer Filtor Modol Numbor _._r.. Minimum Pump erforrnance Required TDH GPK, Z., Ft inlet Outlet Manhole M!n. 4" Above Grade With Looking Device. Inlet MWIhole C 6" Below Grode Sealed Watertight Switch Seams s and R6serve Ca achy 'dank. Voiume � �' ON w Uirnensign'Inehes Volume Gal. (reserve) / ge alarm) B 2OL/ dose) C (dead) D ; ;r e�7 -7 Z�2 Total . U -5-D Total Dynamic Head (TDH) Feet BICyotion Hoad M.......�- ...�..�_.�,�...._ Distal Pressure Notwork Loss Force Main Uss Total R ti d-.....bdA A. Manhole ;Min. 4" Above Grade With flocking Device r.rw• r Sam r Disconnect Mears Bottom Eleva `on .i i L GENERAL INSTAf LLATION: The septlddose tank is bedded and hack filled in accordance with t e manufacturer's prodact approval speoifioations. Maximum depth of bury as spuoffied by tho manufacturer may not be exceeded without prior 4pproval. Manhole covers exposed to grade have an efi'eative locking device (padlock) installed. Piping at the inlet and `outlet 1s of approved material, cortnected to the tank with watertight fittings, and laid can atubl 901H to prevent wttling or sagging. The fcrcu main Is slooved with 4" Sch. 44 PVC to bridge the tank excavation a Id the sleeve Is sewed watertight. Electrical servico complies with NBC Oo and Comm 6.2 . 02/05 11 Wage 5 of 1 280-SERIES 112 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pimp for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow, Performance Curare: 280-Series Designed around Liberty's unique "Uni-Body" casting, 3 the 280-Series will provide years of reliable performance. * All Modelo FeaturesLL 9 Vortex style Impeller ermittiri passage of solids Y p p g P 9 cD up to %" Z • 416 stainless Steel rotor shaft Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners -- corrosion -resistant stainless steel • 11/? Discharge • Stainless steel bottom screen - easily removable Maximum fluid temperature:140' F. 280-Series cord Lengths Model 10' 25' -2 35' -3 50' - 280 Standard Optional Optional Optional 281 Standard Optional Optional 0 tional 283 Standard Optional Optional N/A 287 Standard Optional NIA N/A 10' cord length standard on all models. For optional lengths, add "-2o -3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) e -7 Z_ Model 280 Manual, no switch VA Model 281 Wide angle float switch with quick - disconnect 0 5 01 i e e i n#; in is; 2n 2s so 35 12 i1 9 8 6 .(D 5 3 2 0 T - U.S. Gallons Per l inute --� 0 38 78 114 156 s 192 228 270 Liters Per Minute Dimensional Data Weight: 29 Ibs. Height:13" Major WIdth:10" (model 287) - q 5 sU_f preg Minimum Sump Diameters: Model 281, 283...14" Model 287 VMF... 10" Factory switch Model 281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn oft level 7" 4.0" The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 is not adjustable. Model 283 Wide angle float switch with series (piggy -back) plug vj-A -C Dfiy Model 287 VMF-Serles Vertical mag- netic float for smaller pits .- will operate in a 10" diameter sump SS �ico CLIrT�iFD G us Certified $pWRoaWm we subjoot to ohango wlthou! nollcw. V . v Liberty Pumps 9 7000 apple Tree Avenue • Bergen, Now York 14415 • Phone 800-543-2554 Fax (585) 494-1839 www.11bertypumps.com Copyright 0 Llborty Pumps, Inc. 2017 All rights reserved. LLIT 2000 R06/17 N mim?-A OAS= 5 RAP .0 1 Gap between Lose and Sewnrne SECTION A -A 91 1.1921 59 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of -FILE INFORMATION OwnerN � W � Peron # ]ESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units >12LISIA Estimated flow (average) ailda I Design flow (peak), (Estimated x 1.5) . . ir�rr��.rrrr..n...mrir.r.rr•- rwr gat/day Soil Apolcafion Rate 1 z aUda f Monthly average* ,Standard influent/Effluent Quality Fats, 011 & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (13013,5) s220 mg/L ❑ NA Total Suspended Solids (TSS) S150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODQ) :530 mg/L Total Suspended Solids (TSS) :530 mg/L *NA Fecal Collform (geometric mean) :1 (� cfu/100mi +Maximum Effluent Particle Size Jfi in dia. NA Other: NA '*Values typical for domestic wastewater and septic tank effluent. N A1NTENANCE SCHEDULE - SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model '� ❑ NA 'Pump Tank Capacity gal ❑ NA Pump Tank Manufacturer z ,% ❑ NA Pump Manufacturer ; � - 0 NA Pump Model ❑ NA Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland CJ Dislnfecfion ❑ Other. Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) 13 -Ground (pressurized) ❑ At -Grade 41 nd ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA i Service Event Service Frequency Inspect condition of tank(s) At least once every: � month s) ears (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cells A � () At least once every: rY30year(s)(Maximum ❑ month(s) 3 years) ❑ NA dean effluent filter At least once every: month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ mo � s(s) 2a ea ❑ NA Hush laterals and pressure test At least once every: ❑ month(s) ear s NA ether; At least once every: ❑ month(s) ❑ year(s) NA Other: + NA MAINTENANCE INSTRUCTIONS (inspections of tanks and dispersal cells shall be made 'by an individual carrying one of the following licenses or certification : Master Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator, Tank Inspections must Include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate 'a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (16) or more of the tank volume, the entire contents of Me tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, end any, servicing at Intervals of :512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page , of START UP AND OPERATION ce of aiming products or other chernlcals th l� For new constrtrctlon, prior to use of the P�3�iUTS check treatl�tent tanks) for the preson concentrations are detected have the contents of thi. process and/or damage the dispersal celi(s). if high may Impede the treatment p l o tank(s) removed by a Septage servicing operator prior to use. Face, 0 occur when soil condltions are frozen at the Infiltrative su cess wastewater will bia System startup shall not war is restored the ex um tanks may fill above normal hlghwater levels. V�1h8n salt In the backup or surface discharge of effluenit. During power outages pump ewer to tl 1e cell s) In one largo dose, overloading the call(s) s) and �naY re ervlcin operator prior to restoring p discharged to the dispersal� To avoid this situation have the contents of the pump tank removed by a Septage S the �Im controls to restore normal Iev(11s effluent pump or connect a Plum ber or PO'�ITS I'�aintainer to assist in manually operating P p within the purnp tank. or otherwise disturb or compact, the area wittr1r� Do not drive or park vehi cles over tanks and dispersal cells. Do net drive or park over, 15 feet down slope of any mound or at -grade soil absorption area. performance and prolong the life of the PtJW� .3 from the wastewater streaex� may improve the p®� $� d9sinfectHnts; fat; foundation drf��n Reduction t l~ lmfnat on o the following ton swabs; degreasers; dental 11=1 diaper , $• oily air)jing producl1s, antibiotics; baby wipes; cigarette butta, condoms, cot reuse; herbicides; meat scraps; nn+edication , I� g (sump pumps water, Trust and vegetable Peelings, gasoline-, pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT shall be talca3ll to Insure that the system is prop�:lY S falls and/or is Qrmenentiy taken out of service the following steps bode: When the POWT P d in compliance with chapter Comm 83.33, wisccnsin Administrative and safely abandons P + A11 piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing operator.. ! covers removed and the void space filled with ;�r��il, • After pumping, all tanks and pits shall be excavated and removed or their gravel or another Inert solid material. CONTINGENCY PLAN ve Keen or must bf� taken, to provide a code compil'lrnt If the Po'Wl'S falls and cannot be repaired the fallowing measures ha replacement system; e utilized for the location c��� a replacement soli absorption sys �e rr q A suitable replacement area has been evaluated and may b com actlon and stjould not be infringed upon by requ The replacement area should be protected from disturbance and p pro the replacement area will result in the nc!ec p setbacks from existing and proposed structure, lot lines and wells. Failure to P s stems must comply with the rulefi it for a ne w soil and site evaluation to asteblish a suitable replacement area. ReplacementY effect at that time. C] A suitable replacement area rs not available due to setback and/or soil limitations. Barring advances in PC3iI�TS technologll 4 a holdingtank may be Installed as a last resort to replace the foiled PC.�'V4''TS. d site evaival�das o Identify a suitable replacement area. Upon t��.�llure of the PC)WTS a loll a installede site has not been evaluated,to fy suitable re lacement area, If no replacement area is avaliable a holding tank may be installed must be performed to locate a p last resort to replace the failed P+OVtlTS. oval of the biomat at the infiltraliv at- fade soil absorptlotl systems may be reconstructed in place fallowing rem d and g surfac e, Reconstructions of such systems must comply with the rules In effect at that tine <<WARNING?> N LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAi STANCES, DEATH MAY RESULT, RESCUE 0j . ENTER A SEPTIC, PUMP OR OTHER TREATMEN-' TANK UNDER ANY CIRCUMSTANCES, PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS E ROVIWTS MAINTAINER -7 �-- POWTS INSTALLER � 7 Name Name ' � ...�._......,... i 2 Phone i- _ ) Phone - l�:K SEPTAGE SERVICING OPERAT R PUMPER LOCAL REGULATORY AUTHORITY Name Name r'' 1• _ -� Phone Phone � +'- t )( )� and 383. 4(1 }, (2) s, (3), �llr�sc:onsln Administrative Code. This document was drafted In compliance with chapter SPS 383.22 2 b (d) (f� c SANITARY SYSTEM.� ^ ��m File #: Office Use Only OWNERSHIP/ADDRESS FORM Created 212 02 7 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can dosob«using the Pruerly Fil,,es Scanned vveb|ink. - --/ / Owner/Buver C.'- Mailing Address City/State/Zip Phone Number (required) Email Address (required) Parcel Identification Number (found on the property tax bill) OWNER/BUYER INFORMATION &r"twr Raas 0n 12 ' NEW SYSTEM: LEGAL DESCRIPTION Property Location ' . T 5ON R W, Town of �'l C) Subdivision Plat: Lot # | . Certified Survey Map # Volume page Warranty Deed # 9befnre2OD6)Vo\unne page Number of bedrooms Spec house Lothnesidenti�ab(e�[�es[]no --^�~--- r� 7-T/~ OFFICE USE ONLY Ne w Prope rty Ad dress (�"M per - (Verification of new address required from Community Development Department for new construction.) This form must be submitted with oil Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form orecorded warranty deed from the Register of Deeds Office and ocopy of the certified survey map if reference is mode /n the warranty deed. CommunityDeveiopmentDepartment—LandUseDivision 715'386-4680 St. Croix County Government [enter 715'245'4250 Fax zdz@succxi.go 1101 Carmichael Road' Hudson'Vv| 54016 WWW.5uccas'9u0v Okwom IRCOM 97-6 vIr It ma-V 006 wq ft fr or-v Shed Dormers over Bonus and Entry Floor Plan Acole 114"-l'-C' !F 1 4' Nr ---- - ------ J-.0- Y-C --4- ve — 14 3W -d AW It— 04 PT 1,1 MrLtt 01..I. Pr 04 _W fil-OW-N&V OFF a.FFN- Vw~ Onat Room sr-3 War ■ W-4 I isr $7.7 Y.,Gr x Hr4 Or a0s 24 R 225 ft T ail ild, S.W R $ LJLI i-Lj-LJ U. A "7 1� __j all 1�� 41, 17-71 1k 7Z droom #47 W-r I W-0 S/Ir SM aq ft 77 1! aq Vw W-S giv am M4 Ft At kfiAr. nears j it 80fkfd Mom" A"w &afflp W Rk- rhr 2r P.C. JL *4% 4 Ur d.VL PhoW i — AIF J&V-dr-4W;r-/Pw —,rKcW -4 1/ - 4' 0"104110 4 w-3 vw IF my ot 79 sw 7W IF, Main Floor Plan HRHH 499 Pioneer FUdge 6-20-23 W= of *ft " � law =P-^.-d %a" oil I I 6alft wd Obwo M." a" ham be anftw" aw .k%"" " on &Mks* OM&d& State .Bar of Wisconsin Form 6-2003 SPECIAL WARRANTY DEED Document Number II Document Name THIS DEED, made between _Lakeland Comtruction Fi ice, LT C, a Minnesota limftd liability .company ..�, ("Grantor," whether one or more), and C,ibXide Develogment,Inc., a Minnesota cor oration ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. r i�c County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lots 1129 3, 4, 5, 617,87 91101,11,12, 13,14915916,17, 18, 19, 20, 21, 222 23, 249 259 26,279 280 299 309 319 321 331,34t 355 36,379 381t 390 40, 41, 42, 43, 44, 45 and Outlots 1 and 2, Plat of Pioneer Ridge in the Town of St. Joseph, St. Croix County, Wisconsin Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through, or under Grantor, except: easements, restrictions and reservations, if any, of record. Dated 41"?, ! i d AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: i and In 132 CA ::. MARIJO THOMFORDE — Notary Public -Minnesota Notary ubli tate of i; •arj *'0 My Commission Expires ,fan 31, 2014 My Commission (is permanent) (expires: 4 d (Signatures msy be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY ID NTIFIED. SPECIAL WARRANTY DEED a 28e3 STATE BAR OF WISCONSIN FORM NO.6-2003 ) Tame below signatures. 111111111111111111111111111111111111111111 915947 BETH PABST REGISTER OF DEEDS ST. CROIX CD., WI RECEDED FOR RECORD 05/12/2010 10:50AM SPECIAL WARRANTY DEED EXEMPT # REC FEE: 13.00 TRANS FEE: 1500.00 PAGES: 2 Recording Area Name and Return Address KRISTINA OGLAND ESTREEN & OGLAND 304 Locust Hudson, Wi 54016 Sec attached Exhibit Parcel Identiflcation Number (PIN) This is not homestead property. (is) (is not) La n Constr i inance, LLC (SEAL)BY (SEAL) *Rjclia"'rd Loerek.vice president (SEAL) (SEAL) ACKNOWLEDGMENT STATE OESOTA ) COUNTYj SS. COUNTY Personally came before me on 'aV 2610 the above -named Lakelalld Ca strnction Anance. LLC, a Minnesota limited liability cOMRany, by Richard j&rgw, vice president to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. INFO -PROS" Legal Fora 800455-2021 www.foprofbm.00m Wisconsin Depactment-of-Safety-a;id Professional Services Page of rvoflnd4sr Servi ce5," P (SOIL EVALUATION REPORT j C ' �,� � -(� c, '06 20?3 In accordance with SPS 385, Wis. Adm. Code CountySt.Croix Attach complete sile plan on paper not less than 8 112 � 11 inches in size. Plan must include, but not limited to: �ertical and horizontal reference poi0l(BM), direction and percent slope, Parcel I.D. scale or dimensio north arrow, ,and location sand dist4nce to nearest road. 030-2153-01-000 RKieZwedby Date -.—P-1a4ta-ji0!n"H4nf*ftation. 7/ I3(123 Personal information you provide may be used for secondary purposes (Privacy Law, s, 15.04(1)(m)). Property Owner A I..D Property Location ❑ 0 City Wide Development Govt. Lot SE ir. NE 1/. s 20 T 30 N R 19 E (or) W Property Owner's Mailing Address V Site Address or CSM and Lot #: 404 La Grandeur Road 499 146th ave Lot 1 Pioneer Ridge City State Zip Code Phone Number ❑ City Village IN -1 Town Nearest Road Somerset Wi 54025 St. Joseph 146th Ave 0 New Construction Use:❑ Residential/ Numberof bedrooms 3 Code derived designflow rate450 GPD �Replacement ❑ Public or commercial - Describe- Flood Plan elevation if applicable ft. Parent material. ti I IS W cetcN- General comments and recommendations: Mound System -kQ5 P4q�;5! X r--1 � 00% Boring # UBoring 102.3 ZO EKPit Ground surface elev. ft. Depth to limiting factor in. / elev. I Soil Armlication Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-9 1 Oyr3/2 none L 2rngr mfr CS 2m .6 .8 2 9-16 1 Oyr6/3 none Sil 1 msbk mfr cs 1 f Ac .6 3 16-26 1 Oyr4/6 none CL 1 msbk mfr gw n/a .2 .3 4 26-48 7.5yr4/6 f 1 f 5yr4/6 SL -m- mfil n/a n/a .2 .6 Boring # E]Boring 105.3 26 Wit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. I Soil Application Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-8 1 Oyr3/2 none SL 2mgr mfr CS 2m .6 1.0 2 17-26 1 Oyr5/4 none SL 2msbk mfr gw 1 f .6 1.0 3 26-48 7.5yr4/6 f 1 t Syr 4/6 SL -m- mfi n/a n/a .2 .6 CST Name (Please Print) Signa CST Number Shaun Bird 226900 Address T;97 Evaluation Conducted Telephone Number 1432 120th st. New Richmond Wi 54017 /23 715-246-4516 Effluent #1 = BOD > 30!5 220 rhZ91L and TSS > 30:5 150 mg/L Effluent #2 = BOD,:5 30 mg/L and TSS!5 30 mg/L SBD-8330 (R04/21) 3 Boring # 0 Page of ❑ Boring 105.3 30 BE Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Anolication Rate Horizon Depth In, Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 1 0-9 10yr3/2 none L 2mgr mfr CS 2m .6 .8 2 9-30 10yr5/4 none SI 2mgr mfr GW 1 f .6 1.0 3 30-48 7.5yr4/6 f1 f 5yr 4/6 SL -m- mfi n/a n/a .2 .6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil ADDlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. / elev. ft. Soil Armlication Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 5 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L Soil Test Plot 7aun Project Name City Wide Development Bird Address d(ld I n fZronr-Ic"r Rnnr-1 Somerset, WI 54025 Lot 1 Subdivision Pioneer Ridge SE 1/4NE 1/4S 20T 30 N/1319 W ❑ Boring 0 Well PL Property Line kBMorVRp Assume Elevation 100 ft System Elevation 105.59 scCo" Y7 CSTM #226900 Date 7/5/23 Township St. Joseph County ST. CROIX Top of 3/4" Pipe * H R p5ame as benvimarK 146th Ave "" u� '`� Wisconsin Department of Safety and Professional Services 9 Division of Industry Services 7 Ps SOIL EVALUATION REPORT 'M In accordance with SPS 385, Wis, Adm. Code County , St.Cr01X Attach complete site plan on paper not less than 81/2 x I 1 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (13M), direction and percent slope, Parcel I.D. 030-2153-01-000 scale or dimensions, north arrow. and location and distance to nearest road, Please print all Information. Reviewed by Date l r s s Priv Personal Information ov�de may be used for seconds u o e a Law, s. 15.04 1 m ( } Properly Owner Property Location 0 City Wide Development Govt. Lot SE %i NE 'l. S 20 T 30 N R 19 E (or) W Property Owner's Mailing Address Site Address or CSM and Lot #: . 444 La Grandeur Road 499 146th ave Lot 1 Pioneer Ridge City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Somerset I Wi 154025 1 ( St. Joseph 146th Ave New Construction Use: Q Residential/ Number of bedrooms 3 Code derived dasignflow rate 4� 50 . GIRD ]Replacement ❑ Public or commercial -- Describe: Flood Plan elevation if applicableft. Parent material MIS General comments and recommendations: Mound System j Boring # 08oring 102.3 2 6 N]Pft Ground surface elev., it. Depth to limiting factorin. / elev. ft. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 1Oyr3/2 none L 2mgr mfr CS 2m .6 .8 2 9-16 1 Oyr6/3 none Si! 1 msbk mfr cs 1 f .4c .6 3 16-26 1 10yr416 none CL 1 msbk mfr gw n/a .2 .3 4 26-48 1 7.5yr4/6 f1 f 5yr4/6 SL -m- mfi n/a n/a .2 .6 aBoring # [']Boring 105.3 26 ®Pit Ground surface elev. - ft. Depth to limiting factorIn, / elev. .-.ft. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Az, Cont. Color Gr. Sz. Sh. Soil Ap lication Rate GPDIF12 *Eff#1 'Eff#2 1 2 3 0-8 17-26 26-48 10yr312 1 Oyr5/4 7.5 r4/6 none none f1 f b r 4/6 SL SL SL 2mgr 2msbk -m- mfr mfr mfi CS 2W n/a 2m 1 f n/a .6 .6 .2 1.0 1.4 .6 CST Name (Please Print) Af Signs CST Number 1226900 Shaun Bird Address Evaluation Conducted Telephone Number 1432 120th st. New Richmond Wi 54017 go / /23 715-246-4516 * Effluent #1 = BQD > 30 s 220 r g/L and TSS > 30 s 150 mg1L * Effluent #2 ^ BQD, 5 30 mg/L and TSS S 30 mg/L SBD-8330 (1104121) Boring # Page of ❑ Boring 105.3 30 N Pit Ground surface elev. ft. Depth to limiting factor ln. / elev. ft. Soil Application Rate horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr, Sz. Sh. Consistence Boundary Roots GPD/FF *Eff#1 *Eff#2 1 0-9 19jr3/2 Otte L 2mgr mfr CS 2m .6 .8 2 3 9-30 30-48 10yr5/4 7.5yr4/6 none f1 f Syr 4/6 S1 SL 2mgr -M- Or mfi GW n/a 1 f n/a .6 .2 1.0 .6 Ong # ❑ Boring in. ! elev. ft. Pit around surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft� ln. Munseil Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 Boring # ❑ Boring [] Pit Ground surface elev. ft. Depth to limiting factorin. / elev.,_ ,ft. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = SOD > 30 s 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, s 30 mg/L and TSS 5 30 mg/L Soil Test Plot PljhProject Name City Wide Development SBird Address d(ld 1 a C�ronrin� rr Rnnrl Somerset, WI 54025 Lot 1 Subdivision Pioneer Ridge SE 1/4 NE 1f4S 20 T 30 N1R10 W [] Boring (D Well PL Property Line BM orVRP assume Elevation 100 ft System Elevation 105.5' Sce XB9rM #226900 Date 7/5/23 Township St. Joseph County ST. CROIX Top of 3/4" Pipe *IH! R p�jarne as BencrimarK 146th Ave r WER-AND Jr; LOT 43 rr LOT 44 K4 Fn 0 6 6 ir flo to LA -01 rz7 f DRA INA CE- C37 --EASEYLNF wZw % 9 co 153,89. •5 C12 N790158 o1w 4 9-794. N 79 -0,1 TOP OF V* IRON PIPE tj -30 w BM ELEV.- 953.8 ................. 30 1 33 -24 LOT 3 jo): IC3 cw LOT 2 LOT 1 DRA INA GE EA avEN r 'K, AE i j U H WE — 9 4,5.5 LBO m 94&8 -4 op Cl) •7- J9 ti DRA WA GE EA SEMEN 7- 'wJ m' 24 HWE — 934.0 LBO m 938.0 J17 51- 1 33.00 -- 204,73' (..):192.85 • J76 223.16* El /4 COR. SM. 206 MID'S Ln o U) im 33' Z9 S7975'08 "E 11 DRAINAGE EASEMENT TABLE "Jo # DIREC 770tV C/ JI N7975'08 OW 4. .2 S2845'30 "E It JJ SO I V5'31 "E 21 J4 SJJ *4 010J "W 17 ,15 N553I'09 mW 2. J6 N37*29'20"W 5, J7 N545747"W 4, ,18 544 28'4 6"W 9. ,/9 S644727mW J J10 S877 4 *39"W 9, X I S87*14'39"W 2 ,112 SO 7 *JS'l 2 NE 3 ,113 N877439"E 2 J14 N8 7 7 4J9*E 2 ,115 S0546'09'OW 4 ,116 N89 743'08 -E 1. J17 N3943'08 NE I JIS N05'40'35"W 6 dI9 N66 'JI'09 OW 4 J20 N33'40'0J'E- I J21 NGI'05'JI"W J22 N2845'J0 OW I ,123 N79V5'JO"W ,124 N07*J8'120W d25 N03558'49 OW L126 NO3 5849 "W .127 NOO VJ58 X DRAINAGE EASEMENT TABLE W ,�f DIREC 77ON i Kl S0738'I2'"E K2 S0738'12"E- K3 N434456"W K4 N09:2855NW K5 N48 *4 7'59'OE K6 N4847'59'wE K7 N65V625"E K8 N4 1'57J7NE K9 S8540'JSmE K10 S85'40'J8E KII S21 2 0'51 mE K12 52J:24'JO "W KlJ S00'48'47*W K14 S4 6 5258 "W K15 S6174'12'"W KIS N84 VJ57wW K17 S6814 744 wW KIS NOJ'5849 "W K19 N0358'49"W s � Can f k COUNTY OWNER CITYW(tse J)6-1J0-a������c.• PLUMBER TOWN OF ST 'W-MSEP�1 S V- U Nq AND/ xx LIU 0tilCEf� I \ b6s No.��2...�{e CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of the permit, county authority. lease contact the cvun P 0 - '� �' '� - 70*1-1 AUTHORIZED ISSUING OFFICER — DATE E V V� - "�d - " C m4i i Thl- 04, 11 W T141S PERMIT EXPIRE3 13 'orZ SBD-06499 (RI 1/20) ;'A I /2iqz3