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HomeMy WebLinkAbout657101 026-1126-39-000Wisconsin 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 Bradley & Caren Momchilovich TOWN OF RICHMOND CST BM Elev: Insp. BM Elev: BM Description: Iq9.6©' ST ee�er TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 657101 State Plan ID No: Parcel Tax No: 026-1126-39-000 Section/Town/Range/Map No: 12.30.18.800 STATION BS HI FS ELEV. Benchmark 3.3v Alt. BM Idg. Sewer SUHt Inlet ' - 1 St/Ht Outlet Inlet Dt Bottom Header/Man. l I Dist. Pipe Bot. System 7TT I` gig / Final Grade St Cover ` 5' S3 r BED/TRENCH DIMENSIONS Width [ % Length l q D I No. 7,enches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: P/L [ I L% 18LDG 5q [ IWELL r � / [) ID LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer. V\ L Model Number: � DISTRIBUTION SYSTEM I--7 t, (rav_ Header/Manifold Distribution x Hole Size x Vent to Air Intake ` Pipe(s) Z [� Length Dia L Dia Spacing 7 J SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems 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: 1440 166TH AVE 1.) Alt BM Description = 2.) Bldg sewer length - E�,> amount of cover = 3� Pfrw cslk lj aK:SU� 5T Plan revision Required? ❑ Yes X No 31 D /Z 2 Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #1: 312,D1uj�L+ f Inspection #2: �- Insepctor's Signature Cert. No. J J LJxSI�id NJ t5® Industry Services Division 41. ('rotx 50_ 20 a 1400 E Washington Ave S S.tnilan Pcnnn Number (to he filled in h% Co) • PCt7 ] 4J�4 P.D. Box 7162 't' GC] L Madison, WI 53707-7162 4 S� O I °ff •`Iry .+' t—j ermit Application State hransaction5utnher in acenrd'anec with SPS 38; 2112i. Vris, Adm. Code, submission ol'this iitnn to tltti: appropriate gnxcrnmentaV unit , is required prior to ohlalnin .l sanilar} permit Note: -application fi}nns for stag-oxxrtcd POW-1 S arc uhrnittcd to [he I)epartmem of Salon :tnd Protesstonal Sen l�rs. Personal infnmtiauon %oil pro%ide tna% he used for secondar} ' Pro 'jcct Address ltl diltcrcttt than matlms address) plurposes in acconlancc ntth titc 1'rivacx l.at+, s. 15.04(1 YInt3. Slats• 1440 t66"' A%enue L. Application Information — Please Print All Information Propem 0,micr-s 'Name Parcel it Bradlee & Caren Momchilovich 026-I 126-39-000 Propene Owners Mailing Address �� ProperlN Location 1440 1 f')6" A, `c Goat. Lot Sl: <°, NVa °.,. Section 12 Cm. Stale Lip Code Phone Numher Noe, Richmond. Wl 54017 circle one) I3llN R1K1!ar IL Type of Building (check all that apply) I of a Suhdicision Nantc 1 or Famih [)welling - Numher ol'Bedrooms 39 %w atcr, I dgc •__ ❑ Public/C'otnmercial Describe Use Block _ a ❑ i. 1n nh �i itc Owned -- Dcscrihe Use ❑ a'lllagc of _ CSM Nutnher uaxn of Richmond 111. Type of Permit: Check rr one box on line A. Complete line B if a licable A. ❑ New S}stcnt ❑ iZepJacctnent SNstenr ❑ l reatmenulloiciing Tani: Replacement Orth ❑ Other Modification to Fxtsting S-'stcm w(Plain) B. [] Pcrritlt Renewal ❑ Permit Re,ision ❑ Changc or ❑ Permit I rtvister to Ncw List Precious Perrrur Numher and Datc Issued Before [ xperation Plumber ()wner 405.140, 6/7.2(H)2 IV. Tlpe of POWTS System/Component/Device: (Check all that apply) ®.Non -Pressurized -Ground ❑Pressurised In -(around ❑ ;lt-Ciradc around = 24 in uf'suitahle soil ElMound < 24 in. ofsuilahle soul holding Tank ❑ Other Dispersal Component lexplain) ❑ Pretreatment De. -ice l.explain) N'. Dispersal/Treatment Area Inforrinatio- cata --- _ e s �T tdMa cn I.Io", IgPd} ❑Cs't2Tt Snit 'Npl,ltc,liion Dispersal :area Required (st) Dispersal Area Proposed (s1) ! Sssdrna 1.Icxatwil 857 900 94 tl' 0.7 N I. Tank Info C'apacitx in Gallons I6r_ A-40V CA �` C Total r! of Manulacuircr W r New I anks. I:xisunt Tanks (ialltlns Unit, Scptic or I lolding Tank 1250 I 1250 1 Wieser Concrete ❑ ❑ ❑ ❑ ❑ _ Ikrsing Chanther 1 ❑ ❑ L1 ❑ VII. Responsibility Statement- I, the undersigned. assume responsibility for installation of fhe POWUS sholAn fin the attached plans. I lumher•s Name (Print) r Plu S nature l? MMNS Numhcr Business Phone Numhcr John Schmitt �jL�[ 2237611 +1s-7611-0486 Plumher s address (Strcci. City, .State. Zip Code) 586 Vallta View Trail. Somerset. Wl 54025 VIII. County/Department Use Only (� Approved s Permit Ice I]ate Issued Is s in Agcr1t Sienaturc S E �0 2-i2 9 i n° n to ial 2 12d IX. Conditions of i,F'� ,a o.. r '• ,� V+ �1 3) �� � ar.,.(t; (i2e 121- v -�o�.r -h, oe (>lLe�,Q D� `ereS`F 4 _d SYSTEM OWNER: 2(eJ and CeII 4!a effluelwed t. Snus ICuter - In bg s d aspal B tplgd!meinlailby as per management by ge plan pmviAed plumber. 2.RR satha* fequiremenls must be malmained as per applicable code; ordlnanow. Attach lip complete Phan. for (lie w dent and submit to Ilit t uunh unh on paper not le•s than K 1 2 x I ineh(K in size SBD-6398 (R03. 14) SYSTEM PLOT PLAN Momchilovich 4 Bedroom Replacement Project Address: 1440 166th Avenue BM1 Symbol: AL BM Elevation: 99.60' BM Description: Top of septic tank cover. BM2 Symbol: A BM Elevation: BM Description: Slope Gradient of Tested Area: (2%) Well Symbol (d applicable) Notes: See CSM for complete lot p�pe�y Ube Garage Existing 1250 gallon Septic Tenk wl Zabel A-100 Effluent Filter Tt T2 fib T3 oe, T4 �/;>e 2% Slope ■ B5 j Design Flow: 600 GPD Attach design flow calculations for commercial plans: AP' a Materials! ASTM Standard ab s 384.30-3 & 384.30-5 4" SC 40 PVC pipe ASTM- D2665 4" 3034 VC pipe I ASTM-D3034 Existing 4 Bedroom House ■ On' -'away Valve B2 B4 Existing Well .1 t .t •t t COPY T1 Existing 3'x93.75' Biodiffuser trench El.= 94.03' T2 Existing 3x93.75' Biodiffuser trench El.= 94.13' T3 Proposed 3'x90' EZ Flow trench El. 94.00' T4 Proposed 3'x90' EZ Flow trench El. 94.00' 166th o� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Momchilovich 4 Bedroom Replacement Septic System Owners Name: Bradley & Caren Momchilovich Owner's Address 1440 166th Avenue New Richmond, WI 54017 Legal Description: SE1/4, NW1/4, S12, T30N, R18W Township Richmond County: St.Croix Subdivision Name: Waters Edge Lot Number: 39 Block Number Parcel I.D. Number 026-1126-39-000 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Effluent Filter Information Page 5 System Sizing & Cross Section Page 6 EZ Flow Information Page 7 Management and contingency plan Page 8 Existing Tank Certification Page 9 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Date: 2/14/2024 Signature: Licnese Number: MPRS 223760 Phone Number: 715-760-0486 In -Ground Soil Absorption Component Manual Version 2.1 May 2022 Page 1 SYSTEM PLOT PLAN Momchilovich 4 Bedroom Replacement Project Address: 1440 166th Avenue BM1 Symbol: AL BM Elevation: 99.60' BM Description: Top of septic tank cover. BM2 Symbol: A BM Elevation: BM Description: Slope Gradient of Tested Area: (2%) Well Symbol (d applicable) Notes: See CSM for complete lot p�pe�y Ube Garage Existing 1250 gallon Septic Tenk wl Zabel A-100 Effluent Filter Tt T2 fib T3 oe, T4 �/;>e 2% Slope ■ B5 j Design Flow: 600 GPD Attach design flow calculations for commercial plans: AP' a Materials! ASTM Standard ab s 384.30-3 & 384.30-5 4" SC 40 PVC pipe ASTM- D2665 4" 3034 VC pipe I ASTM-D3034 Existing 4 Bedroom House ■ On' -'away Valve B2 B4 Existing Well .1 t .t •t t T1 Existing 3'x93.75' Biodiffuser trench El.= 94.03' T2 Existing 3x93.75' Biodiffuser trench El.= 94.13' T3 Proposed 3'x90' EZ Flow trench El. 94.00' T4 Proposed 3'x90' EZ Flow trench El. 94.00' 166th 4" CAST- 4" CAST -A -SEAL 0 w d O w INLET ---- - ---- OUTLET v� + oo Ln � I � 2in a 9 PUMP PAD W1250— M R TANK SPECIFICATIONS 2 a , DIMENSIONS: F WALL: 2 7/16' s d BOTTOM: 3" COVER: 5' MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 64 1/2" LENGTH: 8'—B" WIDTH: 7'-2" BELOW INLET: 53" LIQUID LEVEL: 47" q WEIGHT: BOTTOM 4,025 LBS. o COVER 3,195 LBS. a E INLET AND OUTLET: 4" CAST —A —SEAL BOOT OR EQUAL GASKET o INLET AND OUTLET BAFFLE AND FILTER: a e o w o ti WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W LIQUID CAPACITY: 26.81 GALAN HOLDING TANK: ' a OUTLET HOLE PLUGGED cc ACTUAL CAPACITY: 1.340 GALLONS a Ln LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: o SEPTIC / HOLDING / PUMP OR SIPHON � � 0 W COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) � F, 3 CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE X O REVIEWED 6Y c�v REVIEW DATE J Q z a IL W N SHEET N;J OF TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PAGE 2 of 2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilterg alarm, you will be notified by an alarm when the filter needs servicing. FF Step 1: Locate the outlet of the septic tank and remove the tank cover. ta1( Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. S1( Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. r• Step 2: Firmly pull the filter handle and slide the cartridge out of the case. (3 Residential Applications Certified to ANSYNSF Standard 46 Copyright 2014, Polytok, Inc. All nghts reserved Product($) covered by one or mere U.S. and/or frntemational patents Other U.S and $ntematlonal pafent$ maybe pending Page 4 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I .11 Geolextile I Cover 99 SOIL COVER 2' min. french depth 1, (typical) — - '- c .00 System Elevation — ft- (typical) min. 127 (typk-l) Septic Tank(s) ISAanufacfurer- Wieser Concrete Septic Tank(s) Volur*s): 1250 gill gal gal —ga[ Effklent Filter Manufacturer. Zabel Effluent Filter Mortel #, A-100 TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet 1 outlet pipe connection on plan view.) PLAN VIEW Obsorvallon ploeshall be Installed No Scale) 4" 0 at ;unction between two units, Perforated Lateral Observation Pipe (typical) (typical) — — — — — — — — — - — — — — — — — — �- B = 00 ft (typical) INSTALL PER TRENCH: 9 10-ft bundles @ 50 ff EISA/unit = 450 ft` CIO `n + d 5-ft bundles @ 25 fe EISA/unit = 0 ! = Proposed EISA per trench = 450 OBSERVATION PIPE DETAIL (No Scale) Screw -Type or Slip Cap (loose) y 4"0 PVC Ripe Top of pipe to te:rmnate _ at orahovefnished grade (4) 114'-11) a ar Slats apart , Anchoring Uev Ice 10 ft (typical) A = 3.0 ft (typical) �— EZ1203H Bundle (typical) (mfci by Infiltrator Systems, Inc.) Install pursuant to manufacturers instructions Required Infiltration Area = 900 ft x 2 Irt,nr:ho�� = Proposed Total EISA = 900 Fnlshed Grade (rrn+lr.1-sed R seeded) Topsoil Cover (run_ t root) InNiration 5 u rfaee Distribution Method: branched manifold -D G) m w 0 n RESET Installation Instructions for EZfl`a, Systems in Wisconsin 4*Z FI4Tw- RATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & l-ocations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center -most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate -only bun - A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- - ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre - only and is held together with polye'l,ylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed : shall make sure the the GEO is positioned upward and is • EZflow Bundles : in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow internal Pipe Couplers • Pipe for Header and Inlet 8, The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator ; level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions ; surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below, This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, ;tepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately • after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- ' lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might ' be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem wher systems have a minimum • of 5" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 12O3H-GEC3 down along the sides of the product to a point at least six inches from the bottom of product. Gectextile Barrier Matena! 4. When installed in a trench, the trench should be dug to & a width of 36 inches. This not only saves labor in excava- tion, but also provides better load -bearing capacity after backfilling is complete. • e� 36• Page 6 In -ground Gravity Management Plan IMPORTANT: The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum_ Dispersal Area Operating Limits: Design Flow = :!1 gpd; BOD5 5 220 mgL"; TSS 5 150 mgL"; FOG 5 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use c age of system a nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution i drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) c extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wising, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Sep -tic and dose tankfs) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (113) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Schmitt & Sons Excavating, Inc. Phone: 715-760-0486 Local government unit: St. Croix County Community Developement Phone: 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1). Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc, Admin. Code. Page 7 Sdeb and ewWWV 1Diri am 201 W. Watltiom AVC.. P.O. Aeon 7162 %fisconsin >~FadWM W1 S3W - 7162 Department of Comfneraa 4, -10- 0 Z f�l� Smkwy Pamit Apcatina 1n *=wd wa Caaa>! n2l. Wk- Adm. Code. r� 'VED may ea mod far tsrr a L Applrtrtk a hd rradlaa - trlrrt AM h&nmadm rowna Owases w.a t I}tlJ{!N Y Pn=wt l Owowfa Malian Addear t- C). E3o�r dqS cky� soft Puce 1 kAM go AdaeM $,isrr Pamit l9eueb�er ❑cbmk it UvisionADS / erne ltea Lf?. Numbn a v �i QL�6---�- 1 1ILAA LU,•S I T R Lat �. ria ft c3m Kupwm f Ws Q [1`7 r5 �1 W Tm of WAAWG (cbmk In that appw �2.�h., ❑csa �juse or 2 Pen* UKWC ft - lloeabw o1" 8e�oo®r DYfilw -` ❑ SMrla QwsOd NewW Y 3 UL Type of tarn& (Cbm* and ana bm a. flrre A f far 6*wml arre). ea mpbm aft s If arpscaw A. 1 Ne+r 2 ❑ IEeplae*aaar shy 3 Cl ftqlm� of 6 ❑ Adana. 0 For CONEV •* a. ® Cheek if saearrr reins Peariou* kawd Pssalrg" Drre inaea IV. Type of tarmlt (Check aR furl tWptr)tat■reiar fagt ademe Y for Yard raa) /�C •� f Gc �.- sarren-re.rr.r�c+ ie v.00xd Z O t�sa�a r, O s.aa Pear so ❑ w+.d �l Sid 1i 3 ?x ❑ pftmniaea ia-firvamd 41 ❑ iodY Tank 48 ❑ SkSW Para 3i ❑ l.me �f� x /fit.�far 45 ❑ Ar-Owaa 46 ❑ Ammbk Tmom ec liar a ❑ 3ci ❑ virr raw Dodge PAW QWQ Dbp and AM DDirpwW Ann sad rrred.da. >be � >�� � Ekvadm PmPQdmd ROW Ft, Pribb silo soar FVXI Pt■aic VL T k itde a•pa Taf.i 1vei W Carenw conarm�a Gim C t�derlaa Arlkuls d Zlaior I �/ Via. Re =mmaiq - I. tka far leertitira of an POW a dwwa m tho s r � y 1 `T'i-K IDA:1 51 R16bue"a Aet&= ( but. CW. Saaa. Z* CW vm. Uai © s aesrrr rbe ice• (1tti,aaaa.eer /Dean+ if.asa s aP•� ❑ Q~oor Ghee bm*9 Admw � S� ['^O M CandUlaws of Appraral ilaarwer for Dian pprrrd e ,ti ,4 & 0 ` 6 et"iW .r Arne% oe WkW *00 M ab On C.rr •trr is MO-rn FNW aW has dm asli 2 U hYua In doe l [�'�"►� 7-- CR1 "l%QR (R ni fli ) Wisconsin Department of Cornmarce PRIVATE SEWAGE SYSTEM Safety and Building Division r + INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personsi information you provide may be used for secondary purposes [Privacy Law, 8.15.04 (1)(m) Permit Holder's Now: city villa" Tip Brushy Mound ParMershi Richmond Township 'ST SM Elev-. Ir". SM Elev: BM Description: 1 /01 *1 r 1,IaI;I2,e1l4 ,_►_11lelll TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Hoiding TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION Man cturer Demand GPM - Model Nu TDH rift F Loss System Head +t Forcemain L Die. to was p SOIL A14SORPTION SYSTEM PGW 1RGnYrI T�NtlI / � Ltll tll ' DIMENSIONS 3 (L INFORMATION DISTRIBUTION SYSTEM -I IIZ Trandws 'I got ) bel- ELEVATION DATA county. St. Croix Sanitary Permit No: 405140 0 State Plan IO No: Parcel Tax No: 0W 1126-39-000 C�■��l�LL#7 ���t�1�GSll CHAMBER OR UNIT � HeadeAManifdd _ Die_ M FDM—uson q�ij� x Hob Size Ix Hole Spacing ant to AIrdelto k i 3 ei SOIL COVER x Pressure Svatsms Ordv xx Mound Or At -Grade Svstsrris Oniv . ,,,. �-. —+!►.fit!, IN Depth Over / h over xx Depth Of xx Seeded/Sodded ftnrawh Center g—f FTrenchEdg es T%P" Q Yes No Yes tt No COMMENTS: (include code discrepancies, ies, persons present, etc.) Inspection #1: / d Inspection #2: Location: 1440166thAvenue New Richmond, WI 54017 (SE 1/4 W 1/412 T30N R18W) Wa s dge Lot 39 Parcel No: 12.30.18.800 1.) Alt BM Description = 'J'j , CeTl%'", Q � r %ib �OMtJ�-(/t+1�- /ar,Le. 2.) Bldg sewer length W / e � Vp - �Gtra 4�Q�,c�i:.., - �^ygnt" 'f' �-"t c,�tv-� 1, t la&,L., - amount of cover =X#' 4- C6�h Plan revision Required? Q Yes No Use other side for additional information. SSD-6710 (R.3/97) Date insepctoes S Cat. No. n-2�- 4e: k1raNM r- HUM r . � PMW `$"' 'SOIL AND SITE EVALUATION REPORT n of Saie�y � >�aro„ in &=Dfd with 1LHR 83,05, Wis. Adm. Cods AtSWh can+plete silo plan on POPS mot less than s 112 x 11 inch., in aiz,- plan must +rx*jdo, taLR S . not limn*► to ► fbcAl "horizontal reference pQirrt I0", drec4om aril % of afop�e, W40 or P CEL I D fr di►r+snslorWI, north arrow, and loca wn and drstanea 10 nearest rcad. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION �� I D �' 70A PROPERTY OWNER: Derrick Cat . PROPEm LOCATION GOYC, LOT SE '14 NW 114,E 1 Z T 30 ,NA s g w) w F'�IDPERI`1r 1505 wv IK� hh+MA.INf3 Al3DRESS LOT a 8L0C#t II $MO. NAAAE OR CSII s _�._ 34 New Richrsat>d ZiP PFI4NE IYUWER CI ILLAGE OWN NEAREST ROAD S+T1 • 1.7 i 7140 sex--21411n NOW cameo 1 17t1 AeslGerrllal A Number d bedrooms 4 r� [ ] A"dan b ems lirg i 1 � [ j Public Or�afwOrala! describe b�lanp C,W0 der+ W daily Ilow i go - R� desW ka ft rm --X_bK 9 & kwmh. Ate► area r _45a _ bgjt rtz 7�o r hn;h. 42 Maximum dedpn ba *V raW Remmrrrende4 irrl6llrafkv surface WWAW on(sj -__.�_..._bgd. XWM2__&_ftldr, 4PW A*%O► W de Wp I sib *m*bn6wm arm h1 10 nrbmW to mb plan W ctirrra Pea" r►lah rw Ot,ttvash S. u= Ftaod 0ain Wwation, it M*kmbb ri R LlrlStll lol f 7L j` U MV{'iPI mo PRE.RSLtRE ATfi,sildF SYSTM FILL DWj Tm sndtre hit or s ©� [as U $❑ u fl s Lis u SOIL DESCRIPTION REPORT Baring A Gmur d ems. is. 7 fL 0%* to iirritkv fxw +96- Rernarks: 3oring s 2 ;round 4ev. ,L _ h. Ieptr to TOnp rdor F CST Nurtc:--please INjnr Gir signaturc: .Sicel ew R.ichn . x7 7 71 PROPERiYOWNER Derrick rmnst— TNc+. SOIL DESCRIPTION REPORT Page,,Z_of_3__ PARCEL I.D.! pending +. Boring # 3 Ground elev. 98.1 ft. Boring # 4 Ground elev. 9]_$ ft Depth b limiting factor + 1� Ground elev. g7_8ft Boring # 13 Ground elev. ft Depth to imtling factor Horizon Depth in. Dominant Color Munsell Mottles tau. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistsnoe Btxid3y Roots GPD/ft Bed rerxh 1 0-11 10vr 2 2 none 1 2msbk mfr es if .5 .6 2 11-19 10yr 4/4 none sicl 2msbk mfr Cjw if .4 .5 3 19-33 7.5 r 4 4 none scl 2msbk mvfr qw ria .4 .5 4 33-90 .5 r 4 6 none cos 0SQ mi ria na .7 ..8 `J2- Remarks: Remarks: STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SEVMk S12-T30N-R18W New Richmond, W! 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #39-Brushy Mound Lake This soil evaluation eras conducted to satisfy a zoning requir mt, it may or MY not be suitable for your use. The location of the test may or may not be no sho+m as permarieet lot lines vere nat established at the time the test vas conifteted. N 111 =40, BM.= top of 1" pvc pipe Oel. 100.00, Alt. EM.= top of 1" pvc pipe@ el. 97.70, Gary L. Steel 6-21-2000 U Doc #G30776' bcw-,4 43077C « WA TEAS Localea '.n po-t C1 the SW ti6 of the NW 1/4, Porl of the NW 1/4 of the NW 1/4. •s..sb Pv,A sru yew par: of the NE 1.14 of the Nw 1.4• the SE ij4 of the NW 1/4. the NE 1/4 or ' tM1e Port o' the \IW 1/4 of :re SE 1i4, ano Parl of the SW 1/4 of the • P1J pO""O'0' �_3 L.•, ,.E 1/4. ee n Sect'0, 12. 130N, RiBw. Town of R:cnmontl, 5t. Croi, Co—l>. Wisconsin. �1 Pwr DIY MOUND PARTNB . LLr- non ••.E •w.w«o"+E .�[on°'i es sysac- was '^'M ......... °"0 ^s s.roc.• .�. Lam, rw.xc. +=-r) w W.., t, am iQIWAY No, m�..jm+ � ria. eainre ,• roe•.. 9.wwrsor t6W IipMOND, Wt 5400 = « c w .ww«w.-[ . .�- •�w.a ...c .r e. Y - - j I - �"\ nYHVTifNCS> GdW.YR `t=, , wc» w. ma [u• mow. o.• s. c n. co. rr vF" S(CION FOU/e0 `�-10-IE I Yh- J � UWNUU Clk1MJY JS'vi'E ✓.r r r .�...ap rwren MAP Y CINIT«nr, no;' VI -r I-+- .,.wrzr+-s»,i o•ri.r,w r=of Cr.wdin \. .� s c NORTH � �"-" .m°s ,E e_°'?•, .� ''/� s GOT JD � (� tt u.w[ woo! [.r Dt�c.M• i���D 1 .' g i.""wr - - - y , '•„'• ww g LOT is �. I i { uw4 ro araw[. I I I r y .3 I S) Izzila e Q r Q �Ifr � I F- x x 1 xRca$$sl xl .-�is� Ip�swl� a 8�$R88fr 8888'$ $"$$8188888$�88 xI AS '.a t�•s Y ^Ic : ZIP otona __--= LOT 07 31 - - " '� / �.-�' ' K '' [rE 3. •4>, » s ;Lor is >'.'av'•`,uaioii4[roo! �I Y t oro as I vd°` � •y ^'R" row[wm uw,. g a • 9S 1`.cres • sera . "tp• x w �, �a ___ ,1 r 1 3� LOTH a 9d'e• * JJ•r, l JIW �302T LY/i47IF a1Z.• K SdrP {��� !�V _� s. "/*>� ' ro,�ur[:D w n ry �•mfi�-. ` �% 3Y,�h OO4e1 1,\9 R ;� nw:'j '/ • $__ O So I f' _ ,l -., '• i � Me97201C _ :'• ts��� i 4, Jl�a� It/ � IF � ry � p . t I --_ •[ a, \•_ 1cjs�`/ 'aa yy. ISt �_ u. b - _ue� \ ©: ^4 LOToI6 ,•'. f. •'�. e'�' ____ p z : �s , LOrI \s J > «[ a �� \'} ' a4' ///I, \ f°st cM1t °0."`reeo I � LO.Tiwl[7 rr ,_ $. � •' .,/ W �' ° ..s ' a•c c ` - 1•� . - _ • tea•• - ��4rry4CC F4 SfM __ we9'sz 44E _0 Yae9'S744'E 194 >S 3,94.15' LOT J J 1{: - • ••- \ �i �.` a o.,«h•- E .. . an a 2 y L O T 9 P Loral R LOT JO � LOT.iPD\ 4`y eun«sn. ,���\ \© �'4. .., _ rrf .• •s�y a _ {s arc .X cr .... _ _ _.. _.. - - ___ -- - _ 3 � •s we .... SCCAOh •, .w->e a✓Hir4v n: ' JJ'� •.no-'a�a we9-J+Ja'w----gOe.e1' ..-. s.: �.Ea ,�� r-cam n .s..wa ,0 r.:• _ toe 9[w nov. ro. w . x ew Y I p u K!D q K E SHEET 1 Of 4 SHEETS 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) 1440 166th Avenue located at: SE 1/a, NW 1/a, Section 12 , Town 30 N, Range 18 W, Town of , 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 Did flow back occur from absorption system? Yes No (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): Wieser Concrete Age of Tank (if known): 2002 Permit umber (if known) 405140 AA; k John Schmitt (Li(*7sed Plum er Signature) (Print Name) MPRS (Title) (Date) 223760 (License Number) MP/MPRS 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 Page 8 fii�1911 STATE SANIT, A RY PERMIT 1440 lid ME- r'- ,-- -� rc �r�y r... �,._. -- T«� � T PREVIOUS NO.5or)[qD LJ 1 �tv r.l COP< ma's s CWnl MOMalfLOMW TOWN OF Q IGI��M.orS� r , AND/OR , -BLOCK PeTC5 ' 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: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. AUTHORIZED ISSUING OFFICER - DATE 2-12 7/2Z-ZLj PERMIT . EXPIRESTHIS -y2ghb-Z UNLESS RENEWED BEFORE THAT DATE SBD-06499 (R11/20)