HomeMy WebLinkAbout026-1165-36-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit N
552366 0
GENERAL INFORMATION (ATTACH TO PERMIT) state P I N
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. -7 Z3
Permit Holder's Name: City Village X Township Parcel Tax No:
Oeverin , Kenneth J. & Am aro Richmond, Town of 026-1165-36-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
6D , Ito D e~-- S W 641C, -kSk_) 22.30.18.1302
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
CCU l C b-Z ; --b a r!. ,5 Z.~ bLk v
Dosing 1, & Alt. BM ILV Li Aeration ^c Bldg. SevveY 9.5 -7
Holding St/Ht Inlet
/4) 6. -7
TANK SETBACK INFORMATION SUHt Outlet -7.0
JS S'
TANK TO P/L V1 EL BLDG. Vent to'Air ntake -ROAD Dt Inlet 5(1-- ~l 0
I f Dt Bottom Septic f/ q
c y
Dosing ~A 777-17 r Header/Man. 7- 7
Aeration Dist. Pipe S c~~
Holding Bot. System
/
Final Grade 5 6L -3` 3 / 17
PUMP/SIPHON INFORMATION ee~}
Manufacturer Demand St Cover
zl~ GPM Co 2 O ~ ~ U
Model Number „ L,, La
TDH Lift Friction Los System Head TForcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM Z2
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of P' s Inside Dia. Liquid Depth
DIMENSIONS (q "-2v_
SETBACK SYST TO P/L *BLDG WELL LAKE/S EAM LEACHING Manuf urer - 1 /
INFORMATION Type Af System: IQ IT 01 CHAMBER OR /
N+ UNIT Model Number: /
DISTRIBUTION SYSTEM 071GC4 / tS 1J A ~,~J K'
eader/Ma ifold Distribution j a . ~F r x Hole Size x Hole Spacing Vent to Air Intake
f / Pipe(s)LO ,
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~IC1-{ Q
ver Depth Over xx Depth of xx Seeded/Sodded xx Mulch
Bed/Trench Center Bed/Trench Edges Topsoil Yes Rd No 0 Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1473 129th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 22 T30N R18W) Lundy Meadows f 6 Parcel No: 22.30.18.1302
1.) Alt BM Description = G W r t j t C 1i !7 C A'g. c t - y 1j( C _ ~
2.> Bldg sewer length ° 21 F amount of cover 1-4
GN ~ r; ~s-I-~~" ~J,4-~~~"~ti~~. ~ ~~~i
ylCf t jf1-~~' ~n'tt`Tr`"YI
16
Plan revision Required? ❑9 Yes No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctors Signa L Cert. No.
Soil Test and System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 114 SE 114s 22 /T N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 6/3/12 BEDROOM 3
DATE
CONVENTIONAL XXX IN-G U D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44
BENCHMARK V.R.P. Top of telephone ped ASSUME ELEVATION 100° Filt BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shal be SDR 30/34, within 10' SYSTEM ELEVATION 91.8/91.7 5.5' below qrade
of tank, pipin shall be Schedule 40.
Plans Designed Using
Conventional Powts Vent
Please note: I staller must Manual Version 2.0
verify all lot 1' es and setbacks ~6„ Quick4 Standard
before install tion. of Cover Leaching Chamber
with 20.0 ft2 of Area
Scale is 40' 12„ 10.2ft^2/pair of end caps
4' Long
unless o erwise 3 4„ Grade at System Elevation
noted
Well is to meet all
setbacks required by
WDNR
129th St.
Highw, y
Bed om-!~C`
us
0% Sloe ,2- ' 9Q'~C,lk61
wit1~,Zr acing
B-3 15
30'
o ST
0, ,
0,
Ven 4III j 6
t. B-2 5 a0
M: 305 90, 13-1
t
operty Line
,v"~^ rt.
1 Ll,' , tj 1L. C^ t k , % tri} G ! a(-) Z
ICE
commerce.wi. Safety and Buildings Division ounty~
201 W. Washington Ave., P.O. Box 7162
4w m SCi`2 O , 1 7 Madison, WI 53707-7162 sanitary Per 't M b- (to bC filled in//__byCo_)
kon "rtm ommer 57!;-Z 3to
&
Sar"IfWfffltApplication State Transaction Nurpb r
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental A
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1 m , Slats. 73 16; ~e-l Y
1. Application Information - Please Print All Information Property Owner's Name l Parcel #
Property Owner's Mailing Ad Property Location
Govt. Lot
City, State D = - Zip Code Phone Number y_ i/,, Section
c one -
/ T2N; OY'W
II. Type of Building (check all that apply) Lot #
>Uror 2 Family Dwelling -Number o edroo sSubdivision Name
Block # /a Xo '0 1_1Z6
❑ Public/Commercial - Des rit be Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of _
own of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
.00
etmit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
B. ❑ Permit Renewal
lrf~
Before Expiration Owner SsZ 3 ~Q
IV. Type of POWTS System/Component/Device: Check all that a I
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (exp in)
V. Dispersal/Treatment Area Information: .S~
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired (sf) Dis rsal Area Proposed (s evatidn
~v - 6-- 9o6 M 7// ov/
VI. Tank Info Capacity in otal # of Manufacturer
Gallons Gallons Units o
v~
New Tanks Existing Tanks 6 fl
n, V v~ zn ir.w C7 0~
A -1
Septic or Hot '-g Tank
Dosing Chamber 0
VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the PO S shown on the attach d plans.
Plum r' Name (Print) Plu s Signature MP/MPRS Number Business Phone Number
6th 7i~~~~~~
Plumber's Address (Street, -City, State, Zip C
L
5v
oun /De artment a Only
Permit Fee Date Issued suing Agent Si at
Approved ❑ Disapproved 22
❑ Owner Given Reason for Denial $ 27 l C~!
IX. Conditions of Approval/Reasonj for Disapproval
Attach to complete plans for the system and submit to the County only on paper not less than S 12 x 11 inches in size
SBD-6398 (R 02/09)
Soil Test and System PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 1/4 SE 1/4S 22 /T N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 6/3/12 BEDROOM 3
CONVENTIONAL XXX IN-G U
D PRESSURE CONVENTIONAL LIFT HOLDING TANK
6 ,
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44
BENCHMARK V.R.P. Top of telephone ped ASSUME ELEVATION 100' Filter BEARFilter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shal be SDR 30/34, within 10' SYSTEM ELEVATION 91.8/91.7 5.5' below grade
of tank, pipin shall be Schedule 40.
Plans Designed Using
Conventional Powts Vent
Please note: I staller must Manual Version 2.0
verify all lot 1' es and setbacks >6" Quick4 Standard
before install tion. of Cover Leaching Chamber
with 20.0 ft2 of Area
Scale is = 40' 4' i✓ong 12„ 10.2ft^2/pair of end caps
unless o eiwise Grade at System Elevation
34"
noted
Well is to meet all
setbacks required by
WDNR
129th St.
Highw y
Pro 3
Bedroom
House
0% Slope
2-3' X 90' Cells
with >3' spacing
B-3 15' 15'
30'
ST
3 0'
10'
Vents
it.
M. B-2 Lr ZTN--n
90, B-1
M. 305
Property Line
? SOIL EVALUATION REPORT-~ Page of
Wisconsin Department of Commerci
Division of Safety and Buildings Jut ~O ~~1
' in accordance with Comm 85, Wis. Adm. Code
f
S1 NIf3G U r r . County
Attach complete site plan on mjoetNii i an 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q 6 - 36 .,Cuo
Please print all information. Re ' e y Date-7 Z
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)).
Property Owner Property Location N
~ 1 /4 2Z_ T 30 N R E (o W
e t~ / /rrI L Govt. Lot 1/4
Property Owner's Mailing Ad ss Lot # Block # Subd. Name or CSM#
33 , r 34
City state. Zip Code Phone Number ❑ City Q Village To Nearest R d
P~~ ( ) (__rt/J
9-New Construction Use: sidential / Number of bedrooms Code derived design flow rate J GPD
❑ Replacement ❑ Public commercial - Describe:
Parent material FjI Plain el vation if ap le ft.
General comments / %t/ ° Z.
and recermtendations:
System Type Zo System Elevation
F/9 El Boring i
Boring # Ground surface elev. 9 ~ 2-
pit - ft. Depth to limiting factor . //3 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
77
~Lo L"
# ❑ Boring r~'y
Boring
A Pit Ground surface elev!_/` 1~1_ ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
Z !s rn ,
67-
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mgA_ ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Nance (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 715-246-4516
Property Owner Parcel ID # 02-&- ''to Page !i of
FI) ❑ Boring
Boring #
Pit Ground surface elev.&'1?7ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
! 1
/D d e'
Boring # ❑ Boring
F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # F-1 ❑ Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 rrgA- and TSS < 30 mg1L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact
the department at 608-266-3151 or TTY 608-264-8777.
SBD8330 (IL6=)
commeree.w Safety and Build' i to County C
201 W. Washington Ave., P.O. Bo C~T , f'
C-n ' S~ n Madison, WI 53707-7 Sanitary Permit Number (to be filled in by Co.)
~epaltrnerH core xM, X12 55Z.
S nita r ication State Transaction Number
In accordance with s. Comm. 8 21(2), ~d mission of this form to the appropriate governmental
unit is required prior to ob ' g a~ t Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department o C~ Personal information you provide may be used for seco dary u oses in accordance with the P Law, s. 15.04 1 m , Stats. I ~l 7
1. Application Information - Please Print All Information
Property Owner's Name Parcel #
Oe e ac7-?-6 6s-
Property Owner's Mailing A ess Property Location
✓l / i Govt. lot •
City, State Zip Code Phone Number :5_ ,
Section
le one)
'-YD` T ~0 N; R E o
11. Type of Building (check all that apply) Lot # C_~ I or 2 Family Dwelling - Number of Bedrooms Subdivision Name
Block #
❑ Public/Commercial - Describe Use
❑ City of _
❑ State Owned- Describe Use CSM Number ❑ Village of
I ~ Town of
~i 1.15 ~Za-ZZ, (~nat.,,,•~oeIII. Type of Permit: (Check my one box on line A. Complete line B if applicable)
A. ~<ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner _ i ( f
IV. Type of POWTS System/Component/Device: Check all that a 1 77 '
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treat nt Area Information:
Design Flow (gpd) Design Soil Application Rat-e(gpdsf) Dispers Area Required (sf) Dispersal Area Pro sed (sf) tteem Elevan
-z"? ~ 5
T1 f 1 J 291
VI. Tank Info Capacity in Total of Manufacturer a
Gallons Gallons Units o aaa~~~o
New Tanks Existing Tanks it u a
Al r"► ` a Cg zn cn W c7 a
Septic or Holding Tank /
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assu a onsibility for installation of the POWTS shown on the attached plans.
Plumber's ame (Print) Plumber' 1 ature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip ode /
VI oun epartment Use Only
Approved ❑ ~ Permit Fee Date,;SJU Is sui Agent Sign e lf~:)
751 _7/
~
Owner i n Reas r Denial
IX. Condi ~,QMVReasons for Disapproval
i . 'Se tic tank effluent fikar ead: J ' t'~i j'd✓ t
dispersal cell must all be services fmaiittaated: W +9 S M.~'~ ~AC2!(Zutts v~,
as per management plan provided by pluffAwt,
2: AN setback regt*ements must be,maintaindd ,
n ` bk code / tii~naliGtis ~ P O +
Attach to complete plans for the system ands mit to the County only on paper not less than 8112 x 11 inches in size Yt-Wt5 af' r~;~ I
9
SBD-6398 (R 02!09)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 6/3/12
Owner: Oevering Homes LLC
Location: S1/2 SE1/4 S22 T30 N,R18W Lot 36 Lundy Meadows Richmond
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Conting ncy Plan
7. Filter Specifications Shee %
Signature
License n b #226900
PLOT PLAN
PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
N 1/2 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE6/3/12 BEDROOM 3
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 1001 Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Sameas Benchmark
All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 90.9/90.6 5' below grade
of tank, piping shall be Schedule 40.
Plans Designed Using
Conventional Powts Vent
Please note: Installer must Manual Version 2.0
verify all lot lines and setbacks >6" Quick4 Standard
before installation. of Cover Leaching Chamber
with 20.0 ft2 of Area
Scale is 1" = 40' 12" 10.2ft^2/pair of end caps
4 Long
unless otherwise 34„ Grade at System Elevation
noted
Well is to meet all
setbacks required by
Pro 3 WDNR
Bedroom
House 25' ST
20'
95' Highw, y 6:
96'
B-1
4%
Please note: soils Slope
are to be verified
prior to installation 95'
to see if a .7 can B-3
beinstalled!
45'
2-3' X 90' Cells
with >3' spacing
Vents
30' -2
30' Alt. B.M.
L B.M.
Property Line 90'
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft 2 pair of end plates
Finish grade elevation
Typical Installation 95.5'
jVen, Grade Vent
4" 3'
X30/34 Septic Tank
5' S' Long 1
36" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 90' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A__90.9
B 90.6
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA ~e -7 Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units fig:NA Pump Tank Capacity gal NA
Estimated flow (average) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) ;/JZ7 gal/day Pump Manufacturer 11 NA
Soil Application Rate _ gal/day/ftz Pump Model jNA
Standard Influerft/Effluent Quality Monthly average*! Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) <_30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L '~_NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size %a in dia. ❑ NA Other: ❑ NA
Other: ~]NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: TVear(h(s) (Maximum 3 years) ❑ NA
'°~yeears)
Pump out contents of tank(s) When combined sludge and scum equals one-third ('/3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: year( )(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
/ ar(s)
Inspect pump, pump controls & alarm At least once every: OW-111 ❑ month(s) NA
❑ year(s).
Flush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other: At least once every: ❑ month(s) NA
❑ year(s)
Other: NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
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 (%3) or more of the tank volume, the entire
contents of the 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, and 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.
GMW (4101)
Page oT
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
a All 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.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
__16 A suitable replacement area has been evatbaated and may be utilized for the location of a replacement soil absorption
/''---system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name 7
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATOR AUTHORITY
Name Name rb;~ k
Phone ✓ - l~ Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Page OT
START UP AND OPERATION
For new construction, prior.to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All 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.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name / Name
r Phone
Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name K n
_2_ J
Phone J ) - Phone lJ -b
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address IS S Zel- t 6A ac4 A~. D z
Property Address _ / 73 1
(Verification required from Planning & Zoning Department for new construction)
City/State Parcel ,identification Number
LEGAL DESCRIPTION
Property Location '/4 , Sec. , T -30
N It YLW, Town of
Subdivision '4'~e - - , "'t- Lot#
Certified Survey Map # , Volume _ Page # .
Warranty Deed # ~"~Izzz-s
~ volume Page #
Spec house es no Lot lines identifiable yes 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 §Comtn, 83.52(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 (l) 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 113 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 Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on is form are true to the best of my/our knowledge. 1/we am/are the owner(s) of the
property described above, by virtue of a aT ranty deed recorded in Register of Deeds Office.
Number of bedrooms
IGNAT OF APPLICANT(S) DATE -
***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. 08/05)
es
_..1 ISL A---
A.
.y
P
x
7 a~ I~
9 0 0 5 7 2r} 1
900572
STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Oevering Homes, LLC, a Wisconsin 07/22/2009 08:00AM
limited liability company, Grantor, and Kenneth Oevering and Amparo WARRANTY DEED
K. Oevering, husband and wife, Grantee. EXEMPT I
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00
described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 128.40
PAGES: 1
Lots 35 an 36 Lundy Meadows in the Town of Richmond, St. Croix
County, Wis sin.
Recording Area t
Name and Retum Address: ,~l~
Oranzo I've '
PO Box `7v
New Riond, WI 54016
026-1165-35-000 & 026-1165-36-000
Parcel Identification Number (PN
This is Dot homestead property.
Dated this t b day of `-(b , 2009.
Oevering Homes, LLC, a Wisconsin limited liability
company
+ * B
* By:
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
COUNTY OF ST. CROIX ) ss.
authenticated this Personally came before me this day of
the above named Oevering
Juyle-
Homes, LL( a Wisconsin limited liability company to me
* known to be the person(s) who executed the foregoing
TITLE: MEMBER STATE BAR OF WISCONSIN in ent and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)'
0 Lim ft~'AZ4 _01
THIS INSTRUMENT WAS DRAFTED BY
Notary Public, State of isconsin p
Robert L. Loberg My commission is permanent. (If not,rsiati~p t
V • y )
Loberg Law Office sw/ SFA7235 t&L
(Signatures may be authenticated or acknowledged. Both are not necessary.)
•~Q ;
'Names of persons signing in any capacity must be typed or printed below their signature 4
••ST9
WARRANTY DEED STATE BAR OF WISCONSIN FORM Nat-2000
1 of 1
~ I
~50g~ ~'37~-
W0859 3 C 3• ~
111,60
lal
AOFIN
Soo% 2.9
PE 11 • 14 NOR978" w
3707
53: ~8"-~---~ 584.56'-
•3,T'44f ~w-~'"r,~fs of 11-4
1315.69 SS E SHEE T 2
26~1..3B -
JKM
Ala
1 YfRl1 rse 7
06
1 .y
t
d ~
....r
r N d • ,afvn
slog
sir x~
N a fill
110!N
lam IN
r
IYi
w
lot
r
N
a
i
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / ofL
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2 i -3~~
Please print all information. view _ Date
to
Personal information you provide mal'tre'usedforsecondafy parpro3e5 (PrtV~cy Law, s. 15.04 (1) (m)).
Property Owner x Property Location
.5 T-~ s j Govt. Lot 1/ 1/4 S T N R E (o W
Property Owner's Mai ' Address Lot # Block # Subd. Name or M#
City fate Code Phone Number [3 City ❑ village ; T Nearest Road 71
i
44
New Construction Us • Residential / Number of bedroom Code derived design flow rate . ~ GPD (15 K)
❑ 1k, Replacement Public or merdaI - Describe:
Parent material Flood Plain elevation if applicable
General comments /
and recommendations: ILA-, ` fr ti~~ 9V / of "I
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil AppliAtion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
,61 ( oZ
2 1Z -
~I
® Ong # Q Boring
/U~(l Pit Ground surface elev. J ~ it. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont_ Color Gr. Sz. Sh. 'Eff#1 'Efff#2
f!
Effluent #1 = BOD > 30 < 220 mg/L and TSS > < 150 mAV ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L
CST Name (gym Print) r CST Number
Bird Plumbing, Inc. Shaun Bird 41zt-~ 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 9- 1/-"" 0 n 715-246-4516
-3 L
Property Owner _ Parcel ID # Page of
5 Boring # ❑ Boring
Pit Ground surface elev. j_( ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Mun ell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2
4
3 I z
T . . . . . . . .
Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
❑ Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff 'Eff#1 'Etf#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
F-1 Boring # Boring Ground surface elev. ft. Depth to limiting factor in
❑ Pit Soil lication Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
Gr. Sz. Sh. 'Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color
Effluent #1 = BOD; > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BODS < 30 mg/L and TSS 30 m911-
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
sBO.9330 (R.W00)
Soil Test Plot Plan
Project Name William Stock/Steve Dalton Sha ird
Address 1748 112th St.
New Richmond Wi 54017 TM #226900
Lot 36 Subdivision Lundy Meadows Date 8/11/03
N 1 /2 SE 1/4S 22 T 30 N/R18 W
Township Richmond
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 10o ft. Top of Survey Iron
System Elevation 90.9/90.6 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
Scale is 1" = 40'
Please note: Installer must
verify all lot lines and setbacks unless otherwise
before installation. noted
Please Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating. >
95' 3
B-1 96'
4%
Slope
95'
B-3
45'
30' -2
30' M.g .ilA
M.
326' Property Line 90'