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HomeMy WebLinkAbout026-1160-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556342 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Todd Marek Construction, c/o Todd R. Marek Richmond, Town of 026-1160-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: Mb /05 23.30.18.1216 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 10, Septic , Benchmark W , S ~ 5s 105.5 /aa Alt. BM A- YYI\ bod-1~. t 1.~ Go (o /66.0/ Aeration Bldg. Sewer -7. 7 ,~q S ~f '7 Holding St/Ht Inlet x,45 97a TANK SETBACK INFORMATION St/Ht Outlet ~-7 TANK TO P/L ELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 16 63 5 / Dt Bottom Dosing Header/Man. Aeratio Dist. Pipe 1~ •5 Holding " - Bot. System Id .15 C7$ . PUMP/SIPHON INFORMATION Final Grade (o.77 Manufacturer Demand St Cover GPM 11 / iv f1ld. ~L Model Nu, r TDH LI Friction Loss System Heg0,, TOH Ft - Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM r Q BEDITRENCH Width Length No. Of Tren hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 162 A4 psi - SETBACK SYSTEM TO P/L 11 BLDG WELL LAKE/STREAM LEACHING Manufacturer: . INFORMATION CHAMBER OR -27;~ , I °Z Type Of System: 0 UNIT Ai A-- i Model Number: DISTRIBUTION SYSTEM l Z~ = 160 J ..7 Header/Manitold v_.7 ) 1 Distribution x Hole Size x Hole Spacing Vent to Air Intake ty l Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Gk," xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil s No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / ~ Inspection #2: Location: 1316 146th Ave Net Richmond, WI 54017 (SW 1/4 NW 1/4 23 T30N R18W)rWhitetail Meadows Lot 1 Parcel No: 23.30.18.1216 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover A +c) or Plan revision Required? Yes No LJ\T~ I _ Use other side for additional information. c - ~s ~a eel lJ Date Insep ors Sign re Cert. No. SBD-6710 (R.3/97) PL-,94- PtA- tA r ~0 1 l~ ` r commerce.whgov Safety and Buildings Division County C O r 261 W. Washington Ave., P.O. Box 7162 c Madison, WI 53707=7162,. Sanitary Permit Number (to be filled in by Co.) sonsin Department of coamwroq 55 (p 2- Sanitary Permit Application State. Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm, Code, submission of this form to the appropriate governmental 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 v purposes in accordance with the Privacy Law, s. 15.04 I m , Stats. RECEIV EN 13/ q6 A ~ 1. Application Information - Please Print AI In rmation / Ip T C'J Property wner's Name .3 Parcel # A-A-e- 'IW 0 Z ~o I td0 0 Prop rty Owner's Mailing Address 8T cm.., Property Location ` to fi D C~ irhlAUNG & ZONING OFFICE= Govt. L 9t City, St(~aattee r I ` ~f r Zip Code / Phone Nurn(beer 7 yr~ Al &J Section , Al t(C4/A6 J D \ _ O( / 115-- ! 1 J / circle one) T N; R E o II. Type of Building (check all that apply) Lot # PU4 or 2 Family Dwelling-Number of Bedrooms 06 Py a Block # ❑ Public/Commercial Describe Use e--- ❑ City of CSM Number 11 Village of ❑ State Owned -Describe Use ji~_Townof '41 ead.~ ' r C ~i Z G~a,~~r3 111. Type of Permit: (Check my one box on line A. Complete line B if applicable) ❑ ❑ to Existing A. ANew System ❑ Replacement System Treatment/Holding Tank Replacement Only Other Modification System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration OwnerQ-ar f V. Type of POWTS S stem/Com onent(Device: Check all that apply) ' Q A4 cf-a", a r )Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. ofsuitable soil ❑ Mound < 24 in of suitable soil )5r ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) w.tD~3 V. Dis ersal/Treat nt Area Information: Des n Flow (gpd) Design Soil Application Rate(g Dispersal Area Required (so Dispersal Area Proposed (st) System Elevation 00 o YSe e 13 1 ©00 7Z7-0 0 Vt. Tank Info Capacity in Total # of Manufacturer b Ai I Gallons Gallons Units ° y New Tanks Existing Tanks ~ 1-9 2 .9 2 i7, 2 P Zak 16D Septic or Holding Tank (lR x Dosing Chamber goo VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu er's Name (Print) Plum;47 MP/NrMS Number Business Phone Number ~ N etw/ XOL- 1 z:z to 1,5-Z7? Plum s Address (Street, City, State. Zip Code)) / / ~mi "4 ~ v ~ o ff VI11. Count /De artment Use Only Approved ❑ p Permit Fee Date ued Issuin ent Signature $ `175.ze ~Z ❑ Ow 4 el' Given Rea for Denial IX. Condi*ffiJ4JJflrJ#f4Vfeasons for Disapproval 31 ~ /pe~e~ -o r ne... V►o„vte~,,, 1. Septiti tank, effluent flker and ✓ ~ n dispersal cell must all be servtees I rrtai ttafned. r~ b /►f c..~ e~..t,n..Q, as per management plan provided by.PIUP- , r n 2. AU se(baali E'eguWornents must be roia tait* l Nd d F 3 rvir p LV- r n ~l ra nay Attach to complete plans for the system and submit to the County only on paper not less t Wan 8 in x t i inches in size A^ u SBD-6398 (R. 01/07) Valid thru 01/09 ~D~ h/ ~Pt~ ~vf ~fi ~ P~' ~ .J~P ~ ~ L L- g~ ~ L L lY~ Q~~~ v ~ o~ s~ d 0 ev G ~5~ $i >y D CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 60p AJ 5 + Owner's Name: 4-0 EP 44 AP-115- [<:f - Owner's Address: Z Z 2tCt~ MoNp W c 5 Legal Description: r~Z IV A J Township: gt 0944 0 AJA County: Ck-4 (Subdivision Name: V1~J 1'F 1-r6~ ( L ~0U) 5 Lot Number: C/ Parcel ID Number: Page 1' Index and title Page Z Plot Plan Page 3 4'A 38System Sizing & Cross-Section Page 4, LJ,4 Filter Specs ~Ig loamp c"vc- Page 5 Maintenance Information Page 6 #91 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 _ Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: ~L yd License Number: P 2 Z~ 77 ,01 Date: Phone Number Z/ Z7} ~ Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 LJL- 6~G P /moo a ~ f~`~ ~Pf L L.- g LL d° ~ Q -11: Fea! loor d O fl/ G I Sep. 25, 2012 8:19AM No. 4837 P. 2 $ r 0 co C:> C-) z~ Lo, <=M v N~j~ pp T~~ R~s TOr ►~TI . WoNO o C n t" V -94) Q r m7 u, ~~ic z $o~Sosg W m n m -V v fib. o L 4444-" o G S J, 1 11 D r O -3; V m o$-4~ U-nQ~ > n 0 -rj lJ C SvSv~v Z O co n CD W = W ~ --~J oo~~ pp .O o g J g N r rn ~ ~ m $ co m ~ m ~ m a ~ R ~ CD m w m Lh O i -n ~ m m O 1 aS m 18 rt~ m m T O Z lb m ,a Ilp . , •i ~ ~ • Quick4 Pius Standard Chamber Side and End Views 48" - (EFFECTIVE LENGTH) 12" - = Im - _ ue . = - : 34 Quick4 Plus All-in-One 12 Encap Front, Side and End Views 11.2" - 13" 8" INVERT 8" INVERT 5.3" INVERT 33" Quick4 Plus All-in-One Periscope QUICK4 PLUS ALL-IN-ONE PERISCOP (36G' SWIVEL ' QUICK4 PLUS 12.7" INVERT ALL-IN-ONE 12 ENDC ENDCAP Quick4 Plus Standard Chamber Specifications 1 Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) _ Invert Height 0.6", 5.3", 8.0", 12.7" Effective Length . 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm) INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured,by Infiltrator ( "Units"), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT' TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, systems inc. including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Sys Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation Instructions; the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475 terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860,577.7000 • FAX 860.577.7001 third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. 800.221.4436 (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. 0 2009 Infiltrator Systems Inc. Printed in U.S.A. PLUS0510101SI-2 Combination Sep><ic;Tank and PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS - •VE1JT CAP: WEATHER P~OOF juWCTIOU 60X H'C.I. VEMT PIPC APPROVED LOCKIMG ' OM OOOIC, MA,00LE COYER P-AV jQ FR 1 wAFtJ11JG L.p.gEL. ii,Qoow OR FRCSH Col.-, DuIr ~r~sP~cS1o~ PIPE Ai -R oiTAKE S 6'Mw. l00 T I i ~ - ~ ~ ~ 18' hll Il. 18,'MIN. ' PROVIDE IM LE T AIRTIGHT SEAL eA~ A I I I APPROYED JOIUT: APPROVED JoI1JT Z1'~BL Fttr I II W/C.T. PIPE~I"' W/C.I- PIPEoyTank construction I III ALARM I shall comply with ~I II TLH~ 1;3.15 and 33.20 a I I 0►J C I PUMP OFF O COWCRETE BLOCK cz_ 3" APPRO- RISER EXIT PERMITFED OIJLy IF TAUK MAWUFACTURCK HAS SUCH APPROVAL gEpOtNG SEPTIC E SPECIFICATIOUS DOSE W 1 CHIC-' ~ t~ WMbER OF DOSES: PER DAy TAi.IK MA►JUF,hCTURCR.: • TAWK :,IZE; GA,LLDAJS 005£ VOLUME I~ ALARM MAIJUFACTURCR: S•5.~~1- IZO S~(S~L INCLUOIMGP OACKFLOW: _ (q ` GALLONS "Z 3, 91 MOOV L WUMBER: L OL Hl v CAPACITIES: A= IUCHES OR L GALLOUS SWITCH TtIPC: 8= Z IWCHES'OR -11 ~ G~LLOIJ5 (SUMP MAMUFACTURER: L~ C: `7 IUCHES ORAr -r tiALLOUS MODEL fJUMBER, Z11f/ D= INCHE5 OR( 23` GALLOMS SWITCH TYPE: DOTE: PUMP AMD ALARM ARE 1"0 61. MI)JIMUM•DI5CHARGE -RATE----,T-,5-GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMP OFF ALI0,.015TRIBUTIOU PIPE.. hEET + MINIMUM NETWORK SUPPLY PRESSURE FCET + 3 0 FEET OF FORCE M IM X ~ , t(F/loprLFKICTIOW FACTOR.. l Sc FEET TOTAL DYNAMIC. HEAD = z- FEET As per,nanufacturer gal/in. J J LL! ~ ~ ~ o4n w cn a o ,off In Of aM=3 -j 0 N- Q= m m a Q ~ U W a c7 Q EF n ~~v v ch m?M ~M N E o R 0o U z o L O ~r oo~ ro a CL ~ LO _ E U -FI rn N N d rn CO V d d l11 d _ W ZI o ~ Jr+ N U1 Z U CA z ca w Q /O V u Q ~ 0 LU 002 CD C3 C~) r M U 0 ~W u U U Q ~~m1 i d LH8 'IN O W8 ZHZ ~z ,tlas APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 NGOULDS PULPS Submersible Effluent Pump`~ . PE nN'•1'•, ~ MJ, ' PuMp SPECIFICATIONS MOTOR FEATURES Pump -General; General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104°F (400Q • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts 1111111 Thermoplastic impeller and fully submerged. • Built-1n thermal overload pro- cover, • Solids handling-1h" tectlon with automatic reset. ■ Upper sleeve and lower maximum sphere. • Vass B insulation. heavy duty ball bearing • Automatic models Include a • Oil-filled design, construction. APPLICATIONS float switch. • High strength carbon steel ■ -Motor is permanently Specially designed for the a Manual models available, shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor. working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum Cape* 61 GPM • 115 and 230 volts Cord, 20' standard length, • Maximum head: 29' TDH • PSC design 1heavy 15 or d230 uty 16/3 SJ U~ with !I 51 Pump: PE51 Motor. plug. Maximum Capacity: 70 GPM • .50 HP, 3400 RPM Complete unit is heavy duty, Maximum head: 37' TDH • 115 and 230 volts ■ portable and t is hea compact. METERS FEET • PSC design ■ Mechanical seal is carbon, 40 ceramic, BUNA and stainless MODELS: PE31, PF41, PEST steel, •I 35 r ! I I i HP.33, .40, .50 ■ Stainless steel fasteners. 10 I: 1 I 2 GPM I I l 30 ••~Ey ` , ' i t - (I AGENCY LISTINGS 1FT I ~~0 C ~ I C I !i ~t. ~ i;! C US c zo I 4.1. Tested to UL 778 and 1 r! M C5A 222108 Standards 15 I - BY Canadian Stanftrds AnocWon file #Mao 10 ^-I•-~ I ; - i..,L ! 1 ! ; . Goulds Pumps Is I50 9001 Registered o ,o° ; I I l 20 SO 40 50 60 70 GPM 80 0 5 10 15 M3/h Goulds Pumps ® 200411TWater Technolo CAPACITY Eff•divalune, 3004 inc "931/41 ITT Industries POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner YZPP Septic Tank Capacity Z~ al ❑ NA Permit Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ~L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ;KNA Pump Tank Capacity al O NA Estimated flow (average) 6t gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) Q gal/day Pump Manufacturer a- JA L, p ❑ NA Soil Application Rate al/da /fts Pump Model LZ/ ❑ NA 03 g 71 Standard Influent/Effluent Quality Monthly average* Pretreatment Unit JR NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average " Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L 0 In-Ground (gravity) ❑ in-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. E3 NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency month Inspect condition of tank(s) At least once every: a ear( )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA month Inspect dispersal cell(s) At least once every: ® ear( ,(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA ® year(s) Inspect pump, pump controls & alarm At (east once every: ❑ month(s) ❑ NA 3 B ear(s) Flush laterals and pressure test At least once every: ❑ month(s) [3 NA '1M year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ ear(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 (Y3) 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 theservicing•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 (4/01) 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: O 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. 13 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. 0 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 © & 2 CL 5o.,V Name Phone -7 1 S - Z 7 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ~0g foAJ Sf}rj/-~ Name C ~Q ~Q el/ /v9 'l 1 Phone j Phone 7/5- 8 jf This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.64(1). (2) & (3), Wisconsin Administrative Code. i Soll Absorption System Cross Section 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching -Lo, Chamber System Elevation ~-ft ft ft Soil Absorption System Plan View /a o ft 3 ft { 3 ft Leaching Trench 1 Chambers 4' Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 ~ ~~~'V G{~ Leaching Chamber Specifications Manufacturer And Model u S EISA Rating sq ft per chamber Soil Application Rate polsq ft vV gpd Design Flow Soil Application Rate ZO EISA Chambers 4(rows of Z chambers each. Page of (A COUNTY PLAT) )uaiter of the Northwest Ouarter and part of the Southwest Ouarter of the Township 30 North, Rcnge 18 West, Town of Richmond, St. Croix County, Wlsc UNPLATTED-LANDS -~------T-- 1016,11 N89°53'33"E ~4.4j -ea62637.27' 393.40' -.b.. 04, sy~a 446.02' Z , 6 ~ OS 7T ~ h ^ ~Kt, I ~oscoQ~o Ng$~ 0 6 sq. ft. OC1195 96 sq. ti M M .0.=1 75 • 5~~~ LOTS 135,617 sq, ft 3.11 acres i ~ 80 I L. B. O. =1003, 75, Oj I Drainoge III ~~~.•IEasement 1017.28 1 co 0 tR : ~ Z Z zl Joint I 72.' 67' Driveway I 555• 233' co Eosel"en t ~ i 43 , ea.s6 ; t4,78 :5d LOTS N b, 33 ti~ ~4 I 111,251 sq. ft. N o 2.55 acres 0 t3r-- _ L.B.O.=1003.75 1 O m N ♦R r ' _ O m~ N IA / Existing N ~ " Wetland 10116.0 ZI c°n N89' 9'25"E 539.41 / LO f~9.3B' I r 262.82' 83,465 s g'3~•~•.•yA >q X336 ~y6lt 1.92 pC. 1 ~ N 11 8gj . _~~P ~ L ~T ~ J 106, 4.32 sq. 00 66~ `Drainoge Nf L. B. D. =1003.75' ~ N 6 Easement arvswvy , 0 ~5 27.06' 323.60 216.55 N8949'25"E W.2C p ' 2:00z XV3 TO:TZ ZTOZ/CZ/60 Wisconsin 0epartmeht of Commerce SOIL EVALUATION REPORT Page / of 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. - L-A lJ V 1 ocation and dist2ri to nearest road. percent slope, scale or dimensions, nol!th arrow, and R ewed Date Please pript all information. R Personal information you provide may be utled for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location / Govt. Lot 6 1 A S023T N R E( w Property Owner's Mailing Address Lot # Block # Subd. Name, or CSM# State Zip Code Phone Number city ❑ lllage own Nearest Road - S ( ) New Construction Use Residential / Number of bedrooms Code derived design flow rate ax GPD ❑ Replacement ,.,,r ❑ Publi or commercial - Describe: Parent material CZL ~ itiC Flood Plain elevation if applicable - - ft. General comments 9 and recommendations: Boring # E4 QV" O Boring It Ground surface elev. ' J' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. j Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 -30 'ZJY -,7 . ~b ,n Boring # ABoring C Pit Ground surface elev. Y'e~' ft. Depth to limiting factor I'Z<2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a-jz lZ ~31~ s l~= rv~~>r w I , Z 3 Effluent #1 = BOD > 30_< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Naante (Please Print) Signatur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r 715-246-4516 Property Owner _ Parcel ID # Page of a Boring # ❑ Boring it Ground surface elev. ft. Depth to limiting factor in. E*'Effi#1 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#2 A4 Mry- pie, kila, T Boring # ❑ Boring F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I I ~I ~I 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BODS < 30 mgll. and TSS < 30 mg/L 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. SOD4330 (8.6(00) Soil Test Plot Plan Project Name William Stock/Steve Dalton Sa i Address 1748 112th St. New Richmond Wi 54017 M #226900 Lot 10 Subdivision Whitetail Meadows Date 8/15/03 S 1 /2 N W 1 /4S 23 T 30 N/R18 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.7/95.6 *HRpSame as Benchmark Alt. BM Top of 2 Pipe @ 100.2 Alt. B.M. B.M. 446' Property Line Scale is 1 = 40 Please note: Installer m st unless otherwise verify all lot lines and et backs before installation. noted 2 B-2 1 % Slope, not 346' enough slope to establish Property 50 contours Line 45' 5' 685' Property Line B-3 35 B-1 5' Pro Town Road 175' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Bird Plumbing Inc. 1008 192nd Ave New Richmond WI 54017 715-246-4516 Subject: Whitetail Meadows Soil Tests To Whom it may concern: I Shaun Bird did the soil tests on this subdivision known as Whitetail Meadows in Richmond township. Aftbr a couple of installations, some of the soils were found to have a more weak structure than what was found in some of the borings. In order to protect home owners and contractors, it is my recommendation after discussing the issue with Pam Quinn from St. Croix County Zoning office that the systems be oversized using a.3 loading rate Instead of the original.4 rate. On the lots that were originally sized for a.5, I recommend using a.4, not the new.6 that the state has suggested. The soils are what the tests indicate but the large areas tested did not reveal some of the weaker structures that were found upon installations. If a installer can prove otherwise, that the weaker structures do not exist, then the installer should proceed with the soils that he/she believes are present. Shaun Bird CST #226900 Z.d ds4=Tt 40 so Jdd 1 , ST. CROIX COUNTY WISCONSIN r-~'r"'`.,.✓ '"i, ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715) 386-4680 Fax (715) 386-4686 Memo to File From: Pam Quinn Date. 4/27/2004 Re. Sandy loam structure misinterpretation on subdivision soil reports Recent soil on-site determinations have brought a problem to our attention. During these on- sites, borings were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zonidg department review. The soil profiles, evaluated by myself, Dave Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that massive (structureless) sandy loams were encountered in horizons that were described as having either moderate, medium subangular blocky (2msbk) structure by Adam Schumaker or weak, medium granular structure (1 mgr) by Shaun Bird. There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness, but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive". Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist), Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the original soil report described the third horizon as sandy loam, "lmgr". On Lot 6 we checked soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy loams in question were a weak, coarse to very coarse subangular blocky structure, where planes of weakness were just discernible when peds were parted from the profile. The peds separated with vM light pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9 soils, which supported the determination that some structure existed to allow water to move through the n of the sandy loam horizon. However, below the weak-structured soil upper ortio portion we found massive (structureless) sandy loams and the boundary between these horizons was irregular, which would mean a distribution cell could encounter alternating weak and massive sandy loam. Shaun said he would amend his soil reports with a memo recommending that any sandy loams he identified as "1 mgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to provide a larger dispersal area. Page Two - Soil Memo 4/27/04 Massive sandy loams have been assigned a soil application rate of 0.2 gpd/ft2 with the code changes in Comm 83.44-2, effective as of 2/1/04. The application rates listed on the soil reports were higher due to the structure having been described as either weak or moderate, which affects the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon had been described on the soil report as "lmgr" with firm consistence. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on-site verifications for any lots with this potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as its structure will be required to use a design based on the current code's soil application rate for h rwise. massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves of e j Naa.W Omw WHITETAIL MEADOWS dbPlUhlbfk r}p ra • y/daYl'seaaaO (ACgMiYllAi) AW°^aY^r1~. 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YAera ae0m r r I BEFORE HAKI 10 M DEVELOPING ANY PARCH, CONTACT V ' A IRE ST. Qp1I WW'I TOTING DIFICE NO aC WPAffmAh ' WMI 801 FOR IadCE Wlm Cm Nabmml d Road (Wing fenadm r I - i! NO OmmRAA OR AE90DI191111 DO ANYMPIO R9R(N no 8w9arq SeNatll lee Ili' Pran R-O-tlj - - g1Pmb pim°P la°al'an } VISE` INTERFERE MIN OR CNANM AE OPERATION OF THE IPPINIUEO p Fad 1-1/f km PO - ` tr WAY Emamnt (104 00YPAElOL41E RAID PAM a SILL DO901 PLAN FOR if THIS ME IN INQIA6S OUT K NOT W RD M &UK R Sa 1-114' a It Nm Rad - OMiage Emanate er I u UPON, &BRUCK ILTEANO, FtLK EMCAYAIN OI ("v" 42) Nt W bar Nd) on, A PLANING N ANY W" EA41ANIS N11FA OINNME 116MOY EmmmN ■ maw Iy,..,,,~ UTM SIR ROMYS NARK CULVERTS, BERYS OR CHAS ® Bmdunae (lap of rm Plpe) E°ammb SEEKS, am UL T x =Eti a-•: KOGS ARE RfEEWM 10 THE NEST Lff Of THE NI-1/4 'ALL OTTER LOT MINERS ARE NAREJ) Nr = High Nate EM■tin FAA a FEET. bO .IN ba Bddnq uPaiq NCAIT YAP Of SEC TIM LE *0 6 AB$aEp TO BEM NOVW'M N. MM 1,$ IC n PR vow 1.13 LAD • Yuman Dmtim of Lmat SHEET 1 OF T SHEETS A T M ` Aa PUN FOR LWAR FOOT om■ 25-M So We LeM) Of f a low NOeM4 m mou awn, N ELEVATORS ARE BAfED OR AN USCS NA1O Wee CAM, prAr q ue,A a ar.a abw ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4fi-0 ✓ 6 Mailing Address ro 2. 719 ! iec~ P t C t~ ryiokv w 0- 'f-A A:~~ I Property Address 3 j ~P 16 - I e2 (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 4 Z /U Q /D 000 LEGAL DESCRIPTION / Property Location /V (kf %a , Sec. TN R l W, Town of -'j Lot Subdivision cjj Certified Survey Map # , Volume , Page # Warranty Deed , Volume , Page # Spec house J01 no Lot lines identifiable <0 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 §Comm. 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 (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue f aunty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE 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) i Illllllllllllllllli111111I State Bar of Wisconsin Form 1-2003 8 0 5 9 2 8 4 Tx:4043402 WARRANTY DEED 957492 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 06/01/2012 12:09 PM THIS DEED, made between Verhasselt Construction, Inc. EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 90.00 and Todd Marek Construction, Inc. PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Kristina Ogland Estreen & Ogland Lots 7 and 10, at of White Tail Meadows in the Town of Richmond, St. Croix 304 Locust Street County, Wi sin. Hudson, WI 54016 Grantor warrants that the title to the Property is good, indefeasible in fee simle and free 026-1160-07-000; 026-1160-10-000 and clear of encumbrances except: easements, restrictions and reservations, if any, of Parcel Identification Number (PIN) record. This is not homestead property. (is) (is not) Dated Z7 7i Verhassel Construction, Inc., by: -(SEAL). *Ga erh selt (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gary V rhasselt authenticated on ? l 2-- STATE OF ) f ) ss. 1 County ) Kristina Or-land Personally came before me on TITLE: MEMBER STA E BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Kristina Orland. Estreen & Orland Notary Public, State of 304 Locust Street, Hudson, WI 54016 My Commission (is permanent) (expires: ) . (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com 1 of 1 I