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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567209 0 GENE L INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal i rmation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. v Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, aka Oeverin Pro ertie Richmond, Town of 026-1161-23-000 CST BM Elev: Insp. BM Elev: IBM Description Section/Town/Range/Map No: e AN Gs 7- 15.30.18.1246 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER n CAPACITY STATION BS HI FS ELEV. Septic Benchmark ? 3 d~ Dosing Alt. BM A b a 7Sd D`r . P Qwratien Bldg. Se r l Ito ,I Holding St/Ht Inlet q f l ~ [ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f 4 l e-h t Dt Bottom lad z? U t'o l0• Dosing 1 t „ Vr- T~ I Header/Man. Aeration ~ ~ ~ •I p Dist. Pipe c... L, IV r Holding got. System e ` ser r3 Final Grade PUMP/SIPHON INFORMATION Manufacturer 6tl _n.f_ Demand St Cover T>~ GPM Model Number elq n ~~v( L ( c~( C1 9,7 TDH Lift Friction LQ.s System3. SV TDH g ~ alt ` A n !;.0 7, r xll Forcemain Length RDt Dia. l/ Dist. to well SOIL ABSORPTION SYSTEM •yt . BED/TRENCH Width Length 1 No. re T hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I;. _e SETBACK SYSTEM TO W P/L BL G WELL LAKE/STREAM LEACHING Ma ufact INFORMATION CHAMBER OR Type Of System: 1-33 1-toDl All / UNIT Mod I umber: DISTRIBU IO SYSTEM Header/Man' Distribution l~ x Hole Size At Hole S,p/acin Vent to Air Intake Pipe(s) 5/3Z Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xa Depth of 7ded/Sodded )o( Mulched Bed/Trench Center Bed/Trench Edges Topsoil El Yes E] No Yes i [M ]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / X31 /0 Inspection #2: 23 Location: 1547 126th Street New Richmond, WI 54017 (NW 1/4 SE 1/4 15 T30N R1 8W) Cherry SdoIlAdd LoT2 Parcef-01015.3 .18. 4 ~o 1.) Alt BM Description = w` 6ke_ t. %tew- 4). ' / '2.) Bldg sewer length 'X, •a'~'T+Mw2. 6~~h5~QGg1^ - amount of cover = y (QQ ~t SD L u Vd,r Plan revision Required? Yes K No D l Use ot her side for additional information. Insepctors Signature Cert. No. *Date SBD-6710 (R.3/97) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.2' BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK 1 SIZE1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° ❑ BOREHOLE O WELL * H. R. P. same as benchmark \ B.M.* Property Line 5 98.5' 3 Acre Lot Scale = 1/4'1 = 10' Grading is to be done to divert Property Line run-off away (not to scale) from system 3% Slope Area 15' below system is to remain undisturbed B- ( 99.2' Huffcutt Combo k Well is to meet Property Line all WDNR (not to scale) setbacks Pro 4 Ho use Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line (not to scale) 126th St. - qh 9EH SERIES SUMP/EFFLUENT PUMP 11.65 8.95 Q 0 0 Specifications NOBEL CAL 50005 SIZE RUNNING PERFORMANCE (GPM @ HEAD) SHUTOFF PWR. CID. WEIGHT DIMENSIONS NO. NO. USiNl6 NP YOUS P.S.I. (Dw. Is.) ANPSIWATTS 5' 10' 15' 20' IFtI la.► Ills.) (H x L x WI 9EH-CIM 509330 III= 4(10 115 314 13.0 1000 70 64 55 41 32 13.8 20' 24 9.11 x 11.64 x 8.94 9EH-CIM 509340 U= 4(10 230 3/4 6.5 1000 70 64 55 41 32 13.8 20' 24 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509350 111= 4/10 115 3/4 13.0 1000 70 64 55 41 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509360 Ut= 4/10 230 3/4 6.5 1000 70 64 55 41 32 13.8 20' 27 9.11 x 11.64 x 8.94 Continuous Duty Rated -"L.ittie Giant Wastewater pumps are rated continuous duty as long as they are run within the published ratings forthese pumps." FLOW- LITERS/HOUR Construction 0 1000 2000 3000 Motor Housing Epoxy Coated Cast Iron Impeller Material Poly Carbonate 30 to Impeller Type Closed Vane Volute ABS W Power Cord SJTW-A w 7.5 20 W Mechanical Shaft Seal Nitrile with carbon and s ceramic faces W Q Fasteners Stainless Steel Io Shaft Stainless Steel 2.5 Bearings Upper Sleeve and Lower Ball Bearings 0 0 1111 fill fill ]III Hill 0 20 40 60 80 FLOW- GALLONS/MINUTE PUMP PERFORMANCE CURVEQ a A~R4". Little Giant Pump Co. 115V 60HZ 6 ' PO Box 12010.Oklahoma City, OK 73157 Phone: 405.947.2511 • Fax: 405.228.1550 r E-mail: customerservice@litdegiant.com www.LittleGiantPump.com A, Form 995235 - 07/03 County-_.. ~ t ,`~~b~tlc Industry Services Division %J - 1400 E Washington Ave Sanitary Penult Number (to be filled in by Co.) f P.O. P.O. Box 7162 P S i~ . Madison, VVI 53707-7162 5 7 z a/^v "'~:,amtkA3i'" - - - - State Transaction Number S ry Permit Application 2 3 In accordance with SPS 38121(2), Wis. Adrn. Code, submission ofthis form to the appro1~ ayarnmentai unit _ _ - is required prior to obtaining a sanitary permit. Note: Application forms for state-owned l' r%i submitted to Project Address (if diff'erem than malln,g ddress) the Department of Safety and Professional Servies. Personal information you provide may be seconclary purposes in accordance with the Privacy Law, s. 15 04(I)(m), Stats.' 1. Application tnformatiou -Please Print All Info to in Property Owner's Name r- " 9- Parcel f f r t ~J ST C 0 3 E,/ L~ / G~JZ Property Owner's Mailing ess O Property Location 4ty, ~ ~Govt. L.oi~State Zip Code Phone Number /v~ 1.L~ Section/ - - y~7 r ncle o I C <2{ KJ - - ; - N, R /.1l'- E ryf w/ II. Type of Building (check all that apply) 1'0 - - e/IC Subdivision- Na me- or Z Family Dwelling - Number of Bedro I 100 ❑ Public/Commercial - Describe Use ❑ city • CSM Number ❑ Village of PTa ❑ State Owned Describe Use - wn of---- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - - _ A' ew System ❑ Replacement System ❑ Treatment/1-lolding "rank Replacement Drily ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Is; .red B. ❑ Permit Renews Revision Change of Plumb Permit Transfer to New G ~3 ty( Before Expiration Owner !V. Type ofPOWTS S stem/tom onent(llevice; (Ghee all that app yl- r - Nun-Pressurized In-Ground ❑ Pressurized In-Group -Grade ❑ Mollnd % 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil Holding'ranlc U Other Dispersal Component Pretreatment Device (explain)-. _V. Dis ersaUTrtat t Area Information: a! Area Proposed S Eh~atictn d Design earl Application Rte(g sf) Dispersal Area Required (s Disper- Design aw (gp) VI. 'l'ank Into pacity in Total # of Manufacturer v v Ca a, o Gallons Gallons Units v rte.' a !2 j NcwTanls Existing Tanks v i'^r p; U v3 ~ cn w (7 w Septic or 14olding'rank - ' _ VII. Responsibility Statement- 1, the undersigned, assu a •spousibility for installation of the POIrCTS shown on the attached plans. plumber's N• me (Print) Plumber' S' nature - - MP/MFRS Number Buslress Phone Nu ,her Plumber's Address (Street, Ciry, tote, Zip Code .57z-:n 12- Vlfl. 'oust /De artment Use Only - - Permit Fee Date Is ed Issuinj Ag t ignau«e Approved Disapproved cc n Keason fo\r DeTftal - - - - IX. Conditi T~Fl114►V .kftasons for Disapproval i. LeptiG tank, elfluenttlter and ! / //JJ disperse! gett•must aU be services / maintained c ^ i 5 r r r, re- r` n as per management plan provided by plumber. g 4d4*cft regtllrelments must be maintained as per ~licalble 6WO / ordkWW s. Attach to complete plans for the system and submit to the County only on pnrper not less than 8 112 z I I inches in sire SBD-6398 (R0313) t PXRTDIVISION OF INDUSTRY SERVICES yti? To,, PO BOX 7162 MADISON WI 53707-7162 3 D S Contact Through Relay k P s y www.dsps.wi.gov/sb/ www.wisconsin.gov ~~SSIONA~ Scott Walker, Governor Dave Ross, Secretary September 13; 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/13/2015 Identification Numbers Transaction ID No. 2306994 SITE: Site ID No. 795428 Oevering Homes Please refer to both identification numbers, 1547 126TH St above, in all correspondence with the agency. Town of Richmond St Croix County NW1/4, SE1/4, S15, T30N, R18W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1448946 Maintenance required; 600 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). All industrial waste shall be properly disposed of onsite or offsite. • Building sewers shall be insulated beyond 30 feet per SPS 382.30 (11)(c). • The tall grasses, shrubs and leaves need to be cut short and removed prior to plowing the surface for CONE installation of the dispersal component (drainfield) to prevent matting under the dispersal area. AP • Your design still references "Dept. of Commerce" code sections. To prevent future plan review delay, DEPT OF please update all plan details so that they are current with SPS code. PROFESSII Owner Responsibilities DIVISION OF It • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the SE COR POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). SHAUN R BIRD Page 2 9/13/2013 • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Sally Shaker Please Include a Copy With Your Engineering Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am to 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. r. SHAUN R BIRD Page 2 9/13/2013 • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh aker Please Include a Copy With Your Engineering Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am to 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. SEP . 5 I NDUS7~7 2013 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/28/13 Owner:Oevering Homes LLC Location:NW1/4 SE1/4 S15 T30 N,R18W 1547 126th St. Richmond System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications +ITIONALLY PROVED Shaun Bird 7 SAFETY AND Signature 3NAL SERVICES License n ber 226900 IDUSTRY SERVICES RESPONDENCE PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 99.2' BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1255 gallons DOSE TANK SIZE 765 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark B.M.* Property Line 99.5 98.5' B-1 3 Acre Lot 11 Scale = 1/4'1 = 101 Grading is to be done to divert Property Line (not to scaled run-off away from system B-3 3% Slope A rea 15' below system is to remain undisturbed B-2 99.2' Huffcutt Combo Tank We[ I is to meet Property Line al I DNR (not to scale) setbacks Pro 4 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line (not to scale) 126th St. At--grade System Sloping Site Cross Section and P[an View AV— Dimensiurl Feet ,L.'S,ryry.L.ywLrLr'L•L•'Lryr'Lr'Lryr"rryrry.•~r•w.'Lr'Lryr'Yry Y'Lryry.l,•'L•'1.•1,»'L•L-'L.'1:.~.."r•1.•L•rr• ~ ,r•rr,r+r•r+r•rrrrrJ,rYrYr Y,+•Yr•Y,rYr■r■r•rYY•Y,rYr YrYr■rYr Yyr r,rYr•r•rrr Yr•r•rrr,r■ r•rr+rrrr A. ~ rLYL•LY'L.'LYL.°LrL•LYLYL•L•L•'4•Lryry.yYywyY'S.Y"L•+yLYLY'L•yL•'L•'L•'LYL•Lr'4r1Y'L•'M1~Y'4~•'L•L•L•'L» ~ / rJr•rY,r.r•r•r•rrr.rr,rrrr,rrrr,rrr•rrrrr•r•r•r•r+r•r•r•,r+r•r•r+r•Y`•r+rwr•r•r• r•r•r•r+r• _x.__.-----_ _..1_..~_. rLrti.•'L.'LwrLr'S.Y'Lry.L.L•.L.'4r„tiry.'S.rL•'L.LY'LrL.'L+LY'L•'LYy'4.L•"L•'L•L•Y4 •'L•q,Yrr•.rY'1iYLrw•'LY'L•'Lr ( l~ rrrrr•r•rrr•rrr•rYr•r•rr,rrrrr•r•r•r.rrr+r•r•r•rrrrr•r•r•rrrr•rrrrrr•r•r•r.rrr• r•Y".~~,y,~.,+~K,~Lf,L~'+~y~y:rr,yr~'tif~~•,'YYrL~4••YL■Lf'LrY'L.'LY'L•"ICY'LWSiY'YYy~ry.yY'kr'L+'L•y•Lr'LYLY'LY'SirLr`4YyYLr'LY r ,rr r.rrrrrr rrrrrrrrrrrrr•r.rrrr+r.rr rrrrrYrYrY. - _ . y.yrS,r.y,yir'Lr.LrM.•yr'LryryY.L.9irwryw'Lr1..'Lr'6.y-Lr'Lr'.y"'L.y•'Y•w•y+Lr'l.r'Lry.w.'S,.'S.•ti.rr..ryLry r 1/613 I r•r•r•r•r•r•rrr+r•r•rr.rrr+rrr+r•rrr.rrrr.,rrrrrrr.r•r•r+r»r»r•r•r»r•r+r-r•r»rrr•r• ry,.Lrr•ry.•r.L-yr"rryrLryr•rryYyr'LrwryrL.'Lryr'Lr'LrwwL.L.'Lr'L.yryr4:.'LtlyrL.y.yyr'S,,'L.yry,yry, ~ . rrr.r•rY,rrr,r,r"r•r,~,.,,rYr„rr,r,r+r•r•r•r.rrrrrwrrr,r.r.rrr.r.r.rrrrr~r.rrr.rrrrr.rrr. ! 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Y.. Yy Yr ~u„ Mx rr_~. ter. tl J l? i - 1/613 0 r< F Plowed r - Clean aggregate L 0 = Q, in. sch. 40 pvc ■LYY _ basal area '/z to 2 '/z in. dia• observation pipe Lateral with Z" Topsoil Cap aggregate over pipe Observation Pipe Geotextile Ci With Can Fabric l r rrr rrrs:'~ti~.r l ` Fl 1 ater)t nvei r YLs%w 06 L• r r••r•r-rr rrrrr•rrr rrrrr ti 'y 'L '6+y"5•L••J•L L•L•L•L L y y L L•L y Topsoil Cap ~I 3 r r r ~•r•rrrr•rr ;rr.rr ,~rfrr•rr•r r r :r+rr•~r+t,rti, y yry V L•L•"L•i5..yrLryr'1:r°,.•'L y yyr• rY ■rrr•r•, F r r•r r r r• r r rrr-r»r»r / f ~•r w L K.~r •JrL y LYL " 1+•!'. ,r-f•r•r r r r r r•r cq•'% Ft COMOU1, L"L'yY yyYyYy Y r» d l rr) r•r r r+r•r r r•r• LrLryr'L•yywL L 9-L•L/ ~ ...r r:r+r r»r:r r r•rrr r r r•r r r r•r r . ~ • rar, Y r r~ r~ryry~~~Lr • Y D Plowed Sul A, x Slope Direction GFENl[ RAIL ]INSTALLATION. The at-grade area is staked out along the desigii contour,. L?xisting vegetation is mowed and raked off` the site. "Fhe basal area (1_, x NV) is staked out and plowed with a rrloldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the paltri.s of the hands. The A x 13 area is covered by clean aggregate deposited overhead by a backhoe. Special cart; r)uisf, be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to prornote vegetative growth, lirnit erosion and protect 1-i'om freezing. 'Che observation pipes are perforated in the lower 6 i.nches and secured in place. 03/OS lgj rage _---oi'_---_.. Pressure Lateral Layout One Lateral. - End Mani-fold `'rWl- 'hltreaded Cle.irroLit lateral "rurn-ur7 _..__.-i► Plug Force Main X \ I'mig Sweep 90 Bend Pressure System Construction Distribution Networrc citications _ Lateral Diameter In.- Laterals are „onstructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X (Ortfrc e trr, thE; pips, with a sharp drill N( and face dowli. I (l ateral Length) lateral turn-ups terminate with a threaded force Main Diameter .Z- In. cleanoul plug, and are enclosed M a 6-8 inch force Main Len tl diameter lam,,ri sprinkler valve box accessible; from finished grade. - - . • • • • • • • • • • Grade 0 • • 0 • • cr:; 6-8 Inch Lawn SPrinider Valve - - Box 03/05 lgi t)age - - of Septic-t')ose J'ank Cross Section And PurnpPerfort-nanue Specifications Tank Mar►xf".turer• lerrxnp i'bi`anuhi ,turer_ tack Mcre;iel Number PumpivlWel Murrber Votal Tank Capacity T Alarm Manufacturrir .4e Mast, Bury fA,ipti1 Alarta Model Number l ilt~r 1Vlartxrftuclttlrer 't Total Dynatiiie 14tod (1 O.11) Vest Filter Model Wrrtriber _ r levatxFarl>Ie~d ~t~ 1)isstrrl J~rre~gt~re ~ S~ NetwoA. Loss Mintinturr .Pump .performance Required Vorce h4 ain Loss 10 Outlet i.Vtanhole Min. 4y' AbL) ve Gtade With rocking t.tevico. Inlat manhole Manhole Min. 41Y Above Cirmle, 6"" Below Grade sled Watertight ~ j 8et.utel,yl Motlrrtwl With JLookirig Y:re vie,;e Weather.- roof Tent )W irr. 12" 1 >i c;r}rerier Above Crrade; lbleurrts With Vent Cup -~`Yr"t; ;i,-Y-f tiN-.-t-W`.-V'-Y' -Y`.-•~"`-4e~'Y-.ti-r•-.~. ,-1.-...WW .-mN-Y".'Y-.-.-Y'."F-.` -Y- f L f f Y rY Y,Y Y4YJY Y Y f s 1 Y I r 1 JIIf Y ~YrP YCY VV.J1af ~f,DC PCY rZYI Vf~ 1 if1~VYV ~r' VYY 1"1 rVi'r'VY I4 tlPLYrr IYYar'/' Outlet Filtur ►.rllet 1 ~ _ 'Inlet Baffle r•,; 1 r, . r i~yWitClr Settings and Reserve (.trpacit~r X% A, % IY111 LY KL ♦ iJyCA3+~W C cy .r. _ IY 1 YC WVI.~ . . ._-__._.._.....__w.._... p 1 1'1 Note . I Y • rliiriensiorr Iixciles `V'c~lu~rxe Cicl. lit (msorve) A; S J . 5' Y I CYVI 1 , ,I I a l (alarm) B f'1:~ alN!{(~trell (dose) t q, x" lit Y Y,I (dead) I) ;Y- -Bottom 'otat i • r'Vr"'IL 1YC1 (fILV Vf<P 1'Ir U(xJ Ili f-a-YITLf '~Y-L'f-t'f F"f~,IT~Y'L taf-N~ f-r l i. 1'f'L I. Y 'cY-'Z-Y~1-f' .J.'. '"L-i-TTL"T'{'-V:'~ti'rFT'T"i"f'T`C' VY• •+Y" J I 1 ra r Ja Jr Irr4 r r ,.1Y . ♦ •r. I- Y f r"a rr"t"YrYL Y i P f,Y r Y Y 1 Y Y flV rfaY f Y Y'Y'b"I IYrD+YrY"1"Y"Y"V "{~f "?4L JIf Y~I~Y. rk3l..Q..~l1~YV°f! F"Li 1 JLl Z ILJ,ILI yJ 4LIYli L, Z 1VZ " !J'J 1 1 1 f•4 it 1Y J l V Y J J r < IYf'r i f 1 4 1 ! f ILJ YY YY•4'1 YIr~J'.'1•f• GENERAL " r0 •Yr~"L •I C.'Y ~1'I"a" a " r,r r i 4!- _~1,y.y„Y_l..k_Y_1.1J_.Z ~.Y A,, a f f„4-LL.L~.~_►.i GENERAL, I111STAILLATI(l►N: 'file septic;rdow twk is budded Finer bwk fillud in wctPrdui►ce will, tlr(, irtatrutacCixr'dr"s product approval a pa0ifirAti1)lls! Maximum depth of bury us speoltxed by the ruantltacturer lush riot be exceeded without. prior 4pproval. lirtanhote3 cover,, exrpowed to parade thane, an ditautive looking dovice (padlock) irrstalle d. ]Piping at the ildet mid outlet its of approved material, connected to the tank, with vuattar+latptlit 1'Ittrrrg5, rii'ict laid on st:a6lef soil to presvent seitrling or Sagging. 'I"he force, main is slenrod with 4"Scl40 PVC to bridle rlie t<<rrl<. exuayativu and tho srlvvvt~ is seu etj watertight" Isleatrioal service, coglplies With NEC 300 and Coiom 16.1%, WalltaeWat,, a SEN-40 series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow - Liters/Minute 0 50 100 150 200 250 sou Cover Epoxy-coated cast iron 35 or I lotlslng' EpoMY`aaYod call-jrarr 30 - 10 9 YtT•pellC r Material Thermoplastic Elastorner 25 - - _ - - 0 111tpeIlF~l Type Nanc~lct~ LL 20 : - - - - 6 Volute Upoxy-coated cast iron m .I5 N0We1 C OY-d 4J rW . 4 m " Mechaoicai Shall Nitrile with carbon and 3 Sc;al cerarnic faces ,l l astanNrs ~taihless~teel 0 Shaft Steel u 20 40 fde 80 llppHr shitered sleevy Flow - Gallons/Minute Boa~imtpr @I1d Ipwer Galt b a:rir,o COO' 4.0 SI=N-40-AF' SEN-40 Specifications SI=N 40 - 509211 4!10 11 B '1 -112 ' FNPT 9/920 80 70 60 45 25 32 14 20 26.6 1750 SinN~d~ d< 09 4'I l1 116 1/2 FNIAT . v:._ 9 020 60 70 " f30 Ab 25; ~ IA _ 00 2~'S, 77 0 SVN-40-AF 509213 4/10 1 15 1 1/2" F1`11 7 80 70 60 45 26 37 14 20 27.5 1750 EiAN !~a-AF M9214 1 o 11., I - FN PT, . < ~{I0 70 60 40;.., 26 32 14 S? X6.5 t Y5(I Frenklin Electric 400 Cast Spring Street, Bluffton, IN 46%'14 Tel: 260.824.7900 + t=ax: 260.824.2909 Form: U96199 7-11 www.frankiin-electric.curri POWYS OWNER'S MANUAL & MANfAGEMIEN PLANY PILE INFORMA'T'ION SYSTEM SPECIFICATIONS Owner r'~ t Septl7-al; ---______~___C✓P,-~4 k Gapactty Permit # - 0 NA Septic Tank Manufacturer 11 NA IESIGNf PARAMETERS Effluent Filter Manufacturer C1 t~A Number of Bedrooms .-u , 0 NA Effluent Frlf:er Model [I NA Nurnber of Public; Facility Units f' 1VA unrp Tank Capacity [--I NA j Estimated flow (average) I/oY_ PurnpTankNtanufacturer NA Design flow (peak), (Estimated x 'I.5} rump Manufacturer - - r z -..__I-1 NA -.1 C Soil Application Rate - - ~ - - 1.~- L..l NA ICI PUMP Model Standard Influent/Effluent Quality Monthly aversffe* Prr3treatrnetrt Unit Fats, Oil & Grease (FOG) X30 mg/l, l7 Sand/Gravel Filter U Neat Lifter Biochemical Oxygen Demand (80N) mg/L U NA LEI Mechanical Aeration 1=:1 Wetland Total Suspended Solids (T,98) :150 rnq& 1:1 Disinfection L:I Other: Pretreated Effluent Quality Monthly average t7ispersa! Biochemical Oxygen Demand (130106) 530 era /L I'.l NA 9 1-1 !n"ttirounrl (gravity) L7 In-Ground (pressurized) 'Total Suspended Solids (`I•SS) 530 rng/L NA At-Grade l._t Mound Fecal Coliform (geometric mean) X904 cfu/9 Dorm awl grip'-[.fne I-] Other: +Maximurn Effluent Particle Size 1f3 in die, L`J NA Other: - _ 171 NA I 11 NA "Values typical for domestic wastewater and septic tank effluent. Other: il NA l1 tUIIAPNYENANCE SCHEDULE Service Event Service Frequency Ilnspect condition of tank(s) At least once every: month(s) _ v ears (IVlaximtrrrr J years) CJ NA (Pump out contents of tank(s) When combined sludge and scum ecluals one4hird (:rj) of tank volume !d_J NA Ilnspect dispersal call(s) At least once every Q month(s) ~jCear(s) (Maximum 3 years) I'] NA CJ month(s) I"lean effluent filter At least once every: 1J NA ~ ear(s) U month(s) - aspect pump, pump controls & alarm At least once every; [-1 NA =Push laterals and pressure test At least once every' 'U onth(s) LI NA 7ther; CI month(s) n NA At least once every: MAINTENANCE INSTRUCTIONS d Ilnspectlons of tanks and dispersal cells shall be made by arc individual carrying one of the following licenses or certifications: iVlaster IPlurnber; Master Plumber Restricted Sewer; P0VVTS Inspector; POWTS Maintainer; 5eptage 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 volurne 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 ivisually inspected to check the effluent levels in the observation pipes and to check fc.r any ponding of effluent on the ground surface. The pondinn of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local l,egulatory authority. When the combined accumulation of sludge and scurn in any tank equals one-third of more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NIA '113, Wisconsin Administrative (erode. All other services, including but not limited to the servicing of effluent fifter's, ntectranical ~3t, pressurized components, pretreatment units, IAnd any servicing at intervals of S12 months, shall be performed by a certified POWT5 Maintainer. IA service report shah be provided to the local regulatory authority within 'lo days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the Pc) 's check treatment tank(s) for the presence of painting products or other chemicals th€It May impede the treatment process and/or damage the dispersal cell(s). It high Gorr centrations are detected have the contents of this 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 till above normal highwater revels, When power is restored the excess wastewater will bra 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 riot 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 litiprove the performance and prolong the life of the POVV'f:Ii: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tat; foundation dr"alin (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting productls; 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 Gomm 83.33, Wisconsin Adrninistralive Code: v All piping to tanks aril pits shall be disconnected and the abandoned pipe oponings sealed. r 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 vold space filled with :►rNil, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS fails and cannot be repaired the following measureu have been, or, must be taken, to provide a code cornpli:prit replacement system: IJ A suitable replacement area has been evaluated and may be utilized for thc; location of a replacement soil absorption systeim. The replacement area should be protected from disturbance anti compaction and should riot be infringed upon by recluirled setbacks from existing and proposed structure, lot lines and wells. 5ailure to protect the replacement area will result in the rircfed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule;[ in effect at that time. El A suitable replacement area is not available due to setback a"dfor soil fimitations. Barring advances in POW TS 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. tJpron failure of the NOWt'S a soil and site evaluation must be performed to locate a suitable replacement area. If no replacemenI area is available a holding tank may be installed) as a last resort, to replace the failed POVVTS. V..p 01.rnd and at-grade soil absorption systems may be reconstructed in places following removal of the biornat at the intiltrative surface. Reconstructions of such systems must comply with the rules in effer.;t at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GA,811ES AND/OR INSUFFICIENT OXYGEN. DO NOT (ENTER A SEPTIC, PUMP OR OTHER TREATMEtr T TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OiI, A PERSON FROM THE INTERIOR OF A `PANIC MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POINTS MAIAI I',A1NER i_c,,',: ' Narne c.. Gt.t v Narno Phone Phorte SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name C`±N~ .GeJ--~. _ _ / J Phone - 3 Whore This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 363.54(1), (2) & (3), Wisconsin Administrative Code. .'0h!`at~:'. FUNER ARTRIDGEINSTRUCTION'S ! ~3I ij Installation ST OP i Pry fit the filter case ante the end of the nudet pipe to ensue it is, centered under tine ace, u .c.s..aisnin If not, then eikh r insert mare pipe into the tank through the outlet or solvent ''veld (glue) additional pipe nntn the outlet pipe. r.'P ;i While the case. is still dry fitted an the outlet Pipe, measure the length of VA-inch pipe needed to bracer the filter to the tsr'rk r--nd wall if utilizing the C optional supplemental side %upport. If side Jaupport nii4thod is not trtllized, proceed to step four. For installatinos utilizing the optional tiupplNYiYWntelf side support' solvent weld the -/-inch pipe until the filter (-_asi,- If side suprjurt rnetttod is riot itlilized, proceed to step four, r _ `solvent weld the filter cage onto this outlet pipe. Terser) cite fifter rart:ritige Into the case,, pressing down until tine filter locks intr) the butturn tit the Case. U a 1/RS switch is utilised: insert in io the fitter and lock by turning duckwisc 90". Ailainttelnanice* L. the effluent filter should be cleaned eve I V time tho :'elide tank Is Servlt:P_el. f 2. Open the outlet: access opening to Inspect. the tank and filter- 'i. n imp the septic tank crurrpieteiy, snaking sure to retrtnve the sludge. Irryer on the bottom of the tank anri not just the scorn and effluent:. 4. Once the effluent level has beerr lowered below the invert of the outlet pipe, firmly pull up tilt the filter' handle to dislodrie the carthige frarri the case. S. Slides the rartrldcle tip and out of the case lot- cinatuntj. G. If it VRS switch connectefl to an alslrlrl is trresent, the. switch should lie rernoved by turning call riterclot:kwise 40" and cleaned ? F with water only. ti i.. 7. While hoFding the cartridge on its side flange Rat carfare (ae:iny down) aver the access opening, rinse riff the cartridge with water, r only, rniking sure all septage material is rinsed bark: into the tank.. zT i°r a. IF VRS switch is utilized, replace by inserting into lifter and turning clockwise qn", r:,rr l 'r 9, insert yule filter cartridge back into the cane, pressing mown until tile filler locks into the bottom of tine case.. W. Replace and secure the at-cess opening an the tank. is:du.re° k:r'.,: seal. :.l:i :v:,,a,:,:. i I www:twaronsiittf'.fi;olli n 877-NU7~,' ERS (653-4583 ST. CROIX COUNTY v SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM t Owner/Buyer eo e r n ,>,,.,Q, 1~~3 C~el IJA ` Mailing Address Q(~q _ A/ i !~1 Property Address 15q (Verification required from Planning & Zoning Department for new construction) City/State / y 4A~i d/ !A r Parcel Identification Number (!::~~t -ll > IV- c~2 -3 LEGAL DESCRIPTION Property Location %a TIN R_ 91, Town of Subdivision It z ~fl_ - , Lot Certified Survey Map # Volume Page # Z Volume , Page # Warranty Deed # I'd Spec hous ye no Lot lines identifiabl yes o 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/w am/are the owner(s) of the property described above, by virtue of a warranty 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) Alli II IIIIIIII~IIIIIIIIIIIIIIIlI ~II DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 8 1 6 9 7 6 9 WARRANTY DEED TX:4139619 982496 BETH PABST THIS DEED, made between Todd Marek Construction, Inc., a Wisconsin REGISTER OF DEEDS corporation ("Grantor" whether one or more) conveys and warrants to Oevering Homes, LLC, a Wisconsin limited liability company (i`Grantee", whether one or ST. CROIX CO., WI more), the following described real estate in ST CROIX County, State of 07/17/2013 4:38 PM Wisconsin: EXEMPT#: N/A Lot 23, Plat of Cherry Knolls First Addition in the Town of Richmond, St. REC FEE: 30.00 Croix County, Wisconsin. TRANS FEE: 57.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 026-1 161-23-000 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2,013 real estate taxes. Dated this 2nd day of July, 2013. Todd Marek Construction, Inc., a Wisconsin corporation J~ By: Todd Marek, resident AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20_ . COUNTY OF ST. CROIX Ss. TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 2nd day of July, 2013, the above (If not, named Todd Marek Construction, Inc., a Wisconsin authorized by § 706.06, Wis. Stats.) corporation, by Todd Marek, President to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY V % Robert L. Loberg / Loberg Law Office dre'd ~ 1315097 / asc Notary Public ('X_ County, C~ ~I •.'~.H. v::1~.4N. ~ . ~ .v: ~4 My Commission is permanent.o • : (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: r. t" ~c a~ . V'. not necessary.) / , •.;~s'' Names of persons signing in any capacity should be typed or printed below their signatures. fff1i11Hltt~~' a NkARR NTY DEED Form No. 1-2003 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m in accordance with Comm 85, Wis. Adm. Code County'- o I Attach completji lan per not less than 8 1/2 x 11 inches in size. Plan must include, but erti nd horizontal reference point (BM), direction and Pqt I.D. percent slopedim ions, north arrow, and location and distance to nearest roag:~ ~J Q s -~23-M-0 Please print all information. ~eview Date Personal i o ation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). • COG 9 Ildll 3 Property Owner Property Location c152r^ ~ eye ,i'y Govt. Lot IVU) 1 /4 t 1 /4 S T 3 j~ N R ~E (o W Property Owner's Mailing Addr Lot # Block # Subd. me or 7.7 City State Zip Code Phone Number El City ❑ Village Nearest Road New Construction Us esidential / Number of bedrooms Code derived design flow rate (10 GPD ❑ Replacement blic or commercial - Describe: Parent material ,1-6 Flood Plain elevation if applicable NI ft. General comments; and recommendations: 9 9 System Type System Elevation F 1-1 Boring # Bonng Pit Ground surface elev. Depth to limiting factor ~Z) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ® Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor 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 2- j s e Z2 Effluent #1 = BOO > 30:5 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST NWV (Please Print) lure / CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluatioonducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 j o~ 715-246-4516 Property Owner _ Parcel ID # Page of U J:jj, Boring # E] Boring pit Ground surface ele ~ --,ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft;° in. f Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 S ! C Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # 11 E] Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mg/_ and TSS < 30 mglL 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. seo-8370 (RAM) Page ....._.___of Parcel V property f holing --y Boring # ft. (]eptte to Itrrtileng lactor trt Suil rllcetiwn Halt pV! Ground surface eM® _ yN1)Iff Horizon ~prrpth l?ondnan9 Color - fdedox Description Texturo Structure Conr:,isttjrtc a t3oundary Idoots .-.'Eff# 1Yt 4f1t1 in. Munsell Glu Sx cont. <:olor - - 7 v 7 Boling }boring 93 _ ir7 soil~l'c eteon irate i Ll Pit Grour7d surtacay ®lev tl. t]t~rrlh 4tr lirndtrx fari~r _ G L11fF Hotizort tlapth Domirtant Color l ledox Description 1`t~xturo 5ttucturt txrrYSiStence Houndary oduo ~ 1 t 1tYts! in, fUlunseR ctu.l3z. Cortt.coor L~ tljUr►rtt~ in Boring # Ground surface elav. tt• Depth to iimitirnj Tartar Suil~ipltundoer Rate pit Horizon ~`1epYh t7orninant Color µ fdcYrjox 1785cnptiort. _ Texture Structure AGtgtsistence Cioundary Roots ~Ur~Fif#! t~tt. Sz. Cont. Color Cyr, Sr. mitt. in. INunseii - - fllue;tl: #1 r C3C7Cp. 3(? rngli.. and'fSS 30 rnwi. 'Effluent #1 = HOD6 > 3U :S 220 rrtgll, and `I'SS >30~ -150 mu/L need st'rvices ar partment of Corr,tnercc is an equal opp PI-Ovid" and ot 1 Y Y 608-264-8177- delrartrne "ttat 0)8-266-31t51 need The De material '11, all alterntite foillial , please stsu a~w tex.WCtut Soil Test Plot Plan. Project Name Oevering Homes Shau. rd Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 V~OD4 #226900 Lot 23 Subdivision Cherry Knolls 1st. Add Date 8/26/13 N W 1/4 SE 1/4S 15 T 30 N/R18 W Township Richmond E] Boring (:D Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 99.2' *HRPSame as Benchmark B.M.* Property Line 98.5° 99.5 B-1 3 Acre Lot 11 Scale = 1 /4" a 10" Property Line Property Line (not to scale) (not to scale) B-3 3% Slope B-2 99.2" Property Line (not to scale) 126th St. a County ck 0 f!~ Safety and Buildings Division -f- ' 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) S P"' Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number , . 1Z ZW _6. 2 In accordance with SPS 383.21(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 submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 1 / purposes in accordance with the Privacy Law, s. 15.04(1 m , Stats./ 3 0:1 I. Application Information - Please Print All Information 15#7 1~~ 9. '5 Property Owner's Name Parcel # O I• 0 Q d Property Location Property O is Mailing Address p z• ; n p,i.~ ; / ~ Nt~ I ~ •"+Fl n,:_ / ~ Z ~jl{~ Z Z O Govt. Lot r ` Ci ,State Zip Code Phone Number Section (circle one) ~JCgI14G _t/0 -7 ~l J 7 Z ~/o T 3d N; R Eorf II. Type of Building (check all that apply) Lot r # Subdivision Name ;AO`CS 5 k1 or 2 Family Dwelling -Number of Bedroo s ~ (5-9 r 1 S 6 L Block 1. ty f ❑ Public/Commercial -Describe Use ❑ City Of El State Owned -Describe Use CSM Number Village of ❑ II O Town of ~ ff /mod 0 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. KNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement ❑ Other Modification to Existing System (explain) List Previous Permit ber and Date Issued / B. ❑ Permit Renewal ❑-Permit Revision ❑ ange of Plumber e r sfer to New Before Expiration IV. Type of POWTS System/Component/Device: Chec all that appbl~' I,/ L-10 A4,b C ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ t-Gra ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other ispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatm t Area Information: 4 1 10 Design Flow (gpd) Design Soil Applicati n Rate( dsf) D Area Required Dispersal Area Prop Ld (sf) System Elevation VI. Tank Info Capacity in 'Total # of Manufacturer Gallons Gallons Units 2 2 New Tanks Existing Tanks D ' a p a~ C~° a.U G a~ in y in = c7 a Septic or Holding Tank Z 8 0 l2 6 p 1~ Dosing Chamber IrD $ / l 3-c VII. Responsibility Statement- I, the undersigned, assume responsibility f installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP61Q?IE3 Number Business Phone Number 1ls z73 d M A -7 Plumb 's Address (Street, City, State, Zip Code) t 7L-' VIII. Coun /De artment Use Only Approved isappro Pem/ut~Flee Date Issued Issuing ent Signature iven Reason o ial 1 $ 01 : P 3 / IX. Condit~eteasons for Disapproval 9.0 4. tank, tM antt!1Iti1"~ ~nl.~.~►~►n dispersal cell must all servkes / maintain r.J : S "per management plan provioad by plumber: 1 'setowk Peyuirenlents must be, rn*ntait>dd per ~ code / WdkWios, ✓ (gyp cr v Q *c . J' Attach to complete plans for the system and submit to the County only on pa tt l~esf than 8 in z hes in size nn a p cJt, ,',~1"EC.1r ~✓~j -1..;.,e B elver ~s C Zw,,.: 7~;~ooAE- SBD-6398 R 11/11 /t~. 1w.~ Al i9 r,,~~1~..~.~ 5►bMI.J a ~ ~ des ly!'b~ ~►c....~ S~C~-A-°'` ,~r~. ' ~otirkxTl A, DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 3 ®S. { Contact Through Relay F<S N www.dsps.wi.gov//sb/ www.wisconsin.gov A srolqScott Walker, Governor Dave Ross, Secretary March 14, 2013 CUST ID No. 226497 ATTN.• POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/14/2015 SITE: Identification Numbers Todd Marek Transaction ID No. 2214552 County Road G Site ID No. 788539 Town of Richmond Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1/4, SE1/4, S15, T30N, R18W FOR: Description: Four Bedroom Mound System / 2% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1415563 Maintenance required; 600 GPD Flow rate; 90 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2. 0, SBD-10691-P (N.01/O1), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter 'I The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P O. requirements. Condit No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: D!VlSliON OF SAFET Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE CORRES requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. ~ r ROGER D NELSON Page 2 3/14/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART coder 7633 jerry.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. ~I ROGER D NELSON Page 2 3/14/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 (^erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. ReCEIVED ?013 MOUND AND PRESSURE DISTRIBUTION COMPONENTj' S Residential Application VICES INDEX AND TITLE PAGE Project Name: Todd Marek Owner's Name: Todd Marek Owner's Address: PO Box 228 New Richmond, WI 54017 Legal Description: NW 1/4, SE 1/4, S 15, T 30 N, R 18 W Township: Richmond County: St. Croix Subdivision Name: Cherry Knolls Lot Number: 23 Block Number: • T.S. anally Parcel I.D. Number. WED Plan Transaction No.: AND BUILDINGS Page 1 Index and title Page 2 Data entry Page 3 Mound drawings N0ENCE Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer. Roger Nelson License Number: MP 226497 Date: 02/26/13 Phone Number. 715-273-4444 Signature: Tt.,, Designed Pursuant to the Mound Component Manual for POWfS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 vvr aar rvaV . I..VV loll - Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand MI (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 8344-3 in-situ soli trea"nt for fecal 1.50 Peaking Factor (e.g_ 1.5 =150%) ooliform of 36 inches. 600.00 Design Flow (gpd) 2.00 Site Slope 99.75 Contour Line Elevation (ft) 90.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpdfif ) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ff ) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3. Number of Laterals of the highest point 0.125 Orifice Diameter (in) 3.50 Estimated Orifice Spacing (ft) = 11.76 fF/orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 11.92 Vertical Lift (ft) 55.97 5x Void Volume (gal) 0.80 Friction Loss (ft) 69.02 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 21.01 System Demand (gpm) 19.22 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia_ options choice in. dia. options choice 0.75 1.25 x x 1.00 x 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) - 'Total Working Liquid Depth (in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) Poly Loc Filter Manufacturer 22.24 Dose Tank Volume (gaUin) 525 Filter Model Number Wieser Manufacturer Project: Todd Marek Page 2 of 8 vV: ii. •,V1V 64rVV 1[111 - Mound Plan and Cross Section Views 1/10 B - . , . -Observation- '0- K - 1 W L Mound Component Dimensions Down slo a toe extension made. A 10.00 ft E 8.40 in H Lift ft K 7.11 ft B 60.00 ft F 9.25 in r ft L 74.23 ft D 6.00 in G 0.50 ft J W 30.01 ft 600.00 (fe) Dispersal Cell Area 1500.00 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate A6A0 (ft) 1/10 8 Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.02 (ft) .rr..~.r z ...,.r.~__ G F cA • • ' - = Dispersal Cell 100-75 (ft) Lateral 100.25 (ft) - = Dispersal Cell Invert 1 , Elevation E D M3 - 99.75 (ft) Contour Elevation 2.0 56 Site Slope Geotextile Fabric Cover Shading Key Q - Dispersal Call See lateral details on Topsoil Cap :2 CL 1 r5 ft . ; Page 4 for number, sine, frr~. Sub © Soll Cap and spacing of laterals. ASTM C3 • ' ~ • - - © 3 Sand°' _ F laterals are [4~ • equally Tilled Layer c 0.5 ft -:Typical Lateral • spaced from the 0 Aggregate distribution cell's ~A centerline in the distribution cell (AxB). Project: Todd Marek Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the R & B dimension •.r Tum-up wf ba I I valve o of can out plug e P All laterals are Wwntic l lF X-i I Holes drlllad on the bottom of the lateral ea.aal S1 spaoeG . Laterals & foroe main of PVC Soh 40 S (pat COMM Table e4.3p.5) Faroe main oonneotion vla tee or oro.^r to manifold at any point Number of laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft Lateral Length (P) 58.56 ft Orifices per Lateral 17 Lateral Spacing (S) 3.33 ft Orifice Density 11.76 ff /orifice Lateral Flow Rate 7.00 gpm Manifold Length 6.67 ft System Flow Rate 21.01 gpm Manifold Diameter 1.25 in Total Dynamic Head 19.22 ft Foncemain Velocity 2.15 fusee Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --1 Comm 1628 WAC 4 in. min. DISCOrIneCt Tank component Is properly vented < Alternate outlet location Forcemain diameter Wieser Manufacturer _ 2 in_ Ca aci 800.00 Gallons Volume 22.24 gal inch A Weep hole or anti- Dimension Inches Gallons 13 siphon device A 20.87 464:10 C 8 2.00 44.48 Pump off elevation (ft) C 3.10 69.02 88.83 D 10.00 222.40 D Total 35.97 800.001 1 ii -J Dose tank elevation (ft) 3t' Bedding un er tank. 88.00 Alarm Manuafacturer S. J. Electra Systems Alarm Model Number 101 HW Pump Manufacturer Goulds Pump Model Number .PE 41 Pump Must Deliver 21.01 gpm at 1922 ftT[)H Project: Todd Marek Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Nelson Plumbing Phone 715-273-4444 POWTS Regulator's Name ( St. Croix Zoning Phone 715-388-4880 Us-tam Flow and Load Par$metgn; Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Sal Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 years Effluent Fitter Should inspect and clean at least once eve 3 ears Pump and Controls Test once every 3 ears Alarm Should test month Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ndin and seepage once eve 3 ears !fl Other Miscellaneous Coma ctlction and Materialle Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished •00*000099*600• Grade ~ $ . 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Todd Marek Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBO-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706-P (N. 01101)1 and local or state rubs pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed seem openings greater than 84nches in diameter shall be secured by an effective kicking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shah be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shalt have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxunum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. jump Tank The pump (dosing) tank shah be inspected at bast once every 3 years. All switches, alarms, and pumps shah be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. N 12M and Pressure DWbutkm System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5. 30 mg/L TSS, 10 mg/L FOG, and 10a du/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and If orifice cleaning Is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components became detective the tank or component shah be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fob to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by Increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devises such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 . ~ GouLDs PUMPS Submersible Effluent Pump PE Tim M Pump - caleral: Gemraf: ■ Corrosion resistant • Dis~* IA" NPT • Single Oase construction. • Teraperahne:104OF (4WQ • 60 Hou fa Cast on body. maxh+um, cominuous whop • 115 volts ■ Thermoplastic inpetler and ley aubrnerged. • Built-m t omat am oed pro- cover. • Solids handling: W action with aulonak reset. ■ upper sleeve and lower Rraximum sphere. • CI a ipsulation, be" duty bail bearing ~ ~ • Auto mdc models inchide a • O&fikd design. construction. float switch. • High sbao carbon sleet W Motes is permene * • Manual models available. shah SPeale3y desiyrxd for the Iulxicatecl for extended following usm • Pumping range: we PE31 Motor: swviw life, • Mound Systems parfarn'ranoe thart or curve. • .33 HP, 3000 RPM • Powered for mr*ojous • EffluenyDosing Systems PE31 Pump: • 12.0 Ma knum amps operation. • Low Pressure Pipe Systems ' f axhum gpedty; s0 GPM • Shaded pole design M AN ratings are within the • B~ja..s.e..ment Draining • Maxdmim head 25' IN K41 Motor: woriong Gmits of the motor. • .lam}' DW Su"O PE41 Ptrrnp: - 40 HP, 3400 RPM fa Quick disconnect power Dewaleffnil • Maximum copecly.. 60 GPM • 7.5 Maximum amps card, 20' standard length, • Maximum head: 29' TDH • PSC des* heavy duty 16/3 SIT W with M1 fur4c PESt Motor NEMA 5-15P, thm prong. 115 Volt plug. • Madmum capadty: 70 GPM • .50 HP, 3x00 RPM fa Complete unit Is duty, • Mwdff m head: 37' 1DH • 9.5 Mall> u m maps portmWeandampam MMRS FEET • PSC design ■ MKhw" seat is awbork 40 ~ BtlA and g7lpteSS 4P J3, A). .50 35 5tanriess Sikh faSterilfi. 10* 30 . i-+ i Fr tILL .v 1. L . - ...r..~..1-.. - i ..t.. ..L. e. r 4-+..- t U CO S t . s . y Y21 3n i MTi-~sted to t1t.776 and GA 222106Slomi " } -4 $ t { - r.. i.. 4 .4 .4- A ..i.-- T. _A..t. 10 t - Ty y iouldt ►unlpi B fS090011101M1w1t Mir ..}.......i...... ...1... -.3.. r. '4- «y...r...x... ,._i... t...E. p. • -•t., ...~...F...L - •i -t.. t _ _ i t E e ' 0 10 2 30 40 se 60 ' 70 GPM 60 ! Q9c 701n 0 5 10 Is mst Gm*k hvlp6 6 2002 Geurds tamps y l . I CAMITY EfftcVeNpWMber. 2002 !TT Industries SE3m BM1 191.58' north lot line OBI N N O ~ N CD Z O Gj`°q 3 00, ° B2 ~O ~ry Todd Marek ° P O Box 228 ~o New Richmond, WI 54017 W'reser1200/800 tank Lot 23 Cherry Knolls NW 1/4, SE 1/4, S 15, T 30 N, R 18 W Richmond Township St. Croix County, Wisconsin 2.2 Acres 4" pvc Scale I" = 40' 40- o•--~ 63 BM 1 = 100.00' top of iron pipe BM2 = 98.75 top of iron pipe ae 78' lot line BM2 24, i Page 8 of 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 0 L✓ / Mailing Address 0, j ?J X 2 2 9 A-) LAJ Property Address t `5 -7 l a6 4 l (Verification required from Planning & Zoning Department for new construction.) f-T, City/State Parcel Identification Number Q 2-3 60o LEGAL DESCRIPTION , / Property Location %a , '/a , Sec. , T 13QN R 1 O W, Town of ~~CIT Od afi Subdivision l; /UD'L L !..°vfi _ , Lot # z Certified Survey Map # , Volume , Page # Warranty Deed , Volume , Page # Spec house no Lot lines identifiable 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. Uwe, 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 tXthisrm iration date. Uwe certify that all statements true to the best of my/our kn owledge. Uwe am/are the owner(s) of the property described above, by virtue of a ecorded in Register of Deeds Office. Number of bedrooms SI TUBE OF ICANT(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) h RrPoR r ov THIS ARrA A - S8-0•*44'10T ..~v~. ~v'-- 39.0 ' S89•44'10 4 452.14' 9~drdw' m 191.38' of Land Ccntrott ~ ~'I. ~ ~ PoQs 295 ~h ~ 2 _ C~ • o Yr2t Acv v sq. ft. a acres ~ 8 .Q . • h ~ +ir ~FairrrvMr+t .50-,41*E iA 9 7S' gyp. V f ] 4t A- lip ~G LET ~t ~.•s. `'o. l~ 74% 5949 sq. ft. WI Aff t. 84 acres 79,5M sq. ft. p acres . 27 -972 74 It £OO~j XVd OZ:TZ £TOZ/6T/ZO l llllfi flili 11111 Iilff filfl Ifll! if flll 1111 916941 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/02/2010 03:30PM WARRANTY DEED EXE t 1 REC FEE: 11.00 TRANS FEE: 51.00 State Bar of Wisconsin Form 1-2003 PAGES: 1 WARRANTY DEED Document Number Document Name THIS DEED, made between Lake Elmo Bank, a Minnesota banking co oration ("Grantor," whether one or more), an odd Marek C struction, Inc. a Wisconsin co oration ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address f/- A23 erry Knolls I st Addition in the Town of Richmond, ~ x County, Wisconsin. p _ Vox N -,j 12iGh c~td . ~I,tZgFnI 026-1161-23-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Dated _AIQ~ LAKE ELMO BANK (SEAL)By (SEAL) * * emnetz t Senior ce res ent (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF 3I MINNESOTA ) authenticated on ) ss WASHINGTON .~^COUNTY ) * Personally came before me on / 117 oZ Q the above-named Bryan J. Kemnetz, the Senior Vice President TITLE: MEMBER STATE BAR OF WISCONSIN of Lake Elmo Bank, a Minnesota banking corporation, (Ifnot, to me known to be the person(s) who executed the foregoing authorized by Wis. $tat. § 706.06) instrument and acknowle ed the same., on behalf of the banking ,y, corporation THIS INSTRUMENT DRAFTED BY: ~ ~Q- t~ ' - Y Lawson, Marshall, McDonald, Galowitz & Wolle, P.A. * i~0 Q tZ , 11zNB1Le 10390 39th Street North, Lake Elmo, MN 55042 Notary Public, State of Yi/2300M Minnesota Telephone: (651) 777-6960 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. W'ARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 " "type name below signatures. ~n MONA L PIEPEN13URD Notary Putift-WnNola My Comm. Eaphfs Jan. 31, 2016 1 of 1 1 APR 1 6 20004 VMscpnsinDepartment ofCom ST.CROIXC()Uf1T01L VALUATION REPORT Page 1 of 3 Division of Safety and Buildings _11 . Com 85, Wis. Adm. Code County St. Croix 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. 02-&- - 3-0~- Please print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (1 Or Property Owner Property Location Steve Derrick Govt. Lot ,449 1/4 SE 1/4 S 15 T 30 N R 18 E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1438 County Rd G 23 - Cherry Knolls 1 st Addition city State Zip Code Phone Number fly Rage • own Nearest Road New Richmond WI 54017 ( ) Richmond County Rd G E] New Construction Use Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial - Describe: Parent material loess over glacial outwash Flood Plain elevation if applicable ft. General comments This site is suitable for a conventional below grade system, recommending that a pressurized system with equal and recommendations: distribution be uses so as to distribute the effluent over the entire available area due to the massive(Om) fsl. This is not a code requirement, but rather a suggesti6n-. * with 1/2" bands of 1 s, sg,wt an o s, Osg 10yr7/4 Boring # 0 Boring I E 1 111 g a pit Ground surface elev. 98.89 ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture "Structure Consistence Boundary Roots GPD/IF in. Munsell Qu. Sz. Cont. Color Gc. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10yr3/2 sil 1mpl mfr as 2f ..4 .6 2 10-29 1 4/4 sil 2msbk mfr cw if .6 .8 3 29-41 7.5yr4/4 is Osg mvfr cw - .7 1.6 4 41-94 7.5yr5/6 s Osg ml - - .7 1.6 21 Boring # 0 Boring 99.55 >92 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 'Eff#2 1 0-8 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 8-18 1 4/4 - sil 2msbk mfr cw if .6 .8 3 18-58 7.S 4/4 - is Osg mvfr cw If .7 1.6 4 58-78 1 qZr7 - lvfs* Osg mvfr cw - C42 .6 5 78-83 7.5yr4/4 fsl Om MA cw - 2 5 6 83-92 10yr7/4 - lvfs* Osg mvfr - - .4 .6 * Effluent #1 = SOD > 30 < 220 mglL and TSS >30 < 150 mgA- * Effluent #2 = 80D 30 mgA- and TSS < 30 mg/L CST Name (Please Print) - - Signature CST Number Thomas C Nelson yi-- c 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 4/1/04 715-246-2454 Property Owner Derrick Parcel ID # Pending Page 2 of 3 3 Boring # Boring 0 Pit Ground surface elev. 97.95 ft Depth to limiting factor >90 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Ef#1 'Eff#2 1 0-14 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 14-29 - sil 2msbk mfr cw 1 f .6 .8 3 29-46 7.5yr4/4 - Om mfi cw _ .2 .6 4 46-52 7.5y6 - s Osg ml cw - 7 -7 1.6 5 52-90 1Oyr7/4 - lvfs** Osg mvfr - - 4 .6 ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *EW F-1 Boring # Boring u Pit Ground surface elev. ft. Depth to limiting factor in. Soil 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef#f2 ' Effluent #1 = BODS > 30:5 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mg/1- 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. s1313-833OTest (R07/00) • Cherry Knolls 1st Addition Lot 23, l NW lot corner B1 101' 182' 81' B2 C ` 2% 100' \ slope Scale 1" 40' 48' BMi Top of iron pipe 100.09 BM2 Top of iron pipe 98.75' ` B1 98.89 w B3 i B2 99.55' B3 97.95' 98' Thomas Nelson 227387 '$M2 Line pipe Lot 27