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HomeMy WebLinkAbout026-1167-28-000 Wisco-nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567285 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. —7 Permit Holder's Name: City Village X Township Parcel Tax No: Haffner Construction LLC, Robin Haffner Richmond, Town of 026-1167-28-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: -3. (3 - 3 G ST 27.30.18.1330 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ( CAPACITY STATION BS HI FS ELEV. Septic Z 6 Benchmark S 14 -7 9 7 8 93• / Dosing Alt. BM 10 003 1 41 Amatlon J Bldg. Sewer $,.3 t'G D�S, Yc�- 5 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/Lr WELL BLDG. VenN Air Intake ROAD Dt Inlet Septic r ,^ 2 1 Dt Bottom 13• c Dosing Header/Man. Z's 95 Aeration Dist. Pipe Z•45 Holding Bot.System 73.E PUMP/SIPHON INFORMATION Final Grade 141 Manufacturer / , � Demand St Cover/ 3•4 y,/t q GPM i I �O / 7` Model Number �rl-)iL TD H Liftfx Friction Loses System Head / - TDH Ft J� U� � Le Forcemain Length IDia.z t Dist.to Well A SOIL ABSOR TION SYSTEM /�-- 3. 9 BED/TRENCH Width Length No. f Tre hes PIT DIMENSIONS No,Of Pits Inside Dia. Liquid Depth DIMENSIONS I L 5a \EA -� SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty P System- r� ^ �� �� CHAMBER OR — �/41'tl' l/9 ,r�jC/].X,,., 36' 131. UNIT Model Number.� - DISTRIBUTION SYSTEM Header/Manifold Distribution / x Hole Size x Hole Spacing Ve Air I ke Pipe(s) 5 Length Dia Length Dia v Spacing 3Z Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only CJA d% Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil I C es � No Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: G / ✓ / Inspection#2: / / Location: 1371 129th Stree New Richmond,WI 54017(N 1/2 NE 1/4 27 T30N R18W) Lundy eserve Lo cel No: 27.30.18.1330 1. Alt BM Description= � �� � P 2.)Bldg sewer length= 27 V / ' -amount of cover Plan revision Re uired. Yes No Use other side for additional information. page ' SBD-6710(R.3/97) Insepctor's S nature Cert.No. PLOT PLAN PROJECT Robin Haffner ADDRESS 404 South Green Ave New Richmond Wi 54017 NE 1/4 NE 1/4S 27 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 94.3' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of steel Fence Post ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. Top of survey iron @ 96.0' 134th Acre 147' Property Line Wel l is to meet all 288' Property Line DNR setbacks B- 1 Grading is to be done to Huffcutt Combo divert run-off array from Tank system Pro 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels 8 Slope B-3 B-2 95' Area 15' below system is remain undisturbed 9 4.3' 94' 284' Property Line B.M. UV . - • County Industry Services Division c -e/p; !gyp I i m; 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) • p 11 P.O. Box 7162 �� , E Madison,WI 53707-7162 'l0 7 2 8 State Transaction Number Sanitary Permit Application 2 33& 3 86 In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate ental unit is required prior to obtaining a sanitary permit. Nofe:Application forms for state-owned POWTS i: t •,to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for se"• i i'3 , /'�•�-T"1 5-1- purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. t' I. Application-Information-Please Print AB Information t� I A1. Ai ' i i i Property Owner's Name /�/4?`- Parcel# i'v,6,/ °f � � �, - 0 601‘-//.74 7-/i' zv �/ r:. Location Property Owner's Mailing Address . /N,,. Property ocatt (. /33 0 /z7,/ s, �f'ii,./ i f Govt.Lot _ City,State Zip Code Phone Number Al?„ y., Secti / `��-"` (� n KJ G �� /yrcleE one) J / N; R E or W I Type of Building(check all that apply) 1//% Lot# amity 971Z Number of Be oms Subdivision Name Be / 1 Block 4 /r1%L6iE n--e-5er. • ❑Public/Commercial Describe Use /'--- ❑City of • CSM Number ❑Village of ❑State Owned-Describe Use __ Town of III.Type o Permit: (Check only one box on line A. Complete line B if applicable) A. stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision : '❑ Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS System/Component/Device: check-atl1hi'sp ly) ❑Non-Pressurized In-Ground ❑ Pressurized In-Grou - rade Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) - Pretrnent v�c�e�( p m) /.0 V.Dispersal/Treatment Area Information: � X e8h��C C.1� Design Flow(gpd) Design Soiplication ate(gpdsf) 1 Dispersal Area Required(sf) Djgpersall/A_r'ea Proposed(sf) S rri Elevati� j ,7Jvv .� 1 ?Dv x`70 7. LTA 3 ✓ VI.Tank Info Capacity in Total 4 of Manufacturer y Gallons Gallons Units �Q� / a U •= New Tanks Existing Tanks "� �'1 -5/--17YC .� c «�. U 1 `N° Septic or Holding Tank _ :_/I-AlIIWA CAM MIIIIIFla I Dosing Chamber ' A`-1 MIVarA1 I _E - VII,II..Responsibility Statement-I,the undersigned,assum 15. sibility for installation of the POWTS shown on the attached plans. Name(Frio' / Plumber's"•.,re MP/MPRS.I/Number !�C�Phone Number( J 1 Plums Address(Street, ity,State,Zip Code r J �� /2 J �-(V) . 5���l VIII ounty/Department Use Permit Fee Date Issu Iss g Agent Si:•-ture Approved ❑ Disapproved •s Y 7 5- 1 i��/,3 g44-s-C'-- t � ❑ Owner Given Reason for Denial j / J� IX.Conditions of Approval/Reasons for Disapproval' ? L,1. s? SYSTEM OWNER: l G'D 1.Septic tank,effluent filter and A,0— 1,k.- --ter / dispersal cell must be serviced/maintained /G% as per management plan provided by.plumber. 2.All setback requirements must be maintained as per applIcablatootileiendiatences.for the system and submit to the County only on paper not less than 81/2x 11 inches in size SBD-6398(R0313) Q-pARTMEk DIVISION OF INDUSTRY SERVICES r PO BOX 7162 MADISON WI 53707-7162 Tnk 4 Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov �O SSXO1 PLSw Scott Walker,Governor Dave Ross,Secretary November 22,2013 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 Identification Numbers PLAN APPROVAL EXPIRES: 11/22/2015 Transaction ID No.2338385 SITE: Site ID No. 797985 Robin Haffner Please refer to both identification numbers, 134TH Ave above, in all correspondence with the agency. Town of Richmond St Croix County NE1/4,NE1/4,S27,T3ON,R18W Lot:28,Subdivision:Lundy's Preserve FOR: Description: Three-bedroom At-Grade,6%Slope Object Type:POWTS Component Manual Regulated Object ID No.: 1460311 Maintenance required; 450 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 CONDITIO • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction APPRO products shall not be discharged into the drains discharging to the private onsite wastewater treatment DEPT OF SAF 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). PROFESSIONA DIV iSION OF INDUS • To prevent future plan review delay,please remember to include the ASTM Nos.for all piping matena / t used in the construction of this POWTS,including pipe material between the tank and the building. Owner Responsibilities • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions SEE CO )ESP 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). SHAUN R BIRD Page 2 11/22/2013 • 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. Sincerel , Fee Required$ 250.00 // This Amount Will Be Invoiced. When You Receive That Invoice, Sally Sh r/er Please Include a Copy With Your E.I.T.,En eering 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 A ' C top 1 Cover Page '� 0 FS Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11/18/13 Owner:Robin Haffner Location:NE1/4 NE1/4 S27 T30 N,R18W Lot 28 Lundy's Preserve 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 !ALLY 9-11. Soil test 'ED ETY AND 12. Filter Specifications SERVICES / TRY SERVICES Shaun Bird Signature i/ (I ' License num,r 226900 )NDENCE AN • PLOT PLAN PROJECT Robin Haffner ADDRESS 404 South Green Ave New Richmond Wi 54017 NE 1/4 NE 1/4S 27 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 94.3' BEDROOM 3 CONVENTIONAL AT-GRADE X X CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of steel Fence Post ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. Top of survey iron @ 96.0' 134th Ave 147' Property Line • Well is to meet al I 288' Property Line WDNR setbacks 6- 1 Grading is to be done to Huffcutt Combo divert run-off away from Tank system Pro 3 - Bedroom House Tank is to be properly bedded and provided with lockdown covers 6% Slope with approved warning labels • 1 B-3 8-2 95' Area 15' below system is remain undisturbed 94.3' 94' 93' 284' Property Line B.M.*4 0 At-grade System Sloping Site Cross Section and Plan View a.--.-.-. -,- - - - - -s-. -i E r; ' Dimension Feet r ••••••••••%••••••••••••••••••••.•••••••:1411. .a.vai sil. r11:4'�.aor r py4.:41.1:'r'r•'h.10:� I A (, r•r■ •0•r■r■r■r■r■r■r•r•r•r • • • ■ • ■ • ■ ■ ■ ■ ■ ■ ■ •S•S•S S,S•S•'ti.S•S•S•S■S•S•S•S• ti■■•■L�iS■ ■YL fti j5�fti j1.j',f',�,h j•.�tir�r'L1,r�L11FLr t rtiry TTT 1' r r r r r■r■r■r■r■r■r■r■r•r•tt: r r r•r •S■S■ti,h,S■'ti■S■',■•■S■S■S•S 4�L■ ■�L•S■5i•ti■S•�./.■1.■'r■'ti■ti■ti■•,■ti•L■'�■'.,'.■'L•ti•ti■1..y1.•.•5. 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With Cap Fabric - ,, 1," r•r ?' Ft Lateral Invert •r■r r■r■r■t•r• ■rirrrirr•r•r•rfr•r Topsoil Cap S•S S•S•S S S.� S•�•S•lgeff S•�•�■i•i .. r• ■r•t•r■r•r•r•r�11rSrtirti�',�JS�',rStirti':ti:S.ti �.. �f ' ■'C■S .■S S■S•S S (r r•5.11 r•.ra*.r;r.rar;r;r■r■ , r r•r•r•r r•r•r•r •••••01.1,04.1:41:1141.4 S F�• S■ - ■r■r, ■ �r r r; Ft Contour �•�•�•�•�-7 ' 0000-11,7*- ipliNi apl v ■S•tii•■• •S■ / ■r■r■r,r,r■r■r■r■r■ ■• r•r■r r•:}�ti0Sr'S{Siti:ti'1i'S,ti''ti'S' •• i. ► AliNNVI4 4 l►N ViAPNA'*V ,' _ :r r r•r•r r•r 6,,, { ----4,46,16. Plowed Surface X14-106 C 111_i11 1k,... Slope Direction _......b. GENERAL INSTALLATION: The at-grade area is staked out along the desigd contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is f the hands.he A the plow depth to B area is form a '/$ inch soil wire when a sample is rolled between the palms covered by clean aggregate deposited overhead by a backhoe. . Special care must be used when placing the aggregate to minimize compaction of the plowed surface. Afterthe topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative.grew, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05lgj Page of a) Pressure Lateral Layout , One Lateral — End Manifold • 4-----Threaded Cleanout Lateral Turn-up --► Plug Force Main \ , Iii /WM L Low Sweep 90 Bend Pressure System Construction Distribution Network Specifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter :le,Z In. pipe. Orifices are drilled perpendicular to X(Orifice Spacing) In. the pipe with a sharp drill bit and face down. L (Lateral Length) 8 8 Ft. Lateral turn-ups terminate with a threaded Force Main Diameter -2 ln. cleanout plug and are enclosed in a 6-8 inch Force Main Length <<j 6 Ft. diameter lawn sprinkler valve box accessible from finished grade. • • • • • • Grade • • • • • • : _ 6 8Inch L awn Sprinlder Valve Box ' I 03/05lgj Page of Septic-Dose 'dank Cross Section And Pump Performance Specifications Pump anufacturer IN- Tank Manufacturer , ' =il r► pip Model Number V Tank Model Number ,•• d Alarm Manus ' t r� -Sy6�G'� Total Tank Capacity l•- I a Alarm Model Number I — 7 ° Max.Bury Depth ` - it A-sG. Switch Type ���� ncturer : ��1� Total Dynamic Head(TDH)-Feet E Filter Manuf Elevation Head Filter Model Number 3f Sr- ' Pressure sr Network Loss Minimum Pump Performance Required Force Main Loss _.. 02 , 3 GPM l j 3 Ft TDH Total - . Outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Device. Inlet Manhole ' With Locking Device <6"Below Grade Sealed Watertight E Securely Mounte mi Weather-proof Junction Box ...• ... . -.., f— Finished Grade -' ~' ' ! 1 fall — ssssss� i Vent Min. 12" Disconnect Above Grade Means • with Vent cap •. ii ,,,1, !„!!l,,4•f as 4a a<<<.{.;, , , � :•:I•:•.:�:::•••:•::...:�•:,:•-'� 1 ,t,4444. ,ai.b,h .. .,., . �. �, , ` outlet Filter ' t 04 1, inlet Baffle —r— , .- Inlet .� 4.0::::: ,. IQ 4444. - _ ,. , .: A '<' %a” and Reserve Capacity ;,. _�iwitch Settings e 1 ,;;, •` GPI ..�_ Weep .a Tank Volume= / _< ,, :':c: Dimension: Inches Volume Gal• 1 B Hole .` '- 3� 7, .C. t:: -rr- • Y(reserve)k 02 � X44 444 '. Off Elevation C ,' , •i f• Ft • •i •<. (dose) C, b--� f.7.c •,'r, ?3 + s, --�•-�- r• Bottom (dose) , .:. . ;;: � ,�- ::.•; DI.... :i' Elevation ... g a Ft .<. Total �r:•, ,. ,•►-,t�,.:., ;. ,. ,,4444. .,.,�, lllltllilill a;4,..444•a'i 'tin I „Tf,•rtri'►l,rr►,,4,• ,••„r. <<a<s 4 a a a 4 4 a a a s s e f•.a s a s s t i t is t i t t s f<•t't'ti'i i t a'a'f'la a•:a a:i4< 4 4 1a a•4..:4 4 4 4. ♦.4 ,,rlr,l,,,,•s,,,,,r f,f,,,,„ ,r,,,,,,f,,,,t•1,,,•S•<,�>•,r h•r,Tl�••� •••+••••ii,•;!. .,,.r. ;4<�a;ayf a4::f �{:�a.::{, <••:' L4.::<< <:.4 ,a,':.a:••dt 444.4 Sa:•f:.t,t,t,t,t,t,t,4�.t.:44td.:a,f.t;i d,td:.t.',<,4.t.'. GENERAL INSTALLATION: The septic/dose tank is bedded and hack filled in manufacturer with the manufacturer's product approval specifications. Maximum of hazy as specified by be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device(padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4” Sch.40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm l6.28. 42/05 LT Page of 0 \ \ --------- w ,3> . o D C 7C -I r a -H r�i0 \ / 0 V 0� -1 m TIN D CJ V 0 70 X 2 / 55' / Qom CD x D / ` to _ / 47 / 8" / C7 D m o r //3' 44' / u ❑ El -ii n O-r1 xj D a cn to ru rl z v, O C7• ru\,\ \ \ ________1. ri,)ii] O_I \ \ — s_____, , w ,_r \ L k 20' / 2' m r m ) D z 7: /r\ 10 to D '1- 0 ty n -I n m x 1 f 2' c; n 0 n ' Z C N \ R° A A r in n clm ') 0 0 7 ru -4 ru ru O C \. / A Z ON sO m 00 m 111 L) < O ci: 1 A w A D O D D o A UI x ul is /T,l� �\ ry A / 6"/ — o a x, C D D m n A z 17 r m ry D m Z D C)b C -I Cl C)Z D m 00 d m D C7 f) Cl C op r II II ti A -I <m I- 0 o n D m m oA Ul .'O CI C z 'n Cl M td D CI W N :0 D m r Cl Cl ry ry d 45' / 10" / A I-I Dry n X rn / 42' / o < vo m� ry A Cl A z I- w ay• Xl fM''I 73 r 0 \ \ r °c < m vci A `" •VI \ ''9 D G7< o Nm z T -1 b z D D N I a Z ru PROJECT: 4154 123rd STREET N.P.C.A. CERTIFIED PLANT HUFFCUTT CHIPPEWA FALLS, WI 54729 "44BIE T 1,000/600 GALLON (715) 723 7446 w (800) 924 1516 MEMBER OF: (U PUMP OR SEPTIC TANK CO A C R E T E. I A C ;M a NATIONAL&WISCONSIN PRECAST CONCRETE ASSOCIATIONS FAX (715) 723-7111 ■ www,huffcutt.corl ���� SNOIIVIOOSSV 3132iONOO ISVO3ad NISNOOSIM 0 IVNOLLVN g R w Woo•}}rod3nyMMM x IIIL-62L (Sib XV3 :30 2138w3w g .g m 9ISI-t26 (008) x 944L-C2L (SIL) UI 313 S! U 0 NNVl �Ild3s bo dwnd cv i g NO11V9 009/000'1 t^ �8 i �' 62LPS IA 'ST1VJ VA3ddIH3 INVld 0313112130 y d'N o 133�I1S P-462t tSIi 1133(0214 \ \ \ 13i1no / \ \ / Co 410 iirs m- O in / ,6E ,6E I I / .. ,8L (I ` In v in N' i \ / Q w O J / 5 \ n 0_ P1 o_1 a~ m Zr, // I I I .L9 I // I I I ,2L I / ,8L / z z z Li 0_ o, <:f a ca u a N.~. 3 y \ / 31dv8 r0 \ \ \ \ 131NI \ I i I Effluent SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow-Liters/Minute 0 50 100 150 200 250 300 Cover Ep 7(�1. 0811QC 7i t6t i t 35 • 1 I 11 10 30 y Irt1p9118T 1UISfieFlat Tt1 @rlt►bplas 25 — 7 i Volute -GAa 5 ! I 15 a 10 — 3 = 2 5 . 0 20 40 60 Flow-Gallons/Minute I '0 0 ..., , .. 1......-4.101—.1 0.11111Millil p., -r..., ___\), sir II II c( , ' —hi(pi WI ter Iggi 9110' SEN-40-AF SEN-40 Specifications P.uuNIt1G �___. PERFO_f MAEICE_(GVM) SHUT F CORD 1FIGH id r1 ll OFF MODEL NO. ■ ITEM NC. HP VOL75 ISCHAFGt Sit, AMPP.`.y�y,vUA'l S 5 10' i 15` -0• 25 I FEET 5� I EP�'F" (IFS) a, �a :' ! sq <�.� .' 147�'� �r r'.,, Franklin Electric 400 East Spring Street,Bluffton,IN 46714 Tel:260.824.2900•Fax:260.824.2909 www.franklin-electric.com Form:996199 7-11 0 4 4y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ( of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County • ( ' f 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 refe a •aNar:0 A•I!!-•qi•,r• • Parcel I.D. / percent slope,scale or dimensions,north arrow, •I•cati. ,r:. ,4 a @ -. crest road. 0 Z 4—/16,1- 2 Please print all i •t' 1, 16. Revi= ed b Date (� Personal information you provide may be used for seen a purpose ( rac9 Low.i U�' (1)(rrr). L)/j{�{/W�-- 1 3)1 O 1 0 a Property Owner Property Location \ I. i 6' "'' 1'4'0 N I cr ✓ 1f' frA, r:�:••.. U` ..Lot i 1/4 /4 S T ,� N R 6 E(o)W Property Owner's ailing Address •1 •y : # ' ,.Name or CSM# -?0 Owners/Mailing ri4 5.-/. 5. , # /0-Ai ,+Grave, City State Zip Code Phone Number ❑City ❑Village I , •wn Nearest R -�_ ../.4• .c ) of ( o 0 /Z%GG - ,,.-' /V0 New Construction Use. Residential/Number of bedrooms 9 Code derived design flow rate -- 6 00 --- GPD ❑Replacement �� `` Public or commercials-DD scribe: ------- Parent material ��r� 74 7 t. �✓c�<�`� Flood Plain elev ' i applicable :_.it", ft. General r and recommendations: S ,/ec /emit' J 'Li' 3-- Gam, S • �/•• / _ S 574,.- _ , __ ,,`.dam SW / /-- e.A ❑ :•ring Boring# ft. Depth to limiting factor Pit Ground surface elev.9 - i 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 I 0-13 joy,-3rzr. 5/7 ia ri. /11 - -- - ' 6 ;3 2, /.3-373 /01 ,-.s' 0l , sin.sh �C� 11-41 1 - , 2). e 3 ' ,- ( Sy 1/(p J/4-- --m -_,17/ 444 /44- - 1 r/I Boring# ❑ ring I Pit Ground surface elev. ( ' 7 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 Z-). mfg ------ ®/1©1i 0M111 l I • 3 IMM •Effluent#1 =B005>30<220 mg/L and TSS>30 f,150 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Number CST Name(Please Print) 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number Address Signature Date Evaluation Conducted 1008 192nd Ave, New Richmond, WI 54017 s 5/-0 715-246-4516 (t/ r r Property Owner Parcel ID# Page of Boring V 3 Boring# 1 ft. Depth to limiting factor in. Pit Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNfEft#2 in. Munsell Qu,Sz. Cont.Colo r Gr.Sz.Sh. __.._.. ___I 6-14 I c`� , _ 5 1 0�me E . ►? • 6. . a i -z 1o�� 1 m wk ' S (A-) 1t' .a , 3 .2p-so 1,Sy r`F/� i /csbk fyif: S a a ..5.0°1t,l 0 ✓5140 C.a, b 6 yr 5/h V Fc -11-, _ - n .= 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 *Etf#2 0 Boring Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD EtT#2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Effluent#1=BOD6>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L 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. SBQ1330(L6/00) ti s . Soil Test Plot Plan i/ Project Name Environmental Holding L.L.P. Shau • Address 706 19th St. S. Hudson Wi 54016 (FM #226900 Lot 28 Subdivision Lundy's Preserve Date 5/24/04 N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 94.3 *HR pSame as Benchmark Alternate Benchmark Top of Survey Iron @ 96.0' 147' Property Line 95' B-1 288' Property Line 93' 75' 6% Slope Please note:Soil test • 50' • 50' was done to satisfy B-3 B-2 county zoning requirement. Soil test may not be suitable for owners desired building location. 90' Scale is 1" = 40' unless otherwise noted Alt. B.M. 284' Property Line 4B.M. RECEIVED ci'''*1 JUN 0 1 2004 Lundy's Preserve Comments: ST.CROIX COUNTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand,other consist of glacial tills. In certain areas,the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning,she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size, and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 5/28/04 i a FILTER CART I E INSTRUCTIONS ,� #xr,= s 9 Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it •is ,,,,, ,,. centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the lengths., of 3/a-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: - solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. mui E r = ,. 2. Open the outlet access opening to inspect the tank and filter. i 3. Pump the septic tank completely, making sure to remove the sludge 'im a ui° ._ . K layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. _ 5. Slide the cartridge up and out of the case for cleaning. .. ! _ 7,-- . ,,,, .f.,";._-,..-„,-4-.5-01.--, ' ' 6. If a VRS switch connected to an alarm is present, the switch f, should be removed by turning counterclockwise 90° and cleaned _ with water only. 7. While holding the cartridge on its side (large flat surface facing ; # down) over the access opening, rinse off the cartridge with water : only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and ,!,N the turning clockwise 90°. ` 9. Insert the filter cartridge back into the case, pressing down until w'`° , the filter locks into the bottom of the case. '� 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5}years from the date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty. Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs.ii,In no event shall the liability of Bear Onsite exceed the purchase price of the product. — _ _ 4 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION r( v Co 141-Crei t--r'"'10/3 �-t�v SYSTEM SPECIFICATIONS , Owner c1U 41�� t Septic Tank Capacity /41j0 gal ❑NA Permit# S641 Septic Tank Manufacturer A,/regie ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer 831.4. ❑ NA Number of Bedrooms 3 ❑NA Effluent Filter Model ❑NA I Number of Public Facility Units 7b NA Pump Tank Capacity (2 gal 0 NA I Estimated flow(average) __ 674,7 galday Pump Tank Manufacturer L:.G�!rl 0 NA Design flow(peak),(Estimated x 1.5) 9..1-0 gal/day Pump Manufacturer Je kti ❑NA I Soil Application Rate 9 -.) galday/ft2 Pump Model S'F.r/— 7 ❑ - - Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 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. 1 Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑NA Biochemical Oxygen Demand (BOD5) 530 mg/L ❑In-Ground(gravity) ❑In-Ground(pressurized) Total Suspended Solids (TSS) 530 mg/L > \ -Grade ❑Mound Fecal Coliform(geometric mean) 5104 cfu/100m1 ❑Drip-Line ❑ Other: .. _ !Maximum Effluent Particle Size 36 in dia. 0 NA Other. ❑ NA 'Other. A Other: 0 NA `f -N Other *Values typical for domestic wastewater and septic tank effluent ❑NA IAI ITENANCE SCHEDULE Service Event Service Frequency i ❑ orrth(s) 'Inspect condition of tank(s) At least once every: .� r(s) (Maximum 3 years) ❑NA Pump out contents of tank(s) When combined sludge and scum equals one-third(36)of tank vOlume ❑NA (Inspect dispersal cell(s) At least once every: 4$r (Maximum 3 years) ❑ NA At least once every: nth(s) 0 NA ^I�lean effluent filter rY l /Aemar(s) -1 _ lamonth(s) Inspect pump,pump controls&alarm At least once every: .76,year(s) ❑ NA Flush laterals and pressure test At least once every: 3 +o r ❑NA other. At least once eve ❑month(s) ❑ NA every: ❑year(s) ether. ❑ NA I 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 ivisualiy inspected to check the effluent levels in the observation pipes and to check for any pending of effluent on the ground surface. The pending 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 (36)or more of the tank volume,the entire contents of the tank shaft be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. lail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components,pretreatment units, land 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. /� t Page -of._"_•, o START UP AND OPERATION presence of painting products or other chemicals thfjt anon, prior to use of the POUVTS check treatment tank(s)for the p For new coe thu P and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thpa may impede the treatment process use Y operator prior to n o erato p tank(s)removed by a septage servicing p System start up shall not occur when soil conditions are frozen at the infiltrative surface• r is restored the excess wastewater will bye tanks may fill above normal highwater levels. When power a to effluent.w ll be um tan Y may result in the backup or surface discharge r outages d es p P cell(s)and Y power to th To During powe g verioadin the ce ( } or to sectoring p � is real cells)in tee large dose,o g Se a Servicing Operator pri I levels the d b a 9 nonna discharged to Pe m tank removed Y � the pump controls to restore of avoid this sir cont have the contents or of the pump effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating 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 from the wastewater stream may improve the performance and prolong the life of the PO swabs; degreasers; dental floss; diapers; disinfectants; fat foundation dram antibiotics;or baby wipes; cigarette the teilbwMg painting products; antibptipu; baby wipes; itgand butts; condoms; gasoline; grease; herbicides; meat scraps; medications; oil; (sump pump) water, fruit and vegetable Peelings; pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT m is propefily When the POWTS fails and/or is permanently taken out o8service is o ell Administrative steps shaillbee taken to insure that the system and safely abandoned in compliance with chapter Co opening s sealed. • All piping to tanks and pits shall be disconnected and the abandoned pipe o Re g e Servicing Operator. rl din • The contents of all tanks and pits shall be removed and properly disposed Septage by a • 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 falls and cannot be repaired the following measures have been, or must be taken, to provide a code complirpnt replacement system: for the location of a replacement soil absorption systelm. utilized fo requited ❑ A suitable replacement area has been evaluated and may be infringed upon by req The replacement area should be protected from disturbance and compaction and should not be infring P for apes from existing and va proposed structure,lot suitable replacement acaarea.t Replacement systems must comply with in the rule l in for a new soil and site evaluation to establish a sortable effect at that time. ❑ A suitable replacement area is not available due esetbta and/or O limitations. Barring advances in POWTS techno ogv a holding tank may be Installed as a last resort replace failure of the POWTS a soil and site evaluation The site has not been evaluated to identify a suitable replacement area. Upon be metalled/as must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may a last resort to replace the failed POWTS. 7C.mo and and at-grade soil absorption systems may b reconstructed cted in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply «WARNING>> NOT SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY TANK UNDER ANY C RCUMSTANCES. DEATH MAY RESULT. RESCUE O� A ENTER A SEPTIC,PUMP OR OTHER TREATMENT TAN PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. _ ADDITiONAL COMMENTS POWTS MAINTAINER � POWTS Na INSTALLER �� � , �- Name � �1./1�� Phone Li���i' A ' i Phone i� SEPTAGE SERVICING OPERATOR� MPER LOCAL REGULATORY AUTHOR! Name z,rc, yXtiwL.AMIIIIIIIIIIIII Name > I M A .._- ��..- � Phone ''— i � Phone ,� This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. I ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM A Owner/Buyer ;R.,D�j I. r� np�h,/ a..F_..e l -41/UCI D�'1 I, LC � � Mailing Address y0� 5. 4 r�e i� 4,.Q� /U � � 1/tj) Property Address l 3.71 / 21 i41 S f i,,2.e-1- FQ �; (Verification required from Planning&Zoning Department for new construction.) City/State &J1W 62:+1/146A1 1/4Dni O, �tParcel Identification Number D, — / b 2— .,9 e-ecru LEGAL DESCRIPTION -7 Property Location N .,/V� %a , Sec. 27, T 3/2N R IW, Town of d(e . Subdivision ZA1ae7-() , Lot# 2 ,..... Certified Survey Map # .--- , Volume , Page# . ��{ Pi -Warranty Deed# 14-11 , Volume Page# '"r . Spec house 0 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. 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. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. N ber of b_edroo 1 --.-3 i. _§,2g 3 SIG"='1e 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) flIDhIilIIIDIuI B Tx:4110958 STATE BAR OF WISCONSIN FORM I -2000 974482 WARRANTY DEED BETH PABST Document Number _ REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Haffner ST. CROIX CO., WI Construction,LLC,Grantee. 03/05/2013 4:01 PM EXEMPT#: NA REC FEE: 30.00 • Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 22.50. described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 28 of Lundy's Preserve in the Town of Richmond, St. Croix County, Wisconsin. Recording Area Name and Return Address: • Title One File#19202 Together with all appurtenant rights,title and interests. 026-1167-28-000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways,Easements and Restrictions of Record. Dated this 25th day of February,2013. Citizens State State Bank /l7yJR /4a - *Tom Van Pelt,President/CEO * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST CROIX COUNTY. )ss. authenticated this 25th day of February,2013 Personally came before me this 25th day of February,2013 the above named Citizens State Bank, Tom Van Pelt to me * known to be the person(s) who executed the foregoing TITLE:MEMBER STATE BAR OF WISCONSIN instru • ac •wiled_ • the sam . (If not, ""pub JAEGER authorized by§706.06,Wis.Stats.) EVELo ry es. el M J er t . Y THIS INSTRUMENT WAS DRAFTED BY State 01 W" -• ary Public,State of Wisconsin My commission is permanent. (If not,state expiration date: 12/11/2016 ) Michael H Forecki,Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) "Names of persons signing in any capacity must be typed or printed below their signature 1 Of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.1-2000 Pi =M a i 0 ig 111 utiaj 4.,. 511 —1-1 •1 f.,...1/ : ill 0 a I ... ....110 opol I ........................ ........ gh . + (RIZ,.00N) & Uf IOWA 601111 oos ` , � a ./ r ..- 1 .` � . ` I ,/ ---. .,, II I: is, I` we 4. .%•• 5 li §g 11 1 b:.. \ \N. g._ N N. \ 11 ............... .•..... ti i Z .. \ 1 i _z___Ilii--------. \ _____—• ,4 l - • II /ARRA : • , , . :. . --.... t gi !g' 1 1 I 6 1 as - / I I i Oil i 'r r. :0.9. La I imm g .„.. -. .... •IR e : : 1: _ cm ,..1 ..; • ig I /e / , 4 . / 54a §. lat Dip 0 t '' i �' mmiiiC i , ir ,, . ,• '')I, li illiiiit °I ."- ./1 /i7T : a 1: • ..,. g Gil , ..... ... 5q .. ti i . , I g 1: P 2 1: 1 •' 4%. i .:1 . 545s_ / ..... / : -*/ 1 / .. . zone. ...1 1