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026-1167-31-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569504 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal informaticr you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Stene, Charles &Theresa I Richmond, Town of 026-1167-31-000 CST BM Eiev: RZ p.BM Elev: BM Description: ,,//�� ` Sectionrrown/Range/Map No: -9 LJ 2- G.GT, 27.30.18.1333 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3 Septic -t, Z. Benchmark Dosing C6.nn Q� r i / Oa Alt. BM /t 7 7 /Z. VUT r ion Po 'a '5Z.5 (o Bldg. Sewer Z .(p 9 7 CIO St/Ht Inlet *. 3 Sit •a St/Ht Outlet `+ TANK SETBACK INFORMATION(�e�• .� �, TANK TO P/L WELL BLDG. ent t Air Int ROAD Dt Inlet Septic �O6 ' �b Z 7 , Dt Bottom r•3�p Dosing / i / Header/Man. 7 Aeration Dist. Pipe $9•Y Holding Bot. System Final Grade PUMP/SIPHON INFORMATION 3. 45 73 -5 Manufacturer 'Demand St Cover (Do vl S GPM + �k1.A L �� 93 0. 5 9Z-8Y Model Number 64 5� TDH Lift Friction Loss System H TDH V t 2.9 s4 Forcemain Length Dia.Z I/ Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS pX .-� SETBACK SYSTEM TO V U P/L JBLDT WELL LAKE/STREAM LEACHING Manufacturer: �Z ��oc.�J INFORMATION Type f System: CHAMBER OR n UNIT Model Number: Type 174 7 za R'j 7, DISTRIBUTION SYSTEM a Header/Manifold �� Distribution x Hole Size x Hole Spacing V to Air I e Length Dia Length Dia Spacing _ 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~r... Depth Over ,/ Depth Over xx Depth of xx Seeded odded xx Mulched Bed/Trench Center l Bedrrrench Edge. Topsoil 1 ` tr es No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 6 /Z1 /�14 Inspection#2: Location: 1383 129th Street New Richmond,WI 54017(NE 1/4 NE 1/4 27 T30N R18W) Lundy's Preserve Lot 31 (Parcel No: 27.30.18.1333 1.)Alt BM Description= �,r — J C�� �5 16,,k5 .0"', (J 2.)Bldg sewer length= 3G -amount of cover= 4Z/I Plan revision Required? Yes No f (973q � Use other side for additional information. _ /____ SBD-6710(R.3/97) Date Insepctor's natur Cert.No. a \ v 'y tla ri �;?QI \`\ LP ` � c b d G� \ r Sa- v 30,t Smart 8ac/� ow CO Ov 4S CD cyp .,p f c yo i � Q 37 S commerceml.gov Safety and Buildings Division County ■ 201 W. Washington Ave.,P.O.Box 7162 a o � s c o n s i n AltcelvtD 2 Sanitary Permit Number to filled in by Co.) Department of Commerce 5 5� Sanitary Permit A 1• State Transaction Number In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission o t� � appropriate governmental A)A unit is required prior to obtaining a sanitary permit. Note- Appli to POWTS are P oject Address(if different than,tmailing address) submitted to the Department of Commerce. Personal informatiort O� A04ed econdary ]�� �Z+tu s ur oses in accordance with the Privac Law,s. 15.04 1(m),S MUN T J I. Application Information-Please Print All Information /I eA— Wi• Property Owner's Name Parcel# Property wner's Mailing Address / Property Location (. 1333 ) ox I� 1 ..3 / Govt.Lot City,State Zip Ae Phone Number & y N,-V Y•, Section_7 circle one II.Type of Building(check all that apply) (��r Lot S �� N; e E ot� 91 or 2 Family Dwelling-Number of Bedroo 3 3/ Subdivision Name El vim, Block r Public/Commercia►-Describe Use ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of Q t f,�- /O J Town of oe?i• III.Type of Permit: (Check onlyotk box on line A. Complete line B if applicable) A. -,KNewS stem y ❑Replace tern ❑TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. El Permit Renewal Permit Revision Lis[Previous Permit Number and Date Issued❑Change of Plumber ❑Permit Transfer to New Before Expiration Owner CyJL IV.T ype of POWTS S stem/Com onentfDevice: Check all that apply) Non-Pressurized ln-Ground A Pressarixad ft, and ❑ At-Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis elsal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System EI vation D. y/ / IZJ� 4q•_3 g.7 VI.Tank Info Capacity in Total #of Manufacturer v Gallons Gallons Units 8 New Tanks Existing Tanks ,ono w P /dk- Septic or Holding Tank 1AW1 '— C Dosing Chamber ' 1:S C4, M.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' Signat re MP/MPRS Number Business Phone Number .� /nP zo ?/$- • yt-alld Plumber's Address(Street,City,State,Zip Code) -7/$'- 5Z3-JZZ$ 321 4> • co >r Alt,, ,;rA "'0--d A✓," VIII.Count /De artment Use Only pproved ❑ app Permit Fee ;F11 sue ( Issu $ // ❑ ner9 en Reaso Denial �r IX.Coed easier for Disapproval t eat 1. Septic tank,effluent filter and � ` t t dispersal cell must all be servibes 1 maintained 3) I�Me,v as per management plan provided by'plumber, 2, V s.t,ftck�eciueetneMa least be maintaifaGi! �p� tide 1 ortltas. Attach to complete plans for the system and submit to the County only on paper not less than 8 itz x 11 inches in size SBD-6398(R.02/09)Valid thru 02/11 { o J � 'F J tl'f SO CIO Ilk >1�n \\ S nQ` nk' � � I ILA �i v g Iz- so / PAGt cF PUMP CHAMBER CROSS SECTION ANG SPECIFICATIONS VENT CAP Y'C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG JUMCTIOM BOX MAIMHOLE COVER - 25 FROM DOOR, WIIJDO O W R FRESH 12"MIU. ( AIR INTAKE GRADE GRADE I y"MIN � � IB"rrlu. COIJDUIT -- PROVIDE I ----- IMLET AIRTIGHT SEAL I f I * I I( ALARM S ( II ( I C *APPROVED ON JOINTS WITH 1 ELEV_ FT. APPROVED PIPE __� 3 ONTO PUMP—� OFF r D SOLID SOIL COMCKETE BLOCK RISER EXIT PERMITTED OWLIS IF TAWK MAUUFACTURF.R HAS SUCH APPROVAL SEPTIC E SPECIFICATIOKIS DOSE / TAUKS M R � AWUFACTU ER: 4/i G 51;1' LIUMBER OF DOSES: PER DAS TAAIK SIZE: 1000 Lt ed GALLOMS DOSE VOLUME ALARM MAIJUFAGTURfR: 5,T -Pr%bjr, INCLUDIM& 6ACKFLOW: - 12) GALLONS L 3 - -0 L IJS P _ R GAL o MODE UM E cweY CAPACITIES: A IIJCHESO l 1J B R .1 ! S i - �. iMCHES OR GALLOWS SWITCH T`lPf: �P�-��� B- I +Sy I PUMP /AAIJUFACTURCR: Go„I s C= IIJCHES OR —rGALLOIJ5 I MODEL MUMBEM EEO H D- IUCHES OR � GALLOW`- j SWITCH TYPE: Suete £P+ MOTE: PUMP AMD ALARM ARE TO BE I MIMIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL D IF E REIIC E BETWCEW PUMP OFF AWO DISTR I UT t OW PI P E.. 5 FEET 1 + MIIUIMUM METWORK SUPPLY PRESSURE . . . . . . . . . . . 2.5 FEET �� -�- FEET -{- FEET OF FORCE MAIN X � F�ooFLFRlCT1oW FACTOR. o/ TOTAL OyWAMIC H q EAD = i, FEET �J IUTERAJAL bIME►JStOIJC OF TAIJK: LEAIGTH ;WIDTH gs ----;LIQUID DEPT H SIGNED: LICENSE HUMBER: 1H2 22S`''�d DATE: W-GWODDIA `31U OLOZ *Nv 43SLA3a Z 9 M HO08 N301VIN OL AMH Sn 9LL£M \ :8nod-1SOd *:31Vo olob kNvnNVr 31va idnNdW OLLd3S w o 13131M \:NnOd-38d .0—,L=.4 L :31VOS 3WS 'A8 MVaa 3138 aw_009/OOOM m ? Z LLI Ir w O J o o LLI v J r. U Q Q U°- rn U m N O O F� p M. W U W I-- a LLI WW LL z a-Q N Om p � vZ � a p p W Z-1 �� Q O U mU Z H Z w w J m OQ p p OW IlaalIFQ-W a0 Z ~ F � U O � o Z 0 > U dOp N mN -IWW U O WZO W Z Z(n I"' v H a O 6 O pp I�:- Q Q LWi p to t0 pNp e > N to O cp�� Y c ¢ d ^p000 WII mWWN 0; O Z 'lA Q U d_ �sO_ Z a U ` O OD H I N N F- 00 o Q p F fn ' ujl- �W N N�� FJM J Q Q w a � z \►'��II--IIt�O�MOJI,'�WIIc' FEU �K-� F- � � J W F UU-i0 Q10 INI C) 0 V� JNI�-L..J .. �?J -. =ONw OZw U N = � W UW WpW Hy Y 0Jl->ZUZp�OU Za'Q zcn Q p UJp Z W M xX NU �j z �3°m coin=��m� a�c� a�° 0 Z zFt a rn o �� �o W F F p p IQ- D:Y OW a z In W Y 0 Z Z z Q Oa 0 F U H U F- LU Cl F- � Q J19 a a w i} D W a Ir �O 1 svo „ti / \ N „Cs do ui i U 3 5 a 5 � I O� I . ~ X x Q .9 J l9 w� W =N � °° / o Sd0 �� ` F \g ~ „99 do o F W N ck: W Z_ Q „LS 038 a 4 £6 sv .. „f 69 w Q N Y Z Q H HGOULDS PUMPS Submersible Effluent Pump 10 6 : . 8 EP05 6 EP04 & 5 4 Series 3 2 COMPONENTS DIMENSIONS (All dimensions are in inches.Do not use for construction purposes.) Item No. Description 1 Impeller 2 Base 3 Pump Casing 4 Mechanical Seal i 5 Ball Bearings 6 0-Rings _I 11 MAX 1'/:NPT 7 Power Cord 71/2 — 10'A 8 Oil Filled Motor Motor Housing/ 9 Stator Assembly 10 Motor Cover � 3'/e 4'/I % PERFORMANCE RATINGS 9'/' 6"MINIMUM WATER LEVEL WHEN Gallons Per SUPPLIED WITH FLOAT SWITCH Total Head Minute (ft.of water) EP04 EP05 5 53 — 10 46 62 15 36 55 20 1 21 46 25 0 33 30 — 11 MODEL INFORMATION Minimum Minimum Minimum Minimum Maximum Shipping Order No. HP Volts Amps Circuit Phase Float Switch Cord Discharge On Off Basin Solids Weight Breaker Style Length Connection Level Level Diameter Size Ibs/k EP0411 Plug/No Switch 10' 1'/z" Manual Manual 15" 20/9.1 EP0411A Piggyback/Wide-Angle 10' 1'/2.' 12" 6" 15" 21/9.5 EP0411 F 4 115 12 20 Plug/No Switch 20' 1'/z" Manual Manual 15" 20/9.1 EP0411AC Piggyback/Wide-Angle 20' 11/2'. 12" 6" 15" 21/9.5 EP0412 1 Plug/No Switch 10' 11/2'. Manual Manual 15" 3A.- 20/9.1 EP0412F 230 6 10 Plug/No Switch 20' 1'/z" Manual Manual 15" 20/9.1 EP0511 F Plug/No Switch 10' 1'/z" Manual Manual 15" 22/10 EP0511AC .5 115 13 20 Piggyback/Wide-Angle 20' 1'/7" 12" 1 6" 1 15" 23/10.4 EP0512F 230 6.5 10 1 Plug/No Switch 20' 1'/z" Manual I Manual 1 15" Goulds Pumps Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. www.goulds.com PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. <& ITT Industries MGOULDS PUMPS Submersible Effluent Pump EP04 & EP05 Series APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings:Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance. construction. following uses: heat transfer. ■Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Heavy duty sump matic models include resistance. sly`File#LR38549 • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. 3/4"maximum. ■EP04 Impeller:Thermoplas- 0 Power Cable:Severe duty •Capacities: up to 60 GPM. tic semi-open design with rated oil and water resistant. >r •Total heads: up to 31 feet. pump out vanes for mechanical •Discharge size: 1'/2"NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 1041(40°C)continuous METERS FEET 140'F(60°C)intermittent. •Fasteners:300 series 1° i- ------------ --- ------------I-------- ------------ + stainless steel. 9 30 ►�.-5GPM •Capable of running dry without damage to s --------------------------------------------------- - ----------- - '�2.5 - — components. 25 0 7 - -- -------- ------ Motor: "' x •EP04 Single phase:0.4 HP, u 6 20i 115 or 230 V, 60 Hz, 1550 --- - - a — - - - - - - - j- - ---t— RPM,built in overload with e 5 15 automatic reset. ------ -- - •EP05 Single phase:0.5 HP, 0 4- - - `- - � -- -' -—{ -- _- EPOS ---- 115 V or 230V, 60 Hz, 1550 3 1 RPM,built in overload with ---- automatic reset. z -- -_____ ___ - -- ---- ---EP o - ------ - •Power cord: 10 foot 5 standardlength, 16/3 1 ------------------------------------- ______ ------------- _.._. _ _..__._.F------------ S1TW with three prong o 0`---— grounding plug.Optional 20 0 10 20 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug ' (standard on EP05). 0 2 4 s s 10 12 m3/n CAPACITY Goulds Pumps ©2003 Goulds Pumps Effe c tive July,2003 ITT Industries 83871 <& commerce.wi. ov Safety and Buildings Division County 201 W.Washington Ave.,P.O.Box 7162 ST. CROIX s co n s in Madison,WI 53707-7162 Sanitary Permit Number(to be filled in by Co.) Department of Commerce 5 9 Sanitary Permit Application State Transaction Number In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental /v 14 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are roject Address(if different than mailing address) submitted to the Department of Commerce. Personal ation you provide may be,} ad or secondary 1383 129TH STREET ur oses in accordance with the Privacy Law,s. 15.04 ts. ff++ NEW RICHMOND, WI 54017 I. Application Information—Please Print I mati n Property Owner's Name Parcel# CHARLES & THERESA S ` ��(,; 26-1167-31-000 Property Owner's Mailing Address R� Property Location cD P.O. BOX 231 MINONG, WI 54859 Uri' Govt.Lot 31 City,State Zip Code Phone Number NE NE 27 '/., '/,, Section MINONG, WI 54859 N/A 30 1( ircleone) II.Type of Building(check all that apply) Lot# T N; R a E or W Ell or 2 Family Dwelling—Number of Bedrooms C3_ Subdivision Name ek, 4A Block# LUNDY'S PERSERVE ❑Public/Commercial—Describe Use N/ ❑City of ❑State Owned—Describe Use CSM Nu ❑ Village of N/A Town of RICHMOND III.Type of Permit: (Check only on box on line A. Complete line B if appy le) A. New System ❑ Replacement System eatment/Ho �ng T k Replacement Only ❑ Other Modification to Existing System(explain) -----� B. El Permit Renewal ❑ Permit Revision ge of P Permit Transfer to New List Previous Permit Number and Date Issu Before Expiration er � td n6 D IV.Type of POWTS System/Component/Device: Che I t apply) EI Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At de ❑ Mound>24 in.of suitable soil El 'Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat nt Area Information: Design Flow(gpd) Design Soil Application Rate(g f) Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation 450 .4 1,125 1,200 89.3,88.7,88.1 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units 2 New Tanks Existing Tanks W 4/c SZ 5 Septic or Holding Tank 0 .1,000 , 1 WEISER X Dosing Chamber N/A NIA VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature I MP/MPRS Number Business Phone Number TIM DE YOUNG 715-246-2660 Plumber's Address(Street,City,State,Zip Code) /! / ��j— 2-- / ZZ 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 P(f7/// VIII ount /De artment Use Only N-111 I Approved ❑Disa roved Permit Fee Date Issued Issuing nt Signature wn ' en Reason for S _// - � 17 /f IX.Condi . easons for Disapproval resewe � 1'EM 0�� .� � �ClL�I'1b� � La- • 1:'Septic tank,effuent filter and dispersal cell must all be services/maintained as per management plan provided by plumber. 2. All setback requirements must be,Inaintained Ale A ac to complete plans f or the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R.02/09)Valid thru 02/11 t CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: CHARLES & THERESA STENE Owner's Name: CHARLES & THERESA STENE Owner's Address: P.O. BOX 231 MINONG, WI 54859 Legal Description: NE 1/4 NE 1/4 SEC 27 T 30 N R 18 W Township: RICHMOND County: ST. CROIX Subdivision Name: LUNDY'S PRESERVE Lot Number: 31 Parcel ID Number: 026-1167-31-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber: TIM DE YOUNG License Number: r Date: 01114114 Phone Number (719) 946-2660 Signature -;� Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 t o a 2a -so �► u.` J �7hv N d OO cQ r a V N _e v Q h Q 4� l� SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page_of Project Name: N)5 3 No. of Cells Per Cell G .� ft Cell Width Total No of 8a ft Cell Length rOQ sq ft EISA Per Cell 34 ft Cell Spacing // 20,4 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 FZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: 6-4 Gravelless Leaching Unit Model: Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent Soil Backfill 3 f; in Geotextile Fabric y ft Infiltrative Surface 12 in 0 __- ft Limiting Factor - a 6 Z in Slotted and Anchored Vent/ Observation Pipe with Cap ...............- ..-......was.......................wave■.................. Plumber/Designer Signature: License#: Date: INSTALLATION INSTRUCTIONS .,asamr4aM z �a PL-525/PL-625 FILTER &Wasrewa•er P!oG«^s A tRvieicn o:Qolyek tra PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: * Rated for 10,000 GPD *PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently *guilt in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every,time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm,.the owner will be notified by an alarm when the *Accepts PVC Extension: Handle i filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS p, Potylok PVC Filter Extension Handle A t., j Risers&Riser Covers Extend& Lok- Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend&LoO4 Polylok safety screens srnartFiltecTM Control Switch. septic tank cover to grade. is a simple, easy to use prevent tragic accidents This allows locating and solution that can extend from happening by children Potylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending.filter and tank entrance. Fits.3"and 4"pipe_ servicing. For a full list of Polylok products please visit our web site at: www.potylok.com W-WWR :31W 99ti8-5Z2-008 OLOZ 'Nv 03SVA3N o\ OSL48 IAA ')1308 N301VM1 01 AMH sn 9lL£M Z anod-lsod 3ivo o�oa AaVnNVr Siva l`dnN`dW OLLd3S w o :anod-38d .0-,1=.4 l :31V3S 3WS 'J18 NMV80 313011111 13131M 8ri—o00t" cn w J W c' Ww Z N !9 v O _ 0 z H CY � J O F- > = W Q N cn O w O Z ° O O O U N E: W OC LL z0 ° vVi°� o° °� 0 w w r ° �� v 0` F- ° a� m ° a Z ,n R �! �zJ a w a Z W _j Z LAJ 0< QJU J O N O > > rO ZO H f Q LLJ O m o Ow <_U 3t n w O mVI WwW 0 0O ? Z O d O U m v~i m z > a O oz �UU O ,*M.J waI mWN 1� dU O W yl QO QpO Z O V o Q a a°C _ ° F- N > ik� Q o ¢ a O W Na. N�~ COI:�.IiJj ~Qa ~Na JQ <O = VWj� �Z Y� \� �W°L, OQZWto �UNVI Y=U Lit J '\ WN QO J N J .. —J •• pQw OZW Q Z~J N => Jr3 WU °W �Vl (n ..O KO~ ..3p2 UY U d �w< 0 J MI) X° °U UJ z 2goo coy<i `J` m� Q:r0 a ° Zia z Z� a ON �� o z ° a .. ow F-- M ui z z v Jo o z z o a cn ° — — = J M F- U; U w U z Q S U W X >W J cr d W t-O� fn Q O I J J U Q w m w N a J Q W In a o>° Z U H Q Q 2 a O o a w ONw a _w m a D w a w i n N N W\ sbo ti cv (if O-J U- „8£ do V) I a d 1 ,� s ° o � 2 . 92. .ti I U w I < W Sdo .t, 1iv do W m 0 F- ° w N w W J Z U i „Zb U- M a .98 .l9 w w Q N Y Z a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer *1�- ""� Mailing Address Pc!' (b c y Z Property Address `�j (Verification required from Planning&Zoning Department for n w ttuction.) City/State W1pat6el Identification Number LEGAL DESCRIPTION Property Location '/a , Y4 , Sec.'Z- , T N R k% W,Town of V-1 C-A-1 Subdivision L'M Lot# y P Certified Survey Map# , Volume ,Page# Warranty Deed## � � 6 G Volume Page# I Spec house yes no Lot lines identifiably)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 andior 2 after inspection and pumping(if necessary),the septic tank is less than 113 full of sludge. Lwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herei as set b the Department of c t of Natural Resources,State of Wisconsin. q y Dep Commerce and the Department Certification stating that your is Croix County Planning& ng y epri system has been maintained must be completed and returned to the St. Cr ty g Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a wa my deed recorded in Register of Deeds Office. Number mb r of bedrooms JA un Ip, J1 tw � / / A SIGNAT F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked b the Planning&Zoning Department *** eP Y Y g azY P g it 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.08105) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of�! FILE INFORMATION SYSTEM SPECIFICATIONS Owner CHARLES & THERESA STENE Septic Yank Capacity 1,000 qal ❑ NA Permit # I- SE — eptic Tank Manufacturer WEISER ANA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK d NA Number of Bedrooms 3 Q NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units 13 NA Pump Tank Capacity N/A gal ❑ N A Estimated flow(average) 300 gal/day Pump Tank Manufacturer N/A ❑ NA Design flow (peak), (Estimated x 1.5) 450 qal/da Pump Manufacture r N/A ❑ NA Soil Application Rate al/day/ft2 Pump Model N/A ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit 1(1 iT Fats, Oil & Grease (FOG) 530 mg/L E3 Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L 77 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cells) O NSA Biochemical Oxygen Demand (80D5) SSO mg/L jI In-Ground Igravityl ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L Q NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' ofu/100ml 13 Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. Q NA Other: ❑ NA Other: tA NA Other_ ❑ NA 'Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service(Frequency inspect condition of tank(s) At least once every: 3 Q F1anth(s) (Maximum 3 years) -❑ Nye year(s) Pump out contents of tanks). When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ Nit 3 ®yeads) month(sl ❑ NA Clean effluent filter At least once every: 10 year(s) ❑ month(s) S1 W, LInspect pump, pump controls& alarm At least once every: p year(s) aterals and pressure test At least once every., O Lear(.,(s) M Ni, ❑ .earls)At least once every: ❑ month(s) t3 NFL year(.,) O Ni. 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 tanks) 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 surfacs, The dispersal cell(s) shall be visually inspected to cheek the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:1, Wisconsin Administrative Code. Ali other services,including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Z. START UP AND OPE RATION Page Z of For new construction, prior to use of the POWYS check treatment tankls) for the presence of painting products or other ehemic3 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conterr of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cells) in one large dose,se, overloading the cell(s) and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fait foundation drain (sump pump) water, fruit.and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; toil painting products; pesticides; sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant replacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkin system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area K ill result in the need for a new soil and site evaldation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Th r-49 hoe not been evaluated tv idMtifY a NUMMM leplacarte"t M-969- Upon faitwe ef the 120"AMS ----U _--l`� ik slue' - e CaNSTKtlG?t ilk ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tine. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name LIQUID WASTE TECHNOLOGYU Name ST, Cp tie ��1 Phone 715-246-5738 Phone- ]rf�j — (J((A (p 0 This document was drafted in compliance with chapter Comm 83.22(2l(b)(1)(d)&f) and 83.64(11. (21 & (3), Wisconsin Administrative Code. aMN1a1 N�DM/S W SIN AVM OpaIINO Aa110A115 LUNDYS PRESERVE ,a in$r,ON oa a sor mom� I M2p1 (7 s MM 1501 m"5)31 Im LOCATED IN THE NI1114 OF THE NE114 AND PART OF THE N11/4 OF THE NE114 OF SECTION 27,TXN,R18W,TOWN TOM Tl+amn anal ' OF RICHMOND,ST/CROIX COUNTY,WISCONSIN, Pala NIINa 11aNNa alas ' l =ff a aapa 14111 NIa INK aia iw 11MR Naar,aN R ally e6'Ll pale NR APa RRI 1fAlla v o 09 � � H RMaaRllaltalawn'alnwrrAalalaRMlRaa4N URI.117RDI.ANDB _ L—_TIYr4111a14 w Mat NI N WM wo a RelAa AallMlR w ------------ v arNlxequaaRNUawalNalnc ---------------------- IAlalllrtv —1aaJIYIt1MRa1 t10111AwaY1 u1rRNN ►'� Rla t n _ nw pea omw r, R sa —n aruan as a NM q Mwal M M j -°---'t- ----------i a Ia wa°li• arNl a wr Inv = I rar uarr - / 1 Y 10x1 BOA1p Rc5pU11o1 Na I I I ,�,.,... � wal I n _...... .......................... ............ LI n wow InN I �............... ............... " IOW aRRMTaaa1 N[aaMA[laaaNaIN491Nalabl v �Q}� I I�t n @. 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INIIM "a6M LOT. "•,. _ =r-- WAN waNaaa rANo ,pin ; I la I ` LOTm Ty I I. NR AOa I Y A I 1 ps�n LOT U.N.Q4 AMILn V 01 K 6 w mil" L, I ®'N .nlaa COUNTY WA9AER$R1111OATf —iwr t u wr I tr PAR v 4026, 1" "' h ■ A 1 iW 1 161 $T,wx OWIITY PUMNNO AND im OOa1m ALSOI o aYn a P.aogr --t6rnRTtlllas x1NU1aR 1a11111646Rrlr 0uila Nala NR Aa1R wARlaa 177{r prrsp 670L'a.AOiRMTr uNrI iRLMNRNNrrgrNp,varara P.aaaaRa16aralrrwuRaaarwaAalpl r I aIaNGW.as{16orwlaanRft.aalNNnNNIrNNN6al 4 Na MONIAIa M1narRAS64a6s anaW L7 UTOWDS I cum WaA liar. TAa11011aIWA4 a1MRT sir maim mmlM TIa110R 111a14 MR I Waal as 1A; M 11wo a/n RAW a ww IN m rlal am a 2X21 IY w� V Iq 1,112�IL r ww+ re • w!T Y 1� Y !� 7T r WM an ° rm IN Ar6 Bala aR • wPJI Y • afar u wNwaianaaww wNaM ae wrlw a4l alAyw WWIIN= 8182923 Tx:4151400 STATE BAR OF WISCONSIN FORM I -2000 986026 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX WI THIS DEED, made between Environmental Holding Company, LLC, a 0ST. CR IX CO.,O., PM Wisconsin Limited Liability Company, Grantor, EXEMPT*: NA and Charles S. Stene and Theresa L. Stene I Husband REC FEE: : NA and wife suvivorship marital property ,Grantee. TRANS FEE: 40.50 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property"): Lot 31, Lundy's Preserve, Town of Richmond, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc. #408527 2200 W County Road C,Suite 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 026-1167-31-000 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 Easements,Restrictions, Reservations, Roadways and Rights of way, if any,of record Dated this 10th day of September,2013. Environ ental Holdin Or- ,n olia 0-* William P.Sherman,member NOTARY A N* it ACKNOWLEDGMENT UTHENTICAT ft Signature(s) ATE OF WISCONSIN ) CROIX COUNTY. )ss. authenticated this I Ith day of September, 46. GO Personally came before me this 10th day of September, OF Vq 2013 the above named William P. Sherman, a member of * Environmental Holding Company, LLC to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN person(s) who executed the foregoing instrument and (If not, acknowledged the sa authorized by§706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Merit a J. Bune Notary Public, State of Wisconsin Larry S. Mountain,Attorney at Law My commission is permanent. (If not,state expiration date: 10/27/2013 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must he typed or printed below their signature 1 of 1 WARRANTY DEED S'1'A"I'F:BAR OF WIS(:O\51\ FORiV7 No.I-21N1U Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than A8X indude,but not limited to:vertical and horizontal in yc)�t Parcel LD.percent slope,scale or dimensions,north arrow, and distance to nerest road.Please print all in Revie Date 2004 Personal information you provide may be used for seeo s(Privacy Law,s.15.04(1)(m)). Property Owner F.CROP P090111 Locati n , F i 1!4 Vk A S T N R E(o W Property Owner's ailing Address Lot#f y Block# NameCSM# City State Zip Code Phone Number ❑City ❑Village wn Nearest R New Construction Use. Residential Number 2 A ' m r of bedrooms Code derived design flow rate GPD / 401A ❑Replacement b lic or commercial-D scribe: ----- -- -- Parent material C r-t/ Flood Plain elevation if applicable /1,-6W General rnmeerrts S UG%�''L��`J 9� $ U V and recommendations: / F 71 # ring ` � Pit Ground surface elev.�!ff. Depth to limiting factor /0 in. mil ApplicaMon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 SAL Wng# E] Boring ��//�/ pit Ground surface elev. r ft. Depth to limiting factor—L— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 Z_ o I S/ ( loc . '7 4 Y11. / Effluent#1 =BOD >30<220 mgll and TSS>30<_1 'Effluent#2=BOD _<30 mg/L and TSS<_30 mg/L CST Number CST Name(Please Print) 226900 �gnatur$/ Bird Plumbing, Inc. Shaun Bird Date Evaluation Conducted Telephone Number Address 715-246-4516 1008 192nd Ave, New Richmond, WI 54 17 --� i I Property Owner Parcel ID# Page of Boring 3 Boring# Ground surface elev. ft. Depth to limiting factor J_L __—in. F131 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description on Textu re Structure Consistence Boundary Roots GPD/f i in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 C_ rn 2 0_3 L C I �2 3 a � � I F-1 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 GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Etf#2 I E 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/ff in. Munsell Qu.Sz Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1=BOD_>30<220 mglL and TSS>30 1150 mg1L 'Effluent#2=BODr,<_30 mglL 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. SBD•0530(;.6!00) i Soil Test Plot IM ,Project Name Environmental Holding L.L.P. ird Address 70619th St. S. Hudson Wi 54016 226900 Lot 31 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 89.3/88.7/88.1 *HRpSameasBenchmark Alternate Benchmark Top of Survey Iron @ 96.0' AL Please note:Soil was done to satisfy Scale is F = 40' county zoning unless otherwise requirement. Soil 392' test may not be Property noted suitable for owners Line desired building AL location. 9% -2 Slope 45' B- B-3 91' 40' 92' 93' B.M. 438' Property Line 90' A A t RECEIVE `O JUN 0 1 2004 Lundy's Preserve Comments: ST.CROIX000NTY 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