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HomeMy WebLinkAbout026-1290-03-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569520 0 GENERAL INFORMATION State Plan ID No: Personal information 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: Cievering Homes LLC, aka Oeverin Pro ertie I Richmond, Town of 026-1290-03-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 1 r'o.. 22.30.18.1456 TANK INFORMATION ELEVA ON DATA TYPE MANUFAETUFEK7,-,jj CAPACITY STATION BS HI FS ELEV. Septic y Benchmark 9.3 Dosing / Alt. BM �p o� Co,M.�o ( Q'� r l L Aefetiff Bldg. Sewer F a,, 3 b 7 Q Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent to Intake ROAD Dt Inlet Soj�4, Septic i 1JA- $ ' Dt Bottom d --' /1.5 97 �� Dosing / Header/Man. /d Pr- I 7 81 yt. S /6 1�.g Aeration Dist. Pipe 415 /0 Y, ray Holding Bot. System S, 4 Final Grade 3 5 /Q 5 •$ PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loos System Head TDY Z. Ft �i Forcemain Length / Dia. 1 Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No. Trenc es PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS /Z- Qp 8 � SETBACK SYSTEM TO !! P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR Type f System UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution /( x Hole Size x Hole Spacing V Air I e Pipe(s) Length Dia Length Dia Spacing 3 L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Ai I Depth Over Depth Over xx Depth of 1xx Seeded/Sodded u,,' xx Mulched Bed/Trench Center f, �} Bed/Trench Edges Topsoil , >@Ves No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: s /Z3 / /4 Inspection#2: / / Location: 1406 129th Street New Richmond,WI 54017(SE 1/4 SE 1/4 22 T30N R1 8W) Lundy's l orth Lot 3a k' Parcpel No: 22.30.18.1456 1.)Alt BM Description= — �.`_ GLk,%!A.5 6IA— 1 2.)Bldg sewer length= 26 -amount of cover= 7 � O�. WC�C. �a.+�.t�n w►�.d 4ignature Z Plan revision Required? 0 Yes No `Use other side for additional information. 5 (SBD-6710(R.3/97) Date Insepct Cert.No. PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 106.0' 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 Ilk BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 129th St. 104' B-2 106' Property Line ❑ Scale = 1 /4" = 10' I 9 Slope Grading is to be done to divert run-off away from system B-3 Area 15' below system is to remain undisturbed Wei I is to meet al I WDNR setbacks B.M.* 368' Property Line ❑ Pro 3 B- 1 Bedroom House Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels County L k Industry Services Division , 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) " P.O.Box 7162 O ` r1W;t Madison,WI 53707-7162 Sanitary Permit Application Stater s cr.- Z In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 1- is required prior to obtaining a sanitary permit. Nofe:Application forms for state-owned POWTS are submitted tS PrW Addre s IbGdn2 than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary "/ (+ u ses in accordance with the Privac Law,s.15.04(1 m,Stats. zl Wl v.a �� # I pknl 1. Application-information-Please Print AI fo n `7� Property Owner's Name/ I Parcel# t7p e o�6 � 13- Property Owner's Mailin Property Location ( t�e/' Go Lot li �� City,State Zip Code Phone Number ��,Srz -/., Section _� _�L_ 'rcle one � T-3 -N:-R E of W J H.Type of Building(check all that appl Lot# X.9,2 Family Dwelling-Number of Bedroolps Subdivision Name C• V— Block# G�!G yl p ❑Public/Commercial-Describe Use ( t G ti ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 12- 96 4 - .6r-�� own of 2 III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑Treatmont/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 I IV.T ype of POWTS System/Component/Device:. Check all that apply) OL) ❑Non-Pressurized In-GroAd ❑ Pressurized In-Grou rade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Tre mentArea Information: Ot Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Required(s Dispersal Area Proposed(s System Elevation -T/ t7 VI.Tank Info _ Capacity in Total #of Manufacturer Gallons Gallons Units o New Tanks Existing Tanks U Septic or Holding Tank Dosing Chamber VII.Responsibility Stateme t-1,the undersigned,assu ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum MP/KVRS number Business Phone Number J Plumber's Address(Street,Ciry,State;Zip Cod C VIRL-County/De artment se Onl OF Approved v Permit Fee Date Issue Issuing nt Signature $ // q rr,, O iven R n for Denial (p`5' - 5 )4 IX.Condiiyg o ftlW Weasons for Disapproval Q, Do, 1, Septic tank,effluent filter and' -3) `'�`�`""" k"e dispersal cefl,must all be. es rvices/maintilrOd Ae� 5 eL V,Le_ as per management plan provided.by pWmI, �� � 2. Atlaetback requifemettts tpust�;tt'raiMa41 as per applic"Code i ordutilTlCi O. Attach to complete plans for the system and submi to the rCounty only on paper ess than s tlz x t t i�ches in si - SBD-6398(R0313) I Q TARxn g DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay www.dsps.wi.gov/sb/ ~ www.wisr-onsin.gov Scott Walker,Governor Dave Ross,Secretary February 21, 2014 CUST ID No. 226900 ATTN:PO WTS Inspector SHAUN R BIRD M 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:02/21/2016 Idefitifica Numbers Transaction ID No. 2371722 SITE: Site ID No. 799802 Oevering Homes Please refer to both identifie 60n nw nbers, Lot 3 129TH St above,in an Correspondence with the Town of Richmond a St Croix County SE1/4, SE1/4, S22,T30N,R18W Lot: 3, FOR: DcSCiiption:At-Gracie, 3 bedroom Object Type:POWTS Component Manual Regulated Object ID No.: 1471649 Maintenance required; 450 GPD Flow rate; 42 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 sob the D m y epart ent 1e r s.145.06 stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the At-grade Component Manual,Version 2.0, SBD-10854(N.03/07,R. 1/12), and the Pressure Distribution Component Manual- Version 2.0, SBD-10706-P(N.01/01,R. 10/12) N In the event this soil absorption system or any of its component parts malfuncti o a th hazard the property owner must follow the contingency plan as described in the ap ed 'a s Ii the owner must comply with the operation,maintenance and monitoring duties �ftftb of the at-grade component manual. A copy of this information must be given to the owner" Ab the project. Maintenance information must be given to the owner of the tank ex lama that e c cleaning. the filter i I p g s g. required. Access to the filter for cleaning must be provided per SPS 4 0 S$i� oval conditions. A Sanitary Permit must be obtained from the county where this project is locNd in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Slats. SHAUN R BIRD Page 2 2!21!2014 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, Owner Responsibilities: • SPS 383.52 Responsibilities. The e 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 ved mana em n t plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The own r i e s responsible for submitting a maintenance,verification cation report acceptable to the coun ty 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/installatioWoperation. 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. Sincere! Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, 161a Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 juiia.lewis@wisconsin.gov 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 Conunerce 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. /N DusFEB T 2 02014 RY SERVI Cover Page CFA Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/18/14 Owner:Oevering Homes Location:SE1/4 SE1/4 S22 T30 N,R18W Lot 3 Lundy's North 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 Y J "TyANO Shaun Bird 'uSTRYRV�CES Signature SERVICES License number 900 COR57" PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 106.0' 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 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 129th St. 104' B-2 106' Property Line ❑ Gale = 1 /4" = 10' 9% Slope Grading is to be done to divert run-off away from system B-3 Area 15' below system is to remain undisturbed Wel I is to meet al l WDNR setbacks B.M.* L-1 368' Property Line ❑ 1 Ll Pro 3 B- 1 Bedroom House Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels At-grade System Sla ng,,Site Cross Section and Plan View Dimension. Feet ,ti•ti■ti. .ti.tiK ti. 'r �■�■11• •1■•�'�■ •W1r1■f■ ■ ■. .�M ■ tiK■t■��'i■y�tiwK� '��Y� rMK■ •7■ ■ �. �ytitiK tii■ ■ti■'Ups■ti■ti■■'L.ti■■ y �' ,/ r■j�■ yr�■ ■■•r ■�� r■f■d•�� .�.tier•til•r•�•�■r ■ti:•rti ��K 1/6 B Wr�r■�'■r■ yi�• ' ■�'tiKS S•1•ti•S•ti•y'.L LM■ U•;•�L ti•ti A ti ti tiKKK•ti . ■ i• ■f■j■�■j■ ■r■fa 2.0 ■ M■t�'■r■r• i���ti■��'k�i'��tif'LrS•ti■ti�'1 �L ti■S•■'L•titi•1+•�L fK .e�� '�■ �■■�K•S�ti,■ti■'L■i�T"LK • �d•��■�■.r�l•�'•�•f'• �'•it•fr•r.,pr■�1■t■ � �,: �. l• '�tiK•�■y�'L•�.■SKK tiKf■tiKK•'ti■titi■-1�■'1.4■� ■rLK rsp. D • : ■r 1■f■ ■r■ r ■r■l■rM■r•f■T■it■r.t■.F r r r•r•1 1•l��M• y1• .,A: ■ ti.K ■'Ii. -Ir. ••y�'(� SK •S•ti■9K■ tiKKK•Si•tiK■bS•ti�L■'LK■ti■�L■�■■ti■-�■ ■ +x E 5.0 i i �SjK{SK K KKK■4•tiK UKrT%% 't ti•SKKK•S•S■4• S■5■. tires •d'•f r •■I�■1•j■1•�•�r■�■ •r■f■r■f■?.1!■1'■r■�■1■r■1'■■li■ ,1'•+_■f� !tiKK 1� ■;• • K.ti■ti w;•ti .•ti•'�•4j, '�jS�•ti� .ti�.•; F 0.5 K.+;'r■$ ■5� _ ��' r�r •ti:'fw� .' fL:' .-��K'•�•�F•r•1•j•' •�. . G 1.0 .SKK• K■ ,6K �ti� K■ ■ ■y■ L E 1/6 B W Z E B L L F % Slo t =Plowed •sr: =Clean aggregate =4 in. sch.40 pvc ■% basal area sw %to 2 %2 in. dia. observation pipe Lateral with 2" Topsoil Cap ^ aggregate over pipe observation Pipe Geotextile G With Cap Fabric f' Q Ft Lateral Invert ;M'1`L'j■'Y•''� �: Hr ■r■j:rife. Topsoil Cap CZ Z Ft Contour;�■ , ■ S■���■;■;.■�. of , D Plowed Surface C Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the desigA contour:'`-:Existing vegetation is mowed and raked off the site. The basal area(L x W) is staked out.and pl©vied with a moldboard or chisel plow. Plowing may not proceed if the<soil is wet enough at the plor`depth to form.a%inch soil wire when a sample is rolled between the palms of the hands.'.The A x B area is covered by clean aggregate deposited overhead by a backlloe. Special must be when placing the aggregate to minimize compaction of the plowed's'.bce topsoil cap is:plaeed, e is seeded and mulched to promote vegeta#vim erosio '� bait n and pest the entire at grad ate perforated the lower fir' and securo.- �place: from freezing. The observation pipes pe 03/05.1gj Page of Pressure Lateral Layout.. , One Lateral -End 'Manifold .---Threaded Cleanout Lateral Turn-up --► Plug Force Main k X --� L Long Sweep 90 Ben&' t . Pressure Sistem Construction Tfistributiae Network ecifications , , . Lateral Diameter In. Laterals are constructed of Schedule 4Q PVC Orifice Diameter v� 3 Z In pipe• orifices are drilled perpendicular to , the piper with a sharp drill bit and face down. � X Orifice.S acin °Z Lateral turn-ups terminate with a .threaded L ateral L $ Ft. Force Main Diameter In, clean&A plug and are enclosed in a 6-8 inch Ft. diameter lawn sprinkler valve box accessible Force Main from;finished grade• • • • s • Crrade •a . 6-8 Inch Lawn SprinIder Valve Bax , Page 03/05 ig} septic-Dose Tank Cross Section And Pump Performance Specifications Pump 11ds��' Ta� a +ear Model Number Tapir Model bomber AlUMU Total Tank b Max.Bury D Alarm Modal Nomber t-- � R ' switch Type 9Q1'✓ / Filter Msaufactutr 2-' Total Dynamic Head(TDH)-Feet Filter Model Nwnbor Elevation Head DtsW NeBMUO •S� NetwOdL Lose . y PUMP r�'Requ red / Fm+ee Main Loss 1511y- 3 GPhC, S: 3 Ft TDH ,/ Total OWW Manboj h m.C Above Ora&With Mmhoje Min.4r Above C`m& Locking Dairies. b"Manbole fly Mounted With Looking Device <6"Below tirade Sealed wow" WON&U-Prod _.,..__♦ •�■ ?unction Bari .. " Fit}ished Carsde '" NM t• Vat Min. 12" Diecomoct Above Grade Meets With Vent Cap •e..s a i•fs•sdsO i 1 1 s••s's lls+s•.' >•> , .s s Outlet Filter tifiGl ►?' .inlet Baffle ---- I rS s. Y� p� ..• A X. Switch iVP�/a s►B rty r %a" W ( ,y �P Teak Vohune= Hole B Dimension: IncBas Volume Cal. ':• (reserve)A. J a���,: ;. •ti Ems►} B ; r: (dm) C; 6.S Bottom .f. Ld!4 D: /3 D t, Ft .. 1 •fs'is`e's's's'ffi s'ldll'�s rLrs4rffa's 1 s:'ll s s .'f :'si''.,t','►sr;►'i.aa�a'.t..r.sti.t�.t •s'•'�;•s''i's'e'i i.ri i i'iri'i 1•i f'�i'fs'r' GENMR AL INSTACL.AnON: The sept+eldoee tank is bedded and book Rued m w=dmwe with the manafaatvror'a product epPw,d WOOModkw. Maimm dW&of bu1Y.m h'Y the mmActurer may not be exceeded wdhout Pw oval- bdua wk covers eMo.ed to grade hwe an effective l dit device(padlock) instalbdr Piping at lire inlet and outlet is of gproved material, owneded to the tank with wsterd&fitlnegs, and laid on stab lq soil to prevent seldiag or sagging. Ths force main is sleeved with 4"Sctz.40 PVC tie bridge the tank excavation abd the akww is sealed watordghtr Electrical service Complies wilt NBC 300 isi Comm 16.M. 02/051,) of ��fluen� f"AWSOrks Submersible Pump. • • 50 100 150 200 300 30 9 20 6 i ���®►� 0■®®P , LW SEN-40-M M40 ONVO rL/J r r� 1 - i0 East spring Street BIUMOn,IN 46714 Tel:260.87A.29W&Fax 260.224-2W9 POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of ILE.INFORMATION SYSTEM SPECIFICATIONS owner - 2 i Septic Tank Capacity go 17 NA permits . Septic Tank Menufadurer 0 NA IGN.PA&ETERS Effluent Filter Manufacturer �L E3 NA Number of Bedreoms 3 0 NA Effluent Filter Model 13 NA i Number of Pic Fa igtOnits Ig.NA Pump Tank Capacity 17 NA. Esdmatod 11ow gaVday Pump Tank Manufacturer NA Design flow(peak)(E.sdirtahed x 1.5) �'?� Pumd Manufacturer d, 13 NA i Sofl Application Rate - 13 UaVdaW Pump Model . � O NA Standard Influent/Effluent Quality Monthly average~ Pretreatment Unit Fats;OR&Grease (FOG) 530 mg/L 0 Sand/Oravei Filter O Peat Filter Biochemical Oxygen Demand (BODs) 420 mgtL 0 NA 0 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BODE) 530 mgA_ 0 In-Ground(gravity) O In-Ground(pressurized) Total Suspended Solids OW) 530 mglL rade 0 Mound Face!Collform(geometric mean) 510,cfu1100ml 0 Drip-Line 0 Other. iMandmum Effluent Particle Sin Nh in die. 0 NA der If NA Oilier. NA NA 'Values typical for danestic wesbewdw and septic W*eAluenL Other: NA NTENANCE SCHEDULE Service Event SerAoe Frequency linspect condition of tank(e) At least once every: C3 s s (Maximum'3 yea=) 13 NA Pump out contents of tank(s) When combined sludge and scum equals oneahird(Xj)of tank volume 0 NA inspect dispersal cefl(s) At least once every: 0 morth(s) (Maximum 3 years) 0 NA Clean effluent filter At least once every: morhth(s)/ s 0 NA Inspect pump,pump controls&alarm At least once every: 0 month(s) 0 NA 0 °nth 0 NA Flush laterals and pressure test At least once wary: s At load once every: 13 13 mo*(s) 0 NA yea r 0 NA MAINTENANCE INSTRUCTIONS ilnspedons of tanks and dispersal colas shall be madeby an individual carrying one of the following Ikenses or certification: Master Plumber,Master Plumber Restricted Sewer,POWTS Inspector,POWTS Maintainer Septage SwAcng Operator. Tank inspections must Include a'visusl inspection of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks,measure the volume of oombined sludge ge and scum and to check for any beck up or ponding of effluent on the ground surface. The dispersal cefl(s) shaft be Wously inspected to dhack 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 falling 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(%)or more of the tank volume,the entire contents of ft tank shah be removed by a Septage Servicing Operator and disposed of In accordance wfllh chapter NR 118, Wisconsin Administrative Code. All other services,including but not limited to the servicing of effluent Stem Mechanical or pressurized components,p whistrneltt units, land arty servicing at Intervals of 512 months,shalt 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. START UP AND OPERATION tans for the prssenos of painting products Or other chemicals th4t the pOWTS check treatment For new coon, prior to use and/or the d Cell(s).) If high noncan am ton� contents of th¢ m impede the beStrne process tank(&)removed by s septW servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the Mffd*M surface- Wastewater will bp is restored the 0"" During power outages pump tanks may fill above Hamel hlg)oell(s)and resuit in the backup or surface d of effluent. discharged to the ol WWW ceN(s)in one l�dose, tank by a Saptage Servicing Operator prior to restoring Power to title To mold this situation have the concerts of the pump rah the pump controls to restore Hanoi levels effluent pump.or corcad a Plumber or poWrS Mainialner to assist in manually operating the pump tank, disturb or compact+the area within within Do not drive or park vehicles over tanks and dispersal calla. Do not drive or park over,or ose 15 feet down sops of any mound or at-grade soil absorption area- and proionS the life Of tine POWT$: Reduction or elimination of the following*Om the wastewater aUsaurr rraY ima; de flo ', diapers; disinfectants, fat: foundation-drain antibiotics, baby w pea; dgwette bootie: condoms, cotton swabs,degnmw dental top) water, fruit and vegetable peolings; gasourW grease; herbicides; moat scraps; medications: ON; painting VWucW' psocid,sanitary napkins;tampons,and water softener brine. ABANDONMENT POWTS falls and/or is permanently taken out of service the following steps shall be taken to insurs that the system bl prope r and swish►abandoned in compliance with chaps Comm 83.33,Wisconsin Administrative Code:. • AN piping to tanks and pits stall be dksoonnected and the abandoned pipe openings seeded. • The contents of all tanks and pits shall be removed and properly disposed Of by a SgAags Servicing Operator. Ned removed and th ed with stldl, • After pumping, all tanks and pits shall be excavated and removed or their covers e aid space gravel or another inert solid material. CONTINGENCY PLAN res have been, or must be taken, to provide a Dods oomPN$rc If the POWTS falls and cannot be repelred the following measu replacement system: be utilized for the location of a replacemennt soil absorption system. 0 A suitable replaosmrent area tree been ova disqubarnce and compactor► and should not be infringed ►Pon by required The replacement area should be protected ment area will result in the naiad setbacks from g and proposed structure,lot lines and wells. Failure to Protect the replacement ocrrPh►with the Hole&in for a now soil and site evaluation to establish a suitable replacement area. Repiaosmo t systems effect at that time. in POWTS ledmoiogp a C] A suitable replacement am is not available due to setback WTS. nations. Barring advances holding tank maybe installed as a last resort to replace the failed Po area. Upon folure of the POWTS a soil and site evalua1on The site has not been evaluated to Identify a area. i�repiacement area is available a holding tonic may be installed as must be perfortried to locate a suitable repiacemen► a WA resort to replace the failed PWM- d and at-grade soil absorption systems may be reconstructed in place at towing removal of the tubmst at the infNtrm#h+e *M-O,W Recor>strur�ons of such systems must oomph►with the rules In effect at that limns. «WARNING» TANKS,MAY CONTAIN LETHAL GASSES ANWOR INSUFFICIENT OXYGEN. DO T SEPTIC,PUMP AND OTHER TREATMENT ENTER A SEPTIC,PUMP OR OTHER TREATMENT E 14K UNDER 10R CIRCU�EANCES' DEATH MAY RESULT. RESCUE O PERSON FROM THE INTERIOR OF A TANK MAY B ADDITIONAL COMMENTS POYVTS INIAINTAINER POWTS INSTALLER Name Name ci Phone �/� — ljiJ,- Phone 1 - S- . — LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATO UM Name �� Nature 70�.,- ���/ Phone ?ice= a2 7` /y This domffnWd was drafted in omOffince with chsptsr SPS 383.22M(b)(f)(d)&(f1 and 383.54(1),(2)&(3),Whow4in Adininiatratl�e Cods. Ojv r:�► HL TER:•�.. CARTPJDGE INSTRUCTIONS x STEP i Dry fR the NNW Case opts the MW Of the outlet pqm to ensure it is centered under the access opening. It pot,theft 6WW insert more pips aft the tank through the ohrlfet or soh►ant weld(Vue),additional pipe onto the outlet Pipe. STEP a While the case is still dry fitted m the outlet pipe,measure the length of tin-itch pipe rt.&aded to brace the fiRsr to the tank end wall ff utillWng the optional suppieinertat side support.If side support method.is not udimed, proceed to step look S�FP 3 For h us Utftng the optional nrppwmw*W side support: solvent weld the'f,-inch pipe onto the filar case. if side support method is not Utilized,proceed to step fold. Solvent Weld the filter was onto the outlet pipe. Insert the filer r t f:•. cartridge iMo the MO, "• pressing doxm'uantfi tits Bier krJts into the bottom of the case. ry If a VRS switch is utllixsd:kaert kits the filher and kick by 4z clockwise 9W. tlirrU� r,';i,'•',•'#; Maintenance 1. The WNW*filter should be cleaned.&very time the septic tank is serviced. 2. Open the outlet access opening W inspect the tank and filter 3. Pump the septic tank uarnpknbeiy,making sure to remove the sludge loyar on the both n of the tank and not just the scum and effluent. s. Once the effluent level has been hwwred below the invert of the outlet._pipe,firmly PUN UP on the WAW handle to dislodge the ,h .Cwm fre�{s the case. 5.•Slide the Mt klge up and Out of the came for cleaning. 6 N a VRS swltdh connected to an Warm is prement,the switch' shmW be removed by turning cmmtwdodewke go-and cleaned wink water a*. 7. While holding the cartridge an its side(large out surface facing a •ti.;. down)agar the across opening;:rinse off the cartridge with water only,making sure al sePtaga MM Wktl is Wised back into the tank. If VRS switch is Utifted,replace by inserting into filter and turning clockwise We. 9. Insert the filter cartr'idg.&balk into the case,preening down until the filar k+cks into the batten of tla Case. ; IO.Repiace and secure the access epaNng.on ths.tank. h:o f.r.,•n��•s'••,l•'7S:a><'strx.e Ave• I e..::rr ".R;vaxHl+i-•. . www.bear+o�f+be cow 877 KUUn S(653-"83) . ST.CRODIL COUMT '.�•• - SF.MC TANK MAINTENANCE AMEEMW - F OWNERSW CER'TIFICAT ION FORM Owner uyet el-f/ Mailing Address Property 7 d p�A I� c.� z (Verrctllon tie med frorn r amft&zonmg Dvmftw four new ecagavebon.) Ci / State. Parcel Idenfi6cation Number a/,7/-1 06 3 �FCAY.1nta�r�` N .Property Loeati°i �, Y ,S� V4, See. N R , c �'W,Town of Subdivision Lot# C'ertl Survey.Map# 'V'ollune page# War=ty Deed# no � �7 .� Volume_ "�--page# Spec l+ no Lot lines rdem#ifrab Yes no sY �. �. , O QTFvtrl A.r f;JN hVrOPW use and rrmintena�e of yaw septic system could result in its prime fxr7rrre to handler wastes. proper. Consists °f l "m8 out t3se tank every three tsu affect the QVhat the Y"m Or sooauu- if by a 1icaused you put into function of fire septic tank as a treatment stage in the waste dimpoul ibilitics ate specified in§Con=83.52(1)and in Chapter 12-St.Croix sY� Owner in&t*Mance CmRAY Sashary Vie. owner and by a owner a��t0 Submfit to St Croix Comq pig& t a certidcatioa wastewater 'J�phunbec,inetricted plumber or a l6XMwed pti v g mat(1) by the less dies 1/3 full of lodge. 1 eortdittan °r(2) t o and pun*ing of necessary),the septic tank is staadairls sat the undersigned have read the above MQ--rnent,and agr eo to fob'b�asset by ire of Commm ce and the maintain the private sewage disposal system with the t sePttc system ea be BPD d to the S�c� of & days of the ffiree Uwe certify that all stateri3cmis en from are bw to the bast of /our knowledge. Property deed above,by virtue of'a Ow recerde d in Uwe am/are the owners)of the Regietet of Deeds Office. KV=ber of bedrmomx-� OA F PLICANT S DATE "Any information that is murepreSented may result in the sanitary Permit being revoked by the Planning&Zoning Deparhumt. ** Inchide with this application a reworded wwmty deed from the Register of Deeds Office and a copy of the certified survey reap if refenearce is made in the warranty deed, (RRV.OMs) I 8210819 Tx:4173771 STATE BAR OF WISCONSIN FORM 2-2000 992434 Document Number _ WARRANTY DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between John E. Schommer and Barbara ST. CROIX CO., WI A. Schommer, husband and wife, Grantor, and Oevering 02/10/2014 2:40 PM Homes LLC,a Wisconsin limited liability company,Grantee. EXEMPT#: NA Grantor for a valuable consideration, conveys and warrants to REC FEE: 30.00 Grantee the following described real estate in St Croix County, TRANS FEE: 64.50 Wisconsin: PAGES: 3 SEE EXHIBIT OK ATTACHED HERETO AND MADE A PART HEREOF Recording Area Name and Return Address: Exceptions to warranties: 026129003000 Easements,restrictions and rights-of-way of record, If any. Parcel Identification Number(PIN) ( N) This is NOT homestead Dated this property. rn IE.S cho e d— . /' 1'0�9t� arbara A. Schommer WVARRAN"DEED 'STATESAR4]F'AISCONSIN FORM No.:Z%2000 St.,Croix County 992434 Page 1 of 3 I AUT:;EN iICATION /ACKNOWLED'G'MENT Signature(s) STATE OF_.�/`: Z©nom tuthemficated this IG�OU:NTY Personally came before me this 3 q the above John E. Schommer and Barbara A. TITLE:MEMBER STATE BAR OF WISCONSIN Schommer, husband and wife to me known to be the (If not, person or persons who executed the foregoing authorized by§706.06,Wis. Stats.) instrument and acknowledged the same. 'TMIS IVNSTRUMENT'1N/A`S)DRAFTED BY Martin D. Henschel (680'0 IFrarnce Men,nue,'South, Suite-4'1(0 Edina, MN 55435 Notary Public, State of (Signatures may be authenticated or acknowledged. My commission is permanent. (If not state the Both are not necessary.) expiration date: 'Names of persons signing In any capacity must be typed or printed below their signature. Heather Hugill Notary Public-Arizona Maricopa County My Commission Ex�Tres June 5th,2015 WARRANTN(DEED 'STiAIiEIB'AR1OP WISCONSIN IFORMINa.1-:1000 St.Croix County 992434 Page 2 of 3 JEA,Ut/A Legel(Description Lot 3, Plat of Lundy's North in the Town of Richmond, St. Croix County, Wisconsin. WARRANTY IDEED 'STATE(BAR 01"WISCONSIN (FORM INa.:2 4'2000 St.Croix County 992434 Page 3 of 3 w.iv.t I (90.057 so FT.) # LOT 15 3 LOT 16 3 3 i 3 LB.O. - 966.5 e ' 2.16 ACRES 29.85 % y LOT 13 • '3' "�^� 1.62 ACRES 3 544 ROE--' in 2.10 ACRES ti� r � Mme' (79 206 sq. FT) (93.977 Sq. FT.) y N N ` (91,677 S0. FT.),� rN� TOP �� LB.b. 966.5 Ft �1 j^ Cl ��:•, LB.O. - 966.5 k° �hI IRON 1FYA71OW LOT 17 -v 966.5.,i kb nW 1.919 ACRES N :R a~i p •, � EASEMENT 3 964.0 (86,420 SO. FT.) ,WI o N NI �I HWE- 964.5 i N8 JO'i DRAINAGE EASE'A/ENr Aff, N88'IS'it'E 409.63' ��� --— 129TH STREET — — --- — \ �4` 7892' S6815'11'W 409.63• , t LOT 18 -�- —.�L.� \ i. 2.13 ACRES jj•/aj• _`'_ — —— —— — —— — {{1 \ \ / ' (92.620 SO. FT.) t� DRAINAGE / EASEMENT V�t / WE - SO&... 0 ............................ S ......................... �{ \\ \ \\ 428 { i \ 1 N8539'35°g 9 I• s 5837927•?37. , '75• d LOT 3 ' { \�/l `� ' \111 t 145621•�Vl% ---�N4 2�7' 2.32 ACRES 41, W (100.876 s0. FT{) o oz ) �^' I m I LOT . 1.70 ACI (73,961 SC LOT 4 3.23 ACRES (140,620 SO. FT.) 15 ` LB.O. 965.e 4�' LOT 2 ' g$ ACRES (88,,8585 9 Sq. FT.) `'s�e,•0 � � ,' ......1. •; BENCH MARK: TOP OF 1'IRON PIPE. `< ELEVATION 977.0 +st s5' /! LOT CRE �+ m� 1 (90,517 SO. I '` ��� S�° / / �' ��'�•VI _10.97' '' � O• ?`sQS. / / i/i i �1Sh �` HWE_ fit I o� ^ � J �• � 979s_ ?l�. ` •dry ��`� /` /' y \ LOT 21 � t Ate • �� 0 ./i `��..� 2.87 ACRES (124.961 50. FT.) hry� 9 LOT 1 C.S.M.IN /;' ,5 LB.O. - 981.5 y VOL.18 PG.4828 LOT 22 \� ---- ------- -- ---- i , :•.•• 2.21 ACRES BENCH MARK: TOP 86' (96,127 SO. FT.) �5r` ElEVA110N 9IK 33' 33• I LB.O. - 981.5 .................... .. .. ................................. _ � �IIIIIIIIIIIIIIIIIIIIIIIIIII .. G ��� � ��:s� :� n .. �I! Ii�� � ,il � � a �I IIII II II _lillllllillll IIII Ilil�l� �, � i O �������������li� � � � �� - � � !Illll�i �; � '_ � � - � , , = ; I. � �= � e� � a� ����� ;• n�>�� ��� ��4 t @d�61 &�9� uuwuwu ; ,���� i �pit I � ,'�� (I , �i�a i�I�� �.,.. �. � ,;i I I IILII '' `� � ! j � �I�� iiiiiiii � , ,- ,r,.,f.; , 0 x w M 88 -s d I � I I � I I I I 5S I I III's I ple 1111 .111's F — z gill , i I j I I s 1 I I �I � b x I 6 1 — b } x s� ° p I • :�s • iC x 6 6 Qi s -- -----------J-- ------ ' I _ x I alsromns. � �n��Yen'� I x I I g I Lam/ a ' ` I - - p s — b I d � miN<arw�bdY/IY.w f�� a•x o-. o•s a-s ,•n ebb� ggloEl @§ ' ------------------------ � I , I 1 I I : �gj I I1 i I '- ------- C r = 1 I I I s e s l y! II �_ �qj �0yp 1 I 1 .. �$ �_•� 1 1 I I j I 1 j j Y ------_ - 1I it it raT- S i ¢ , ---- - - ------------ -- •I 1 I L J L J I r°-- ---- I 1 I I [ D'oiel YegWltlOOUn � i I.,Ifi I 1 Ci®g I R 1 1 I I I pp l�gR I I h I I 1 1 II ✓� � I I I Y 1-------- I . - , MM1Vtt®JYN °I .f 1 1 ,ne,1 Mt'N i I tle ,•.0 a 8 a RECEIVED Wisconsin fP Department ofCommer IL ALUATION REPORT Page l of 3 Division of Safety and Buildings pmm Wis. Adm. Code County Attach complete site plan on papc es 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. Please print all information. eview Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I Property Owner Property Location Govt.Lot 1/ �_ S r��T � N R /6 E(00 Property Owner's MailinY'775'/Add Lot# Block# Name CShf# S . City State Zip Code Phone Number ❑City ❑Village )KTowrf Nearest Road New Construction Us Residential/Number of bedrooms--' Code derived design flow rate GQ GPD ❑Replacement ❑ Public or commerce Describe: Parent material �� �� Flood Plain elevation if applicable /li11,57— R General comments and recommendations:M l Boring# Boring Rpit Ground surface elev/_&23i 1 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. 'Eff#1 'Eff#2 v �' o2.f' 10 3 -� S Jr /. rill /✓� J, a Boring# ❑ Boring Pit Ground surface elev. �' ft. Depth to limiting factor // 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. i 'Eff#1 'Eff#2 -1 r -3 51 mr c S 2- it), r"'-1 L4 w !o '7- S 6 .o •Effluent#1 =BOD >30<220 mg1L and TSS>30<150 `Effluent#2=BOD 130 mg/L and TSS<30 mg/L CST Name(Please Print? CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401;-", 40 /17 j 715-246-4516 . 3 Property Owner Parcel ID# Page of Boring# ❑ oring Pit Ground surface elev. / I ft. Depth to limiting factor D in. Shc ication Rate Horizon Depth Dominant Color Redox Description Texture Stnachare Consistence Boundary Roots GPD/ff in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 0-17 /b L4 n-)Fr Z - L ( msblc mFy a w / F Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. -Eff#1 'Eff#2 F Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate. Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/I! in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 Effluent#1=BOD,>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5 a 30 mg/L and TSS 130 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. 3868330(RAtOO) +� Soil Test Plot Plan ProjeLt Name Environmental Holdings LLP Shaun Bird Address 70619th St. Hudson Wi 54016 CSTM 6900 Lot 3 Subdivision Lundy's North Date 1211 r4 S 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 10o ft. Top of Survey Iron System Elevation 106.0' *HRpSame as Benchmark Alternate Benchmark Top of 1/2" Pipe CC 100.3' 129th St. Scale is 1" = 40' B-2 unless otherwise 133' Property noted Line 100' B-3 9% Slope AL 30' * A1t.B.M. 40' 90' 20' B-1104' 106' �7 � Please note: soil test may not be suitable for owners desired building location,Soil test was done to satisfy zoning 368' Property requirements,please verify system location Line before excavating.