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Home My WebLink About026-1294-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 578909 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: Oeverin Homes LLC, aka Oeverin Pro ertie Richmond, Town of 026-1294-40-000 _Er CST BM Elev: Insp. SM Elev: BM Description: c.sr ( Section(rown/Range/Map No: '6b , _.-L- - • Z I 28.30.18.1522 TANK INFORMATION ~J ELEVATION DATA TYPE MANUFACTURE a : CAPACITY STATION BS HI FS ELEV. Septic V L ' b~V Benchmark 7 ~ Bvslrit~ V Alt. BMTi.~ y- b V U 1 Aeration Bldg. Sewer 8 Holding StA*"Iet 2--4 q-3 TANK SETBACK INFORMATION St/Wt-Outlet 10.5. 13. TANK TO P L ELL BLDG. Vent to Air Intake ROAD DUnWL Septic )IC0 r._ Dosing Bader an. 2 Aeration Dist. Pipe Holding Bot. System f Z•~ /Z,/ 12- PUMPISIPHON INFORMATION Final Grade 2- Manufacturer Demand St Cover PM del Number TD Lift Friction Loss S m He TDH Ft Force ain Length a. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ~5 Length / ti•'I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ./~/A,}~ r^ INFORMATION T Of Sy W CHAMBER OR UNIT Model Num rJ L4 / 2 / _ AVA 0 'l NJA DISTRIBUTION SYSTEM ,V s J(,9 t Header/Manifold Distribution x Hole Size x Hole Spacing _ Vent to Air Intak STL Pipe(s) Length Dia Length is Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges/ Topsoil / Yes No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1139 132nd Ave New Richmond, WI 54017 (SE 1/4 SW 1/4 28 T30N R1 8W) Richmond Acres Lot 40 q~Parcel No: 28.30.18.1522 1.) Alt BM Description = 1~""ch c&./e-.- ~M PQS-ft yed. /^j 7 S 6n 2.) Bldg sewer length = 12_0 I / r - amount of cover q 21116n ad Ne II ti ~ (d *IS tAk Plan revision Required? Fw] Yes Fffi-1 No M5 A W Use other side for additional information. (VVZ SBD-6710 (R.3/97) Date sepctor's Signature Cert. No. WIN A -W W.I. + `rv ro runty 1 Safety and Buildin ivlslon p~ ~u 201 W. Washington Ave., P.O. itary Permit Number (to be filled in by Co.) P Madison, WI 53707-7162 q J ° IX COUNTY Z.~ l State Transaction Numb r and rye Permit Application j In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Smies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 115.04(1) m), Scats. 1. Application Information - Please Print All Informatio Property Owner's Name ^ Parcel 4 I UZ(n-129Lx- yu -o o6 oe-0ems; Property Owner's MMailin, ddress Property Location 5 2Z. `1 3 3 C e/ Govt. Lot City, State Zip Code ; Phone Number r ,,a lam' Section I ) circle o H. pe of Building (check all that apply) Lot T ~ N. R E t) Yy r_171 or 2 Family Dwelling-Number of Bedrooms 7 Subdivision e aS lock it ❑ Public/Commercial - Describe Use rA ^ City of p CSM Number ❑ Village of _ ❑ State Owned Describe Use L/ ! / Ul w Lli LL~ 1,) own of III. Type of Permit: (Check only one box on line A. C plete line tf applicable) IC. A. stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) List vio Permit N tb r rind Daig Issued B. ❑ Permit Renew it Revision J Change of Plumber El Permit Transfer to New f / Before Expiratio Owner /V Y IV. e of POWTS System om onentlDevice: (Check all that apply) 4e6 ressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 it... of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: s Design Flow (gp Design Soil Applicati ate(gpdsf) Dispersal Area Require Dispersal Area Proposed f) I Svst Elevatiot V1. Tank Info Capacity in Total ti of Manufa rer Gallons Gallons Units l / ' a i o 3 New Tanks -Existmg Tank: 2 ( v ~n U u Septic or Holding Tank i T_ l Dosing Chamber I ' VII. Responsibility Stateme - 1, the undersigned, a &c responsibility for installation of the POWTS shown on the attached plans. PI be 's Name--(Print) Pl r' Signature MPMIPRS Number Bumf ess Phone Num e Plumber's Address (Street, City, Late, Zip Co z, CL C V111. Countv/De artment Use Only roved i t ed Permit Fee Date Issued f Issuing Agent Signal en Reas tat $ LX. (09itia nf0r yaUReasons for Disapproval 1. Septic tank, effluent filter and 3• ~vtld~-r Devete pr6Vida dispersal cell must be serviced / mal, twined bONA6VW -r V-S 1 i~ .i n i` If' r ti 6~ as per management plan proviu,ud by pWrl-Peer. 2. All setback requirements must be maintained t4 Weil % U VUw, f - /V4- 012 S~& n „ i 'for the system and b 4t to the County only an paper not less than 8 t _ i l l inches in sia d F.y G S N o pcr o-~ s~s~em 4b b-P 1'n SBD-6398 (R 11111) Soil Test and System PLOT PLAN aj PROJECT Oeverino Homes ADDRESS 143 Cernohous Ave Suite A New Richmond Wi 54017 ~?COUNTY ST. CROIX SE 114 SW 1/4S 28 /T 30 N/R 18 tNVENTIONAL N Ric mo d SYSTEM ELEVATION 93.0/92.9 6' below grade 6/12/15 3 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P . Same as Benchmark to 132nd Ave All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 210' Property Line Scale _ 1/4" = 10' Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6ftA2/pair of end caps 12" 5. 4' Long 34 Grade at System Elevation B.M. Pro 3 Bedroom House 50 25' 40' 5' 25' ST 25' B-'1 0% Slope 5' 100' Vents 20' 30' 2-3' X 66' cells with >3' spacing B-y 203' Property Line G1~O ~1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location Govt. Lots 1/4/'LJI/4 S YT 30 N R E (o W Property Owner's Mailing Addr Lot # Block # Subd. Name CSM# /q- 3Z-> Cep D City State Zip Code Phone Number ❑ City V' ge own Nearest Road D ( ) *l 6-New Construction Use 'dential / Number of bedrooms Code derived design flow rate J-22 GPD loo Y ❑ Replacement ❑ Public or commercial - Describe: Parent material &jy Flood Plain elevation if applicable 01 ft. General comments i ~f/'~cc ; ~C? , ! 5 G and recommendations: System Type A~~. 204 t.t/1n~ System Elevation L? ! 7 Boring # cam ~n~ ' Pit Ground surface elev. ~ ft. Depth to limiting factor /7Gin. 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 -5 - S '60 0 2 3p sw (0 CA Z Boring # Boring q ' ] Pit Ground surface elev. ft. Depth to limiting factor /y 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 0-1/2 /0,,31, Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < 150 mglL • Effluent #2 = BOD, < 30 mg/L and TSS < 30 nx;& CST Name (Please Print) S' at CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 PIP- Property Owner _ Parcel ID # Page L of Boring # ❑ Boring 71 JL~-5JI Pit Ground surface elevi_ 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 c~ 3 e9s i ❑ 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/(f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C] Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth 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 = BODs > 30 < 720 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-6730 (8.6W Property Owner Parcel ID # Page Z of Boring # ❑ Boring pit Ground surface elev L, ~ ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 'Eff#2 0-Ljs37- S Z 12- vo 1h A. , V/ L2 e ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ~Eplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Colo Gr. Sz. Sh. •Eff#1 -Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD, 130 mg/- and TSS < 30 mg1L 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. SBO.8330 (8.6=) Soil Test and System PLOT PLAN J al~3 PROJECT Oeverina Homes ADDRESS 143 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 28 /T 30 N/R 18 W WN Ric moi d COUNTY ST. CROIX SYSTEM ELEVATION 93.0/92.9 6' below grade 6/12/15 3 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE NVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark to 132nd Ave All piping shall be SDR 30/34, within 10'-~ Property Line of tank, piping shall be Schedule 40. 210' Scale = 1/4'1 = 10, Vent >6" Quick4 Standard ?4' er Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps ong 3 4" Grade at System Elevation B.M. Pro 3 Bedroom House 50 25' 40' 5' 5' ST B j Slope 5 100' Vents 20' 25E30' 2-3' X 66' cells with >3' spacing B-y 203' Pro ertLine 00 srac to 1; t I d V., 14-3 t County<`T Safety-at~d-6t7itctirtp Division ~J 201 W. Washington Ave., P.O. Box 7162 t . , ; . , ~Sanitar}• Permit Number (to be filled in by Co.) i s 1 Madison, WI 53707-7162 C~ 1,0Mh ;taffy ermit Application State Transactio Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PUWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.040)(m), Stars. ~ L Application Information - Please Print All Info ti / Property Owner's Name Parcel tl Nb" f l Y~ h 0 4? 2- 6 Property Owners Mailing Ad Properly Location .fb City, State Lot ~ 162-7- Govt. Zip Code Phone Number_ S n coo ) :S le H. Type of Building (check all that apply) Lot Family Dwelling -Number of Bedroo _ I Q Subdivision Name Blockt /7, n Public/Commercial - Describe Lise Zb k abb D, City of ; ❑ State Owned Describe Use CSM Number ❑ Village of ~T 2- wn of. S III. Type f Permit: (Check onl one box on line A. Complete line B if applicable) x A. t stem ❑ Replacement System ❑ Treatment/holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Owner IV. e of POWTS S stem/Com onent/Device: Check all that apply) ` -Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil G s ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate( si) Dispersal Area Required (sf) Disp al A Proposed "s Svstem Elevation VI. Tank Info I Capacity in Total it of manufacturer Gallons Gallons Units I New Tanks -dusting Tanks Septic or Holding Tank i Dosing Chamber I VII. Responsibility Stateme I, the undersigned, assume sponsibility for installation of the PUR'TS shown on the attached plans PIb 's Name (Print) Plumber's ' atune MP/MPRS Number Business Phone Number Plumber's Address Street, City; S te, Lip e) z (A/) S D) VI ountv/De artment Use On Approved pprove Permi`t~Fee Date sued Issuing, e Signature n Reason for Dental S { N ~Si IX. ConditiSilssX%, -asons for Disapproval 1. Septic tank, effluent Nei* and a dispersal cell must all be services 1 Maintaiinesl' (n1 J, as per management plan provided by plumber. p~ ~etn.Q t~eQ., i n t-a~t.an 2 `Ap suck ret~virements mast be 'maiMaineed: j r as per 40*AwCOd@ / ordin7nC@8. / ~/6 41 I^ d 5 rL~.. . Attach to complete plans for the system and submit to be Co ty only a paper not less than R t..^- z 11 . ches CODA., e b&VA SBD-6398 (FL 11/11) PLOT PLAN PROJECT Oeverino Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.5 3' below grade DATE 4/12/15 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 1131 # of chambers 56 BENCHMARK V.R.P. Top of 1/4 steel pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark to 132nd Ave Ak- All piping shall be SDR 30/34, within 10' 210' of tank, piping shall be Schedule 40. g M * 12'99' Scale = 1/4" = 10' 6% Slope ents 100' 2-3' X 114' cells with >3' spacing 101' 93 B-3 25' 20' ST 20' 110' B-1 Pro 3 Bedroom House Please note: soil test is almost completely worthless and is only suitable for permit purposes. Borings will need to be dug deeper and possibly and new location will 257' need to be done. Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area of end caps 'P y 4' Long 1 ;~_5.MA2/pair 34" Grade at System Elevation 203' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/13/15 Owner: Oevering Homes Location: SE1/4 SW1/4 S28 T30 N,R18 1139 132nd Ave Richmond Manuals Used: In-ground absorbtion system (version 2.0) Page# 1 Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and C tingency Plan 7. Filter Specifications et Signature License nu ~ #226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 97.0/96.5 3' below grade DATE 4/12/15 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA 1 131 # of chambers 56 BENCHMARK V.R.P. Top of 1/4" steel pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark to 132nd Ave Ak- All piping shall be SDR 30/34, within 10' 210' of tank, piping shall be Schedule 40. B M * 12'99, Scale = 1/4" = 10' -2 6% Slope ents 100' 2-3' X 114' cells with >3' spacing 101' 93' B-3 25' ST 20' 20' 110' B-1 Pro 3 Bedroom House Please note: soil test is almost completely worthless and is only suitable for permit purposes. Borings will need to be dug deeper and possibly and new location will need to be done. 257' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" 3 4" Grade at System Elevation 203' Property Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 100.0' Vent A CI Vent 3' 4" 3' .A~~30/34 Septic Tank 5' Long 1 99 51 5' Long 1 19 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 114' ' Cells Same on other end Observation tubeNent At end of cell A B 28 chambers per cell System elevations: A-97.0' B 96.5' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer (%e Mailing Address - Property Address _ 4___ (Verification re aired from - --------&AL q m PI ruing Zoning epanme r new construction. City/State Parcel Identification Number ®v2 6 _ LEGAL DESCRIPTION Property Locatio,4 Y,1,5- / , SCC. T30 N R/-~w, Town of Subdivision; _ Lot # T L7 Certified Survey Map # - - - Volume Page Warranty Deed # Volume ~ Page # Spec house yes no Lot lines identifiabl ye, no - - SYSTEM MAINTENANCE AN 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 What you put into pumper. 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' necessa less than l /3 full of sludge. ry}, the septic tank is 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 Re State of Certification stating that your septic system has been maintained must be completed and returned o the Stec Croix County Plannin Ailing Department within 30 days of the three year expiration date. I/we certify that all statements on this f' n are true to the best of my/our knowledge. I/we andare the owner property described above, by virtue of a Warr deed recorded in Register of Deeds Office, (s) of the Number of bedrooms iGNAT ~ OF APPLICANT(S~ DATE *'"*Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if- reference is made in the warranty deed, (REV. 08/05) POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page Of FILE INFORMATION SYSTEM SPECIFICATIONS Owner (j (,1 Tank Manufacturer: ❑ NA Permit # eptic ❑ Dose ❑ Holding Volume:/6t7b (gal) DESIGN PARAMETERS Tank Manufacturer: NA Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: NA Vertical Distance Tank Bottom(s) to Service Pad:,, (ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: /17 - (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): J V (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (galidayKe) Effluent Filter Manufacturer: ~ ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODS) s220 mg/L ❑ NA Total Suspended Solids (TSS) s150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - ` Manufacturer. El Mechanical Aeration ❑ Peat Filter ( TSS) ) > 15 >150 0 mg/L mg/L / `"A AA (TSS ❑ Disinfection ❑ Weiland Pretreated Effluent Monthly average ❑ Sand/Gravel Finer ❑ Other. (BODO s30 mg/L Soil Absorption System (TSS) 530 Fecal Coliform (geometric mean) 5,10`mglL A Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ Aft-Grade ❑ Mound Maximum Effluent Particle Size in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: A Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) n combined sludge and scum equals one-third of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA th) (s) (Maximum 3 years) ❑ NA ry: J ❑~non ears Inspect dispersal cell(s) At least once eve Clean effluent filter At least once every: month(s) NA ear(s) Inspect pump controls & alarm At least once every: ❑ month(s) NA pump, ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ; NA ❑ year(s) Other: At least once every: ❑ month(s) NA ❑ year(s) Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifica ons: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02105) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be=discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to -the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette"butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sani4ry napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 repla ent system: =suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. T e`replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need fora new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Name Name r Phone Phone 4,17 SEPTAGE SERVICING OPERATOR MPER LOCAL REGULATORY AUTHORITY Name_ Name Phone - Phone JJ W U This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ,~~==TTTIII T INSTRUCTIONS AN- b'' L FILTER CARTRIDGE '2 Installation ST it is onto the end of the outlet pipe to ensure filter case EP 1 Dry fit the into he f centered under the access opening. If not, then either insert more pipe 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 length of 3/4-inch pipe needed to brace he If side support e hod wall if tutilizing he optional supplemental side support. 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 Yal y Al 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 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. + 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge 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 II outlet pipe, Y Pull up on the filter handle to dislodge the firmly , cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. ry.~ 6. If a VRS switch connected to an alarm is present, the switch* 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 a, only, making sure all septage material is rinsed back into the tank. , 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 91 Insert the filter cartridge back into the case, pressing down until`. w+f , the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. BEAR ONSITE"" FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY BEAR ONSITE". Filter Case -Llfeti+r,e Limned war-any _ - P JI :11'. ..I; E~r wwwbe~ ewM 877- F :M f6-534583 . a L. B. Q 955.0 ` 952.2 a w 89.25'18. E 104.81 N 89'25`18'" E 392.28' ~321f' N1f975 t8 260 .1 ' •4.3:582`r'~N 89'2518" E 196.57 ~4Q 232.39 ; t3RAlNAGE 7,y 75'L, r4" X 5a' EASEMENT 18 '2.14 959.8 H. W E. = S2725'06' 9.53. Q R ~ 27.23' . WE.=9530 95T'arw 7J81' o z ~ W m 1.83 41 79-9,816 2.97 acres 129,219 sq. ft. µ 2.76 acres L. B. 0. 955.0 120,151 sq. ft. L.B. O~ 955. 0 e 6~ a I~ { 200.1 9695 50, Ea"Ment Q for Pmk 0 Gross r Pre~serrgfior~ -0 i~ 1 0 0 0 968.5 / 96.7 9 969 6 rn 203.62' 202.81' S89"49'16"W 406.43' (R=N89'49'11 IF 406.41 1 CEP TIFIEQ ~-SUR VE)' MAP ~ LOF LOF 2 VOL 201 PG 50.68 i DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 8 2 4 0 9 9 0 WARRANTY DEED Tx: 4197210 998137 i THIS DEED, made between Richmond Acres, LLC, a Wisconsin limited BETH PABST liability company ("Grantor" whether one or more) conveys and warrants to REGISTER OF DEEDS Oevering Homes LLC, a Wisconsin limited liability company ("Grantee", ST. CROIX CO., WI whether one or more), the following described real estate in ST CROIX County, 07/03/2014 09.57 AM State of Wisconsin: EXEMPT#• NA Parcel 1: REC FEE: 30.00 TRANS FEE: 825.00 Lots 7, 11, 17, 18, 25, 26, 27, 31, 34, 37 40 41, 44, 45 and 49, Plat of PAGES: 2 Richmo>I d Air sin the Town of Richmond, St. Croix County, Wisconsin. RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: see attached This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2014 real estate taxes. Dated this 27th day of June, 2014. Richmond Acres, C, a Wisconsin limited liability company By: Je a illiams, managing member AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20_ ss. COUNTY OF ST CROIX TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this 27th day of June, 2014, the above (If not, named Richmond Acres, LLC, a Wisconsin limited liability authorized by § 706.06, Wis. Stats.) company, by Jeffrey S. Williams, managing member to me known to be the person(s) who executed the foregoing instrument and acknowledge 'the, same. THIS INSTRUMENT WAS DRAFTED BY Robert L. Loberg / Loberg Law Office * v 1 v w • Notary Public St.'Croix County, Wis. L yr~~ls 1417332 / alm 0 j~ W s My Commission is permanent. (If not, 's fe'e~Cp4F on?datt (Signatures may be authenticated or acknowledged. Both are not necessary.) C2 L Y, V *Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED Form No. 1-2003 St. Croix County 998137 Page 1 of 2 i Legal Description: Lots 7, 11, 17, 18, 25, 26, 27, 31, 34, 37, 40, 41, 44, 45 and 49, Plat of Richmond Acres in the Town of Richmond, St. Croix County, Wisconsin. Tax Id Numbers: 026-1294-07-000 026-1294-11-000 026-1294-17-000 026-1294-18-000 026-1294-25-000 026-1294-26-000 026-1294-27-000 026-1294-31-000 026-1294-34-000 026-1294-37-000 026-1294-40-000 026-1294-41-000 026-1294-44-000 026-1294-45-000 026-1294-49-000 St. Croix County 998137 Page 2 of 2 g F;~o= ':l~i a o^ `4~~ 35txa3~~ E z ~ Y M 2 U a o~ ~d = m O T m v ~ ~ ~ 8 ~„fry ~ ~ ¢ 51 1; > -j w ~ J dw oQ °m¢ Nw W ~Q 1 ~ ~ Q T~~~ 't b ~ I (~7`-'y~ i t hill lll.. s L f . ~ ~I I . ~ i I Lii W Hg ~ M H I 6 Mg e ~ I I FAT I. R c~~. o Mq H1 I'm E W N 's d' a N Ims him !Uhl myi TP > s r ~ w s .Ni z d~ n u[ J J w~ yz5 ~W ,~E a s N z w t i 'R S' Ell I I I I I I n t ws: NN I.r '4 e i iA tg k p ~ I i ~Y _ ~ I I I I i M1 F g "man- I .3m, rnM aeaw g E 8 8 8 ~ - n ~ E b E8 N Z X 2 N a N ~Eg~ ~ z Q XXXH t a$ 9pt ~ N ~W-~l w <x ? i J J biz i~ z~ ai n +x J Q Q W ~ 30 q W W 3 ~a ~ UZ CD - - - - - ----------------------1 9 I I I y _ mmmau anovuexsz i n 1 I - ER 1 - 6 31 I I I 1 I I I -F ~ I I 11 I aa+e~s3nnwuoov+~ I I $ I I I I I 1' H__-_ e j1 M +n a - ` it i~ ® ®L 1 - I ~ ° ' x I I I - a 2 I I I 1 g 1 I I I ~ p ~ I I I ~ Y I I +.v+ +.x - I 1 I I ~ I I r I r S s I ~ I I I 1 1 1 1 I 1 , ~ F I I cm s3nnwuwv+~ rr~~~ s 'w I I A 1 1 °i ~ I vin v II I p - 1 I >I I 1 1 I I 1 1 I 11 I I I I I i 1 I i ~ I I I I I Ifl, - v„ann „rma3arus a~ 05 j (ss 8 B ~o r s Property Owner Gera Ids T ; Sm A ` Parcel ID # Page of _ F,_31 Boring # ❑ Boring p pit Ground surface elev. qo -L ft. Depth to limiting factor 75 -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 1 5 F b1'°~~ w Yid -7 _S Y1 4A. 'L ry)-f C) I V L4 a~ 5Y,R `l 5L 1 K m-'r c~v La L; L4 15,E Y!/ S ML •t Boring # ❑ Boring ® Pit Ground surface elev. _ 03'4 ft. Depth to limiting factor 1 o~y_ 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 'Eff#2 0 -cl I oy R3la 4 F51 W_ tv~ Fr 4.w a~ 11.0 Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. F-1 - 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 Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (RAW Wisconsin Department of Commerce -yam VALUATION REPORT Page of Division of Safety and Buildings 4y in with Comm 85, Wis. Adm. Code , County S-t~ C a ( --tie Attach complete site plan on paper not less than 8 1/2 x 1 ~/~I include, but not limited to: vertical and horizontal referent int ( ECJI Parcel I.D. percent slope, scale or dimensions, north arrow, and locat n and distan r1~"! ce to nearest road. 6 Zoo' 2 ` V, Please print all informati n. 7Q~5 ewe Date 0 Personal information you provide maybe used for secondary pur ses (Pnvacy aw, s. 15. 1) (m)). ~0 6 PropertyOwner tion ST. CRC I~Cr~~ j S aq T30 N R E (or ZONI CB;6ZFt,F~t6}E f Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I// too 90 h e. NW 140 Plat of ~c m crc City State Zip Code Phone Number ❑ City ❑ Village (9 Town Nearest Road R~~ R N 30 ( 8 le I K1CjNM 13';)%A 0L, F)K M New Construction Use: T~ Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public orcommercial - Describe: Parent material -Oud- 1 .1,t'~~_/ -r i W. _ Flood Plain elevation if applicable ft. a General comments 5 v SS g v -7 ) Fv r L e --L1.. s A-< and recommendations: , T-3 t g 7 t. l .1 S ; t~ 2e' 9 7. 1;11: 5 Boring # O pit Boring 4~► Ground surface elev. ft. Depth to limiting factor 1 a0 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 a K M4 a D Y % Ct,J 1 Ep ® Boring # ❑ Boring b R Pit Ground surface elev. _ 7 L ft. Depth to limiting factor 7.5 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 _ru 10YR /a L L'< m r aL'i (a a p-) `7,5Y LF/ (m5bk 14- I ►I Effluent #1 = BOD > 30:_< 220 mg/L and TSS >30 5150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS < 30 mg/L -QST Name (Please P Signature CST Number 64-A J'7 a a. Y-k a d a Date Evaluation Conducted Telephone Number 09 w:t -os -7 IS -d $ 35pp ~~~ad r Property Owner Gera I k V ` Sn' A ` Parcel ID # Page C~_ of F,-31 Boring # ❑ Boring t Pit Ground surface elev. 9f 1 ft. Depth to limiting factors 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 10 'K, v 4 17 I tr L},E 5L -r rY C it .rte 'u`~~~. i.. - ~•'),6'f J ""1 f~ Boring # ❑ Boring ® Pit Ground surface elev. _ D mn ft. Depth to limiting factor c_ 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 CL '-o C) P-"f 14 -7 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil A lication 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 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6=) v - - - 39 S Eyy J S ys/`~i . ast, 3av, Pu is - N -7 yl V4 Cl+ G S c"a ► '7 Lt V To C* /l1 (D U "1 v N E co{ J\--r-f- p - a o °fy f a ~,oa oo' _ h ~a 99-6 103-85 "Lo+ of u",~1dE 50. lot line..