HomeMy WebLinkAbout026-1048-50-100
Safety a n Uepdinj Di of Comrrer-_e PRIVATE SEWAGE SYSTEM """t' St. Croix
Safely and Budding Division
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) 582084
State Plan D Vc ~c~~n~
°ersonal information you p•ovide Tay be used for sexndary purooses [Privacy Law, s 15 D4 it )(mi] Z ' ~~j
Pe•md Holder's Name: City Village Townsnip Parce, Tax No-
Tammec LLC TOWN OF RICHMOND 026-1048-50-100
CST Bbl Elev Insp BM F ev 13M Cescrption SectionfTownJRange/Mao No
/OCR 13 ~ 5 ( 16.30.18.2438
TANK INFORMATION ELEVATION DATA
TYPE IVIANJFACTURER w s CAPACITY S-tkTION RS HI FS ELEV.
Septic r ft /5 Benchmark j~
D aFG Alt. BM 01"2 L
+ Ga t.. Z
Aeration Bldg. ewe
I lolding SVHt Inlet
9,3 9a-98
TANK SETBACK INFORMATION SVHt Outlet ` 9~
TANK TO OPIL VVELL BLDG. lent t Air Intake ROAD Dt Inlet \ `
Septic ~ J I ~ `,7, L ~G /~O/ Dt Bottom
~f 'T I ~ ~
Dosing HeaderrMar.
Aerati - Dist. Pipe
!b• qa. 1
Holding Bot. System
/d` 9 ~7~ 3
Final Grade
PUMP/SIPHON INFORMATION 3 S `1(. - 7$
h4anufachuer Demand St Cover /r ' 7 (o
GPM fr'
Model tuber _
1 DH Litt Friction Loss System H TDH Ft
Forcemain Length Dia. Dist ec well
SOIL ABSORPTIO SYSTEM
BED/TRENCH V'Jldth Lergtn No. CF Trenches PIT DIMENSIONS No Of Pits Inside Di< _ g Depth
DIMENSIONS 3 '~O Z i r~~ * ~
SETBACK SYSTEM TO P!L BLG3 WELL LAKEISTREAh4 LEACHING Manufa er:
INFORMATION CHAMBER OR Z ~/d
Type Of System: 4
a - r y [ -7Z_ UNIT Mode! Numb
G., r L A r►
DISTRIBUTION SYSTEM -7 7 ~ / ~
HeadenMan'rfold + I C strtAor x Hole Size x Hole Spacirg Dent to P.i Intake
Pipc{sj
Lenglh_( Gia Length Dia -Spacing JZ a~0
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a S
Depth Over Depth Over xx Depth xx Seeded Sodded J xx Mulched
BedrTrench Center q Berf,'T ench Edges Topsoil Yes No es No
. T
COMMENTS: (Include code discrepencies, persons present, e.c.) Inspection #1: / Inspection #2:
Location: 1180 CTY RD G ri 1 / O~~/ /~~Q,~ ~.O a_ 5 a V _
1.j Alt BM Descript on = r 1~
2.) Bldg sewer length = qq C1tD3 4
- amount of cover = (O f ^ n ~~O_~ ~,.eo~
Plan revision Required? Yes ~o Q 1 / 17
Use other side for additional information ✓ I 1 V l0
S6D 671D (R 3197) Date Insepctor' rgnature Cert. No.
County 1 ,
KFMICEI
`f J Van(J Buildings Division ~T
•y.
291 W. Washington At~71 O. Box 7162 San;tary Pernut Number (it) be tilled in by Co.)
f S P S , YY-I G A RR L J? Q Wdison, WI ~J -
ST. C OIX COUNTY `S S Z
, f
.
-0041 Ils,
State Transaction Number
Sanitary Permit pplica ion 2~8~i6y
ht accordance with SPS 353 2I (21. %k :s. Adim. Code, supmission of this form to tae appropriate governn c l unit
s icyuin•d prior to ontatnmg a sanitar; pcn:it. Note: Appli, anion Grnm for state-owncd PO TS arc submittL to Pi-wect Address 0i dittcrent than mailing address)
the Depanmcn- of Safcty and Professional Scrvies. Personal inforration you provide mr,y be used 1017 scc•ondary
r. oscs in a.cnnlaucv ssith the Privacy Law, s. 15.04(1 )till), Stats.
1. Application Information - Please Print :_111 Information IJIJ l- Itt;/1 CT
Pror.rt hvn is Narte Parcel 4
02l
Property ~Ucvncr's Mailing Address / Propcm• Location Z y j~
<,12-J Govt. Lot
t'it Srttr /J~ / 7ip Code Phonc Number if,14' Section /41~
one)
-.$-l f7I 7 ~II Ircle F. or W
Il. Type of Building (check all that apply') Lot >s T -317 N; R A -
or 2 Family Dwelling - Number of Prdromrs 1- Subdivision Name
Block
ublicrCnnunciciA Describe Use 6`_ "GC
Cray of
❑ State Owncd - Describe (Ise C'S% umbj ❑ Village of
vs1f'z~ _ Town of ~iC~G/f~s
Z ;s1- e,1i c,.J zt~ e e.JS I
I11. Type of Permit: (Ghee ox on l ine A. Cumplete line B if applicable) ~av.C
ew System Replacement System ❑ lrra[n:ent !holding Tank Replacement Only- ❑ Oth,:r Modification to Existing System (explain)
B• I I Pcnnit Rcrw%%al cnn;t Revision I-~ Change of PlumSer -Pcnnit Transfer to New List Previous Permit Number and Date Issued
Before Fxpiralion
I i I Ov.ner n
Z
V. Tv e of POWI'S System!Component,Deviev: (Check all that apply) 4e~~y~S
Non-Pressurized In-Ground ❑ Picssurizrd In-Ground ❑ At-Grade I I Mound > 24 in of suitable sot! ❑ Mound = 34 in. of suitable soil
❑ holding Tank ❑ Other Dispersal Corfponcnt (explain)_ ❑ Pretreatment Device (explain)
V. Dis ersal,Treatiwiji Area Information:
Dcsipn Flo%. (:pd} Design Soil Apa:tcation Rat gPdst) Dispersal Ara R:qut d (.S t) Dispersal Area Propose {s0 System Elevaliun
VI. Tank Info Capacity in I Total r+ of Manufacturer
L Gallon., Gallons Gnits L - u
New Tanks ENk iu~ Lank,
n L C7 G
V)
ticF:ic or lIolding Tark
llo,ing Chamber - -
VII. RcsponsibilitA Statement- I, the undersigned, assume responsibility for installation ofthe POWTS shoisn on the attached plans.
Plumb Name (Print) Plumhci's Signawre MP MPRS NIIIIII)CI FiLIATtess Phone Nu:nbcr
I'lunmer's Address (Street, Cirv, State, 7ip Code) - -
VIII. Countv!De artment Use 0111
r\pproyrd • Permit Fee Dat- lssu I issuin, r.t Signa[ur5 Z
cn Reason '.i?r De that
,q to.
It. Condit&3ffitMPAarAUfteasons for Disa rova
1. Septic tark. eTcrit fllte, end pP 31 rte 14, { 47
oisper- i cell mast al' be set':ic~s ! nl;~drtaEegr~
as per management plan provided by plumber. w f AIL
2. AV saftj is regwthelnents must be maintz ined lr
cis per apFiit:able code I crdinanr s.
Anach to cornploe plans for the vrstem and submit to the Count only on paper not le%% than S 12 x I I inches in iir
S B D 63 )8 i R. I I' I t
LEGAL DESCRIPTION SCALE : 1" = 40FT.
NE 1/4SE1/4S16T30NR18W
APPROXIMENTLY 416 ACRES
WEST PROPERTY LINE W
300 FT TO THE WEST
PROPCSED
ELEVATIO F BUILDI G OFFICE
AT CEMENT BUILDING
SW CORNER 5.10
I
I E: SEPTIC COVERS
OCK DOWN.
WIESER
POLY LOCK ' f 000GAL
VENT PIPE- OBERSERVATION PIPE
'C 525 FILTER 0 SEPTIC TANK
a 1
OSXf VATIO P PE
!i ~ " " X11^
B 2 SYSTEM ELEVATION 89-6
O
NOTE: STAY A MI N 5FT OFF
2 THE PROERTY LINE
B-3 j B-1
O 94.0 -e>or3,4-rvry E 0 98.3 snaz-
1013.0 2 PROPERTY LINE.
DIVISION OF INDUSTRY SERVICES
3824 CREEKSIDE LN
r~ HOLMEN WI 54636 9466
.tip Yt
Contact Through Relay
http:!lcsps.wi.goviprogramslindustry-services
vnvw vvisconsin.gov
~IQp _ cb~
Scott Walker, Governor
Dave Ross, Secretary
April 18, ?016
CUST ID No. 225410 ATT 4 P097SInspector
PAUL R KOEHLER ZONING OFFICE
COTTNTRYSIDE PLUMBING & HEATING INC ST CROI X COUNTY SPLA
321 W7SCONSLN DR 1101 CARNIICILAEL RD
NL%V RICILMOND WI 54017 HUDSON NVI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL, EXPIRES: 04/18!2018
SITE: Identification Numbers
Monarch Paving Transaction ID No. 2689164
1190 County H~ny G Site ID No. 822633
Toum of Richmond Please refer to both identification numbers,
St Croix Countv above. in all correspondence with the a enc .
NE 114, SE 1/4, S16, T3 ON, R18W
FOR:
Description: Commercial Non-pressurized In-ground POWTS /8.4% slope
Object Type: POWTS Component Manual Regulated Object ID No,: 1594364
Maintenance required- 467 GPD Flow rate; 120 in Soil minimum depth to limiting factor from origin:.l Lrac~;
System(s): In-ground POWTS Component - Ver. 2,0, SBD-10705-P (N-0 P01, R. 10/12); Effluent Filt:r
The submittal described above has been reviewed for conformance with applicable Wisconsin Administra.i, Co,;:
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be construc_cd
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
slats.
'T'he following conditions shall be met during construction or installation and prior to occupancy or use: CONDITlO
APPRO
Reminders DEPT OF SA
• A sanitary permit must be obtained from the county where this project is located in accordance with the PROFESSIONA
requirements of Sec. 145.19, Wis. Stats. aIvISION OF INDU
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be m e with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Nfaintcnance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be prov'
per SPS 384 product approval conditions.
• All POW"1 S component piping material shall be SPS 384, Wis. Adm. Code compliant.
• 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.
NOTE: This system has been approved for disposal of only domestic strength wastewater. The WI. DNR must
be contacted before any comingled or high-strength wastewater can be discharged to this system.
PAl_"1. R KONILLR Pa c 2 41 8, 2016
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual andlor owner's manual for the POWTS described in this approval.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure. or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation; operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
erard !VI Swun When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608),'89-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swimt'A%wisconsin.gov WiSMART code: 7631
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484. Monday - 1'riday 8:00 am To 4:30 pi i
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Seim ices (fonuci ly
Safety & Buildings) witl be modified. Code references with prefixes starting with "Comm" have been replaced with
"SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Satety & 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.
7
P.%UL R 11"OFT FF. Pa<c 2 4,'18'2',) lh
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter inciuding instructions rela-ing
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and,lor owner's manual for the POWTS described in this approval.
• The oNvner of a PO WTS shall he responsible for ensuring that the operation and maintenance of the PCM7S
occurs in accordance with this chapter and the approved management plar. under s. SPS 383.540
• in the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the count}; for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utiti
in the PO) TS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions sh<
conditions arise malting them necessary fo: code compliance. As per state state 101.12(2), nothing in this revic,.,.
shall relieve the designer of the responsibility for designin; a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the teiephone number listed below, or at the adds
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 POWT'S.
Sincerely, / Fee Required S 250.00
r This Amount Will Be Invoiced.
erard MI Sw.un Whcn You Receive That Invoice,
POWTS Plan Reviewer, Division of Industrv Services Please Include a Cop}, With Your
(608)789-7892, Mon - Fri. 7:15 am - 4:00 pm Payment Submittal.
jeM,.swim(u;wiscomsm.gov WiSMART code: 7633
cc: T6win A Taylor, Wastewater Specialist, (%15) 634-3484 , Monday - Friday 8:00 am To 4:30 pm
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly
Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with
"SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Depanment of Safety & Professional Services. Additionally, all IS (fonuerh- S&B) codes have been renumbered
and addressed in a "300" series. For ftmure reference, the Wisconsin Commercial Building Code will 'x addressed
by SPS Chanters 360-366.
1
r
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGF
^,R 2 ( 2011;
Project Name MONARCH PAVI NG
Owner's Name MONARCH PAVING
Owner's Address 1190 CTH G, NEW RICHMOND, WI 54017
Legal Description NE 1/4 S 1/ 4 5] 6 T 30 N R 1 S W
Township RTCHMONE
County ST. CR.OI ;
Subdivision Name N/A
Lot Number N/A
Parcel ID Number 026-1048-50-100
Page1 TNDEX AND TTTLE PAGE 10 CLRTIFTED SURVEY MAP
Paget COVER LETTER _ PAGE 11POWTS OWN MANUAL MGMT PG
Page3 PLOT PLAN PAGE 12POWTS OWN MANUAL. MGMT PG
Page 4 SYSTEM SIZING & CROSS SECTION
Page 5 FTT TFR SPFr)ALLY
Page 6 SOIL TEST PAGE. 1 OF 3 /ED
Page 7 SOIL TEST 'PACE 2 OF I ETY AND
Page 8 SOIL TEST PAGE 3 OF 3 SERVICES
Page 9 RICHMOND PLAT -'RY SERVICES
Attachments: Soil Test & House Plans /
Designer/Plumber: PAUL KOEHLER License Number 225410
Date: 2/23/16 Phone Number 715-246-2660
Signature
PAGE 1
This system is design for Monarch Paving,
Location is 1190 county road G New Richmond Wi. Ne 1/4se1/4s16t30nr18w.
The system is sized for a commercial office building with 22 employees. And 1 floor drain. So sizing is
based on an estimated flow of 311 gpd. Design flow will be 311x1.5=466.5 or 467. Proposed drain field
material will be ez flows, by infiltrator with an eisa rating of 50. Soil application rate of.7 467/.7= 667.14
or 668. 668/50= 13.36 = 14. 14X10 = 140 FT OF EZ FLOWS OR TWO 70 FT TRENCHES. THE SYSTEM
DESIGN IS BASED ON VERSION TWO OF THE POWTS DESIGN MANUAL. THE FLOOR DRAIN IS T`,"JO ul. IN
THE IvITCHANICAL ROO%1 AND TO MEET PLUPv1BING I I'L PLU1',1RING CODE, SPS, ;~.'t~ LI 3
PAGE 2
LEGAL DESCRIPTION SCALE I"= 40FT.
NE 1/4SE1/4S16T30NR18W
APPROXIMENTLY 416 ACRES
A
44
' 1..`
WEST PROPERTY LINE
300 FT TO THE WEST
PROPOSED
ELEVATION OF BUILDING OFFICE
AT CEMENT BUILDING
SW CORNER 95.10
NOTICE: SEPTIC COVERS
TO BE LOCK DOWN.
WIESER
POLY LOCK "4 1,000GAL
VENT PIPE- OBERSERVATION PIPE 525 FILTER o
SEPTIC TANK
h OBSERVATION PIPE
B2 SYSTEM ELEVATION 89.6
0
c
NOTE- STAY A MIN 5FT OFF
THE PROERTY LINE
B-3 B-1
O
094.0 8Ml--0P0=34"PVCPiPE 98.3 QM2-
Q PROPERTY LINE
SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-
-of-Project Name: BRUSHY MOUND PARTNERS
2 No. of Cells 7 Per Cell
3 ft Cell Width 14 TotaI No of 14
140 ft Cell Length 50 sq it EISA Per Cell
3 ft Cell Spacing 700 sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 100' 50.0
Gravelless Leaching Unit Manufacturer: INFILTRATOR
Gravelless Leaching Unit Model: EZ1203H-10FT
Typical Cross Section
Finished Grade 95 ft
:-Observation Pipe with
approved cap or vent
MIN 12" ABOVE GROUND
• y,~- Soil Backfill
Geotextile Fabric
v
5.6 n Infilt tive Surface
12 in I( l / r
miting Factor
36 in Slotted and Anchored Vent[
Observation Pipe with Cap
usage s..:::...-::....................... r.....■ .
PlumberlDesignerSignature:
i
License MP 225410 Date: 4/12/16
k .
J
lnnoval:cnsin, re:>:. n.;;r`'1 _ n`z;; 7.? , I: PL-525 Effluent Filter
- & {Haste:vatcr °:c~uas p UMsion of Fotrlek Inc.
" -
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an autoinatic shut-off bail
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tail{.
Features: 1/16" Filtration Slots J
st _aa
r ~ filann Switch
• Rated for 10,000 GPD (gallons per day). (optional)
• 525 linear feet of 1/16" filtration. Accepts 1" PVC
• Accepts 4" and 6" SCHD 40 pipe. Extension Handle
• Built iti gas deflectur. ! x '
• Automatic shut-off ball when filter is removed. !E` Ley'
1yf s r
Rated for
• Alartn accessibility, , = r r, TSi` •y 10,000 GPD
• Accepts PVC extension liattdle.
PL-525 Installation: ,y z- c`^ y'
525 Linear Ft.
Ideal for residential and commercial waste flows up t~ , of 1116"
10,000 gallons per day (GPD). Filtration 510t,
1. Locate the outlet of the septic tank. ,
2. Remove the tank cover and pump tank if necessary.
Accepts 4" & 6 -
3. Glue the filter housing to the 4" or 6" outlet pipe. If SCUD 40 pipe
the filter is not centered under the arcess opening use a 1 r
Polylok Extend & Lok or piece of pipe to center filter.`
4. Insert the PL-525 filter into its housing. = -
Certif3 ,0 to
5. Replace and secure the septic tank cover. i NSF(ANSt Standard 46
PL-525 Maintenance: '
.+Y;7
The PL-525 Effluent Filters will operate efficiently for
1
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter 1.-. Gas reflector
needs servicing. Servicing should be done by a certified f r
septic tank pumper or installer. r automatic
Shut-Off Ball
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.,
4. Pull PL-525 cartridge out of the housing.
. Hose off filter over the septic tank. Make sure ally`
5
solids fall back into septic tank.} k _
6. Insert the filter cartridge back into the housing making
Uutduur Su:artl;i:ter:ry Atarrn ttYe.=d 3 L.~[:"'
sure the filter is properly aligned and completely inx rted. Po,yick, Zabel & Best filters accept Easily installs
7. Replace and secure septic tank cover. theSmartFilter% switch-and alarm. into existing tanks.
Polylok; Inc. 3 Fairfield Blvd. Wallingford, Ci' 06492 Toll Free: 877.765.9565 Fax: 203.284.85111 .www.polylok.coM
PAGE 5
POWTS R'S MANUAL & MANAGEMENT PLAf4
FILE INFORMATION SYSTEPA SPECIFICATIONS
Li NA
Owner i10AIARCH PAVING Tank Manufaturer: WIESER
Permit # Septic n Dose ❑ Holding Volume: {qsl;
Tank Manufacturer:
DESIGN PARAMETERS r al'
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume:
NA Vertical Distance Tank Bottom(s) to Service Pad: (t'
Number of Public Facility Units: ZL EMPLOYEES ❑
f
aUda Horizontal Distance Tank(s) to Service Pad;
Estimated (average) Flow 311 (g l)
Specific ser+icing mechanics must be provided if vertical is >15 feet or
Desion (peak) Flow = (estimated x 1.5): 467 (gaVday) if horizontal is >150 feet. Specific Instructions to be provided on back.
In Situ Soil Application Rate: (g" al/daYife) Effluent Filter Manufacturer: POLYI,OK n NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model- ; 7 S
Fats, Oil & Grease (FOG) d30 mg/L Pump Manufacturer: NA
Biochemical Oxygen Demand (BODs) 420 mg1L Ld NA Pump Model:
Total Suspended Solids (TSS) s150 mq,L
High Strength InfluentlFffluent Monthly average Pretreatment Unit
(FOG}. >30 mg;L Manufacturer: [31 NA
(RODS) >220 mg1L NA ❑ Mechanical Aeration ❑ Pea' Filter
(TSS) >'S0 mg L ❑ Disinfection ❑ Wetland
pretreated Effluent Monthly average ❑ SandlGravel Filter ❑ Other:
(BOD5) -_-30 mcpL Soil Absorption System
(TSS) <_30 rncy'L NA In-Ground (gravity) [:1 In-Ground (pressure) ❑ NA
Fecal Colifcrm (geometric mean) <_10` H At-Grade ❑ Mound
❑
Maximum Effluent Particle Sizen in dia. NA ❑ Drip-Line Other:
❑ N.4
Other: ❑ NA Other:
MAINTENANCE SCHEDULE
Service Event Service Frequency
When combined sludge and scum equals one-third Qi) of tank volume
Pump out contents of tank(s) ❑ When the high water alarm is activated
C3 m~u~(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: 3 g] year(s)
❑ n,onrh(s) (Maximum 3 years) El NA
Inspect dispersal cell(s) At least once every: 3 year(sj
- L3 month(s) ❑ NA
Clean effluent filter At least once every: j I ❑ year(s)
❑ month(s) ~ NA
Inspect pump, pump controls & alarm At least once every: p year(s) -
- ❑ month(s) ® NA
Mush laterals and pressure test At least once every: ❑ year(s)
month(s) ❑ NA
Other: At least once every: ❑ ❑ year(s)
❑ NA
Other: ,
MAINTENANCE INSTRUCTIONS of the following licenses or certifications:
Inspections of tanks and soil absorption systems shall be made by an individual carrying one
Master Plumber, Master Plumber Restricted Sewer, POVVTS 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 pending of effluent on the ground surface. The sail ing absorption sbe
surface may ndicateoa filing aacondit on and rrequirreesnthe mmediate
por d ng ofteffluto check the efflunt er,t on the ground levels in the
on the ground surface.
notification of the local regulatory authority. more of the
enti 113
tank When the combined accumulation of sludge and scum in anytreatment lank equals third (3 ofrin accordance w tholume, the
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed chapter NR ,
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 regulator; authority within 30 days of completion of any service event. GMW-005 (02105)
PAGE 11
of
Page -
START UP AND OPERATION ucts. For new construction, prier to use of the POVdTS check treatment tank(s) for the present°Q psystem.prlfdhigh concentraton~arc
chemicals or sediment that may impede the treatment process arid/or damage the soil absor t
detected have the contents of the tank(s) removed by a Septge Servicing Operator (purnper) prior to use. res
under
power
thesc~ Pum p tanks may fill above normal eater levels will be discharged to the soil absorption syst nS in otnenlarge dose causing at
conditions is not recommended, as the excess s wastewater
overload that may result in the backup or surface discharge of effluent and damage to the system.
power to avoid this situa athe pump or contct ahave ter
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring or f'OWTS 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 vehicle over tanks or the soil absorption system. Do riot 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. ce and
condoms, atoutton swabls,rdg the life of egreasers tdental floss`
treatm Reduction or elimination n of the system: a ids, antihitcste baby rwipe, cigarette butts, the
tanks and soil absorption sasinine, ceases, herbicides, meat
diapers, disinfectants, fats, foundation drain (srimp pump) discharge, fruit and vegetable peelings, g 9
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water suftener 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.
e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
o 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:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption 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 will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems roust comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not. available due to setback andlor 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. fai
POWTS
ure of
and ❑ The site has not been evaluated
no replaceent,are a slavail ble a hold ng tank hmay behin talled evaluation must be performed to locate cate a
uiable replacement p' barea replacement
last resort to replace the failed POW] S.
❑ 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 COUNTRYSIDE PLUMBING 5 HEATING, INC Name PAUL KOEHLER
Phone 115-246-2660 Phone 715-246-2660
LOCAL REGULATORY AUTHORITY
SEPTAGE SERVICING OPERATOR (PUMPER)
Name DARRELS SEPTIC SERVICE Name ST. CROIY COUNTY ZONING
Phone i 15-386--4680
Phone 715-425-1075
This document was dratted by the staffs of the Green Lake, Marquette and Waushara County POINTS regulatory agencies in cor-hpllance with sections
Comm 83.22(2)(h)(1kdA(f) and 83.54(1). (2) & (3), Wisconsin Administrative n e r_F 1
-.5-F wi connn ~w~tsfj~e SOIL. EVALUATION REPORT Page 1 of 3
Uivisi r `pdE3U I In accordance with Comm 95, W'is .Adm Code -
Count),
r.~rt~1406plan on paper not less than 8 x l I inches in sic. Plan mus Cou St. Croix
Me but not limited to: vertical and horizontal reference point (6M), directio and Par cel I D.
dimensions, north arrow, and BM rcterenced to nearest roa . 026-10 8-50-100
ST` ~ ~ IEV OP F 7 rcw b}' Date
nnuIMUNI'r( asc print all information C7v
FETS a information you provide ma} be used for secondary purposes (Privacy law, s. 15.041:1) tin)) S Z
1'ropcm Owner Property Location
Cemstone Readv-Mix Inc. Govt. Lot NE. SE : s 6 T N R 18 W
Property Owner's Mailing Address Lnt # Hlock t; 1Suhd.NameorCSM#
1 190 CTI I G I
Cin, State Zip Code Rhone ❑ City ❑ Village 0 Town Nearest Road
New Richmond W1 54017 Richmond CTH G
0 New Constnlction Use: ❑Residential i Number of Bedrooms-- Code derived design flow rate GPD
❑ Replacement 0 Public or Commercial - Describe: Office building
Parent Material Loess over vutwash flood Plain elevation if applicable N/A ft.
General comments and recommendations: The system may be installed parallel with the property line between borings I and 3using
an application rate of 0.5 GPD-1l-' or the system may be installed along the contour greater than 74" below surface using a soil
application rate of 0.5 GPD/W.
1 Boring Boring -
0 Pit Ground Surface Elcvati 98.3 ft, Depth to Limitin- factor >125 in.
Soil Application Rate
orizon {
Depth Dominant Color
Redox Description Texture Structure Consistence Bounda Roots GPDlft`
in -Munsell
1 Qu Sz-_Cont. Color l Gr. Sz-Sh ry~ 'Eff#1 "Eff#2 -
0 9 1OYR3/2 - SIL 1-f-gr mfr as 2f 0.4 0.6
2 9-18 7.5YR4/6 CL 2-m-bk mfr Cs if 0.4 0.6
3 18-34 7.5YR4/4 LS 1-co-bk mvfr cs 1.6
5 34-51
1
25+ OYR4/4 10YR4/4 S/ F&- - 0-sg ml cs - 0.5 _ 1.0
S -sg ml - - 0.7 1.6
Sand with bands of fine sand -
❑ Boring
F Boring # OPit Ground Surface Elevation 94.5 ft. Depth to Limiting factor '120 in.
- _ ! Soil Application Rate
Horizon Depth Dominant Color Sz_ ContrlpColor Texture Gr. Sz. Sh Consistence Boundary Roots GPD*
in
in. Munsell Qu. -
•Eff#1 'Efftt2
0- 1OYR312 - SIL 2-m-gr mfr as 2f 0.6 0.8
2 7-12 10YR3/4 SICL 2-m-bk mfr cs 2f 0.4 0.6
3 12-18 - 10YR314 t GRSL 2-m-bk mfr gs
18-28 l l 0.6 1.0
4 ~r 7.5YR314 0.7 1.6
' LS 0-m mfi cs
5 28-62
10YR414 STS 0-sg ml cs - l 0.5 1.0
6 62-12 ~1OYR4r - S 0-sg ml - 0.7 1.6
*Sand %vilh hands ref line Sarni
" Ettluent €l1 = ROD. - 30 < 220 - -
-0 m Land TSS > i(< ~ -
_ gi 150 mp,`L Eltlucnt v2 = 130D. 30 mr,I. and TSS < 30 mgrL
CST Name (['lease Print) Si c CST Number
Mark Iverson 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond- W 1 54015 ~larch 12. 201(
1I'~ f )rh~rrtnrrit rilllr7iiri~rc: i- iu rqu,ii nn~riuril', .~r~c 1)r~~ iti_•r ;icy' ~irhl~..r It ,~ii nr:l r' . : ri t+r'. ;'ri~ -
rni
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S'r. CROIX COUNTY
SEPTIC TANK MAIN'T'ENANCE AGREEMENT
AND
OWNERSVIP CERTIFICATION FORM
O~~ner/Buyer -
Mailing Address
Property Address
(Verification required front Planning & Long Department for new conrtructi
6 ia~ l
City/State _ Parcel Identification Number 6Z/a__
LEGAL DESQRJrl'T0N
Property Location Ni t✓ 5 , Scc.._L& , T G N R W, Town of ~~tNi~, ~rJ , Sr (Z-Lne. ~uu
Subdivision L-ill 5tc -N,a►~ t ~;u , Lot # 1
Certified Survey Map # , Volumc , Page tt
Warranty Deed # Volume , Page #
Spec house ❑ yes C no Lot lines identifiable i I yeti C no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of vour 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 1 icenscd 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 maintenancc
responsibilities arc specified in SComm. 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 iwr pcction :and pumping, (if necessary), the septic tank is
lese than 1 /3 full of sludge.
Uwe;, the undersigned have read the abovt requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as sct by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic Fystem has been tnaintauied must be completed and returned to the St. Croix County Planning &
Zoning Depcartrncnt 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. l/wc aru/are the owner(s) of the
property described above, by virtue of a warranty deed rccordul in Register of Deeds Office.
Numb room
rODATE
***Any information that is misrt-presented may result in the sanitary permit being revoked by the Planning & Zoning Department,
Include with this application a recorded warranty deed fi'otn the Register of Deeds Office and a copy of the ccttifted survey map if
reference is made in the warranty decd.
(REV. 08/05)
(-,5rr-7.ois_ qs-7
w
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of
Division of Safety- and j1nitt111,~s In accordance with Comm 95, Wis. Adm. Code
' r+ County
Fwt 'lfttach aomplete site plan on paper not less than 8 S x l ]inches in size. Plan must St. Croix
-
[nclude,ltutlµlt.,liUiited to vertical and horizontal reference point (13M). direction~td 5' Parcbl LD
Retcek 4.11 ,scale or dimensions, north arrow, and B\4 referenced to nearest road _g ,QO .1 /1 C4 ""c , 026-104 -S it100
tJ .,.-illease print all information 3 2
Perse"! iri~~im~t{anD+ntr~rtbvide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))
Propcrh (_wnyt. Property Location
0 Govt Lot NE s; SE s I r 30 R 18 w
Cerrlstone Ready-Mix Inc.
Property Owner's Mailing Address Lot # Klock # Subd- Name or CStvt#
1190 CTH G 1
City State Zip Code Phone ❑ City ❑ Village 0 Town Nearesl Road
New Richmond Wl 54017 Richmond CTH 6
0 New Construction Use: ❑Residential /Number of Bedrooms Code derived design flow rate GPD
❑ Replacement Q Public or Commercial Describe: Office building
I
Parent Material _Loess over Outwash _ Flood Plain elevation if applicable N/A ft.
General comments and recommendations:
Boring
1 Boring 0 Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor >1 15 in.
Soil Application Rate
Horizon Depth 'Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD_1W _
_ in. Munsell _Qu. Sz. Cont. Color Gr. $z. Sh. - - 'Eff#1 'Eff#2
1 0-12 10YR3/2 - I SIL 1-m-gr mfr as if 0.4 0.6
2 12-22 10YR312 - SIL 2-m-bk mfr gs if 0.6 0.8
3 22-42 10YR4/4 - CL 2-m-bk mfr gs If 0.4 0.6
4 42 -,5Q, 7.5YR414 - FS* 0-m mvfr gs - 0.5 1.0
5 69-115+ 1. YR4l4 - S 0-sg ml - - 0.7 1.6
*with layers of sand
}
- fI
❑ Boring
Boring * EIPit Ground Surface Elevation 99.9 ft. Depth to Limiting factor >120 in.
So Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell_.__ Qu. Sz. Cont. Color Gr. Sz. Sh,_ 'Efi#1 'Eff#Z
1 0-12 10YR312 - SIL 2-m-bk mfr cs If 0.6 0.8
2 12-23 10YR312 - SIL 2-f-pi mfr gs if 0.0 0.2
3 23-44 10YR3/4 - SICL 2-m-bk mfr gs - 0.4 0.6
4 44-70 7.5YR4/4 - FS* 0-m mfr gs - 0.5 1.0
5 70-120+ 10YR4/4 - S 0-sg ml 0.7 16
*with layers of sand
l
' Effluent # I = BODt > 30 < 220 mgiL and I SS > 30 < 150 mgfL ' Efllucnt #2 = BODs < 30 mWL and TSS 30 m&tL
CST Name (Please Print) Signatur CST Number
Mark Iverson j - - 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, «'I 54015 Nov 19, 2015 715-796-5664
Gemstone Ready-~,lix Inc:. 026-1048-50-100 Pa- C Owner F arccl 1 Dk_ ye _ of
Boring # ❑ ON Boring Gn) - - - -
~ untlSurface F,levation l OO., ti. Depth to Limiting factor ---130 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ t`_ -
*Eff#l 'Eff#2
in. _ __Munsell_____ Qu. 5z. Cont. Color___ Gr._ Sz Sh ~
1 0-14 10YR312 - SIL 2-f-bk mfr cs 1f 0.6 0.8
2 14-23 10YR413 - SICL 2-m-bk mfr s 1f 0.4 0.6
3 23-33 7.5YR314 - GRSL 2-m-bk mfr Cs - 0.6 1.0
4 33-57 7.5YR4/4 - FS* 0-m mfr cs - 0.5 1.0
5 157-130+ 10YR4l4 - I S 0-sg ml - - 0.7 1.6
*with layers of sand
❑ Boring
PI Boring # ®pit Ground Surface Elevation ft. Depth to Limiting factor in.
_ Soil Application Rate _
Horizon Depth Dominant Color Redox Description Texture Structure Fcon,istence Boundary Roots GPD/ftZ {
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - -*Eff# l Eff#2
I
i -
❑ Boring
5 Boring ppit Ground Surface Elevation _ ft. Depth to Limiting factor _
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ 6PD;ft,
in. Munsell Qu. Sz. Cont. Color'Eff#i E f 2
Gr. Sz. Sh _ - - - - - - - i
i
I (fluent P I-11(0) Ali 220 uneil. and 'I ~S > 30 - I m~~ i ' I.I lluent ;2 13()1), zit :eer'I. and h S - 31) me'l.
he l)cpartmcnt o(~ OIT1mCiCC I!, an cauul oppurtunitN scr. i~c pru%idcr and cri[lo~:.r li mn need ,~,sr;tancc to accts, sere ice. or
.
Nced matcriai in an alternate lorr mt. pica .,c colloid lh1.c department a: GU7{- 66- i I I or I'IY OWN-26,11-87-17,
Page 3 of 3 0 ft. 24 ft. 40 ft. 80 it.
N
Berm
i
o Berm
T
G B-2
BM*2 - Top of 314"PVC Pipe 99_9'% ;
103.3' )~._.rl.+•~
Berm
Pt
- - ,.100
Berm
BM#1 - Top of 39"PVC Pipe `100 5
103.4' - 7040
I
c!z
oSed O~
Z SO ~a PL. Q,oP
The nearest property line is is about 250 feet south of the system area
• = Ground Surface Elevation
BM* & Description =Bench Mark ` -
Fievn ; B-1 1 - Boring Location & Elevation
Owner: Cemstone Ready-Mix Inc. Site Information: Completed By: Mark Iverson, PSS #197
1190 CTH G NE1/4, SE1/4, S16, T30N, R18W 680 Larcom Street
New Richmond. WI 54017 Town of Richmond Hammond, WI 54015
St. Croix County 715-796-5664
Phone: CST# 46672
N.;TES: Lri FAWRI :MFR:F_•HSLI-LUULL AFL I:"13UII FI N(:E(INIY'•/rQrYal. FM!;IIr: Jr'lunAwn
ROOM FINISH SCHEDULE
WALL FLOOR CEILING /
Number NAME FINISH FINISH BASE CEILING F941SH HEIGHT COMMENTS /
A': IT -,l IN F. -ti.-I.r,` r, \ \ \
- G LL ;N-[L UN:. I.:.r~.l
100 ;CT V.C. 2+:2 ACT-
101 -omr , -FT. G}£. CA7FE-TILE 'V.U. ^Y3 ACT e
10: O`FIGF FT. GYP. GlRPC TILE V.B. A(T. _ - -e -
10-! .-,A FT. GYP -T J I, .Y '.1 l Gmr KNvXk IAM•N `tx-ukr V t.' It :.-,-12 TRFAD~
IW, U, tl_' PI. C.YP CA:F„t. 11-t Y-L. ACT. p c -
IU~ CFFI~ PT. GYT' CAi'FCT TILE Vb. 2'2 ACT. b-S
106 0'rl, FT. GYP _C',R°ET TILE V.B. 12 .ACT. _ _ e - - J
IF G B2F4K!l0-:l FT i:YP `::=T O
1w -UIL[.- - - r1. i-1T -'-T. J.C. - p . C -+I rLIvu lC '.VA-L 4' at' \
DOORSCHEDULE -
DOOR FRAME HOWR
DOOR # FROM ROOM: NAME HEIGHT WIDTH TYPE TYPE GROUP COMMENTS i III
OC3 ?TORh:,C _ - O' '3'-c7 A 'Fr I RCUTATPD
Il7iA ~TCN?h(:F CF N 1-2 1':
I CtJ lC_Ugv 7-0' 31-0' A -ri 1 PCULTED
I C - OI t.C - - T C' 3' Ce B F2 .,A COAT rOOK 01.7 BRICK CR ?00R -
,Cc OF-CC f. '3 -:7.__Ff FP •r4 r,* rfril: 1-11N BAn, r
. R DO---P.
_ T .
I
IC_ ---SihIR - 1" - I1'- A
I f. ;h L~ :F,-r U' I' - J 6 F2 =A 60 kUr1. CCL`~. cC-'t11L r kFINS
Ca -Or-ICL - - -I' C• 3' - 0' B U. _C0a' I Oc;.r. JN 64Cr. OF UCJR
I Cl- h OF'ICE " - G• i' - cr B Fr =A t:C•A- rCYF: -;N BrLL,I: GF c:OP.
IG°. CJFFI("F -G:---_-- :?N t+q(. F, ilt ll::t lft._
c:(, U'_I(_= 0, '3: O' D - '1`2 .a COAT, 00K ON RACK. OF D--OR
I CT CQA1 ROGIJ 7 0• 3' 0- B F2 3
ICc T;'ILLT T-0• (7 m F:
\ \ \
HAVP.VAlf LEGt4- HOT' AL. nAAp'h•A>I GFOU~S aR,C rCR>lf C2HCE 7
C:14" :E JFr ALL YV1TI1 GA%CR /
PG ,OJ° :;41i /P i I\T~tt ::k LIX.N 7[f r-Z'• DA.~iEh'=rJ-
- n,.Ax i u:F✓tit,_CO'. •.c~ A!!. _ - : I'4' - 1'-0 ' /
f ~2 I. -r ..ry~.~. '1.1.951 J I 1
C°tr7 C
V 1^JLU. V . I /
L f E T.ITIG VL=✓F^!- al_ fitJ F?: V-itH l",..'te: -
nc[ t . 7r,_ IUIItI A TOILETS / i
uRO J° 2 INTERJOR. (FU5tIrFU'~L.1 e I' A~.cxs.•I 'I
=n L'CO .y J
_¢v.T' ° INTE~J:f LATCH ~ \ -
OFFICE
1 TOILE' C +21 TOILET C
'~4" = 1 1' 1 4 1'-C.
J 1
:...tv
\ - - \ \ \ \1-N r \ \ - -
OFFICE
FRAME TYPES .-3•I UOJH TYPES y , UPY AREA L5HLAK H~><Jbt \ I(`.5
L4" 1 I ra• = I'-D' - u~' _ I' 0' 14' = 1'-0'
NO`
M ,
r_
\
'-S ; W INDON/ TrPE ' : y. Iy ILRIUR WALL TYPES F :X'. R PI AN
.4 A
4 ARCHNET
r _
/
mum
architecture • interiors
sustainable design
ST R 333 N Main St. Ste. 201
i Stillwaler. Niti 55082
651-030-0606
arehnetusaxom
STORAGE
VING
FRICHMOND ARCH
. G
\ OWNSHIP,
Revisions
MECR
J72 Item Date
li
I
> - 'HALL RATING KEY - ' -
~i
_T ! Re, li tAwtiun Information
_ `-.erebv eet `y tca: chis ~IZn,
- H spe, 5L3nur.. or r_part Y,a. preD-J 6y
- - \ me or under rry dire[[ su 9er: vn^. r,nd
OFFICE \ U t: am a Culy Licenei A --I- ,
fnt - OFFICE t mdcr th^ law-, c' n, S tt.. of
- - - it Yncrnn:In
.02
\ Printed Name
- BETH F. DIEM
- SraIR_ Signature
1 ;;5 1N1..........
\r ONStn~'%.
•as '.Iwn_. -W. y'g
A a
~ t \ V'bnlgiwll~t`'
DATE License
1-19-16
G L(i!.>I 'c \ oFOfCE Shee:Inturrration
BREAK RC FLOOR PLAN
TOILET v
inF
i ItM1 i \
P.o)ea rra : :5-I`% Car: nr. r,-. :
S~ret 517c : 24' > 'S"
> - o o N
I_nelked Csy FT Al. O
IF, AP.CHNFT, 1-.
r i
FF ..-'s '+r County
` Safety and Buildings Division ST . CROIX
4 d MAR 0 4 ZO 1 61 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
SP I Madison, WI 5 7-7162
ST. CROIX OUNT(
S`;
EVELO ENT I'A it bl,
Sanitary Permit Application State Transaction
ffN°//mb//e~~r
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate gove t nit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submi to Project Address (if different than mailing ad ss)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats.
1. Application Information - Please Print All information 93 0AA.A.0
Property Owner's Name
14, f -Parcel #
T~,TnxT A_n I~LT nA~7T ATf~ 41df% 026-1048-50-100
Property Owner's Mailing Address Property Location
1190 CTY ROAD G 0 Lot N/A 1 AJ3
Govt.
City, State Zip Code Phone Number (10
SE- Section
NEW RICHMOND, WI 54017 N/A leone)
T 30 N; R 1W_ E or W
II. Type of Building (check all that apply) Lot #
❑ 1 or 2 Family Dwelling - Number of Bedrooms N/A Subdivision Name
Block # N/A
Public/Commercial - Describe Use oEriIcE-AIL q_NG N/A ❑ City of
❑ State Owned - Describe Use CSM Number 0 J ❑ Village of
U&A--L. 11104-16 /L Q N/A R1 Town of RICHMOND
111. Type of Permit: (Check only o box on line A. Complete line B if applicable))
A. New System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. T e,of POWTS S stem/Com onent(Device: Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Ra[ gpdsf) Dispersal Area Required (s Disper Area Propo d (sf) System Elevation
467 .5 934 NO bcp 95
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o n o
New Tanks Existing Tanks ^/D ` v o. L L, U o.
o v
Septic or Holding Tank 1 , 000 0 1 , 000 1 W ESE X
Dosing Chamber
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 MP/MPRS Number Business Phone Number
PAUL KOEHLER 225410 715-246-2660
Plumber's Address (Street, City, State, Zip Code)
321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017
VIII. n /De artment Use Only
'Pwty
pproved Permit Fee ed Issuing Age 'nature
y iu
OReason for Denial
IX. ConditibMS', 41N,611 teasons for Disapproval 1
1 Septic tank, effluent tilte• and
disper ->:i cefl must all a setvrc•?s l niaintaittec' t / G /I~l
as per management plan provided by plumber. (Mne- K .
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is pM appNMW 0od 1,2td~'iAtN 0a,
Attach to complete plans for the system and submit to the County only on paper not less than S 1/2 x I I inches in size
SBD-6398 R.II/11
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