HomeMy WebLinkAbout026-1121-06-000 6 5. 36 , >8a -72-1
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NOTICE TO OCCUMIN
u .A Aay�o- lfr a ion Report
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dwdyaw PAST afavm,1"a:wry..a***-"A 6—mae,+roo a h—amaa tbeabtla ar Wa r m
Wkw '° 0` ��° Private Onsite Wastewater Treatment System f
tyaww, "° " ° °° "�°°° °°°. y Individual Subsurface Treatment System
mum (T+Ja[1'}raK IYWRra JCe prawAIX�t ti l,QjlClitSW t![
}Ym{fray,.illb¢taa+i+rg toeRNQaY tar as xnaa-•.,.pw.ia:arna+a.F
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Thank you for Allowing us to heO extend Me rife of your systeml
Let us know If you have Any questronA.
swow }arauata®., F�ar t�,�ad
a€ aW ow"AM dw dx ta�.M aoubrc as« rkr T lS our report to you-Please read carefully
Aagt I,—b.ek—b. F�Pine WA,yw relics w-4.
ofdw.kdta a: xr rs dy wax xx aPffie� f.We srv�a
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{ InStaMCaSoM oc� on�ry CAsiter, f '- �r�7
pAPI�A PRUblll:'F'S
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ter die.wEki pawl Pradaa4 Sala roasat t emn da Sat w usaar.gm+a p,gar ea�i .b aW �+/
eo6aad paper AarblootbaA papa CManm is off}bleat�Weg a+aa w Wea4di,+n�+ds oa 9ta ikaana6lewr}aP ✓
wood
NO TOILET BOWL TABLET'S SSOUID BE kWO
NO DISCHARUE fROM WATER SOFTIENERS SWALD 00 MPC THE SYSTEM
40 ANIMAL PATS,SUCH AS SACON OKEJSE,LARD.OR ANY OTNER OILSSWX� LO001X70 THE y�
SYgTEM.(imsmti draws ofp--4Poo l+.a'P"o SarnOnQ Needed:A,,,✓
t30 DSUUV CLEANERS S€3OL40 BE I*W-(VM.W OW haRtog Soria,s gaud subOMW As a tsar r.Wa
ehanieai dram deww a can be rioti bus ux Vmagip bom m they arc toxic*t1w beacon t3 tbt
srs i ATU Installed: Install Date:
SO LIQUID FABRIC SOFTFNE lS SWULD BB USED-(T W Pmducss ttip dOl-Dams q merrxy
-hichto IM,toSx bwwu Pleaaevsa&yea*,.m.I ATU Serial Number:
N0 HAR"i 4WCAU OR 70)3125 SHOULD BE P(2T Wr0 71fe SYVI rsN
�af'Wx ,wraa¢t. p+iabtsafvbgh<.t raaWVPe -;pebftdcd ac.)
AT ."`°.._ ArgrARYrurxwa - Inspects n Agreement date:
pwa
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A,1a.. vss 'Riwg3 � fro€ .00 „_s! � P'rovKitr
PeberaYtl Mahapoment Co..t1.0
x ap R7 w�sre
OLD s r PO Box 524,427 Wheeler AvemFe
r�l Fredonia,:1@1 SM
IaraAt�aaa t.. ra �I,5� TN:$8&4554W*r262-42-2426
ti a uaa win leads as by era ale.«k. Phone Number Fat:510, M1232 or 28266'2-2416
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lt�wowsni w,W t*WX0QMWY wN+adaa.aetl salsas Sad aM1 W Tut7o
VIOLATIONS OF THE ABOVE STANDARDS OF GOOD? PRACTICE / �
MAY VOID THE PRODUCT WARRANTY l 4'$
I
digsaau 5 ors
Your$Felt*of the Art treatment s, des an ideat way to exWod th*lit*of j, We oneclied W pondkV in your t W 7
your
yo dispersal fletd and ram r track inks the Significant ponding May. the Wd 6 a met,the weer
br$pect r$can dlsediver minor probkw»s that could cause YOW di$penat fieid to flaw d too high Or Viere is Some otter proW$m with the find.
fall resulting In coruid$ralrie repair or re'040ement costs. tnepecting and
can increase its Iwo,Save money,protect K We chocked the pumps {ewai CtStttld in tt19 PsNnp tY�afle d0 DI
water WO R$,,your agst$rn Property row u do not appear to use we iwV The pump ccurYar Me**
water wel4,and pur$r$Ny khprawe
Seloor are of the:%Wns we PhscRed, Pleasereadcarefullyancletusknowifyou pp Ph, °F Tamp.
have any L Ttaa ter atSu +t treadrrie tdy abWe or clisechied Oxygen rkf the kr even dwe reading in"
A.We roMOved boa blower housing to clean the liter and check the bOmer for
below 7 may indicate a dram+
unusual Wilift OF visible,signs of electrical ex rnaehar 1 Pipe help evaluate en
co ,filters,lot ,and rxrt da f o root ter on sat visual' ,Y f does not appear to us to be
be in g r. working property with the proper ray of .
9.The electrical panel swtchaa and alarm were ell b i not seem to to tank pumper or your system W may�any time to diecuse tt�
working propierty. You.your ask Your Panpar to clean and reptede
report.Wherre ter your tartle(s),sails he M*W, of the te*and 03 baMes while it is
C.The water turbulence in the Boa-ltu mbics FAST treatment u rSasee r *$a roost any aftAt"t fifers as neadad,cheat
the inis9rth Me biological
to utdksme store i adequate air Corning from the may.The tank(s)do not reed to be aMPOW o sludoot on bottah baps the osiabbent to restart om"when the System is W blm*
D,The vet deK aces not to be operating An use
Obstructed went war The vent holes or should be M dw hot enter the tanks or use equipment to examiro underground comports,our
equivalent to a V NERMEW ur sysl�n iruittded to primary that usually
�' Y6 pStM WDrStittg 1 �' Our- � t�Ot gtJarertl98 t11bf0 F. There was tees rat odor, When the aerobic system is werkrng wall,it with tl s sys an or that a may hSl aOtNtar that errpscbd. Treatment an le beat the quantity and quoli y of the waste load ft� r tltere are s�ftCart�$ let�quarrtrty or quetrtY-
A i musty odor is no"OL ayy,on use days CaR ycur system on the oatdC �'!i� a w+�r ar haws any F. The risdrnttg term lbe FAST"un was nos clear. Clear water indicates kse provecor if you sum X�SYe
there is good quality wate(Wrov treatment pto as. property treated questions.
wastewater should be ct"r of solids and may have a Slightly cloudy appearance. V&appreciate the opportunity to help you safeguard your$yetam.With proper
a�Fjs he sl in your septic lank and it appears Your system does rd and care your system�Pe+wTn sabstaaoriiht for many years.
us,pumping The septic setting tank Should be Pumped when the Comments�Suggestions:
ZS%to 30%to the water depth in the tank. Flows,advise
s septic
filet com and tank should be pumped
Settling Compartment Or'tail rieekis pun-Ong,
N.The water depigh of the ) does not appear to be correct. An
increased may gros ui water may be the tank from
your fold or two may be looks in your tank.A low crater level also may mean
your tank is tSaking.
t, We looked for Cracdcs or 1 is the tar*risers 8,14 mannole covers arid y do!
do net to be nomiid• Lellft may atiOww8ler tea enter your tank and
overload your disperser field.
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• 0ct- 21.2010 01:22 PM St. Crolx County Plan /Zoning 715- 336 -4686 ) 2/3
f �1
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B1r+d Plumbing Inc.
1006 19 Avg
New Rlchmand WI 54017
715 -248 -45
Inspection Report for Greg Clooper Property
Location: 1712 10 M. New Richmond Wi
54017
1 Shaun 51rd Inspected:
- Septic Tank _ ,A T Grade(outslde and In observation Tunes)
,_ Pump Tank ,_,,_ 4-- Pump and Floats FAST UnIt (4.6)
Inspectlon of PAST Unk consists of bfowerrunning, air Intakes clear of debris, agitatlon of
watarin tank, color of effluent in does tank(clear)
Date of last pumping 1 rt g
,,_System functioning properly
Ccmments
Shaun, Baird
PO Inapector#226gpp
Date
X0_2 -Q �1J
d s«:80 ZO BL Ddb'
Z•d etSOL 90 U Ue
Oct -21 -2010 01:22 PM St. Croix County Plan /Zoning 715. 386 -4686 113
FEB 20,2007 12:04 Bob ZhrioEe, ofQx 719- 726-2026 Page 1
PDWTS INSPECTION AGREEMENT
The conect opotetion ar the betowagwnenl slgnlf11caMy IMluences the We of the wasla" or ejolsm. Poriodla
lnspectinns will help cmiand 11 Ilia of tie *)%Ic sne praranl Um need for costly repairs. TMs awe:ernenl authorizes
MGM 10 your POINTS equipmdril by a ttained and aulhorized taohnicton during dayllghl hours to provide regular
h,ap■ellone and routine irlRfntenanca to help mature the aq utpm nl is librking pro y
it Gs hereby E>tyrnfld by ohnd Detveeen Purchaser and�`� °t ��;. :. JL
�r:' ;Sarvbo t that In
wnelderatbn of the payments provided for herein. Service provider Wit pravldo kt: the G sarvlaeao
to faelory_{rained
reprownleft 10 porlorrn periodic Inspaothons at Iha QguiPmani described below. Service Pra0der VAJ pe,pgre a wrlU94
rcW lifter Will inspeellan and prwids a cepyof the report to the Purchaser. This report all{ conteln recommends nna
for Any riperArion and rnafntenancs deerrred slpprppnote by tRtr lnapsator.
This agroemenl dues nut a,eauma any ta3punslsilTve rte ablJyafarts that cra rwmally the reaponobiI = of Purahrhl,er and
e
d0ft not extend to cover any assts Ihal may he wescl W� 8„y recomrt, hnadc under th{a ngreetnenl, to no
t vent khan to w h o A or wc r or responkiblatar any spoclai ar conaaquanUai damage;, including bill not limped to. Iwo of
7rslc, lniugrto neon or prgrsety or kwld*antal acenumis leas duo to Cqulpmeni failure at low any other MR114rt whatsowor.
Ewyka Provider may B usty aWVon2l senrteaa. parts or labor only sitarauitlarizalion by PurGhesor.
This eproetnent *hull remain in rumc fDr>, `ZD+ �,
aataawtic311yrenew each Pw of Z yehors, lu$inninp r' �° and wiH
year 1lhereatler 10r enR year fen lass oaneeled by altitice p:utr wi0� at (daft ;30 ter) Robes.
_N8 agmenlantmaybe canceled by the Purchaser oniyUreplaced by a an aulhoriwd oewks
provider for the oyuiPmonl listed barow. Son(oo provider may delay orcowel tutura insireottons b payrnent bscomes w
(085115 days mast due.
Periodic Inspections: The Purdwor s rtes to
e I�Y�er+s S � _ per htspetJlitlA
for four (4) inspeellans far Ibo first two years at six m oath intervals and 1 (orle) inspeclion each Year lfioreaftor. Payment
for Ihs )trot duo years or inspac ona is due at the drne al installoll ; ad 01 pa" are due u�pun inspeot(on. Any
addltlpnai lesting or e w. vines required byftw aserwllt be billed base no erld material amounts.
Service Provider: •Palor� A � B SI Want
Dole. = LIP
Equipmen t Cbvel+t:d L1 r This A r+eetmertt /0 ^oZ0
Oeaert 'on Mpdsl Mij Serial No-
Install Vale Location If dtflarant front S aAt Owner
r�
S (Clem Owner:
Ion A4A ��MnrNsmr. t G� eatr,
Sl9natuno � ""
Prin, tt�M�.
sueex x ,J ` -•
Gar,SIMl,tipl e; — *-- Q EMaM .-.... ��
payrnew type: Chock Caeh America Cr■d2Cerd oho rthy Carlo Mrounl5 Nonro an Crcdk Cmd (print)
J a..
raltilwt�tbep aAl t7r Tel: 111111 W ZMM-PTO
i'e1e1180A Menagernent Co., LLO Fax: 100 -0084234, 202 -M2418
PC hw,r 340,42 WJ,mor AV, Froda,a, VA 63021.034a USA E•Mail *&wine @potarson.ee
wLrLo AE ro SERYE 04u Cusk nrers QCIALiiYPRQDUCT4 MCE 1919
ti RLS:g0 ZC) 61 AV
CA ev9:01, 9 0 £ 1. uer
YES 20,2007 12:04 Bob Zaiefelhofer 715 -726 -2026 Page 1
POWTS INSPECTION AGREEMENT
The correct operation of the below equipment significantly influences the life of the waslewaler system. Periodic
inspections will help extend the life of the %yslem and prevent the need for costly repairs. This agreement auttroritos
access to your POWTS equiprnenl by a trained and authorized technician during daylight hours to provide regular
inspections and routine maintenance to help assure the equiprnenl is working properly.
It is hereby agmed by and nd between Purchaser and Peteiserr (Service Provider) that in
Consideration of the payments provided for herein, Service Provider will provide tha services of a factory- trained
representative to porform periodic inspections of the equipment described below. Service Provider will pneparre a written
report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendalions
for any operation and maintenance deemed appropriate by the inspector.
This agreement does nut assume any respunsitalities rx obligations that aro normally the responsibilities of Purchaser and
does not extend to cover any costs that maybe associated with any recommendations made under this agreement. In no
event shall Service Provider be responsible for any special or consequential damages, including but not limited to. loss of
time, injury to person or property or incidentul economic loss due to equipment failure or for any other reason whatsoever_
Service Provider may supply additional services, parts or labor only after aulhorizaliun by Purchaser. s7 �7
This agreement shall remain in force for a period of 2 years, beginning �v to U arld wiU
automatically renew each year thereafter for one year unless canceled by either party with at least 30 days written notice.
This agreement may be canceled by the Purchaser only if replaced by a service agreernera with an authorized service
Provider for the oquipmont listed below. Sorvico Provider may delay or cancel future inspections if payment becomes at
loast 15 days past dire.
Poriedic Inspections: The Purchaser agrees to pay S y per inspection
for four (4) inspections for the first two years at six month interval's and 1 (one) inspection each year thereafter. Payment
for the first two years of inspections is due at the time of installation; ad ' ' al payments are due upun inspection. Any
additional testing or ce rvices required by Purchaser will be billed base ime and material amounts.
Asi-
Service Provider: Slgnatur _Date
E ui ment Covered Unger This Ac reement
Doscri tion Model No. Serial No, Install Date Location if different from S stem fawner
S stern Owner:
Company Name: eater
5lgnalura:
Prinr Nama:
Streer: - _..
n
Fax:
G,y- Stara Zq: i L.) . Q --
E-uair:
Payment Type; Check Cash American Express Viva : MasterCa Other
Credit Card No. Exp. curity Code Amount 3
Name on Credit Card (print) _ _ . Signa
N K,�rl lfwt 4�fK / �NwCrIWYlilLflllLMIIr1C �rbl
rri n dCM lla u yr Td: 688- 4554864, 262 - 692.2416
Petersen Management Co., LLC Fax. 8W-669-1232, 262-692-2418
PO Box 340, 421 Wilador Avo., Prodon wl 53021.0340 USA E -Mail service @potarson.cc
WE LOVE rO SERVE Our Customers QUALITY PRODUCTS SINCE 1916
Z - d 8 1,9:80 ZO 6L adV
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Inspection Report for Greg Cooper Property
Location: 1712 106th St. New Richmond Wi 54017
1 Shaun Bird inspected:
Septic Tank --,)�,_ Grade(outside and in observation Tubes)
_ Pump Tank _ Y�- Pump and Floats FAST Unit (4.5)
Inspection of FAST Unit consists of blower running, air intakes clear of debris, agitation of
water in tan k, color of eff luent in dose tank(clear)
Date of Last pumping 12 - 30 - p er
System functioning properly
Comments:
Shaun Bird
Powts Inspector #226900
Date y
L e19�90 ZO 6L add
S T CRUx cOU NTY
RECEIVED
PLANNING & ZONING JAN 3 0 2008
ST. CROIX COUNTY
January 2, 2008 ZONING OFFICE
Gregory Cooper
Or Current Property Owner
1712 106th St.
New Richmond, WI 54017
RE: Pretreatment System Service and Inspection Requirement
Code Administration Gear Property Owner:
715- 386 -4680
Landln f ormation This property's Private On -site Wastewater Treatment System ( POWTS) includes a
pretreatment component that must be inspected at intervals specified
in its service contract.
Planning n WI D omm 83.52 1
St. Croix Count Sanitary Ordinance 12.7 and C
y ry ( ) state owner
715
responsibilities for maintenance and inspection of POWTS that require evaluation and
Real Property monitoring at intervals of less than 12 months. The sanitary permit issued for installation of
715- 386 -4677 this POWTS required that an ATU Service Agreement be recorded on the deed for this
property. if ownership has changed, this must be corrected.
Recycling
715 - 386 -4675 Based: on our records l'he pretreatment unit on this property is due for an inspection and
Mdinreriance service. hispecrion and inairltenance reporting for a pretreatment unit is
separate from the routine pumping /inspection required for the septic tank. The certified
septic tank pumper and the POWTS maintainer that inspect your system are required to
submit reports to St. Croix County so that routine maintenance completed on residents'
septic systems can be documented. Please return this form to St. Croix County Planning &
Zoning office along with a copy of the pretreatment inspection form completed by the
licensed POWTS maintainer to avoid enforcement actions. Please be advised that
fines and /or forfeitures of not less than $100.00 and more than $500.00 per
day everyday can be issued if the required service is not completed in a
timely manner.
If you have any questions about what is required feel free to contact me at 71386 -4680.
1 C `
Sincerely, �1 .��CM' `
h N♦ V"
Ran Yarri #tonY -1
_� Technician
��ning
Pretreatment Component inspection and maintenance service date: 7 __
POWTS maintainer Name and license numbe : D S
POWTS In e do Service antra i proved r nV
A ddress: �• 0�IU aw \
Phone )
Service Contract ana duration:
ST CRC,X COUNTY GOVERNMENT CENTER
1 i 01 CARMICHAE1 ROAD. HUDSON, M 54016 715- 386 -4686 FAx
CT
CROIX COUNTY
PLANNING & ZONING
January 2 200
ry , 8
y .
Gregory Cooper
Or Current Property Owner
1712 106th St.
New Richmond, WI 54017
RE: Pretreatment System Service and Inspection Requirement
Code Adminisrratiisn' Dear Property Owner:
715 -386 -4680
This property's Private On -site Wastewater Treatment System ( POWTS) includes a
Landlnformarion & pretreatment component that must be inspected at intervals specified in its service contract.
Planning
715- 386 -4674 St. Croix County Sanitary Ordinance 12.7 and WI DComm 83.52 (1) state owner
responsibilities for maintenance and inspection of POWTS that require evaluation and
Real Pro e - '
monitoring at intervals of less than 12 months. The sanitary permit issued for installation of
P `77
715 - 386-4677 this POWTS required that an ATU Service Agreement be recorded on the deed for this
'
property. If ownership has changed, this must be corrected.
Recycling
715 - 386 -4675 Based on our records the pretreatment unit on this property is due for an inspection and
maintenance service. Inspection and maintenance reporting for a pretreatment unit is
separate from the routine pumping /inspection required for the septic tank. The certified
septic tank pumper and the POWTS maintainer that inspect your system are required to
submit reports to St. Croix County so that routine maintenance completed on residents'
septic systems can be documented. Please return this form to St. Croix County Planning &
Zoning office along with a copy of the pretreatment inspection form completed by the
licensed POWTS maintainer to avoid enforcement actions. Please be advised that
fines and /or forfeitures of not less than $100.00 and more than $500.00 per
day everyday can be issued if the required service is not completed in a
timely manner.
r;
If you have any questions about what is required feel free to contact me at 715 - 386 -4680.
Sincerely,
?ai'13.
Ryan Yarrington
Zoning Technician
Pretreatment Component inspection and maintenance service date:
POWTS maintainer Name and license number:
POWTS Inspection Service Contract provider name:
Address:
Phone:
Service Contract date and duration:
ST. CRolx COUNTY GOVERNMENT CENTER
1 10 1 CARMICHAEL ROAD, HUDSON, Wi 54016 715- 386 -4686 FAX
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
SafetJfSnd BuIAg Division
INSPECTION REPORT Sanitary Permit No:
395190 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Z
Permit Holder's Name: Village X Township
City Parcel Tax No:
Martin, Michael S. Richmond Township 026- 1121 - 06-000
CST BM Elev: Insp. BM Elev: BM Description: (Z (()(per
o / o l S
TANK INFORMATION ELEVATI N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (y, Q (,S-0 Benchmark
Dosing r'� n� // ' g Alt. BM G
Aeration fr `}- � - ( Bldg. Sewer
Holding - - - St/Ht Inlet
.34 fSQt
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic �. / 3 Z 1 Dt Bottom I
, z
Dosing L / 3 t( Header /Man.
L. D
Aeration Dist. Pipe 3.3 9
Holding Bot. System *2 D tb0, 90
Final Grade
PU IPHON INFORMATION t,
Manufacturer � D and St Cover
o ! / GPM
Model Number / YO ? Sr ILI X0/2
TDH Lift . n } Friction Loss oss System�� TDH / Ft r ��
Forcemain Length ia. + Dist. to Well
SOIL ABSORPTION SYSTEM c,.. -s�... = Z 4e
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No Dia. iqui
DIMENSIONS t
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHIN Manufacturer.
INFORMATION CHAM OR
Type Of System: NIT Model Number:
DISTRIBUTIO , � YSTEM
Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake
Length_ Dia�6
Length 3 I Dia I f Spacing / 3 2 (� / /
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 A Yes [] No [] � Yes � No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 9 /_ 6 / Inspection #2: / Z7 / 0 / ' 1S
Location: 1712 106th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 5 R1 8W) Partridge Run �A Parcel No: 05..30.11/8.7J21
1.) Alt BM Description = t4 , -- 0� s« /`: q l ' O « r" ""'"'"`� �CnQ' [xo5 c 4*-*
/ / r
2.) Bldg sewer length = ± , f��Grynlilr 41 +�- /e / A�a n i to�d dtain e�t- per ss
- amount of cover = >''/2 a �S ApFea�S y14 /n5� 0n 4 /l A'jd k",
3'�w utl at -�a+. _ �- s, 3 awd (.
Plan revision Required? Yes ® No
Use other side for additional information z _ 0 �/
Date Insepct Signature Cert. o.
SBD -6710 (R.3/97) � '/O L/� 2- _ �� ^'
r 19-1'2- 06 mot
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
1*6consin Personal information you provide may be used for secondary purposes Madison. WI 53707 -7302
Department of Commerce [privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach com fete plans (to the county copy only) for the system. on paper not less than 8 -1/2 x I I inches in size.
Count tate Sanitary Permit Number ❑ Check evious application State Plan 1. D. Number
�-: U4 /X �5 o j 65 T7 Z.
I. Application Information - Please Print all Information Location:
Propert y OwnerName 4 ••�/ Property Location
REC _
� 1/4 1/4. SS T30 N. OE o
Property Owner's Mailing Address ern q — Lot Number Block Number
City, State Zip Code Phone b -, Subdivision Name or CSM ® Number
/ �f "YO Z / ZONiIdG OFFC£ B lut+� Cit
II Type of Building: (check one) c > u l
13 1 or 2 Family Dwelling — No. of Bedroo s: 3 nn ❑Vilage
❑ Public /Commercial (describe use): ` 12, n df
❑ State - owned
III Type of Pc. (Check only one box on line A. Check box on line G if applicable Neare Road 6 +[ S 1'—
A) 1. {flew System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Oniv Existing System ppo e
n�� r�eng
B) Permit Number . -= 4 d
11 A Sanit Permit was reviousl issued a —'3
IV. Type of POWT System: (Check all that apply) T- Cn F F 5
• Non - pressurized In- ground 0 Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized - gro'� 8S ) ❑ Holding Tank ❑ Single Pass ❑ Drip Line
X At -grade c> ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
r X 9 1) r X — trlR�Q,
V Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
e7/5' zQ o 70(3 S — /0 /.3 s— f ?, G Z
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
Goo -- Loo
VII Re ponsibility Statement
1, the undersigned, assume res onsibilit• for installation ofthe POWTS show ed plans.
Plumber's Name (print) PI is Signature tamps): Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
37 Z /yd- Tl s 7
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Sig azure (No stamps)
�pproved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination � 32 S /3 ZX ( t�ti
IX. Conditions of Approval /Reasons for D' p roval: l. � _S
a C, S T. a
0.4 mss, Ukaij e_0jVA_%L_!s
cun_.<zou ru n,7inm
I I
I '
i I ;
I
•� I i I i I I. i I I
I I � � i i L �•. ��
ez
AW
77;
i i i i I I i t
?0 39tid 9NI>i :)nH1 3-1-II9 Ala f.4 !FggRq7.qTI ge:PT TAA7/C7/1'n
• . Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
Vhscons www.commerce i n.gov
www.wiscon wisconsin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
July 30, 2001
2 1
CUST ID No.221471 , ' ATTN: POWTS Inspector
ZONING OFFICE
DENNIS J GILLE ^rl�e'^1 ST CROIX'COUNTY SPIA
372 140TH ST �(� �: _ 1101 CARMICHAEL RD
AMERY WI 54001 - ST GtoX HUDSON WI 54016
CONDITIONAL AP ` U t . } i
PLAN APPROVAL E 3W2Q(1$ ",�% Identi ton bers
�, Transaction I No. 656712
SITE: Site ID No. 632
MICHAEL MARTIN Please refer to both identification numbers,
106TH ST above, in all correspondence with the agency.
TOWN OF RICHMOND
ST CROIX COUNTY
, S5, T30N, R18W
FOR:
DESCRIPTION: THREE BEDROOM AT -GRADE SYSTEM
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 799650
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
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 Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD-
10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment
Systems" SBD- 10573 -P (R.6/99).
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the at-
grade manual, and section VI of the pressure distribution component manual are complied with. A copy of this
letter including instructions and information relating to proper use and maintenance of the system must be given
to the owner and each subsequent owner upon completion of the project.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area.
• Comm 83.52 Responsibilities. 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.
Comm 83.54(1). In addition, 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.
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
DENNIS J GILLE Page 2 7/30/01
I
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a
person who holds a registration issued by the department as a registered POWTS maintainer.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• 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.
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 /instal lation/operation.
In granting this approval the Division of Safety & Buildings 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.
Sincerely,
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
�!�yCc✓ / BALANCE DUE $ 0.00
Charles L Bratz
POWTS Plan reviewer II- Integrated Services
(608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM WiSMART code: 7633
cbratz@commerce.state.wi.us
cc: MICHAEL MARTIN
AT -GRADE AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application Level Site
INDEX AND TITLE PAGE
Project Name: MICHAEL MARTIN
Owner's Name: MICHAEL MARTIN
Owner's Address: 508 HOPE ST
PRESCOTT WI. 54021
Legal Description: S S 1 30 Al /e /S U/ b�
Township: RICHMOND
s qF c , /vi z ® 0
County: ST CROIX J �Qd�
Subdivision Name: PARTRIDGE RUN ` ^
Lot Number: 6 Block Number:
Parcel I.D. Number:
Plan Transaction No.:
Page 1 Index and title
Con&donally Page 2 Data entry
APPROVED Page 4 Lateral d drawings
dose tank
�� Page 5 System maintenance specifications
3 ffkF Page 6 Management and contingency plan
Page 7 Pump curve and specifications
SEE CORRESPONDENCE Ae7 l
Designer: DENNIS GILLE License Number: 221471
Date: 06/1 1 Phone Number: 715- 268 -6637
Signature. JZ"
Designed Pursuant to the
At -grade Component Manual for POWTS SDB- 10570 -P (R. 06199), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 3.0 (03/01101) Page 1 of 7
At -grade and Pressure Distribution Component Design
Design Worksheet
Site Information
(r or c) R Residential or Commercial Design
300.00 Estimated Wastewater Flow (gpd)
1.50 Peaking Factor (e.g. 1.5 = 150 %)
450.00 Design Flow (gpd)
0.00 Site Slope ( %)
100.85 Contour Line Elevation (ft)
26.00 Depth to Limiting Factor (in)
0.50 In -situ Soil Application Rate (gpd/ft
Distribution Cell Information
90.001 Dispersal Cell Length Along Contour (ft)
10.00 Cell Width (ft)
2 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(c or e) c Center or End Manifold
5.00 Lateral Spacing (ft) If N above, enter the elevation (ft)
4 Number of Laterals of the highest point. E
0.156 Orifice Diameter (in) (e.g. 0.25)
1.75 Estimated Orifice Spacing (ft)= 1.78 Actual (ft)
Z.00 Forcemain Diameter (in)
c� 408:60 Forcemain Length (ft) Does the forcemain drain back? Y
92.00 Pump Tank Elevation (ft) Enter Y or N
i
4.55 System Head (ft) x 1.3 1y , o f8-S1 Forcemain Drainback (gal)
8.35 Vertical Lift (ft) 55.57 5x Void Volume (gal)
5-92 Friction Loss (ft) :.a 7489 Minimum Dose Volume (gal)
J 5 - W..62 Total Dynamic Head (ft) 53.85 System Demand (gpm)
Lateral Diameter Sele Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25
1.00 1.50 x
1.25 x X 2.00 x X
1.50 x 3.00
2.00 x
3.00 x
Gallons /Inch Calculator (optional)
Treatment Tank Information F Total Tank Capacity (gal)
zs'o1"7j a_ Septic Tank Capacity (gal) 1 40.001 Total Working Liquid Depth (in)
HUFFCUTT IManufacturer 1 15.00 gal /in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
600.001 Dose Tank Capacity (gal) JZa Filter Manufacturer
12.001 Dose Tank Volume (gal/in) A480- IFifter Model Number
HUFFCUTT Manufacturer
Project: MICHAEL MARTIN Page 2 of 7
At -grade Plan View
t
F -0 11/6 B Observation Pipes (2 typical) D
S• ." S S S S S S 5e ' S * S -S S
....5 =.• L S ti ti •. . 5 .... 5 ,. A
B
D
L
At -grade Component Dimensions
A 10.00 ft D 5.00 ft 900.00 (ft Dispersal Cell Area A x B
B 90.00 ft W 20.00 ft 2000.00 (ft) Total area (L x W)
1/6 B 15.OQ ft L 100.Q0 ft 5.00 (gpd /ft) Linear Loading Rate
At -grade Cross Section View
Aggregate Dispersal Area
Finished Grade 102.62 (ft) ►(' Observation Pipe
Lateral Invert (ft) Typical lateral see Details
101.35
r; :.::•:;: Geotextile Fabric
3 ~ � yy i 1 y a 3 a a ;, J, a 1,
l.• •Y a : �+l` ' F., ti ^^.�'�A.J A '"v. `_/'^.,C •.i�. :�jJ ,� .,{' ^�.�. � '•,.i'.J ^..0 _. - . �•i,
��''�,''� {'= a .''� }�.� : -t' '��', �?�a^ j� ,,�, .;L� ..:tom . J ?.,.r�..;. 1'.. _A. J ,{ �'kf ._''_�,f''^.:
0.0 % Site Slope 100.85 (ft) Contour Elevation
Shading Key
0 Topsoil Cap See lateral details on Page 4 for the number of
:0 Tilled Layer laterals, size, and spacing. Laterals are equally
{ Aggregate spaced from the center of the distribution cell as
per Table 3 of the component manual.
Project: MICHAEL MARTIN Page 3 of 7
Center Connection Lateral Layout Daigram
Force main connection Wa tee or cross to mar"d at any point. Laterals are identical
ri
r P S
AV—
Turn-up %9 bell valve or � X 1 IE st2 ur2 41 Laterals & for. main of F VG ScM 40
oleanoutplup per COMM Table $x.30 -5
Holes drilled on the bottom of the lateral
Number of Laterals 4 Orifice Diameter 0.156 in
Lateral Diameter 1.25 in Orifice Spacing (X) 1.78 ft
Lateral Length (P) 43.61 ft Orifices per Lateral 25
Lateral Spacing (S) 5.00 ft Orifice Density 9.00 ft /orifice
Lateral Flow Rate 13.46 gpm Manifold Length 5.00 ft
System Flow Rate 53.85 gpm Manifold Diameter 2.00 in
Total Dynamic Head 18.62 ft Forcemain Velocity 5.50 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and
Comm 16.28 WAC 4 in. min.
Disconnect
Tank component is property vented y = Attemate outlet
location
Forcemain diameter
HUFFCUTT Manufacturer_ 2 in.
Capacityl 600.00 Gallons
Volume 12.00 gal /inch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 28.23 338.74
B 2.00 24.00 C P� ump off elevation (ft)
C 7.77 93.26 — t - 1 93.00
D 12.00 144.00
D
Total 1 50.001 600.00 11
Dose tank elevation (ft)
3" Bedding
uncler tank. 1 92.00
Alarm Manuafacturer ILEVEL ALARM
Alarm Model Number JDV1L
Pump Manufacturer IZOELLER
Pump Model Number 1140
Pump Must Deliver I 53.85 gpm at 48:62 ft TDH
Project: MICHAEL MARTIN Page 4 of 7
i
At -grade System Maintenance and Operation Specifications
Service Provider's Name DENNIS GILLE Phone 715- 268 -6637
POWTS Regulator's Name [5j- C ru ' C v.� •,: ) Phone ['7 i 3rE_ ye *-0
System Flow and Load Parameters
Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow- Average 300 gpd Maximum BOD5 30 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 30 mg/L
Soil Absorption Component Size 900 fe Maximum FOG 10 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform 10E4 du/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once every 3 years
Effluent Filter Should inspect once a year and clean once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested every 1.5 ears
At -grade Inspect for ponding and seepage once every 3 years
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished •.. ................
Grade
6-8" Diameter :. Threaded Cleanout
Lawn Sprinkler Plug or Ball Valve
Valve Box
Distribution
Lateral _.
101.35 ft -- Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: MICHAEL MARTIN Page 5 of 7
I
At -grade System Management Plan
Pursuant to Comm 83.64, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component
manuals [SD &10570 -P (R. 06/99) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and
maintenance repotting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings
used for service and assessment shall be seated watertight upon the completion of service. Any opening deemed unsound, defective, or subject
to failure must be replaced. Exposed access openings greater than 8 -inches in diameter stall be secured by an effective locking device to
prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank
shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter stall be assessed at
least once every 3 years by inspection.
The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are
made to retain solids in the tank that may slough off the filter when remoMed from its enclosure. if the filter is equipped with an alarm, the fitter
shall be serviced if the alarm is activated continuously. Intermittent filter alamis may indicate surge flaw or an impending continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If
the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the avner of when the need
service needs to be perfomxed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. Hanever, if such products are
used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. Al switches, alarms, and puns shall be tested to verify proper
operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
At -tirade and Pressure Distribution System
No trees or shrubs should be planted on the at -grade. Plantings may be made around the at- grade's perimeter, and the mound shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative
maintenance) on the * -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the at -grade and
snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily
mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L
BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flaw may not exceed maximum design flaw specified
in the penrat for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed
of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the
system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the
dispersal loll.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels
above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Continaenov Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper
operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired
or replaced with a component of the same or equal performance.
If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in
its' present location by increasing banal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related
piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
See PageA of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: MICHAEL MARTIN Page 6 of 7
15, HIM CURVE 1o7nL DYNAMIC M H
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• Variable level control swftahsi are &rillable for controlling single phase
systams.
• Double piggyback varlable lei al ffrat shyltrhes are avallable for variable SEWCMN Gul A:
level long oyale controls. 1. Single plggyback variable lavelfbataw Idi a. rouble plggpclvvadebls level
• Sealed Qwlk-Box avallable, fc! - cu.-Iijor Installations. See FMI42D. float slultah, Refer to FW477,
• Over 130'F. (64"C.) speclaJl F uotF 0: n required. 2. Marhanlual ellarnstor M-Pak 10.007(! or 1 0- X 1 1 5.
3. Sea PM0712 for correct model of El" ic9ilPti:rnator E-ft.
• Rei�w to FMOBOO for 200" F.; ip:)V Jcins, 4. Vednble level control switch 10-MS tm id jra; c-inud acavator, Spa* duplex
(3) or (4) tout syslam.
6. Four (4) hole J-Pak kinagon box. fartwailig-it junnaefionorwhd-haimplax
140 Serle 6;! 11, 3. 4.140 Series - 73 tbs. Di 2 pump operation, 16-M.
1014140— MOD R�s Control seractl*n
Modal Model Volts l'h h ride i1m — amplex DUP
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RESERVE POWERED ID SIGN
For .......... . . L WaIM1. Co nditions a reserve saf4 faCtor is enflInaored into the design of every Zoeller turri 3.
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ML T& P.0, BOX 18347
L. Lmk*. KY OMW341 e4anurarlur9y LV
SHIP 70: 3349 0wa Ran Rred
an U*WHS, KY 4021 1-1981
(502) 778-2737- 7 1&90) Lr.J&PUMP
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Wisconsin Departmer °t of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete sib: plan on paper not less than 8 1/2 x 11 inches in size. Plan must County '
Include, but.not lima ad to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scalf or dimensions, north arrow, and location and distance to nearest road.
Please print all Information. Reviewed by Date
Personal information , ou provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner jreLrt,yt Location ..
t
G 114 1/4 SS T N R f E (or,' Property Owner's MaliV Address Block # & Name v i:C.5 jA#ti
IS 7
City fate Zip Cade Phone Number ❑ Cl . ❑ Villa Q Town. Nearest Raad
WET 'S - (/0 'Z I ( ) l G S 77
0 $� New Construction Use: 0 Residential 1 Number of bedrooms Code derived design flow rate 'y L> GPD
Replacement Publi mmercial - Describe:
Parent material -- - Flood Plain elevation if applicable _ ,_ •_, ft.
General comments
and recommendations:
`. Boring # ❑ 3oring r �
Gro u nd loo 'F
ou d surface lev. ft.
e Depth to limiting factor .2 t
d — p n n,
g _ Soil A
pplication Rate
Horizon Depth Dt.minant Color Redox Description Texture Structure Consistence Boundwy Roots GPD/fF
in. Munsell Qu. Sz. Cant. Color Gr. Sz. Sh. _ 'Eff #1 •Eff#2
r
Boring #! ❑ I. oring
a 1'it Ground surfaceeiev. Depth to limiting factor J Gn
Sort Application Rate
Horizon Depth Do ninant Color Redox Description Texture Structure Consistence Boundire Roots GPD1fF
in. rAunsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
2, 9Z 2'vksxlt�
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Efiiuent #1 = BOD > 30 < 220 mg1L and TSS >30 a 150 mg 1. ' Effluent #2 = BOD < 30 a p /L and TSS < 30
CST Name (Please Prin!) r e6:15 CST Number
Address Date Evaluation Conducted Telephone Number
��� /�o �� Si � ��ipr�i �.t,.'.,� S`�/cxti / �W��O• C� f ' ,i,�.1 -..Z6� ����
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Property Owner %Q+v�C . Parcel ID # F age of_-?_ _
Boring # ❑ Borirtr;i
pit Glimund surface elev. ft. Depth to limiting factor 2_ tn.
Soft lication Rate
Horizon Depth Dominant 1,10of Redox Description Texture Structure Consistence Boundary F oots (MOM
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Et) #2
9• S+Y` .rY�s,?t� C2,0 y SL User --
Boring # ❑ Boring
�J ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sort A
allcation Rate
Horizon Depth . Dominant; C olor Redox Description Texture Structure Consistence Boundary Rcots GPD/fF
in. Munseell _ Qu. Sz, Cont. Color Gr, Sz. Sh. *eM1 'Eff#2
Boring # ❑ Boring
❑ diu
Pit ound surface elev, ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Ro.kts QPD
In. Munsell _ Ou. Sz, Cont- Color Gr. Sz. Sh. 'Eff#1 'Eff#2
" Effiuent #1 = BOD > 30 c 220 mg/L and TSS >30 150 mg/L • Effluent #2 = BOD 5 30 mg/L and T 3S 130 mg/L
The Department of Comm,mcc is an equal opportunity service provider and employer. If you need assistance I a access services or
need material in airt alternate format, please contact the department at 608 -266 -3151 or TTY 608 -2 a4- 8777::
S013-6330 (P-W)
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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 8 112 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. R 'ewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). oo 7.
Property Owner Property Location
i
Govt. Lot 1/4 1/4 S T N R E (or) W
Property Owner's Mailing Address Lot Block # I S' ++d. Name o CS ,
So A S
C' tate Zip Code Phone Number ❑ City ❑ villa C3 Town Nearest Road
(,u2' .S'v z l ( ) /0 t: TX S r
10 New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate — GPD
❑ Replacement 0 Pu )110 r al- scribe:
Parent material Flood Plain elevation if applicable ft.
General comments .�
and recommendations: = R ECEIVES
9, 6 2001 w
❑ Borin
F/-1 Boring #
u Pit d domI Depth to limiting facto in. Soil Application Rate
Horizon Depth Dominant Col 1 io Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell olor Gr. Sz. Sh. 'Eff#1 •Eff#2
f�- 2. sy e , 7 . r// S4 ,2vFSf -4r h -iJ�rd a&l �
ak/
3
i
F2-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ` g� ft. Depth to limiting factor , o in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fE
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
0-// 7 1C rC.s/ SL UFS�i�' irJ vF� 4 6✓ !/G i
Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 nV& • Effluent #2 = BOO < 30 mgA- and TSS 5 30 mg/L
CST Name (Please Print) t na re CST Number
A=^ ( , "/ / ZzZv2
Address Date Evaluation Conducted Telephone Number
3) 14v 4 s i A h-iep I Gv � S' you
Property Owner Parcel ID # Page of�_
F31 ' # [] Boring
/� ft. D to limiting factor 2_ in.
pit Ground surface elev. �' 73 P 9 Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Eff#2
3 9•y4' ,.rY4s/ C2o sy ff y/
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
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
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
I
Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 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.6/00)
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
WNERSHIP CERTIFICATION FORM
Owner/Buyer R
Mailing Address S 7 1,ee4,-,W G+/S S'
Property Address I a. / O (Q �T /
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number O a to — / / — 6 — 0 0 C
LEGAL DESCRIPTION
Property Location '/4, % a, Sec. S , T 34 N -R W, Town of
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # & y e7 Wa , Volume X �o 3 , Page # o26 7
Spec house ❑ yesX. no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
tiiaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the 'Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the a 7earptration date.
SI A OF APPLICANT DAT
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.**
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
' YO 1663PAcc269 ra
STATE BAR OF WISCONSIN FORM 2 - 1999 64$ 746
KA IHLEEN H. WALSH
WARRANTY DEED
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Halle Builders, Inc., a Wisconsin RECEIVED FOR RECORD
Co rporation, -
- 06 -14 -8001 3:00 DM
WARRANTY DEED
Grantor, and J. Martin, as EXEM FEE:
tenaats.ip_eenman, O f COPY FEE:
TRANSFER FEE: 87,60
RECORDING FEE: 10.00
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
of Partridge Run, Town of Richmond Recording Area
SC CROIX VALLEY TITLE SERVICES. W
PO BOX 750 109 N. 1tAIN S
RIVER FA.LB, VA 644U
G r - c` >a7
026-1121 -06 -000
Parcel Identification Number (PIN)
This is not homestead property.
not)
Exceptions to warranties: municipal and zoning ordinances, easements and restrictions s) record.
(is) (is
Dated this �5 day of June 2001
- HALLE RS,
• y: esi W alle President
` • By: Linda R. Halle, Secretary
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
ST. CROIX _ County )
authenticated this day of
Personally came before me this /S?`Z day of
June , 2001 the above named
+
Wesley W. Halle as President and Linda R. Halle as Secretary of
s aid Corporation _
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, t9 wn to be the person(s) wh executed the foregoing
authorized by § 706.06, Wis. Stats.) , �Qi d acknowledged a c.
THIS INSTRUMENT WAS DRAFTED BY NOT
Judith A. Remington - Remington Law Offices Y P tic, , ate of Wisconsin
P.O. Box 177, ew Richmond, W1 5401T PuftlGot rri s, n is er anent. not, state expiration ate:
(Signatures may be authenticated or acknowledged. Both are not a �L b 2 )
' Names of persons signing in any capacity must be typed or printed beN didQj9iVyqq0 InlonmUon Profesaonals Company, Fond du Lac, WI
WARRANTY DEED STATE BA soo- ass -2021
FORM No.
l
S 89 W 660.00'
d 3x.00 I 220.00' 162.19 323.37
-- - _ 627.00 - - -- -
y S89'08'47 "W 705.56' -
I STORM WATER 1 8
�a, ! RETENTION AREA
Na 1.014 ACRES �^
I MINIMUM BLDG. iv 7
44,147 SQ. FT. 0
ELEV. = 978:7 9J
k
I \, , ;,� N 1.017 ACRES
I I
co 44,277 SO. FT. N • yh
I r N ?
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1 33' 33' ` 70;430 SQ. FT. I 80 y 9'
I � l 1
' j 1
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` Z` 25.00 rn �/ 4 ,217 SO.
w I SEPTIC SYSTEM' �i
E o i a ,►� EASEMENT N 1.028 ACRES •..•
I 1 r
I N� TO LOT 1 44,779 SQ. FT. I I S99 20
I : ��-- - - - - -- 50' F -
l S89'32'57 "W '~ W 150'+
q
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00 �' j 1.019 ACRES I w 3 1 ;
w l ...... _._. 44,389 SQ. FT.
� W L N N
Q j I d 1.047 ACRE
M u t o 5 I N O Z 45,612 SQ.
I i I
'Qi I : ''� I i BENCHMARK USGS rn
N 1.127 ACRES 1 1
o f I DATUM 1929 ,ri 49,112 SO. FT.
o I I I ..
"r f ELEVATION = 982.34 i o 9'55 31 E 20
i in I N
w I 2.2Q7 ACRES
j 96,149 SQ. FT.
1.013
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I
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100, a 1.826 ACRES
33' 33' I M 79,555 SO. FT. \ `�
I _ S 89'55'31'_ W 331.70' \
M r' --
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.. -, --. :
1 1
1 1 33 33%
j STORM WATER RETENTION AREA c�
4m C4
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I I H.W.L = 979.10 o,n 1
1 i o
L - -- -- - -- •-- •- -• - -• -- • - -•- - . --
S1 /4 CORNER M S89'55'31 "W 559.16'
- -- SECTION - - -
M SOUTH LINE OF THE SE1 /4 N 8 9 '55' 31"
LD —
I IAIC
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� " 2004
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421 Wtwbxer Aw., Par. 800 4232
Frad6n1a, W1 51021-0.340' USA . "d*Pet"mce
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Jun 21 04 06:32a Phil Lundman 262- 692 -2418 p.l
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IFEELD
INsPI&
Pete rsen
cxxr & SER'VIC'E REPOR'X`
For Use Onl ' Y nY Petersen Certified Prot'essionais OCT .� � 20013 For B'
o- licro
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U nuAMI Odor
7lvbulencc
1'umpout Required:
PritnarY Settl AS Zone
Aerobic Trcatmcmt Zone
Effluent
Clear Color
Septic Odor
Estimated Dai n ow
pl'l (Standard Units) 6-9 S.U.
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1'O Box 3a0 QU. 19X6
421 Wheeler Ave Tel: 888�'SS�6864
Fredonia, VVx $3021- USA Fax- 200- 669 -1232
Ps Fw3r"1'L0ft'W KVarr,,r,d Itt 1LMf0� E-Mail mail@pctcrson.cc
Jun 21 04 06:32a Phil Lundman 262- 692 -2418 p.2
nnnl
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Peter
a�x�x.D � e �'i
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my By Petersen Certiflcd Pr
For B o- Microbics FA(S7�System
,YY J
Installation Add
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Owner Name llb- Name
AAA
Mail 444ma Stmct" /
city WWO 1 State 7a1p t ddress
Td
Tel Email
Model No.
Serial N
o• D of Ynsmllatiott Date afLast Pump out
Electrical s T�
Visual Alarm opemang a
Audio Alarm Oporating t;it'pracnQ
Slower(s)
Air Inlet Mtcr Clean ✓
Blower Hood Vents Glean
Excessive Noise
Excessive Vibration
r
Treatment Un ic(s)
Unusu$I Odor
T'urbulence
.r'
Pumpout Required:
Pri=tfy Settling Zone
Aerobic Treatment Zone
RMuent
Clear Color „
Septic Odor S
Uintatied Daily Flow
PH (Standard Units) 6 -9 S.U.
Dissolved Oxygen - Dist. Sox + -------
- Aerobic Unit
,�,,.. 1 tp 1 •%� a W6 •?t? 1S
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PO Box 340 ffr,L0MEro QUAfIrYPROD crssrACE19x6
421 Wheeler Ave. Tel: 988-45$-U64
Fradoetis, Wl53021.034{0 USA Fax: 800 -"9 -1232
PSFAWnCLbWV'$1MVWjnd IW ALAk01 E"N/lxil nWl@p0z=.cc
Jun 21 04 06:32a Phil Lundman 262- 692 -2418 p.3
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'VICE RIPOR
For Use Only By Petersen Certified Professionals
For Bio- AIicrobics .FA�''?�,S stem
Installation
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Visual Alarm Operating
Audio Atari Operating (,ifpe J ✓
131ower(s)
Air Inlet ?Utrx Clears
Blopver mood Vents Clear .�
Excu sive Nobc
-Excessive Vibration
Treatment Unit(s)
Unusual Odor
Ttisrb ace ✓ •
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Pampout Required:
9`t'imary Settling zone
Aerobic 'I=U=,ftt Zone
Emuent
Clear C)for
Septic Odor
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PH (Standard Units) 6 -9 S.U.
Dissolved Oxygen - Dist. Sox +
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PO Box 3 QUALr7 Y ARObUC7SSZNCLc 1916
421 wXjoelGr Av e. Tel: 888 -455.4"
Fredonia, W153021.4344 USA Fax: &W-469 -1232
ptvPsrrreMn►srmavwrpe a.., �uv+oi Bail mail*Pva=.ec
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Jun 21 04 06:32a Phil Lundman 262 -692 -2418 p.4
Peter
sen
,F D Oar & S MICE REP
For'YJse Ozdy sy Petersen certified ProfessiOMIS
For .3io- Microbi,= FASX0 Stem ..
Installation Adds' ���(ea -Se. k.,
'St\ Name
tao. ti
Owner Name �, Svod Address
Mail / •
Qty v State -7 .T.�p
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Model No. Sa ul No. �
Da of elation Date of'L.ast P Out .
�ectrical Par�et(s) , � •
Vssaal Alarm Opd*tiug
Avdio Alarza Opcxating Cif pmq=1 '✓
Blower(s) "
Air Iwo filter CI=
Blower Hood Vents Clear
EX0ewvO Mix
ftoessivo Vibration ✓ _
Treat U nit s)
Unusual Odor
Turbulences .�
Pumpout Required,.-
Primary ScUUAg Zone
Aarobie Treatment Zone
Etllucne
Gear Color
Septic Od or
Estimated Daily Now
PH (Swoar -am 6-9 S.V. -- - _
Dissolved Oxygen - Dist. Box
15x Unit
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PO Box 340 if LOVE 7'70 SERI QU.4L17 YPRODidG`XSSINCL� 19X6
,
421 'VAiceer Ave. Td: 8884SS-6864
Fredonia, WI5302I -0340 USA pax: 800469 -1232
a..r a.-g W,ttuo+
SAFETY AND BUILDINGS DIVISION
commerce Integrated Services Bureau
13 East Spruce Street
■ ■ Chippewa Falls, WI 54729
t i Department sconsin INSPECTION REPORT www.commer �. 5aa of Commerce
Date of Inspection: April 20, 2004 Plumber Name and Address:
Project Name: Martin Dennis Gille, MPRS 221471
Parcel ID: 026- 1121 -06 -000 372140 Street
Legal Description: 5- 30 -18W RECEIVED Amery, WI 54001
Site Number: 632114
Subdivision: Lot 6 Partridge Ru Cert fled Soil Tester Name and Address:
Municipality: Town of JUN 0 7 2004 Dennis Gille
County: St. Croix
5l - . CROIX COUNTl
Plan Transaction Number: 6 ZONING OFFICE
Sanitary Permit Number: 395190 Owner Name and Address:
Michael Martin II ll
Wastewater Flow: 450 gpd OLJ
Persons Present:
This inspection was completed pursuant to s. 145.20 (3) (b) Wis. Stats., as part of the annual audit of the
St. Croix County Private Onsite Wastewater Treatment System program.
Issues for the installing plumber /maintainer include:
1. There is no record of the initial and 6 -month service required for the FAST unit as per the
manufacturer's requirements. A licensed maintainer shall complete the required maintenance
immediately and submit reports to the county and the manufacturer's representative, Peterson
Supply.
2. A deed notice shall be recorded indicating the need for maintenance as per Comm 83.21(2)(c)5, Wis.
Adm. Code. Contact the county for details. e " a Q - le ,
3. Manhole covers on all above grade openings larger than 8 inches need to be securely locked.
Padlocks are present, but are unlocked and still have the keys in them.
4. The pump tank manhole riser needs to be at least 4 inches above finished grade to prevent surface
water from entering the tank.
5. One of the valve box enclosures over the lateral turn -up is broken, and needs replacement. This is
an issue for the owner to correct.
If you h ve any questions regarding this report, please contact me.
L G. Jan Waste ter SpR-ail
Ist
Ljansky @co erce.state.wi.us
715/726 -2544 Voice
715/726 -2549 Fax
cc: DKCounty ,®. Plumber r_1 CST ❑Owner ❑
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From: o Jansky, Leroy ansk commerce.state.wi.us
Y I Y@ l
Sent: Monday, July 12, 2004 8:29 AM
To: Pam Quinn
Subject: RE: Mike Martin Biomicrobics Filter Inspections
I'm pretty sure that Peterson Supply will make sure that there is
someone to
continue inspection /maintenance. There is a guy from Chippewa Falls
that
has quite a number of there type of units and will travel. His name is
Bob
Zwiefelhofer 715.839.3100.
I
Leroy G. Jansky, Wastewater Specialist
DComm - Safety and Buildings
13 East Spruce Street
Chippewa Falls, WI 54729
(715) 726 -2544 Office
(715) 828 -5902 Cell
(715) 726 -2549 Fax
• - - - -- Original Message---- -
> From: Pam Quinn
• Sent: Monday, July 12, 2004 8:16 AM
• To: Leroy Jansky (E -mail)
• Subject: Mike Martin Biomicrobics Filter Inspections
> Leroy, we received a copy of the inspections done on the FAST system
at
> 1712 106th St., New Richmond (Lot 6, Partridge Run) from Dennis Gille.
> Dates from 3/28/02 to 7/2/04. However, an attached note says their
> contract wiol not extend into 2005, so owner will have to renew or
find
> new POWTs maintainer. Will copy the copies and forward for your file.
>
> Pamela Quinn, Zoning Specialist
> St. Croix Co. Zoning Dept.
> pamq @co.saint - croix.wi.us
>
��► �,a0� -� o T
FEB 20,2007 12:04 Bob Zwiefelhofer 715 - 726 -2026 Page
POWTS INSPECTION AGREEMENT
The correct operation of the below equipment significantly influences the life of the wastewater system. Periodic
inspections will help extend the life of the system and prevent the need for costly repairs. This agreement authorizes
access to your POWTS equipment by a trained and authorized technician during daylight hours to provide regular
inspections and routine maintenance to help assure the equipment is won irip prop.
r�lr s FFyy 12.
It is hereby agreed by and between Purchaser an d n - tcrRrerrt,6e- (3ervrce Provider) that in
consideration of the payments provided for herein, Service Provider will provide thn services of a factory- trained
representative to porform periodic inspections of the equipment described below. Service of wi l prepare a written
report after each inspection and provide a copy of the report to the Purchaser. This report will contain recommendations
for any operation and maintenance deemed appropriate by the inspector.
This agreement does riot assume any re$Fxwn5ibili6es or obligations that arc normally the responsibilities of Purchaser and
does not extend to cover any costs that may be associated with any recommendations made under this agreement. in no
event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of
time, injury to person or property or incidental economic loss due to equipment failure or for any other reason whatsoever.
Service Provider may supply additional services, parts or tabor only after aulhorizafiun by Purchaser.
This agreement shall remain it, force: for a period of 2 years, beginning
20 and will
automatically renew each year thereafter for one year unless canceled by either party with at least 30 days written noticd.
This agreement may be canceled by the Purchaser only if replaced by a service agreement with an authorized service
provider for the equipment listed below. Sorvico Provider may delay or cancel future inspections it payment becomes at
least 15 days past due.
n ., ..._ pect
Periodic Inspections: The Purchaser agrees to pay L Per ins ion
---
for four (4) inspections for the first two years at six month intervals and 1 (one) inspection each year thereafter. Payment
for the first two years of inspections is due at the time of installation; addido payments are due upon inspection. Any
additional testing or services toga� ed by Purchaser will be pilled based o and material amounts.
iZ L7 7�/un+ �` 1 w 2 X02 D
Service Provider: Signature: - Date
EcatuiPme nt Covered Under This Agreement
Description Model No. Serial No. Install Date Location if different from System Owner
S stem Owner: /
company Name: �--L �,v LL ��`/ .Y.v �-- Date:
l v5 --2o —o 7
nature: ✓ tlama: Rme:
/ 7
Street: .._..... _...
E-"l:
City, Stew, La
Payment Type: Cheek Cash American Express Visa : MasterCard Other
Credit Card No. Exp. ate Se rity Code Amount S
Name on Credit Card (print) ignature: _ --
• •• — HeG+h MMwt hwRMtNSLNW2l4BM7UtM1 %IC
- Tel: 888- 455-6864, 262.892.2416
tl>v; awaillu.N r N • by Fax: eoo -609 -1232, 262.892 -2418
Petersen an agement Co., LLC E - Mail service@potorson.cc
p0 eo>i 340,421 Whodor Avo., frodaua, Wl 53021 -0340 USA QUALITY PRODUCTS SINCE 1916
WE LOVE TO SERVE Our Customers -- ..
i
FEB 20,2007 12:05 Bob Zwiefelhofer
715- 726 -2026 Page 2
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