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HomeMy WebLinkAbout026-1296-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division . • INSPECTION REPORT Sanitary Permit No: 488107 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)). Permit Holder's Name: City Village X Township Parcel Tax No: Osborne, Caroline I Richmond, Town of 026- 1296 -16 -000 CST BM Elev: Insp. BM Elev: BM Descripf n: Section/Town /Range /Map No: 00, b /00 a K m / 07.30.18.1547 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t • , ` Benchmark 0 ' Dosing Alt. BM t>> 3.2O 10 3. 1 Aeration Bldg. e 1 / 9b /O /, / !• . S Holding SUM In S 775utlet TANK SETBACK INFORMATION TANK TO P/L L G . en o it Intake ROAD Dt I ep Ic l , U � Dt o o ' `'b - / g l• • ` l i ea an. �. -11 A eration Uist. Pipe / Zsi• 2•qn , Z' o Ing 1361 S ysterin b2► & 4�L Final PUMP /SIPHON INFORMATION ra e / /D anu ac urer eman r GPM �Ma�' •e a r ti o e um er '� 3 `o • �� lum I 0 ^ ric ion o ys em ea I or i eng 4L ia.� t• �•� Z- /o/, // Ndl SMUMSURFTIUN SYSTEM ENSIGNS /_ INFORMATION r CHAMBER OR UNIT Pipe(s) �J j 1 ��O 0 3 I L)IST=N 5Y5 Length Dial •� Le Dia L_ Spacin 2 . x Pressure Systems Only ound Or Grade Systems Bed /Trench Center Bed/Trench Edges Topsoil / V Yes o Yes �t••=t'No COMMENTS: (Include code discrepencies, persons present, Inspection #1: / , / Inspection #2: Location: 1641 97th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 7 T30N R18W) Country View Ridge Lot arc;,:. 1.) Alt BM Description 2.) Bldg sewer length - amount of cover �' - -- - b �J i � / Use other side for additional information! Plan revision Required? Yes No S ctor s- nature - -- SBD -6710 (R.3/97) J Luc �� Mo Subject: Utgard /Osborne, Lot 16 Countryview Ridge, 488107 - plowing Location: Richmond Start: Fri 6/16/2006 9:00 AM i End: Fri 6/16/2006 10:00 AM Recurrence: (none) Final @ 12:00 J 026- 1296 -16 -000 r� 07.30.18.1547 t 164197th Street i r n f u S v 1 r— Safety and Buildings Division County m 201 W. Washington Ave., .O. Box 7162 ,� Madison, Wl 53707 162 Sanitary Permit Number (to be filled in by Co.) Re artment of Co merce (b08) 26 51 Qg 0 1' c� LOU Sa tary Permit Application State Plan D. Number �p �1�qq�$ 2 �F9 o = �AJL. � n ST ;I ti VUN with C m 83.21, Wis. Adm. Code, personal information you pr tde 5i)ay b d for secondary purposes Privacy Law, s15.040 )(m) e e / Project Address (if different than mailing address) ., 1. Application Inform rint n ormation �J L 7�1 11 1 InAp FF L4�4j4 Pro rty Owner's Nam t �R a # t # Block %Rf operty Owner's Mailing Address it perty Location (� ©d & < P - %., � /., Section City, State Zip Code Phone Number T 3t✓ N; R o; II. Type of Buil ug (check all that apply) p I]Dr S Subdivision Name CSM Number 9L or 2 Family Dwelling - Number of Bedrooms _ (" _ ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ i�0—slip f 1 11. Type of Permit: (Check only one box on line A. Complete line B if applicable) D 214, - /z9(e - /tio ^ eM 6 A. New System p y p Y ❑ Replacement S ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil XMo..d 124 in of sttiWJC- o il ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chain Drip Line Pi ❑ Other (exp aver -less ain / f V. Dispersal/Treatment Area Information: X 710,5y (Of' • 0 Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 00 /,O O© (:�; b ,33 VI. Tank Info Capacity in Total Number Manufacturer efab Site Steel Fiber Plastic Gallons Gallons of Units GJI� Q -,,M Crete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber o o t VII. Responsibility State ent- I, the undersigned, assume responsibility for biptallation of the POWTS shown on the attached plans. Plu Na Print) Plum 's Si atur rM MPRS Number Business Phone Number Plumber's Ad r ss (Street, C , tate, Zip Code) U /u 4A-,e 2 sy o0 VIII. County/Department Use Onl Approved El Disap Sanitary Pennit Fee (i ludes Groundwater Date Issued Issuing Agent Sign tur (No Stamps) Surcharge Fee) ❑ O ve easo or Denial IX. Conditions Approval SYSTEM NER: 1 Septic tank, effluent filter and {An? �x S dispersal cell must all be serviced / maintained as per management plan provided by plumber. S 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plant (to the County only) for the system on paper not less than 81/2 x It inches in size SBD -6398 (R. 01/03) ]� 8/k .406 loref - N vo Cr � O DO ��OCa a 115, I o X13 -� O f 1 • ®p ,G l L Safety and Buildings 10541N RANCH ROAD Commerce.Wl.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commer www.wisconsin.gov www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 15, 2006 CUST ID No. 220357 ATTIC• POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/15/2008 Identification Numbers Transaction ID No. 1249060 SITE• Site ID No. 710365 Western Wisconsin Homes Please refer to both identification numbers, 87TH St above, in all correspondence with the agency. Town of Richmond St Croix County NEIA, SETA, S7, T30N, R18W FOR: Description: New mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1065939 Maintenance required; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes W,� and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 410 No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: ca • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. BRADY J UTGARD Page 2 3/15/2006 • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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/installation /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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operatio maintenance of t e POWTS. Si rely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 P atricia L r POWTS PI a viewer , Inte ated Services WiSMART code: 7633 (715) 634 -7810, `Fax: (715 34 -5150 , M -f 7:45 am - 4:30 pm pat.shandorf@wiscongin 1 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 CONCAVE DISTRIBUTION CELL CALCULATION FORMULA 8 OFT. ; 75 FT. =.08X 100 =8 FORMULA 9 8 X 0.00265 + 1 X 75 FT. = 76.59 FT. 15 1 5 N A- GO N G� �1 1, AA A r f (o. S(1 > Ln ON C.6 t.d,, W i i-c- Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 °/6) colftm of - 36 inches. 600.00 Design Flow (gpd) 10.00 Site Slope ( %) 101.00 Contour Line Elevation (ft) 20.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/ft Distributiop Cell Information 7e * , Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 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 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2. Estimated Orifice Spacing (ft) = 10.00 fe /orifice .00 Forcemain Diameter (in) / 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 7.08 Vertical Lift (ft) 46.75 5x Void Volume (gal) v 3.20 Friction Loss (ft) 63.06 Minimum Dose Volume (gal) 13.53 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x X 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallonstinch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 35.97 Total Working Liquid Depth (in) WIESER Manufacturer 22.24 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) izable I Filter Manufacturer 22.24 Dose Tank Volume (gal/in) Ja100 Fitter Model Number WIESER Manufacturer Project: western wi. Homes Page 2 of 9 Mound Flan Vie ------------------------------------- 1/10 B : . J . - . - . . . . . . . . Observation Pipe — K :--- ... . . ": L Mound Comoonent Dimensions A 8.00 ft E 25.60 in H A6.01 ft K 10.51 ft B Sg F 9.25 in z ft L 96.03 ft D 16.0 in G 0.50 ft J ft W 28.60 ft 600.00 (ft Dispersal Cell Area 1 1694.20 (ft) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.10 (ft) - -► E.:.,. �.... G * H 2 �rfr:.. •j F ......Dispersal i cell — 102.83 (ft) Lateral 102.33 (ft) — Invert Dispersal Cell t Elevation E D . 101.00 (ft) Contour Elevation 10.0 %Site Slope Geotextile Fabric Cover Shading Key c. T Dispersal Cell See lateral details on 10 _ Topsoil Cap c ° 1.5 ft Page 4 for number, size, Subsoil Cap c .,+�: ;• • .• and spacing of laterals. 0 ASTM C33 Sand — Z r�• : •'ti : �':? iti'• F Laterals are equally ®Tilled Layer m 0.5 ft Typical ! ?��a!_ spaced from the Q J� r�:ti Aggregate et c • "'r:; :::.• I distribution cell's ' ' A ' ' -j-- centerline in the distribution cell (AxB). Project: western wi. Homes Page 3 of 9 Center Connection Lat=er-al Layout Dai�:�:F Force titan —nectim via tee or cross to manfold at am poatt Laterals are identical I R S •= Turn -up rdball valve or 02-)l Laterals & force main of PVC Sch 40 deenoutplug per COMM Table 84- Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 fe /orifice Lateral Flow Rate 9.83 gpm Manifold Length 4.00 ft System Flow Rate 39.32 gpm Manifold Diameter 1.50 in Total Dynamic Head 13.53 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Ling cover with war„im label and locking device and sealed watertight Electrical as per NEC 300 and -► Cantu 16.28 WAC Disconnect 4 in. min. Tank carponent is prey vented Alternate outlet location Forcernain diameter WIESER Manufacturer 2 in. Capacityl 800.00 Gallons Volume 22.24 gal/inch A Weep tole or antF Dimension Inches Gallons B sipton device A 22.14 492.30 B 2.00 44.48 C �Ptxnp off elevation (ft) — f C 2.84 63.06 95.75 D 9.00 200.16 D Total 1 35.97 &M.00 F �Dose tank elevation (ft) 3" Bedding u tank. 95.00 Alarm Manuafacturer LEVEL Alarm Model Number DL Pump Manufacturer GOULDS Pump Model Number EPOS �^ Pump Must Deliver 39.32 gpm at 13.53 ft TDH Project: western W. Homes Page 4 of 9 I Mound - Svstem Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715 - 268 -6995 POWTS Regulator's Name st. Croix zoning Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once evTj 3 years Pump and Controls Test once every 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound In for i and once ev 3 ears 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 mound structure and other disturbed areas will be seeded and mulched to prevent sal erosion and help reduce frost penetration. Lateral Tum-un Detail Finished •����� • *06 *00 * Grade \ ' .. 6-8" Diameter Lawn Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Proiect: western wi. Homes Page 5 of 9 • u•ursuant to c.omm as .S.04 yyrs. MGM. k,oae General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD- 10691 -P (N.01101) and SSWMP Publication 9.6 (011811) and local or state rules oertainina to system maintenance and maintenance rWorting- No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and DUMP tank abandonment shall be in accordance with Carron 83.33 Wis. Adm_ Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole tsars, access risers and covers stwuld be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound defective or subject to failure must be replaced. Bposed access openings greater than 84riches in diameter shall 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 shag be assessed at least once every 3 years by inspecdion. The outlet filtershaill be cleaned as necessary to ensure proper operation. The filer cartridge should not be removed unless provisions are made to retain solids in the tank that nay slouah off the filter when removed from its enclosure. If the filter is equipped with an alarm the filar shall be serviced if the alarm is activated continuously. Intermittent fiber alarms may indicate surge flows or an impending continuous alarm. The septic tarn shall have its contents removed when the volurne of sludge and scan in the tank exceeds W the liquid volume of the tarns If the contents of the tank are not removed at the time of a triennial assessment maintenance personnel shall advise the owner of when the nerd service needs to be performed to maintain less than maximum m scum and sludge accumulation in the tarn. The addition of biological or cbemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The plump ( dosing) tank shall be inspected at least once every 3 yeas. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it strap be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perineter, and the mound shall be seeded and mulched as necessary to prevent erosion and to orovdde some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is rot recommended since sW compaction may hinder aeration of the infiltratim surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October- February) dictate that the mound be heavily mulched as protection from frepzina. Influent quality into the mound system may not exceed 220 mg/L BOD 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 flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and 4 is recamrnended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure lest 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 ft dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent pending. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an irrwending hydraulic failure requiring additional more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tent or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, lump, plump controls, alarm or related wiring becomes defective the defective comportertt(s) shall be immediately repaired or replaced with a component of the same or equal performance . If the mound component fails to accept wastewater or begins to discharge wastewater to the around surface, it will be repaired or replaced in its' present location by increasing Nasal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media. and mated piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider_ Project_ westem wi. Homes Page 6 of 9 [qGOULDS PUMPS Submersible Effluent Pump - EPO4 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged thermoplastic design provides AGENCY LISTING • Homes Available for automatic and • Farms manual operation. Auto- superior strength and corrosion S� c Standar& Amodamn • Heavy duty sump matic morsels include resistance. t • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Got" hinips is BO 9001 • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4' maximum. ■ EPO4 Impeller: Thermoplas- a Pow Cable: Severe duty • Capacities: up to 60 GPM. tic semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 1 /2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104 (40 continuous METERS FEET - - - - -- - -- - _ _ - — - -- _ _ - -_ -- - - - - -- - 140 (60 intermittent. ---- -. T_ -- —� 10 • Fasteners: 300 series stainless steel. _ ' -- -- _ —__ -- -- __ -_ -- 9 30 -- - - - -- -; - - -- -- ��5 GPM — -- - -' • Capable of running I dry without damage to $ - _ _ , - - '�2.5 r:r components. 25 0 i i 1 Motor s • EPO4 Single phase: 0.4 HP, u 6 20� - - - - — -- - 115 or 230 V, 60 Hz, 1550 a - RPM, built in overload with r 5 f automatic reset. _j I • EP05 Single phase: 0.5 HP, o a 115 V or 230V, 60 Hz, 1550 RPM, built in overload with E - EPO4 automatic reset. 2 • Power cord: 10 foot 5i- standard length, 16/3 SJTW with three prong grounding plug. Optional 20 0 00 - -- -_._ 1- 0 - -.._ - - 20 - -- 30� - - - - - ao �50 GPM foot length, 16/3 S1TW with three prong grounding plug ' (standard on EP05). 0 z a s 8 10 12 m;fi CAPACM P °-I I 11��V BA = Joy I 1 V Cr � ° la m 1 5 1 l X1 3 J P in do WO SO COW" SS. Vft Adim Cpds Albch eoenpiele aw plsn an pepst not kn $ian 81a x 11 orld In alas. Plea n , t btrhlft bat na *riled toc vt kM and hwbond ratorsttoe p ( eelion and petosntabps. Uskordowsmwmw. andbcetlo narddet. di enceto sarsKiwd, Pond fA ova .ia -PAW ON kdiibf!!Ialdom Reviewed by pob ( otWtnAogt+ MIN 1tAYp ttldN�wYNwdnrwoatyrypirpe�M I5A4 P ti ter Peep"Locafise eS��r GWAtoe 1Ft$ IM s —7 "CPW / T (� N R �} E Lot A 9bG*k o T iiSd Nerve or csw Fla n , ►d�� ❑� � Tawtt `� v Nm Oottakvdon UM43 PMWWatW i Ntmtbsrafbedtsottts ❑ Pepieoett- - Q Ptaa ar amvmwdal . pasct� Cods 01 adpn aow raw /�l7 Patentmdww IQ � Fbod Plefattlt,W*mMappBceble Cc �l�v. /o�•�° + �}of iA� S � a� S;:s� � � 1M ui� bq S a o � ext R ll _ c/do� 8trigar ❑ 8otiap +► 5Gc d.�ut_ woes OFjy2 Lai ER Pit - t3tmw s mbm else "To _ it oopw b *.&9 fst br _ h a Conthnttt Cd 1 Rsdotc Ssi Rtt1s t)sa�Non TinMee Silrucfiw Goneiadettos Root b• "Now OL SL Cott Cdw Gr. Ss, Slt. 'Elpl1 'H1122 �= wzo lm C oteteettrfios t isv: i o�G R popm to mtmg ftw �' sor Rate OWN awI*ard ftodmcn jpt<ctt TOM" Statebm Cat+sistenm Boundwy Rode GPOW im muma am SL Cort Color Q SZ WL Owl L _ r O s` r f A tin i IT • tJilttetM 01 > 3D a 22p niSL w dT= *W; t%** L 6nktstoR . d p esr slow vv� _ ttrAldandT59: 3o ett�i csr Ntatber _ l)ale'Cwellto/ott CattFuasd Tihptane Ntn*W n •4 - cy Z - -- O fo 7/ � 7loca'pL � q Id c I 1' 1 1 Pk ml� f 1 1 • NAME �w+c rein o.X. 14-VIA 5 LOT# f LEGAL DESCRIPTION '/s 'A,S T ,N,R E(OR)W y` SCALE: t» = v BM 1 ELEVATION ,(��• y BM 1 DBSCFt1PTiON r-F eta i�c,L;v" br,4C _ BM 2 ELEVATION ---- SM 2 DESCRIPTION SYSTEM ELEVATION 10Z -� SYSTEM TYPE iAt""% r-ck Sx S�� on I ,o z, oc J 0 0 art, Qg+x SIGNATURE DATE � "�v� I wlsco0atn DoMment of Commerce ` ' ' SOIL EVALUATION REPORT P age i or Melon of safety and BuRdlrgs in accordance with Cornm�8 Code � - Attech aomplets site plan on paper not less then 81/2 x in size. ED 1 include. but not lb-9 to: vertic l and horizontal reference I.D. percent slope, scale a dimensions, north arrow, and t road. Please print all infonwe d 2006 R awed by pate ,/ Pwswdd Wormason ra+ prnvrd* may be uasd ror seeondsry purpaon 1 .or +) (m))• Z 7 Property Owner iv ( (- ( S1 Govt Lot Eim S 7 T30 N R )$ E Property Owner's Mailing Address •S. �� Block # Subd.. Name or CSM# 1jv © ©O .S ne V CRY Phone N ❑ City ❑ Village ® Town Nearest M' V 3 716' 2y1 j , c- --N P, New Cwmftcft Use: 19 Residential / Number of bedrooms -! :Z Code derived design flow ram GPO ❑ Repieoement ❑ Pubk or cornmerclal - Describe: Parent material f')t .0 h Flood Plain elevation If applicable Generalcommenis and recommendations: s y-s4e wt �l e u ` /c � CGn -�,,r ote-v: 1 ° rA ode, 4 !:;Lf rt Sa /irk /L »1 y n t .� rb YG vr� d — O ai ui F ❑ Boring nG (:2 5 k nsz_ tN 4c S G+�J `S:c I ] Boring # Pit Ground surface elev. �dl ' 'O ft Depth to limiting factor in. Soil Application Rate Horimr► Depth Dominant Color Radox Description Texture Structure •Consistence Boundary Roots GPD In. Munsell Qu. SL OWL Color Gr. SL Sh. •Eff#1 'EH#2 C I P ZE V CA k, ► 1 1 r f f It E 0 80" # ❑ Being W Pit Ground surface elev. �g ft Depth to limiting factor 1_ in, Soil Application Rate Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. 'EIr#1 Inn ,- l /1- 6 - V z o v r 116 T4 n 3 14-2Z Etl wW #1 :BOO > 30 < 220 mg& and MS >30 < 150 ffq& ' Effluent n = 800 1 30 mglL• and TSS 130 mg& CST Name (Please Rant) CST Ntsnbx Address DaN Evaluation Conducted Te**Ww Number PtOpeftY Owner a LA , i 4o P parcel 1011 -r t—! 1---- p° oi —.c- - • 00 App!g!!M Rate t torixon Depth Domirwt Color Redox Das0rWorr Tsxkn Structure Corafatenas Bourxlwy Roots t3PONP in. mumda Ou. SL Cont. Color Car. Sz. Sh. •F.M#'t •E1f#2 D -K - SL- L ( , 4 Zl i6 l f C 0 LI 3�._, r- _ 7, 9- 4tW q , E Ap*o # Plat f3round surface elev fL Depth to p nft %CIOr — in' g� gp Rib Modaon Depth Dominant color Redox p pin Texture Struck" Consistence Boundary Roots GPD/R In. Munsel Ou. SL Cont. Color tar. Sz. Sh. •EM#1 'EM#2 Boring in. Bong # ❑Pit end surface elev. 1t. Depth to I TMV factor Rate Modton Depth p Redox Description. Texture Structure Consistence Boundary Roofs In. Munael Ou. SL Cont Color tar. SL Sh. •EM#1 • Etlltent 01 = BOD, > 30 1220 mglL and TSS z-30 =150 mgll • Effluent #2 = 600, 530 MA and TSS 130 M91L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alteraste format, p lease contact the department at 608 - 266 -3151 or TTY 608- 2648777. aors>•ta�u .. I` E W M mmwm Iola •. m..m�... r.•.... o�� er�e®®r■��s ©iii . PA GE - OF 3 NAME G�cS�a jk'i'"� S LOT# / LEGAL DESCRIPTION 1 /a 1 /a,S T ,N,R E(OR)W SCALE: 1" _ <0 BM I ELEVATION )• Q BM 1 DESCRIPTION Ile 64{G & BM 2 ELEVATION BM 2 DESCRIPTION SYSTEM ELEVATION SYSTEM TYPE W��v S� S��.v✓� N v c� 0 7# w 3 = --- SIGNATURE DATE r t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code .,,� //� Attach complete site plan on paper not less than 8 112 x Tines in st County 01 X include, but not limited to: vertical and horizontal referenc rcel I.D. percent slope, scale or dimensions, north arrow, and locaistance to � Please print` all informa eview by Date - Personal information you provide may be used for secondary pu acy Law, : tas.l>a�pr). Property Owner N ` . i , x rgperty Location �l �� z (,c�4lN;r �J C•onr 1 r �(,y 114 1!4 / T3� N Rf E(o W Prope is Mailing AddrKs Subd. Name or CSM# City State Zip Code Phone Nu C' ZOVI'llage To Nearest Road ` I New Construction Use: esidential /Number of bedrooms > Code derived design flow rate GIRD ❑ Replacement ❑ Public or commercial - Describe: -- Parent material / / f Flood Plain elevation if applicable i't/� ft• General co mments and recommendations: Boring # a gyring r/ Pit Ground surface elev. S, ft. Depth to limiting factor in. Soil ication Rate zon Hori Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQAf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 - Faun 0 12 �31L - r Viz- s �, Boring # Boring tJ / in Pit Ground surface elev ft. Depth to limiting factor �b 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 I - Eff#2 L d 3 Z S/ Q m �` S ' to 1,6 Effluent #1 = BOD > 30 720 mglL and TSS >30 1 150 ' ffluent #2 = BOD 1 30 mg/L and TSS < 30 mgA. CST Hama (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 070 -- 0 S� 715- 246 -4516 l Property Owner Parcel ID # Page of a Boring # Boring pit Ground surface elev. & 2 1 ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GPDIF>? in. Munsell Qu. Sz. Co Color Gr. Sz. Sh. 'Eff 'Eff#2 16 . O J F-1 BOnrlg # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in- Soil Application Rate Horizon Depth Dominant Col 'E11#1 Redox Description Texture Structure Consistence Boundary Roofs I ' Etf#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. i ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in- El ❑ Pit F*Eft#1 cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#2 ' Effluent #1 = BOD. > 30:S 220 mglL and TSS >30:5 150 mglL ' Effluent #2 = BOD, < 30 mglL and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SOD4330 i L&W) r Soil Test Plot Plan Project Name Country View Ridge LLC shau ird Address P.O. Box 176 New Richmond Wi 54017 M /#226900 Lot 14 Subdivision Country View Ridge Date 5/20/05 NE 1/4 SE 1/4S 7 T 30 N /R1$ W Ri Richmond c mond F] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron /Nail System Elevation 105.7 *HRpSame as Benchmark Scale is 1" = 40' 339' unless otherwise Property noted Line 100' B -1 10' 20' B -2 106.5' B- 50' 102.5' 16% Slope 110' 245' Property Line B.M. . POWTS 'OWNER'S MANUAL & MANAGEMENT PLAN Page f of 2 FILE INFORM ATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity IR ga l ❑ NA Permit # 4 4U (1 Septic Tank Manufacturer ` ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Q ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) QQ gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 6 © gal /day Pump Manufacturer ❑ NA Soil Application Rate ,g gal /day /ft' Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODd :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD : 530 mg /L round (gravity) ❑ In- and (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade Mound Fecal Coliform (geometric mean) :_10 cfu /100m1 ❑ Drip -Line ther: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0 year(s) Clean effluent filter At least once every: / / ❑ month(s) ❑ NA years) Inspect pump, pump controls & alarm At least once every: onth(s) ❑ NA ❑ yearls) Flush laterals and pressure test At least once every: ❑ month ❑ year(s 111 ) ) ) ❑ NA Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of :_12 months, shall be performed by a certified POWTS Maintainer. A sewft-'*feshall be provided to the local regulatory authority within 10 days of completion of any service event. IL r ' d F i � START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ 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 must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T fed to 4&-ntif alua ' a o mg tank be ' e ai a ?jg0gl'E5 rri✓is f 40 61 STRl1c -l. p 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone — f/ 4? Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s-�- G ( _ C) (j ZOAIt� Phone Phone "7(S— 3 w 4a This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.54(1), (2) & (3), Wisconsin Administ tive,&dO • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;:RTIFICATION�F Owner/Buyer D i F ( Mailing Address F&4100 ktyn a.v k M tJ 3 Property Address 1 z /l /`, (Verification required from Planning Department for new construction) City/Stat -1,� P ar cel Identification Number LEGAL DESCRIPTION oZb ^ 1 - fib - ozz �• IS��� Property Location �IJ E /,, J G V., Sec_ � , T 30 N -R W, Town of 11 ic � I p Subdivision i�71 rL1 V! Id s Lot # °Certified Survey Map # (o.� 6 Volume Page # Warranty Deed # F to SO Volume ' J ^. Page # Spec house �es ❑ no Lot lines identifiable �es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its prtmature•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 pat into the system can affect the .function of the septic tank as a treatment stage in the waste disposal system_ The propertyowner agrees to submit to St Croix Zoning Department a certification form signed by the owner and by a masterplumber, Soruneymanplumber, restrictedplumber or a licensed pumpervedfying 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. Uwe, 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 rmrst be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date_ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form arc true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descri a of a warranty deed recorded in Register of Deeds Office. ' 9 SIGNATURE OF 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 r 81G65iZ KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 1 -2003 ST. CROIX CO. WI WARRANTY DEED RECEIVED FOR RECORD 01/18/2006 10:40AK Document Number Document Name WARRANTY DEED EXEWT t THIS DEED, made between COUNTRY VIEW RIDGE, LLC REC FEE: 11.00 TRANS FEE: 140.70 Grantor, whether one or more), COPY FEE ( " " CC FEE: and CAROLINE OSBORNE, A SINGLE PERSON and CAROLINE ENGH, A PAGES: 1 SINGLE PERSON, AS JOINT TENANTS CGrantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in ST. CROIX County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): 1810 CREST VIEW DRIVE, #1B HUDSON, WI 54016 o*oA S400—s '*7" S LOT 1 , COUNTRY VIEW RIDGE, TOWN OF RICHMOND 'pt. a -a Ste, oft. 026- 1025 -40 -100 (hart of) Parcel Identification Number (PIN) This IS NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: ROADWAYS, EASEMENT, RESTRICTIONS, AND RIGHTS OF WAY OF RECORD Dated December 28, 2005 Co 'dge, LLC Coun View Ri ge, LLC + (SEAL) (SEAL) * Oranzo J. Oevering, member Kenneth J. OiWermi, member tAi)77S'Yl/1D 4 (SEAL) (SEAL) ** A� K. Oeveri g, member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on E ss. St. Croix COUNTY ) * Personally came before me on this 28 Day of December, 200 .4 TITLE: MEMBER BAR•@Ta DISCO the above -named Oranzo J. Oevering and Kenneth J. O e y e r i n q and Am aro K Oeverin , as members o f (If not, authorized b to me kn a the perso ( who executed the foregoing 70 y �§ 6.06 ) G y ' s an ac wledge same. *Country View Rid e THIS INSTRUMENT D YVL$ Redmon Law Chartered * Kami L. Nischow 2217 Vine Street, Suite 204 Notary Public, to Wiscon ' Hudson, WI 54016 My Commission is permane' t (expires: b `N (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDE FIED. 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