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HomeMy WebLinkAbout026-1290-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488211 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information y% 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: LeQue Builders LLC I Richmond, Town of 026- 1290 -14 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /0:3,5 VA Z C S� 22.30.18.1467 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURERS CAPACITY STATION BS HI FS ELEV. Septic `,� 4 ! Benchmark z 15 ag�lsi 420P 9esla�— t Alt. BM F,1 v (v lc 5 ZS i:'.o,_, 1 3. Aeration Bldg. Sewer 3.76 /V,95 Holding St/Ht Inlet 5.55 St/Ht Outlet 5. 17 7y - 7 g TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �- L Septic `� � � Dt Bottom ` Dosing Header /Man. V.S. &-V- Dist. Pipe 'off 9ej, qT Holding Bot. System /a. 79 -7 /b. 7 b PUMP /SIPHON INFORMATION Final Grade 63 Manufacturer Demand St Cover / 0 Z . Q—] GPM 3 . S4 Model Num r - TDH Lift Friction Loss System Ft Forcemain Length ia. Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits inside Dia. Liquid Depth DIMENSIONS ` �� 3 TO 3 1r611j " SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Z I 15� N UNIT Model Number: DISTRIBUTION SYSTEM E Z`{ �o Header /Manifold / Distribution x Hole Size x Hole Spacing Vent to Air I /t Pipes) Zn / 'a Length Dia Length Dia Spacing ` e�n- 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 \_1 Topsoil \ e S No Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1417 129th St New R ichmond, WI 54017 (S 1/2 SE 1/4 22 T30N R18W) Lundy's North Lot 14 Parcel No: 22.30.18.1467 L� {- 1.) Alt BM Description = [ � q; �, S L o�s a vim, 2.) Bldg sewer length - amount of cover = . 1 j I � 1 ( (/— (moo 3. S e js fit. l ,moo y.�/� lUr7 r' A. Pe Plan revision Required? Yes 1 ] No 5 I (O Use other side for additional information. Date In pctor' nature Cart. No. SBD -6710 (R.3/97) • Safety and Buildings Division County 201 W. Was \ ` Madison, 537 "" Sanitary PermitNum r (to be illed in by Co.) isconsin (608 266 -3 C� g Z Department of Commerce I.D. J,.,cpt lan Number Sanitary Permit Applica on JUy In accord with Comm 83.21, Wis. Adm. Code, personal inform ion you pro rd 2006 s (if different than mailing address) maybe used for secondary purposes Privacy Law, s15 (Ix ��". CROI - � �Q� �- I. Application Information - Please Print Ali Information Property Owner's N ame _ t Block Ie u L ` nQ V�S property Location Properly Owner's Mailii A.dddr+ess �^ 1 1�C� 1 -5 '/. Section — City, State TLICode— PhoneNumber ` T R E off JJ I. Type of Building (check all that apply) . L $ ubdivisi n ame e. X or 2 Family Dwelling - Number of Bedrooms ' ©�� ( ❑ - Describe Use \ ❑ State O ccibe Use 4Ci ' l age W� wnship of 111. Type o ermit: (Check only one ox on T A fete line B if applicable) D - Z.q D l - A ' w System ❑ Replacement system ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a Non - Pressurized In- Ground [I Mound > 24 in, of suitable soil ❑ Mound <24 in. of suitable soil El At Grade [I Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑ Other (explain) V. Dis ersa Vrreatment Area Information: ign Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Proposed (sfJ System El i ( V1. Tank Info Capacity in Total Number M ufactumir f Prefab Site Steel Fiber Plastic Gallons Gallons of Units lJr PO ST "� Concrete Constructed Glass New Existing Tanks Tanks Se)%ic or (ding Tank l •" � t rS Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, we r ponsibility for i f the POWTS shown on the attached plans. P hen's Name (Prin PI her' igna re RS N tuber Business Phone Number c s 1 Plumbe s Address (Street, City, State, Zip ode) VIII. Coun /De artment Use On Sanitary Permit Fee neludes Groundwater Date Issued I ing ent Signatu (No Stamps) A Approved ❑ Di lra Surcharge Fee) ❑ Gi n Reason for ial I IX. Conditions o 3 6 — — k.A& SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviiCgd / maintained s (yr%j as per management plan provided by plumber. 2. All setback requirements must be maintained � }tt,vt cceS . as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper teas than gin x It inches in s'me� SBD -6398 (R. 01/03) S cAy U. f u?. oWa i z � i l of S Ala, St iv 1cS'U.J q , o Ab - i0lp --q ,p * / C-11 Sae C�Y OAS 5Z� D yo r A S � :�pc� � ��nC �( 1 00 d 4 it 1 I / ��rcon - t o� 0 1? 1 1 1 ( ." P ;1d �e IS S �/ � S �( S R as b N 1P )cS (c.1 � r �- � ►�� � 'ch nk.I (,3s S y o i ,7 u n 4y% A) o -IA, Lo ) y 5 � p 1 pai'v q o at o -I0U(o -qs ,00 y� -e r,S� D D�b- Iab7- 30 GG ' a _�o ,, ,6m - S�4„U,A, a, loo A & It Bm -`t' T`tir�cS�. Q°s�@ )03,s ! 1 � � PIS�z �I �113�� oo,Y, L �:EII/ JAN �x � 2D °zk - CRO1X COUiv Wisconsin Department of Comm ONING OFFICE OIL VALUATION REPORT Page of Division of Safety and Buildings in accordance with 85, Wis. Adm. Code c County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must `J include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.o. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. l.e d Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location n Govt. Lot 1/ s 1/4 S pto Tao N R E Property Owner's Mailing Addr ss Lot Block # I CKO'bri. Name CSM# City State Zi Phone Number City C:) Vi a To Ntres Road� f it New Construction us�Residential / Number of bedrooms 3 Code derived design flow rate �/Q GPD ❑ Replacement c � P��orcommerq� Describe: Parent material _ 7 [�IG�� ` - � / Flood Plain el vation if applicable /�i1� General co mmen ts � - - -- - -- T . a recommendations. lions: q , I dJ nC L kn Q�'a� M Bor ng;V Boring 2 � { Pit Ground surface elev. � ft. Depth to limiting factor � in. Soi 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 2 - 2-0 - Sv 1 0 S ✓w 7 �J Yri ------ s0 / v) if y✓� �- - 1. o Boring # [] Boring q X Pit Ground surface elev. L ft. Depth to limiting factor Yin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 l L r 3/2 rn S ,40 /. Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation C ed Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ,� —� onduc 715- 246 -4516 Property Owner ' I ID # Page of Boring # [) rin ( fp—it Ground surface elev. I ft. Depth to limiting factor T = in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDMf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •EfI#1 •Eff#2 0- - 0 0 3/L ,mot-) f� e 2• s b 3 / n R- 2 '� �• 9 �o ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f!< in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground Surface elev. ft. Depth to limiting factor in. Sod ication Rate. Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/f! In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD > 30 5 220 m91L and TSS >30 1150 mg/L ' 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. SBD4330 MLd=) ` Soil Test Plot Plan Project Name Environmental Holdings LLP Shaun ird Address 706 19th St. Hudson Wi 54016 CS #226900 Lot 14 Subdivision Lundy's North Date 12/1/04 S 1/2 SE 1/4S 2 2 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.0/94.7 *HRpSame as Benchmark Alternate Benchmark Top of Steel fence post @ 103 .5' A1t.B.M. 199' Property Line B.M. Scale is 1" = 40' 99' 26 unless otheirwise 4% Slope t noted 1�0 o 90' 35' X81 n 461' B -2 5, B -3 r Property Lane Phase note: soil to �h mv y not be suit a for o er, desir bu Ming to tion, Soil test was one to i sat Ls zoning re irements, please verify system locatio before excavating. ¢ i i 3�� oUtM PLAT OF: LU N DY'S NORTH `A= W PMT OF THE SO /4 OF THE SEt /4 AND PART OF THE W/4 OF, THE SE1 /4 OF SECTM 22. T30N. RI 8W, TOWN OF RICHtc10ND. ST. CROIX C OWM. WISCONSMI. EACH PMOH. ON IM MAP tS SUM= 70 R� etT SNAIL ANYlH� NO�POIE g2M ARf 70 tE SIAlE COUtTY AND T0WWW LAWS. RILES 93 UIH Oit oo GAMINE 1IE KAtm S m 1NAt 71E NSTAIEA7M 110ULD AND N NUAWIS O.E. WWA14K t W LO? F 7!E APPtINY® Co1PfEleme Dt3iURB ANY SURNU SVXF. OR OBSIRM SM AOCESS 10 FAR= E1G) BMW VAE AND lot. Btfl M PLAN FOR NSI011 ALONG ANY LOT Lm OR S7trffl' LW- /UtCHASNN OR DEVF1OPt1N ANY ►MOLL Ito 11CLUX3 Off tS NOT OWED IM DMIURBA O F A 314MY STM BY CONTACT WE SL O10 0t CDtWW 20NM OFFICE 7 =w MSCO M ST WEM EASBADM AS NO 1W WO t R�QNOIO �t ADMC7: W w ANNE EASOMM WAUR t0 SET FORM ME FOR IM USE OF R]E� i17FIt RUN1M1f4. �11EIt PUBLIC BCOFS AND PRA611E PUBLIC UILMD B>11S Olt aUIS S1oDt10S HAWS IM WONT 70 39M IM AREA. OF LL'N DY'S MEADOWS 1 LOT 32 \ P ; cc; LOT 20 NOM UNE OF tW �� LOT 30 LOT 31 1 \ 1 1 -1 st/t of 7FE la /4 \ / omm A P11w }._. Ic 3t 3r `` / EIf19 um 95" NW47'01 - E 1!!! . 0•" WT -- � 8 m > 0.10 s s�9�fTNl1l - - — - - ( I LOT 12' X TO 10 ) LAM Sd9v1f6'1✓F �Tp. �" N I \\ ) LOT 15 LOT 16 LOT 13 �' M AW- ACRES (93.9i7� ) SI4�I63o� Ncq 7w o ) r N cq z10 ACRES �'�` lOP OF f \ \ (91.677 SM Ft.) ttON PPE. LOT 17 LSJX tns d' , E1EVAIM 1.98 ACRES .14 L45VASVr \ \ \'` 'Y k •� ' ' ...................... ..................T. . ... \ � HOE DA 9 1 `— — 129TH STREET — ' LOI ites CL FT) • -c3 339? $W i — \ \ � 213 I _ \ , (92.620 • / EA aoovT 4 \ \ LOT 3 i�pzbi� r6z j - - 9�i - m �!� 232 AC7�£S I �— ��s= " ��, ,.� (100,676 5a FlV � � I I : LOT 4 3.23 ACRES �\ (1406620 SCL Ff.) `j7 ?� �_ •i 1 ` 15' LOT 2 •�. : \� / / 1 204 ACRE:; t , 1 ' (66.6559. SO. FT.)� : '• �g. / % PENN MAM WP Lf .......i" •' • ^ OF f NCN PPE 2C OLVATM i• ,•f, � �.� (9013 LOT 7 1.e7 ACRES (72.671 SCL FT) 1 Q `�� 0 / %� i •` N - .� ��a ; / ;' , r \ �. •� LOT 21 Se7'iTII7''t 274.24 1 : : . �' 267 ACRES .�► i •• / / •N . -•' (124.961 906 FT) LOT 1 C -SM. IN LOT 22 fig' y VOL. 18 PG. LOT 5 2 - - - - -- _ (K127� .) \ CF 1* Q� __ t7 L 1.67 ACRES I I LAA - INA , ` .1.......� SO. - Fr)...........!&= �± 33• I �. ............ .............................�. ..................... I L gut EZ'I 203 H aevaa to • ^tip '� '� ••�'','' +'•. avateta tevt o vao va va Ota � • i ^t• " �� ~ l 1 �.ti.•ta ~. ?` avvvevo OOP. •v'.�« ..y i Y` 9vaa VVW l�ft a v v •'�• r �• "• •'`•`; v s 24" ova t�.- ::a 4 11 evv vsv V 5 evv vo vea vav vvv aaa v v s 1 n 1/2 Circ. = 18.84 voe vvv vsv evv vv• atvo v vv vvvv t vvvevvv a Vvevvvevtee� vvvv° v °°°vvvv vavavvvaysaeve vvavavv vtvvv►v vevovvvvvvvvve vavvvvv 2 4 11 Bottom i Bottom 36ft 12 -1/2 DIA. (typ,) Void Volume - Void Coefficient in Aggregate given at 57.4 %. Soil Int rfaceArea 11 ig RL Flt Sidewall (2 Sidewalls) 2 e 18.134! O D, of 4" pipe = 4.625 inches ( 12in = 3.14 Void volume per linear R = 3.14•( 2 .3125 in l� . Ift = 0.117 t}' Bottom 1R l 12in /ft J 2.00 O.D. of centercylinder -• T2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder = 3.14 • 6 =sin (12intft, - 3140 .( -3nift 'J =.422 If? l I Zin / tt JJ O.D. of outside cylinders - 12 inches Projected Trench Area Void volume in outside cylinders= 213.14 bin •.574 l t2in 1 ft 901 ft' Sidewall Height - 12 in. •2 - 2.00 Sq.Ft. Void volume at bottom between cylinders Bottom = 36 in. = 3..00 Sq.Ft. = [ ( T2 2 i 4i jft _ 6i" t2i"�P ►J -( bin 31 llzin�fr) 0.215 W Projected Trench Area -• S.00Sq.At. Void volume outside bottom corners (U2 orvoid volume between cylinders) 0.215 / 2 - 0.108 ft' Total void volume - 0.117 + 0.422 + 0.901 + 0.215 + 0.109 = 1.763 cubic It / fl Gallons per ft = 1.763 X 7.48 - 2 nalions n linear ft It / ED'S Aggregate Trench System EZ1203H EZ ow Rin g Industrial Group 65 Indus-triol Park Rd. Oakland, TM .18060 SCALE FILE NAME t7t203H SHEET: t o! i t1 -27 -Ot POWTS OWNER'S MANUAL & MANAGEMENT PLAN P a of FILE INFORMATION Ow SYSTEM SPECIFICATIONS ner. Permit # p , f=SS Septic Tank Capacity ai 0 NA 0 Z Septic Tank Manufacturer 13 NA OESi6N PASg IETERS Effltuerrt Filter Manufactures NA Number of Bedrooms NA Effluent Fiber Mode) 191 0 NA Number of Public Facility Units NA Pump ank Capacity parity al NA Estimated flow {average) ai /da Pump Tank Manufacturer *NA ' Design flow (peak), (Estimated x 1.5) g al/dav Pump Manufacturer A Soli Application Rate aUd V Pump Model F NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit -WNA Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter 17 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L 0 NA 0 Mechannical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average ispersa4 6eNlsl 0 NA Biochemical Oxygen Demand (SOD,) 530 mg /L In- Ground (gravity) 13 in -Ground (Pressurized) Total Suspended Solids (TSS) 530 mg/L 0 NA At -Grade 0 Mound Fecal Caliform (geometric mean) 510 efu /iooml 0 Drip -Line 0 Other. Maximum Effluent Particle Size y in dia. 0 NA Other: 0 Other. a NA D NA or= 0 NA 'Values typical for domestic wastewater and septic tank effijent. Other: MAWTENANCE SCHEDULE Service Event Service icy inspect condition of tank(s) At least once every: 0(s) (Maxiliman 3 ) C] NA Pump out contents of tank(s) When combined sludge and scum equals one-third (y) of tank volume 0 NA Inspect dispersal cell(s) At least once every. 0 EXyear ontthh(s) (Mwdmum 3 years) 0 NA Clean effluent filter At least once every; nth(s) 0 NA ears) Inspect pump, pump controls & alarm At least once every: month($) O NA 0 years) Flush laterals and pressure test At least once every: 0 monthtsl 0 NA Other: 0 years) At least once every; 13 nvoth(s) Other. veerf$i 0 NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal calls 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 tankls) 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 an of effluent on the ground surface. The pondkng 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 %) 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 fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of o For new construction, prior to use of the POWTS check treatment tank(s) for the that may impede the treatment process /or d Presence of Paurting Products or adter chemicals of the tanks) removed by a septage trio t use. mss)' If high concentrations are detected have the contents �g Operator prior to u�. 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 ceff(s) in one large dose, overloading the c 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 Septege Servicing Operator prior to restoring Power to the effluent Pump or contact a Pkwiber 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 so0 absorption area. Reduction or elimination of the following from the wastewater streem 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 dram (sump Pump) water; fruit and vegetable peelings, gasolfne ;. grease; herbicides; meat *crops; 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 shelf 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 bb u b Infringed Pon y required setbacks from wdst*V and proposed structure. lot Imes and weft. Failure to Protect the septacement area will result in the need for a new soil and site evaluation .to 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tine. < <WARWSiIG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL BASSES AND/OR INSUFFICIENT OXYGEN. DO NOT HITTER A sEPTfC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE FOR OF A TANK MAY BE DIFFICULT OR mnVSSRBLE. ADDITIONAL COMMENTS POWTS MIST P011YTS MApMTAR Name c - Nau000e : . Phone ( phone SEPTAGE SERVICM OPERATOR ) LOCAL DILATORY AUTHORITY r\ Kel Name Name s " Phone phone s T 1119 document was drafted in compliance with chapW Comm 8 &(f) and 83.54(1), (2) & (3). Wisconsin Administrative Code. Sep 09 05 01:57p CRLVIN POWERS 715 -246 -5135 p.1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ �`�Q, ' 11 r Mailing Address p 0 . 15 Property Address T�` (V ification required from Planni ng_Dcpartmmt for new construction.) City /State Parcel Identification Number" ' 1(� LEGAL DESCRIPTION _ 1 Zt�p - /c� - t12f0 l �1) Property Location ' /t, '/a , Sec. �, T N R�; Town of Subdivision r Lot # I'T Certified Survey Map # _ , Volume , Page # Warranty Deed # �� 0 1 '::J Volume O Page # Spec house (yes) no Lot lines identifiable B no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failare to handle wastes. Proper maintenance consists of pumping out the septic tank cvcry three years or sooner, if needed, by a licensed pmr4m. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner rnaifftmnce responsibilities are specified in §Corms. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix Canty Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if 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 rmintained mast be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is rude in the warranty deed. (REV. 08/05) � f - 4 ••uir••n �w•ww.wn•pR•w N 4 J iZ6 93 ell r 01 SR low Ole �i a ! l i • i i • � r • t t � s N . � e OF LU DY' DT 2 NORIN UN E OF E TH LOT 30 � _LOT 31 '� � S1 /2 OF THE SE1 /4 BENCH MARK: TOP (ss9•47'03mw) ELEVATION asap N89 °47'01 * E 1 496.60' � j BLOCK DIST = 1 9.80'.- --.- -x 3 199.09 15:22' 68R 178.:58 OR, j. LEST i a 9 .� �,�• 1.87 ACRES al (81,330 SO. FT.) " . -�k �8� E..a >o. m ass.s S " 13 07 �- # S.5276 52.06 *� � 1 .c� 413.85" f 1 $ �O LO 14 � o� 65. 70 ' � � a,o�7 Sv. FT.) 3t LOT 15 39 1 r ► �� , 3 L.B.0. w 966.5 1.82 ACRES �tES � 04 a MARK: #� !� B C6 9fifi.5 96 5 ` c i IRON PIPE* 09 " lk ELE ORAINAGE" N I 984.0 E"Asmmr a >• w w s . s �� w a w> r w .. r r r r w w r w. w w .. r w a . r ►. � w w • «. r rt► r w r w w w w w w ►• a a ♦` HwE 964.5 JoAl 1 N881 5"11*E 40#.83` i -- �.. 1 29TH STREET 572 S88'15"11 " vet 4M.SX t i DRAINAGE i1' h •r t j t EA_czy,ENT w 4wE m 963.8 .. r w w w. ♦ w a r w w a. rt rt w w w w . w • s w s a w w w r w r w w. t z s. w . ....... w w w w w w. w w ...... l « 79Ei 335 U. 2805�P 272 State Bar of Wisconsin Form I - 2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name THIS DEED, made between Environmental Holding Company, RECEIVED FOR RECORD LLC, a Wisconsin Limited Liability Corporation , @5/18/2005 12:45PH ( "Grantor," whether one or more), WARRANTY DEED and LeQue Builders, LLC EXOPT # ( "Grantee," whether one or more). REC FEE: 11.00 TRANS FEE: 75e.00 COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CG FEE: described real estate, together with the rents, profits, fixtures and other PAGES: i appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lots 9, 11, 12 14 and 15, Lundy's North, Town of Richmond, St. Croix County, Wisconsin. Recording Area Name and Re�turn Address - l I Part Of 026- 1066 -95 -00 and 026- 1067 -30 -000 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, Easements and Restrictions of Record. Dated May, 17, 2005 Env' ding Company, LLC (SEAL) (SEAL) * *Jeftfrarren, President (SEAL) (SEAL) AUTHENTIC �/ ACKNOWLEDGMENT Signature(s) NOTAR STATE OF WISCONSIN ) M.O. �t ) ss. authenticated on St. Croix COUNTY) Personally came before me on May, 17, 2005 , l � the above -named Jeff Warren * TITLE: MEMBER STATE BAR OF WI to me known to be the person(s) who executed the (If not, foregoing instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: *Merile Jr. Bune Michael H. Foreeki, Attorney at Law Notary Pu lic, State of Wisconsin Eau Claire, WI 54701 My Commission (is permanent) (expires: 11/20/2005 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2003 *Type name below signatures. Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701 -7928 Phone: (715) 935 -3029 Fax: (715) 935-4112 T6011577.ZFX Merilec 1. Bune produced with ZipFormTM by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383 -9805 www.ziolorm.00m RECEIVED DEC 0 5 2006 VW�l otofCo.,. ST. CROIX CO AIUATlpN REPORT Division of Salary and Burgs Page Comm 85. Wis. Rdm. code C ) courdy Attac WnVkft site Plan on paper rat tens tfu n 81/2 x 11 k cues in size. Ptah must c�T- include. b1A not li *ed 1b: vertical autd i relarence Pmt . dredion and pertiwd slope. scale ordfrne w'Mw, MM arrow. and location and distance to nearest road. Parcel LD Please print all Imimmat." Reviewed by Date FA EP W porgo " Ww ""M You MW'ft may be Used for sewWg y pines {Privacy taw, ( tc+))- owr�r Property Location n PeUpertY ow w's Mai�rtg Govt Lot 1 .J 1/4 S pC 0T N R I � Lot Block # 100ta Name 5• State Cade Pane O r - / ? Nearest Road Now c«>sat,� Resident) Number of bedrooms O Replac tt O PubBc Code derived design flow rate as GPD rent rrtt�erfat Flood Plait tint if appGCable ��.f. � rdenaat conments R j;/ r EE Pit Ground stnfm* eev. R Depth to Muft factor / 2 I fi. Horizon t . Dw*,. trt Red= Dewdp&m rext�me 8trtrckrre tiooLg S� Rabe its Meats Sw�rY G ttu Sz caru color Gr. sz sn .fit .am 2- Boft # O s a t r ! (J t=it Ground ate rev. L f t 1 D to *mbV factor L, Horizon t]eih pontartt 71-EW2 Redwc Desa"m rexhae Struchrre CalsWence Boundary Roots In. Mu ma QL Si curt color f'r SL sit L jZ 6 3 rn Y � j ' Eftrue a #1 = am 30 ; 22() nrtgti. and TSS >30 1 150 ' Eftent #2 = BOD 1 30 mg/L. and'TSS 130 mglL CST IVryml3 {Ptfse prat} CST N weber Bird Plumbing, Inc. Shaun Bird 226940 Address Date Evaluation Conduc Telephone Number 1008 192nd Ave. New Richmond, Wt 54017 .— 715- 246 -4516 Soil Test Plot Plan ct Proje Name Environmental Holdings LLP Sha ird Address 70619th St. Hudson Wi 54016 CWM #226900 Lot 14 Lund 's North Subdivision Y Date 12/1104 S 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond Boring {D Well PL Property Line County ST. CROIX ` BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95 . 0 /94.7 *HRpSameasBenchmark Alternate Benchmark Top of Steel fence post @ 103 .5' * Alt.B.M. 199' Property Line B.M. Scale is 1" = 40' 99' unless otherwise 4% Slope noted 100 ' 90' B -1 30' 35' l 5 461' B -2 45 B -3 -Property Y O Please note: soil test f may not be suitable for owners desired building location, Soil test was done to satisfy zoning requirements, please verify system location before excavating.