HomeMy WebLinkAbout026-1127-30-000 Wisconsin Department of Comm PRIVATE SEWAGE SYSTEM eme County: St. Croix
Safety and Building Division jo
INSPECTION REPORT Sanitary Permit No:
430497 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:
Baumann, Jerome I Richmond Township 026- 1127 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
IGG�' r �� j v t Sty L'f S-I ke.. gm) 25.30.18.840
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
1 0 00
U���� �L1' YY1 `1 , 0
Dosing r' .} Alt. BM
L
Aerati Bldg. Sewer
loan »3•S
St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic yip / Dt Bottom
liv
Dosing 3�r Ll eader/Man.
Aeration Dist. Pipe 3 S of
Holding Bot. System
q, 2- (P • o
Final Grade
PUMP /SIPHON INFORMATION 5�•� )p�:1 OJ
Manufacturer Demand L
+ Ui (,l�rarv� GPM over . /013 cl
Model Number
TDH Lift Friction Loss ISystern Head TDH ,Ft
'�•� rs r/ 3,2� (,�`:� ttitt�c, 1u.2 /IU:L 1(i0 . C)
Forcemain Length I lia- r/ Dist. to Well
br1 S t f c� e
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length l No. OfTraneHes_ C;� ! PIT DIMENSIONS No. Of Pits Depth
DIMENSIONS 5 q , .Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE /ST LEACHING Manufacturer:
INFORMATION BER OR
Type Of System: / no+ on N Pnb
c U� k._ 1 ' '70 s
DISTRIBUTION SYSTEM
Header /Manifold, Distribution x Hole Size rr x Hole Spacing Vent to Air ]Make
2 �r Pipe(s) (� ' r " y 3
Length Di a ✓1 Length _ 1 d Di. Spacing �'�
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over jxx Depth of xx Seeded /Sodded
B /Tre % Yes No j ,'I Yes ` ''I No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: rr / 7 1 E4 Inspection #2: 1 f / / 03 & - Z—
Location: 1423 134th Avenue New Richmond, WI 54017 (NW 1/4 SW 1/4 25 T30N R1 8W) Richmond Nills Lot 30 Parcel No: 25.30.18.840
7 L "
1.) Alt BM Description = ',-,e � � � � p/0
> 2 . G3Dri W t v
2.) Bldg sewer length = 3,� v r
�, � t,�
amount of cover = 5c C v`vely - SOIL V12 y� 6ira./✓► bit,/ /
VN Vy � 1bk f I y L
Plan revision Required?
q ed? No I
Use other side for additional information. I ` J � _
Date I sepc or's Signature Cert. No.
SBD -6710 (R.3/97)
0 1 t. \\
Safety and Mdiags Division County
201 W. Washington Ave., P.O_ Box 7162 5� CTo r
Madison ^ ' anitary Permitt Number (w be filled m by Co.) yq
Department of Commerce (608 2 66 - RE CEIVED 4 3o
sate Plan I.D. Number ((
Sanita�rY Permit A,gpiicat� OC 8 2003 � s l v & 3 571
In accord wide Comm 83.21, Wis_ Adm_ Code, personal on you provid
t Address (it di
may � y rojecfferent #m maitin8 address) for Privacy Law, si3. i)Cr�}I -• CROIX COUNTY 23 13 i
ZONIM App)�olo information - Please Punt All Btfo�rmation
�� ir
p Owner's Na me Parcel a L ot' Block
} 3d
�� � n .,.t f � fi->.i vh /�-" -� ^•� L ocation
.perry owner's M aiamg Address PMpertY w D
S�+. N - sotic> zrLID S► l`IW ;, 'A,Section zs
y Smot Zip Code phone Nuutber I
� k10\ (circIe one)
r./ LIJ S �/ 7 T 30 Vii; R j� EorzV
Type of BWding (check all that appILY) Subdivision Name CSM Number
I o 2 Fay Dwelling - Number of Bedrooms 3 L -
PublirJcommercial - Describe Use
State Owned - Describe Use ❑City_ ❑village (`owrship af_1 <.
. Type of Permit (Check only one box on line A. Complete lime B if applicable) i
j �i� w<*� ❑ Replacement System ❑ Treatmen trHold gg Taint Replacemert Only ❑Other modification to Existing System
Change of ❑ Permit Tra,tsfer to New
L Previous Permit Numb --r and Date Lssued
❑ Permit Renewal ❑ Permit Revision ❑ Chan
Before bon Plw-nber Owner
System: (Check all that ap
ly) i' L� – X
❑ " a Pass Sand Filter
Non - Pressurized In- Ground k Mound > 24 in. of s u i table soil ❑ Mound < 24 in_ of suitable soil ❑ U U Recirculating Sand Filet
nit A Smgl
t,om�tucted Weiland ❑ Pressuraned In- Ground ❑ Bolding Tank C1 Peat Filter 13 Aerobic'I';eatc-,aezrt ❑
Recirculating Synthetic Media Filter ❑ Cbamb x ❑ Drip Line ❑,Gravel -less Pi Q Other (explain)
reabmeat Area fnformation_ r ( S El "on '
sign Flow (mod) Design Soil Appiicati n Ra ` i) Dispersal A. eoul eel (sf) l Dzs c s' /O(p
LfS $ rI I o / nob 5' c
/ Prefab Site Steel fiber Plash
� Capacity in Gallons Numb f its � Manufacturer ,S � � Glass
I- Tank Info
Gallons Gallons of Uni /1 / X_�C Q v Concrete # constructed
New Facisdt3g vJ ( y
Tanks Tanks / 1
ptic or HoMing Tanis
Unit
rabic T ieaunen<
( �= y e
H. Re pousjlb lity Statemen 1, the oAda'sigued, assume resPo ; for fmstallatiou of itte PQYVTS sb awn om tlxe attached plans-
Business Pho Number
lumber Na me (Pt in I F1 `' 's gnaturc I umber �.�57o-
; r
FF -2 rv_L�/
lumber's Addre ss (Street, City, State, Zip ° ode)
�� 0 �o LA7i- D
`III Court ADepartment Use Only swing Agar i e S )
Sanitary Permit Fee r" eludes G round- wate r a 03
Approved ❑ Disapproved Surcharge Fee) 3 ✓
❑ Owner Given Reason for Denial
SMi vaUReasous for "S
uent filter and `T� -�f✓` 0 I
dispersal cell must all be sew / maintained
as per_ma ent Ian provided by plumber.
setback requirements must be main acne
as per applicable code /ordinances. q3
003 �
size
1
Attach compkie LD the County only) for the system at less than 8I2 char m
�LX �Y4C w ^4NV� r. 1 � {:7 •
NW}SWJ S25- T30N -R18W
town of Richmond
lot #30 Richmond Hills
N
1 =40'
BM.= top of SW lto stake @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 105.85'
.
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Safety and Buildings
t 4003 N KINNEY COULEE RD
i LA CROSSE WI 54601 -1831
TD
#: (608) 264 -8777 erc
Visconsin www
www.comm .wis c ons i n.gov
.wisonsn.gov
Department of Commerce
Jim Doyle, Governor
Cory L. Nettles, Secretary
October 09, 2003
CUST ID No.222774 ATTN.• POWTS Inspector
HENRY F GROTE ZONING OFFICE
CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA
E4366 353RD AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
Identifi 9 2 Numbers
PLAN APPROVAL EXPIRES: 10/09/2005
Transaction ID No. 926357
SITE: Site ID No. 666087
Jerome Baumann Please refer to both identification numbers,
140TH St above, in all correspondence with the agency.
Town of Richmond
St Croix County
NW1 /4, SWI /4, S25, T30N, RI8W
Lot: 30, Subdivision: Richmond Hills
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 923776
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 101)
and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems
VERSION 2.0" SBD- 10706 -P (N.01 /O1).
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited. Coed
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption A P 1 F
area. chs. NR 811 & 812c D ARTMEN
OF
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the L. N �-
requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE C ®RR
• 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. Stat
• Comm 83.22(7) 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.
HENRY F GROTE Page 2 10/9/03
C OwnerResponsibilities:
• omm „ 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).
• 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.
• Comm 83.55 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.
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, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer II , Integrated Services WiSMARTcode: 7633'
(608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Henry F Grote , Certified Soil Testing
Kent Hoke, H & H Plumbing LLC
I
s F40
F
Jerome Baumann - Mound #AA
Eby
Transaction #
Construction Materials and Techniques O
All materials must comply with Comm 84 and be installed in accordance with manuf 4er's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD - 10691 -P (01 /01)
Pressure Distribution, SBD - 10706 -P (01 /01)
Location: Lot 30, Richmond Hills
NW 1/4, SW 1/4, Sec. 25, T 30 N, R 18 W
Town: Richmond
County: St. Croix
Date: October 9, 2003
Owner: Jerome Baumann
Address: N. 3040 440th St. N
Menomonie, WI 54751 G.-
ti
�`?
Designer: e y Grote Gao 9g
_1
6 -
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NO
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S g e. � �N
' ����i • �ESIG�� Q:
License # WI D - 1-007
Attachments: 6748 -Plan Approval Application
SBD -8330
page l: cover
2: design criteria & calculations F .
3: lot plan { � /-Y
p p
4: system cross section
5: plan view, lateral detail � 0 COMMSRCI
6: pump tank exit detail star;
7: pump curve s
8: system management =SP ONDE f"` --
page 1 of 8
Design Criteria
Residential a Wastewater Contaminant <
Load: 30 mg/L BOD < 220 mg /L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
t Fats, oils, grease < 30 mg/L
3
Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load
Design Calculations
In situ designed loading rate (D,3 gallons /sq. ft. per day 0, 4 0'
Depth to estimated high ground water 4 4 in.
Depth to bedrock in.
Cross slope at system %
Force main length ft. of z in.
Ma_ nib eader length z ' S ft. of Z in.
Drain -back gallons �S
Lateral length @ `� ft. of k` z in. �^ ��I 1/+
` Lateral elevation o
f 3 o b• ft. @bottom of lateral j lo S
Lateral hole size / to in. @ 6 ° • c in. ( s " ° ft.) Spacing 5 y�
holes /lateral g holes total
Lateral volume 1 b.S"6 gallons
Total lateral discharge rate gallons /minute @ Z ft. head
Network pressure compensation losses
Elevation difference ft
Friction loss ft. @ •Zap gallons /minute
't
Total dynamic head ft
Pump /siphon gpm @ Z ft. of head
Manufacturer Model # S � 3
Dose volume 9 Z,k t3 gallons
Lift/siption tank `'" �-on - oa C.n L,o 6 U-0 gallons
Septic tank t 6-fr-o gallons
Effluent filter
Measurement pump on and off in.
Height alarm from tank bottom in.
Reserve capacity gallons
specs.calcs.res
Page Z of 8
I
i NWJSWJ S25- T30N -R18W
town of Richmond
lot #30- Richmond Hills
N
1 =40'
BM.= top of SW lto stake @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 105.85'
S& n 4 1 0
�
S ,
k 9iZ Y,ue��
� � 4
r te.j ( p� ,s
2 I (.p ,
AA
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4L Q. } I o%O%
dw
'�z•�''�Z �� - z�a.Q 1 .,.51
Z .,
� o is • o � t>tr*ti (o � + o,p e � �,
a
i
n
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1
' I 0.h � �iiw►
0 t. :r
1.ay•
10 g.b
o'. 4� ? uC. �. � o\. �a.rv. -�s... �- •.a�l� t. b. �o.., � t.�lr� ��.
1V o `F�.; `VTfq�`S � �.l.V.�.1�►�.�, ��'.,� 7V0�► O.� • �• 4�Oi.� ��
r
40 /
S,o� S•o l I
I S.• 7C) 1
L
J
' 11
i
•
WEAT'NE
LO.CKING�COVER JLNcT,cN
�c
GvA.�'N Luc .c ABED .
QUICK Cl�co.IVtGT --•\
C .r •� �-C -,�. tea, .., w.
b�
to
� "7771777777777rfrr4of IL
4° PIPE 3' o�
no No►STuRbED
SOIL. 24" VD.
a� ctovIL
Wr
s ET t.5
WFLE, 1A� ' 3'
L, P
1W E CT 10 KS
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SEPTIC t _ SPECIFI
l O O S E
I TAki S MAWU FACT URCR: WUMDER OF DOSES: S ' 1 PCK
TAWK SIZE: I�y'o l+ GALLOWS DOSE VOLUME
etZ.i$
ALAR►') MNJUFACTUf,CR' `'-��� IMCLUOING 5ACKFLOW:
MODEL WU"ER: , f 3
CAPACITIES A = �'� WCHES OK
SWITCH Tin: �S -.5
puM,P /'1AIJU FACT URCR: "�� '-"`�777 - 77 C• S^ �, rr IUCHES OK ctt.
MODEL ►JUMDER; ON 9 INC HE; OR
SWITCH TbPE; � " WOTE' PUMP AWD ALARM ARC TO DL
MIWIMUM DISCNAR(,C RATE Z�_GPM INSTALLED OW SEPAaATC CIKC_
VERTICAL DIFFERCWCC bETWC[U PUMP OFF AWO OIJTRIbUTIOW PIPE., (r.s FEET
+ MIWIh1uM WETWORK SUPPLY PRESSURE .. . . . .. , . 2 "� FLCTy
+ �S FEET OFFORCE FT 40
MAIW X p F>�FItICT1o1J FACTOR 7-
...__ FEET
TOTAL OyWA/'11C NfAp = '\ FEET
IIJTERIJAL DIMCW610AJC Of TAWK: LEW(,TH ? _;W,DTH ;LIQUID DEPTH 3 b
'i g
' Engineering Deta
Pump Characteristics Performance Data
► Motor Uwt Sv6M$1w y
Avltwotk Med•13 SNEF30A1
I � _
Hors•pewN
M1 load Amp
AUIof T Shoiod PA 14 ) �
R.M. i SSO
►hose 0 1 3 Y.. .. ..... .
y6hage 113
Hoyt: 60 ss I I
4Mpentao 120 At w•ar°s.a).4 o
NtNLk Doom A a 1 1 1
)nselath+s
Coss A
Disshar Stso 1 I /Y oss (Stars) natal KwW foot 4 i 12 16 20 44
SOW w"Alnq 3/4• (19111111111) GPM (U.S.) 44 1 36 2' 1 231 12 0
UAI werght 30 11L
(owsr tpr 16/3, SJ1w, W 04 Dimensional Data
Materials of Constr uction 7 r•'" l • t 40 AE���
Ip , IpeskJla'rsugionr,rx.
(w" MI tyemim ms)
H Stslsiess MOO
frp •.,n 3. 1w for sq(wv -A wpm
W4 wq�h
Lubrk"" OM DWKIrk Of "'+ 601" W" Nwtor Hw! Cost kos ,.. csa Ros � rr
t m Cat keg •s1 S. W" 64 *MW I
8, vow M * ro nmis
t wo" is sr prow ■d 1*
IgdRmtao at1aA Mtr�
Auk" SW Few caw /Cw=dc �
Shoff Seel SMi Ndrt A"kd Ste•1
&-I— SWO611 Stall
r ij; W51 kwN
r E 1k I , •Tic
cx n
IW Gs1 kat $ Mw
q2 oz
Lower RM IAN
tett m Moto E y. s•vo
LM
fasloNrl Sta&%$ S1•o1
C 1999 H drorrok' Pumps, Ashlond, OIuo A.P. R' s pgwve .
I HYDROMATIC w - Ywr Aulhor,xk Lo;ol Diwb�ror -
PENIAIN PUMP GROUP
1$40 10ney 494 AAA, Oho 44105 14:414414142 4x, 414.111.1011
Web Site: w".p,nldrpunp.rom "' Q
SAIFS OFFIM IN ALL MAJOR CITIES AND COUNTRIES or v
Ism u. W-02.8350 1206 SM
it
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, H & H Plumbing, 715- 962 -4155, or the St.
Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
volume of water which flows
Proper functioning of an on -site disposal system, septic system, is significantly dependent on the v o
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include aseptic tank or compartment to settle out solids and contain
greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment
to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to
protect ground water quality and public health.
I . If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water- saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly.
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic or pump tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching
may be required to maintain a functional system at start-up.
Maintenance a � " �����
1. The septic tank must be inspected eve three ears b a properly licensed erson. Q�
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume. ' 10A -4
3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
11, Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient
oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and /or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer J�o� Q��<h •�
Mailing Address N30 qO q-vo -St 42-11 Sq Ll
Property Address / 4) 3 13 t As. --J
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number UQ6 lQ 30 - 22
LEGAL DESCRIPTION
Property Location N�- ' /a, SW ' /s, Sec. T N -R W, O Town of �, eL,� a✓
Subdivision Lot # 30
Certified Survey Map #- - , Volume -r . Page #
Warranty Deed # 7q/ 7 a y , Volume . Page # 1 S 3
Spec house yes ❑ 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
mastcr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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.
1/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 three year expiration date.
l0 /a� l 03
ATURE OF APPLICANT DATE
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.
Z�� 2-11a"�� /D /a? / 03
ATURE 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
U 2422 P 153 - 741 - 7alZ 11
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between RJC Development, Inc., a Wisconsin RECEIVED FOR RECORD
Corporation 09/29/2003 11: 30AH
Grantor, and Jerome Baumann, a single person WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00
TRANS FEE: 88.20
(if more space is needed, please attach addendum): COPY FEE:
Lot 30, Plat of Richmond Hills in the Town of Richmond, St. Croix CC FEE:
County, Wisconsin. PAGES: 1
Recording Area
Name and Return Address
EAGLE VALLEY BANK, NA
1301 Coulee Rd
PO Box 70
Hudson, WI 54016
026 -1127- 30-000
Parcel Identification Number (PIN)
This is not homestead property
(is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of September 1 2003
RJC Development, Inc.
By-
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Development, Inc., a Wisconsin Corporation STATE OF )
County )
au he ica t ' /f'r day of September 1 2003
Personally came before me this _ day of
Kr a and the above named
- - - -- —g - -- — - -- -- - -- -- --- - -.... - --
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stars.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016 Notary Public, State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 2 - 1999
WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page 1— of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must St . C ro ix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north an ow, Tocl3tlp (stance to nearest road. eridiri 3
Please print I(1 f'ra rrr i'oh. Date
R ewed by
Personal information you provide maybe uyrd Co,�oondary plopose� Privacy Law,' s. 15.041: 31 d
Property Owner -• i t„ . `. Property Locati n
R J C Develop I r Gdvt. Lot N 1/4 SW 1/4 S 25 T N R (or) W
Property Owner's Mailing Address " " '. Lo # Block # Subd. Name or CSM#
1868 CtY. Rd. C.
p
City State Zip Code Phone t. City E] Village ®Town Nearest Road
.43G
New Richmond WI 1 54017` ( 71t ,, Richmond 14 0th -
® New Construction Use: ❑ Residential / Numbe[.dtbC?d o6nt ' 4 Code derived desigh flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material glacial drift Flood Plain elevation if applicable n a - ft•
General comments / r
and recommendations: p ta' o
mound @ el. 106.50', based on contour line of el.105.50'
a,^
F Boring
Boring #
Pit Ground surface elev. 1 0 5 . 8 e ft. Depth to limiting factor 47 in.
Soil A licetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 - Eff#2
1 0 -10 10 r 3/3 none L 2msbk
3 22 -47 7. 5yr 4Z4, none mfr QW na
4 47-
2 ] F ❑Boring
Boring # r �i 105 .8 0
l� Pit Ground surface elev. ft. Depth to limiting factor 4 4 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
.5
2 10 -23 10 r 4/4 none sil 2msbk mfr aw
4 44-70 7.5yr 2 7.5 r 5 na na
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ` Effluent #2 = D < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature . CST Number
Gary L. Steel 02298
Address Dale Evalua ' n Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -18 -2000 715- 246 -6200
Property Owner R J C Developme Inc. Parcel ID# pending Page 2 of
F3 Boring # ❑ Boring
® Pit Ground surface elev. 10 4 . 0 O ft. Depth to limiting factor 54 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -8 10 r 3/3 none L 2msbk D H cs if .5 .8
3 19 -54 7 4 none sl 2ms
F-1 Boring # El 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
F-1 Boring # F] Boring
El Pit Ground surface elev, ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 5 220 mg/L 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (R.6/00)
STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc. 1554 200th Ave.
CSTM2298 NW4SW4 S25- T30N -R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #30- Richmond Hills
N
1"=40'
BM.= top of SW lto stake @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 105.85'
IN �
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or
Gary L. Steel
10 -18 -2000
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THE FOLLOWING LIST MUST BE COMPLETED PRIOR TO THE
SUBMITTAL OF ALL SANITARY PERMIT APPLICATIONS.
❑ A COMPLETED SANITARY PERMIT ( COMPLETENESS IS ESSENTIALHH) l/ `�( -0 t u ct
• MUST HAVE LICENSED PLUMBER'S SIGNATURE
• ATTACH STATE APPROVED PLANS (IF DESIGNED AS A MOUND SYSTEM, AT-
GRADE SYSTEM, IN- GROUND PRESSURE SYSTEM, HOLDING TANKS AND
EXPERIMENTAL SYSTEMS)
❑ DETAILED PLOT PLAN
0
• ABSORPTION SYSTEMS: BOTH PRIMARY AND REPLACEMENT SYSTEM
LOCATIONS
• NORTH ARROW AND LEGEND
• LOCATE AND DESCRIBE THE BENCHMARKS
• IDENTIFY ALL SETBACKS DISTANCES FROM THE SYSTEM TO LAKES, STREAMS,
BUILDINGS, PROPERTY LINES /EASEMENTS, CRITICAL SLOPES, ETC...
• LOCATE DWELLING /BUILDING THAT IS SERVING THE SEPTIC SYSTEM
• IDENTIFY ANY SETBACKS ISSUES ON ADJOINING PROPERTY
❑ MANAGEMENT /CONTINGENCY PLAN
❑ ORIGINAL SOIL REPORT (PLEASE INCLUDE THE DATE THE SOIL REPORT WAS
COMPLETED AND THE ORIGINAL SOIL TESTER'S NAME)
❑ A COMPLETED MAINTENANCE AND OWNERSHIP AGREEMENT FORM (MUST BE
SIGNED BY THE OWNERS, ORIGINAL SIGNATURES ONLY, FAXED COPIES CANNOT
BE ACCEPTED)
❑ COPY OF THE WARRANTY DEED (REGISTER OF DEEDS) rec.or&e& c
❑ COPY OF THE CERTIFIED SURVEYOR MAP (CSM) OR COPY OF THE LOT FROM THE
RECORDED SUBDMSION PLAT (REGISTER OF DEEDS)
❑ COMPLETE SET OF HOUSE PLANS (NOT REQUIRED FOR REPLACEMENT SITES)
❑ APPLICABLE FEES
Incomplete applications will be placed in a "hold" file until they are completed.
The workload and number of permits we receive necessitate that we handle only
complete applications and that we obtain cooperation from the plumbers
regarding the submittal of COMPLETE permits! REMEMBER: WE REVIEW ALL
SANITARY PERMITS ON MONDAYS. YOUR COOPERATION WILL IMPROVE THE
SERVICE WE PROVIDE.
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