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Z County: i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514984 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: Marek, Todd R. I Richmond, Town of 026 - 1127 -48 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: &57 25.30.18.858 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I /Z �� Benchmark 4• '7 i 6, I / ik� G; �r...- U" Alt. BM a 1- 161. 69 X % Aeration Bldg. Sewer C , Holding St/Ht Inlet 64 4(c SUHt Outlet TANK SETBACK INFORMATION 32- TANK TO Pt WELL BLDG. Vent to Air Intake ROAD DtInlet ` Septic >56 / /lJ�+, ` A - /s y 3Q Dt Bottom Dosing '� Header /Man. 07 cU -i Aeration ` Dist. Pipe G : Z; 97. Holding Bot. System • 7 , `► - 4-7 Final Grade PUMP /SIPHON INFORMATION I- ) �P•3 `7g• Manufacturer GP n St Cover 3• Z ? . J Model Number ___ -__ ___._ ......_ _�_- _._�.. -__ _ 91v • SS TDH Lift Friction Loss Head T91i Ft 19- I to Forcemain Length Dia. Dist. to Well H. 8 95 • � SOIL ABSORPTION SYSTEM BED /TRENCH Width Len fr o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ( ri�l rT d\ UNIT Model Number: "op a.,. 0&— /VA'' N►Q"" G�: �k. L4 -L. DISTRIBUTION SYSTEM 1 5 v 4 4_ Header /ManifolI if Distribution x Hole Size x Hole Spacing I V Pipe(s) \ �� L� Length 7. Dia Lengt Dia Spacing Z .n / ^I .V i•l .nti SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only r Z (is 4•- a Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched •r Bed/Trench Centel . Bed/Trench Edges \ Topsoil Yes ❑ No Yes ❑ No COMMENTS: (include cod d s, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1303 144th Str et New Richmond, WI 54017 (SE 1/4 SW 1/4 25 T30N R18W) Richmond Hills Lot 48 Parcel No: 25.30.18.858 1.) Alt BM Description = '"'�- 164 r L-- v bJ 41L.Af)l 2.) Bldg sewer length - amount of cover = No ` — - -, - — — -- Plan revision Required? Yes - — - - - Use other side for additional information. SBD - 6710 (R.3/97) - -� - - - - -- Date Insepctor's Si ature Cert. No. I _— I Safety and Buildings Division County ` M 201 W. Washington Ave., P.O. Box 7162 C �sconsin Madison, WI 53707 -;.7164 Sanitary Perin it Number to be filled in by Co.) Department of Commerce (608) 15 C/ G7� Sanitary Permit Application state Plan I.D. Number / In accord with Comm 83.2 1, Wis. Adm. Code, personal informatio provide may be used for secondary purposes Privacy Law, sI5.04(1)(itt) Project Address (if different than mailing address) 1. Application Information - Please Print All Informs ' n / �Q Property Own is Name Parcel # Lot # lock # 0 �� SEP 1 1 2008 z If z oa Property Owner's Mailing Address o Property Location l X ZZ /�? ST CROIX COUNTY / J ZJ ZONING OFFICE 4 2 �� /, 7 (,+ Ci State L__C Y <, Section C� �'. Zip �7 P lone Number / �lC W 1 / circle e) TN; R Eo I . Type of Building (check all that apply) at�� VV /// CA Fri - or 2 Family Dwelling - Number of Bedrooms Su Number f bdivision Name d El Public /Commercial - Describe Use /I ❑ S ❑City_ ❑Villageo State Owned - Describe Use wnship of ` Q III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ?Flew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. f"' nn' newal El Permit Revision El Change of El Permit Transfer to New List Previous Pennit Number'and Date Issued Bet ` Plumber Owner IV. Type of POWTS System: Check all that app I yL -10- - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Q 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. Dispersal/Treat ent Area Information: Design Flow(gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Dispersal Area Tp7J ( System Elevation '7 7 /♦ GI C . S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding. Tank ' Aerobic Treatment Unit l t Dosing Chamtxr \ t l VII. Responsibility State ent- I, the and ( rsiig ( n / ed, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is ignatur MPumber Business Phone Number Z_ z - z73- �K PI rnber' Ad ress (Street, City, State, Zip Code) VII . Count /De artment Use Onl Approved ❑ y � Sanitary Permit Fee (includei�undwater Wnt Issuin ge Signat Surcharge Fee) Ol5 S ❑ even Reason for Denial IX. Conditions of Approval /Reasons for Disapproval ^ /� SYSTEM OWNgk ,3 )&, �t PW, 1� e.J 1. Septic tank, effluent finer and r c ! t dispersal cell must all be servtces ( maintained I,I f I �.�,� 6 t.,,J, A,.,, Mt r► 4j 4W_ I �►(L7 + as per management plan provided by plumber. 2. All setback requirements must be maintaifwd as pier applicable code / ordinoncers. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Lo A- 4to M A-k6/K X9' e �& uc, 7�k 03 COPY Z ® sM 2 3a 7f �Lo� SAP JM ref • 06 w 7 q 03 AftfA Z ® Sm 2 3a 1 Wisconsin De .partment of Commerce SOIL EVALUATION REPORT Page 1_ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference po "JBW, defection and Parcel I.D. p ercent sloe scale or dimensions, north arrow, and I on and d'gstangetonearest road. pending P slo 9� Please print all inforr93it5n. Revi ad by Date ��, N Personal information you provide may be used for secondarypurpos (PriQacykfw, s. 15.Od (1X(m)). Property Owner j = "" Property L, cation R J C Develo ment Inc I , r . r ' ; vt. Lot E 1/4 SW 1/4 25 T N R 1 (or) W Property Owner's Mailing Address Lot # ock # Sutxi. Name or CSM# 1868 Cty. Rd. C { 48 14i I I.CZ City State Zip Code PN5o 8 lambpr ; c)��1 : ❑ City ❑ Village Town Nearest Road New Richmondl WI 1 54017 1 (715. 7- 1 30t - h - ave ~ d 4 Code derived design flow rate 600 GPD ® New Construction Use: El Residential / Number of bedrobrt+s� -- 9 ❑ Replacement ❑ Public or commercial - Describe: Parent material gl acial d ft Flood Plain elevation if applicable „a ft• General comments and recommendations: trenches 2.5' below grade, spaced to code Boring # Boring ® Pit Ground surface elev. 99.50 ft. Depth to limiting factor +80 in. Soil A plication 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 -8 10 r sl 2msbk mvfr r S if .5 2 8 -21 7.5yr 414 nnnp cz I 2msbk 3 21 -80 7.5 r is os i� Il 2 Boring # f 2 El Boring 13 Pit Ground surface elev. 99.50 ft Depth to limiting factor +72 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 1 -9 10 r 3/3 none sl 2m 2 -19 7.5 r 4/4 none sl 2msbk mvfr • 3 19 -72 1 7.5 r 4 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` E ent #2 = BOD < 3 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature P ST Number Gary L. Steel 02298 Address udiv ELvakfation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10 -19 -2000 715 - 246 -6200 Property owner R J C Developmen Inc. Parcel ID# pending Page 2 — of 3 D Boring # El Boring ® Pit Ground surface elev. 95.6 ft. Depth to limiting factor +84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 -13 10 r3 3 none S1 2 13-28 7.5 r 3 8 -84 7.5 r4 6 none Is n.-I r I mi A n A .7 1.2 F-1 Boring # E] 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 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF 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 mg/L • Effluent #2 = BOD < 30 mg/L and TSS :5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R6100) • +s . Property owner R J C Developmen Inc. Parcel ID # _ pending Page 2 of 3 F31 Boring # ❑ Boring ® Pit Ground surface elev. 95.60 Depth to limiting factor +84 in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 -13 10 r3 3 none sl 2 13 -28 - j. - 5 U4 3 8 -84 7.5 r4 6 norie I Q m 1 na .7 1.2 mi ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F - 1 * Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, 5 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6=) Y STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. RJC Development, Inc. CSTM2298 SE4SW4 S25- T30N -R18W New Richmond, WI 54017 ` MPRSW- 3254 • town of Richmond (715) 246 -6200 lot #48- Richmond Hills N 1 " =40' BM.= top of 1" pvcpipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el.96.00' p�( Yom' I e . k� a� 30 GAry L. Steel 10 -19 -2000 I i (� N 4 11 M 10 o w r t 4 V p Oo `4 N ZZ 4 " j 1 DO g CX q � 10 a a S r 979 ?7.S�t . 1248M S* R • • 227 •A0111fS . . . . . . 3I AOW Ff a 7074.0 .....r SqAr ,/ 1-41 248 AMM a - At �.F.E 101�C0 J S1R FT. ORES s -a • 10 44 SO FT. - 2.13 AGREES t4!' 7C?? SY! T. A/ 2 4J AMM 1AL F:F.£ 1014 Adm fr-,� 1Ma0 y d-42 45 v 2� AFT. •t AW F.F.E 701Q0 94 JAS 218 AOPES - 2.2a A V &: F.F.E 101410 Sa r Q4ES 4 I t �•9d2m fx • O C.S.M. PEN De4Q LOT 4 SOU l/ sad. ?JG r r ' _ SEC FOG r RAILRO, . ,»� ,� ,. ter• r i 130 T A UNT AND .EA/Y KELLEY 1429 7J07N AW.. Mrw .91(-Wtw7 m 104 T 1 il669bzS1 Li 'Hajew ppol dT0 =60 SO LT inC 46 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner P e, Septic Tank Capacity 1 1 Z g al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model 1 4 7 4 t 9V SZ ❑ NA Number of Public Facility Units — ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) 0 gal/day Pump Tank Manufacturer ��7 ❑ NA Design flow (peak), (Estimated x 1.5) al /da Pump Manufacturer — �d ❑ NA Soil Application Rate al /da /ftz Pump Model .__ l.� t ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 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 ❑ In- Ground (gravity) ❑ In - Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100mI ❑ Drip -Line ❑ Other: 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 3 ❑ ear(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: ❑ months) (Maximum 3 years) ❑ NA ❑ year(s) Clean effluent filter At least once every: / ❑ month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: 13 month(s) At least once every: ❑ year(s) ❑ NA 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 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. GMW (4/01) Page z of START UP AND OPERATION 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 cellls). 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. • 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 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 d ffl ,/l/ Name Phone l' Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name j C lip /V Phone Phone�� 6g(� This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 2D M Mailing Address 2 .�� o gyp Property Address L k:3 (Verification required from Planning Department for new construction) City /State Parcel Identification Number 0 Z ( I `f 7 Y o v i LEGAL DESCRIPTION ��, Property Location �� %4, �LUJ Sec. T N -R Town of /C [4M6 JJP . Subdivision �Cf,C �)n�� (tiJ , Lot # Certified Survey Map# , Volume , Page # Warranty Deed # , 7 Page Volume # Z Spec house Wyes O no Lot lines identifiable Xyes O 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 eve three ears or sooner, if needed b a licensed pumper. What step P P put into the s - every Y � Y P P you Y 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 master plumber, journeyman plumber, restricted plumber or a licensed pumperverifying that (1) the on -site wastewater disposal systen- is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standard: set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatior stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three year expiration date. AAA. SIGNATURE 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. .Y"�g A&0L__L__ -7 SIGNATURE OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department,****** ** Include with,this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2y93P 132 75 1 926 STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between RJC Development, Inc.. A Wisconsin RECEIVED FOR RECORD Corporation Grantor, 01/16/2004 09:30AH and Todd Marek Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin REG FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 465.60 Lots 10, 19, 20, 46 and 48, Plat of Richmond Hills in the Town of COPY FEE: CC FEE: Richmond, St. Croix County, Wisconsin. PAGES: 1 Recording Area Nate and Return Address KRISTINA OGI..AND ATTORNEY AT LAW P.O, BOX 359 HUDSON, WI 54016 026- 1127 -10- 000; 026- 1127 -19 -000 026 - 1127 - 204100: 026 - 1127 -46 -000: 026 - 114748 -0 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to w arranties: Easements, restrictions and rights -of -way of record, if any. Dated this J day of January 2004 RJC Development, Inc. 9 -- - By: AUTHENTICATION ACKNOWLEDGMENT Signature(s) RJC Development, Inc., A Wisconsin Corporation STATE OF _ ) By: r \ C4,- ) ss. ��/l County ) authenticated this r day of January 2004 I Personally came before me this _ day of _ _ the above named * K ristin Ogland - — — -- 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. Stats.) 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 1-6 0P IWIVO< CONVENTIONAL SYSTEM CROSS SECTION NO SCALE �I 12" COVER 12" COVER 12" COVER ,t t':k';$ � � "t:i i!FF:. , i:., : I•,j.' ^ , !.;i'�i<a; ?,d: • ?�i111i }�.r ;i yy: r:,l.: ;..:is�ll':'i!;:'�,ii: ^ ":.• !; `i: �� ?y %i'i'i >!;:: , , ..., ,+ !.Jl.: .,..:.:. t. � ........:. .., . , d l 1 ...x ... .... . ...... .. ....•.,. .:: i,. .s �. ;1'.r: l,: - ::ic�il#�';:, ' .`:�;.y . : .....:.,. ,1 � k .., � ...,...,,. .....k.,, ... \,. � ... ,.. �. � ... •:21 I • ..... .:. ,, „ i:�:'II:' 2 � I � .:t;r. . y k �.. ...... ..... .. I,.,.I....... . 1 .•....... .n In,., ..... �� n. L,......... I. . ;1:'rr.:.r. ": ,, ;:ili iiVJ;. %' .: �... I � ...... 1. i ..: : .I. ......:: : .... .. 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I ELEVATION T] ? _ IN SITU SOIL T4 (OS I I QUICK 4 STANDARD TNFILTRATOR DIMENSIONS: HEIGHT 12" LAYING LENGTH 40" WIDTH 34" I COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS° PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of coyer, must eidend to a point no greater must eldend at least than 6" Beim Finished Grade 4" Above Finished Grade Cover wAth VJCAjN EIZ : OOF-, Y �PPr 2 .e L `�D f , 0% F Locking Device � Jll� b� 89X Finished Grade N (typical] 1 .M /N / r1r um r 36 !.Dl/v6r r �t:Vv� Min. 23" > 301fi > IN r Access Opening O it LA's jM5U Min. 23" Access Opening N n.2 c�/yi,4i�l Oulu Effluent Filter j IV /77Y � �'O✓C SL.�'� Union 4 wR-.oVEP P IRG 3 Pr- � p/tf7a .SOS -/D S"O /L Inlet Baffle r �� r � 1 r Pump � 3 ",Sand or rave beddl4j urndt f — W TA ean-ler 2'• Iocuer khan ed�ps Two Compartment Septic/PumpTank C h * e11 / qh} on oU ide GU�I�) SPECIFICATIONS TANK MFR: DOSES PER DAY: Z / TANK SIZE: SEPTIC GAL. DOSE VOLUME: t GAL. DOSE _ GAL. (INCLUDES FL OW B A K � 20% OF D / ALARM MFR: - �� CAPACITIES: A = 'z� INCHES= l L 1 GAL. MODEL # ✓ / o ! ��/,Z Switch type: Lo -.I- B = _2_INCHES = , PUMP MFR: L 1> C = _INCHES = ['1'' �. Z GAL. MODEL M 12 4� * SWITCH TYPE: ?! er& : D= INCHES= L277-' GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = 1 FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) = + 0 FT. to FT. OF FORCEMAIN x g 5:1 FT. /100 FT. FRICTION FACTOR ...... = + TOTAL DYNAMIC HEAD (TDH) _ 1A 51 FT. INTERNAL TANK DIMENSIONS: LENGTH ; WIDTH ; LIQUID DEPT MP/MPRS SIGNATURE: LICENSE NUMBER: Z ZO � � GOULDS PUMPS Submersible Effluent Pump PE • R1++h7 PIMP SPwnanoms INOTOR FEATURES Pump — General: General ■ Corrosion resistant • 5i le construction. • Temperature: a : 104OF (4000 ` 60 H ■ Cast iron body. maximum, con0nuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • BuNn thermal overload pro- cover. • Solids handling: W team with automatic reset ■ Upper sleeve and tower CI 8 insulation. hea vy d maximum sphere. ass vy ury hall beating • 1 -filled • Automatic models include a 4f de sig n. construction. APPIUCATIDNS _ float Switch. • Nigh strength carbon steel ■ Motor is permanendy designed far the • Manual models available. shaft. lubricated for extended Specialty Specially uses: - Pumping range: see PE31 Motor. service life. follovAng performance chart or curve. • 33 HP, 3000 RPM ■ towered for continuous • Mound Systems • Effluent/Dosing Systems Pb31 Pump: 115 volts ■ All�ratings are within the - tow Pressure Pipe Systems ' Maximum ca pacity. 51 GPM Shaded pole design worldng fimits of the motor. • Basement Draining - Maximum head. 25' TDH PE41 Motor: ■ Quick disconnect power • heavy Duty Sump/ PE41 Pump. • .40 tfP, 3400 RPM coral, 20' standard length, Dewatertng Maximum ra • 115 and 230 capacity: 61 GPM volts heavy dory 1613 SJiVIt with • Maximum head: 29 , TD1i PSC design 115 0 230 volt round' r grounding PE5I Pump. PE51 Motor. plug, • Maximum capacity. 70 GPM ` .50 HP, 3400 RPM ■ Corriptete unit is heavy duty, • Maximum head: 37' TDH ' 1 15 and 230 volts portable and co rnpam • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, WNA and stainless 40 _ 1 '{ MOM&- PED.K41,PESti steel. -fir., t ' + Stainless steel fasteners. 9 35 T , 10 � 2 l i— AGENCY USTINGs , 301 FT s - ! � •�•.i C� US }- } Tested to UL 778 and 20 , : -� 1 Starudards h - — CSA 22.2 OR - t--r -r + Sy CallatllAtl Srdridirds Assorttition L J— L - ' - — �-: -� C"ftPw4sls ISO gem vw iswai 0 .� F - s-i• i `I_` -�' i + I _ T i C�56�'T {A Mffi �ZOw_�� 0 0 10 20 r 0 40 50 60 70 GPM 80 .� V+� 7 f Ntf+lzi-A 0 5 a 10 is m3lh N � •d t - 2 u sa t �s> d n S SLLT -9Z� STL .3 1 / �S r� T ET'TD BD TO T C Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479340 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Marek, Todd I Richmond, Town of 026- 1127 -48 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /town /Range /Map No: 25.30.18.858 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Bo tl Dosing eade M Aeration Dist. Pi e Holding Nandt t. Sys em / i i nal Gr e PUMP /SIPHON INFORMATION Manufacturer D Cover G Model Number TDH Lift Friction Loss System Head H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes �_ No L Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1303 144th Street New Richmond, WI 54017 (SE 1/4 SW 1/4 25 T30N R1 8W) Richmond Hills Lot 48 Parcel No: 25.30.18.858 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. — Date Insepctoes Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County L /� 201 W. Washington Ave., P.O. Box 7162 T C 11 �- b fisconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3 5 Y 7 93 '1 Department of Commerce State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you o Project Address (if different than mailing address) may be used for secondary purposes Privacy Law, sI5.04(1)(m) f � J G ., I. Application Information - Please Print All Information Lot '5 Block Property Owner's Na me 'J /t Lt Property Owner's M ailing Address 1 � + `r rope Location 0 13e S� Z /a, S %,Section City, State n �/ Zip ,Coode Phone Number '� c ) Q I l l a4li46 v o T 01 7 . d 0 N; R N�or�V , C� II. Type of Building (check all that a ly) ok C'.S ej 5 I Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedroo s L.G ❑ Public /Conhmercial - Describe Use 57 Vb ❑ State Owned - Describe Use 7 ❑City_ ❑Village 19Township of R(Cl{Mol III. Type of Permit: (Check only one box on line A. Complete line B if ap cable) A. ther Modification to Existing System t stem ❑ Tr mietit /Holdin Ta Re placement Only ❑ O g Y � New System ❑ Replacement Sy g I —� B. El Permit Renewal El Permit Revision El Change Permit Tran List Previous Permit Number and Date Issued sfer to New Before Expiration Plumber V Owner IV. Type of POWTS System: (Check all that: 1 ) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ \un < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter IT — Comnucted Wetland El Pressurized In- Ground ❑Holding ilk Filter El Ae robic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter eaching Chamber ❑ Drip El Gravel -less Pipe ❑Other (explain) V. Dispersal/Treat ent Area Informa lon: Desig Flow (gptl) Design Soil Application Rate(gpdsf) ispersal 6 ,rea Require (sf) Dis a Proposed (sf) System Elevation 97 0 7 VI. ank Info Capacity in Total N ber Manufactu r 7Concrete , e Steel Fiber Plastic Gallons Gallons Units Consnvcted Glass New Existing Taaks Tanks Septic or Holding Tank Aerobic Trealihlent Unit Dosing Chamber c/ VII. Responsibility Statement- I, the undeligued, assume responsibility for installation of the P WTS shown on the attached plans. Plumber's Na me (Print) Plum is Si gnatur MP /M� Number Business Phone Number P lumber's Addre ss (Street, City, State, Zi ode) �5 Gow rn-tcf Iti( 3 — y e ff VII ount /De artment Use Onl Approved Sanitary Permit Fee (includes Groundwater ate Issu d ssuin gent Sig to (No trip Surcharge Pee) ?� + O 7 dS en Reasot enial ( ) IX. Conditions of Approval /Reasons for Disapproval 3) �t S il�C D✓\ r 1.' Seplic tW*, eflkw t Moir end 'mss 5 Z� !� diepenmd cell must all be services / maintain toper management plan provided by plumber. \ 2. AN eelmk requirements must be maintained J +` S t f � �; �, j o (L /tip 6C ACAI w14 is per applicable code / ordinances. ' p " I e — Z C, Gav lo.� r Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01 /03)�j� dv