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HomeMy WebLinkAbout026-1294-46-000 'WisconsimC5epartmentofCominerce PRIVATE SEWAGE SYSTEM County: St. Croix *Safety and Buildin%Division INSPECTION REPORT sanitary Permit No: 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: �y �� Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. T Permit Holder's Name: City Village X Township Parcel Tax No: Richmond Acres LLC, c/o Gerald J. Smith Richmond, Town of 026 - 1294 -46 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: l 6 D /Q ` 6 SIV U&4wkU 28.30.18.1528 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark Dosing VV —� L I Z Alt. BM j� lL _ s� t� 1 Aeration Bldg. Sewer �JO ►'� d3 q GN 5 18.3 Holding S t Inlet Der Qt 4 —7 q l 0 / /7' TANK SETBACK INFORMATION St/ t Outlet TANK TO P/L W� BLS_ Vent to Air Intake ROAD Dt Inlet �— Septic Dt Bottom >80� Dosing l , eader an. 3 �b S Aeration J" Dist. Pipe Q " -V CdL 034 IJ Holding Bot. System '5 _ Cl .S 40 W q Final G de PUMP /SIPHON INFORMATION 5 .5�/�/ 24 ' Manufacturer Demand §LiCover / GPM s &J 1 / 5 Model Number �• � � � TDH Lift Fricti oss System Head TDH Ft J Forcemain ngth Dia. Dist SOIL ABSORPTION SYSTEM w 16 BED /TRENCH Width Length 7 No. Of Trenches LPITSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 57& SETBACK SYSTEM TO Pj& BLDG WE LAKE /STREAM ,L-MCHFNG Man ctu ,C / .l 4 , / INFORMATION CHAMBER H U , j (/ Ty p Of System: _ D Model N ber: IBUTION SYSTEM 1 Header/ anifold Distribution I x Hole SizK I x Hole Spacing Vent to Air Intake J� ) 511 % 7 Pipe(s) Length O Dia L Length Dia Spacing �(J SOIL COVER x Pressure Systems Only xx Mound O r At - Grade Systems Only Be ch Center 5 d � �� /� Bed/Trench ch Edges Topsoil De p t h of xx Seeded /Sodded xx Mulched Yes E] No i Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /I DD Inspection #2: / / Location: 1157 132nd Ave New Richmond WI 54017 SW 1/4 SE 1/4 28 T30N R18W) Richmond Acres Lot 46 Parcel No: 28.30.18.1528 1.) Alt BM Description =,64 �� � t .� l - IP���ty✓d( G� Cdr. 2.) Bldg sewer length = ) - amount of cover = r(1`'1 ,3 3 Plan revision Required? f Yes No �/ _ v 1 Use other side for additional information. L -- ---- -'a - -- � -- Date Inse p ct is Signature Cert. No. SBD -6710 (R.3/97) P T PLAN Xl CT Richmond Ac res LLC VR1 s 1160 190th Ave elk River Mn 55330 SW 1/4 SE 1/45 28 /T 30 W TOWN Ric hmond COUNTY POLK MPRS Shaun Bird 226900 DATE 9/10/10 BEDROOM 3 CONVENTIONAL )00C IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE WELL H.R.P. Same as Benchmark 0 SYSTEM ELEVATION 95.3/95.1 6' below qrade Well is to meet all setbacks required by Vent WDNR >6 „ Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts 5.8ft 2 /pair of end caps 4' Lon 12" Manual Version 2.0 g Grade at System Elevation 328' Pro ert Line 34" p Y S Pro 3 Bedroom House 50' S 10' B -4 B -3 100' 2% Slope 2 -3' X 66' Cells with >3' spacing 80' 0 S"/ Vents o B -1 45' 52' � 1 B_2 284' Property Line I REG Wisconsin Department of Commerce SOIL VALUt�lgr$ OR Page � of 3 Division of Safety and Buildings 1 L in accordance with Comm , Wis. Z. wel; V r Attach complete site plan on paper not less than 8 1/2 x 11 inches in ze. PI T C t&Z include, but not limited to: vertical and horizontal reference point (BM), i Parcel I.D. percent slope, scale or dimensions, north arrow, and location and dista o nearest road. �� Please print all information Re ' wed by D ''{{ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / U Property Owner Property Location C, 4 I (� - Govt. Lot S 1/4 f::�1/4 S L7T -�D N R 4� E( ) W Property Owner's Mailing Address Lot # Block # Subd. Nzaor CS o T?� City State Zip Code Phone Number ❑ City C-] Y age 9AITo Nearest Road ' l )!!J-New Construction Use' idential / Number of bedrooms Code derived design flow rate ,y GPD ❑ Replacement ❑ Public o_r#ommercial - Describe: __— Parent material Flood Plai le`va�tionn if applicabl ft. General comments and recommendations: J p ni �z^il System Type � System Elevation Boring # Boring Pit Ground surface elev. / Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color G Sz. Sh. •Eff#1 , 'Eff#2 1 3 - 0 7 Y r �� ✓LJ 1 1 r 15 N .3 f .. l =ms a Boring # O 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L / • Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Heme (Please Print) Sig re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Data, Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 —1 f� 715 - 246 -4516 i Property Owner _ Parcel ID # Page of F-1 Ong # E) Boring E) pit Ground surface elev. ft. Depth to limiting factor in. Soil licatlon 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 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 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F ❑ Pit Soil ication Rate Horizon ' Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:E 150 mg/_ ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (RAW) I 430/R T PLAN PROJtCT Richmond Acres LLC ADDRE s 1160 190th Ave elk River Mn 55330 SW 1/4 SE 1 /4S 28 / 1 W TOWN Richmond COUNTY POLK MPRS Shaun Bird 226900 DATE 9 BEDROOM 3 CONVENTIONAL )00( IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 IL BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter BESTFilter ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 95.3/95.1 6' below qra Well is to meet all setbacks required by Vent WDNR >6 1, Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts 5.8ft 2 /pair of end caps Manual Version 2.0 4' Long 12" Grade at System Elevation 34" 328' Property Line Pro 3 Bedroom House 50' S 10' B -4 B -3 100' 2% Slope 2 -3' X 66' Cells with >3' spacing 80' Vents B -1 45' 52' B -2 284' Property Line 91,514 sq 1.90 ages •'` 1.62 acres 82,75J sq'. ft. / `'� .� : N89'50'27 "E 7 sq. ft. 8 '' .... • • • 2.24 acres 97, 480 sq. ft. : „ 342.48 �!, I l • N89'50'27 "E 52 342.48 , '43' "E _ —\ 7 17 acres z o 94,407 sq. ft � 45 46 N$930'27 'E � S W 1.96 acres► 1.74 acres N 85,178 sq. ft. \ 1.94 at 75, 741 sq. ft. '� ®d `• 1 ' 84,691 s+ OD N89'50'27 "E 283.65' 4 NSOW27 "E "W 39.96' 569 42 47 w �2 .° 1. (A 8 Z 220 sq 1.96 acres ° ' 85,398 sq. ft. N yy ° I N89'50'27 "E 450.26' / I m o 4 II -1 \ • 0 ° l 2.22 acre N t • v = g I 1.85 acres � •,�� �, ` 96,598 sq. iron g 60, 415 sq. ft. of S87 52 "E 303.02' N89'50 27 "E 350.98' / , S O A49 'e o 1.80 acres 78, 214 sq. ft. �, N w w L.B.O. 962.0 .01' S ,g 1.75 acres w g k E . 1 / �`�'Cr�r I cn s 1 ...........:.............. 1 1 4 45.11' i t,�3. o ao g I 76,130 sq ft. - E N N848' -. -� EASEMENT \`� -, o rn �+ o, 6� m 4+ IV (+ I W O H. W.E. = 960.0 �� o ° o_ 340.06' I L 61..3 �!_ - -27J 67'— . 66 00' 325 — —1 Y eortwte rmvA.90v and Buildings Division County 1 /+ W gton Ave., P.O. Box 7162 ■ ■C son, WI 53707 -7162 Sanitary t Num (to filled in by Co.) Sanitary P t App 1�� i O nR State tasetwnNumber I1C In accordance with s. Cotton 83.21(2), Wis Adm Coda submission of this tm to the ap Pro Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Applicatio forms for state -o ) na submitted to the Department of Commerce. Personal information yo provide be used for es in accordance with the Privacy Law, L 15. 1 m , Stets. �' ? I. A licatlon Information — Please Print All Information pal # v Property Owner's Name H /HG' G /'rC ja property Owners Mailing Add f/ property Location CF f Govt. Lot p City, State Zip Code Phone Number ' /., ' /., Section �o ` 2 ucle o ss J3 c7 T N; R�Ee JQ II. Type of Building (e heck si! that aPMY) - ^� Lot # L �//J/ J Subdivision Name 1 or 2 Family Dwelling — Number of Bedrooms Block # ❑ Public/Commercial — Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned — Describe Use Town of ^ III. Type f Permit: (Check only one box on line A. Complete One B if applicable) A ' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision a of Plumber Permit Transfer to New /SO d Q Before Expiration Owner D IV. Type POWTS System/Component/Device: Check all that appl Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. `of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ eatment ( lain V. Dis Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Diagersal Area Required (sf) Dispersal Area Proposed (at) System El - - 1 %- ? 1/ -- Y 57 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units A � n Existin Tanks 8 New Tanks $ - VN rn i% C7 CL Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the undersigned, swam usibility for l utailadon of *a POWTB sbown on rho attaedred Plans. Plu Name (Print) Plumber' i MP/MPRS Number Business P hone Number l ' zz Plumber's Address (Stree , City, State ip Code) t / Y!U &ounty/Deputnent Use Onl Permit Fee Date Issued 1 $Agent 'gtlattre approved ❑ Disapproved $ �5 l 13 Owner Given Reason for Denial q ��� a ! 1 3 U AL Conditions of Approva_measons for Disapproval Attach to complete pleas for the system and submit to the County only on paper not rem than a 111 x 11 laeba in due SBD -6398 (R. 01/07) Valid thru 01/09 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 9/10/10 Owner: Richmond Acres LLC Location:SW1 /4 SE1 /4 S28 T30 N,R18W Lot 46 Richmond Acres Richmond System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingency Plan 6. Filter Specificati s heet Signature _ Licens nu er #226900 PLOT PLAN PROJECT Richmond Acres LLC ADDRESS 1160 190th Ave elk River Mn 55330 SW 1/4 SE 1 /4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY POLK MPRS Shaun Bird 226900 DATE 9/10/10 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1" steel pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark AL SYSTEM ELEVATION 97.3/97.1 4' below qrade Well is to meet all setbacks required by WDNR Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber Plans Designed Using with 20.0 ft2 of Area Conventional Powts 5.8ft ^2 /pair of end caps Manual Version 2.0 4' Long 34" 12" Grade at System Elevation 328' Property Line Pro 3 Bedroom House 30' AL ST 50' B -3 2% Slope 2 -3' X 66' Cells with >3' spacing 80' Vents B -1 45' 52' B -2 284' Property Line No Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with 20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade - / Finish grade elevation Ty Installation 101.0 Vent Grade Vent 4 ' 4 " 4 ' X30/34 Septic Tank 4' Long 1 5' 4' Long 1 Grade at System Elevation 3 4 91 Grade at System Elevation Spacing 5' 2 - 3' X 66' Cells Same on other end Observation tubeNent ir -y � A B 16 chambers per cell System elevations: fft� U axe A__97.3 B 97.1 LJjAJ Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 - Co Ian Option #1. If sy em fails, determine cause of failure, use alternate area and install new stem in ed replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 w p o cri 0 1 � LL < �°M Z ac�c�c� U Z _ o i w wz F _J Zr LL mam w = Q d LL LL mho ""-0 co ti �i ti o - o N Z O d n-m LL � � O LL tz W r � N fT r O O N rn T T 0 d ZD W • LL ma O m r , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page __— of Division of Safety and Buildings � _� in accal`dan ' IY�omm 85, Wis. Adm. Code , County S1, C Ca Attach complete site plan on paper not fess than 8 1/2 11 iinnF allc include, but not limited to: vertical and horizontal refere e i )`t llffffEE I Parcel I.D. percent slope, scale or dimensions, north arrow, and to tion and distance to nearest road. D `�'� �Z 7 yb Please print all informzsion. AU G 10 2005 eviewed b Date Personal information you provide may be used for secondary p rposes (Privacy Law. s. 15.04 (1) (m)). Property Owner ocati n ` ZONING F IC GG 1/4$1_ 1/4 S a� T30 N R1 2 E (or Property Owner's Mailing Addre,� Lot # Block # Subd. Name or CSM# / 90 77 e. NW `/ to I P lat o f R ic h mprjdL A c. rc City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road �1K R���R P11N 30 ( 8 (K rn a "� X1Jt, ($ New Construction Use: Residential / Number of bedrooms Code derived design flow rate S 0 __ -- GPD ❑ Replacement ❑ Public or commercial - Describe: -- - -- Parent material ^ ,- .J. V21" W r^-S 1-, Flood Plain elevation if applicable T —_— ft. General comments '= S u S g t x't Q -TrG r.` k' 5 "f 1 rod- and recommendations: „ I C 9 -i. i 5 1 3 �� 4.$Y , � uhf K-t O �+^� • � ( Boring # O pit 9 9 y y I 1 I 4F� Ground surface elev. ; ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 c 1 3 /a -- L Sin a l� 0 rr)� r4 r w I to D w 7 -b Y -rY -. - - -- 5 rY) L ... J l IV 5—al Boring # Boring r Pit Ground surface elev. /0 ft. Depth to limiting factor in. [ 2 - 0 -- ilEiplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 L a r e - f Ytx Nei a rrSL. L 3 ,s,( 4 -_ 5 � s. L c u I V r J --- sr F ° r 99 Le �t Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L T Name (Please P Signature CST Number acA { a,,r1G A d O S� to Evaluation Conducted Telephone Number t` �' WM -� _a g - iu 5 -� Is a y$ 3598 SY0a1. Property Owner Gera ldQ S rn Ak Parcel ID # ___ Page _ of F,-31 Boring # ❑ Boring Pit Ground surface elev. -LD I- as ft. Depth to limiting factor �D D 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 YR l- a ; K r a -ti U Y2 `�f �—�° �� 11� b� Y Cl.a I r gip` 2 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 Boring # Boring ❑ pit Ground surface elev. _ ft. Depth to limiting factor in. 1 Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 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. 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DATE s ioltpnititian that is misrWaa*d may te8ltft it, the soft pertrtrt bang makes by t w Mm4t w � ZoQhv Dvwkw s«e fetclaft with this apiiastion a mo9r6d ww"aty deed from On Register ofDo,& Office: nd a aqY of dte eftwad rap if rxftMW-9 is ttga In tfte wormy dead, (REV. 051") i f'd 'b9b?STZL:471 Tcn 21 b - SIt - TILt�Ei 511 1 �1"bFf:l�i ddg:Zo ^ U 2851P 077 601423 �? State Bar of Wisconsin Form 3 -2003 KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIK CO., WI Document Number Document Name RECEIVED FOR RECORD 07/26/2005 10:00AM QUIT CLAIM DEED THIS DEED, made between Gerald J. Smith and Jeannine B. Smith, husband and EXERT # 10 wife REC FEE: 13.00 ( "Grantor," whether one or more), TRANS FEE: and Richmond Acres, LLC. a Wisconsin limited liability company COPY FEE: ( "Grantee," whether one or more). CC FEE: PAGES: 2 Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address See attached Exhibit A Kristina Ogland Attorney at Lw P.O. Box 354 Hudson, WI 54016 026- 1082 -40- 000;026- 1083 -10- 000;026 -1082- 70- 000:026 - 1082-40 -000 Parcel Identification Number (PIN) This is not homestead property, Dated��d �0 i (SEAL) (SEAL) erald J. Sniffh eannine B. Smith (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF 1N1�'Orr: l n ) ) ss. C FIX COUNTY ) * TITLE: MEMBER STATE BAR 04WONS Personally came before me on (If not, e above -named Gerald J. Smith and Jeannine B. Smith, authorized by Wis. Stat. § 6.� �, usband and wife o me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED B instrument and acknowledged the same. h STATE Ck Kristina O land Estreen & 021and 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: 9-r75'b5 ) (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. QUIT CLAIM DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infbprofbrms.com U 2851 P 078 M EXHIBIT A Parcel I The East Halfofthe East Halfofthe Southwest Quarter ($1 /2/El /2/SW1 /4) of Section Twenty Eight (28), Township Thirty (3 0) North, Ratrge Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 24,1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW 1 /4 /SE1 /4) and part of the Southeast Quarter of the Southwest Quarter (SEl /4/SW 1/4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteetl(18) West. Parcel 2 The West Half of the Southeast Quarter (Wl/2/SEl /4) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: 1. Lot One (1) of Certified Survey a filed Aril 24, 1990, in Vol. 8 of C.S.M., eY P P P8• 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW 1 /4/SE1 /4) and part of the Southeast Quarter of the Southwest Quarter (SE1 /4/SW1/4), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast Quarter (SW 1/4/SE1/4) of Section Twenty Eight (28); Township Thirty (30) North, Mange Eighteen (18) West; 3. Commencing at the Southwest corner of Lot One (1) of Certified Survey Map filed August 13,198 1, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89 0 59'15" West 20.00 feet; thence N.0 11 East 262.00 feet; thence S89 0 59'15" East 224.00 feet; thence SO °01'41" West 15.00 feet; thence N8 5915 e 9 West 209.00 feet; thence e SO 0141 West 242.00 feet to the point of beg it ning; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter (NWl /4/SE1/4) of said Section ' 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginni � giro: nF. i ;rox 40 commerceml.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 u ; 1 CommSco n S 1 n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of erce Sanitary Permit Application tate Transactiog Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are roject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purpo in accordance with the Privacy Law, s. 15.041 m , Stats. t / ' 3 2 J avc I. Application Information - Please Print All Infor tion ISECEIVE Property Owner's Name tt 3 ?nnq 0 9 k o 0 .1 � Parcel # Property Owner's Mailing Address Property Location ©�� Cr V f W ST CROIX COUN OFFICE Govt. Lot �SZ$ City, State Zip Code Phone Number �,� � t:. /., Section 8 VC-f- 1 j - 330 �� j - `�' / ' Pi f'! (circle one II. Type of Building (check all that apply) J ? 6 k Lot # T s c1 N; R 1 Pi E or �1 or 2 Family Dwelling - Number of Bedroo s y Subdivision Name Block # R . C_k G rC-E .S ❑ Public /Commercial -Des 'be Use ❑City o ❑ State Owned - Describe Use CSM Number ❑ V ' ge of cl Z p ob �, �� rg own of �� cl- ..+-.. �. III. Type of Permit: (Check only one x on line A. Complete line B if applicable) A. O LKNew System y El Replacement Sy in ❑ Treatment/Holding Tank Replacement ❑Other Modification to Existing System (explain) B. El Permit Renewal ❑Permit Revision Change of a er Ne Previous Permit Number and Date Issued Before Expiration --r� / , 4 IV. Type of POWTS S stem /Com onent/Device: Chec all t t a . t' Non - Pressurized In- Ground 11 Pressurized In- Ground 11 At rade M suitable soil ❑ Mound < 24 in. of suitable soil El Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/I'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Are quir (sf) D ersal Area Pr osed (s System Elevati7 YZSM W-1, , 7 Co-1 3 L W �' g 1. S VI. Tank Info Capacity in Total # Manufacturer Gallons Gallon Unit d o v a New Tanks Existing Tanks / . c a� a a U 00 y rn iw C.'7 a eptic Holding Tank o 0 c cJ w/ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum esponsibility for installation of the P TS sligWiLiall the attached plans. 'Tri ber's Name (Print y Plumber's gnature M Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 7—(. / Sd 1., J'_� u FY VII Coun /De artment Use Onl )CA pproved ❑ Permii/t Fee Date sue Issuin gent Si atur 1 09 ❑ isappro t)O IX. Conditions of Approval/Rea s for Disapproval 1, leptic tan , efflulnt fitter WW dispersal cell must all l as per management plan try ptat�ltber. Vrti s O 'G. V �/J ~ / b l �- P[ '`� o r / a 2. All setback rsq*WfWrts mt*be rrtkiltRiAtlid as per gvNc le t;�dt ! txd taaf�s A to complete plans for the system and submit to the County only on paper not less th n 81/2 x 11 inches in size / lalk �b _ J f SBD -6398 (R. 02/09) Valid thru 02/11 I L i U .�.. V N t✓% a Al u ca �h x 1 V ..7 t1 �� tl Q M1 o r 1 � Os 0 cA -� k Pl � m � r q � a w r� \ � O W O� � � Q h V \ b 1 1 � b TIC, Z a "A, u y 03 v n WJ(a -22 -20 11:43 FROM:JELL CONSULTING GROUP 715 - 246-3830 T0:2487B39 P.001/001 PRE'LIMI'N PLAT CR RICHMOND ACRES' Pr--)O cA COLPM FIAT iaa'"r h ?71 "r In" S"M.wt 114 and Mr S-mmel IA 01 10611 94 MW &V V J9 Ai "4 ft-p eb n Tqn or *_,WW S! 10.b f✓NA AL M NA \ ^'" � � �• 1...a.a � ` � l ' \{ �� � A r^Eb iAS� \ �.... 1 ri w a w t y. Olt, ' rJ ♦. u�::riG'di}r . p� N .•.t �OQyr a1 ..$ �l . N.9+ \ y / ✓ bW N.Y. '%/ / T, 6O K 65 r.+.+i..1' r.rc err« gr • ,�+1, �^ � i.ww� -� � 1 % ��.��r... � t W6/p fK,Klpaim�. 1 AOL N.VA._�.�i"������"����' It 1 +�� y �tlJaea�M .�, { � ..." , ,,,_ r,, / —r'— t *�� •` --;.. r 7' r ax 1 � 1 � ` �, �1 ti., 1 � 1� CC�➢1' �i .�,:.. . .... /' i � � `,�;\ ``••,,�.,..•• ,120; �� } ,� pw "N, �`' u 1.2A6 a rpg yi � 1 1 n 7 7 1.,�'\� \' ��� '` ``.`�,'..� \� "`.rfTl�ras'.•. -..X,y Ise eNy'� ! aw _ _ 1 a+s S- itk Ceres t. OC�e@ a I7t oc f ` l { / r h ? 1t 'e�t6 ®6 y .•. A� l�rQ,l, ':. i -+NIaA r is + T Nay / /arl "� y [/,)`�� l 1 / xw..r� /' Y 1 M ,, w ,,. HI V•'p Psre I.'.. IY�' 0.7 t.�2 i7[l a N Na4 , pu 3. AAA, I } 1 7"'1' M i t :� 4 p rt ' 7 / 1 8 t , 2,4 . 11 Y % ♦ �� - -.� r ' i "a�� ��,•%'' c �' �: f 1 , �� 1 P j1 ^'1 q t Ma�e�bS ' J � / 460' I —= i w P• i�7 vgdv ,"`� f Re � rea.w+l �. -W +6 r ° I w. 2.79 vcrv: 1.74 ccres \ 1 1 u 7.94 eIG3 f 97 9" --i ti `+ 1 d,q W 1. d nr f l ti.enaN+� S 1 l- N • / !L. Y nkB.N r.•%ff {{e,��gre7y /X *- �.a owe aau mo ,, ^Y .nlr " 7 \•\ s tMA ' 1 I'IRTU.�:D SLAT N +F` w.r {tilt ...r.. iL . �!• t� .waP0,1• M1 _ PL21al �� 1 SQS ? , QV. �'6A'illY'0 .M . 7 p''�y� 0 .wd' • .�..''`�• ~ )1y�� ..., r .: X 21 acres ., rl .''`'"W S �, � f. $A� /'J. -.. / � '�" �• Aen...r — uu1L0 .+,•.�ui • N„ a :P"'Y• X I NAN YI'Mrialn aAKA 11111 M qv k n r..M 1• . Ylx 1 v e �a w6s ,.,.•'' f •'". ,.� j •} \` - ..._r0h;e."ewn 1 �"'w , ^r •� .... YO!'.+ 1,' Y,11 R"wYn1 \N1 {. 1 G • 111i•M IGNf 1 • t. M,l f �' •! ... r I.aeAr. �`y� i 1 •r .rNt1 idt'�"frll \,,,•• ' + ,,/ w� � •I'. s. 75 acre+ �'r � . I z+l�, a `` ......+..�•• t• n;11 i.1. l.a. ."e Aduelxi >'u " ~" w � .. •irBC ocra5.. �y� i i .. '.,.. •.. 1:aA.. �4t w , � 1 1 �,� —,^—� NwIN Maa Y. e1w au1a. aaMYL p lN1 i,1 ..._ —•-'•, j I I W�.. �'' - n Me Ih r r tow lw // Onaa OwYnil AUwirM11 re11 �•+U :r 11a►1A1A I / 1 r dYMI� a1 fy:1 w! irtll' aww =vr MAMA. L l '�• «{. i / % "t', C — +..a pjb — — •,rant U. ✓ c :�ta�i G!`a "' re ' Y � M CA►ItIVlO SCIl11C m u�i ti �rw �'"aiii ;.�iw n! E a �q ' i fAY IYa 1 INa N Mr1+Pa1' .� A1"r CGMCeAIIIV 11Y K"/7 J ��' 4 � R 1 9 F 1tIARYAr.YN AIRiOYd'g7PrPYt�vxl+ mnda w .. m a tq, twrW fOMrOGAC+e1/YYD ^- . .:i'r'.. «. 1 Soil Absorption System Cross Section 99.s ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap �_ l Leaching Chamber ft ♦— System Elevation 3 ft S ft Soil Absorption System Plan View ft 3 ft i ft Leaching Trench 1 Vent Or Observation Pipe Chambers 11111111111110mid] 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating P 1 sq ft per chamber Soil Application Rate gpd /sq ft gpd Design Flow T - 7 Soil Application Rate + j 9 / EISA = 3q Chambers 2 rows of 1 7 chambers each. J Page of l Z- e 722 FILE INFORMATION r-vvv 1 J UVVIVth*b MANUAL & MANAGEMENT PLAN Page of Owner vFti •� SYSTEM SPECIFICATIONS i 5 Septic Tank Capacity f O P D Permit # al ❑ NA Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer PP f Bedrooms ��5 f 13 NA .3 ❑ NA Effluent Filter Model /=�8 11 NA Facility Units f Public Faits --B'NA Pump Tank Capacity � flow (average) aI !D gal/day Pump Tank Manufacturer .13-NA Design w (peak), (Estimated x 1.5) 7.2 al /day Pump Manufacturer -121 -NA ation Rate al /da /ftZ Pump Model nfluent /Effluent Qualit Y Monthly average Pretreatment Unit Fats, Oil &Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter ical Oxygen Demand (BOD 5220 mg /L �q El Mechanical Aeration ❑ Wetland otal Suspended Solids (TSS) 5150 mg /L 13 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand e Dispersal Cells) (BOD ► 530 m /L ❑ NA e g n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L EMA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: L aximum Effluent Particle Size Y in dia. N Other: El NA her: B-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: 13 month(s) ---t]] year(s) (Maximum 3 years) El NA Pump out contents of tanks) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every; / ❑monthls► 4a-year(s) (Maximum 3 years) 13 NA Clean effluent filter At least once every: _-G-Month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every; month(s) Po ❑ year(s) 13 NA Flush laterals and pressure test At least once every: 1 ❑ monthls) ❑ NA Other: -2-year(s) At least once every: ❑ month(s) ❑ NA Other: 13 year(s) ❑ 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 s12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the cal regulatory authority within 10 days of completion of any service event. ^,, GMW (4/01) 14110L S � 2- 7- 87: - of the tanKls) removed oy 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 MAINTAIN R Name c W 1�, t Name Q Phone J y Z yz-/ Phone Y? Z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone (, - U This document was drafted in compliance with chapter Co 122(2)(b)(1)(d) &(f)a 8�(2) & (3), Wisconsin Administrative Code. /�'�1°�6 7— z LeF 7 U ~ • x „ttl-,6 F 0 ii .o o i ru ru 0 g O = ry LL N 1 � a dj � � r•n•�•a� rn•�•a� tC 0 m � „�II•,e „�to,e ro 9� a Ou �o g 3 (jW W€ v ` ~ U E ui Z> v V• 3Q ] Q�" x 0 � 3 Sr Q d1 r3�• p ' AVIS COW wuww ~ ^ ............... ................. .... ....................... b � * t� I II � ' �� ---------- ------------------------ --------------- ................. ----------------------- -- ------------------ Fr ---- ------------------------------------- - -- -------- --- - ------ -- - -------- ----------------- ------- ............ . .. .............. . ........ ..... 1 ----------------- 0 $ 0 \ � T 0 i �F �� � ■ � z x F z 0 e \ I K3 0 2 �, % ® ° e g \ O w % E\ k co 2/§ 2 k CL CL } > . k \ [ E E § \ / 0 CD g� pa ■ _ % g ; � fI� t �\ i ° < 0 a 00 ® k CL 0 ��^ ° 0 e\ 2 E c }\ • "Me 0 0 0 \ � _ � ■ ■ ■ �; � � w w % 2 ■ a ■ L \ k CY o q , § £ d C ° 0 \ 0 § ( \ > — (D § (D z E z g§ Q > 2 ; 3 J m \ �, £ E § CL \ ( : \ c ® j 2 z CD . \ \ \ / z 0 i � § n ® d § z § i \ Cl) 7 2 \ �_ § U) % � \ � ± 0 § � E c z % \ C \ � \ � t � / 2 � \ a . 2 to % 0 4 CD � \ 2