HomeMy WebLinkAbout026-1175-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr •
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463146
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:
Railsback, David Richmond Townshi
CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown /Range /Map No:
140 /Cl0 PA 1 30.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark C
/4Z J ' Z �o �. Z /d®
Alt. BM
1r s4-, 3
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 7A
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Z 1 A -39 / Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe Z q7
g5 x-7.35
Holding Bot. System 1 94
.% yt,.
PUMP /SIPHON INFORMATION Final Grade q' l0n 1
Manufacturer J @emand St Cover
GPM •� �6 Z
Model Nu
TDH Li Friction Loss Syste a TDH Ft
i
Forcemain Le Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width y Length / No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS (
1 J
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION ,
CHAMBER OR + c�. .
T yp e O() AU9_4; I j 1 /� UNIT Model Number: 5�
LIJ IL
DISTRIBUTION SYSTEM T ZZ 1 t a
Header /Manifold Distributi n x Hole Size x Hole Spacing Vent to Ai Inta e
/ Pipe(s) \ \ Z_ 4O k 4,
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed/Trench Edges Topsoil -
Yes 0 No Ifs Yes [ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: New Richmond, WI 54017 (SW 1/4 SW 1/4 30 T30N R18W) Willow River East Lot 7 Parcel No: 30.30.18.
1.) Alt BM Description
2.) Bldg sewer length
- amount of cover = U IF
-- -- -- i
Plan revision Required? :a�' Yes No
Use other side for additional information. , L �
SBD -6710 (R.3/97) _ __
Date Inse tor's S' ature Cert. No.
Soil st and System PLOT PLAN
PROJECT David Railsback DRESS 5 133rd Ave New Richmond Wi 54017
SW 1/4 SW 1/45 30 /T 30 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/12/04 BEDROOM 3
CONVENTIONAL XXX IN- GROUND RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100° Filter ZabelA -100
❑ BOREHOLE O WELL sH.R.P. SameasBenchmark
SYSTEM ELEVATION 96.2195.6 4' below qrade
Plans Designed Using Well is to meet all
b
Alt. BM Top of Steel Fence Post @ 104.0' Conventional Powts setbacks required Manual Version 2.0 9 y
WDNR
Pro Town Road
Pro 3
Bedroom
House
B -2 B -3 150'
35' '
15' 8%
Slope
60'
08' Property Line
o be >5' Vent
from p.l.
1
>6"
of Cover
B- *B Standard Biodiffuser
6' Long 1191 Leaching Chamber
with 3 1. 1 ft2 of Area
34"
Grade at System Elevation
I
Safety and Buildin s D' "s' County /1
N *I 201 W. Washi 2 seonsin Madiso , — Sanitary Permit Number (to be filled in by Co.)
Department of Commerce ( ) 2 6e 3) (o
Sanitary Permit Applicat n I Plan I.D. N 7 7 ) A In accord with Comm 83.21, Wis. Adm. Code, personal infoin a n you provide 2 0 �
may be used for secondary purposes Privacy Law, s15. IXm) Nd� Pro Address (f diff t than mailing address)
L Application Information - Please Print All Information
S.
N G GFFIC�
Property Owner's Name Parcel L7 Block #
r
Property Owner's Mailing Address perty
/ t.oeae
J �- fi r; , 1 , 7
City, State tip Code Phone Number 7 W Section
A-lelln—�ew-d - LA 1,5Y- 7 ..Z_
ci one
O N; E rW
IL Type of Building (ch that apply)
,-/,-/,, Or 2 Family Dwelling — Number of Bedrooms � � ivision N to / D V
PoblialCommereial — Describe Use / i l
State Owned — Describe Use City_ Vdlage"'4?mship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ew System Replacement System Tmatment/Holding Tank Replacement Only Other Modification to Existing System
B • Permit Renewal t Revision grange of Expiration Permit Transfer to New Lin Previous Permit Number and Date Issued
Before "rration Plumber Owner ` S — U
IV. TM of POWTS S Check all that a l 1S 1
* — Pressurized In- Ground Mound ;_> 24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter
Constructed Wetland Pressurized in and Holding Tank Peat Filter Aerobic Treatment Unit Recirc g Sand Filter
Recirculating Synthetic Media Filter g Chamber Drip Line Graveldess Other (explain) fx
V. Dispersavrreatment Area Information: 1 ot) l M • 2,
Design Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area Repaired (st) s Area Proposed (sf) System
VL 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 Trqurnnt Unit
Dosing Chamber
VII• Responsibility Staten I, the uudehsignedj&me mwcsibility for installation of the POWTS shown on the attached plum
Plumbet�3 ame t) • Plumber's MP/MPRS N tuber Business Phone Nu r
zz _Z 4)
Plumber's Address Stree ty, State, Zip
,� s o/
VIII. artment Use nl
Approv Disapproved Sanitary Permit Fee uhcludes Groundwater Date Issued t Sign tote tamps)
Surcharge Fee) v
�
Owner Given Reason for Denial Q / 6 ` / D \
IX. Conditions of Approval/Reasons for Disapproval
C �-l�vt '7a 7� ) L"
SYSTEM OWNER: 46IL d MX-.01- l/ Sri 11f AAI; l V/ L
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained �b
as per management plan provided by plumber
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system oa paper not less than 81/2 x 11 Inches in size
Soil st and System PLOT PLAN
$ROJECT David Railsback DRESS 845 133rd Ave New Richmond Wi 54017
SW 1/4 SW 1 /4s 30 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/12/04 BEDROOM 3
CONVENTIONAL XXXX IN- GROUND /RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter Zabel A-100
❑BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 96.2/95.6 4' below qrade
Plans Designed Using well is to meet all
Alt. BM Top of Steel Fence Post @ 104.0' Conventional Powts Manual Version 2.0 setbacks required by
WDNR
Pro Town Road
Pro 3
Bedroom
House
B -2 B -3 150'
35' 40'
15' 8%
Slope
60'
08' Property Line
o be >5'
15' Vent
from p. I.
>6"
B -1 of Cover
20' B.M. Standard Biodiffuser
6' Long 11 Leaching Chamber
with 31.1 ft2 of Area
34" Grade at System Elevation
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Wisconsin Department oY Commerce SOIL EVALUATION REPORT Page / of (i
Diyision of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County s7 � f
Attach oomplete 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 point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Re ' wed Date
Personal information you provide may be used for seconds purposes \ /
Y secondary P Poses (Privacy Law, s. 15.04 (1) (m)). _7Q
Property Owner I Property Location
0 �,g ovt. Lot J�� 1/4<J4 S 3 OT R E( ) W
Property Owner's Mailing Address Lot # Block # Subd. Nam or ea
s' / 3 3,d Ae---- 7
City late • Zip Code Phone Number City ❑ Village7CTo Nearest Road
ew Construction Use QAP's d entiall /Number of bedrooms Code derived design flow rate ' 7�-�y GPD
❑ Replacement Public or co erclal - Describe:
Parent material t1Z,z.vG Flood Plain elevation if applicable A O tte ft.
General comments
and recommendations:
el
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 GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
—1
B a Boring
Boring #
Pit Ground surface elev. 7 - -�-=- 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
j (J -
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signs CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluati n Conducted Telephone Number
1008192nd Ave, New Richmond, WI 54017 Z /— ��� 715- 246 -4516
I
Property Owner Parcel ID # Page of _
Boring # ring
FS Bo
it Ground surface elev_ ft. Depth to limiting factor 1� 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
® -i /O t,,
.e
ti1 -, r
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
❑ 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
Effluent #1 = BOD > 30 220 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 alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -5330 (R.6100)
Safety and Buildings Division County t
201 W. Washington Ave., P.O. Box 7162
f� Of� , Madison, Sanitary a 't Nuumber (to be fdlfd in by Co.)
(608 266 -3� Cs I`6 J to
De artment of Commerce E i
Sanitary Permit Applicat' n S to Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal info n you provide 1 g [ 0
may �'
be used for Senn Priv ect Address if Brent than mailin address )
y sec purposes J f hng
' %T. CROIX COUN I t
L Application Information — Please Plant All OFFI
C
Property Owner's N Parcel # Block #
� S
Property Owner's Mailing Address Pro Locau
S� d Vk `'t/ 56, Section 30
City, State Zip Code Phorte Number
IL Type of Building (check all that apply) ., Par ~ N: R E a(W J
g Subdivisioa Name CSM Number
or 2 Family Dwelling - Number of Bedrooms
PubliCIComraeCcisl - Describe Use �/l / ✓� ��
State Owned - Describe Use City_ V llage>t'ownship ojX�
III, Type of Permit: (Check only one box on line A. Co line B if applicable)
A ew System Replacement System Treat woldig Tank Replace Only O to
B. Permit Renewal Permit Revision Change of Permit T fer to New Ust Rficatiou
10 Date issued IVR
Before Expiration Plumber ner ON A
IV. Type of POWTS System: Check all that apply) z j
X on - Pressurized In- Ground Mound Z 24 in. of suitable soil Mound < 24 f suitable soil At -Grade Single Pass Sand Filter
Constructed Wetland Pressurized In -Ground Holding Tank Peat Filter erobic Treatment Unit R lating Sa nd Filter
Recirculating Synthetic Media Filter Chamber Drip Line - pe Otber (ex 'n) ; s
V. Dispersal/Treatment Area Informs on:
Design Plow (gpd) Design Soil Application RawUpdsf) I Dispersal Area (sO OVersal Area Proposed (st) ystem Elevati
VI. Tank Info Capacity in Total Number artufacturer Prefab Site feel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New E"ng
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the a 'bility for lnstallatioa of the POWTS shown the attached
Plumber' Name (Print) Plumber' gnatum MP/MPRS Number f � Business Phone Nu
Plumber (Street, City, State,
VIII. Co /De artment Use Onl
roved Di�pp
SjUbuy Permit Fee eludes Groundwater Date Issued t Signal (No Stamps)
( �V lf mha4 e
Fee) 2S' 2f7D �
O
ven Reason for trial z
IX. Conditions of ApprovaUReasonsfur Disapp val,�
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be service i P
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
4
a`
F
4.
P T PLAN
PROJECT David Railsback DDRESS 845 133rd Ave New Richmond Wi 54017
SW 1/4 SW 1/4S 30 /T 30 /R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/20/04 BEDROOM 3
CONVENTIONAL XXX 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 684 # of chambers 22
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL s H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.8/94.0 3.5' below qrade
Plans Designed Using Well is to meet all
b
Alt. BM Top of Steel Fence Post @ 104.0' Conventional Powts setbacks required Manual Version 2.0 9 y
WDNR
G-
Pro 3
Bedroom
House
28' 45'
Property
Line
S
30'
B -2
30 Vent
>6 „ Standard Biodiffuser
5 ' of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
-3 10% 6' Long 11 Grade at System Elevation
Slope 34"
40'
30' Vents
B -1 40' 508' Property Line
0 '
* Alt.
001?*
T PLAN
PROJECT David Railsback ADDRESS 845 133rd Ave New Richmond Wi 54017
SW 1/4 SW 1 /4S 30 /T 30) /R 18 W TOWN Richmond COUNTY ST. CROIX
10/20/04 3
MPRS Shaun Bird 226900 DATE BEDROOM
CONVENTIONAL XXX 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 684 # of chambers 22
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.8/94.0 3.5 below qrade
Plans Designed Using Well is to meet all
Alt. BM Top of Steel Fence Post @ 104.0' Conventional Powts setbacks required b
Manual Version 2.0 y
WDNR
Pro 3
Bedroom
House
328' 45'
P roperty
L ine
S
30'
B -2
30nk Vent
>6 „ Standard Biodiffuser
35' of Cover Leaching Chamber
with 31.1 ft2 of Area
-3 6' Long 11
10% 3471 Grade at System Elevation
Slope
40'
30' Vents
B -1 40'
508' Property Line
30'
,� Alt.
- 7 , I
w�sin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code n
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Cam' ^ ( ro I A.
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions. north i now and location and distance to nearest road.
Please print ill in"QSLV'ED by Date
Personal irdarnation you provide may be used or secondary purposes (Privacy Law. 1 15.04 (1) (m)).
Property Owner prz-;A N / 1 5 2003 tion
mot!✓ :!rid 3v
. Lot W wA.) 1/4 hW 1/4 S^ 1 T d N R 40 E( W
Property OwrlersMaiftAddress uwIXCOUNTy ot# I Block# Subd orC
�� / Z !NG OFFICE "— W�
N) K111e'i &"
City . Zip Code Phone Number ❑ City ❑ Y T M Nearest Road
New Construction Use: Z Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Pubic or commercial - Describe: --
Parent mate w Da r~.� Fl000 Plain elevation appficabie ft.
General comments ,,t
and reoommendations: s ge� O l e au:� " �/ ' T4 (J
Borin /'--j 1'-UJ� Ld�tn 1
r 1-1 # �, Pit Ground surface ed u Q
- R Depth to IkftQ factor IM Soil Application Rate
Horizon Depth Dom1nantColor Redox Description Texture Structure Consh tenoe Boundary Roots G PDW
In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 1 I -Efl#2
3/ 4-
aZli
Borkv
Borhv
— #
/)
Pit Ground surface elev. ' R Depth to 1&nidng factor Sol
Rate
Hortzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Mtxeell Qu Sz. Cont Color Gr. Sz. Sh. 'Eif#1 'Eff#2
3�z S i- d r m4 K
'2 C_ L- k j a r 2- 3 .2
� � _._- .S Q rYl � n h a. • � � - L • �
• EMUNd #1 = SOD > 30 < 220 mglL and TSS >30 < 1y " ' Effluent #2 = SOD 1 30 nV& and TSS 130 mglL
CST CST (Please ) .•�$ raZ Number
Address Gate Evaluation Conducted TE Number
V) j�� J s OI ? p2f-
l
Property Owner g Parcel ID # Page of
l Bori # ❑ B t Ground surface elev. r � ft Depth to limiting fa� in.
Pit son tcation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
�" 13 Xz 5L a rn ci r k /
3 •2
I m1 01 n , 1
a+ 9? • �'
77
❑ # ❑ Boring
❑ Pit Ground surface elev. % Depth to frtniting factor in. Soil Rate
Horb= Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNIF
IM Mtrisefl Qu. Sz. Cont. Color Gr. Sz. Sh. '0f#1 'Eff#2
i
F-1 Borin Bori
❑Pit Ground surface elev. ft. Depth to Nmiting tailor in.
Sol Aipplication Rate
Horizon Depth Don*wd Color Redox Description. Texture Structure Consistence Boundary Roots GPDIf>t
In. Munsd Qu. SL ConL Color Gr. SL Sh. 'Eff#1 'Eff#2
I
I
I
• Etfluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg& ' Effluent #2 = BOD <_ 30 mg& and TSS 1 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777.
MW-1038(RAW)
T3
Soil Test Plot Plan
Project Name 'David Railsback ST
Address 845 133rd Ave
New Richmond Wi 54017 226900
Lot 7 Subdivision Date 12/12/02
SW/NW 1 /4S W/N W 1 /4S 30/31 T 30 N/R 18 W Township Richmond
M Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevatio 100 ft. Top of Survey Iron
System Elevation 94.8/92.0 *HRpSame as Benchmark
rA — lt -- BM - Top of Steel Fence Post @ 104.0'
Please Note: Tested area may not be
suitable for desired building area.
Check system location before
excavating. Soil test was done to satisfy
Zoning Requirement.
328'
operty
Line
96'
98' 94'
B -2
30'
5 '
10%
Slope
40'
30'
B -1 40'
508' Property Line
* Alt.
I
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent 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
51n c Plan
E tio ystem fails, determine cause of failure, use :ornate arba and instal! new
sted 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 71 5- 246 -5148
Shaun Bird #226900
ST CROIX COUNT
SEPTIC - TANK �ENAI`tCE AGREEMENT
AND
0
J$R,SHIP CERTIFICATION FORM
Owner/Buyer
s �!
Mailing Address
Property Address D artme t for new construction) \
(Verification required from PI S
Parcel Identification Number
City /State
jg!gAL DESCRIPTION
C.J /, .5� , ec ✓ 'I' = N -��W' Town of
Ica ti °n i — /. S 2,
pr °pay '_____ � Lot # �.
Subdivision #
f— Page
Volume ___ ----- '
urve ap # .
ed S Y M
Certify page
� 3
# .
'L- e
- ?l d
Volum
Deed
Warranty es Q no
Lot lines identifiable Y
Spec
house yes � no
o �ntenance
f to handle wastes. Pr per
a�1
N � d result xa its P remature y ou P ut into the system
Y STE is s stem cool ature f p
a M I �' A � � tena nce of your sePti 3' a licensed pumper , What y
Improper use and ears or sooner, if needed by
the se ptic tank every three Y aste disposal system
of p umpin g out ent stage in the w
� consists tic tank as a treatm
can affect the function. of the rep cation form, signed by the owner and st a
to St. Croix Depar a certifi disposal system
owner agrees to submit r verifying that (1) the on -site Wastewater of sludge.
The property Cix Zoning r cstrietedplumber or a licensed pumPe the septic tank is less than 113
o yntanplumber, d pumping (if necessary),
masterplumb�', J 2 a inspection an pimzP
condition and/or ()
is is proper operating a sews a disposal System with the standards
to maintain the private g . cousin. Certification
ents and agree urces State of W isconsin ' have read the above reQuuem eni of Natural Itcso Office within 30
d ha artm
e the uadcrsiSIIe C ommer ce and the Department Croix County Zoning a `D of Comm returned to the St
th
t forth, herein., as set by epa�nen't . d must be completed and
se rth• c s tem has been matntame
� TGNAnME that your septic
r ex "tion date.
the three yea
DATE
OF APPLIC
Ctu�FA r�R�t'IFICA ours knowledge. I (we) am (are) the owner(s) of
m enu
I (we) on this form are true to the best of my ( cods office.
tatc f D
certify that all s deed recorded in Register o
above b virtue of a warranty
the property described Y
P
i2l
DATE
OF APPLICANT �••` #«
SIGNA revoked by the Zoning Department.
Permit being ma result to the sanitary
nted Y
tion that is mis represe
*:
Any informs
Deeds office
warranty deed from the Register of D made in the warranty deed
is a lieatioa: a stampe if reference i
•' Include with this a copy of the certified survey map
.9 mcgenvao foe *9 C01101NO DATA 00CUMENT NO WARRANTY DEED
STATZ BAR OF WISCONSIN FORM 2_jm'l
M042 I
V n --- - � � OL_
PEGISMIM C, FILE
I ST. CROIX CO., W1
Ann&..L,._Mondor single. person.
..............................................
............................................................ .............................................. Reed for Record
......................................................... .................................... .............. a JUL 0 11991
...... I ..................... .. ............. I ....................................... ......... at 8:30 A. M
conveys and warrants to.David..H-..Railaback...4A4.Ar:L4t..Sp ............
..............
... of..fi_V4r.V_i:V.Q.rAhi1k ................... I ....... I .................... .......
............. ........ V ............. ............................................................................
...... ..........................................................................................................
....................... ........................................................ 0 r_ MCTURN
.............................
... ....................... ............................... ................. ...............................
... .
* "* ............. * ..... * ....... ---------- ................... *'***"* --- ---- * --- * ..........
the following described real estate in .... St....CmAx ....................... County,
State of Wisconsin:
Ta Parcel No: ..............................
The Southwest Quarter of the Southwest Quarter (SW} of SW}) of Section Thirty (30),
Township Thirty (30) North, of Range Eighteen (13) West, EXCEPT the North 165 feet
it thereof;
and
That Part of the Northwest Quarter of the Northwest Quarter WWI of NWT) of Section
Thirty-one (31), Township Thirty (30) North, of Range Eighteen (18) West, lying North
ii of County Trunk Highway "A" as currently laid and traveled, SUBJECT' to a 66 foot
jj easement for ingress and egress running frm the East side of the existing driveway off
County Highway "A in the Northwest Quarter of the Northwest Quarter (NW} of NW}) of
ii Section niaV-me (31), Township Thirty (30) North, of Range Eighteen (18) West along
County Highway "A" to the Western boundary of said Northwest Quarter of Northwest
Quarter (NA of NWO, AND running along the western boundary of said Northwest Quarter
of Northwest Quarter (NA of NW0 North of County Highway "A" and along the Western
boundary of the Southwest Quarter of the Southwest Quarter (SW} of SWD of Section
Thirty (30), Township Thirty (30) North, of Range Eighteen (18) West to the North
line of the first above described parcel.
Thi ...... 4.Aq;� .......... homestead property.
(is) (is not)
Z A
Exception to warranties: FEE
Dated this .............. _28.th_ ..................... day of ... ................... June-_. -- --•-..... ............ ..•......
.......... ............................................ (SEAL) ----- (SEA -
G a. . L Y-1/
VA n n I
............ .......... .................................. ......
...... ........................ ..............(SEAL) ...................... ........ ........ ... ........ (SEAL)
li ............... ........................................... . .............. .......... .......... ------ - .........
AUTHBNT�FATION ACHAiO_�11I�EDiiISIB� __
N,
F REC E RVED
2 2004
COUNTY OFFICE
OWNERS COUNTY PLAT ,
DAVID B M AVENUE SBACK
805 133 WILLOW RIVER EAST
80 VENU wv. CORNER
NEW RICHMOND. WI 54017 ^ BEc=. LOCATED IN PART OF THE SW1 14 OF THE SW1 14 OF SECTION 30 AND IN PART OF THE NW1 /4 OF THE NW1 /4 OF
I q SECTION 31, ALL IN T30N, R18W, TOWN OF RICHMOND, ST. CROIX COUNTY, WISCONSIN. r
SURVEYOR
EDWIN C. FIANUMI
NORTHLAND SURVEYING. INC. e1
858 A HWY'BS \ P.O. BOX 10 L
ROBERTS, WI 54023
M PLATT ED LANDS
a E
tq RADIUS TEMPORARY I R iB
CUL -DE -SAC EASEMENT TO .
BE EXTINGUISHED UPON
ROAD EXTENSION N89 °40'55 'E 1442.08 SOUTH LINE OF THE NORTH 185. OF THE SNIA- SWIM OFSECTTON 30
!3 DRAINAGE R EASEMENT n,1z 761 By
• ., '•. 1390.78
-
SV4M'E 194.06`____ N ' A 're 105.00 �Tj `I
\ e, e LOT 5
2
♦ "p L ACRES
I �° 113.235 w• 8.
LOT 1
I \ \ 1.88 ACRES 6�
L 8
81,887 . R 2.10 ACRES LOT 7 DRAINAGE EASEMENT DETAIL
.`...••••• \ ' \al I' - p. R 2.09 ACRES
.
G1 kIPIA9�E® ®$ ..... I 91.345 90,851 p. n,`,
iR
r \
BENCHMARK S I \
sa9.59374W LOT 22 E MDETNL'` ELEV. - 9,Y.S9POWING
22001 2.00 ACRES I I
'A REA
BB.9B3 w. n. i OT 2 $ .a
IR - I a6 eb 2.42 ACRES ,, rc M • .tP - I a ...............
w J , CI. 917 - - - 105,473 n.
M CI. 9 3 17 8: R j w• 1 I 'k, ,',(• ... TOKID TEx1ENDB
1 �\ ? TO SETBACK UNEY
SETBACK LxaE R
ajel 300.48 '
LOT 4 CIA- DE•SACEASEMENT TO EXTINGUISHED 1.82 ACRES ' • 9, ' - - - - BE EXTINGUISHED UPON
w fl
70.435 • \ y]L�- EASfEKY ROAD E%TENSION
LBO -913.8 a // ` ,_ - - 1 _ -
$ LOT 21 \ i�` 7 %- W
- - - - - - I��_ 2.03 ACRES. \ s StM'659
zz 4
i
88,282 p. fL* r
o {g i90 -930.0 -
I DING
LOT3 +y 7r / , �.... ..... ............................. ....... V o
\ 8 ACES /�
S\I $ I e 73 / A2t!T••. , \\ ` �`. \\ 1, R A• / // \\ 2.04 TS. N BY IP.A sq. IL
• j2 N / LOT 20 ��`\ \ �\\ / �� / '4r 11170 913.0 BENCHMARK
1.81 ACRES \ r h" / ELEV. 929.77
i in ; ' 78,649 p. n.
LBO -930.0
' BENCHMARK
` ELEV. - 929.s, LOT 19 \ Vi/ ': ' �• ELEV. - 938.1
1.94 ACRES /
B4 295 w• & ' ' , 'LOT 10
/ 253 ACRES
I a �i• O //' 110,395 LOTS SEEACCESSRF9tRIC7aN
- 2.11 ACRES
/ $ ,��E I LOT 18 91,778 w.R :'
T I 82,075 p.R \ �.'-�. ��. 5... •LL.
i a1 I 1:� A RE A S
\ 10 \ LOT 11
I t •\ SEE ACCESS RESTRICTION
;, \\
1'08 ACRES @ '� / �- a 130TH
sw coaNEn I I \d \ ' •. p. I
81,753 L'
SECTION 30 AV
ENUE
LOY9 Nw CORNER
P¢�� ,�- -------- -------
SECTION 31
i LO 1 7 /® LOT 13\/
2.14 ACRES 4
1.57 ACRES 93,081 w
I I LBO -93111) �Y
® Pl y X 1 ,
LOT 12 LEGEND
j 3 T 1 6 b DfE
ACCESS RESTRICTION N
ALIXAINUM COUNTY SECTION
101,844 p. 8.
• N 70 ACRES % Py�O \ i / CORNER MONUMENT FOUND
11s.a• 78 p.R � � �[: /
LBO-93t.0 LBO - 992.0
' 24V x If IRON PIPE SET. WEKLYND
PaVOlNG + 1 ;'PJ\�P 385 LOS PER LINEAR FOOT
\ \ I AREA" j LOT 14 0� / o rx,r IRON PIPE SET, WEIGHING 13
NWl ELEV. - I . .•/ '/ / /; \� • LOS PEA LRNENi FOOT
928.59 1 SEEACCESSfEBTICTCN NOTE
v
210ACRES ,- ♦ ,' LPi , yr x /r ,RION REBAR SET, WE094G
91.434 p. n. : �A�p/ yLAO LBO LOS PER LINEAR FOOT.
BENCHMARK LBO -omo *•' ♦ p. '\ ,
ELEV.- 937.16 !.••'
• OD x1ON PIPE FOUND
C' SIT j • A �Q \ / // a / - / Ct i 15(Ir DD IRON PIPE FOUND
I � y / • • �.�• / �� �/ - PROPOSED DRIVEWAY LOCATION
Soj' 1zwoE UTartY PwSEMENr
�d TEMPORARY CUL4)E - SAC DETAIL
HAIL - (10A EVENT)
POHDINt AREA
YEAR ENT)
I � .� � • `._-�� '/' ' / (Lao YEAR EVENT)
LCrr 15 W • / / / .80 . WEST BUILDIN OPENING
RESTRICTION PBEEACCESS RESTRICTION NOTE : • • • • • / /' ...... 10a'RO♦OWAY SETBACK I.WE
/� / LOCATION SKETCH - 2. a�
ELBV..o3oz /. O �� // LAOTH AvENXiE
so: 6 I • • • /�, p- / • �/ e1.TP R NOTE: ACCESBRESTRICTDN
= I • • •// Fy \' / �1 �' \ ALL LOTS WITHIN THE PLAT OF WILLOW RIVER EAST ARE
-� .. •• / , ,1 / \ RESTRICTED FROM DIRECT ACCESS TO COUNTY TRUW HIGHWAY
4I91 / �y ✓J /' 'A•. ALL LOTS 94ALL TAKE ACCESSHIOM PUTTED TORN ROADS
• / •O" /' ,/ -`- LOT 1VIMNSADPLAT.
+ .'•• � �
�I � ��/ /' / / /�\ PLAT � NOTE: NOOwNER OR REBIGENTSNHAU DOANYI/NpW1eC11
APPROMOOMPREHIENS NAMD A MO�E� BOIL EROSION
PLAN FOR THIS MT. nee pCLUDES BLA IS NOT UMITE070
LOT M1
EX CDUPO R PLA OBSTRUCTING. G.
ALTF DWGAR A SOR
\ 5
EASE ME0ft WATER p AINAGE OITCHES. WATER NJ
LOT B - \ CULVERTS. BERMS OR GRASS SEEDWGS.
NO I= OR KOM CABLES ARE TO BE PLACED SUCH THAT THE
31 == = D =. STREET LIE nE DlSileB/V9CE
131 %STREET OF A SURVEY STAKE BY ANYONE 6AVIOLATION OF SECTION 23832
/ / LB / �•, r�q \ OF WISCONSIN$TATUM& UTILITY EASEMENTS AS HEREIN BET
FORTH ARE FOR THE USE OF PUBLIC BODES AND PRIVATE PUBLIC
, ®A UTILITIES S HAVING THE RIGHT TO SERVE T AREA
)`L'_ \ LOTS. LOTS EA H PARCEL SHOWN ON THIS MAP (PLAT) IS SUBJECTTO STATE.
/ // �,• \ ZONING WETLANDS, MINI LOT S4 TO PARCEL TEL' M) BEFORE
COUNTY TRUNK HIGHWAY'S'
THE SY
CRWCOLEVELOPWNG OFFICE AND /
THE Sr. ST. OIx COIIHIY AL OFFIE AHD AIIOPIMTE TOWN
SEC. 30 & 31, T30N, R1 8W BOARD FOR ADAM.
WIN CORNER SECTCN 31
/ POSITIONED FROM WffNESS
MONLIME \ SCALE IN FEET I"- 100'
t 9 7M 299 SHEET 1 OF 2 SHEETS
'
THIS INSTRUMENT GRAFTED BY KARL PUTTNER J0902-15 DATE 5 4-04