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HomeMy WebLinkAbout026--1286-18-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitar Permit No: 506154 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: Sunset Ridge LLC I Richmond, Town of 026- 1286 -18 -000 CST BM Elev: Insp. BM Bev BM Description: Section /Town /Range /Map No: d / ab B Gtj i 34.30.18.1440 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY TA ION BS HI FS ELEV. ! Septic /0-0 b B� ar / 0 7�O Dosing VV l / S m Alt. BM Aeration Bldg. Sewer 3 %n Holding St/Ht Inlet — ••� 6 SUHt Outlet TANK SETBACK INFORMATION TANK TO P/L W� Vent to Air Intake ROAD Dt Inlet �— J Septic > 5'�� 6� i ' Dt Bo ttom � 2 3 q3 Dosing H eader /Man Aeration (',"A, Q1 - 1P 2 ,_7 /o 3 Holding B ° s tem * Final Grade ! t l6 S PUMP/ SIPHON INFORM Manufacturer L4 4-le GPM nd Stwer /� �/ mi 3 l D .2 Model Number & W 1 U T1 L/ A " TDH Lift r / Frict3n L ss Syste He TDti Ft [0 r Forcemain Length Dia. 2 ,. Dist. to We11 ±f" S Z i� SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches P DIMENS NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS L� SETBACK SYSTEM TO J P/ BLD WEL LAKE /STREA EACHING Manufacturer: INFORMATION OR Type f ystem: ` J i > UN Model Number KIST N SYSTEM s / A_C d lA` Head r /Manifol Distribution V x Hole Size x Hole Spacing Vent tgFjir make Pipe(s) (c N J � j � Length Dia H Length Dia Spacing I 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 Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: S / Z 2 / b 7 Inspection #2:_ / I 0- 7 Location: 1227 121st Street New Richmond, WI 54017 (W 1/2 SW 1/4 34 T30N R18W) Sunset Ridge Lot 18 4i Par I No: 34 30 ..'18.'f4�40 'I 2 ntia�nnliLvP� Gn;coL 5 :15 Ac dtc io 1.) Alt BM Description = �/ 1 �' n Ai 64— uSr�. 2.) Bldg sewer length = M - amount of cover =� I 4d A.,. ^*� - - u Plan revision Required? Yes o t S * s , Use other side for additional information. —t Date Insepctor's Sign ture Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County coff �. 4 201 W. Washington Ave., P.O. Box 7162 �� n Madison, WI 53707 -7162 Sanitary Permit Number {to be filled in by Co.) SO � State Transaction Number Sanitary Permit Applicati 3 In accordance with s. Comm. 83.21(2), Wis. Aden Code, submission of this form to t e appropriate governmental Pro Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms fors submitted to the Department of Commerce. Personal information you provide may be used for secondary sea in accordance with the Privacy Law, s. 15. 1 m , Stars. I. Hcation Information — Print AU Info" tin _ Pa # Property Owner's Name , S � � �e%� - C RE EtVED 6 ! Property Location property owner's Mailing Address 7 Govt. Lot j u r`.ti A D_ A __, City, State Zip Code Pone umber �_ y., ,L(�t/., Suction � hrcle o S Q i�T. CROIX COUNTY ' _E, ' _ N; R E r _ II. �, pe Building (check aS Lot # -that apply) _ --- .--- -- / - T ---� J ""-' -- Subdivision Name Family Dwelling - Number of Bedrooms � (�� I Block# J ❑Public/Commercial - Descnbc Use wino CIOSe ❑ City of -- {Q�(,a� Use `" L ' CSM Number El village of D State Owned - Descri Town of rRefo reExpiration t: (Check only one box on line A. Complete line B if applicable) m ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ewal ❑ Permit Revision ZEIChan =Pem-it to New List Previous Permit Number and Date Issued tion TS S tem/Com onent/Device: D Non - P ressurized In-Ground 0 Pr essurized In- Ground D At -Grade _and? 24 in. of suitable soil D Mound < 24 in. of suitable soil 2 [I Holding Tank [I Other Dispersal Component (explain) 0 Pretreatment Device (explain) e V. Dis rsal/Treatment Area Information: Dispersal Area aired (sf) ispersal Area pro sed (sf) System Elevation f - l t x Design Flow (gpd) Design Soil ApplicatiyuRalp Q dsf) P /Z 5 5:6— J V1. Tank Info apaciry in !L Total # of Mamifactur Gallons Gallons Units o l � New Tanks Existing Tanks Q7 D ` E III p. septic or Holding Tank Dosing Chamber VII. Responsibility Statement -1, the undersigned, assume respons b for i of the POWTS shown on the attached plum. ess Phone Number Plumber's Name (Print) Plumber's Signa MP/ivIPRS Number _ Plumber's Address (Street, City, State, Zip Code) LN — 0/ V11 oun /De artment Use Onl Permit Fee Date I ued I g Agent Si Approved 0 Disapproved S ❑ Owner Given Reason for Denial C?��� A-, /I� a Conditions of Approvimasous for Disapproval , y G S STEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber 2 gyps m and subtgit to the c only on paper not an 1 Sachea In size A „— as per applicable code /ordinances 3 SBD -6398 (R. 01107) Valid thru 01109 PLOT PLAN PROTECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W 1/2 SW 1 /4s 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 102.5' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallo TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RA E 1.0 A SORPTION AREA 456 # of chambers none IL BENCHMARK ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Property Line Scale = 1/4 = 10' 3 Acre Parcel 220' Property Line B -2101' =W 102' Area 15' below system is to Grading is to be done remain to divert run -off undisturbed away from system 3% Slope (g B-3 Tank is to be properly * bedded and provided with lockdown covers with —__W -- approved warning labels Ih� l U Uh �V►a Huffcutt Combo Tank B -1 Pro 3 Bedroom 344' Property Line f H Well is to meet all setbacks found in Comm. 83 Qf� d 1N" 121st. St. Safety and Buildings 4003 N KINNEY COULEE RD commerceml.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Co mmerc www.wisconsin.gov www.commerce.wi.gov /sb/ isconsi De artment of P e Jim Doyle, Governor Mary P. Burke, Secretary April 17, 2007 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/17/2009 Identification Numbers Transaction ID No. 1385953 SITE: Site ID No. 724221 Sunset Ridge LLC Please refer to both identification numbers, 120th Street above, in all correspondence with the agenc Town of Richmond St Croix County WI/2, SWIA, S34, T30N, R18W Subdivision: Sunset Ridge; lot 18 FOR: Description: Three Bedroom Mound System / New construction Object. Type: POWTS Component Manual Regulated Object ID No.: 1126593 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01101') The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and. located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. I SHAUN R BIRD Page 2 4/17/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 e Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. i i Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 4/ 9/07 Owner:Sunset Ridge LLC Location:W1 /2 SW1 /4 S34 T30 N,R18 W Sunset Ridge lot 18 121 st St. System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and igency plan 9 -11. Soil test r` Shaun Bird Signature License numb 6900 IV1S�(1!`+ OF f E7Y 3N� fsUlLC31N65 �T Sr: - =� C;Gf1RLSPONDENCE PLOT PLAN PROJECT Sunset Ridae LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016 W 1/2 SW 1/4S 34 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 102.5' 3 BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallo TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RA E 1.0 A SORPTION AREA 456 # of chambers none , BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL - H.R.P. SameasBenchmark Property Line No Scale = 1/4" = 10' 3 Acre Parcel 220' Property Line B -2 101'` j, 102' Area 15' below 0 system is to Grading is to be done remain to divert run -off undisturbed away from system 3% Slope B-3 Tank is to be properly B M * bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank B- Pro 3 Bedroom 344' Property Line House Well is to meet all setbacks found in Comm. 83 121 st. St. �g�er go Date Noi- -Woven Filter Fabric 4" Observation Pipe Perforated Aistribution Pipe Belov Filter Fabric AM C -33 S " Topsolf 'c= t3 -f 7. Slope - _Plowed Berl Oi � 2 � Force Main ifs �Z s Layer Drain Rock From Pump D ;.E I Cros Section Of A Movnd ' SYstem Using F . A Bed For The Absorption Area A Ft Ft. � -� eY �� . 1125 . _. K eft.. .. .__ - -- ; • �.. -• _ ......_._! L'I Ft. . 4- Observoi ion Pipe t{ A _ _ __- - - - - -- 1 Force Main � w -- ._.�--�.__ ------ ...____ �- _.._ From Pump __...__. L Bed Of % 2 o Distribution Fipt Drain RocK 4O bservotion Pipe= cCaita Permanent Marker ' �S•s�i ll � 'tam p ip e or Roder Plan View Of.Mound Using A Bed for Tht Absorpifon Area PAGE., QF..� Perforated Pit Oeicit EA_ dVi&W _- - �Fertoratta �. PVC P' p! � MO LOLatt4 Qa 89110M. Are Eq++snY Silos :a r Sf y Pvc Force Maas .. �iJCjsT 1d oLi. 1i1i7['C t0 CaRAtC�'� IP VC trtnrgio(d P;pe I " t� �2 — ups �� r" ,istf?burion Pepe Layout Ft. 1 � X Inches �! x .,,.: inches Signed: Hole Diameter( inch Lateral 'Z . � Inches) License Number: ber: Manifold Inches Bate Force Main Z Inches # of holesfpipea invert ElevAtion of Lateral S4 OFt. P i4P CliAMB,E'R C2flSS �EC-T AND SP€CIF LCAT1014 SEPTIC' TANY, GRADS BOX n . tjI# . ABO V $QX MA O DLE COYER tun r.1 VVT r OK • DOWN L&BEL +F REs Z AIR : I � . to f `_`" HIM TIGHT S. z FIl�� •`. � �� i - sit" B 4 .' �p1It3 Sol' rule O FF 3 Batt � • ETE A DAY aER . _ :. C DOSE ING / 7 ' ..- .. �FACTUR i.- SOS F ; ` 6AI'' 0 33 ALAS MAAJTP ��: �-- j - - _� .� RW PIPE - � PUMP tsas��� tzA �I - _ �-" FEET $ ££$ pgililp OF _ • - SE TCTTo% �pCTt3 VE XTICAL DI A Slip pLy - F&rs:sj FT �j'q' . FT- T?* VyN o'% HEAD FEET W16TH ILL. DISICI ^tes Sent By: HP Las e rJ et 3100; 1 !lb 55[ Oviet may -u -vv c.uur 4 9EH S ERIES SUMP /EFFLUENT PUMP specifications ,� Cut 31111m � r�aa aswl 211111111111 Nl K B► !MR Bii.1r1 8MMWU Y is a 0`1 fm *21.114 5mm MCA +re M 3N 13.0 10M 70 tit 55 41 32 tae 20 24 att 1C ttb4xtt94 ant 5mo wm are 230 3f4 63 1000 70 sa 55 41 32 t 20` 24 11111IS4:8,94 �i p4 f8S 509334 WW 4"0 115 314 13.0 1000 76 84 55 41 32 tie 2Q 77 &11 % itMA94 =0 AM Or e 280 34 ss WO 7e 64 55 41 _32 13.8 2Il M 9 tt s 1t W s B9t Ca�noess Duty AauA— 'tlttlt fia[tiltastsihterpumpsane tale0co�warsdMYa bnpastt+ryare ft4twit9ln 91sp1�b8ahed r�n45forfle pW17R ROW- LITEn/HOM („pnstruct 0 1000 2000 3000 Motor Housing E�o7ry Coated Cast Iron .. Impe!ler Material Poly Carbonate Io Im ller'T c Closed Vane ^ _ 'Volute __ -. ABS __.�... Power Cord 31TW -A 4 20 7.5 W Me Shalt Seal Nitrile with carbon and cera faces 9 Fasteners Stainless Steel so x Shaft Stainlem Steel 2.s Bearin &� -- Upper Sleeve and Lower Ball Bearings 0 0. 0 20 40 60 e0 FLOW- GALLONS /ytNUTE PUMP PERFORMANCE CURVE Little Gimt pump C o. 119V 60HZ ` PO Bea 12018 • UWmbom C1V 011 73157 Pkesm 495- 9171511 •Fax: 493.22E.1550 IT.maiF eastao4» www LittleGiantFump.comt 0 Form 995235 - 07103 LUATION REPORT Page / of Wisr;�sin Department of Commerce d • - Division of Safety and Buildings in accordan Es GE WE [1 . a L�so [ . county Attach complete site plan on paper not less than 8 112 x 1 et t size. Plan must include, but not limited to: vertical and horizontal referen pod iz�c Parcel I.D. percent slope, scale or dimensions, north arrow, and I ion and i s n t n road. R ew Date Please print all informa 'on, ST. CROIX COUNTY a6 Personal inforrnatiwu Provide may be used for secondary Pu l •� 1 ) fm)) Property Owner ff77 ,'�� -- Property Location y 1( ! V - Govt. Lot W 1! X 11/4 S T_3 C) N R E (o W property owners Mailing Address // L Block # Name or CSM# City State Zip C Phone Number ❑ City �7 Village own N est Road New Construction Use esidential / Number of bedrooms �__ Code derived design flow rate GPD ❑ Replacement Public or commercial - Describe:. _ _ -- - - - - -- - -- - - - -° -- Parent material -- _._ _ Flood Plain elevation if applicable General comments /,/) 5 and recommendations: [d i, t7 Lt Boring Boring # it Ground surface elev. V t✓ f . Depth to limiting factor in. Soil A Rate i Structure Consistence Boundary Roots GPD/ft Horizon Depth Dominant Color Redox Description xture e _ •Eff#1 •Eff#2 in. M �� // unselll Qu. Sz. Cont. Color Gr, 5z. Sh. r 3 jb 7U V1 J �' • a Boring Boring — Boring # pit Ground surface elev � ` t. Depth to limiting factor m• Soil Awfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 C7 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 z - 5: r ig/L- • Effluent #2 = BOD < 30 mQA& and TSS < 30 mg/L CST Nalme (Please Print) `tg CST Number Bird Plumbing, Inc. Shaun Bird 226900 Date Evaluation Conducted Telephone Number Address 715- 246 -4516 1008 192nd Ave, New Richmond, WI 54017 �� , Property Owner, Parcel ID # _ __ Page of Boring # ❑ Boring L_31 � f�'� it Ground surface elev. LI ft. Deb t, t( Jaliting factor . �-0 in. Soi Application Rate Horizon Depth Dominant Color Redox Description Texture cture Consistence Boundary Roots GPDAf in. v Munsell Qu. Sz_ Cont_ Color y:z�5h, `Eff#1 '042 2 0'1 L r 3j A. A0 2- /2.- --- t s k' w s E Ong # ❑ Bori ❑ pit Ground surface elev. ft. Dept o limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture ' jcture Consistence Boundary Roots GPD1fF > In. Munsell Qu. Sz. Cont. Color t ? -3z. Sh. 'Etf#1 'Etf#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Dept tilting lting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture ti uctnre Consistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont Color Gr, Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD, > 30 5 220 mglL and TSS >30 < 150 mglL ` Effluent #2 = BOD, < 30 mglL and TSS 5 30 nVL The Department of Commerce is an equal opportunity service provide- aad employer. If you need assistance to access services or need material in an alternate format, please contact the derarment at 608- 266 -3151 or TTY 608 -264 -8777. SOD 330(RAMO) Soil Test Plot Pla Project Name Sunset Ridge LLC Sh bird Address 838 Summer Pines Circle V Hudson Wi 54016 M *226900 Lot 18 Subdivision Sunset Ridge Dat 4115105 W 1/2 S W 1 /4S 34 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Nail /iron System Elevation 1 02.5' *HRpSame as Benchmark 230' Property Line 220' Property Line Scale is 1" = 40' B -2 unless otherwise noted 3% Slope 80' B -3 0' B.M. 45' 35' 10' B -1 344, 101 102' Property Line e - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHT CERTMCATION FORM OwnerlBuyer J �"� Mailing Address 4 -�, Planning & Zonin p ro p erty Address g Department for new co nstrucUou-) (v ratio required from �( GG! fn Parcel Identification Number 0 7, 6 City /State / 2 l LEGAL DESCRXPTION 3 a u �( T N R L WI Town of 7/'1 `L Property Location � '/: a , Sec. Subdivision S� ,1 s-�- jZ Lot # .L. Certified Survey Map # --- Volume ri Pages# ,Volume 26 v Page # D Warranty Deed / Spec house no � Lot lines identifiable Q no es ANCE Arm OW�x CERTIFICATYON 3 _ � f�J� �=�-�� �Gr��✓y SYSTEM ���Il�EN failure to bandle wastes. Proper Improper use and maintenance of your septic system could result in its p tore needed, a licensed pumper. What you put into consists of pumping out the septic tank every three years or sooner, if needed, by owner system can affect maintenance maintenance the function of the septic task as a treatment stage in the waste disposal system� are specified resperosibilities d in §Comm- 8352(1) and in Chapter 12 - St. Croix County Sanitary �� to St. Croix County Planning a-' ��g Department a certification -form. signed by the to submit The property owner agrees lumber, restricted plumber or a licensed pumper miffing that (1) onon-site; owner and by a master plumber, journeyman P • the s on and pumping (if n��') eptic tank is wastewater disposal system is in proper operating condition and/or (2) after inspection less than 113 full of sludge. stem with the req uirements and the private sewage dispo S Uwe, the uadersigtred have read fire above req nd agree to ma and the De ent of Natural Resources, State of Wisconsin. standards set forth, herein, as set by the Department of COMM' p Certification stating that your septic system has been maintained must be completed and returned to the St. C County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the Owner{ of j O — Pu'o described above, by virtue of a warranty deed recorded in Register of Deeds Office. / d� DATE I 4 e SIGNATURE APPLICANT(S) Q t cam ,�,Qs ,Q,� yrn���. --, � • - U & Zoning I7cpartment�� i ts Any information that is minWre;=ted may result in the sanitary permit being revoked by the Planning recorded warranty deed from the Regster of Deeds Offzce and a copy of the certified survey map if Include with this application a r reference is made in the warranty deed. 0mv. 08/05) �ovv - OVNNER`S UAL. & MANAG FMENT PLAN SYSTEM: SPE tCATK7Als � mvx Septic Tanis c aP�Y 1T1� 0 NA o l% 5 u r` '� . t^ C- a Wank Mang D NA a NA Effluent ill' . t PI�Rf CI OVA ��UW �W� o ds D� o NA X=bwof B® Purnp-Tank D MA Num�terOf Units pu Tank M ©NA ExgMded tiow (an 3 , UMP Q Na awd x 1-) pump Model Solt �1pP�O hly everjQe' rgvel t3 Peat F![ber Mont QuaCAy Rio mg/l- II M donical Aeration II Wetland F� Oli d� Grease flCO : 5= mg/L f3 p�{�ion II Other. 4xy�8'e1+ ASS) S1so /i Manufachrrer Mor lY average` flisQecssl Ceti(s) round (pressurized) t Q uaw s3o mglt. D in-ground (gravity nd Pc+ O Demand (BODs) 0 Aft -grade 17 Outer_ Bjodt T� Suss 53o c ❑ tart ne - Suspended Sollds �S) 510` � t QomI pp� wss�waosr ana . Fecal tric mean) . v W j ar for doe>� t fO fi+ w n' um e ffl uen t parade Size 3, lncizdiameter � �,� dle wv� sir v (VER1NlfErU►NCE SCHEDULE Service Fra4uency service event -7; rnonttz s) (Maximum 3 yrs.) At feast once every on NO of tank volume tnspeot opnd - �lon of tank(s) When combined sludge an scorn equals PUMP contants of tank(s) p months r{s) (tv aArnum 3 ym.) At }east once every ) inspect dfspersal MKS) At least once every � d months s f3 m s) O NA Clean affluent fitter 8 tarn'+ At least once every s) p HA Inspect p. �p contrary a At least once every 0 months l3 s) O NA Flush lei and Pre5wfw t At least once every ❑ rnc; ndts Y Q monft II year(s) 0 NA At writ Once evert+ onWc any i one of O��nuRner. Sept - 68AiE[t'ENMM IN3T R[1t�'IONS its chart be made try 3tt i p �� Ir�spec�o Plumber: plum -d er R 6&kftd S8wer; k s fJD iderrBlY n' or browe+n must on of the Wl scum and sxi check �. r. Tank WwpOc include a yLsesal insp for any back UP dw Swwk* flr leaks, crease th e rroiums cf combined sly bb {hg effluen l e t le ce s shall W vlou -- Tice pew t on t tardwam or porAW e�itte t one p �,d� g ��ofwent on ttte gt oltl su the � r , ry ea y- in the o PrP� CondWon and requires the lrnmedr� n Me tank volume. � g=jW mutate msy Ind 'sfle s fasin$ or move of . wit gc wm al any tank eqUahs tMten the comttTired axurn elation of sludge a nd Sepfi3ge Servit rig pPerafor' a� disposed of In NR entire oottt nts Of lire tank shaft be r emoved bS` eras: and 31Y 113, W19Wn0in AdmiNsixatrve Code. oneilts, p� Th seltng of efltuettt ffit". > flk"." p 5surtmd PowT'S comp a pow Maitt at intetvais of .12 more s tx mss. shall be P? Pi o f 2nY ses� event attlermak*Mce or moa?twin9 autttarify within 1t) dWs of A fVIVAShanbe provided to the local regu START UP AMC) OPERATION ent tank(,$) for the p cif Qau t� uct5 of 6, For new +o��. p� to use cif the PDT • am OK if high oonoen� � dt that may impede the �frtent process and/or damage Cite d'tspt o Pefrator P rior to use. dt tk," the oQr Wnts of the tank(s) removed by a septage servicing '! � start up son riot occur vrtieri Sa conditions are frozen at the infRtMlive sut€acia DwvV p pump tamlo; W jS above tonal higt wafer ieve}s. When POWsr is teStWed the t rw�i be dished m the d cWs) in one Lange dose. ovefW3ding the mss) and may result in fire cr sctrE;aoe d> z9e L Ta avosd f9s s&afion h ave the conbx is cf the pun* tank temoved by a Of e Sere S P 9 j resWdW p t o she effluent Pump or contort 8 PfucnbM or POWT$ Malrtt *W 10 i fttP oortt is to restore normal Wmis tiv& m fhe pump bnk Do trot Mye Or � vehi s o 1 anb grid 6SI3 �. Do not drive t3I pat�c over, Of � dtS� tncortipact, ttte a -= *Mdn is feet lows ,-tape of WY mound of at-grade =1 absarpiion area. Ramon or-e tbria n ofthe Wining from the wastew�sbraam may iMpit)ve Me perfc)trFt xe and pit IMg the Be t�f the POIKtS= ati / butts; condoms,, oatton swabs; degmwis: dentd fi= drapeM p=p) water, d� tat: dtakt (SUMP r, �t and vegetable pe�sit X $ % 9=W � mist ct oi�nft prodWW. ped'# a napkuw tamporw mid w ter softier brfna. At3AuDoNf UEN r fie Vitheti the PtJ4tliTS faits in is p,armsttemtty.taken out of service the fnttot+ring steps 9 W 1W tafcen m insile'e that sysmm is WDpedyartd safiely abandoned in compliance- YAM rh_ Comm 83.33. {Ar attain Adrtslyitstratit+9e Code: Alt pipfng to tanks and pits shall be disconnected and the abandoned pipe operfts seated . The cocAp nta of air tames and i� shat! tae removed and property d'sPosed of by a Se�B'� �>� Afor pifrrtp&ig, art tattles and Pits shaft be e=avafed and removed or Vvgr covers mnoved4and the VOW spore tilted arM soil, gmvef or• anogW Inert safrd rmatsdaL CONTBIGENCY PLAN if the POWT'S Ws and c tiriot be repdfred th foFlowing measures have been, o r must be faked. m provide a code compEant repbcomentsys teM Q A suitable rePhW*m it'ar+ea has been evaluated and may be utit¢ed far the #ocafion of a repiar ment soil - Th repot area should be protected from disturbance and cmp=Wn and should not absorption be k Ved upon by reclaimed setba� frcrn e�ng and proposed structeine, rot ru- and teens. Fa lure to t Pro th replacement area to result in the need for a new soil and sitw&Valu2V0A to est2tbfish a suitable went area ROp ent Systems must comply with the rules in effect at ttet tune_ 0 A su aUP- replacement arVa is not aval7abie' due to setback and/or soil rums tons. Sari advances in POWrS teehmoFogy a taofding t Wk may be h stalled as a last resort to replace the failed POWTS site has not bean evaluated to identfy a suitable replacement area Upon Emote of the POWTS a soit.and ny W pined to locate a suitable replacement area if no reptacemerst area is avafabls a . hokffg tonic may be instaffed as a Fast resort to replace the failed PQVVTS_ rarrtotiraf of the bcomat at and at -grade *a absorption systems may be reconstructed in place fofFavving e. Me �� rit of such systems must comply VAttt the n1Fes effect at gnat tfrr «gUARNFNG>> SEPTIC, PUMP AND OTHER TREAT DENT TANKS MAY CONTAIN LETHAL GASSES �4NDlOR INSUFFICIENT OXYGEN. 00 NOT ENTER A Sl:pnC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRICIJMST"A ES. DEATH MA RESULT_ . RESCUE OF A PERSON FROM Tf iE RCMMOR OF A TANK MAY BE DIMCULT OR NW- OSS ADDITIONAL C0WNW -- TI'S POtfifi S INSTALLEfZ PowTs mAiNTPJNiER /J� /. 7d Name fu r Phone / -- z �6 ��.� Phone SEPTAGE SEtYfC1NG OPERATOR LOCAL REGULATORY A€TTHORf'FY ^ Agency 57, �✓- /� d5e Phone J� — 71 - �, 0 This a by VAS Lie Marguesla and w=mharz Coamiy ZonEV and Sat V&Wbs- This daanttait vo m anwn r awft of di Coarns 83 -Z Q MX1 Xd)&M arsd 8 3 -U (S). (z) 8 (3). W,�s =is ln A&rrinF� C.od,-- f ise of tint dorsttnent deb f guarantee the pdumarue of the Powr'S. GUW (7101) FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10 :14PM P12 sit ' � r o f F i _ I a a r r r ' FROM :OEVERING HOMES LLG FAX NO. :7155311282 Dec. 14 2004 10:14PM Pll i. 0 _ '� • 17101D f SIN ® 1L b y • - • r • W-, f Of ----- ------ ---..r..r -. f .rr......... M al t Parcel #: 026- 1286 -18 -000 04/26/2007 05:12 PM PAGE 1 OF 1 Alt. Parcel #: 34.30.18.1440 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/26/2005 00 0 x Address: Owner(s): O = Current Owner, C = Current Co -Owner OEVERING HOMES O - SUNSET RIDGE LLC SUNSET RIDGE LLC BOX 179 N 154017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 1227 121 ST ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.248 Plat: 10/073- SUNSET RIDGE LOTS 1 -21 026/05 SEC 34 T30N R18W PT NW SW SUNSET RIDGE Block/Condo Bldg: LOT 018 LOT 18 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 30N -18W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 08/26/2005 804638 10/073 PLAT 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/22/2006 - -cription Class Acres Land Improve Total State Reason rNTIAL G1 2.248 29,700 0 29,700 NO - tv 2.248 29,700 0 29,700 0.000 0 0 q 29,700 0 29,700 0 0 cation Date: Batch M Category Amount xial Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 I U 2660? 306 �? 774'340 STATE BAR OF WISCONSIN FORM 1 - 1999 Document Number WARRANTY DEED K ATHLEEN EGISTER OF DEEDS ST. CROIX CO., WI This Deed made between Herman W. Keller, Sr., Herman W. RECEIVED FOR RECORD Keller Jr and Karen M Keller, husband and wife 09/21/2004 10:25AK Grantor, and Sunset Ridge, LLC Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEIPT i the following described real estate in St. Croix County, State of Wisconsin REC FEE: 13.00 (the "Properly ") (if more space is needed, please attach addendum): TRANS FEE: 1440.00 See attached Exhibit A COPY FEE CC FEE: PAGES: 2 Recording Area EStreen & 091and t ' 304 Locust Street Hudson, WI 54016 Together with all appurtenant rights, title and interests. 026 - 1098 -20 -000: 026- 1098 - 30-000 Parcel Identification Number (PIN) This is homestead property (is) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any,, of record. Dated this 24 day of V 71 2004 * Herman W. Keller, Sr. * Herman W. Keller, Jr. * Ki M. Keller AUTHENTICATION ACKNOWLEDGMENT Signature(s) Herman W. Keller, Sr., Herman W. Keller, Jr. STATE OF WISCONSIN ) and Karen M. Keller, husband and wife ) ss. ST. CROIX County ) authenticated this 2 7 da of V14 2004 Personally came before me this day of 2004 the above named Herman W. Keller, Sr., Herman W. Keller, Jr. and Karen * Kristina Ogland M. Keller, husband and wife 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 Kristina Ogland, Estreen & Ogland 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may W 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 HEED FORM No. 1 -1999 I U 2660P 307 EXHIBIT A Located in part of the northwest quarter of the southwest quarter, and the southwest quarter of the southwest quarter of Section 34, Township 30 North, Range 18 West; Town of Richmbnd, County St. Croix, State of Wisconsin described as follows: Commencing at the southwest comer of said Section 34; Thence North 00 degrees 08 minutes 04 seconds East along the West line of the southwest quarter of said Section 34 a distance of 484.68 feet to the POINT OF BEGINNING; Thence contiue North 00 degrees 08 minutes 04 seconds East along said West line of the southwest quarter 2157.27 feet to the West quarter comer of said Section 34; Thence North 89 degrees 50 minutes 54 seconds East along the North line of the southwest quarter of said Section 34 a distance of 1018.75 feet; Thence South 00 degrees 08 minutes 04 seconds West on a line parallel with the West line of the southwest quarter of said Section 34 a distance of 2007.79 feet; Thence North 89 degrees 59 minutes 59 seconds West 694.55 feet; Thence South 00 degrees 08 minutes 04 seconds West along a line parallel with said West line of the southwest quarter 164.50 feet to the northeasterly comer of a Certified Survey Map recorded in Volume 5, Page 1400; Thence North 87 degrees 49 minutes 24 secons West along the northerly line of said Certified Survey Map 324.40 feet to the POINT OF BEGINNING and there terminating. St. Croix County, Wisconsin. "7 Z � vu NV.. y .av aVaww / . ` \ ` / . S t' E j 373.32' �+ 263.37' 110.00' t - f 373.43' _173.20'_ mass - '3140* t � _ t 33' 330 t DrcWop t ' Eosunent 20 #AJW t t i t 21 r M333 soft- 1. 500 acres I r Vf N 97.921 sg.ft. N 2.248 acres O Rt I v � I I 5 ,24.23' N 78.40'11 17 84.989 sq.ft. 1 1.931 acres 2 . N85'1541E 1 �) \ inn' I Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD M (608) 264 -8777 www. commerce.wi. govisb/ It isconsin RECE11/ED www.wisconsin.gov Department of Commerce Jim Doyle, Governor APR 1 7 2007 Mary P. Burke, Secretary ST. CROIX COUNTY April 17, 2007 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/17/2009 Identification Numbers Transaction ID No. 1385953 SITE: Site ID No. 724221 Sunset Ridge LLC Please refer to both identification 120th Street numbers, above, in all Town of Richmond correspondence with the agency. St Croix County W1 /2, SWl /4, S34, T30N, R18W Subdivision: Sunset Ridge; lot 18 FOR: Description: Three Bedroom Mound System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1126593 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. f SHAUN R BIRD Page 2 4/17/2007 t. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. hi the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART Code: 7633 jen cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.