HomeMy WebLinkAbout026-1298-02-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
488102 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: 0216 • � 8Z eOp
Jurnisch, Carl Richmond, Town of 62
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
(V\, 1 G 34.30.18.
TANK INFORMATION ELEVATION DATA IS/OC
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / ' t 1 ZSb Benchmark
W r (�� 5
�t r IJI dV u gx Z(J Alt. 1.4.x. o , b /a 4 31
Aeration Bldg. Sewer
z.s Ial�`6g
Holding N, St/Ht Inlet
O utle t
TANK SETBACK INFORMATION .17 Ao , Z 1
TANK TO P/L WELL 61-1.77 v ent to Air In ROAD ne
We �
S eptic 7L N � 3o' � - . Dt ROAD
B ottom
osing ea er �'
Header/Man. •9 c ! - it -
A eration Dist. P ipe �7. &k 9 - 7. 3 7
ing
Bo t. ys em
PUMP /SIPHON INFORMATION F inal G rad e 1 3.1 - 7 & I ` Z /
anu ac urer GPM n over 0• b rby.
o e er
1.6\ 9 !v. 3
i v riction LOSS system nea
j Z
li- ai
SOIL ABSORPTION M
DIMENSIONS 3 166 3 f. C ( /� F __
INFORMATION e5 � CHAMBER OR I_
ype! 01 UNIT 26 S 1 I /V'►T A-4 Q J
254 ZS-1- Z S d
/ J ' N Pipes) � \ � ,
Length Dia Length Dia Spacing
Sul VI=K x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed /Trench Center 4 � i BedlTrench Edges \-I Topsoil � Yes �', °,I No 'Yes 7, No
COMMENTS: (Include code discrepencies, pe ns present, etc.) Inspection #1: / / Inspection #2: / /
Location: 1206 128th Avenue New Richmond, WI 54 7 (SE 1/4 NW 1/4 34 T30N R18W) Riding Meadows North Lot 2 Parcel No: 34.30.18.1354
1.) Alt BM Description=
2.) Bldg sewer length = 3 tic-ILI,
t I
- amount of cover = O r S `�S�C C�tQ o S e - 0 f--
Co� �.. V J
Plan revision Required? Yes No
Use other side for additional information.
nsepctor
- 0 -6710 (R.3197)
i
Safety and Buildings Division County
Nv isconsin
201 W. Washington Ave., P.O. Box 7162 C r Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
De artment of Commerce (608) 266 -3151 40 102
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, sl5.04(1)(m) Pro ect Address (if different than mailing address)
I. Application Information - Please Print All Information
Property Owner's Name I Parcel 4 Block #
C &A J
Property Owner's Mailing Address y� Property Location . re,,k /-0r Z - Aa--
2 Q d i N 0� roet{ �Ow W S %, � %4, Section 3 _ �49 , J Rdeex ,
City, State Zip Code Phone Number
r
I S
D oi (circle e)
yn J T.� N; R or
II. Type of Building (check all that apply) L
6 /t 5 s^1 ubdivision Name CSM T 4A, r
%I or 2 Family Dwelling- Number of Bedrooms p � � Public /Commercial - Describe Use !� tJSQ_ ✓` : 5
/-Z ❑City ❑ illage ®Township of a ; l ,
State Owned - Describe Use z J — � h 1~ o
C
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) _
A. New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. ❑Permit Renewal El Permit Revision El Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply) i 4 e
ly Non - 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- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
r
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rat gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
L" o ✓ �, ./ i S oo ✓ I,5 00 ✓ 9p, 3s'
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel, Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing W
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
K &0 0 , ee , �B u 1 - 715 - - .7yr�o�6vo
Plumber's Address (Street, City, State, Zip Code) /
3a (v �sl o.., s c,�1 ]bR c /U
VIIIL-Countv /De artment Use Onl
Approved Sanitary Permit Fee (includes Groundwater D Iss d Issuin gent Sig t e OS ps)
Surcharge Fee) / I/Y\ � 2 D r
iven Reas or Denial ✓ YJ
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER: 3) J� u� 7 a ✓�1
1. Septic tank, effluent MW and ��
dispersal cell must all be.sen4m / maintained V� rx 6 r c� 0.btd�l�td G
as per management plan provided by plumber.
2. AN seftck requirements mast be maintained
as per apps code / ondnances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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v Visconsi n SOIL EVALUATION REPORT #1709
Page i of 3
Department of Commerce in accordance with Comm 85, Wis. Adm. Code
Division of Safety and Buildings Steel's Soil Service, Inc.
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. .
percent slope, scale or dimens'
north h arrow, and location and distance to nearest road.
��, �O ndin g
Pf �e Revie By Date
Personal information you provide may used EPriva Law, s. 15.04 ( (m))• 3 ZZ
Property Owner Property Location
Stallion Development LL a JAL 1 5 2005 Govt. Lot na W1/4, 1/4, S34, T30N, R18W
Property Owner's Mailing Add n Lot # Block # Subd. Name r CSM#
1221 130th Ave ST. CROIX COUNT) 2 na Riding Meadows
City ❑ City ❑ Village ❑ Town Nearest Road
New Richmond I WI 54017 715 - 246 -5440 Richmond 1 120Th St
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe na
Parent material Benches and large drainageways of ground moraines. Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 99.35ft. Trenches spaced and depth to code 3.75ft below grade.
and recommendations: �-
F I Boring # ❑ Boring
pit Ground surface elev. 102.10 ft. Depth to limiting factor 96 in. Soil Application 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 '042
1 0 -26 10yr3 /1 none Sil 2msbk mfr a 1vf .6 .8
2 26 -36 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 36 -96 7.5yr4/4 none Is 2msbk mfr na na .7 1.6
AA
Boring # ❑ Boring /
® pit Ground surface elev. 102.10 ft. Depth to limiting factor 92 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 '01*2
1 0 -11 10yr3 /2 none sil 2msbk mfr is 1vf .6 .8
2 11 -24 10yr4 /4 none sicl 2msbk mfr a na .4 .6
3 24-51 7.5yr4/4 none sl/IS 2msbk mfr gw na .6 1.0
4 51 -96 5yr4/4 none I I scl 2msbk mfr na na .4 .6
nQ
Ifid n
33
" Effluent #1 = BOD 5> 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) Signatu CST Number
David J. Steel 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 6/27/2005 715- 760-0347
SBD- 8330 (R.07/00)
I
Property Owner Stallion Development LLC Parcel ID # pending Page 2 of 3
Bonn # Boring J
M
g ® pit Ground surface elev. 103.10 ft. Depth to limiting factor 92 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. *Eft#1 •EfM
1 0 -18 10yr3 /1 none A 2msbk mfr cs ivf .6 .8
2 18 -36 10yr4 /4 none sicl 2msbk mfr Cs na .4 .6
3 36 -92 7.5yr4/4 none SCl/Is 2msbk mfr na na 4 .6
it
Boring o Boring # B
❑o
B Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 `Eff#2
F-1 Boring # F1 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/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t *Etf#2
* Effluent #1 = BOD 30 < 220 mg/L and TSS >30 <_150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS <_30 mg/L
I
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 (R07 /00) SLCdS SON M IM.
STEEL'S SOIL SERVICE INC 3 of 3
David J. Steel Stallion Development LLC 994 200' St.
CST - POWTSM SW1 /4,NW1 /4,S34,T30N,R18W Baldwin, Wl 54002
Lic. #248956 Town of Richmond, St. Croix Co. Direct 715- 760 -0347
Riding Meadows Sub. Lot, 2 Fax 715- 684 -3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
The location of this test may or may not be as shown, as permanent lot lines were not established at the
time the soil test was conducted.
Legend N
1" = 40'
♦ = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 99.70 ft
Top of 3/4" pvc pipe
= Borings
Boring Elevations
B1= 102.10 ft
B2 = 102.10 ft
o o �Wj B3 = 103.10 ft
0.00 ft
lo /D Z00
y�
1
S
0 0 ,
I
x 977.7
L T 5
_ 980///
LOT 6
cN
N 1.57 o es
979.2: ti
x : .54 a s 3
— — . ... . — — 1. acres
- --
� --- - - - - -- --- ---- - -- --------------- --
981.3 0
x s N
x
98018 L _ 3�•
COW o
—�— ,
-.------- .. ...... . . . .. -
... .............
—N 8 16
1.5 acr
acres cV 1.50 acres
998.8
X
00
X
985.3 -
F , 232 243 25
989.
{ x
NOTE: The parcels shown on this map are subject to State, County and Township
laws, rules and regulaVions ( i.e. wetlands, minimum lot size, access to parcel,
etc.). Before purchasing or developing any parcel, contact the St. Croix County
Zoning Office and the appropriate Town Board for advice.
l�
82�b687
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX Co., WI
STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 03/14/2006 01:15PH
EED
THIS DEED, made between Riding Meadows, LLC, a Limited Liability WARR EXOPT #
Company, Grantor, and Carl E. Jurisch, Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00
described real estate in St. Croix County, State of Wisconsin (the COPYSFEE: 255.00
"Property "): CC FEE:
PAGES: 1
Lot 2, Riding Meadows North, St. Croix County, Wisconsin.
Recording Area
Name and Retum Address:
Land Title, Inc.
1900 Silver Lake Road, Suite 200
New Brighton, MN 5 l 12�q Z
Together with all appurtenant rights, title and interests. Q2(Q (t Z 17 — a Z -V 0 0
Parcel Identification Number (PIN)
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated this 6th day of March, 2006.
Ri to cad ws, LL
t
r
* arles W. Schulz, Chief Man e
fp a
�n
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF MINNESOTA )
WASHINGTON COUNTY. ) ss.
authenticated this 6th day of March, 2006 Personally came before me this 6th day of March, 2006 the
above named Charles W. Schulz, the Chief Manager of Riding
* Meadows, LLC , a Limited Liability Company, to me known to
TITLE: MEMBER STATE BAR OF WISCONSIN be the person(s) who executed the foregoing instrument and
(If not, ackn, ledged the same
authorized by § 706.06, Wis. Slats.) �hf I
THIS INSTRUMENT WAS DRAFTED BY
Notary Public, State 4f Min to
My commission is permanent. (If not, state expiration date:
Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New . r) )
Brighton, MN 55112
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature NANCY J. LENTZ
Notary Public- Minnesota
— Commission Expires Jan
WARRANTY DEED STATE BAR OF WISC 1 -2000
J
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CRTIFICATION FORM
caner uyer c�, ( �l v r%� S
Mailing Address
r
Property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location S F %., -U]�/ /., Sec. 3 t/ • T- -R Zk Town of JAW K, ck mo n:
Subdivision ` ; L A!; 4 M p g 5 6 L r`k .- 01 2 . Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume . Page #
Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYSTEM NL41MNANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property -owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, jounneymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (Z) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
1� a a A-. 3 1
SIGNATURE'OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.******
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of '
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Tank Manufacturer: W J e sc,r ❑ NA
Permit #
Septic ❑Dose El Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer: @� NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: ❑ NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow: L l 0 C> (gal /day) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: 0 (gal /day /fe) Effluent Filter Manufacturer: 0 c r G G ❑ NA
Standard (Domestic) Influent /Effluent Monthly average Effluent Filter Model: ff)r 2 2
Fats, Oil & Grease (FOG) <30 mg /L Pump Manufacturer:
Biochemical Oxygen Demand (BOD5) <_220 mg /L ❑ NA �NA
Total Suspended Solids (TSS) !150 mg /L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg /L Manufacturer:
(BOD >220 mg /L O-NA ❑Mechanical Aeration El Peat Filter d NA
(TSS) >150 m /L
Pretreated Effluent Monthly average [I Disinfection ❑ Wetland
Y 9 ❑Sand /Gravel Filter ❑Other:
(BOD !30 mg /L Soil Absorption System
(TSS) <_30 mg /L R NA
Fecal Coliform (geometric mean) !10` 9 In- Ground (gravity) ❑ In- Ground (pressure) ❑ NA
Maximum Effluent Particle Size in dia. 11 NA ❑ At -Grade ❑ Mound
❑ Drip -Line El Other:
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ❑ When combined sludge and scum equals one -third (X) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
❑ year(s)
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
❑ year(s)
Clean effluent filter At least once every: ❑ onth(s) ❑ NA
year(s)
Inspect pump, pump controls & alarm At least once every: ,, II ❑ mo nth( ) ❑ NA
/V � ❑
Flush laterals and pressure test At least once every: (� ❑ month(s) El NA
N ❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
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 a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 treatment tank equals one -third (X) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) 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 <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW -005 (02/05)
Page I of Z
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and /or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
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 s. Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems 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 (pumper).
• 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 the time of their permit issuance.
• A suitable replacement area is not available due to setback and /or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
*,- SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER
Name Co -lf ,& m Name
Phone O _ 2 ` Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name ( Go Zan,
Phone Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Parcel #: 026- 1170 -02 -000 04/12/2006 05:28 PM
PAGE 1 OF 1
Alt. Parcel M 34.30.18.1354 026 - TOWN OF RICHMOND
Current *1 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/26/2004 00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner
O - RIDING MEADOWS LLC
RIDING MEADOWS LLC
2440 N CHARLES ST
NORTH ST PAUL MN 55109
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 42922 2ff 'S T
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description Acres: 2.040 Plat: 10/37- RIDING MEADOWS 026/04 LOTS 119
SEC 34 T30N R1 PT NW NW FKA C Block/Condo Bldg: LOT 02
18 -4684 LOT 1; RIDING MEADOWS ('04)
LOT 2 (2.040AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
34- 30N -18W NW NW
Notes: Parcel History: 2
Date Doc # Vol /Page -- ype
12/2712005 815151 2949/618 WD
03/31/2005 791025 2775/284 WD
10/26/2004 778109 10/37 PLAT
2006 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 0612112005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.040 29,200 0 29,200 NO
Totals for 2006:
General Property 2.040 29,200 0 29,200
Woodland 0.000 0 0
Totals for 2005:
General Property 2.040 29,200 0 29,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
f
I
Parcel #,; 026- 1170 -02 -000 03/22/2006 03:24 PM
. • PAGE 1 OF 1
Alt. Parcel #: 34.30.18.1354 026 - TOWN OF RICHMOND
Current F ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
10/26/2004 00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co - Owner
0 - RIDING MEADOWS LLC
RIDING MEADOWS LLC
2440 N CHARLES ST
NORTH ST PAUL MN 55109
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.040 Plat: 10/37- RIDING MEADOWS 026/04 LOTS 1/9
SEC 34 T30N R1 8W PT NW NW FKA CSM Block/Condo Bldg: - LOT 02
18 -4684 LOT 1; NKA RIDING MEADOWS ('04)
LOT 2 (2.040AC) A j ,( Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
W V�V 34- 30N -18W NW NW
Notes: Parcel History:
Date Doc # Vol /Page Type
12/27/2005 815151 2949/618 WD
03/31/2005 791025 2775/284 WD
10/26/2004 778109 10/37 PLAT
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
96980 34,000
Valuations Last Changed: 06/21/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.040 29,200 0 29,200 NO
Totals for 2005:
General Property 2.040 29,200 0 29,200
Woodland 0.000 0 0
Lottery Credit Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Wisconsin Division WISCONSIN UNI FORM BUILDING Application No.
of Safety and Buildings PERMIT APPLICATION
Wisconsin Stats. 101.63, 101.73 Instructions on back of second ply. The information you provide may be Parcel No.
used by other government agency programs j(Privacy Law, s. 15.04 (I)(m)]
`VMIT REQUESTED Constr. AC Electric Plumbin Erosion Control Other.
rs N�te Mailing Address Tel.
-cky l tX
t- ontractor's Name: ))Con ❑Elec ❑HVAC ❑Plbg 11 Cert#REC 'Vi@ A a,7/ "I 3, Tel. /�- . 3
c =r ; S (, _ FAX# yj YEA"
Contractor's Name: ❑Con &Elec ❑HVAC ❑ P(bg Lic fCer* g Addr Ms Tel .- 4 =
jr , (� ., n vet .,�,l� :a cl�z
Clf3TY 6L .V%e FAX#
Contractor's Name: ❑Con f ❑Elec WWAC ❑ Plbg Li Cert# Mailing Addr s :17(r 1 �, Tel.
(\ 1 A
00 FAX#
t t". w
Contractor's Name: Con ❑Elec OHVAC ❑ Plbg L iic/Cert# Mailing Address Tel
pv r•'t 1 i IV ,h 6:.A. q 713 FAX
PROJECT Lot
LOCATION 6 S q. ft. S_ E 114, � 114, of Section 3 , T 3o N, R /k E (or)( v
B ' ddress Su vision Name Lot No Block No.
Zoning District(s) Zoning Permit No. Setbacks: Front Rear Left Right
J 3 ft. R. S ft. '_' ft.
1. PROJECT 3. OCCUPANCY 6. ELECTRICAL 9. HVAC. EQIJIPIME r 12. ENERGY SOURCE
XNew ❑ Repair XSingle Family Entrance Pane Forced Air Furnace Fuel Nat LP Oil El. Solid Solar
❑ Alteration ❑ Raze ❑ Two Family Amps: 2 QD ❑ Radiant Basebd/ Panel S ace Htg
❑ Addition ❑ Move )LOatage Underground ❑ Heat Pump Water Htg
❑ Oder: 0 Other. ❑ Overhead ❑ Boiler ❑ Dwelling unit has 3 kilowatt or mote in electric space
7. FOUNDATION ;id Central Air Cond. heating equipment
2. AREA INVOLVED 4. CONSP. TYPE` ' RConcrete ❑ Other 13.IlEAT LOSS
Site -Built ❑ Masonry —
/S� 1 Sq Ft ❑ Mfd ❑ WI UDC ❑ Treated Wood 19. SEWER •J BTUIHR Total Calculated
`-` ❑ U.S. HUD ❑ other. ❑ Municipal Enve and Infiltration Losses ( "Maximum Allowable
.,rea l Sq Ft S. STORM & USE @'Sanitary Permit No.: Heating Equipment Output" on Energy Worksheet;
1 -Story ❑ Seasonal 9kf< 10 a "Total Building Heating Load" on WIScheck report)
Garage + Sq Ft ❑ 2 -Story APermanent 11. WATER 14. EST. BUILDING COST
❑ Other. ❑ Other. ❑ Municipal Utility u
Deck Sq Ft. Plus Basement �rivate On -Site Well $ /
I agree to comply with all applicable odes, statutes and ordinances and with the conditions of this permit; understand that the issuance of the permit crates no legal liability,
express or implied, on the state or municipality; and certify that all the above information is accurate. If I am an owner applying for an erosion control or construction permit,
I have read the cautionary statement regarding contractor financial responsibility on the reverse side of the last ply. I expressly grant the building inspector, or the inspectors
authorized agent, permission to enter the premises or which ' permit is sought at all reasonable hours and for any proper purpose to inspect the work which is being done.
APPLICANT'S SIGNATURE r DATE SIGNED 3 A y( 0(c
APPROVAL CONDITIONS This permit is iAbed pursuant to the following conditions. Failure to comply may result in suspension or revocation of this
permi or other penalty. ❑ See attached for conditions of appr oyal.
ISSUING Top of 0 Village of, ❑ City of ❑ County of ❑ State Inspection Agency # Municipality Number of Dwelling Location
JURISDICTION
. PERMIT(SyISSUF•D' WIS PERbff SEAL # PERMr ISSUED BY:
'.eview $ ❑ nstruction
ion $ ❑ AC Name
. ermit Seal $ Electrical
1
.outer $ Plumbing 23 Date
Total
Erosion Control Cert No. - 2z ) 3 7 (&2
$
SBD -5823 (R.4J(r2) Dictnlm6tm: f1Pty 1 - issuing Jurisdiction nPIv 2 - Municinality Frxwardc to State NNew nweltino nPty 3 - insnector f1Piv 4 - Annlicaa�