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Home My WebLink About026-1064-11-100 (3)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Y St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. 615397 GENERAL INFORMATION MIT (ATTACH TO PER) 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 Township Parcel Tax No: Ron and Kathy Derrick I TOWN OF RICHMOND 026-1064-11-100 CST BM Elev: Insp BM Elev. BM Description. Sechonfrown/Range/Map No: (00.0 thv n CA G 1 21.30.18.318B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic } Q %I FL6V Dosing n Aeration Holding TANK SETBACK INFORMATION ®mm�- PUMP/SIPHON INFORMATION Manufacturer emand G Model Number TDH Lift Friction Los System Head TD Ft Forcemain Leng Dia. Dist to Well STATION BS HI I FS ELEV. Benchmark 5.17 Alt. BM IW Bldg. Sewer SVHt Inlet SVHt Outlet Of Inlet Dt Bottom Header/Man. (p/ �• Dist. Pipe n 55 U �f I l0- Bot. System .I0 Final Grade 6.3Z El Cover Ikr 1. Z •'C W �t�icrkr figs JI/IL ACAWRr I Iui4 JTa f rm BED/TRENCH Width I Length DIMENSIONS b1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: I PIL JBLDG 1I (OBI ( IWELL I. LAKE/STREAM (1 I LEACHING CHAMBER OR UNIT Manufacturer: 7 n [i liYl� 1 Model Number. DISTRIBUTION SYSTEM Header/Manif?ltl U Length Dia 1' Distribution Leng(th_G Dia / Spacing/ z Hole Size / x Hale Spacing Vent to Air Intake Oh SOIL COVER x Pressure Svstwms Only xx Mnunrl Or At -Grade Svstems Only pepth Over ( BetllTrench Center 8 Depth Over BedlTrench Edges rx DepID of / Topsoil xx Settled/Sodtled xx Mulched V Yes ❑ No '- Yes 0 No 011"COMMENTS: (Include code discrepancies, persons present, tetc.) Inspection#1 Location: 1462 112TH ST 1.) All BM Description = rr.\Ur ``'�``��rr� 2.) Bldg sewer length = toil � f lrwa � 1,,"' v- ,/ - amount of cover = J V N 1 l q Inspection #2: Plan revision Required? ❑ Yes No Q Use other side for additional Information. SBD-8710 (R.3l97) Dale Insepctor's Sign re Can. No. _ ranIaflFE l <�-AIU -aum - 00 9 r-. C Cony f L JUL 2 5 2019 Safety and Buildings Division 1 W Wa'hinglon Ave., P.O. Box 7162 �adlSOrl, WI 53707-7162 ST CROIX Sanitary Permit Number (to be filled anby Co.) " (01539-7--' St. Croy County ernut A11plic � SteteT Nuaba In accordance with SPS 38321(2), Wis. Adm. Code, suhmimoo of the form to the Project Address (if different Wm moi'in address) is roquved prior to obuuug a sanitary permit Note: Apinbcauon form for sul=nod POWTS am iWA fo the Department of Safety and Professional Servies. Personal information you provide may be used for aerooddS' lg / '1 I a'1..lt-Y puTosm in accordance: with the Privacy Law, a. 15. 1 m Stab. V of L Application Information - Plan Print j1drWorimation Property Owner's Name / Pwtd a RON AND KATHY DERRICK 0 — Property Owners Madmg Addren Property Lonbon I .5 0. P6. 6) yr 1462 112TH ST Gowp,a NW i4 NW u Section 21 City, State Zip Code Phone Number NEW RICHMOND 154017 T 30 N; R IS EorW IL Type of Building (check all that apply Lot a Subdivision Nam` I or 2 Family Dwelling - Number of 4 1 Block a ❑ City of ❑ Pubba Commercial- Deecrrbe Use ❑State Owned -Describe Use ❑ViWge of RICHMOND CSM Number t /! y/�L' ® Town of 2-9� Ez9OL IIL Type of Permit; (Check old line A. Complete Hue B if applicable) A. ❑ New Sysmt m Rephcement System TrnatmmvHokling Tank Replecemrnt Only ❑ Other Modification in Existing Syncm (explain) B. ❑Permit Renewal ❑ Permv Revision Change of plumber ❑ Permit Transfer to New Owner List Previous Permit sued 3$ y N Z %olel Before Expiration ry -2 atfeom ent/Device: Check all that apply) reaemiaed In es ❑ Prsuued rized In-Gro❑ At -Grade ❑ Moues > 24 in. of suvabk soil ❑ Wood <24 i of wiuble soil piepasal C (explain) ❑ Pretreatment Device (=plain) V. Di tut Area Inform'n• Desipr Flow (gpd) Design Soil App .on Rate(gpds f) Dsper-al Area Reg (of) prr Dispersal Am(s0 Syuem Elevation 600 .7 857 900 93.00 VL Tank Info Capacity in Trial a of Manufacurrcr u Gallons Galloon U.,c '8 g .E Nov Taub Exiting Tmks I L y U 0. %tkf Septic or aoWn Twk X 1250 WIESER J X Doering ohaarbu N/A WA N/A VII. Responsibility Statement- 1, the undersigned, aawmr respossibigty for imu cation of the POVM shown on the attacked plea Plumber's Name (Prim) Pbmber's SiDumee MP/MPRS Number Business Phone Nurnber 246-2660 PAUL R KOEHLER /✓ G— 225410 Pl mbet's Address (Sheet, City, State, Zip Code) 321 WISCONSIN DRIVE NEW RICHMOND WI VIII, a at Use on ved PermitsAFA�ee Date 1 Issuing Signature 5 �W i�o /� Ow turn Reason for I / IX. Condi oua for Dhlapproval 1 1. - n .k, ae tiler CM 3 fr Wei— lit._- JU Po/ a e (aAparuk cl11 r%tat al )241!r.'ICt ! tiul��?i as per ,TraFayemen! plan pro mt)arl by pkhnbe;' 2. AN a*ItW* ttgL"-lane tnt JAR, rad:tdf w per appawhis ax}t l •rifiranoaa. Attack W complete plan br t►e "m, =d mbmtt ta ibe Coasty oaty ea paper cot b ma s in a 11 mcam m rue S SBD-6398 (R. 11/11) RON AND KATHY DERRICK REPLACMENT. SEPTIC SYTEM Well 50 it plus away Maintained yard Current Wieser 1250 septic tank home filter existing Diverte NJ PARCEL026-1064-10-100 NW1/4NW1/45EC20/21T30R18W TOWN OF RICHMOND Woods and unkempt part of yard Slope 5% Current infiltrator chamber two trenches i Proposed ez flows two each . System elevatio 93.0( LOT LINE 275 FT oA� 90 ft long it CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: RON AND KATHY DERRICK REPLACMENT Owners Name: RON AND KATHY DERRICK Owners Address: 1462 112TH STREET NEW RICHMOND W1 Legal Description: NW 1/4 NW 114 SEC 21 T 30N R18W Township: RICHMOND County. ST CROIX Subdivision Name: Lot Number. 1 Parcel ID Number: 026-1064-10-200 Page 1 Index and tide Page 2 Plot Plan Page 3 item Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. PAUL R KOEHLER Date: 07/25/2019 Signature License Number: Phone Number MP 225410 (715)246-2660 Dpipmd pursuant to the In -Ground Sop Absorption Component Manuel for POWTS Version 2.0 SOD-10705-P (N.01101). Pape 1 RON AND KATHY DERRICK REPLACMENT. SEPTIC SYTEM Well 50 ft plus away Maintained yard Current I Wieser 1250 septic tank home filter existing Diverter NJ PARCEL026-1064-10-100 NW1/4NW1/4SEC20/21T30R18W TOWN OF RICHMOND Woods and unkempt part of yard Slope 5% Current infiltrator chamber two trenches I Proposed ez flows two trenches 90 ft long each. System elevation 93.00 LOT LINE 275 FT 0 r 7 r SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page_ot_ Project Name: RON AND KATHY DERRICK 2 No. of Cells 9 Per Cell 3 e Cell Width 18 Total No of EZ12031 90 h Cell Length 50 sq n EISA Per Cell 3 e Cell Spacing 900 sq ft Total EISA Manufaefunr Medal Lavine Lenalh FJSA Raane InfBtrator EZ1203H.5ft 5.0' 25.0 Q12031-1-10ft MY 50.0 Graveliess Leaching Unit Manufacturer. INFILTTRATOR Gravelless Leaching Unit Model: EZ1203H- Finished Grade_ft ,.. in Plumber/Designer Signature: License C 225410 Typical Cross Section Observation Pipe with approved cap or vent Soil Backfill i Geotextile Fabric a Infiltrative Surface O I a Limiting Factor Slotted and Anchored Vent/ Observation Pipe with Cap ............................................... Date: JULY 25 2019 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION owner RON AND KATHY DERRICK Permit 0 DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate aVd /ftn Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOO,) :=0 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretrsated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ❑ NA Fecal Conform Igeometric mean) 510'` cfu/1 OOmI Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 1250 al ❑ NA Septic Tank Manufacturer WIESER NA Effluent Filter Manufacturer 7ARFI ❑ NA Effluent Filter Model ❑ NA Pump Tank Capacity al X NA Pump Tank Manufacturer X NA Pump Manufacturer X NA Pump Model LXNA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Pest Filter ❑ Wetland ❑ Other: 0(NA Dispersal Collis) X In -Ground Igravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) O Mound ❑ Other: Other: ❑ NA Other, NA Dther: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 1 month($I (Maximum 3 years) earls) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume O NA Inspect dispersal cents) At least once every: 3 ❑ mont) paearls) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 11 1 . month(sl p4 yearls) EI NA Inspect pump, pump controls & alarm At bast once every: ❑ month(s) ❑ year(s) JQ NA Flush laterals and pressure test At least once every: month(sl O earls) X NA Dthe`' At least once every: O mll sl ❑ yearls) OWA Other ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal collie) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of v For new construction, prior to use of the POWTS check trsatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wig be discharged to the dispersal cells) in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of servicethe following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: _ • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot fines and wells. Failure to protect the replacement area will result in the need for a new soil and she evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. POWTS INSTALLER Name COUNTRYSIDE Phone 715 246 2660 POWTS MAINTAINER Name PAUL R KOEHLER Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name DARRLES SEPTIC Name s^r• �' ((DUZOA/f�t/ Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(t)(d)&(f) and 83.54(11, (2) & (3), Wisconsin Administrative Coda. P�: -- gip;q„ PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION Poraonid Iniwmaeon you Prcvloe mey be used for Im TANK INFORMATION rACH TO PERMIT) p rp soo IwwaW taw, a.15.Or L = CSr Q,tt�-1 TYPE MANUFACTURER CAPACITY Septic Z� Dosing Aeration — Holding TANK SETBACK INFORMATION PUMP/ SIPHON INFORMATION - Mantillsiqurer Demand Model Num TDH Lift Fn ern LOU PA I TON t Forc ,�w6in I Length Dia. Dbt To weB OIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Penwit .. 384112 State Plan 10 No ParTax No.: 026-1064-10-; .11. 30, (8, 1(8i4Z0 STATION as HI I FS ELEV. Benchmark ?. 3 4- 4D?,3} tan . o ' Alt. BM Bldg. Sewer �y St/Ht Inlet St Ht Outlet 19,7S7. gg.b2' Dt Inlet Dt Bottom Header/Man. �d•o gi-3r Dist Pipe ' Q }.;Z' Sot System ((•3S )1.36 •e Final Grade z St cover Oft E wxfth / e h o o Nf wenches PIT No.Of V is rrsiee o>a- tlyud Depth pimENsroln— 3 DIM ENSIONS SETBACK SYSTEM TO P/L I BLDI WELL I LAKE/ STREAM LEACHING �Fum INFORMATION CHAMBER ORUNIT ype >Sa , 190 7 tip.;_ system: DISTRIBUTION SYSTEM �— Nea er/ nio L.%u Drtr ution pi s xN Sae xHoeSpaang nt To A,rlroae oia. tengtf� --1-- �n9 — SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth 01 xx Seeded/Sodded 1 xx Mukhed Bed [Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No 0 Yes ❑ No COMMENTS: (include code discrepancies, perspns present, etc.) lnsmtion #l: ae/1 `(/ 0( h=ection #2: Ti Location: 1462 112th Street, New Richmohd, W1 54017 (NW 1/4 NW 1/4 2173 R18W) • 213018318A 1.) Alt BM Description= Iwat-tjl11ar►eSrB...�CS6lA.e.-tsI„pi> OX+.e. 2.) Bldg Sewer length = - 30 -amount of cover = 3) wsr /<.:.ts /w.:Is , r.& Plan revision required? ❑ Yes 0 No Use other side for additional information. SeD.6710 rt"7) ate Inspectorsiignature CM. No f2 9�s•, r� I sT.caouccouNn• oab_ior.y-ioZoo.. sjg,A_ ro Y RONND r. F71„E� JMI!lSOli .i.4-lOby-lO-�b '� d 2�m afrr�etA•'r JUN � G 2001 �,Q�'q�4 1+a ®1i:z � f o-iT n nanrnad.e+n 5omn of'9 0 R T I F E U IeMMefe� Located h earl of the Southwest Quarter of the Northwt Oumtr of Soclbn 21 and part of the SouNo r Quarter of IM Northeast Quarter of Section 24 all In TovnM4 30 North, Range IB West, Town of Rfchmor4 SL crabs county, Wisconsin. / Prepared for and of Ns request of: I eECMV -447-4 li if .graov to-Jp-fe Randd L and Kathy Drrlak �p +t if S PSOSRarTrunk fllylwoy 'S5' : ®; O • Q p, New Mahmond, 1N 54017 I I J I BI r wed by Ty It 0dge yyg 'Gr> r� " ifs//".. usr/we oc•a'c Ae 7/� craw 110 526.10'.• •'i 50725'OYE 321.30' i ,07'-'' i i MM7114 Camp-- , M2PRGrr .........n� 0 9freW ap-aT-fe 10 318A-(d AVGHT WAY OETA/L O 3.9 jig �aNr ZI It u stan3TnE seG7r I,�$��g�go+$�N IR ,NM89 xg A��Fo 1 I W 10 i ,JOB / A00112 Prepared by: JEO Consulting Group, Inc. r 9t1Qfn• 167.78r 1t0.10� (�a(Lc[eer Phone No. (715) 246-4319 —_ — 109 East Third Street, P.O. Bw 325 Nw Rld,mmd. MA 54017 S2 fASf INE Gr 6 AE Sir yY / BEARINGS ARE REFiAOKO TO 7W EAST-W6T 1/4 or peel 11NE OF SECl10N 20 TONNSIYP 31 N.. A ME 18 W. o AE /al' WHICN IS ASSUYEO TO BEAR Na9'31.37'W. ur(Pu �uaos EAfy I/l G1iB�Ely NOTE: the parcels shown m this mop ara wDJeel to Slate. County and \ pay H-JO-fe To►ndllp 1aes, lutes and regWatbne (La. wetlands, minkrum lot slim, access to parcel. etc). Before purchasing or developing my parcel, contact the St Sheet 1 of 2 Crab( county Zwhg Office and the appropriate Town Board far advice. j VOL. 15 PACE 4112 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving th following residence: (Street address) �4(p2 it V" 5T located at: '/4, '/4, Section Ll , Town bV N, Range a W, Town of RiOA!v r1 , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent da6 of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: I a,O Construction: Prefab Concrete X Steel Other Manufacturer (if known) Age of Tank (if known): P rmit number (if known) icensed Plumber Signatuio a soh C • 3-P'iAty (Print Name) P«v / A. a a.y/0 (Title) (License Number) MP/MPRS g4l If (Date Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) located at: NW ''/4, NW `'/4, Section 21 ToWn30 N, Range18 W Town of RICHMOND , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service JULY 24TH 2O19 Did flow back occur from absorption system? Yesx No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete x Steel Other Manufacturer (if known): WEISER Age of Tank (if known): 18 YRS Permit number (if known) 384112 PAUL R KOEHJLER (Licensed Plumber Signature) (Print Name) MASTER PLUMBER MP 225410 (Title) (License Number) MP/MPRS JULY 25TH 2O19 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIPP C�ER"TIFICAVTION FORM / Owner/BuyerOVi I Iy}1"W�I/✓l iif'— J Mailing Address I �I �iL t'*W j l NEw Ac.A1mh�l W i si4o17 /4 40;1 Property Address XY)()( �Z Est Pub (Verification requited from Planning Department for new City/State )"Motlid TWsp Parcel Identification Number Kc,.k m46-10(04- lo-- loci LEGAL DESCRIPTION d501101 VAI FWoev Property Location Al VJ '/., N 0 '/., Sec.h II T_�C>N-R_15 W, Town of �V"VJ_ Subdivision Certified Survey Map # Page # -- ----- Lot # Warranty Deed # 5 8 3 54 Volume / 34 Page #_. Spec house ❑ yes A no Lot lines identifiable K yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank 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 master, plumber. journeymao plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 s ens n maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the eLyear xp do te. /- l l0� NATURE OF APPLI&7RF DATE OWNER CERTIFICATION I (we) certify that all staterfictifton this form are true to the best of my (our) knowledge. I (we) am (are) the Owners) of the4ATURE bed abo , y v' f a warranty deed recorded in Register of Deeds Office. APPLICANT DATE •s•••• 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 VOL 131°4057 - 583159 WARRANTY DEED , bucumxnr Number ST. CROIX CO., WI anum .Address aes'° er s.." Bank of New Richmonu JUL 19 1998 PO Box 128 2:00 p •!! New Mcheond, W1 54017 M �aa� rx �x'1• ► ✓�oMr hm.1 I.D. Number: 26106e-t0-0a0 k G nn A. Basel, a/k/s Gig A. Basel. and Karen M. a...r husbAllid apd wife, conveys and svarran6 to Ronald I- Derrkk and Kathy Derrie& husband andwife,/k/ sachl i T. Derrick the following described real estate in St. Croix Cntulty, Sute of Wisconsin: r A parcel of land located in part of the SWI/4 of the NWI/4 of Section 21 and in pan of the SEIA of the NEI/4 of Section 20. all in Township 30 North. Range 18 West, Town of Richmond, St. Croix County. QWisconsin, ftuthor described as follows: Beginning at the West 1/4 comer of said Section 21; thence 589036'37"E, along the easl•west 1/4 line of said Section 21, 1299.63 feet to the east lint of said SW I14 of the NW 1/4; thence N00013'01'W, along said east line, 626.77 feet thence N89036'. 7"W 1302.00 feet to the east line of said SEI/4 of the NEIA of Section 20: thence N00026'02"W, along said east lire. 521.30 (eel; thence 589033'58"W 232.27 feet theme 539045'23"W 691.34 feet, theme 515015'37"W 630.03 feet to the eau -west 1/4 line of said Section 20; theme 589031'37"E, along said east -west 114 line, 848.94 feet to the point of beginning. Above described a parcel contains 35.W acres and is subject to rightofwuy along the east 33 fen for town road purposes and subject to all other easements, restrictions and covenants of record. f� This is not homestead property.tI-� Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this '�J� day of July, 1999. (SEAL) V- e(3e.4GQ (SEAL) Glenn A. Basel, aWa Glen A. Basel Karen .Basel yy+7t AUTHENTICATION #' Signature(s) Glenn A. Basel, aWa Gkn A. Basel, and Kama M. Basel, husband and wife, authenticated this day of July, 1998. 1�Qe►(lA_ Kristine Oghtnd TITLE: MEMBER STATE BAR OF WISCONSIN /I i _! THIS INSTRUMENT WAS DRAFTED BY: Attorney Kristine Ogland Hudson, WI 54016 8 i �'""" Industry, SOIL AND SITE EVALUATION REPORT urrwn i Buikl Division of iahty a euloinnsge in accord with ILHR 83.05 Wis. Adm. Code i i i , i Pap -L of 3 COUNTY Attach complete site plan on paper not less than 11 d 04l ' e. Plan must include, but St • Croix not limited to vertical and horizontal reference ); dir -- nttI nd'$ of slope, scale or PARCEL I.D. i dimensioned, north arrow, and location and to necr�at road.'Pendin APPLICANT INFORMATION -PLEAS PR4NT ACLINFOUAT10N ' I€WED DATE PROPERTY OWNER ":1 ERTYLOCATIDN .:w LOT NW 114 NW 1/4,S21 T 30 ,N,R 18 5gor) W PROPOATYOWNER':SMAIL,NGADDRESS >:�'+'• Ti BLOCKS SU . t)itCSM1I 1505 H . #65 -' , . » ,'. 1 na i'7 csm S3 CITY, STATE ZIP CODE PHONE NUMBER =' New Richmond, WI. 54017 (715) 246-2320-,, ❑CRY ❑VILLAGE NEAREST ROAD d I<) New Construction Use IX) Residential / Number DI bedrooms 4 I) Addition to wdsting building I I Replacement [ ) Pudic or commercial describe Code derived daily flow 600 gpd Recommended design loading role_j bed, gpcW_,a_hnch, gpd4t2 Absorption area required B58 bed, ft2 750 belch, ft2 hla>umum design loading rate _, jbed, gpdm21b__bench, gpdrtt2 Recommended infiltration surface elevab"s) 96.10 ft (as referred W site plan benchmark) Additional design / site considerations trenches 4. DO' below grade Parent material outyash Flood plain elevation, g applicable na it S . SUfahle lof system U . Unsuitable br ten DONYe oNAI ®$ ❑ U LtOIAJD ®S ❑ U P14RD 1ND PRESSURE I ® S ❑ U ATC,RADE ®S ❑ U SYSTEIA N FILL )[is ❑ U HOLDMG TAM( 1 ❑ S fl U Boring # El Ground elev. 92--M Depth to limiting factor 10" SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Conswonce X13Y Roots t. GPDM Bed tends 1 —20 10yr3/3 none 1 2msbk mfr cs 2f 5 6 2 0-32 1Oyr4/4 none sit 2tasbk mfr gw if 5 6 3 2 45 10yr5/4 none sit M na gw na n� .2 4 5-110 7.5yr4/6 none tns Osg ml na na .1 i.0 .2 Boring # C2 3 Ground eldty. 97.601. Depth to limiting Won +1001, Remarks: 1n"XJb" sit lens 10yr5r 1 —10 10yr3/3 none 2 0-25 10yr4/4 none 3 5-100 7.5yr4/6 none Remarks: vt sl 2M917 sl 2msbk ms Deg I� L MIA mvfr gw 2f 1 .5 i .6 mvfr gw if i.5 '•..6 .S ml na na .7 ( .8 �. CST Name: -Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Avr,, yew Richmondo WI 54017 Signature: Date: 5-11-2000 CST Number: rnp2298 � I 1 i I. i _ I i t , - I• ---------- PROP-E-R-TY-O-W-W-ER Ron Derrick SOIL DESCRIPTION REPORT PARCEUD4 pending Ground elev. 99.5 tL Depth ID irriting bw +99" Boring # 0 Ground elev. 100. 1 fL Depth ID knitting bm +88.. Boring # 04 Grand elev. 99.9 fL Depth to uniting bw +881, �wl Ground elev. —ft. Depth Jo Imbv WIN MR NMI Remarks: 1 0-12 10yr3/3 none Sl 2msbk mfr 9w f 2f .5 .6 2 12-24 10yr4/4 none 2msbk mfr gw *naa If .5 .6 3 24 -88 7.5yr4/6 none Me Osg Ml n .7 1.8 Remarks: 1 0-8 10yr3/3 none sl 2mgr mvfr gw 2f .5 .6 2 8-88 7.5yr4/6 none ME 06g Ml na na. .7 .8 Remarks: R SBD4330(. 1 05v2) STEEL'S SOIL SERVICE Cary L Steel CSTM2298 Ron Derrick MPRSW-3254 NWVW'1 S21-T30N-R18W town of Richmond lot #1-csm it 1554 200th Ave. New Richmond, WI 54017 (715)246-6200 Gary L Steel CSTM2298 MPRSW-3254 STEEL'S SOIL SERVICE Ran Derrick NWVM4 S21-T30N-R18W torn of Richmond lot #1-csm 1554 200th Ave. New Richmond, WI 54017 (715)246-6200