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026-1121-04-000
ST. CROIX COUNTY ZONING DEPARTME � ' , ♦ \_ .= AS BUILT SANITARY REPORT -, Owner Property Ad ess /d S i r City /State : ICE Legal Description: Lot / ,/ — V4, , 5 ' 1' Block Subdivision/CSM # S' ' /4, Sec. TAN -R/ W, Town of h PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: i r Tank manufacturer Size ST/PC / G60 Setback from: House Well > - P/L -S Pump manufacturer Z Model �7 Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: Width ' 4 1 Length `�' Number of Trenches f Setback from: House Well P/L Vent to fresh air intake ELEVATIONS Description of benchmark 7 Elevation /00 Description of alternate benc k Elevation 95'0 In Building Sewer I ':.' /HT Inlet ST Outlet PC Inlet PC Bottom S - y Header/Manifold Top of ST/PC Manhole Cover Distribution Lines 41 () ( ) Bottom of System () / 7, Final Grade () () ( ) Date of installation / / Permit number 3 State plan number 2�Z�gS= T`O''t Plumber's signature &, License number ..?2 / "/ 7 / Date Inspector 44 Complete plot plan �' NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW INDICATE NORTH ARROW WisconsID Department of Commerce SOIL AND SITE EVALUATION givision of Safety and Buildings Page of � . Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County , include, but not limited to: vertical and horizontal references int (BM), direction and , percent slope, scale or dimensions, north arrow I&q_0on an tlis*nce to nearest road. Parcel I.D. # APPLICANT INFORMATION - P' ago prigt,aN - o!ft oration. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15;04 (1) (m)). Prope Ow er Property Location Govt. Lot S(V 1/4,S- 1 /4,S ,$°- T 3a ,N,R f E (or)(0 Property Owner s Mailing 24) Addrss Lot # I Block# I Subd.Name r C M# r City State Zip Code Phone Number ❑ ty El village ,® Town Nearest Road S / 7 IC New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow -Z 'M gpd Recommended design loading rate /_bed, gpd/ft gpd/f1 i Absorption area required _ bed, ft c � trench a , , ft 2 Maximum design loading rate � bed, gpd/ft "2_ trench, gpd/ft Recommended infiltration surface elevation(s) ! 7 / ft (as referred to site plan benchmark) Additional design /site consi at ions Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system [7 S •�U as ❑ U ❑ S .23 U - Is [ U ❑ S [-� U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth - Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 3 qZ s VY Fd 10 2. S C 6646, �/c �• elev. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. , Depth to limiting factor in. Remarks: CST Name (Please Print) 2 natur L e Telephone No. Address Date CST Number r SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.ff Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground elev. ft. , Depth to limiting ' facto ; in. Remarks: Boring # Ground elev. ft. , Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure P2 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench � Boring # ' i ' E3 Ground elev. ft. Depth to limiting factor ' Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R. 07/96) 02/17/00 THU 14:08 FAX 715 386 4686 ST CRX CO ZONING Z013 2 Z ♦Y7 NO aw+, ,c,Y y ... ( f It J T3 1, 74D 1 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT ST CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344693 Permit Holder's Name: ❑ City ❑ Village X] Town of: State Plan ID No.: RICHERT FRED RICHMOND z`E� � = �S th;#� CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: b� U 47 6 7r ,5 026- 1121 -04 -000 TANK INFORMATION 9 Z 3 - ELEVATION ATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c �� 6 Benchmark �� �_ Z D v Dosing A" Bldg. Sewer I H g St/ Ht Inlet �.9`� j3. 3 / TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to ROAD Airintake Septic >5-0 9 r �—� NA Dt Bottom �� S Dosing $p -- NA Header /Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Ste - �'� Manufacturer .2. Demand n Model Number S �. GPM *- �, 2 oe TDH I Lift ,'h'j Lrictionj / .(i Systema.s TDH tZ.oaFt H ead Zp dl, dS Forcemain Length Dia. y. Dist. To well' SOIL ABSORPTION SYSTEM E RENCH Width Length No f renches PIT No. Of Pits Inside Dia. Li uid Depth MEN I N S DIMENSION SETBACK SYSTEM TO P/ L I BLDG WELL LAKE / STREAM L CHIN anufacturer: INFORMATION Type? r r I CHA R Model Number: System: p :2 5' 2S�- 5'� OR I DISTRIBUTION SYSTEM Header / Ma of 4 Distribution Pipe(s) ai x Hole Size x Hole Spacing Vent To Air Intake U Length Dia. 21 Length q(�G Dia. Z Spacing —�' 11,f u 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 An COMMENTS (Include code discrepancies, persons present, etc.) RICHMOND 5.30.18.719 1704 106th Street ( gu_ `A 0 6e 3;, ' 4wa, waif r• 33 (lb' 4 fir/ h[CG� Q6fp r1Ta. n.� �o r,:• Oe Ga Iwvw�v a f 5 i q � •f A Plan revision required? �] Yes N S e the side for additi nal infor on. oZ "' ff 1447H © D -671 (8.3/97) � � --4a[ re c�{i Inspector's Signature /� ert No 6'l.e'�nn (�IiTUVCT G� ( (� IG�'°� %0. . D.Q, o rec -c:.04 '` t . ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: k F ° a A ll � � f A . . .... t 3 mm,'.m� , , . ._ e� � � f t #� p m «�® 1 1 # � � 3 } y i f ..4,.. e4 ° °. . . ° ° n y � � g 3 E # a E E j 2 a #.. 3 j a f ee_ °m °�, i� °.m .n me® f � I s r s Safety and Buildings Division SANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Visconsin In accord with ILHR 8305, Wis. A ,`� P D Box 7302 . . Department of Commerce ,7 ! Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syst �)"aper rgt less'--. ty than 8112 x 11 inches in size. �, /� • See reverse side for instructions for completing this applica i EGEWt-0 St tej nita ry Permit Number Personal information you provi may be used for seconds purp ses r ( 1 CD p R 9 El � if revision tb pievious [Privacy Law, s. 15.04 (1) (m)]. I - Zr� t b `{' C S t T CROiX Se n I.D. Number T" YYYi i I. APPLI ATION INF RMATION - LEASE PRINT LL I �l a a Propertn Name _ Property Location _ ' S - / 1/4.5�1g:� =�$� T 3O , N, R /rE (or Property Owner' ailing Address L u eiI Block Number c , State Zip Cod Phone Number Subdivisio ame or CSM Number S7_</60 / ��1''SoZGd = 4 e r 'Y 0r -Q 11. TY B ILDING: (check one) El State Owned ° !t Nearest Roa Public 1 or 2 Family Dwelling - No. of bedrooms 3 r-1 Tow o f r GnifrOA ere III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) tt24_ I /Z /– D 1 4—Ooo 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an ------ System ________ System_____________ Tank Only______________ Existing System ,_______ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 214flMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 []Seepage Pit / 43 ❑ Vault Privy 14 ❑ System -In -Fill 94 VI. ABSO RPTION SYS E INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade L/ Re fired (N.ft.) Proposed (syft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 7� — .6 Feet Feet Capacit VII. TANK i Ca allon n Total # of Prefab. Site Fiber- LApp INFORMATION g Gallons Tanks Manufacturer s Name Concrete Con- Steel glass Plast Existin structed Tanks Tanks Septic Tan Holding Tank pop ❑ ❑ 1:1 El Pum ank /Siphon Chamber Od El E] El 1:1 ❑ Vt" ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew tem shown on the attached plans. Plumber's Name: (Print) Plu is Signature: ( amps) M PR .. Business Phone Number: Plumber's Address (Street, Ci_y State Codey; p S/ ljl/Yi -Q✓ G� X5'0 IX. COUNTY/ DEPARTMENT USE ONLY ❑ Dis approved Sanitary Permit Fee (Includes Groundwater ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) Approved ❑ Owner Given Initial OD Adverse Determination 3'Z5 • S X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority_ 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to besubmitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years_ 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil testdata on a 115 form; and F) all sizing information. ----------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations " and establishment of standards. ' Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 isco nsin www•commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 03, 1999 CUST ID No.221471 ? ' 47* POWTS INSPECTOR 1 ON, G OFFICE ! Xs DENNIS J GILLE '. T IX COUNTY SPIA 372 140TH ST tJ y �, l l61 ARMICHAEL RD AMERY WI 54001 f,^,ral*a�3t ��Gc SON WI 54016 RE: CONDITIONAL APPROVAL ` APPROVAL EXPIRES: 09/03/2001 Identification Numbers Transaction ID No. 242795 Site ID No. 179385 SITE: Please refer to both identification numbers, Site ID: 179385 above, in all correspondence with theagenc ST CROIX County, Town of RICHMOND; 1113 HWY 64 W, NEW RICHMOND 54017 SWIA, SETA, S5, T30N, R18W Facility: HALLE BUILDERS INC 113 HWY 64 W, NEW RICHMOND 54017 FOR: MOUND FOR A 3 BEDROOM DWELLING, 450 GPD Object Type: POWT System Regulated Object ID No.: 487090 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the direction of maximum slope. 3. The area 25' below the downslope edge of the mound must remain undisturbed. 4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a). 5. The designer proposes to install a Huffcutt 1000/600 gallon combination tank. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sinc DATE RECEIVED 08/17/1999 FEE REQUIRED $ 180.00 � RECEIVED $ 180.00 PATRICIA L ORF , POW AN REVIEWER BALANCE DUE $ 0.00 Integrated Services �7 (715) 634 -7810, FAX: (715) 634 , M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WISMART; code: 7633 I 1 MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET Fd Project HALLE BUILDERS INC. 1999 Owner HALLE BUILDERS INC. Address 1113 HWY 64 W NEW RICHMOND WI. 54017 Legal Description SW SE S5 T 30 NR 18 W Township RICHMOND County ST.CROIX Subdivision Name PARTRIDGE RUN Lot No. 4 Parcel ID Number . � r Plan Transaction Number `$& qH %E `-T A t fJ6AlGS Index and title sheet Page 1 Mound calculations Page 2 y UF'C;�f)ENC Mound drawings Page 3 Pres. disc calcs. and laterals Page 4 TDH and pump tank drawing Page 5 Designer DfiNNIS GILLE License Number 221471 Signature Phone No. 715- 268 -5637 Date 9- 10 - -99 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Slats. Personal information you provide may be used for secondary proposes [Privacy Law, s.15.04 (1 xm)]. SBD- 10462 -E (11.05418) Pagel of s� ter, r � re es e I 1 1� 331, w HEAD CAPACITY CURVE 3 7/8 6 1/4 MODEL "98" 4 5/8 4 30 - 8— N 25 /8 = 6 1*4 15 4 /16 10 2 5 1 1/2 -11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 50 60 1 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENTAND DEWATERING CAPACITY 12 HEAD UNITS /MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 4 3/16 20 6.10 1 25 95 Lock Valve 23' sx11o2 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Wei ht 39 lbs. - 1 /z H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) D98 230 1 Auto 4.7 1 or 1 & 7 — float system. 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hole J -Pak, for watertight connection or splice. CAUTION Forinformation on additional Zoellerproducts refer to catalog on Combination Starter, FMO514; Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable Level Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FM0487; and Single Phase Simplex Pump Control /Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 — ` Louisville, KY 347 Manufacturers of. . SHIP T0: 3649 Cane ane Ru Road Op wA Louisville, KY 40211 -1961 QTYPUMP9 11 `O (502)778 -2731 - 1 (800) 920 -PUMA FAX (502) 774 -3614 "/Visconsin Department of 9$ rce SOIL AND SITE EVALUATION Pa / of .S Division of Safety and Dut Bureau of Integrated Se s in accordance with s, iLHR 83.09, Wis. Adm, Code Attach complete A plan on paper not less than 81/2 x 11 inches In size. Plan must County include, but not Omited to: vertical and horizontal reference point (BM), direction and ,, j r. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Beroonal intorrnation you provide may be used for secondary purposes (Privacy Law, s, 15.04 (1) (m)). Prope Owner n Property Location 4 Y^ Govt. Lot S&I 1/4 &!!��114.S T..30 N,R /p E (or p Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# k State Zip Code Phone Number [j City dill 0 Town Nearest Ro* E5•New Construction Use: 0 Residential /Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - 'Describe: _ Code derived daily flow 4 0 gpd Recommended design loading rate / bed, gpd1ff f Z trench, gpd/ft Absorption area required 3US' bed, ft 3 1s trench, ft2 Maximum design loading rate _ Z bed, gpd/ft Z trench, gpdAt Recommended infiltration surface elevation(s) .___ T 7, S S ft (as referred to site plan benchmark) Additional design/site c n IdEfra ns 1, Parent material Flood plain elevation, if applicable ft S - Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = unsuitable for system [3 S E!� v 4!3 S C7 U 0 S U 11 S au ❑ S ®u ❑ S a u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure yt2 13 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz: Sh. Consistence Boundary Roots Bed Trench •3 1 713' - -Y //o C L s med ct w i 2 Ground 11 7, s' +P3 ?. �'>'s/ S'� t i''6 AAje 9 ; Depth to limiting factor , Remarks: Boring # El / .S / - / L UG . z 3 3 l -$ . S 3 J 20 - x s, L 111f 4 1^' .- Ground Depth to limiting ctor a2—In. Remarks: at CST Name (Please Print) Signature Telephone No. Address D to CST Number 3 *7 z yo C 14014 r W T vo s� PROPERTY OWNER SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles In. Munsell Ou. Sz. Cont Color Texture Gr. z Sh.. Consisteince Bounda Roots Bed .Trench 3 / _ 2.S* .2-r11 N s � :i y�5 /� � C A S, , Z IS Ground 6 - 9 3 y 2,p7 IS ft. Depth to limiting , 1 5 ctor in. Remarks: Boring # Ground , elev. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Structure in. Munsell Ou. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed . Trench Boring # Ground elev. it. Depth to limiting ; factor ' Remarks: Boring # L-`3 Ground elev. — ft- Depth to '— limiting factor in. Remarks: SOD -8330 (R. 07/96) 7" �/ n z y , ar y Sw'Sr'Ss' % 3o At /rw -- -_ Zo r �• 8Z ac•�+• [.7 y f ' spy., 3 31,7 0 JUN-24 -99 01 :33 PM P. 01 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owncr/Buyer � � 9 �J m R / e 'T Mailing Address � g M'9 s GJ/ 5Y061 Property Address 7 L /d 6 A (Verification required from Planning Department for now construction) City /State w / Fareel Identification Number LEGAL DESCRIPTION Property Location � ' /., �� t /a, Sec, — f: — , T—�—Q N -R__�LW, Town of klCHmaa d Subdivision �fl fz R / D�� °'� _ Lot #. Certifled Survey Map # . Volume . page # Warranty need # (n Volume Z_ page # 3 Spec house 0 yes JZ no L ot lines identifiable -0 yes 0 no SYS MA27'ENANCE Improper use and mnintenanceof your septic system could result in its promature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if headed 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, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdispoaal 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. I/we, 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 Resoumes, State of Wisoonsia. Cartitloation 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 exp' tion date. SIGNATURE OIL APPLICANT DATE OWNER CEItTIFICAI= I (we) certify that all statermcau on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop try described obpvlt. by virtue of a warrunty 40ed rec a in Register of Daede Office, p �1 SIGNAr -MLE OF P LICANT DATE - - ""' Airy 9X"%Prmetl0t, Mal to srili- ropreoented may resuls'ln the unitary parmit baln* rovokod by the Z onins Depar"nons. eeeeee •• It,Clude wtttl tltta application: a Ntemred warranty deed from the Reaia,er or rSeede 0 a e espy of 4he aertifted survey nsep !t rererenae to ,nado I- t}ae wwrrenty Deed 3�� "`• +''�� ''fib r• � � '�- *�+ � + � I r x Y y � 1✓ �,�'r., .1r� ,�� ��` �i ✓ . + " ,��tK•� - . y �. a •r.,� t ei r —1 N R OMATTIs"D N T r 4 TM wum 1 uw S 00'51'13" — E 990.00 — -- — — — — SOMI 3•E 1 05TH __ • _ _ 237.02' T _, _ --- - MY 3r I ' .r�. .� 1..• = J. MrRzGo.,q..► 9v. .�.... T...... g� 437.04' u 'o e , 231.9r 26&26 031 201.77 311.63' O y 50't3"E 960.44' 251-10* z 211.02' D 1 �q �� •�� �" .,.' SOD'04 'E 221.,3 STREET— -8-{— �y NOC 04'29 w 25.23 ' 1 r ► sr ai.. •� /1, �. OD m • ell:anf.�.,�t .� �/, � � �'1 `�� '' e .-•� S 00"51'13" E 331.9 56.96 139 :51' { 356.26' w SOOV4'29" E 40.95 —r 223.W I P 365.69' { j 17i 0r ' A Zd A 93 I rg ii.�y7 y Ap � — • O I � t 4� 0¢ Z g �.► � � � � � ,�2L N �; 016 W G � � � ,�0 J "p �• � � m� � �E ;S �� �.is�` � � �� � ' Y� _fF.1•Y.S�M � illy ifQ / p S0004 C 1297.20 — — — ; _ 107TH STREET — ' 7. $ _ m _ �_ - .�...... J ..�. ... ..�� ._..i..�•• .. N w N ; ti tt 4E 3♦ Nf.. x ' 174.Q2 1M�LSr9 U. NPLA, LANDS $ QI o ��,•--- � e ynl 1452PAGE 231 6p9364 KATHLEEN H. WALSH DOCUMENT NO. State Bar of Wisconsin Form 2 -1982 REGISTER OF DEEDS ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD 08 -27 -1999 9:15 AM WARRANTY DEED EXEMPT N Halle Builders, Inc., a Wisconsin corporation, conveys and CERT COPY FEE: COPY FEE: Ki mberly K. Richert warrants to Frederic M. Richert and Ki y , husband TRANSFER FEE: 51.00 and wife as survivorship marital property, the following described S: FEE: 10.00 real estate in St. Croix County, Wisconsin: BANK OF NEW RICHMOND P.O. Box 128 New Richmond, WI 54017 Parcel ID No. Part of 026 - 1019 -10 -000 Lot 4, Plat of Partridge Run, in the Town of Richmond. This is not homestead property. Exception to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this,9 day of August, 1999. HALL pWesle ?Halle, C. By: Presi ent By. l Linda R. Halle, Secretary ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. ST. CROIX COUNTY ) I Personally came before me this o? day of August, THIS DOCUMENT DRAFTED BY: 1999, the above -named Wesley W. Halle as President and Linda R. Halle as Secretary of said corporation to Judith A. Remington pgON L . me known to be the persons who executed the REMINGTON LAW OFFICE foregoing instrument and ackno ledge the same. P.O. Box 177 NQ r New Richmond, WI 54017 .4 R 1 (715) 246 -3422 0 pU� `° otary Public of Wisconsin 7 j� t My Commission Expires: Cam/ d� F C. Qp �'✓1SC0� *Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344693 Permit Holder's Name: ❑ City ❑ Village W Town of: State Plan ID No.: Fred I Town of Richmond CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: 026-1121-04-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand St cover Model Number GPM TDH Lift Friction System TDH Ft oss Forcemain Length Dia. H Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: SETBACK INFORMATION Type of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia Length Dia. Spacing 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 11 No E] Yes El No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1704 106th Street, New Richmond, WI (SW1 /4, SE1/4, Section 5 T30N -R18W) - 5.30.18.719 Plan revision required? ❑Yes ❑ No (� Use other side for additional information. l SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E _ E # g 3 TTT e � Mm. � I # ___ 3 { J - 11 E E: tvv i 3 fl { ev I # i a 3 j -4 -41-444-4- { i S �t r { g } � 1 .» � ?g$ x 7 e { 3 9 F 7 # ! f # 3 j 5 -4- VIA E a t f tt 11 -4 L.. . ] A ee. � ®..gym ^ -x �,.= ...,. 4 ^x h ..... ^ # E 3 1 �... .,y. 3.,. � 1 AT T I { t r 1 .1-1, 1811 . . ....... A-14 3 { ....,, a VJ E e � t � g 44A A +.444 € w,...... . "--1 A ^ 3 i { p ...- s, i 99 � { f r # F t " Safety and Buildings Division I SANITARY PERMIT APPLICATION 201 W. Washington Avenue N*6 In accord with ILHR 83.05 Wis. A Lo P O Box 7302 ° d Madison, WI 53707 -7302 Department of Commerce �' � � � , • Attach complete plans (to the county copy only) for the syste fn�¢aper rat less � ty than 8 v2 x 11 inches in size. '� t nitary Perm • See reverse side for instructions for completing this applica cLO � Cil, St fq it Number 3 Personal information you provi may be used for secondary pure ses =: ❑ 41m rf revision t previous application [Privacy Law, s. 15.04 (1) (m)]. I q b 410" 4'(, � R � S C T" ROIX, � State A n I.D. D. Number I. APPLICATION INF RMATION - PLEASE PRINT LL Propertysrlwn Name Property Location . ' -� / l -r2 T , N, R /�E (or)� Property Owner'; ailing Address L u pr ; - Block Number C , State Zip Cod Phone Number Subdiviiioj5Name or CSM Number fl. TYPE El F BUILDING: (check one) E] State Owned o It / Nearest Roa . p � (; o s Public 1 or 2 Family Dwelling r - No. of bedrooms O Town OF ( -,, 6 a ®•� III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) J _ 1!2 /- a 1 4—Ooo 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4_ E] Reconnection of 5_ E] Repair of an Syrstem System Tank Only______________ Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 tlMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 []Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit / 43 11 Vault Privy 14 ❑ System -In -Fill 9 C Im SU 160 VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 17 nalGrade 7SU Re i��� - ft.) Pro o (5. ft.) (Gals/day /sq. ft.) (Min. /inch) $ Elevation Feet Feet Capacity VII. TANK in allons Total # of Prefab. Site Fiber- Exper INFORMATION g Gallons Tanks Manufacturer's Name Concrete con steel glass Plastic App New Existin strutted Tanks Tanks Septic Tank Holding Tank ' I TF LJ ❑ 1 ❑ ❑ ❑ ❑ Li Pum ank /Siphon Chamber ❑ Vt" ESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sew tem shown on the attached plans. Plumber's Name: (Print) PIu r s Signature: ( amps) M R Business Phone Number: ��,1, � Plumber's Address (Street, CO, State, zip Code p S IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Eat s sue Issuing Agent Sign .1ture (No Stamps) roved A Surcharge Fee) S pp ❑Owner Given Initial � ��. effl Adverse Determination � °I X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: Q 6 , COn_ 0-200 ro 4 4 rn- % DISTRIBUTION: Original to County, One copy To: safety & Buildings Division, Owner, Plumber JUN-24-99,,.011'33 PM P -u� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ ��/ m / C yq e�� 0 7 — Mailing Address 111 V I Property Address (Verification required from Planning Department for new construction) City /State 6L.-' Parcel Identification Number JLEGAL DL,SCRIPTION Property Location .� 1 /,, ' /.. Sec. S , T 31) N -R W, Town of O(ILI - 00 yo Subdivision pfllL�'Riyl�� kL40J . Lot # Certified Survey Map # . Volume • page # Warranty Deed # r 3 . Volume �.L Z_ page # 3 �_ Spec house 0 yes 0 no Lot lines identiflableM yes D no SYSIFcM H AEM NA= 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 tans every three years or sooner, if a ceded 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 it master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewaterdispossl system is in proper operating condition andlor (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 ,Roaou rtes, State of Wisconsin. Cettilleatioll stating that your septic system has been maintained must be completed and returned to the St. croix bounty Zoning Office within 30 days of the three year exp tion date. SIGNATURE OF APPLICANT � DATE OWNER CERTIFICA'j'= I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owaor(s) of the prop rty daseribed abov by virtue of a warmnty deed rec rde in Register of Deeds dfnce. SIGNATURE OF DATE - - "" Auy i- srvrmatlou that is Ibis- rapraaented may result in the sanitary persttit t+eias --ked by the Zoning Department. recess '• Include with (Ills applicntieh: a ■tamped warranty deed from the Raui :tar of Goads oftloe a eapY =r the certified aurwwy map Irreverence to (hide Ira tits warranty tleeO