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HomeMy WebLinkAbout026-1126-24-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM -"`'' St. urOU( Safety and Building Division INSPECTION REPORT Sanitary Permit No: 648403 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 10 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: Adam and Eric Halverson I TOWN OF RICHMOND 026-1126-24-000 CST BM Elev: Insp. BM Elev.. SM Description: Section/Town/Range/Map No: 12.30.18.785 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION UA 1 A STATION BS HI FS ELEV. Benchmark AIL SM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/rRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside is. Liquid Depth SETBACK INFORMATION SYSTEM TO Type Of System: PA- BLDG IWELL LAKEISTREAM LEACHING ER OR CHAMBER UNIT Manufacturer: Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hola Size x Hole Spacing Vent to Air Intake Pipe(s) 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 Seeded/Sodded roc Mulched Bed/Trench Center lBadrrrench Edges Topsoil M Yes Q No r M Yes 1•;:j No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 1447 166TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑E Yes QQ No Use other side for additional information. Inspection #1: Inspection #2: Cart. No. Date SBD-6710 (R.3/97) Insepolofs Signature 51il- 2w13 -010 sar� £ - - � �' epaitment of Safety County - ST CROIX & Professional Services, fessional Sices, Sanitary Permit Number (to be filled in by Co ) `( J0 , I o3 rd FEB 06 2023 Industry Services Division 6 5[. .Nix � urn l, ft*&-"* lication State Transaction Number In accordance with SPS 393.242), Wts. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note. Application forms for stat"wned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services Personal information you provide may be used for secondary accordance with the Privacy Law, s 15.04(1 xm), Stars s inE-0 1447 166th eve new richmond 1 V tiom - Please Prime All Information Propertv Owner's Name Parcel N Adam and EriatHalverson D Z& — ZL{ — e0 Property Owner's Mailing Address Property Location 901 Colman dr Govt. Lot City, StateZip Code Phone Number NEW RICHMOND WI 5407 Se /,nw v.. Section 12 T 30 N R 18 E or VK 11. Type of Building (check all that apply) Lax Subdry ision Namc 0 1 or 2 Family Dwelling - Number of Bedrooms 4 24 ❑ Pubbc/Commercial-DescribeUse waters edge clock q O City of ❑ State Owned - Describe Use 0 Village of CSM Number �A:rc— K 0 Town of Richmond 111. Type of POWTS Perm (Check either/�"New" or "Replacement" and other applicable on line A. Cheek one box on line B. Complete line Cif applivable. rig"New System) y ❑Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' ❑ Holding Tank In -Ground ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑Other Type (explain) (conventional hang ❑ Change of Plumber ❑ Transfer to New Owner List Previous Permit Number and Date Issued C• ❑ Renewal Before ❑ Revision Expiration IV. DispergalfIrrestmeof Ana and Tank Iabn radon: X 78 N Design Flow (gpd) Design Soil Application Pme(gpNsQ Dispersal Area Required (sf) Dispersal Area Proposed (s0 System Elevati yy 600 .7 858 900 96.00 cam. I Tank Information Capacity in Gallons Total Gallons N of Units Manufacturer n �^7 Rec L o New Tanks Ejup Taolu Ne W6 l ` fffPtr�_ �+ o 3 S N 6 U N W Septic ar Holding Tank X 1200 1 WIESER X Dosing Clamber X 800 combo x V. Rsapeaalb ft Statemlamt- 4 the mmianIf, attmme teopomdM■q for huddlaidom of the POWTS dwwo on the attached pleas. Plumber's Name (Print) Plumber's Sign MP/MPRS Number Business Phone Number PAUL R KOEHLER '�"u 1225410 715-246-2660 Plumber's Address (Street, City, Stale, Zip Code) 321 WISCONSIN DR NEW RICHMOND 54017 VI. County/Department Use Only Approved ❑ Dt a Permd Feee Issued lssui g Agent Signature rven for Denial fJ-- b 21vz3 Condition rov rDlSappreeal 3 \ mre- > 3 ${ o / ` "'►, O Septic tank, effluent filter and dispersal cell �ecbuk„`se4 rs 3, must be serviced / maintained as per AOS nW(7AtW &r&z�l -(t q management plan provided by plumber. 4L I I setback requirements must be maintained �,1 ea , •� �i ordinances. U "Mm ens [soma ra me l *MAY M paper Mr rma aW In r r reaea In Yet � a�tr/�ti•�•h�e.� rs v?� s SBD-6399 (R. 03/22) K pjtoo Sy a `�zoc/900 c COrrtzo bil �^ I Iwo - 6 v) 1 of 1 I W Otters €a IC, 1)J4Lm a.nA f e I e a H?'y4r VOIA 1717 1 tc fL Aar Ncw R;c►.,•,,,,,I W PT o tic- uz6 - zf-oov f�Sc� 3aN 1$� s � yy Nwy� I_=Hv I ��c OP*i a� Project Name: Owner's Name: Owner's Address: Legal Description: Township. County: Subdivision Name. Lot Number: Parcel ID Number. Designer/Plumber: Date. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Adam and Erica Halverson 901 Colman Drive New Richmond Wi senwsec 1230n18w Richmond St Croix Waters Edge 24 026-1126-24-000 Page 1 Index and title Page 2 Page 3 Plot Plan System Sizing & Cross -Section Page 4 Fitter Specs Page 5 Page 6 Maintenance Information Management Plan Page 7 Page B St. Croix Cty Septic Tank Maintenance Form Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Paul R Koehler 02/02/2023 Signature �. License Number: Phone Number 225410 (715)246-2660 Designed pursuant to the In -Ground Soil Absorption Component Manual for PoWrS Version 2.0 SBD-107D5-P (N.01/01). Page 1 L of a q tom/ 3,cgo ti�i o� Ajamex ,A F{ cn wily"rSoll 1117 Ili tl AdF PZ 03.6-1116-2�-006 t�Sao 3oN 18 � 4 II I'yd S/rr` SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT PagaL of Project Name: Adam and Eric halverson 2 No. of Cells 9 Per Call 3 ft Cell width 18 Total No of ez 10 ft 90 n Cell Length 50 aq n EISA Per Cell 3 n Cell Spacing 900 sq ft Total EISA �.fl W.frWf.. 0 25.0 ::E EF Q1203H 10.0 SD.D Gravelless Leaching Unit Manufacturer: ez flows Gravelless Leaching Unit Model: loft Finished Grade ft 3t in ■ • 12 In J-16—In Plumber/Designer Signature: Typical Cross Section Observation Pipe with approved cap or vent Soil Backfill Fabric it Infiltra0ve Surface O I n Limiting Factor `Slotted and Anchored Vent/ Observation Pipe with Cap ............................... a ............. a.. License: 225410 Date: Feb 2nd 2023 F ®DMW 1, PL-525 Effluent Filter 8 Wutnalw hodKls A DNMon of Po" Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PLr525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 06" Filtra Accepts 4" & 6" SCHD 40 pipe Outdoor SmartFiltect Alarm Polylok, Zabel & Best filters accept the SmartFiltere switch and alarm. Extend do LokTM Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com PAGE 4 OF 5 GRAVITY -DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(B)(g) Finished Grade CAPACITIES @ 2�2•2� gaUn 4 2 in Depth (in) Volume (gal) A 21 467 B 2.0 44.4 [C] 6 133.44 D 10 222.4 *Pump Tank Liquid Level = 39 in Force Main Diameter = Force Main Length = � 6� Electrical must comply vAth SPS 316 and NEC 300 7l Weatherproof Junctlon Box Conduit *T Weep Hole A _Alorm B _On ' Pump _off Extend manhole riser as necessary Approved Lockhg Manhole vMh Warning Label Attached (Nth) 1' Min. or 2.0 ft above Established Flood Ebvelbn a T � (Ndcal) 3• gpproved Bedding Malarial Beneath Tank Force Main Void Volume = 11 gal [C] Total Dose Volume TDV gal/dose (< 0.2X design fknv +force mein void volume) will Vertical Lift = 3 ft -Approved Joints with Approved Pipe 3 fl onto Sold Ground (tyari) PUMP -OFF ELEVATION = 6.3 ft INSIDE BOTTOM ELEVATION = 7 ft PUMP TANK: SEPTIC TANK(S): Volume = 800 gal Total Volume = 1200 gal Manufacturer: wieser Manufacturer(s): wieser Pump Manufacturer: goulds Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet Pump Model: epo4 (See attached pump curve) Controls/Alarm Manufacturer: sl rombus Filter Manufacturer: Controls/Alarm Model: ps patrol Filter Model: 525 Float switches containing mercury are prohibited. Wastewater METERS FEET 10 9 3 8 2 7 V_ 6 2 Q 5 C 15 J 4 H O ~ 3 10 2 5 1 0 0 0 5 GPM 2.5 Fr 5 0 I EPOS EP04 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 M3/h CAPACITY MODEL INFORMATION Order Minimum Float Cord Discharge Minimum mum um Minimum Minimum Maximum Shipping Number HP Volts Amps Circuit Phase Switch Length Connection On Lev Off Level Basin Solids Weight Breaker Style Diameter Size Ibs.kg EP0411 Plug / No Switch 10' Manual Manual 20 / 9.1 EP0411A Piggyback / 10' 12' 6' 2119.5 4 115 12 20 Wide -Angle EP0411F Plug / No Switch 20' Manual Manual 20 / 9.1 EP0411 AC Piggyback / 20' 12' 6' 21 / 9.5 1 Wide -Angle 1W 15' Y.' EP0412 230 6 10 Plug/ No Switch 10' Manual Manual 20/9.1 EP0412F Plug / No Switch 20' Manual Manual 2019.1 EP0511 F 115 13 20 Plug / No Switch 20' Manual Manual 22110 EP0511 AC Piggyback / 20' 12' 6' 23 / 10.4 .5 Wide -Angle EP0512F 230 6.5 10 Plug / 20' Manual Manual 22110 No Switch PAGE POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z FILE INFORMATION Owner Adam and Eric Halverson Permit 0 DESIGN PARAMETERS Number of Bedrooms 4 ❑ NA Number of Public Facility Units ER NA Estimated flow (average) 400 gal/day Design flow (peak), (Estimated x 1.5) 600 aVd ay Soil Application Rate .7 gaildeytW Standard influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODe) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 moll. Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform (geometric mean) 51 W ctu/1 Doml Maximum Effluent Particle Size Ye in die. ❑ NA Other: ❑ NA "Values typical for domestic weatewater and septic tank effluent. uwnrroreuPr crucni u c SYSTEM SPECMCATIONS Septic Tank Capacity 1200 al ❑ NA Septic Tank Manufacturer WIESER ❑ NA EffkreM Fitter Manufacturer POLY LOCK ❑ NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 800 al ❑ NA Pump Tank Manufacturer WIESER ❑ NA Pump Manufacturer GOULDS ❑ NA Pump Model EPO4 ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Futter ❑ Wetland ❑ Other: ❑ NA Dispersal Cell(s) 0 In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other. ❑ NA Other ❑ NA Ottrr: ❑ NA Service Event Swvlcs Frequency Inspect condition of tankla) At bast once every: 3 ❑ morrth(sl earls) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal celllsl At least once every: 3 ❑ me arnthi al (Maximum 3 years) ❑ NA Clean effluent fitter At least once every: 1, ❑ month(sl 10 earls) ❑ NA Inspect pump, pump controls & alarm At bast once every: 3 W meoa this) [3 NA Rush laterals and pressure teat At least once every: ❑ month)&) ❑ earls) as needed ❑ NA Other. At least once every: ❑ month(s) ❑yew(s) [3 NA Other ❑ NA MAWT13MCE INSTRUCTIONS Inspecdons of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or ications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Saptage Servicing Operator. Tank inspections must include a visual inspection of the tankla) 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 cell(s) 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 (Y3) 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 filters, 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. Page Z of 7i START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(sl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cegis). If high concentrations are detected have the contents of the tankfs) 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 will be discharged to the dispersal collie) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this actuation 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 calls. 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 butte; 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 service the following steps shall be taken to insure that the system is properly 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 ing measures have been, or.must be taken, to provide a code compliant if the POWTS fails and cannot be repaired the follow 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 she evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in affect at that time. ❑ A suitable replacement area is not available due to setback and/or song limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. — _ �� 111CU10 ,vy :o..u....... -. --- -r- 0 mg den alu a alkolllsTTEa ��A% CoNJcat ❑ Mound and at -grade soil absorption systems may be reconstructed in piece following removal of the biornat at the infiltrative surface. Reconstructions of such systems must comply with the rubs in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASINSUFFICIENT OXYGEN. DD NO GASSES AND/OR 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING Nam PAUL R KOEHLER Phona 715-246-2660 Phone 715-246-2660 ERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY SEFTAGE S Name POWERS Phone 715-246-5600 Name Phone anCAM 121 & (3) Wlaconsin Adr&*drative Cod•• This document was drafted In compliance with chapter Comm 69.2212)(b)i10WI) and . O w W� ¢Q w I ' /-________________ LI =____-_----7' 'I INI �I �j 4" CAST -A -SEAL jj I v I IIII III , I r 11IT ` II I FILTER OR I i11 i 1 I BAFFLE I I ' I I llll h I II I -------- ICI ICI I� � - - T rl, I n a a- I: Ina I •I ---- IJ ARE MANUFACTURED TO MEET M r4' CAST -A -SEAL 4" VENT WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" LENGTH: 13'-8" WIDTH: 8'-0" BELOW INLET: 41" UQUID LEVEL 36" WEIGHT. BOTTOM 14.800 LBS. COVER 8,170 LBS. INLET AND OUTLET' 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL 010 (OTHER STATES SEE CHART) LIQUID CAPACITY: 33.48 GALAN (SEPTIC) 22.24 GALAN (PUMP) LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN j8 (NO FIBER) TANK: MIX DESIGN /9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE W r V e 2 J o a I Il co Z a I � REVIEWED BY 8 MP PAD REVIEW DATE F 0. DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO. APPROVAL DATE: PRODUCTS NEEDED BY: "i'dustrr. SOIL AND SITE EVALUALabor VW I kwo POW DMisitln of Sally & Bul6ngs in accord with ILHR 83.05, jo Attach oomplate site plan on paper not teas than 8 1/2 x 11 inches in size. not limited to vertical and horizontal reference point (9M ), direction and % dimensiontad, north arrow, and location and distance to nearest road. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATIO PROPERTY OWNER: Derrick Cant., Inc. .OT e 24 Nett Ricb mnd, WI. 54017 (715) 14eb-' p __L of 3 m. but.Croix Qincr ude, 3 zoo P 1.0. s OL e"112-6oZY--c S BY DATE F>GD OF � ATION Z� 1/4,S 12 T N slal W a D NANE OR CSM W (31 New Construcbm use pt 1 RwkMl iel / Nurrlber of bedaoms' 4 I 1 Addi m to ettising btili ft i I Replaostnent I I Public or ommercial describe Code derived defy Now 600 gpd Recommended design loading rate .7 bed, gpddt2 •8 Tench, gp W Abed om area required 858 bed, rt2 750 f1 ng rate .7 bed, gp * .8 starch, titer Recommended infiltration surlace elevaWKa) 97.40 (as referred to silo plan bendmarh) Aditnel design I site considerations trenches spaced to code 4 ' below grade Parent n111eri11 autva wh Flood plain elevation, if appiceble -niL- R Boring M U Ground OW. 101.7 it Depth to limiting tacbt +84" Ground elev. 101.4 tt Depth to limitingT V4-- z im Is ❑U I� Sam❑uSHE A�T�Cs 0U SYSTBA IN FILL HOLD** TANK US ❑U I IDS Ou I emu n=or-nin-rmsm RFPMRT r sa-. ► + TJ� (' '02* --,;ff Mom ©, . 1•.}- All=.. �� ©®� •� � III = •✓ 1�_ •� MEN Remarks: CST Narne:—FleW Print GarY L. Steel Plane: 715-246-6200 Addrm: 1554 200th e. New Richmong&g 54017 Signattae: f4` Date: 6-17-2000 CST Number: m02298 ,- PROPERTY OWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 0� 3 PARCEL I.D. e2ending I Boring #r 9 Ground elev. 100.6fi. Deo to k t6ng bax +8410 Boring # 4 Groutd 100.0 R. Depth ID Imilirng factor r +8411 Depth to limiting bcw 0. Boring N Ground elev. ft Depth to fronting b= Horizon Depth in. Dominant Color Munsell Modes Qu. S.Z. Colt Color Texture Structure Gr. Sz. Sh. CowsWm Barkry Roots GPD/ft g� nEndl - ane 1 2msbk mfr cs 2f 1 .5 1.6 2 8-23 7.5 r 4/4 none sici 2msbk mfr 9v 1f 1 .4 .5 3 23-34 7.5 r 4/4 none sl 2msbk mvfr gv if 4 34-84 7.5 r 4 6 none cos MCI ml na na .7 .8 f_ Remarks: ©M MM -__-.MM MM Remarks: ------------ nemanas: .j rcemancs: L SSD4330(R.06AYZ) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 2001h Ave. CSTM2298 SEhNW� S12-T30N-R18W New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #24-Brushy Mound Lake 'Ibis soil evaluation vas conducted to satisfy a zoning requirement, it may or may not be suitable for your use. 'fie location of the test may or may not be as shovn as permanent lot lines vexe not established at the time the teat was cxzlducted- it "=40' of 1" pvc pipe @ el. el% BM. top of 1" pvc pipe del. . 9� role Gary L. Steel 6-17-2000 '.,�' 026-1126-41-000 �&1��� 026-1126-03-00 t%• B 1126-39-00 a00 952 026 112610-000 am 7a'4 44' �T `•�'r s � 026112 02126-16-24000 TBS &7128�80-190 026112&23-000 7a6 11A 6112Cr26 TaT 112 a 6112c-oa7000 769 026-112822 000 Tas 764 026- 12620-000 6112621-0 Tat Tat 1126 4r. -000 T .�'' File #: ST. CROP" L�IVTY SANITARY SYSTEM , OWNERSHIP/ADDRESS FORM ice 2ao2iUse y Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. Owner/Buyer Adam t£ Erica Halverson Mailing Address 1447 166th Ave City/State/Zip New Richmond WI 54017 Phone Number (required) 715-246-2320 Email Address (required) halvy09@yahoo.com Parcel Identification Number 026.1126.24.000 (found on the property tax bill) NEW SYSTEM: LEGAL D!j Property Location _ 1/4 , _ 1/4 , Sec. . T N R_W, Town of Richmond Subdivision Plat: Waters Edge Lot # 24 Certified Survey Map #, Volume Page # Warranty Deed # (before 2006)Volume Page # Number of bedrooms 4 Spec house O yes ■ no Lot lines identifiable ■ yes 0 no New Property Address (Siaff Initials) OFFICE USE ONLY 4} I to 4v(- . Ge t S (verific 'on f new address required from 6 z3 (Date) for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds ice and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi aov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov OEMI rFillA �i / 's 1 's 1 1 1 1 1 1 1 1 j I I L� 1 � r 1 1 1 1 �11 1 1 M. � 1 I I 1 1 I V / 1 1 I � ��s �� Jr IRA INS mg �a State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number I Document Name THIS DEED, made between Brushy Mound Partners, LLP, a Wisconsin limited liability partnership ( hereinafter "Grantor," whether one or more), conveys and Warrants to Adam J. Halverson and Erica J. Halverson, husband and wife as survivorship marital property ( heretna er�"Grantee, ' whether one or more), the following described real estate in St. Croix County, State of Wisconsin: Lot 24, Plat of Waters Edge in the Town of Richmond, St. Croix County, Wisconsin. Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Grantor, Brushy Mound Partners, LLP, agrees to sell this lot to Grantees on the condition that Derrick Homes, LLC, will be the builder of the home and other Improvements to be constructed on the lot. Brushy Mound Partners, LLP, a Wisconsin limited liability partnership (SEAL) • onal L. Derrick, Partner AUTHENTICATION Signature(s) authenticated on September 19, 2019 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: St. Croix County Abstract & Title Co., Inc., by Andrea S. Carpenter at the direction of the Grantor. 19-S 15391 1088859 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 09/19/2019 02:54 PM EXEMPT#: REC FEE 30.00 TRANS FEE 97.50 PAGES: 1 Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Avc., Suite #B New Richmond. WI 54017 026-1126-24.000 Parcel Identification Number (PIN) This IS NOT homestead property. ,,,,rrannugry,� N/S� `��•'�-DER lot (n 0 I Q O r oNb S�P� ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY S-r CRoXX ) ss. Personally came before me on SEPF I' O 1 Zo l q the above -named Ronald L. Derrick, Partner of Brushy Mound Partners, LLP, a Wisconsin Waited Uabillty partnership to me known to be the person(s) who executed the foregoing inst ent and c wledged the same. + At ibveFA, C. r wotzz.iT-it�Y Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures may be authenticated or acksowkdgad. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below sipatrnes. St. Croix County 1088859 Page 1 of 1 �'-582.42'23"F AD 1,�' n o -....«.... '� �l • 11-1rQY1�'` _ -® S84006'33"E 175.8 ' .01 2.49 Lor25 TOTAL AREA: 82708 SO. FT. 1.90 ACRES F.F.E. 996.0 . 24 TOTAL AREA: 2.03 ACRES f F.F.E. 996.0 0 0 rn 46,00' L O T. 2 3 .��2 /� ' TOTAL AREA: 97,281 SQ. FT. i 2.23 ACRES .�j 323.86' .W 155. 8 121.5e 494.98' 500.261 582'S2'04�W '•�.. - y LOT 22. TOTAL AREA:- 87,293 SO. FT. 2.00 ACRES F.F.E. 996.0 i J •�� ON if i 49.54 ti �. i ti i i H.W.L. � H %wormongq,:,nnentofindustry. SOIL AND SITE EVALUA R01pvrlbn of ns s Build ngs in accord with ILHR 83.05,.x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. not limited to vertical and horizontal reference point (BM), direction and % dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATIO PROPERTY OWNER: Derrick Const , Inc GO PROPERTY OWNER':S MAILING ADDRESS LOT # New Richmond, WI. 54017 dl N page 1 of 3 dm. fp`d,[e0 i��v� . Croix a i ude, but V� or Z P I D # OL & 12,6o % S"CTv D BY p DATE A.S 12 T 30 ,N W 18 g(a) W ME ORCSM# Wb�i [1{ New Construction Use pc] Residential / Number of bedrooms 4 J Addition to existing building I I Replacement I I Public or commercial describe Code derived dairy flow 600 gPd Recommended design loading rate .7 bed, gPdlft2 . B trench, gpdift2 Absorption area required 858 bed, n2 750 trench, R2 Adaximum deli ingrate • 7 bed. gpd/H2 -8 —trench, gpdm2 Recommended infiltration surface elevations) 97.40 kd (as reterted to site plan benchmark) Additional design / site considerations trenches spaced to code 4. 00 , below grade ft Parent material outwash Flood plain elevation, if applicable na Boring # L< Ground elev. 101.7 ft. Depth to limiting factor +84" Boring # ED Ground elev. 101.4 ff. Depth to limiting factor+8" CONVENTIONAL MOUND [3S ❑u 1 us ❑U IN -GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK ®$ Liu L.fc75 ❑u f]S ❑u ❑S flu Depth Dominant Color mottles Texture Structure Sz. Sh. Consr5tence ay RootsFBe7d Horizon in. Munsell Qu. Sz. Cont. Color Gr. 1 0-9 10 r 3 3 none2 9-17 7.5 r 4/4 none 17-35 7.5 r 4 4none sicl 2msbk mfif 3 4 35 4 .5r46 nnco%Ak „ ., RIN Remarks: CST Name: --Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200th e. New Richmon I 54017Date: 6-17-2000 CST Numtxr: m02298 Signature: PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT 2 3 Page — Of — PARCEL I.D. i_pending Boring # xa Ground elev. 100.65, Depth to limiting factor +84" Boring # 4 Ground elev. 100.0 n. Depth to limiting factor +84" Boring # 11 Ground elev. 100.On. Depth to limiting fac+84 rr Ground elev. n. Depth to limiting factor Horizon Depth in. Dominant Color Munsell. Mottles Qu. Sz. ConL ColorTexture Structure Gr. Sz. Sh. Cor�sistenoe Barclay Roots GPD/ft Bed TrerXh - none 1 2msbk mfr cs 2f .5 .6 2 3 8-23 23-34 7.5 r 4/4 7.5 r 4/4 none none sicl sl 2msbk 2msbk mfr mvfr gw gw if if .4 .5 .5 .6 4 34-84 7.5 r 4 6 none c os m ..8 39 w. % ncmalns. 1 2 0-16 16-31 10 r 3 3 10 r 4/4 none none 1 sicl 2msbk 2msbk mfr mfr cs 9w 2f if .5 .6 .4 .5 3 31-84 4/6 none is os .8. ;7.5 ncu 101 ". rw�w r rvrngr np. SBD-8330(R.05/92) PROPEMY OWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT PARCELLD.t Pending Page 2 of 3 Boring # 3 Ground dev. 100.6fi, Depth to limiting factor +84" Boring # El Ground elev. .0000 it r Depth to limiting factor +84" Boring # 1,3. Ground 100.08, Depth to limiting factorI1 Boring # 13 Ground elev. fL Depth to limiting factor Horizon Depth in. DominigtColor MueselG . •. fvlotties .Qu. Sz. Cont. Color Texture StructureisBnce Gr. Sz. Sh. Corr Roots GPD/ft Bed Tmnch none +..: 1 2msbk mfr cs 2f .5 .6 2 8-23 7. r 4/4' I.,. one sicl 2msbk mfr gw if .4 .5 3 23-341 7.5 r 4/4' - nond ' sl 2msbk mvfr gw if .5 .6 4 34-84 7.5 r 4 6 none cos OSCI ml na na .7 `.8 Tl Remarks: 1 0-16 10 r 3 3 none 1 2msbk mfr cs 2f .5 .6 2 16-31 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 3 31-84 7.5 r 4/6 none is osg mvfr na na .7 .8 b.�at z 3f•z- '� Remarks: ==rpam����rs���:� Remarks: Remarks: S13D4M0(R.05/D2) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE$Nw� S12-T30N-R18w New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #24-Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test vas conducted. i l"=40 , �- t of 1" pvc pipe @ el. 1QQ.W1 top of 1" pvc pipe @el. 99.,.� C . y ae"Oe Gary L. Steel 6-17-2000 &ATM Oc couNrY NO. 648403 STA�E SANI'A1�Y PERMIT a� /44i KkA+e. PLUMBER TOWN SEC ,T_ AND/OR LOT EXPIRES PREVIOUS NO. BLOCK SUBDIVISION ISSUING OFFICER - CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow instaWtion of the private sewage system described in the permit. (b) The approval of the sanitary permit Is based on regulations in force on the date of approval. (c) The sanitary permit Is valid and may be renewed for a specified period (d) Changed regulations will not impair the validity of ■ unitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may Impede renewal. (f) The sanitary permit Is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: Ifyou wish to renew the permit, or transfer ownership of the permit, please contact the county authority. DATE UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)