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HomeMy WebLinkAbout026-1126-24-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 xm)] 'errnit Holders Name: City Village Township Adam and Eric Halverson I TOWN OF RICHMOND :ST BM Elev: Insp. BM Elev-. BM Description: IDI -7 fir, q} 1 ,P S I Tr�r SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic IWO Dosing W� Aeration- Polylo�l� szs TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic �' I �} i Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer II l Demand I a. d GPM D J1 5 458f- Model Number r CP D� TDH Lift Friction Loss System Head TDH Ft Forcemain Len th Dia. Dist. to well 0 IL I, � sal ELEVATION DATA County. St. Croix Sanitary Permit No: 648403 State Plan ID No: Parcel Tax No: 026-1126-24-000 Sectlonrrown/Range/Map No: 12.30.18.785 STATION BS HI FS ELEV. Benchmark 3,5 ��s2 IDI �- AIL SM Bldg. Sewer / Ie Q St/Ht Inlet In SUHt Outlet Dt Inlet Dt Bottom 10 18 9 J q�- Header/Man. Dist. Pipe Bot. System r1. r2 -I 1- 1 l(! Final Grade Fsta�� 15 to . } BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - I of---L� SETBACK INFORMATION SYSTEM TO Type Of System: PAL BLDG IWELL 5Di LAKE/STREAM nl n LEACHING CHAMBER OR UNIT Manufacturer: I Z�i] aio Model Number: EL DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes Length -] pia Length Dia Speci SOIL COVER it Praaallrm Svatama []niv Yi Yound 0r At.,Grada SVstemS Only Depth Over Depth Over xx Depth of Sodded x=�:'n xx Mulched /Tronch Center Bed/1 ranch Edges I,b T iI/� �_/ ey r-1: Ya ■ COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1447166TH AVE 010i,1s.jbK 9iPO e F4" 1.) All BM Description = I/ 2.) Bldg sewer length = yH 2- r ti 1 hs-, z - amount of cover = , y $' Pc, Inspection #1: Inspection #2: Soil i "-{{1.,, ss- � pn SJW y 4e Plan revision Required? ❑C Yes ❑g No 2iI 20-Z3 /5(+q5 I Use other side for additional informaton. l Date lnsepdors 5ignatur Cart- No. SOD-6710 (R.3/97) 5,411- 2023 -0/0 "`"• - — FEB 06 2023 v' epartment of Safety Professional Services, County CRDIX Sanitary Permit Number (to be filkd in by Co ) Ind stry Services Division � �� �03 �t ;:roi.x nL m lieation State Transaction Number In accordance with SPS 393 21(2), Wis Adm Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note Application forms for state-owned 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 purposes in accordance with the Pnvacy Law, s 15 04(I Km), Stats 1g47 166th eve new riehmond`/ Information - Please Print All Information Property Owner's Name Parcel M Adam and Erio<Halverson p 2.1b -- r 2!� _- ZL4 — Property Owner's Mailing Address Property location 901 Colman dr Govt Lot City, State Zip Code Phone Number NEW RICHMOND WI 5407 s e %, nw /.. section 12 T 30 N R 18 E or AX H. Type of BeildlnZ (eheek all that apply) Lot a 0 I or 2 Family Dwelling - Number of Bedrooms 4 24 Subdivision Name ❑ Public/CommetcW - Describe Use watersedge Block M ❑ City of ❑ State Owned — Describe Use Cl Village of CSM Number • / (Z-35 j( 0 Town of Richmond Ill. Type of ri)"TS Perot (Check either' "`New" or "Replacement" and other applicable online A. Check one boi online B. Complete line C i table. A. ®New System y ❑Replacement System ❑Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B. ❑ HoldingTank =(=conventional ❑ At -Grade ❑ Mound ❑ Individual Site Design ❑ Other T (e Isin Type (explain) C• ❑ Renewal Before ❑ Revision Chang ❑ e of Plumber El to New Owner ist Previous Permit Number and Daft Issued Expiration IV. Dispersialffreatmeoll Aral and Tank Information: X 17 Design Flow(gpd) Design Soil Application Rate(gpd/sf) rspersal Area Required (s0 Dispersal Area PraIxiwd (sl) Sti stem Elevati 600 .7 858 900 96.00� . Capacity in Total M of Manufacturer Tank Information Gallons Gallons UnitsoNew Tanks Eiirlaig Tanks WinL'q "e. rr s U h Tt y is t7 a Septic or Holding Tanis x 1200 1 WIESER x Do" Chamber x 800 combo x V. Responsibility Statement- 1, the uodersigaed, ansusoe respesibility for istsRaGo■ of the POWTS shwa on the attacrei pleas Plumber's Name (Print) Plumber's Signatur MP/MPRS Number Business Phone Number PAUL R KOEHLER '�jG��� 1225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DR NEW RICHMOND 54017 VI. Conn artmeot Use Approved ❑ Ur a Permit Fee Dat d Issui g Agent Signature iven for Denial s 7� r b 7i�7-3 Conditions A my prevar1�31 �� a,— > 3S+o,* Fp0 fJre�,w`uu 'dispersal Septic tank, effluent filter and cell ,i�.d +�'�' 3, $ Z . must be serviced / maintained as per 1 " Joel ror(—dhm management plan provided by plumber. 4rr')', D, So CL LW , setback requirements must be maintained — e 1 ordinances, ft a w, romPq puaa. wrrm-�mpre111 aiea wemn to ale Vousilly only oa paper not teu M" rR s 11 metes is site 7 f lti`ti. ri V i $ SBD-6399 (R. 03/22) ti bjrr I. "= 1ou%9 00 o VIAL 3 bil $ � �'w� � 1VA AVC a +e — `°°•° 100 a !11 44c,' � of 1 q w Oltcrz f j 9 a Aiam a,.,� ff;ct H71vG�gp� 1717 1tt i-L �AJ� N (.w R. PT 0 �.L- 1116-1�-ooa S c� ID 1N s yy Nw0� Hv C;OVP*4 Project Name: Owners Name: Owners Address: Legal Description: Township: County: Subdivision Name: Lot Number. Parcel ID Number. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Adam and Erica Halverson 901 Colman Drive New Richmond Wi senwsec 12 30 n 18w Richmond St Croix Waters Edge 24 026-1126-24-000 Page 1 Index and title Page 2 Plot Plan Page 3 System 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 9 Wwranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Paul R Koehler License Number: 225410 Date: 02/02/2023 Phone Number (715) 246-2660 Signature Designed pursuant to the In-Groun l Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01)- Pape 1 Lai 1 q W gtelfs f ) 14 I 1. �ute4t = \f. Ad4m oa,,A f{iGt 17 1�� tz N cw R; Cl, r, o•,� W PI OX,6- IIZ6-i�-oob 40 SOIL ABSORPTION SYSTEM DETAIL 1 GRAVELLESS LEACHING UNIT Pope 1 of 1 ProOd Name: Adam and Eric halverson 2 ^ No. of Cells 3 n Call YYldtti 90 n Cell Length 3 n Cell Spacing 9 Per Cell 18 Totni No w ez 10 ft 50 sq a EISA Per Cell 900 sq ft Total EISA gownR Ifor EZ1209I4-SR — -- - 5.7 25.0 EZ12031+10R 10-V 50•0 Graveness Leaching Unit Manufacturer: Grovellers Leeching Unit Model: 10 f ez flows Typical Cross Section Finished Grade ft In ((� 12 inL -------- ■....■.■a.■■....-.. X Observation Pipe with approved cap or vent Soll Backtill .G&AwWlo Fabric qit Infiltrative Surface n Limiting Factor �Siot#ed and Anchored Vent! Observation Pipe with Cap PiumberMesigner Signature: L esn" t 225410 Dab: Feb 2nd 2023 POE Too 7► roc ]nw..rMI"g CORK e,y. ® Zabel' a wut""Or Products A DfrWN of Po" kc. PL-525 Effluent Filter 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. 1 11 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 PI,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 PL-525 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. 1/16" Filtration Slots Accepts 4" & 6" SCHD 40 pipe �SF l Outdoor SmartFilteAD Alarm Polylok, Zabel & Best filters accept the SmartFilterb switch and alarm. Alarm Switch joptional) Accepts 1" PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots C4rtM W to NSF1A11I81 standard 46 Gas Deflector Automatic Shut -Off Ball Extend & Lok"m Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 To11 Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com PAGE 4OF5 GRAVITY -DOSED SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) IMPORTANT: Andwr tank(s) as necessary pursuant W SPS 383.43(exg) Finished Graft CAPACITIES @ 22.24 gaUin 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 i in Force Main Diameter = min Force Main Length = Force Main Vold Volume = 11 gal i Electrical rrMn1 comply With SPS 378 and NEC 300 Weet►brpr11 ool Junction Box Canduil 111115010� I W� Mal w..Q Hole Dui Exisnd manhob riaar of neosseery. Approved loddnp AAanhale with Wsmkip Lobel AtdrJ+ed 4- Min. or 2.0 n above EatabMl+ad Food Eisvatlon (Np+d) Oukk DFroorrreG r 18- Min. Approved Joints rrkh Approved Pipe 3 R only Sold Grand (Npld) PUMP -OFF ELEVATION = 6.3 ft rr� INSIDE BOTTOM ELEVATION = 7 � 3- Approved Baddlnp Material Beneath Tank [C] Total Dace Volume DV = 122 gal/dose (I 0.2X design Now + ftxca main void vtNtxt+e) / Vertical Lift = fMONSOON t PUMP TANK: SEPTIC TANKS Volume = 800 gal Total Volume as 1200 gal Manufacturer. wieser Pump Manufacturer. oulds Pump Model: $al (Sao aped,ad pumpanve.) Controls/Alarm Manufacturer s' rombus Controls/Alarm Model: s patrol Float switches containing mercury are prohibited. Manufacturers}: wieser tImmediately up-atream of the pUmp tank Inlet. l Install approved effluent filter at theseptic tank ou et Filter Manufacturer. Filter Model: 525 Wastewater METERS FEET 10 9 30 8 25 7 S U b 20 5 1 15 4 F- 0 3 101 2 5 1 0 0 v■��� Ste' � r r 1 1 r• 0 2 4 6 8 10 1 z m2/h CAPACITY MODEL INFORMATION Order Minfnwnr flea! Ditchan" Minimum Maximum "0"1" Number i'ir Voltt Amps rhmm vA ch � Connection Own 1� ll OOR L&M saiaa� style a� EP0411 .4 115 12 20 1 Plug / No Swath 10 is, Manual Manual 15' iG' 20 / 9.1 EP0411A Piggyback / Wide -Angle 10' 12" 6' 21 / 9.5 EP0411F Piug/ No Switch 20' Manual Manual 20/9.1 EP0411AC9 Angle 20' 12' 6" 21 / 9.5 EP0412 230 6 10 Plug / No Switch 10, Manual Manual 2019.1 EP0412F Plug No Switch 20 Manual Manual 20 / 9.1 EP0511F 115 13 20 Plug / No Switch 20' Manual Manual 22 / 10 EP0511 AC Pigback� 20' 12" 6' 23 110.4 .5 EP0512F 230 6.5 10 Plug / No Switch 20' Manual Manual 22 / 10 PAGE 3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION Owner Adam and Eric Halverson Permit 0 DESIGN PARAMETERS Number of Bedrooms 4 ❑ NA Number of Public FacirRy Units Ct NA Estimated flow (average) 400 gal/day Design flow (peak), (Estimated x 1.5) 600 aUd Soil Application Rate .7 al/da /W Standard influent/Effluent Quality Monthly average' Fate, Oil S Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODO) :=0 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Prevented Effluent Quality Monthly average Biochemical Oxygen Demand (SOD.) S30 mg/L Total Suspended Solids (TSS) 1530 mg/L ❑ NA Fecal Col'rform (geometric mean) 91W cfu/100ml Maximum Effluent Particle Size Ye in die. ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank affluent. MAINTENANCE SCHEDULE SYSTEM SPECIRCATIONS Septic Tank Capacity 1200 al Q NA Septic Tank Manufacturer WIESER ❑ NA Effluent Filter Manufacturer POLY LOCK D NA Effluent Filter Model 525 ❑ NA Pump Tank Capacity 800 al ❑ NA Pump Tank Manufacturer WIESER ❑ NA Pump Manufacturer GOULDS ❑ NA Pump Model EP04 ❑ NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Fitter ❑ Wetland ❑ Other: ❑ NA Dispersal Cell(sl I? In -Ground (grevftyl ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other ❑ NA fO NA Other ❑ NA Service Event SM« Frequericy Inspect condition of tankls) At least once every: 3 ❑ month(s) (Maxhrxrm 3 years) (s) ❑ NA Pump out contents of tank(sl When combined sludge and scum equals one-third (Ya) of tusk volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ month(al (Maximum 3 years) ❑ NA Clean effluent fitter At least once every: 1. ❑ months) >a ear(s) ❑ NA Inspect pump, pump controls &alarm At bonce every: ❑ monthis) 3 04 awlie) ❑ NAast Flush laterals and pressure test At least once every: ❑ month(s) as needed ❑ earls) ❑ NA Other: At least once every: ❑ month(s) ❑ ear(s) ❑ NA Other ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shell 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 eellls) 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,I 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 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankisl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). 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 will be discharged to the dispersal calls) in one large dose, overloading the cell(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 pp�p t orestoring ls power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating restore normal levels within the pump tank. ispersal Dells. Do not drive or park over, or otherwise disturb or compact. the area Do not drive or park vehicles over tanks and d 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 fife 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 peelmgs; gasoline; grease; herbicides; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls 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 Adminisuative Code: Ali 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 property 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 he following measures have been, or.must be taken, to provide a code compliant If the POWTS fails and cannot be repaired t replacement system: i A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in affect at that time. to setback and/or sot? limitations. Barring advances in POWTS ❑ A suitable replacement area is not available due technology a holding tank may be installed as a last resort to replace the failed POWTS. N A o mg ank CONS'TKt c--n oo Mound and at -grade Soil absorption systems may be reconstructed in place following removal of the biomat at the with the rules in effect at that time• infiltrative surface. Reconstructions of such systems must comply < <WARNIII > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO 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 Name COUNTRYSIDE PLUMBING Phone 715-246-2660 POWTS MAINTAMER Name PAUL R KOEHLER Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY IF Name P Name S . C ( 20AlII . Phone 715-246-5600 �� Gonvn 83.2212)Ib){1){dldilf) and B3.64{1), 121 (3). yJiaconsin Admavartrative Coda - This document was drafted In compliance with chapter �tw-OW-aotlavk :Ile 99-v8-9N-008 :anod-1sO 00 00 oo :pro 0GOS VA 'NOON N301VM 'oi AmH sn s«aM Z if1NdMY 0i1d3S b'r 313111 13131M dOM :A6 WVHG W wos :anod-�a �0-009-00Z tcnm W W Z QTE > .. W F * coo F— a ai p Q § d p _U �- vi n z z uj r c� m �' V1 Q C3 00 li t Q� ~ o Z OC °r° � W W a lz r` 61� — m w5 S 3 a Q, p ,_ ' ^ a0 m O i]f N �j � IL Z oc a N �p Z Ui OD Z� so 'n�mzm 3 Bit; �F �2 z �jp x ICE U t 8 J a W In I to o U r Svc »4 z »L do a �W a a CL . II ♦ �/ II I I I II = II II � W II IE I I f` II II I N aldD 4 N dn _-- _------ -- _ _ -- U L I II I 1 II I I I. Cc Lj II O U- II II N !YQ II I I I I � m I I »9 «��� •£ I I •a I I 9£--a II Q s _ II U M ,5 do Li F- W e z «« a3aS b3a »�S f- WWJ.i,+DOPWMMofln*"Y. SOIL AND SITE EVALReWlions FAT1,11�a B in accord with ILHR 83.0Attach complete site plan on pae► not less than 8 1r2 x 11 inches in size., knot limited to vertical and horizontal reference pant (BMI), direction and %ary dimensioned, north arrow, and location and distance to nearest roadNT'rAPPLICANT INFORMATION -PLEASE PRINT ALL INFORMATIOcp" �� [7ERT'f OWNER: Prick Cont., Inc. PROPERTY OWNERS MAILING ADDRESS LOT 0 B pop 1 of 3 Croix I.O. 0 ,6. ""114 12 T ,N R(or3 w NAME OR CSMA a t v CfTY, STATE New Richwmd, WI. ZIP CODE FHM NurMn 54017 015) 246-2320 u•.--, L-r - Ricbmond 140th St. 1;4 New Construction use pc I Residential / MvW d bedrooms' 4 ( I Addition ID existing txrild'i1g Replacement ( I Public or mmmetdal desaibe E I Code derived daily pow 600 gpd Remwended design loading rate .7 bed, g0jt2 .8 trench, WW Absorption area required 858 bed, h2 750 trench, 1da�urtnm nq rate •7 bed, gpolfl2 .8 trench, gpd 12 RecommemM ottratiion surWe elevation(s)97.40 (as relerted ID site plan benchmark) Additional design / site considerations trenches spaced to code 4. 00' a n Flood plain elevation, if aPOCable Parent material S Satiable or System CC�rvB�r10NAl M otm N-GROUND PRESSURE AT GRADE SYSTBA N Fill HOODING TAN( Ms O u �] S❑ U C$ S O U fl S ❑ U fl S O u ❑ S fl u u- unsuitable ar T (' �1° SOIL DESCRIPTION REPORT C�oAL ,��► Dept#r Boring # Horizon in. Dominant Color Motlles Texture Structure cor>si8banoe BWXWY Munsell Qu. Sz. Colt color Gr. Sz. Sh. Roots GPDI Bed IErtdt 1 1 0-9 10 r 3 2 9-17 1 7.5 r 4 1 none s ci Boring # 2 Ground elev. 101.4 ft. DepM to limiting favor +84" Lr 4 Omni PROPEWYOW101 DDErick COnst. Inc.SOIL DESCRIPTION REPORT page 2 PAWIL U). # pending Boring # Ground 100dev. . 0 fL D" lo Imav 141cior +8410 Boring # Ground lr.0fL D" ID IlT*Q bm +84- Boring f Gmurid dev. fL DOID M" bw =-tl, 7171-1 for#,' RIM s� s� e WAf VA PA PYl mom mm i m � mm�- mm�mmm� mernam. .lr mmm": — 06 STEEL'S SOIL SERVICE Gary L, Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SEkNW4 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 requir" i t, it may or quay not be suitable for your use. ibe location of the test my or may not be as shorn as pest lot lines wars not ostablishad at the timQ the test was oan8ucted. (Lip= of 1" pvc pipe @ el. 1QQ,W' . Hri. top of 1" pvc. pipe @el. 9j i.2/ Gary L. Steel 6-17-2000 I-_ J V 1�j 8 ti N 0 0 64 File #: ST. CR I�NTY SANITARY SYSTEM Only OWNERSHIP/ADDRESS FORM OffiUse 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 Per pert,- Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Adam & Erica Halvorson Mailing Address 1447 166th Ave City/State/Zip New Richmond WI 54017 Phone Number (required) 715-246-2320 Email Address (required) halvy09@yahoo.rom Parcel Identification Number 026.1126.24.000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIMON, Property Location t/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 G yes ■ no Lot lines identifiable ■ yes 0 no New Property Address (Skaff Initials) OFM ISC ONLY Nerific 'on f new address required from Commun tl � z3 (Date) C% � for new construction.) This form must be submitted with all Private Onsite Water Treatment System (POW7S) applications. Now 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 715-24S-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 WWN/!SCcwi.aoY CPOIX Rim u� l UlFi � 9 .YOnM.1MsrO�rGWfpe�.�a. `�� wn mn 1� a ® ��tauwww� �fiiJfiS� x ztzsllOR �. coma m 1 I 1 1 1 I I t 1 I 1 I 1 1 1 1 1 1 1 1 1 1 ' 1 1 1 V I I I I 1 I 1 1 , I , 1 1 17 I 1 I 1 I 1 1 1 1 I 1 1 1 ' I ---- --------------------------- 1 i i i I I o 1 i V 1 1 1 I I 1 MI-4 ' l -- -- I 1© 1 1 1 1 t •� ' I� ■ , 1 ; 1 i] I ' J — ' I ' f-I I ___________________J_________ tea• w. State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ' 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. r� Exception to warranties: easements, restrictions and covenants of record; highway and stroet rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except heal 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 ,4� (SEAL) 0.4fonall 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:1 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 Arca Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 026-1126-24-000 Parcel Identification Number (PIN) This IS NOT homestead property. DER N/S ..`°�� •. O Oc _S (71V drrrrrrr"��� ACKNOWLEDGMENT STATE OF WISCONSIN ss. COUNTY Sr ORow ) Personally came before me on E Zd the above -named Ronald L. Derrick, Partner of Brushy Mound Partners, LLP, a Wisconsin limited liability partnership to me known to be the person(s) who executed the foregoing lost en' c wledged the same. a �Fi4 C . r14 e. :z_ lT r Notary Public, State of Wisconsin My Commission (is permanent) (expires: (Signatures stray be authenticated or acknowledged. Both are not necessary.) r 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 signatures, St. Croix County 108BB59 Page 1 of 1 _ co Z` • 1 W^, Iu w ti 1 , f►t tn i# s Dy y �' �1 �Dp00i'4 j t� ,..�•, OD + c p -7)'V I 1 ll ` •C 1 jr66.—' 7 "op 6000 O \ s `ss 3 p "; D O _/' 3��33 o n�> ~ m o(. � 1V \\ VA D. Y. CA 0 LA 1 1 1 • Nv-4 1 1 h, , _4 o , 000 t 1 1 �> I v 1 1 s�� w m• I'*1 a 1 10 , I ; � f OD70 I + ! mo W 171 s s?4 8 Jo, O_? ����, .P ; 1 r,, page 1 of 3 gykwonein Depwvrwwt of Industry, SOIL AND SITE E V A L U AT t�bo• erd Hurnsn Relations 4 �� of Sa" a BuMngs in accord with ILHR 83.05, Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. u not limited to vertical and horizontal reference point {BM), direction and % # pe dimensioned, north arrow, and location and distance to nearest road APPLICANT INFORMATION —PLEASE PRINT ALL INFORMATIO PROPERTY OWNER: P � Derrick Const., Inc. GO PROPERTY OWNER':S MAILING ADDRESS L07 1 150 24 CITY, STATE ZIP CODE PHONE NUMBER ❑CIT New Richmond, WI. 54017 (715) 246-2320 dm. �pde 3 irid"ude, but �np scatror, !>� VA �t2x �O SC,OU F1CIE Croix N ►' va,s 12 T 30 " 1 BD. NAME OR CSM k W NO na 'ILLAGE [SOWN NEAREST ROAD .....�.,...� 14pth St. ( New Construction Use pc] Residential 1 Number of bedrooms 4 [ ] Addition to existing building ] Replacement j ] Public or oommeraal describe Code derived daily flow 600 gpd Recommended design baling rate •7 bed, gpd/ft2 .8 trench, gpolft2 Absorption area required 858 bed, n2 750 tiench, ry2/�V imum desi ing rate • 7 bed. gpdth2 ' 8 _try, gP� Recommended infiltration surface elevations) 97 • (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 4. 001 below grade ft Parent material ou Flood plain elevation, if applicable = Suitable for systemI CONVENTIONAL MOUND IN -GROUND PRESSURE = Unsuitable for system 1 [3S ❑ U] S ❑ U ®S ❑ U Boring # Ground elev. 101.7 ft. Depth to limiting %ctor +8411 Boring # El Ground elev. 101.4 ft. Depth to limiting factor +8411 Remarks: FCST Name: --Please Print G; ddress: 1554 200th e.gnature: c nu neerOroTrnU RFP0RT F�M4� Z `t 9(or) W V1 S D❑ U EIS ❑ ULL ElSI NG o U� T--- Dominant Color Mottles Munsell Ou. Sz. Cont- Color 10 r 3 3 none 7.5 r 4/4 none 7.5 r 4 4 none .5r46 nn - Structure Texture Gr. Sz. Sh. sicl 2msbk Consistence Consistence mf y G Roots Bed Trer►ch Horizon Depth in. 1 0-9 9-17 2 3 17-35 j r1 4 35 4 g{- Jk L. Steel Phone: 715-246-6200 7 Dale: 6-17-2000 CST Number: m02298 PROPERNOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 Of 3 PARCEL I.D. A__p_endin Boring # Ground elev. 100.65. Depth to limiting factor +84" Boring # 4 « Ground elev. 100.0 n. Depth to limiting factor +B411 Boring # ' Ground 100.Of. Depth to limiting factor Boring # 0�' Ground elev. it. Depth to limiting factor Horizon Depth in. - Dominant Color Munsell, Mottles Qu. Sz. Cont Color none Texture 1 Structure Gr. Sz. Sh. 2msbk COnSisterve mfr Y cs Roots 2f GPD/ft Bed .5 'Tren& .6 2 8-23 7.5 r 4/4 none sicl 2msbk mfr w if .4 .5 3 4 23-34 34-84 7.5 r 4/4 7.5 r 4 6 none none sl cos 2msbk os mvfr ml gw If .5 .6 na nor .7 .8 memarKs: 1 0-16 10 r 3 3 none 1 2msbk mfr cs 2f if .5 .6 .4 .5 2 3 16-31 31-84 10 r 4/4 7.5 r 4/6 none none sicl 1s 2msbk os mfr mvfr 9w na nor .7 ,g TD / Z 3l.z 7 , t- riemams: MEMO- ' Z'; SBD-6330(R.05/42 PROPEffrf OWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pending ; Boring # 3 Ground elev. 100.6W. Depth to limiting factor +84" Boring # 4 Ground elev. .00.0 ft. Depth to limiting factor +84" Boring # 5 Ground 120. Gtt Depth to limiting factor +84" Boring # Ground elev. it. Depth to limiting factor Horizon Depth In. Doml ial�t Color MuciselL,- ' ; Mottles , Qu. Sz. Cont. Color! Texture Structure Gr, Sz. Sh. Consistence Bmnd3 r Roots GPDJft Bed Tmnch node 1 2msbk mfr cs 2f .5 .6 2- 8-23 7. , r•--�"4/4' one sici 2msbk mfr 9w if .4 .5 3 23-34 7.5 r 4/4' - nono ' sl 2msbk mvfr gw If .5 .6 4 [34-84 7.5 r 4 6 none cos 0sq mi na na .7 ':.8 Remarks: 1 0-16 10 r 3 3 none 1 2msbk mfr cs 2f .5 .6 2 16-31 10yr 4/4 none sici 2msbk mfr gw if .4 .5 3 31-84 7.5 r 4 6 none is 0scl mvfr na na .7 .8 Sri z Remarks: MA 19F M M. IM, 0 Remarks: Remarks: SBD-8330(R.0"2) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SEVNw 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 was conducted. it "=40' �= t of 11' pvc pipe @ el. 1QQ W, . BM. top of 1" pvc pipe @el. 99,4W C � 4 11-t 0Q Gary L. Steel 6-17-2000 M 00 qt tD z D 0 0 A a EEO 00 w a 0 F� 4 H O a z O u V 1 z 0 V F-�-1 0 w w x H z 0 04 w W x H 0 0 P4 w w w