HomeMy WebLinkAbout261-1304-02-100Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)],
Permit Holder's Name:
City Village Township
Spring Point Project
CITY OF NEW RICHMOND
CST BM Elev:
Insp. BM Elev:
BM Description:
100
_� CoJP,r o�
TANK INFORMATION
TYPE
MANUFACTURER
CAPACITY
Septic
11 �F
2G o0
Dosing
H 0 1�c 0 ff
Aefatkm
,
vvid+pg,/
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
�
I00
100
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer
Demand
GPM
Model Number
TDH
Lift
Friction Loss
System Head
TDH Ft
Forcemain
Length
Dia.
Dist. to Well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County: St. Croix
Sanitary Permit No:
651335
State Plan ID No:
Parcel Tax No:
261-1304-02-100
Section/Town/Range/Map No:
24.31.18.2320
STATION
BS
HI
FS
ELEV.
Benchmark
PO ,P 14 c �� cx;S},..�
2, $
�d2
I0D.OD
Alt. BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
lI o)s
2s
Dt Inlet
III
�I �-
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
Final Grade
Cover
Ilse. - Aqk CVO-
I •
C
& s 'vn Ttihk
BED/TRENCH
DIMENSIONS
Width
Length
No. Of Trenches
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Liquid Depth
SETBACK
INFORMATION
SYSTEM TO
P/L
BLDG
WELL LAKE/STREAM
LEACHING
CHAMBER OR
UNIT
Manufacturer:
Type Of System:
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold
Distribution
x Hole 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
xx Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed/Trench Edges
Topsoil
❑ Yes ❑ No
❑ Yes ❑ No
COMMENTS: (Include code discrepencies, persons present, etc.)
Location: 1360 200TH AVE
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
Date
SBD-6710 (R.3/97)
Inspection #1: IIII51201b - +4nk omly 1?0 Inspection #2:
SEE AS -BUILT
Insepctor's Signature
Cert. No.
iOA::Aum
so
M.Ml
Immmotmi
11
16
fai 1)
I ei
6 706 1
ly I' I� I Iz
'n
I
11,19 'O'no "I
Assam t
Department of Safet%,
ea X, 0 Al
& Professional 'fie rwices.
P a t Number (to be Ued in by Co.)
Industr-y Services Division
b51 3 3 500*
Sanitary =It Application
S Latc I -.:n N; Urtb er
Jj! f to!
With SPS 383.2 2"), Wis. A,�=- C-3de. Z�Ub2"iS5,012 0 5 G= . I L: a 0 -rWe go Z-=C3:11 U�z
vttM,- )b2302-
is -r5=i:,ed P.rior to obi a sanjt3� pe�-=t- Nor-o: Applicatior- fb= for s�aze--owr-,ed POWTS are submitc4 to
Projrct -AAL-ress (if cLffe=* thm TrBiling 2Ld& 0
& L- ond
Us :Cpa-== of WC:N. a-d -� ptoPmon ' informatoz you p. vide nay br- used for sez, ar%
15-G4�1)(m), Stat
L AppficAtion Information - Please Print All Information
R.-OpeTty s
2� � — l�o�f-- 02-10�
Ft oPe--,Y0wse--.'s JkHng AN--4dirs;
?-rx)e.-tN, Loaxion
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-0:
clt-v, State Z-� c`,Dde ?Ihoze
Umb er
TL Type of BuUding (exec k aR that apph-)
I or 2 FAIN- Dvt!=g - N umber
U btic) co=eyC. L - D e s,-. nb e se
Lot;;:
R,Iocic =
T N TR
Su bdivisio-a NaT,�
ecity Dr-h
Vivage Of
5-f ID)
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kM. Type of POWTS Permit- (Check either I -New" or "Replacement" and other appEcable on line A. Check one box on Une B. Complete Hat C
A
0 they -ModificaEOM !J0 E.,oxistLng syste= �r�xpiain)
W SYStEr:1 *��Piacemeant syst= I __j Addi dazial Fire t 'L,'air (expiain)
'B,
1In
41d ro= nI-GM 0 -.Lu,� dividual Site Design Cfth cr Typc :cxplain)
10 ding Tazz� L I
(ronveraj
C
Pre 'ous P Number azd.Datc lssued
i et N11 E Rmevna Before Lj RevisIOM ,.fie Of- Plumb Cr 7-.amfL-r to N ew ONVZeT —
ExpLrabon 51"Ielt
I V. 1) wNrsavi: reatment Area &nd Tank Information
22'4m
f
EI) 3 x q2 A4 =4;p 6 301 &.k�c-L q
n
,c*19n Flow '-gpd)
Des�gr, So!'. App-liz:a'.io-, Rzte(gPd/st)
P I rep,
Ms"CrSal Area Req-- 7 redl(s� D'zersal A posed s (f)
Toza: of
Tani infor=Brion
Chalom
U aiis
?0 —W
Exu;6mg Ta-lit's
-7
hole-M& Tank
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lag
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D05LUg chambc:
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. r
V. Resp-c"nibWty Statement- 4 the undeni t�tL assume responsibdin, for uwa-Ujition
qP V
cf the FOWshown TS shoon the attached p1mi.
P!.Lj7n', .)e TS 'X r-,D,
Name (Print) PILM'21er'g Sigra-=e V. NTR.S NLmbe-. B us'l - es s P�4one NLmber
40&n 0 j
Plu=bc7r's 'Strm-, C-.ty, Stazz. Zip Code)
k
V1. S e 0 T1 I V
Z112-
Cor:cUtiens of Apvrova- fo-r D�savvrovall
I
3 A I ts bgs, . 4-raa d-es- Wvwd-�- W'd -fj's
L+,
'7
1. Sep k 0- n k, eff L.: (- Fi � "I i r8
i la-'n r-,Al must be servic.,;!,i!71 h I
r
ma.iagefi,�eii[ plan provk;,�-A by rr
pli.iFiibkal.
2, N1 setback requirempnts must be rnaintgined
.: M
a s pe r a p V! I Ga I; I e, -d e / or in a nL rs
Xtt2Ch LO N-: Tj1PjtWP.;,1S 107, iL:- --i 2nd Lwm the Count% onJ% oo pap.-wL paper lass than 8 3, 11 inches Ln lLz4t
'IZ
0�,/u-,-k,.,wC, v
W i sconsi n I)c p. i I I n % -01L,i-tnd Services
41
4K%Lidi-,ill) Yar&, Wav
R) Box 7-42
khdison, W1 53707
October 19, 2023
C I'ST IFS NO - 22 1471
(111TE
14 0 111 ST
A.Mf"KYWI 54001
rMirAIL14 1
LWOW& - ... I Dam,
PLAN APPRON',% 1, E, \PI RLS - 10: 19) 20."'
MUNICIP.A1.1 I N, :
(1 TY 0 F N IA� R I C I I �v 10 IN 1)
S 1, CROIX COUN I')
SITE;
SPRING J PROJECT
1.1, 0 () , 0 0 111 A V
S
1 W S F S21 4 I. I '1� 1� 18 \k`
FOR:
Design rite" titer Flmor Vidue: 1821
1 imiline , FRMIF(S): 1 1 7 " below Grade
Maintenance Reqijir-eti: 1. fflucnt Filter
Phonc. 608-2 f-P6- 2 112
Web liti,p �t,,J�Ls
Tony Evers. Governor
Dan Hereth, Secrota ry
Identification Nunibers
Pla n Re% levy N o., I I \% I - 102) '3023 8:7-C
Applicalion No. DIS-0921142954
Site ID No.- l V-122150
Please rc f6r to,Ld I i d cnti ficntion nmnbcr� iTI -CUCII
corrc,,pofi&nce with ihQ Depavirlient.
)L!*fMVb4>"ny
APPROVED
DEPT. OF SAFETY AND P90F �: S S;0 NA L
SERMES
ONMON OF INDUS IIRY :� �_,]Rvlc VS
AkIkK70141 _7 1: TA �
In -Ground Soil Absorption Component Manual - Version
1 ...] Ovlay 2022-2027)
SITE IZEQU11ZEMENTS
\ full size cor� o �' (tic appro� cd plaw" -.1nd this letter shall be on -site dUring construction and open to inspect on
by authorized of [lie Departnictit. which may inchide local inspectors, A Depariffiel"It electronic.starnp and
signature shall be ;,,n thc pkans %� hich, are used at the job site f01'C0nL,,1r1IC6A)T1.
Hir follwAing corldition.., kdIall lie met 11.U1,11`14 c(IIIIS11rue(ion or installation aml prior to tjNv:
This system is to be constructcd ',imd located in accordance with the enclosed appnlved plans and with the "in -ground Soil
Aborjltion Comportent N- I',] T1 11 'Lil lor Privaic Onsite Wastewater 11-,:atmetit Systems- - Version 2. 1 May 20.1.2-2027)
LT vce� -liter, indiiitrial hypro( t,or hazardous
rl i,, 1'ir D(W[ IN I W W \",;'[ f:\\V,-\TFR on13 DischLir c of Pi A s
1'h k L I .-Llh,taiiccs L!, pi-ohibitcd.
MVNEJ� I�ESVONSIBILITIL.S
• I'lic ctiri-kmi uwnci-, -and ca;.:1i -sub,,cquent owner. shall rece'iVC �j CLNI)N Of ll)V, ICIACT ill%:[U&112 in,tr LjL. ilons, relating to Proper use
ILI Fid inainter] iince o t"Ific systcrn. Owners steal I receive a copy o I the alirrop [. i -Lite oPenat Ion -,I ri 111. li 111 enance inanua I arid. or
�\ :\d(� 'S 4,L11.
Om an
wner s ual 1br the PO WTS described in th Is tip prov -Li I L and Is- min. 'ode SPS
• In the e,� ent I h k so i I absorption systein or any cal` i ts coi i I IiL ii ici I [ pLi r1s, ma [ funct wil " -�o kv) 10 �, r'�, "Itt: I h v4d fl I I I a &I r d . th L: P I-( JI)CILty
owner inust folk)\,v the contingency plan as described in the approved plans.
ale �cri' cd 0 IWl IlCeii revie-%%ed filr CMINIFT11WIce with applicable Adin inistr-L-it've Codes and \Vis in
SLatutcs- Fhe sub mitial hits been (`(_A1_)l'l 10NA1,LY .,\P1-1R0VF1D. Thiw,.,. system is to I)c constructed imd located in accordance with
the e n : I () �-i e d a rp rn v ed p I in ri� a, 11 d %� i 111 -.1 n � Co III r () n e 11 t nia n I. I a I i1s) re fv rc n c ed � i hov e - 'I I i k: o Ti e r , a �, defined in chapter 101 ,01( 10
Wisconsin StatUICS, is responSiHC 16F c4 11111)1'1:111L'c a11H CO& I_;:qLJiI-CMCI1b-
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.46, stats.
All permits required by the state or the local municipality shall be obtained prior to commencement of ,
construc tioniin sta l l ati on/operation .
In granting this approval, the Division of industry Services reserves the right to require changes or additions, should conditions arise
making them necessary for code compliance. As per state stars 10 1.12(2), nothing in this review shall relieve the designer of the
responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or
construction of the reviewed items.
Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this
letterhead.
Sincerely, Fee Required: $325.00
Fee Received: $325.00
ffA"W WASW Balance Due: $0.00
Matthew Janzen Refund Expected: $0.00
Division of Industry Services
Phone: 715.340.0407
Email: matthewjanzen@wisconsin.gov wisconsin.gov
1� �' T 0N: �. COMPONENT DESIGN
Rase1denflal appitca'd0
NCEX AND T1 L� ����
A"ROVED
DE". CF SAFM ANO L
SERYMMS
DMISM OF DICAMTRY SERVICES
W4&04W WAOY'607
Project �.11
Jeo -cc 7
.Name:_.?'57 f1#14] aloir
/n
OwneesId c r
r .
Name.
__)02_
Oviner's l�C
Address.,
Mega! Descripi:on:
Suodivision: Lot #
Town: �� �t�' ��CIIIyt o•� +7
County:
Parcel ;C# � 4-
IDes nerirpl tuber. h � -
' Licen se #!'
D aTe:
Sig n atU re:
t
commens
� i
f
ti
t
i
to the in -Ground Sot*4 AbSOIw �
-ptlon c:ornponent Manuai for Po^_*'f"`
pe$fgned pu rsuat t Version
!ndex+T#tteConv 2 f Mlz Y ersion 2.1
Spring Point Project
Spring Point Project is lab using swine for testing and the waste from that does not go in the Sanitary
Sewer. But they have 18 employees and they take 18 showers per day and 1-4 loads of laundry per day.
They have another way they take care of the waste from the swine. it is in another facility.
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Iiieptic-Dose Tank Cross Secti
on And Pum Perfo ance S
P pecffli� a TIR
T;mk Manufacturer
Tm�k Mode I Num be--r—
t Filter Manufacturer
--Pilfer Model Number zg-
Z,
Inlet
M*nlmum, Pump Performance Required
'GPM�'-7 -z
Ft TDH
— _:
Ouflet Manhole'MirL 4" Above Grade With
Lack-ing Devica. Inlet Manhoj,e
< 6" Below Grade Scaled Watenij4ht
Sw*tch Swings and Reserve Capacity
Tank Volume — 3- GPI�%X
1"1111 UI
fit
L
—0
PUMP ManUfarturer
P Manufaaur"
Pump Model Number
Alarm Manufacturer
Alarm Model Number
Switch Type
Total E}mamic Head (T.
Elevation Head f j
Distal Pressure
Network Loss
Force Main Loss , 3,�
Total __ %, 3
/ S/O
- Feet
Manhole Min., 4" Above Grade
'With Locldng Device
Disconn=t
Outlet
Weep
Hole
GENERAL INSTALLATION: The 5cptic/dose tank is bedded and back filled in awordance with the
mantifs ;U='s product approval specifjc,-a'to rL5. MxXimurn depth of bury as specified by the manufacturer may not
be exczcde4 without prior approval. Malibole covers exposed to gmdc have an effective locking device (padlock)
inswIled. Piping at the inict and outlet is of approved material, connecW to the Unk with watertight fiffinp,, and
I&W on ale soil. to prcvent scWing or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation an,,l the sleeve !;.eaje ;.qw
h d ate r-fight- El ectrical servi, C e COMP 1, des with N EC 3 00 md Con 16.28 WAC.
02105 LJ Page . of
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0* P .;I, MAGEMEN' PLAN age
TS WN Mi 2L, L
FIE INFORMS ON
Fd Z 7ejr-
DESIGN PARAME'fTzU;W
Number ej Bedruams;
7 iNA
N um bcr of art r, FaDRKy UMis., 54A S 1-t or
0 1
WmaW�averwge) Flow:
12/4
1
:,A gn (peak} Fj ow r- (esftafed
a 11
n Situ Sdi App�cahon Rate:
wPajldaw�L)
stri; 0 d OTcl pme6bc) I nfl uent�Effluent
NJ 0 n t h�'�f av a dras 6
False Off & G real CL (FOG;
--�20'mgiL
131 uohami'cal Oxygen 0 e man d t19 OD5)
ek
-:i?Z
Hfahl Strength 1rffivanYEffiuent
IV onth J1 Y SVS M g 6
>3017.CtL
(BCDg)
>220 mj;L
[2 N A
Prs'LrEzited rnfftjerl�-
&iwago
Ej :r L ) Q�)
mc[L
MA
Fecal Go 10m, (gMM-frJ G M!!'2n)
�i
I
SYS 'EM SPECIRGA L70NS
7ank Manufacturer, WCjAeA-%.-,,
W 4
K SeFfic 0 Doze L] Holding Vauma .45-c;
L —iank ,M2rj1jm=rer,
1:1 NA
YF [13soc 19buse Z:, HU'ding Val LkM C.- ;x 5V 0
Vardug E)isWrive To nX BORDMCS) to Service Pad:
(f1
Harizonisl DkWice Tank(s) to SeMca Pad
L
i y hcgzopw.-!s >1 uo feet. 4eao Insna to be proWded
on bzck.,
z- 0-fluent Rle-F N?odek
PMajFIAM. Mr.
0 NA
PLnr.p Nlade!-
--
PMftP49tM 6n t U nit
L--! NA
Mv:,� an XDraftn ?cat F tilter
.91
—1 t��- rYIre-Grcand (Presaum)
LJ
NA
Ej At -Grade r.7 Mwrtd
r C2 wer.
0 � NA A
MAikF[-ERANCwLF.--
7
Service 5vant
dk
iF j) of tanK Vol= e
M,�Vher ccml:� �zd sludge ar,,d scLM equsls OT
Pmtctetm
AIat� UO
Inapmt =nd1 --,M 0 I"Z
q (i) 3g) 0 —A
UA�-G3T'— I
(M, arjMUM YEO r5)
l ll
,,east Dime aveQV,
Inspect d1sper-saca(S)
El
1=,t leas'; Or-: L"',
L
LJ m o n th W
i,-jespect purnp, pLmp cantvz At �ezas t ix, iz r;,
T
F1 ush I ate ral s and pressi-Te -tw,
16
t 2r: At !SEIS-t OTIU-P,
Mar-
MAI W ENANCE N BYRUCTIO NS one tle foll 0,fijjjg I I causes or CKMcdo I '-s d
"rapectone of ianks and 8011 U IM 2 1 1G., T! r=1TI I ptag�z, S-ervicinQ 00MOr (PMP'Rr�
YYY7,S or Se
pju-n" 9r. V-aster PILtnbar Resd'--F%d.,0-d '-%" - -
"re, dent[Fy any -cracks cr;mks,
D c;Trr-, Lir braken hard 1
7;- Inspeclions must indudo Et viOU01 MspecUcn G. -na tanKfs�) Lo lderYy any jT%js r� The soil
jK bFn e5d -31tidgip an d scu rn'aml ra nhac,j( o r a,ri!, baGk U P r, r pu ndi nq of effluent On the g rouncl surMce
I rjatut-, ipes:a; - i`c fOr a nY PWdlng Ot SMUent
9 R 6 Ll Fe %f he imi Lim qs of :nom -id to clree ,�� ;�, � obsu
TL -X 4N P
jA L th
abscvptiori stern E;hvj'� bc-viisi L U � cij-ton 2,-I,d reqLjres the irnmodfato
orl tile grmnd sut['Hce. yhe ounding o. effl"�,ant (in �hs ground sui-face ITF.-Y a fall1r.9 con
,-,o�ncatcn oj LhB 1UQ?1 F89LAEti-ry authlorllt�,
77 Un d C';�) 0,- M 0 f t-ha ta i LIM a
— --I k aq ua Js On 9--tN n
�Afhori tho i�,ombin&-d auc=ujaban of s4idge nn' scum V trea trn eri CZO FdanCe Whh dia*r NR 113.
1
F, tu of c. ta,,Ik :s h al I be fvmove�L' I bY a Sep(mLae Sarvici,-ig Dpe-ator (purnps,,) 2rd ciisposeci of In a
J -C -afive
p��or?s Fri A drT?lr ist, - u[�ipuiionts, pnAr00*n&TTt ur"t"",
ent f,�t43r,;: 7
tG'the -'serv�Cirig" 07 effiru ac,.na-icm or press uTi2�p-d r
,-�r[ other sorAcez, induchng L�ut nL;L (ik-Ilked R OVV7S M wntiai n er-
0 of,5-.1-t shatl bm perfx:�rmmd k:Ioy
an-u ;�Lny 6-19rVIC�nq at irmarvair,
:qgLtjaLor� atkho&y within 30 days 0-1jo Of aqY SaMCB EVA
In'. sarvicq rQpQrIL' Mall bQ Provided �0 the!CCA'
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TART UP AND OPERAT10N
h ; ; _' ) Itr the Bence of ar nb n rodu , Solvents 01- G or
For Flew =*udon, in�or to use of tec.h€ t c c l# s lm � .. '� s 'are
z. ' ancUor �� a the soli a orpU an s _ � I r T
detected have the contents of the n � � remk�`,r .'4 � a ]Q e L ervt 9 P p r .
!i r � o .�,� � • jgVC; � D7jF,� � � ��Cr'Le �0 P p 9jj S. staff or foraV n p0mr ` r ddev th
eze
P tanks o _. _ . large dose usin an
nd tons i n r m as � vxceas ������ �: �Y�� �e MJ JF d l$Ma ed t the a0F sb sO rPu0n in � 1 t� �
d[saver s effluent and damage to the WzAem. To avoids �i.on havo the
Dyed oad that may 4 Alt E e � or scirfac• �• eraio (Pmpar) p� or n power purrs p a PU ber�
rr n of i pump n m-� � �� � ,� ��. � a �
s.19m ter' up :sJ�z 11 riot car when 0j! co ndi L. � 1� r -fr=e, .. tiha i nf6 j V s�_"'fd r
ID
;�[�yj {!.1,� � r ��a�� ��f�r �! r�hsorp�+�n1i S�'tjylm.+-.� +�0 not d� or parl� over, or
Sr^ 1�IY+ 1! T!■. Y � T�I�J fL, e�/'r� a-L-gi de ill Yi sorp 1YJ h area. M
area ���. � � ��slope
.he ,,i ovyinr M try E ti 1, 5 r LprL Te [ � IMP" e p � a n and prolong e life of tie treatment
sst
twrpt
tanks
coil a
Y+y i [CeBIJC7�7r d J •y1��.+►rfo �drain
(s rnID P Pl'cj-ar eI fcrAL rid Wabla
[nos. b6ne ' # wafter soften
r duc-isap}dns, solvens,P an
scraps,, madl ons, 1t, P ABANDONMEW
VV h ri the P WTfgs an OT j pa enemy . , 1
and safes abandoned ,n c eeea1ecL
- � ���sl �� dc��n� and the hand�P0`
AN 'Ping tc t �l�iS. p and 0thw salt 0 jOn GYM
� The��+� pil �f all and �i��
��! �� r��2r1d ppd of a Sentiage ��e� ��t s�, -
.. l be o and r� ► n O��0,C1 0� "h i r vn" Mnl and a lap�
Attar puni ping, all tan � �
gravel i;r anger jr1eat solid t'nEt.teri1.
�� �' oafs and 11fiur- ba re'p �� . 61v
i _ z �� L-� i`�VjE 2 for 1� is ;d'On �"°
� �� �� it ����� �+� 1
-tlorl a)
esult in the need
a l a e :should be p row try to rGP1 +� tale Tait" In
R n �+ �Lj �r�, lie� Eire n 1
'� area. ! = eFt "a m
now soil and. s e i�, i ; �0 ;.aNish a SUItaale ra id
f fect at the tim5 of ;Moir P n i5sr r Gt_ 'nfta 1o:Ig_ ff tic ab c'rl sy�i"Pt
{ � rt yor f
r
�� i �r tl'�';r
-eti a biliw: d any n y� . upon r0u of th r, PO o d t Bar, i u 11r,r� :-�w Teak n Ir]E iau
� 0 tO ill9 rof')')eel' ey � i I. p-1it l 1.9 no rop12C'EMgrit Brame
mu be p rmed t late suitable I k
lrerpfivp
be rac0ng4f� tee 'in Riau
Eirtd t- d a � s01 b � i a! �ri ire L that ern e.
rt���n��-,-•LLB �m
_ _ . �.. o * e -F-L LJDF TAj pojjFcUO3TAGNACSF0Sm4
ES O C
WAR I �. {r��4 � JT L 1I .� • - } w,y Syr. � �L"i 1 ..sj` N ,,yy rAY
AMY *TAW
pO INSTALLFR
a N;m,rn
L 0 4-3PA L REG UL.A: -LC RY A LfTHQ RITY
tTt Zdi
Nam e _
� �I'y ... '� jjpp jr{� +' Q ��s' 11 °? !flor
[�d�l�l'i PO � C�� top � �� with �?
6 hit dd8u T e[A MA-9 4J�4J `J the s of, �.�• � � �M�L .+�.A4.r1 y 6w ettJ land � 1 �,
COMM ' i, i; d 1 w t WIpD 3:"�L�Fn r [4jiTMi t4� o
I
-VOTAL. DYNAMIC HEAD
00 MEIERS
4-t-
Ar- m
FEU
WIP L 1,
co
% - - w - ,% I , V"" �::,t "' "o "
W���
Sr CRO L J NT'Y SANITARY SYSTEM File":
Office use only
OWNERSHIP/ADDRESS FORM Created 212021
Community Developrrent Department will utill7e this information to provide the property owner with
[nformatioti regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to pratect public health, your well, groundwater,
surface water, property vakies, and county resources. Once approved, this completed form and educational
I
infori-nation will be sent to you by email. If YOU WOUld like to view your ISSLied sanitary pern-iit online, you can
do so by using the Property Files Scanned eblink.
Owner/Buyer
Flailing Address
City/State/Zip
Phone Number (required)
Email Address (required)
Parcel Identification Number
(found nn the F.-)roperty tax bill)
OWNER/BUYER INFORMATION
Ile,
!? 0t --
V - 0% ;r Vor" Cr I
7< V:,200 44r.-L
0e. C t 11 e - W1
261 l7--bq — 02 — IbO
NEW SYSTEM: LEGAL DESCRIPTION
'i ' C ITY
Property Location 114 114 , Sec. T N R k W, Ti�wm of Al +
SLI[DdIVIS1011 Plat. r Lot #
Certified Survey Map# VOILIme Page # z 0
Warranty Deed #, (before 2006)VYalu rne Page
q
Nlwiiber of bedrooms Spec house 0 ye-sU no Lot lities 1deritiflaEMI e 0 yes [3 no
OFFICE USE ONLY
New Property Address
(Verification of new address required from COMMUnity Nivelopment Department for new con5tmc't1nn,)
J
il,-, -. <-i f H r.,I ifrt�
This form must be stibmitted wit)) (M Pt-iV(7te Ot75ite Woter Treatment System (POWTS) applications.
Naw System: Include with this forxi a recorded "for?-otaty deed fi-oin the Registet- of Deeds Office oriel COPyof the certified
survey rnap if reference is iiiode in the worrotity deed.
Cc,inrrunity Development. Del:-',,artti�ew - Laiid Use Division
715-386-4680 St. Crary Couffly Gnverrwiont ('etiter 715-245-4250 Fax
cdd@sccwi.gov 1101 Cartiilchaell Road, Hudson, Wl 54016 WW LV. S CC
0
State Bar of Wisconsin Form 2-2003
WARRANTY DEED
Doclimult Nurr"her Docunicnt Name
`I'HIS DEED, inade between Robert M. Volkert and Maxine Valkert, husband and
W&
( , . (irantor," vvl-iethcr one or niore),
acid S p r i n LF Poi n t P ro i e c t ;i Minrles VU ta rion— profit c2KMra tiOn
(Ll(J,f' 1AR -liether one or 1110rc),
aTI t CC �x
Grantor. for a valuable consideration. conveys and warrants to Grantee the followire' L,.
described real estate, togethcr with the rents, profits, fiat-ures and other appurtcn,!w
interesi,;, Iiii St. Croix Courity, State of Wisconsin ("Property") if more space
need,d, Please au-,,.ch sic demdum)-
That part tif S�VI/4SEI/4 Sec. 24-T31N-RISW described as follows: Lot I of
Cc r t i fied S u rvev Ma v re- c (i rded in Vol. 2 0 () f Certified Su rvey Maps, page 5120 as
Doc. Ni). 9 1 330'L St. ("roix ('ounty, Wiscf onsin.
KATHLEEN Ii. WALSH
RE61STER OF DEEDS
ST. CROIx Co. P WT
RECEIVED FOR REORD
04/17/2006 03:05pK
WARRANTY DEED
E X Eilf T #
REC � `EE -.
TRANS FEE:
COPY FEE:
Rteording A" FEE:
Estreen & Ogland uJ
�L) 304 LOCust Street
Hudson, W1 54016
038-1099-95-000
Parecl ldrnnfification Number 011N)
This is nor homestead property.
(is) (is not)
E xceptions to %varrantics: Easem en ts, rest rictions and righ is -of -way of reco rd, 1 f any, 4
Dated
A 07 el
(SEA I SEAL)
*Robert M. Volkert
(SEAL) I Y AL
Maxine V( AlCrt
A (,.A'H ENT] CATION
Signature(s) R0.1)ert NII...-Volkert and Maxine Voike
husband anti �Nrife_
authenticated TI -1 7
*Krisfina Ogland
TITLE., MEMBER STA T' AlROF WISCONSFN
if not,
auttiorized by Wis. Stat. § 706,06)
STAT F OF'
COUNTY
Personaly came before me on
the above -named
W Me 1%-'.T10\Vn to be the person(s) who executed the foregoing
instTument and acknowledged the sarne.
Alti-grivy Kristlii;i Ogdand Notary Public, State of
Midi.,on, 1 54016 My Commission (is perm aTl t` T1 t C X P i Te S
r71,jY h(- 1)1- Acknowledged, R0111 Aft' 11111
N 011', I'l I I S I S A N'l %' 1).\[fl) I. ORNL -AN Y \101)JY1('\T10,N'S TO THIS FORM S1101 1.1) BF 14X RiA LL)[-..'.N HHED.
�N %RRAN"U11 DELI) il' 2003 NTA-1 f.' HAR (IF WISC"ONSIN 1 4 )RNI NO. 2-2003
hllow INFO -PI 0114 Legal Forms 800.655-2021 11,,�profofms.com
Wisr,onsin DeparVpent of Safety and Profl6ssfarlal Services Page of
D ivision of I ndustrServices
OC T 2 6 20,23 SOIL EVALUATION REPORT 2W23 — 311
1 Iji accordance with SIBS 386, Wis. Adry
n- Code CountT
Attach corn p] t site p 1&f, on pa pe r not Tess than 1/2 x 11 inches in size. Plan must includer
i
bait not I im j t a d tio: Vort I rM a nd h cri zonta I �Qferenc point (113%1), c!irec�ian and percent slope, Parcel I-D,
fo�distance 1-3
scale or dimensions, north arrow, and tance (a riearest road.
Please print all information. Revi wed by Date
Personal information Lou 2rovide m2y_Le used for secondary purposes (PvacLaw, s. 15.04(1)(m)). 10/36 /2()23
Property Owner Property Location
S Pq G 10
Property Owner's Mailing Address Lot # Block 4 ubd. Name or CSM#
T l4 T LI
C'I+Y State Zip Code Phone Number city 0 Village Town Nearest Rced
Zoo e
C C 1rjStr(jr,t7Cj
rived design flow rate PLC
New Use: [I residential/ Number of bedroarns Code de
ReplacerTieT,i-., Ej Public or c-ommercial - Descr;be,
Parent materia I Flood Plan elevation if applicable
Goneral comments and
D Boriing
BSri ng # pjt Ground surface el'ev,q7. ft. Depth to limiting factor In.
Sail Aonfication Rate
HCHzen
Depth
In.
Dominant Color
Munsell
Piedox Description
Qu. Az. Cant. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary Roots
GPD/Ft 2
*Eff#1 E ffilt, 2
4-2
17
7,� yeA
ward—
C&+ `�'��o
Boring 4
0 Boring � 60 ;�-
ER pit Ground surface elev. Depth to limiting farW ?h.
Sol] Appl�ccatjon Rate
GPD/Ft 2
Horizon
1')Pp1h
1 n.
Daminan-1, Color
mu resell
Redo x Description
Qu. Az. Cont. Color
Texture
structuFe
Gr. Sz- Sh-
Consistence
I Boundary
Roots
*Etf#1
i'fi
9-
4Z 2-
40
AM%
71
4t.
4-,
zt2
MIMI 1W-.
CST NDrne (Please Print)
Sign
CST Number
Address
Date E u ion Conducted
17
Telephone Number
It
Boring #
r
❑ Boring
Pit Ground surface elegy
Depth to limiting factor . in.
p 9
.^nil Annliratinn Rate
Horizon
Depth
In.
Dominant Color Redox Description
Munsell Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
Eff#'i
Eff#2
42-
A t
Ohl/
C 05
2,
5o,,X2
7,
M
-//,P
1�,� V12 114
-1.4 0)
A-9 Z
r
t-- -0
ow
D�
Boring #
Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Anil Annlir-atinn RatA
Horizon
Depth
In,
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Fe
*Eff#1
*Eff#2
Boring #
❑ Boring
❑ pit Ground surface elev. ft.
Depth to limiting factor in.
Sni I Annlinatinn RatA i
Horizon
Depth Dominant Color
In. Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD1Ft2
*Eff#1
*Eff#2
* Effluent #1 = BQDO > 30 5 220 mg1L and TSS > 30 5 150 mg1L * Effluent #2 = BQDO > 30 E 220 mg1L and TSS > 30 5 150 mg1L
f
I ®®
X V E 1-� r) o:�#- p, w D H 0 Q I z,0)4 T Ar L----
a M j -ro p v F P LA--g M. jz, o s-r
DO,
4
Pci SCE'
a-
2(ol - k3oq --- Q) ?,
Q� t5 To' #t� aZ-23 y S
2pC�aT" N kJzo-
try 3&-F
�
F iKvkjw I I is A"ALAWMAWT ll==AM
S&O"Awl I
MP OF 3W WMAIR
EWVATM Or
J
4'-
LQ
Z
0
z
rl
NELL LOCATION MAP
MC -NI! WELL IN!STAL.LATION
PRO P10 S=., :,PRiNG POINT FADL i TY
NW Of COUNTY RGAO fS & 2M.P AVE NU
m
35
New Rp[�Hmcwo. wisr-ONSIN
—,-W,,0,bDns1n Depant �f Sakly and pnqj SeMce:s
DmWw of Induaft SeMom
SOIL EVALUATION REPORT
In accordance with S PS W5. Wis, Adm. Code
Attach complete sfte plan on pap-er mi less than 8 112 X 11 Inches in size. Plan mikst inalude
but not limited to: vertical and hay zontal reference point (13M). direnfiGn and pement 610pet
scale or dJmen sloes, north arrow, and kwa bore nd distance to rye res I road.
Please print all information.
Pp-mrinnJ i nrra b cr It A
Parcel I.D.
,*S.r
RevMWqd by Date
W I-, F I
he U�UU JUr SC!C n a Pug?Lses Pr1vaqvLLa
:s.15.G4(1MMA
Property Owner 1 110
Pruperty Loca#on
Govt. Lot < W 114
y4 T
N R r= (or) vv
Property Owner's Ma ilia YAddreSs
4 STC Q .5
L
Lot Block #
r --L—
S ubd. Name oCSM#
city State
Zip Code Phone Number
city 0 Vilia
D Town Nearest Road
orv,D J Z010
NewConction : Residenfimal I N u bar of bedroorrks Code defivW
struUsedesign flow rate
Replacement Public or =nmercial - Descabe- --Lfib
Parent nwWall Flood Plan elevation if applicable
General comments and recommendations:
Barging # Boting
Pit Ground suffaca elev.(; 7 ft.
GPD
ki
71 1�
Depth to lirnMng factor In,
Horizon
Depth
In.
Dominant Golor
untl
Below DescriMion
u. Az- Cont Color
Texture
strucwre
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Effoi *Eff#2
C�-
11-117
73 YA"
Baring #
Boring � l
Gmuoc? 8437
9 5,t �— r
(ppit nd surface elev. Depth to lim1fing f11 P.
SoflI[caban Data
Horizon
Depth
In,
Dominant Color
Munsell
Radix Description
Qu. Az- ConL Color
Texwro
Structure
Gr, Sz. Sh.
Co nsi stun ce
Bou.ndary
Roots
GPD/Fe
*EW
*Eff#2
Z7
PIN
zz
17-3
oat
EM, i;ervt #1
BOD. > 30 15 220
nWL and TS&I;* 30,m"
50 rn a/L
Effluent
#2 BOD. > 30
22-0 ma -AL -and
TS9 > 30�
150 rnn4-
Name (P"se Print)
S hffl
CST Number
Date Eyotue-fi_� on CmducQ
Address ll
Telephone Num6er
Boring
L1 13aring
Pit
GMund surface Olen
Depth to 11miflng tWor// L7iin.
Horizon Depth
In,
Dominant Color
Mun sell
Re DescAption
Qu. Az- Cant Color
1 TeAure StTucture
Consist fice
Soil APPI"flan Rate
-Boundayy Roots GPD/W
Gr. Sz. Sh-
do
41A
oAll
C.2
vl� 44,
0 Boring
[j Boring
0 Pit
Ground surface elev.
ft.
Depth to firniting factor in -
Boring # Ll Boring
0 Pit Ground surfix* We% � IL Depth to limiting factor
i c��_u n Rate
Horizon Depth Dorninant Color Redo x Desc-tipfog TextwTe Stnjc,.Iure Consistence Boundary Rocu GPD/Fe
Munsel[ fin, A,7. Cont. Co 11 lar Gr. Sz. Sh, %,Eff# *EfIQ
Effluent 42 BOD, > 30:5 220 rng/I and TSS > 30 150 m Uft,
Ment 41 F301) 30:�- 220 MgA- Wid TSS > 30!; 150 rngfL
L.
C"MJ
N114. CQ�NEH CERTIFIED SURVEY MAP
j
SFCTI4 C N 2 1
)c A LOCATED IN PART OF THE SW1/4 OF THE SE1/4 OF
c cca. v
IN m "Ov) 5 CURVE DATA TABLE
SECTION 24, T31 No Rl 8W, CITY OF: NEW RICHMOND, ST.
Ln NUMM
CR01X COUNTY WISCONSIN.
IS I FAD US 80 00 80 O'Cell
-
- 74
CFNT'�A_ ANGL.- 16518", r 3m 32 5' REOUESTED BY: OWNER SURVEYOR
0 1 - -
4. U-1 3 ..1-) 3 -T
x 6zi 64 N 56 r b 82 3 -5) W �06ERI'AN`L '-VVINF
ly
L T�2LAND SURVEYI%j 'IN,
w CH 0 R D I E -NIG7�i 8612' 370 200TH
0!
J�j NPA., R ic -1 C, �."J A� t14r'7 p
ARC _ENG'lrH 65', .0. BOX 14
tA IF
P&DERTS. Wl 022.
L
`n�l 1
NJ TANGE.NT IN N89`4732%
J a.. LO
LF!
11 TANNT OUT L_ , _ a _
I I I N24"09- 15`4 ifAvi
- - - - - - - - -- - - - - - >
N89047'32'W 625.97' N89D47'32W 625.97'
I Fig,
F
L:IJ%qlN j /ti
?47I V
Ry
F_
AJ 0 0
z s,
m j
LEGEND z
m
z
I I Tv
ALUM I NU M CO,.__, 0 Z
SECTION C M\ r�:- 0 u
0 0
0
NT KA, N D 0 0
ri
lo:
LOT 1 LOT 2
00 FE E�: L SURVEY MARKER LOT 3
C) 5 E F NOTE(�)SHE ET 3 No cor Ll
I'SE E NO F EOA SHEET 3 0'
SHE NOTE(DSHEE-tr 3 ':;' k
FOUND m cn z
K) rrC
4.58 ACRES EC' �,-W �j%Ni CD 1-4
-1 6 AC q L'-: S EY. C. R
O-D 190IN PIPE FOI leND f 9.533 ACRES EXC Hi, Ll. Ll 7
I 99IL29 SQ 1�7 cr (A (D
,76SO 2074m * m SO PT C > - *
0) V�
0 3/4' X 18' �RON R FBAR S F
WEIGHING OON
50 LBS, PER LINEAR
0 Z
-1 N d Z >
F7 _4 ct
CD bD —07
a)
EXISTING FENMINF 0 0
41
UW I DE UTI LITY liF N
T�
EASEMENT
%
(UNLE
7 r
S�Te
-3C �7R`N_l 14
x rlr
SMACK 1"-4' __4
30! C-RONT
'ENTERLINIF OP
ml
GRAVEL ROAD
............... ................. ...... 1TH '-INrr_- OF T,
.......... ...................
w........ 1 -.1; ..........
% i
L, ba
Z_ rj
.56 4
04 CORN� s _7b 7
r
5EC Tll ON 24 1�91
jpl TO
SB9 7:321
na
47-
U E
_S89547'32"E 1318.66
SCALE IN FEET 1 150' m - --�s �E c 0 � N::
THIS �'6 TR U YLiN T R-Ar 7E- 3Y SAM ADA�IS
JOB NO. Ok-b2 DATE 7- -------
150 0 150 L_ 5-r,$ R;,:--V 110-�l 05 SHEET 1 OF 3 SHEETS SFICTION �4
ST. CROIX COU,N-n, ZONING OFFICE
CE RT I F1 CAT I ON STATF)WN-r
FOR L`J'1t,1Z.---kT10N OF EXISTT'NCY- SEP-FIC TANK0%N
+ I I
ano
This is tc) Cle-rtlN that I have inspected the ex,lstincy septic or Ank
present1v srvffiz the following, residence:
41� it
(Street address) (,0 2eo cyoL- R 1( ocated
at: l�,4- f4 Section Wd%
6-
9
CF-47 Y T &� 0 ff;�� //of Q /0 kw 0 4 St. Croix Counn,- Wi.sconsin.
Upon, M'spection. I cert16- that I ha,Ve found the tank(s). to the best of mN1
knowl edze. w I I I con 10'rM to the requirem ents of SPS. 3 ) 94.2 d it (they)
app..ars) It,", be functionin!2 vroperlv.
Most r,--.-.wcent date of inspection or service 5' - Z .1
Did flow back occur from absorption system". Yes No
(if no, sip next line.)
Approximate volume or Z��
ienc.'ah of time: crallons rrun,utes
b� - I
Tank Capacitv:
w' Construction: Prefab Concrete X Steel
Manufacturer (if known) 1
Aoe of Tank- (if kno)Am):
Permit number if known)
'Licensed Plumt),-,r St�rnaru
(Print Name)
"'Z`z / Y 7 t
(Title) (LicenseNumber} '.NTP,W,,RS
1017s. 2 3 -
(Date,1
b)T liCeII)Sed PjLjjj-jL)er 'Depi of Sai'en, and Flrofessonal
F, o= to completed - 0. W I
Services C'napter -305 and s. 145.06. WISCOrlsin Starutes) or iicensed disposer
(-N-R I I 'Wisconsin AdministratiNie Code)
OFFICie
4SW0*WF..0.,F-4)[)C COUNTY
. .. ... .. . ....
.. ........ . .... ....
....... . ..
. . . . . . . . . .
.. . .....
. ................ ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
OWNER qp"t, ?&I&PR.cxteG�
PLUIVIBER►��rucs CILLe LIC.# 2214 41
� r i
CHAPTER 145.135 (2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
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 a
sanitary 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: 1f you wish to renew the permit, or transfer ownership of
the permit, lease contact the couu authority.
P � P ty ty
- DATE I'll;01w2t,23
&I I 'W T F 0
22 z r-j xx T V I
SS REN'" , W" , RE T'"A'- T%A
N T-j
T S RMI Xr"IRIES...... 5u L
. .. . .. ......... . . ...... ... ... ... . ...... . ... .. .............
..... .....
SBD-06499 (RI 1/20)