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HomeMy WebLinkAbout657105 026-1137-09-000Wisconsin 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)(m)]. Permit Holder's Name: Chris & Heather Ditzler City Village Township TOWN OF RICHMOND CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dos Aerat�i9n Holdi� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Ae raft aa HoIPIP19— PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift F ' tion Lo System Head TDH Ft Forcemain Length Dia. WrAMSgRPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 657105 State Plan ID No: Parcel Tax No: 026-1137-09-000 Section/Town/Range/Map No: 21.30.18.965 STATION BS HI FS ELEV. Benchmar 6 a C&ve- • 03�3l p /, ! b Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet 2 I r Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade a •53 boo, �8'' St Cover o U Art� i �' Z°I °j/� .02 r BED/TRENCH Width 2 ✓ Length No. Tyches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ! I fv SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: 1 -`. 1 1 CHAMBER OR UNIT Model Number: l SV1'r sns ' o na Q. f Q'...t ck`{ DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacin Vent to Air Intake q I �� Length 1 Dia Pi e s Length Dia Spacing ti SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems 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: 1496 111 TH ST 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover =�� Plan revision Required? ❑ Yes Y No T �/ Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #1: 7 �25ZD,2� Inspection #2: c �7/ 24) � Insepctor's Signature Cent. No. ""''`r RECEIVED ti= Department of Safety county St. Croix ` 02/28/2024 & Professional Services, SAN-2024-041 Sanitary Permit Number (to be filled in by Co.) r f Paid via Ascent Industry Services Division o 7 Sanitary Permit Application State Transaction Number hi accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Na Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Scats. I. Application Information - Please Print All Information Property Owner's Name Parcel # Chris & Heather Ditzler 026-1137-09-000 Property Owner's Mailing Address Property Location 1496 111" St. Govt. Lot City, State Zip Code Phone Number New Richmond, WI 54016 (651) 587-5924 NW 1A NW 1A, section 21 T 30 N R 19 W II. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms 3 bedroom 09 Subdivision Name Golf View Estates Block # ❑ Public/Commercial-Describe Use Na ❑ City of ❑ State Owned -Describe Use ❑ Village of CSM Number X Na ® Town of Richmond III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.) A. ❑ New System y � Replacement System U Other Modification to Existing System (explain) U Additional Pretreatment Unit (explain) B. U Holding Tank In -Ground U At -Grade U Mound U Individual Site Design g (explain) U Other Type ( T e ex lain (conventional) C. El Renewal Before ❑Revision L ui n��ee U Transfer to New Owner List Previous Permit Number and Date Issued Expiration Z &,.q 2 3'x 6.' _+wutaS. 420337 issued 8/20/2002 IV. Dis ersal/Treatment Area and Tank Information: Y Infiltrator Quick 4 Standard Plus chambers & 1 pair end ca s, Pol Lok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450.00 gpd. 0.7 gpd./sq. ft. 642.86 sq. ft. 654.40 sq. ft. 94.50" Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units 2 o � � New Tanks Existing Tanks Q 6 b � U Septic or Holding Tank NA 1,000 1,000 1 Weeks Concrete X Dosing Chamber V. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number James K. Thompson /� MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code) 340 Paulsen Lake Lane, Osceola, WI 54020 VI. County/Department Use Only �Q Approved lsap Permit Fee Date Issued Issuing Agent Signature Given R $ 5_�— 3/�[ 202 Lf caner or Conditions of6ppfoval SYSTEM OWNER: q Valve Q40-&,019 u,jz 02e Q4 SIJ��,,,^w 44ra pkr, od2 o %'rnt 1. Septic tank, effluent finer and dispersal call must be serviced / maintained as per management play: rrovidod by plumber. 2. All setback requirements must be maintained as per applicable Gode / ordinances, Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 03/22) }A /41"13 r c O py �n reC�'cr ��� Slope �-iiraccc� Sy$iC..-, ar�q. Tc..ao (2�fi'c�c�e� ee f 3 xG�' • �•rf: � tr-a.Li� � rt Baer �4iwrS xn � � Aeovri �s•.,p.,ZA•o/ /oz. �r+y�OSLcrrJa"v ESil1r7 &Iicf. nwiee l T ae .r m +4e% e-*Oe Ela cl /Da i(o d s� +Qepdrt cd�,prrt�d I` ^ rx.76' 15,/ gA� 3 b�dratlny qQ rarc `,7 +'f�venc4 Gr d II 0 r Xe.�Cf ne' well 4r j i► r 5 z' F�]N e04Q lee,& 7 r1 r of v'r] A)�f; �, c t'x),rk, tuOlQ7 3i. C�iXCvtiuJf, Prdpa scrl a�r3psrx✓ e��r. 5&,r ftCe cut-je. SXel rlr� .�r'cct SAN-2024-041 Conventional POWTS Index & Title Sheet Project Name: Ditlzer 3 Bedroom Replacement Conventional Dispersal Cell Owners Name: Chris & Heather Ditzler Owner's address: 1496 111th St., New Richmond, WI 54016 Site address: Same Project Location: Subdivision: Lot 09, Plat of Golf View Acres Legal Description: NW 1/4 NW 1/4, Sec. 21, T.30N., R. 18W., Tn. ofRichmond, St. Croix Co., WI. Parcel ID #: 026-1137-09-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calculations Page 4 Dispersal Cell Cross Section Page 5 Infiltrator "Q-4" Chamber Specifications Page 6 Conventional POWTS Management Plan Page 7 Existing Septic Tank Certification Page 8 Sanitary System Ownership & Address Form Page 9 Parcel Map page 10 Warranty Deed Attached: Soil Evaluation Report Mater Plumber Restricted Service: Jim Thompson, DSPS Credential #30021 Signature: x /fZB /7i Date: February 12, 2024 Page 1 Of 10 Design pursuant to In -Ground Soil Absorption Component Manual for POWTS, version 2.1 SBD-10705-P (N.01/01) .4� Slope t-krocc�4 ,5XS4-e .-, arecq. Tc.�.ao (2�fi'a�c�e� ee f 3 xG�' • �•rf: � tr-a.Li� � rt Baer �4iwrS xn � � YlCy�3LCrF�i'v ESilJr7 5.-r man ,4 c/r tL4 ve*' pcjJ = aSpRr ,M1�Lc�T..f ..Ln3�rd[G�vn ,Qepd�t cd�,prrt�d ^ rx.76' 15,/ gA� 3 b�dratlny qQ rarc `,7 +'f�venc4 Gr d II s� f� Xe.�Cf ne' well 7 IAr of v'r] Al;�f;3Urt. �, c t'x),r k, t 01Q7 .3i. d,-0i,N&ti uaf, l� {�E,', ry z.n rvcrrx Prdpa scrl a�r3psrx✓ e��r. 5&,r ftCe cut-je. SXel rrr� .�r'cct SAN-2024-041 Ditzler 3 Bedroom Dispersal Cell Sizing Calculations 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7gpd/sq. ft. 3. Absorption area required: 642.86 sq. ft. 4. Absorption area as proposed: 654.40 sq. ft. (32 chambers + 2 pair end caps) Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 7.20 sq.ft, EISA/pair 642.86 sq. ft.- (7.2 x 2)/20.00 = 31.72 chambers required Number of trenches: 2 n 16 chambers per trench (32 chambers total) Trench width: 2.83' Trench length: 67.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 12'x 67' Pg. 3 of 10 SAN-2024-041 IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down -sizing credit) SOIL COVER Highest Trench - System Elevations = 94.00 ft; 11 , r min. 12" (typical) TYPICAL TRENCH 12" CROSS SECTION VIEW min. ch (No Scale) depthpth Z7% (typical) a o v 34 a " � e (typical) a Provide minimum 3 ft Lowest Trench (as applicable) separation between trenches. 94.00 ft; ft; ft; ft Quick4 Standard-W w/ End Cap Observation Pipe (typical) (Show location of inlet / outlet pipe connection on plan view.) (typical) TYPICAL TRENCH Install per manufacturer's instructions. PLAN VIEW (No Scale) I� = A 3A ft __________®—®®® — — — —I (typical) B = 67 ft — (typical) Quick4 Standard-W Chamber ill PER TRENCH: (typical) (mfd by Infiltrator Systems, Inc.) coINSTALL 16 Quick4 Std-W @ 20 ff EISA/chamber = 320 Install pursuant to manufacturer's instructions. ftz O TI + 2 Pairs of end caps @ 6 ftz EISA/pair = 7.20 ftz 01 = Proposed EISA per trench = 327.20 ftz Required Infiltration Area = 642.86 ftz Distribution Method: x 2 trenches = Proposed Total EISA = 654.40 ftz branched manifold 0 n RESET Quick4 Plus Standard Chamber 12" 34" Quick4 Plus All -in -One 12 Endcap FRONT VIEW Quick4 Plus All -in -One Periscope INFILTRATOR® water technologies QUICK4 PLUS Al i _mi_ONE PERISCOPE i0 SA 1!W PL1/S ru CHAMBER SYSTEMS — I w 74.-... ii . .. .. .. .. .. .. .. .. PRESSURIZED PIPE DRILL NTIONS 48" EFFECTIVE LENGTH 18" n 8" INVERT SIDE VIEW INFILTRATOR WATER TECHNOLOGIES, LLC (`INFILTRATOR") Infiltrator Water Technologies, LLC STANDARD LIMITED Drainfield WARRANTY (a) The structural integrity of each chamber, endcap, EZflow expanded polystyrene and/or other accessory manufactured by Infiltrator ("Units"), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original pur- chaser ("Holder") against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installa- tion of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/ or installation of the Units. (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the instal- lation instructions; failure to maintain the minimum ground covers set forth in the installation instruc- 5 91, tions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No 4 Business Park Road warranty applies to any party other than the original Holder. The above represents the Standard P.O. Box 768 Old Saybrook, CT 06475 Limited Warranty offered by Infiltrator. A limited number of states and counties have different war- 860-577-7000 • Fax 860-577-7001 ranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in 1-800-221-4436 Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and www.infiltratorwater.com should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, MicroLeaching, PolyTuff, ChamberSpacer, Multi Port, PosiLock, QuickCut, QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra -Rib is a trademark of IPEX Inc. © 2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in U.S.A. Pg. 5 of 10 PLUS05 0816 SAN-2024-041 Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715) 386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be < 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October -March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 8 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old dispersal cell at 4 year anniversary of new system installation. Old dispersal cell to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Contingency Plan If any POWTS component becomes defective, the component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by alternating the diversion valve between dispersal cells to bring the system into proper operating condition. If alternating cells does not result in a properly operating system, a new dispersal cell will be installed. Pg. 6 of 10 SAN-2024-041 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1496 111th St., New Richmond, WI 54016 located at: NW 1/4, NW 1/4, Section 21 , Town 30 N, Range 18 W, Town of Richmond , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 2/01/24 Did flow back occur from absorption system? (if no, skip next line.) Approximate volume or length of time: Na Tank Capacity: 1,000 Construction: Prefab Concrete X Steel Manufacturer (if known): Weeks Concrete Age of Tank (if known): 21.5 yrs. - ijnstalled 10/02/02 Permit number (if known) 420337 (Li used Plumber Signature) MPRS Yes No X gallons Na Other James K. Thompson (Print Name) DSPD Credential #30021 minutes (Title) (License Number) MP/MPRS February 7, 2024 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Pg. 7of10 SAN-2024-041 ST. CRo IUNTY SANITARY SYSTEM File#: Office Use Only -206 OWNERSHIP/ADDRESS FORM Created212021 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. Owner/Buyer Mailing Address City/State/Zip _ OWNER/BUYER INFORMATION Chris & Heather Ditzler 1496 111 th St New Richmond, WI 54016 Phone Number (required) Email Address (requi (651) 587-5924 Heather. Ditzler@Yahoo.Com Parcel Identification Number 026-1137-09-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW t/4 , NW t/4 , Sec. 21 , T 30 N R 18 W, Town of Richmond Subdivision Plat: Golf View Estates , Lot # 09 Certified Survey Map # Na Volume Na Page # Na Warranty Deed # Number of bedrooms 3 New Property Address (Staff Initials) (before 2006)Volume , Page # Spec house 0 yes o no Lot lines identifiable o yes 0 no OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) (Date) 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 Office 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 cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www. sccwi. Pg. 8of10 m O N 00 O W OD 1 � 01) 00 z r az a� a c i C 0 a r 1 0 ci r� A o --50f —50f ��-�r1o0y Z 1 11-1 i 217.22' 440. 72" 217.00' I 217.00' 87,938 sq.ft. 2.02 acres 18 87,580 sq.ft. 2.01 acres I I i 90,218 sq.ft. 2.07 acres S.AN-2024-041 427 5 87,137 2.00 a 6 2.05 acre C3. 610 G11— ~C12o ►7 cr3— _ r -A 1 100,724 sq.ft. ` n- 0 'Sp 2.31 acres CG CJ % , CO comer r aW In, N h ,tlon 21 �` \� C fig"^ �00.1 �t7�� �j,of �65—��60, �+3 F cP SF `'' I \ �i1r 0y f %.6 $rd� � `v Oe 0^ F r, o �' � �4 .v •rP_ C 4- 11 87,231 sq 2-00 acr. S03902'55 329.45' West line of the NW 1 /4 of Sec. 21 N00°54'45"W 1 --- East line of 1 NE 1 /4 of Sec 12 195,555 sq.ft. 2.19 acres 1j Pg. 9 of 10 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 QUIT CLAIM DEED Heather Jo Ditzler f/k/a Heathecl+.-Myckleby, a married person quit claims to Heather Jo Ditzler and Christopher Jason Ditzler, husband and wife survivorship marital property the following described real estate in St. Croix County, State of Wisconsin: Lot 9, Plat of Golfview Acres in the Town of Richmond, St. Croix County, Wisconsin. NOTE: This conveyance is being done to add the non -titled spouse to title. This is homestead property. (is)(is not) Dated this 5th day of November, 2020 (SEAL) * Heather Jo Ditzler a Heath 01. Myckleby (SEAL) AUTHENTICATION Signature(s authenticated this November 5, 2020 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Robert Loberg, Loberg Law Office, LLP, 359 W. Main St., Ellsworth, WI 54011 AW/ 20-S23124 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures. 1116420 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 11/13/2020 12:18 PM EXEMPT#: 8M REC FEE 30.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 Tax Parcel No: 026-1137-09-000 .< �EAi�j SA -W, SC (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN OUNTY OF IST. CROIX I I ss. Personally came before me this 5th day of November, 2020, the above named Heather Jo Ditzler f/k/a Heather H. Myckleby, a married person to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public St. Croix County, Wis. My Commission is permanent. (If not, state expiration date: C) I.6&•ana_-�_ QUIT CLAIM DEED St. Croix County 1116420 Page 1 of 1 FORM NO. 3-1982 Pg. 10 of 10 Wpscor>sirl Departrnent of commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County SL ( Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point ABM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and,1oca8on and distance to nearest road. Please print all in rhtrnt on- Reviewed by Personal information you provide may be used for s.t1�ry pu Law. s-.15�4 (1) (in)). r r, .. Property Owner __` "' `:' ` Pro Location t NLQt,# .. t Nw 114111W 1 /4 S Z / T p, �; � . Property Owner's Mailing Address 1 Block # Subd. Name or CSM# sT cr.r�lx., C-,01(:V iew o Lax !0(o N^/ Page of 5 Date N R /Q' E State Zip NuFfjG ❑ Village [Town Nearest Road city1 (Cowl 0- S�- ® New Construction Use: ® Residential / Number of bedio'o'R11;" - Code derived design flow rate 4 5� CoO� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material v -few a S. Flood Plain elevation if applicable l� ft. General comments sy �--j-e V. 4G • 3 0 and recommendations: 4 �� , e(.e 0. ?6" 30 FilBoring # U Boring ® Pit Ground surface elev. 9q: $ 0ft Depth to limiting factor 1 I in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/f? •Eff#1 'Eff#2 l U-IZ IU 3 Z -- 5�� k 3 3Z-113 t rgIt, IN.s0 9� F-21Boring # Boring FYI cif Ground surface elev. Qri G ft Depth to limiting factor Co in. S„il Annlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/f? 'Eff#1 •Eff#2 I 2 0-12. iZ -34 IU 31Z in y Iq SO s. ► rn'(- C5 iv� Effluent #1 = BODS > 30 < 220 mg/L and Ttib >J7 < 75u mgfL = „yam CST Name (Please Prim) Signature CST Number Ardour SchurY.oker � �` Z533cA Address Date Evaluation Conducted Telephone Number 2113 80'*-` S�• Somersc �.►I 5�-io2� ."S--9'-0/ 015)2`11-A46o% Property Owner N e 150r 1 Parcel ID # F 3] Boring # ❑ Boring ❑DC Pit Ground surface elev. q9 sd R Depth to limiting factor I 15 in. Page 2 of 3 Soil Annlimfion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 1 '042 C5 l vc 8 2 ► Z- Z( S i tm-Gr c S - -2tq 0 1:1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aonlication Rate Redox Description Qu. Sz. Cont Color ❑ Ong Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Aonlication Rate Qu. Sz. Cont Color • Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg1L and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. san-M30 OL07i00> Y PAGE 3 OF3 NAME /U e ISO^ LOT# 9 LEGAL DESCRIPTIONA/a '/*W `/. S Z(T3o N,R,% E (orr-w) SCALE: 1 '= -� BM 1 ELEVATION /00 -O BM I DESCRIPTION -C z ,00c A,' D e BM 2 ELEVATION /00 • U BM 2 DESCRIPTION-4,,��00r P-' SYSTEM ELEVATION 9(0- 30 ALTERNATE ELEVATION 9l0 � 3C� CONTOUR ELEVATION •Vo S/cam ,Va S1049C SmZ Wpscor>sirl Departrnent of commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County SL ( Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point ABM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and,1oca8on and distance to nearest road. Please print all in rhtrnt on- Reviewed by Personal information you provide may be used for s.t1�ry pu Law. s-.15�4 (1) (in)). r r, .. Property Owner __` "' `:' ` Pro Location t NLQt,# .. t Nw 114111W 1 /4 S Z / T p, �; � . Property Owner's Mailing Address 1 Block # Subd. Name or CSM# sT cr.r�lx., C-,01(:V iew o Lax !0(o N^/ Page of 5 Date N R /,c E State Zip NuFfjG ❑ Village [Town Nearest Road city1 (Cowl 0- S�- ® New Construction Use: ® Residential / Number of bedio'o'R11;" - Code derived design flow rate 4 5� CoO� GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material v -few a S. Flood Plain elevation if applicable l� ft. General comments sy V. 4G • 3 0 and recommendations: 4 �� , e(.e 0. ?6" 30 FilBoring # U Boring ® Pit Ground surface elev. 9q: $ 0ft Depth to limiting factor 1 I in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/f? •Eff#1 'Eff#2 l U-IZ IU 3 Z -- 5i� k c Ivy 5 8 3 3Z-113 t r'Lill' Z-81 le F-21Boring # Boring FYI cif Ground surface elev. Qri G ft Depth to limiting factor Co in. Rnil Annlication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/f? 'Eff#1 •Eff#2 I 0-12. IU 31Z SO rn'(- C v 5 Z iZ-34 in q Iq S; ► 2 �s - 3 Effluent #1 = BODS > 30 < 220 mg/L and Ttib >J7 < 75u mgrL c11SuCIn s c - """S = „yam a. w. , _ __ ...= _ CST Name (Please Prim) Signature CST Number Ardour SchurY.oker��` Z533ca Address Date Evaluation Corxiucted Telephone Number 2113 .-S-- 9'-0/ SAN-2024-04,1 Property Owner N e 150r 1 Parcel 1D # F 3] Boring # ❑ Boring ❑DC Pit Ground surface elev. q9 sd R Depth to limiting factor I 15 in. Page 2 of 3 Soil Annlimfion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fF 'Eff#1 '042 Z C5 l vc 5 8 3 -IIs- y �-- m5 Ds m i _ - -1 1 2 S`f cio 1:1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aonlication Rate Redox Description Qu. Sz. Cont Color ❑ Ong Boring # Ground surface elev. ft. Depth to limiting factor in. El pit Soil Aonlication Rate Qu. Sz. Cont Color • Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg1L and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. san-M30 OL07i00> Y y101Pill zI[or,II PAGE 3 OF_ NAME /U e ISO LOT# 9 LEGAL DESCRIPTION W '/*W `/. S Z(T34 N,R fA E (011 1 SCALE: 1 '= -� BM 1 ELEVATION /00 -O BM I DESCRIPTION -C z ,00c A,' D e BM 2 ELEVATION /00 • U BM 2 DESCRIPTION-4,,��00r P-' SYSTEM ELEVATION 9(0- 30 ALTERNATE ELEVATION 9l0 � 3C� CONTOUR ELEVATION •Vo S/cam ,Va S1049C SmZ 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)(m)]. Permit Holder's Name: City Village X Township P.C. Collova Builders, Inc. I Richmond Township CST BM Elev: Insp. BM Elev: BM Description: / / LP) 1 CO r • 4-0 7-/✓� TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL NO BLDG. Vent to Air Intake o�se d ROAD Septic > �� / / O y Dosing Aeration —� Holding PUMP/SIPHON INFORMATION Manufacturer errand GP Model Number T9111 i Friction Loss System Head TDH Ft Forcemain Leng Dia. Dist. to Well ELEVATION DATA County: St. Croix Sanitary Permit No: 420337 0 State Plan ID No: Parcel Tax No: 026-1137-09-000 STATION BS HI FS ELEV. Benchmark Alt. B 40,0 7 to Bldg. Sewer / -177-21 a St/Ht inlet 7 SVHt Outlet Dt Inlet Dt Bottom �— Head rMan. Dist. Pipe p 9 Bot. System E DI •3 Final Grade St Cover 2 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 31 / � � SETBACK SYSTEM TO [�/ P/ BLDG WELL LAKE/STREAM LEACHING Manu t r. / l L _Q Y INFORMATION Ty f System: a 7b 7 - / CHA UNIT OR Model Number: Y1-�'7 /7 r' DISTRIBUTION SYSTEM // livr..lio.✓s 41""_ts irk Ott 0' Header/Manifold y Distrib io Pipe(s)k I 'l'1 / l x Hole Size �— x Hole Spacing �� Vent to Air Intak C y, Length Dia Length Dia Spacing (— J 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 A Yes ICJ No ❑ Yes [0 No i bcr kll COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:L/ Z / 0 2- Inspection #2: / / Location: 1496 111th Street NewF Richmond, WI 54017 (NW 1/4 NW 1/4 21 T30N R18W) Golf View Acres Liot 9 Parcel No: 21.30.118..965 1.) Alt BM Description = �p,P 4 R' GUI /� �. S'ell � � ® �� 2.) Bldg sewer length = //O/ �ll �� - amount of cover = I Plan revision Required? Yes Use other side for additional information SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. r 611b� 7 Safety and Buildings DivisionY - IIa�oiis,n 201 W. Washington Ave., P.O. Box 7162 I'J •. Site Address Madison, WI 53707 - 7162 Department of Commerce 1C% Sanitary Permit Application Sanitary � - `r--I- �!O� -S in accord with Comm 83.21. Wis. Adm. Code, personal information you provide ❑ Check if Revision y Law, sl5. 1 m may be used for secondary purposes Privac I. kp-p-11cation Information - Please Print All Information State Plan I.D. Number Pmpeny Owner's Name. y i �^ C", C Parcel Number `ibS . 6 ia.-'.) �; �: ,,,��. ozb -�3�—a�'—t�ov • Owmes Mailing Address RECEIVED -j"Loma" l- �` , %; S T,/ N. E City, State zip Code PbNugpl}q;r rH� vv l7 1 4 2002ILW;a Block Number Fumber Name CSM Number ST. CROIX COUNT ZONING OFFICE 4,oj of Building (check all that apply) OCicy r 2 Family Dwelling - Number of Bedrooms [IV ❑ Public/Commemial - Describe Use ❑ State Owned 22)� Nearest 2 3� X 68:aS't 1 - KIZ III. Type of Permit: (Check only one boot on line A (mmhbering scheme for internal use). Complete line B if applicable) A. 1 New 2 0 Replacxa►ent system 3 ❑ Reis acement of I 6 0 Addition to For only use Tank Only Exisft System B. ❑ Check if Satiltacy Pemmt Previously Issued Permit Number Date Issued W. Type of Permit: (Check all that apply)(numbering scheme is for internal use)K —(� 44n Pressurized In -Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland 22 ❑ Pressurized In -Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line 45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recirculating 30 0 Other V. Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Hevation Final Glade Requited Proposed Rate(Gals_/Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Teaks Exisft Tanks Septic or Holding Tank _ fl Make Cibmba VIL Responsibility Statement- I, the , assume resIpondlillity for installation of the POWTS shown on the attached plans. is Name (Print) '� Plumber's cure MP/MPRS Number 22Z- � aU Business Phone N z' � >� �; Plumber's Address (Sleet, City, State, Z,ip /")"j t'J' UO VIII. /De ehht Use inky V,Approved ❑ Disapprmred Sanitary Permit Fee (Mucks Groundwater Date Lswed Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Z2 ��_20 Determination I%. Conditions of Appro for pproval �E `1Mks Xrj .�;S Syj �. s&�%r C 3-( - , �,�, Moat , D W4j cae�oaz- 'A 'a,.1' -{o Nw�QteoQ rMae d111tw ` , C. S AttachCONSPIeft pat" tau the C—ray only) for the ttyatem arpaper a oa acts man axis : aruca m uaa SAD-6399 (R_ 05/01) P OT PLAN PROJECT P.C. Collova Bldrs. Inc A DRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1 / 4 S 21 /T 30 / 18 W, TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/14/02 BEDROOM 3 CONVENTIONAL %00C IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION 1001 Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B.M. 2 SYSTEM ELEVATION I 'D Property Line Property Line Vent I >6„ Standard Infiltrator of Cover Leaching Chamber with 31.1 ft2 of Area Id 6' Long 12„ 20' Grade at System Elevation 0 34" Plans Designed Using Conventional Powts Vents Manual Version 2.0 0% Slope B-1 0' B-3 0.4 40' 2-3' x 69' Cells with >3' Spaci 40' 0' 20' T B-2 Pro 3 Bedroom Vents �^ House Couldesac S-r. No I)c 710 111 ' 1 HW-% ® _ , w--, 7- T dT 2 D rrat4w.' No.4E-710� PREVIOUS . 12,D 3S -7 t �X l -S rr2L49e�R 145.135 (2) WISCONSIN STATUTES P 1 / 'LIC.#—_;oo2-/ /YWIvb AND/OR 64E Vji5vJAe,- SUBDIVISION SBD-06499 (R11/20) (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: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. 31s�