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HomeMy WebLinkAbout026-1147-39-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538870 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Marek, Todd R. Richmond, Town of 026-1147-39-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /~►YI ► I 24.30.18.1097 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t CAPACITY STATION BS,_ HI FS ELEV. Septic y n, 3, 5 Benchmark Dosing Alt.Wq,1 3. Aepffffn Bldg. Sewer S ZS 6 Holding St/Ht Inlet 1.3Z- 1<3 St/Ht Outlet TANK SETBACK INFORMATION TANK TO E P/ly, WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 166 Dt Bottom Dosing / / ~ fDL 165 Header/Man. 3 103 6t - Aeration ✓ Dist. Pipe . . 1P 3. (P/a 3 .d-e Holding Bot. System 161•1 PUMP/SIPHON INFORMATION Final Grade Z, /O• d Manufacturer Demand St Cover GPM leo.~ Model Number TDH Lift Fricti06-21.5 Lo System Head TDH Ft ~S-26 15.11 Forcemain Length Dia. ► ► Dist. to well 1 Z Z 166 SOIL ABSORPTION SYSTEM or-5 BEDITRENCH Width / Length INo.g ~Trenc s PIT DIMENSIONS No. Of Pits Inside D' Liquid Depth DIMENSIONS d IL6 w4y ~ __1% SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type f ystem CHAMBER UNIT OR Model Number: G- 27 17 DISTRIBUTION SYSTEM E /1¢,,' I S Header/Manifold Distribution x Hole Si x Hole S cinp~ g Ve o Air Intake Length NN Dia~%-, Length 117, (P DiaSpacing '17, Lj SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only L~ Depth Over Depth over xx Depth of xx Seeded/Sodded xx M hed Bedrrrench Center Bed/Trench Edges Topsoil Yes ❑ No es ❑ No z_ ZC~ q- I I N- COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-16 / 31/ Inspection #2: Location: 1439 146th Ave New Richmond, 154017 (NE 11/4 NW 1/4 24 TAA30N R18W) Richmond Metado s Lot 39 Parcel o: 24.30.18.1097 1.) Alt BM Description = w 4 V Gz J eo~+ L 2.) Bldg sewer length = $o/ d a 61e-t, OJr-- L../ - amount of cover = 7 4. 5 b f-~ 4-1"I 11 36 Plan revision Required? ❑ Yes No Use other side for additional information. / V _ VJ SBD-6710 (R.3/97) Date Insepct s Sign a Cert. No. cope Safety and Buildings Divi 20, W. Washington Ave., P.O. 7 M s c ns n, / Madison, WI 53707-7162 Sant Permit Number (to be filled in by Co.) Department f Com S 3 UQ 7 KIT t, State Transaction Number S t*n i;r lication 2 p fl g~ In accordance with s. Comm. )1@t submission of this form to the appropriate governmental unit is required prior to obtpermit. Note: Application forms for state-owned POWTS are ProjectAddress(ifdifferentthanmailingaddress) submitted to the Departmenmmerce. Personal information you provide may be used for secondary / u purposes in accordance with the Privacy Law, s. 15.04(1 m , Slats. G`y( 1. Application Information - Please Print All [ Proper7021P er's Name Parcel # t---K- 2(0 -//f~~ - - o oa Property net's ailing Address roperty Location • p d 2 Z Gov/t. Lot City, State p Zip -Co, de Phone Number A) C y., /1J l.tf / Section )per,W 1 tU Y~~CCr/~MONJ~ ( T 3o ctrcleon V (,.i of N; R Eo II. Type of Building (check all that apply) Lot # ~r 2 Family Dwelling- Number of Bedrooms $ubdlvrsiollnName C Block # G IT~~~A4 D 'J-0 NC-4 6~J ❑ Public/Commercial - Describe Use 64~_ Gd ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of `~II ~y~_ 44- &r .,LS own of M OA- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 OWE I ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground 1K At-Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ P etreatment Device (explain) V. Dis ersaVrreat ent Area Information: Design Flow (gpd) Design oil Application Rate(gpds Dispersal ea Required (st) Dispersal Area Proposed (s System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units A D B °o New Tanks Existing Tanks / / y ❑ $r i~ 0.. U v~ v~ rn W 0 Septic or Holding Tank t 0. f Dosing Chamber vv!/ D'6 f t G~ VII. Responsibility Statement- 11,, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's Signature MPARRS Number Business Phone Number aq/ 2 71c5- Z Z ` Plu er's dress (Street, City, State, Zip Code) VIII. County/ eartment Use Onl Approved •sa Permit Fee Date Iss d Issuinatur 0n Reason or , nial $ IQ IX. Condi"N-KIA tweasons for Disapproval 3) 1. Septic tank, effluent fitter and J' 't V r_ dispersal cell must all be services I maintailted, iii kt ~s /1A.4„+t~ at; per management plan provided by plumber. 2.. Ak'sa at ttrequ#ernents must.be.maintained t i 'et - 1 0-i poc" - Z4 Atrac r w complete plans for the system ands mil to the Coun y only ,~.onn paper not less t an 12 x111 inches iin/s` L / SBD-6398 (R. 01/07) Valid thru 01/09 eme j& &4- town road 205' north lot line Todd Marek PO box 228 New Richmond, WI NE 1/4, NW 1/4, S 24, T 24 N, R18 W a~ Richmond Medows lot 39 Richmond Township o St Croix County 3 Weiser 1200/800 tank 3: 0o BM 2= 99.1' top of 1" pvc pipe m drive way BM 1= 100.0'top of 1" pvc pipe Scale 1 "=40' K---ao'o"-A a~ o Well garage house o 4 bedroom v ca a> 0o CO Q z a o0 a 0 7 B-1 102.0' 101.5' a 101.0' rn B- BM 1 2 O °B-3 BM 2 O Q N -°a C° Page 8 of 8 vART.4lF~ Safety and Buildings ~5~` Toy 3824 N CREEKSIDE LA 0 9~ HOLMEN WI 54636 3 S P Contact Through Relay S www.commerce.wi.gov/sb/ www,wisconsin.gov ~O ssIO14N Scott Walker, Governor Dave Ross, Secretary October 19, 2011 CUST ID No. 226497 ATTN.- POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/19/2013 Identification Numbers Transaction ID No. 2006876 SITE: Site ID No. 772850 Todd Marek Lot 39 Please refer to both identification numbers, 140TH Street above, in all correspondence with the agency. Town of Richmond St Croix County NE 1/4, NW 1/4, S24, T3 ON, R1 8W Lot: 39, Subdivision: Richmond Meadows FOR: Description: Four Bedroom At-grade System / 4% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1340050 Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ,<.y{ stats. ¢.n The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with;~+l C", the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which mU include local inspectors. ROGER D NELSON Page 2 10/19/2011 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 ~~W Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WISNIART code: 7633 jeny.swi-Tn@wisconsin.gov RECEIVEL OCT 0 3 2011 LPTY & BUILD"`. RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping site INDEX AND TITLE SHEET Project Marek lot 39 Owner Todd Marek Address PO Box 228 New Richmond, WI 54017 Legal Description NE 1/4, NW 1/4, S 24, T 30 N, R 18 W Township Richmond County St. Criox Subdivision Name Richmond Meadows Lot No. 39 Parcel ID Number 026-1147-39-000 Plan Transaction Number index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 , Specifications Page 5 Management & contingency plan Page 6 Pump curve & specifications Page 7 Plot plan Page 8 Designer Roger Nelson License Number MP226497 Signature JU Nk Phone Number 715-821-4444 Date 09/28/11 Designed pursuant to: S B D- t15 41 - P (N c- % G'T ) At-grade Component Manual for POWTS , and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distnibution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.0 (10/05) Page 1 of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow (gpd) 4.00 % Site slope 102.00 Contour elev. below lateral (ft) 38.00 Depth to limiting factor (in) 0.50 In-situ soil application rate (gpdW2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 120.00 Aggregate length (ft) Pressure Dtetribution Data Entry (c or e) a Center or end lateral connection 1 Number of laterals 0.12.5 Orifice diameter (in) e.g. 0.25 Not a final 2.00 Estimated orifice s calculation pacing (ft) 2.00 Forcemain diameter (in) 2.56 Forcemain flow velocity (ftJsec) 25.00 Forcemain length (ft) y or n Does forcemain drain back? 90.00 Pump tank elevation (ft) y or n Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 11.67 Vertical lift (ft) 4.1 Forcemain drainback (gal) 0.35 Friction loss (ft) 96.0 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 100.1 Minimum dose volume (gal) 18.52 Total dynamic head (ft) 25.1 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Devi n opftu Damon &oice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gatlin (enter result in cell G46) one lateral 1.5 in diameter 2 in x x Treatment Tank Information 3 in x 1200 Septic tank capacity (gal) Wieser Manufacturer Effluent Filter Information Dose Tank Information Po loc~ Filter manufacturer 800.0 Dose tank capacity (gal) PL 525 Filter model number 22.2 Dose tank volume (gal/in) Wiener Manufacturer Project: Marek lot 39 Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW D c116 8 Observation pipes (2 typical) D B 120.00 ft 1/6 B 20.00 ft C 12.00 ft W G D 5.00 ft E 2.00 ft D L 130.00 ft B W 22.00 ft A x B 1200.00 fM2 L Cap Typical off. pipe. = Total aggregate call A x B slotted in the lower 6", and anchored = Plowed area L x W rely. AT-GRADE CROSS SECTION Svnthetic fabric cover 103.83 ft Finished grade Lateral elevation invert elev. 102.50 ft Observation pipe at aggregate toe E Surface contour 4 % Slope 102.Eft C A and system elevation D ® =12 in. topsoil and subsoil Plowed layer over aggregate and tapered to toes. below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Marek lot 38 Transaction Number. Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - End Connection P Last hole dirified next to end cap if X Laterals & force man of PVC Sch 40 Holes drilled on the bottom of the lateral (per COMM Table 84.30-5) equally spaced ♦ =Turn-up rd(bsll+rahreor clesnoutplug Lateral SpecMcations 0.125 Orifice diameter (in) End Lateral connection point x 1.96 Orifice spacing (ft) 1 Number laterals 61 Offkx /iaterai P 117.60 Lateral length (ft) 25.1 Lat. discharge rate (gpm) 2.00 Lateral diameter (in) 2.00 Forcemain diameter (in) 25.1 Sys. discharge rate (gpm) 25.00 Fornemain Length (ft) 18.52 TDH (ft) Typical Pump Chamber Layout Approved manhole ever with Weether-proof warning fabei and locking device Final guide junction box 4" disconnect 'AL Tank ocmponent Allemate properly vented f` outlet location 18" min. Electrical as per NEC 300 and s Approved outlet Comm 16.28 WAC Tank fun jow c Inches Gallons JA Provide 1/4" a A 19.5 433.5 Alarm on weep hole or antisiphon B 2.0 44.4 C 4.5 100.1 Pump on B device. D D 10.0 222.0 90.8 It C Totals 36.0 800.0 Pump off D 3" ing under tank w 90.00 ft JGouMe Pump PE 41 Pump model number 01 h r~ Alarm model manufer number Project: Marek lot 39 Transaction Number: Page 4 of 8 At-grade System Maintenance and Operation Suecftadons Service Provider's Name Nelson Plumbing i Phone 715-821-4444 POWTS Regulators Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1200.0 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 years Effluent Filter Inspect and clean at least once every 3 ears Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound Inspect for pondi and seepage once eve 3 )tars Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downsiope toe will be protected from compaction. 7. Ati other construction details are as per the at-grade component manual Lateral Tum-up Detail Finished 000*0*0*00*0000 Grade Diameter Lawn 1-0 Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral ~y Long Sweep SO or Two 102.50 ft 45 Degree Bends Some Diameter as Lateral Project: Marek lot 39 Transaction Number: Page 5 of 8 L(VGOIJLDS PUMPS Submersible Effluent Pump PE MOTOR FEATtm Pump - General: General: a Corrosion resiswrt • 04doge:1'Am WT corlsbuction• • Tennper *v*: 104'F (WO • 60 Hertz a Cast an body. nla htn. coaftuaw when • 715 volts a Thermoplastic hpeller and y s,i • &*-in t+MWA oarload pro- rover. • Sdi& hardk q: to mn widr avhlmabc reset. ■ upper shave and Iowa • Cass 9 Waukdm heavy duty bat bearng • Auton ok "wdeb include a • OiwiNed design. Wf 6WUc M- APPMTM Moat svvhth. • Hier strength carbon steel ■ Motor is pemarlentfy Sped* designed for the • Manual MOWS available. shale lub(kAud for axtended folio Mng uses: ' Pnmpirg range: see Pal Motor servicelife. S performance &ait or onve. .33 HP, 3000 RPM a Powered for corers • WmnyDoslrg Systems PE31 PuaW • 12.0 MWRMRn amps operation. • low Prtswre Pipe Systems • Ma)dmum capadty: So GpM • Shaded pub design ■ AN rags are within the • lbliedmum head: 25 T+JH K41 Motor: waodring o1the rnota' • H" OW Sao ~A *n . ftrw 60 GPM ; 40 HP, 3400 RPM mo ertfl►ndard i. car d, XY sta ~ • head hw4 Mmdn n 2T MH • PSC door dutY 16/3 S)TW Pr with NEMA 5.1 SP, thrree prang. PEST Pump: PES! Mom 115 volt grounding plug. • AIM XhM opacity: 70 GPM • SON?, 3100 RPM a Car4ka unit is h" duty. • Mwdrrnm tread: 37' MH • 9.5 Mmdmw r amps • PSC design a Melinanial self is arbm% METERS Fm ceramic, iW and Uahrless 40 t~7YRN~~1~1i17- 35 10, lz 4::~Atz elm -.a-. 30 FT 4_1 t -:t 25 CO /~1'aasted to UL 778 ayW .J - - } - i•..»,-... ,.i..'... r. i CSA221108 ~ndu& i - { i-- - , }-4- o111dr llf~rgC It KO feOt M~rllwd tt .L.. ..i.. ..1... ,t..» ..1._ _ I_{ _.l..i $ }..y 4. 4- Ttj 00 10 2030 40 so 60 ` 70 GPM 80 Q~`r ~oT O 0 5 10 is nw Goulds a rips C PACRY 0 2002 GOUWS PPM ff%Cdw ITT Industries BK31141 town road 205' north lot line Todd Marek PO box 228 New Richmond, WI NE 1/4, NW 1/4, S 24, T 24 N, R18 W a~ Richmond Medows lot 39 Richmond Township o St Croix County 3 Weiser 1200/800 tank drive way BM 2= 99.1' top of 1" pvc pipe BM 1= 100.0' top of 1" pvc pipe Scale 1 "=40' ~ - ao' o°- - I a~ o Well garage house o 4 bedroom M N co CO t a~ o a z a Q 0 Nt B-1 102.0' d 101.5' 101.0' rn B-2 BM 1 O oB-3 O BM 2 0 0 (PI -°a m Page 8 of 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q' \ Mailing Address k6td V ~'C ~v L ~o Property Address ` t' tP (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number o?(a - ~ (7 --3 5 ©o a LEGAL DESCRIPTION AI(Z Property Location /j '/4 , W'/4 ,Sec., T _30 N R/. g W, Town of Subdivision (C ~ A4 d &)A /t4 6- 5 , Lot # . Certified Survey Map # cy ! , Volume , Page # Warranty Deed # Volume , Page # Spec house es no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 9A , qrm~' a)ft,- 1Q/a/-11-1 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application 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. 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C." r Ift •P Is.nnl DWxr n ewplsi Y W MwM DAIINICI fL4 tlfBNr SrBSYlNT IM how 0.0n'MxsonrlMWlrnM601' wwr.id«AMM.,IydYrrrWlndl.d.~«w"r.dW EM n'MM 704IMYt ° IM nr wy1.r+~•~rrd~wd,~ry«~r r.r. i. r w nd M ww r 1 31, fAOn tOUIn', n9f0Nnl Mjw w 2 A-DDd1 m wm-l Inlo IT Ah &0.0. pndw •nM Sr6egi tlw M xr.1 1 1100 low OD40D1' rw.~..► IMw Mr ww..q. wn'x rwl' i~''M~'i ry w wr"' 9w11 d 400eeY I /101 • ° 67920 $qFt $ , J 1.56 Ares > 62-• E` / ~JBA=1.56/Acres X45 0. 1~ uj \\~ad, ' Ith / 1010.00 / I 1 1 •4 115"E F 1 }c~ ; 8s J~ 4\ r •100 ~0 A py Z820.00 --y N C ~13 IN I 7010.85 c I ` 179090 Sq \ Na$~~\ 20ft1 wide -1--_~ I 08500 11.82 Acres p r/ / I draipage easement' I I NB =1.82 Acres N • INN L=6 '70 0° / 1 I I grcn 66109 SgFt IK X12 6. pg,• 33' 33' w / 8 1.52 Acres In L 74'- 105_00' +W W r / IBA=1.06 Acr=s Ic1 r-- / S79•'g - 313 32' 1 g~ B 18/~ t478054!5 4ME r . 418.32 O.~ I I a ~,-drainage ,,4523 / N7® ~R 3y L 02, ti I ^ ~n do utility o 58 AS4 W easement 205 87' . _ `_420-36' N79• 135.21' 1 87.02'1 5 W 33, W N8933'44"W 214.4~' 1 135.21 / 3 ' S79•~' °44'51 E 33 N8933'44'W a 'oil / Lml 3.30' j/ o 6~9•~'00• 135.21' j 51 1-0 c ,005.00 6) o drainage 1 0 83.00 NI. C; I dt utility ease i 0 .I 1oo3.oo / FWO :t / - S841°36'03" ment -c_ o / / MCFE 4 ' 11 W k~ / 0 - E •~-r~ g9 000 f / / / , ^ Cop /N 861 4 L - \ 6* / 1 7 N994• S•\ \i cal 38 g 24 to 27 Ac es 100 0' Z 100.00% ®s - I .21 9 -f / /BI at$^ \ \ N III ~ / ~ BA=1.67~Acr 79388 SgFt / 9160' ~SgFt/ / ~b0. 6 1 ~ ^^r \ 1.82 Acres I 2.10 Acr NBA=1.05 Acres / 0 1 p \ /NB =2.08 Gres / sa I Cl I ~58702 'es 2'40"K ppp.~• 'ti ' eh- N I iv b / \332.68 _ VIA of I~ I / ~ M ~~r)ftAag wide j' aie easementT J 9- 20.00 / B25 CO I o/ g I a 3> > ® hr1• o / i \ .0^ Cr 1 j I ,~0 8 8 g I 1\ 52~ SgFt I 71 Acres W N (•4 E r = I NBA=11.62 Acres / , 5229. / u I I I / I~~ I Rs3a p0'" z B168 I I I 4> i I '4718 I OD, I 1 1 I I 132~23'20AE "I 1676 SgFt ~C6 .88 Acres r^ 2 6. I /(/~j~'. 'A =1.69 Acres ry 6V/ V, sp I I o~ fOCV Co. /72703 ~F $ 8 N I / 1.67 {Gres /ham / Boa b") NBA=1.48 Acres 23 ire to Go I /n1N /w~h. / Al l / aYp'1 I I! N 1 y I tD _cf.& 8 ° 67334 Acres s I N /R 584-22'27'E I _ I /C j: 0 363.28' '1002 I 3 2 8 y c~.,?~ /.°j•~ OLD / / B Tx:4001062 5 STATE BAR OF WISCONSIN FORM 2- 2000 918391 Document Number WARRANTY DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Halle Builders Inc, a Wisconsin ST. CROIX CO., WI Corporation Grantor, and Todd Marek Construction Inc, a Wisconsin RECEIVED FOR RECORD Corporation Grantee. 06/29/2010 2.13 PM Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT described real estate in St. Croix County, State of Wisconsin: REC FEE: 30.00 Parcel 1: Lot 39, Richmond Meadows in the Town of Richmond, St. Croix TRANS FEE: 159.00 County, Wisconsin. PAGES: 1 Parcel 2: Lot 27, Richmond Meadows in the Town of Richmond, St. Croix County, Wisconsin. Parcel 3: Lot 22, Golfview Acres in the Town of Richmond, St. Croix County, Wisconsin. Recording Area Name Gand~Return Address: Together with all and singular the hereditarnents and appurtenances thereunto 026-1147-39-000&026-1147-27-000& belonging; And Grantor(s) warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, and conditions of 026-1137-22-000 record, and will warrant and defend the same. Parcel Identification Number (PIN) This is not homestead property. Dated this. 28'h day o June, 2010 Halle Bu' s l a is Corporation G * Pry: Wes( W. Halle * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY OF ST. CROIX ) ss. authenticated this Personally came before me this 28th day of June, 2010 the above named Halle Builders Inc, a Wisconsin Corporation to * me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrume tan kn w. dtrfsame. (If not, tN authorized by § 706.06, Wis. Slats.) ON..•• ' ! THIS INSTRUMENT WAS DRAFTED BY * r v Notary Public, State o Wisconsin Robert L. Lober My co ion is permanent. (If not, state x~ir ,n~te+~/ 1 Q Loberg Law Office sst7320 j ~0 (Signatures may be authenticated or acknowle ed. Both are not necessary.) ; Y *Names of persons signing in any capacity must be typed or printed below their signature •S1'~~♦ WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 1 of 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County C' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2 3 1? Please print all information. /Aptevie d by Date Personal infomration you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q/ U~ir~- 3 I ~ Property Owner f Property L Govt. Lot 7V1/4 ~Jb j 1/4 S 24 T 6 N R I E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# n' 66X 166 2 Z 39 21 C k r,-L anal r✓ 1 e d City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road L M 1 t (Lott) 74 9 -fly &'Z-5 2 ( %'12, New Construction Use. [~5 Residential / Number of bedrooms Code derived design flow rate pD ❑ Replacement ` I I ❑ Public or commercial - Describe:T~ V "L.1 Parent material T Flood Plain elevation if applicable 4A - ft, General comments Cry e j t , J GZ , O 0 ~-TL 01&X0- 6"'/ 2 and recommendations: U- Co 40 U r e~ V, ~U l Sd ST. CROIX COUNTY ZONING OFFICE F1 Boring # ❑ Boring pit Ground surface elev. /6Z,66 ft. Depth to limiting factor (06 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 4 .0-10, 1hyc J? C 5 ~ . 5 .9 Z Ip- p c) 5 v CS - lb m I C - - 4~' Z 7-5 -,7 104 d ~ 17 1 J4 Boring # ❑ Boring Pit Ground surface elev. DOZ. 'nOfL Depth to limiting factor 56 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 10, Z sl' I 2Yrlcc. /V ~ 5 . Sid 5 m 1 c 7 Z m-s CA~ C?- 7~5Ur4lhc -SL Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si nature CST Number G ( f S O Address Date Evaluation Conducted Telephone Number ll G' -S 7L W,0 f 5 az y - y G~ 7/s =Zy - your SBD-8330 (P07/00) ( V N-Q ISM Parcel ID # Page of Property Owner ® Boring # Boring t'Jpit Ground surface elev. Zo ft. Depth to limiting factor 3 ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Eff#2 4-r Z- 3$ 3 foo-45 10 5 y s~ .5 F-1 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ ❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L 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. SBD-8330 (R.07/00) Property Owner 1 V-~ ~S Parcel ID # Page of 3 ❑ ® Boring # Boring pit Ground surface elev. Imo- ZO ft. Depth to limiting factor :3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 4q F-1 ❑ Boring Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L 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. SBD4330 (R07/00) I PAGE 'OF NAME e ,rte LOT#3q LEGAL DESCRIPTION N~ ,S Z T N.R. $ E(or1~ SCALE: 1"= BM I ELEVATION /DO. O ` BM 1 DESCRIPTION 6 D I V _ BM 2 ELEVATION T~ /O BM 2 DESCRIPTION ~P a~ pYG I 52c. L SYSTEM ELEVATION /00, 0 ALTERNATE ELEVATION AIM CONTOUR ELEVATION JGi sy N e (Lo3t are G Ios-e t~ 40 raced . ,gyp Lo~- 'J Pro,"" 0 f3r"I~- 119s- Z ~ ZZS 0 ~l _ I V o ~0' O ' S g-3 3d~ SIGNATURE DATE 0 t- •671920 ~qFt g i 1.56 Ares La82.91 F c~~►`+i / / / ~JBA=1.56 /Acres 3 Qa45~ `~j F i des 0 I 15 qN~~+~!\ R N `goo Z91•28 20.00 'o,o.es c f 79090 I, 20ftl wide 'O '00 11.82 Acres \ a$ N8 w a, lie r,.o drainage easement's J NBA=1.82 Acres, g• ` Pp NN ICI Of% L 670' / 1 I~'=~cn / I 66109 SgFt 08 • o I 33' 33' 1.52 Acres In 7L- 105_00_// l~ I W to ~olea=1.06 Acres T / / 579.48 _ .313 3y I ;r ~ B 189'4 g4-E i o~ N7 -5i o - CN 't CO 32 ~ ~ - 2 ^ 1 o to b 418. j 4'2.35 to b .drains e ® ' ' h ~f ;n & utility o N79•-_, r+'~ 3~ L55.02~~, 4 easement 205.87 "5--4 W X42, 187 N795 ~ 5 w `c°n 135.21' 1 02'1 = 33.0 Q• N8933'44'W~.: 135.21 214.497 , / 0) $79o A-P'44'51- m 33' N8933'44•W 1 i /S2•98. 3.30' o / d`9•s AMP 135.21 Fwo / N 0 o 44 °o 51 oos.oo / a'' o drainage utilit ~i o 994. c ' i oo . I / cv o Y easement o 1003. 00 FWo 0$"~S841_36_03--EE LFE W M c °.00 NN ~F~ i' ~n/ Q2.07 ~ ~t W / / 98.00 I / / ~i ^ N~ / / 67j e- 1l I / N CO / / / / / ^ [317 0 ` 994 \1 38, B24 / W 2.17 Aces 1 UO~pp' 100.00/ 21 / /8 i ro / job;, n 79388 SgFt III NBA=1.671Acre~ 1.82 Acres / 160 ~ISgFt/ 00 0 ~^N No NBA=1.05 Acres t / 2.10 Acr;s • ~o~• 0 s /NBA=2.08 'Acres 3 ' ' ~o / ~y _ NS87*22 40"k I ores 43/- / / j1r I 0 X332.68 to Moir o g0ft, wide - - / ti; M N r~rn / / co ~c J~~ II II rai age easement 20.00/ / fro / co`'~' / ✓ro~'~ I N N / • B25 /g ` h`o r o I \22 21 / ® N-olo 7524SFt ~~rO / 1 o W I 1.171 Acres I ~ 8$' ham/ ~O ( / /0 1-E I NBA=1.62 Acres / 54.i0' N 1 4 / a'S I229• 8168 ! I ~ , I ' •4 18 1 0 D 1~ I~, I I I 81676 SgFt ~°~a'// J IT~1 J ~i 1w N82 3'20~E •~tI W~ s (n 2 6. 6 Acre =8 69 Acs es /`~v, 0 1 / Ory/~ 371 o / 1 N t 1 l ao g ,I 7270f- §qFt tO N ~ NI' 1.67 ~res , p I N M q~ I Ih`y / dip ~ / ~ hJBA=1.4 Acres / ; ~oY' I I I N gV ~r I tC 67334 SgFt M,~ - 1.55 Acres a 404 _ I *2227 / 363.,29• E I ~oo~' I 36 i 582•-E PAGE_ OF_ NAME e I So✓` LOT#.3A LEGAL DESCRIPTION X ^/w X,S Z y T Q.N.R. $ E(or SCALE: 1"= ~(J - - BM 1 ELEVATION L d I BM 1 DESCRIPTION k5 d f I BM 2 ELEVATION rF %O BM 2 DESCRIPTION -inp c3-~ I oVc I 52c. SYSTEM ELEVATION ~Oz. O ALTERNATE ELEVATION mot// !4 CONTOUR ELEVATION 7Gi- 5-0 N e v 2 1100 1pl•p ~ •s 10 Gl s SIGNATURE - DATE ~S" O n ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715) 386-4680 Fax (715) 386-4686 Memo to File From: Pam Quinn Date: 4/14/2004 Re: Soil On-site Determinations for Lots 32, 37 & 43 Richmond Meadows Subd. On April 8, 2004 on-site determinations of soil conditions at the above lots was performed to evaluate conflicting soil reports submitted by Adam Schumaker and Shaun Bird. At 11:00 a.m. the weather/lighting conditions were acceptable, with temp. 50°F, clear and. These determinations were requested by the property owner, Orenzo Oevering and the plumber/permit applicant, Dave Fogerty, who were present during the test pit excavations. Additional test pits were located next to borings on the original soil reports to better compare soil conditions in the tested areas. On lot 32 (see attached description) the soil profile contained massive sandy loams at approximately 36 inches below grade, which does not conflict with the soil tester's recommendation for using an at-grade system. What it did reveal, however, is that both Adam and Shaun likely misinterpreted the structure of the sandy loams: Adam called the sandy loam horizon a "2msbk" and Shaun uses "line'. There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, parted easily into "crumbs" that appeared at first to be subangular or granular in shape. However,. these were not true peds that broke apart along planes of weakness , but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive". Two test pits were evaluated on Lot 37, since the sanitary permit has already been issued. Due to the current house and well location, additional tested area will be required to meet setbacks to the POWTS. A pit closest to Shaun's B2 did have a sandy horizon as reported, but only to a depth of 60", then underlain by a massive sandy loam. Unfortunately, the boundary between the sands and sandy loam horizon was very irregular, with tongues of sandy loam much closer to grade than 60". The recommended loading rate for this site would need to be lowered to adjust for varying pore space at system elevation. v y Lot 43 had conflicting reports, where Shaun's tested area (near the front of the lot) reported conditions allowing a conventional system and Adam's (closer to the rear of the lot) reported mottling at 32" with a mound system recommendation. Additional test pit B4 was excavated next to Shaun's B3 (see attached description) and massive sandy loams were encountered at 17 inches below grade. Weathered cobbles (break into smaller pieces upon disturbance) and oxidized iron deposits around individual gravel/cobbles were observed in the pit wall, but no mottling was identified to 68". Shaun's B3 description of sandy loam with "2mgr" structure starting at 18", then sandy loam "lmgr" from 36-110". Again, I think there was a misinterpretation of texture after a sample had been handled. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on-site verifications for any lots with this potential misinterpretation on the reports. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon was described on the soil report as "lmgr" with firm consistence. 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