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HomeMy WebLinkAbout026-1294-14-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552361 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: 026-1294-14-000 Oeverin Homes LLC, aka Oeverin Pro ertie Richmond, Town of Section/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: n v) v Z 5~t r V 28.30.18.1496 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Iwo, Benchmark 10 2 • /00-6 Dosing Lam' ✓ AI M-1-ct/Vt wait 'Over 3 ~ Aeration +t Bldg. Sewer I d y 3 7 ~i SDv- 3s seem Np Holding St/Ht Inlet / - 6 S St/Ht Outlet G~~y TANK SETBACK INFORMATION TANK TO P/X WELI~ BLDG. V t to Air Intake ROAD Dt Inlet 1 Septic 2 I 2 ~^L Z CQn Dt Bottom / cv; :ti Dosing 7 S L f OVL eader an. ti2Q~v~ 5 O ( 7 (o ~ Lf- Aeration Dist. Pipe :z 0 Holding Both 4 3 Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover/ UY~ D 17 GPM tit /D'Y, 0 Model Number TDH Lift Friction Loss ys Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L ~j BLDG WEL ,f LAKE/STREAM CLEACHING Mage ure . INFORMATION Typ Of System: q0/ O Model Number: BUTION SYSTEM disc-S1GL~ S - Hea an' old Distribution 3q x x Hole Spacing Vent it Intake CD) Pipe(s) ('i SC 1, W~ Length Di- ry Length Dia_ Spacing ~Qiyt~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulc Bed/Trench Center S Bedrrrench Edges Topsoil n' r 0 Yes F No ~ Yes 0 No COMMENTS: (Include de discrepencies, persons present, etc.) Inspection #1:~/ 2ar Inspection #2: Location: 1345 116th Street New Richmond, WI 54017 (NW 1/4 SE 1/4 28 T30N R1 8W) Richmond Acres 'Lfoott 14 Parcel No: 28.30.18.1496 ~ 1.) Alt BM Description WC + ~~~1 ~L. ~ • + 7":,~• S eS~~aA~ 2.) Bldg sewer length = r 1'r`' zl c~tit~f,.etin C afod~ - runt of~ ~~~r 1~Y4 No 3 b5'J - Plan visio~Required? ® Yes Use other side for additional information. l(/ Date Insepctor s Sign ture Cert. No. SBD-6710 (R.3/97) Soil Test and System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave New Richmond Wi 54017 NW 1/4 SE 1/4S 28 /T 30 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6/6/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND SSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.4'94.2' 5' below qrade Plans Designed Using Conventional Powts Manual Version 2.0 Lent Well is to meet all >6„ Quick4 Standard setbacks required by eaching Ch amber WDNR of Cover ith 20.0 ft2 of Area All piping shall be SDR 30/34, within 10' 0.2ft^2/pair of end caps of tank, piping shall be Schedule 40. 4' LonGrade at System Elevation 34" 116th St. I Pro 3 Bedroom 1koolus plv 60' 0, Imo". ~ r 0 4 180' B-3 N 3% SLope e 40 A- 2-3' X with >3' spacing B-1 ent 20' B.M. Property Line 200 •G r• Comm Ce. V Safety and buildings Division County jJ 201 Washington Ave., P.O x J¢2 ~~1 (iV Itlepartm SCC~ Q12 Madison, WI 53707 ~I Sanitary Permit Number (to be filled in by Co.) -tY cUN X510/ e o Commerce 2 3 11 14 1. v4A pPhCiltlon Transaction Number In accordance with s. t~ Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtain g a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary I purposes in accordance with the Privacy Law, s. 15.04 1 m , Stars. `f l 1. Application Information - Please Print All Information ` Property Owner's Name Parcel # Property Owner's M~ az mg Address~ Property Location I Iq Q~ Govt. Lot City, State ZiPC ode Phone Number ,y , y4 Section C dz4~ i r~ j ucle o / t✓ T .J ~ N; R E t V II. Type of Building (check all that apply) Lot or 2 Family~D-wellin - Number of Bedrooms Subdivision Name 11 G C Cr" 6~ {~Yt6C.vn T~ Block # %C C r ❑ Public/Commercial - Describe Use Z ❑ City of ❑ State Owned- Describe Use CSM Number ❑ Village of Town of 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) B. ❑ Permit Renewal 11 Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner W. Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain Pretreatment Device (exp -5 ctZZ-1/ A( 0 V. Dispersal/Treat ent Area Information: J 3 -e A Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propos System El vatio .0 1 far 2225 © (c, I (c 3 VI. Tank Info Capacity in 8 Total # of Manufacturer Gallons Gallons Units V New Tanks Existing Tanks / Y s Septic or Holding Tank Ova- Dosing Chamber VII. Responsibility Statement- I, the undersigned, a e responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Signature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, St e, Zip Code) VIII oun /De artment Use Only Approved El Disapproved $errrtit Fee ~ j DD Issu~ /It-suing Nent Sign ❑ Owner Given Reason for Denial ~ 7 5-' Z $ v IX, Conditions of Approval/Reasons for Disapproval 03 G N E / J 0,1- 4t JA4-).1v , SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. t/Vl OV or the system sy~mit to the only on paper not t~ 8 in x 11 inches in size as per applicab SBD-6398 (R. 02/09) i Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/24/12 Owner: Oevering Homes Location: NW1/4 SE1/4 28 T30 N,R18W Lot 14 Richmond Acres Richmond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-5. Maintanance and Contingency Plan 6. Filter Specifications Sheet r Signature License number # 900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave New Richmond Wi 54017 NW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Rlchmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/24/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 170 # of chambers 57 BENCHMARK V.R.P. Top of 1/4" steel Cdb. p pipe ASSUME ELEVATION 100, Filter BEff Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark B.M.* SYSTEM ELEVATION 96.1/96.2/96.3 , A I~ 80, B-221 'V 331?roperty Line Sc~ ~e _ Plans Designed Using vve- ~D lnce,,.~„~ Conventional Powts EFO t4eC6 15 , r. Manual Version 2.0 4Vents Well is to meet all setbacks required by ST B-3 WDNR 3-3' X 78' Cells with 0 40' >3' spacing 116th St. Pro 3 Please note: further Bedroom House tes in2 will be dine to find better soils All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent 180' >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12" 34" Grade at System Elevation Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation ` 99.0 ,jV,en t 011 Grade Vent 4„ 4, x/30/34 :Setic Tank 5' 4' Lo ng 1 Grade at System Elevation 3 4Grade at System Elevation 3419 Spacing 5' 3-3' X 78' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-96.1 B 96.2 19 chambers per cell CY_96.3 iW!A - n 41 Wisconsin Department of Commerce t L~'~ IL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 1 inche D U t include, but not limited to: vertical and horizontal referenc point (e on an Parcel I.D. percent slope, scale or dimensions, north arrow, and local n and distance to nearest road. Please print all informatitn. AUG ~ 0 2005 R awed y - Date Personal information you provide may be used for secondary purp ses (Privacy Law, s. 15.04 (1) (m)). Property Owner ZONI ,I tion G Ge~al CM r-t 1 0 . 0 1/4-SE 1/4 S a~ T3(~ N R E(or Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# I 90m e. NW I q 1PIc6t o f tc m Acres City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road, F K R wI I` R KIN o f - figs i c.h rn I I (o T 5~ [9 New Construction Use: IS Residential / Number of bedrooms ode derived design flow ate S GPD ❑ Replacement ❑ Public or commercial - Describe: f Parent material Q om " I \ to - Flood Plain elevation if applicable ft. raC e.wc 1.. 5:te General comments = S u a 5 "t 3--Tel d r G S C. `I and recommendations: S S T y V W K h o w i~ ' T I S:-+e a: -r, 5 S H, 5 to 0 5 S; is . -r.a 3 9 Y, 9tr. -r, 4P N t• T-3 FT 1 Boring p 1 Boring # 54 pit Ground surface elev. `ft. Depth to limiting factor I D5_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structura Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o-► D 3/ - 4--- 61 F-a k r Q W F - Ap /v 6 L., a F lb b k- m c F_ 11P S- 3 1la - 4 1. S y1Z y/ *e -el M c.w 1vF _LL . 7 -3 `1-SY y SL JEL-bk, rn r GAA-7 • y S 3a-'fi 7.SY y& o -5 r-, t_ Lw - I • to to y 3 7-SYK S/q r S o_ S Mt- c. t~.~ • 7 I• t~ k.mvrr Boring # El Boring 30% ravctly iE 74, - 5Y(Z`+ly 5L LI F in. I a~c-r'3 % J D pit Ground surface elev. _ b ft. Depth to limiting factor 5 n Soil ADD lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 a -i ioY 3 L a1= s b k mFy- ato aF to .9 3 IL 1 S 4 IMSbIL MT-1 G%•J 7 S ya -W 714K 5/y Effluent #1 = BOD > 30 §420 mg/L a TSS >30 5 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS < 30 mg/L T Name (Please P Signature CST Number a.~ k I d ss ate Evaluation Conducted Telephone Number a -7 a 3 o 'l is a ya :3558 Zot ,540a6 Property Owner Gera Ids Sm Ak Parcel ID # Page _ of F-3~ Boring# ❑ Boring ~~575 Pit Ground surface elev. ft. Depth to limiting factor / S -In. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 , g 0-7 OV L aF I% m r qw F -e 7-1 rn 26 L aFs k M cw 1F .8 3 la a$ -7. SYl2 9/t, L) MFI, e-w l v F • 7 u 1 0 T- r k S S hc( 6c 3 6 i Q vie IL UY~ /,6t- F-1 Boring # ❑ Boring Z--z T 19 ❑ 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/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = GODS < 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.6=) rd (off 4-01 fSba~ ~ h 'es C~. v %.a Lj i _ h 00 o o T 12 o c ~ 0- T a rb (f) C~ -0 r - ca LYE. ty-) V) V) lot ~a V Y z J j _ 1 +°I +-s'v a l , ter = SC _ ~z OCJ IL J 17, - 3 - - - - _ 00 v v to 40 C3 a - - _ 00 C, 4r- s A ow Ica - t~ _ - 4~, V) (06 I , n~ 4-10-ee-20Ot 11:43 FROM:JEO CONSiLl'NG GROUP 715-246-3E30 TO:2487939 P1001/001 PRELIMINARY PLAT OF RICHMOND ACRES (A C0jM9' MAn 1PM.W M Gor 01 (4x 6 hNff{ !N P1tl Of Sa MKV' Lp of 3'tlNaa 04 1LW4V J9 kart" Alu,ae !I 1141E T"A of NW-09 Ft G.1+ &b 4df +wY•ILat '1. 1 LY yV It ti f V • c llrlF^LA M^ ('A r ..._..I AW !Ms a1lm ! ` i~M / CI A.4 P. b42 ?"90 !?Cedp 1 YI[A r" I MBsI. . KIa ,,tle.aw "-rl Irra dc saw 571' t I { ~ I! /'r i~ p / !i ' 101 •r ao {tL.tanM-etc t / t B5 etrd 0 o~ie ca4uat a •r 2, q1 a tl At : :Z: L s Y t 9' o Ana ' e , r r - ..•~aA,.... , ' T 14. 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Iwx. ,ma T_ Mir, POWTS OWNER'S MANUAL &'MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ~.j e/ ; Septic Tank Capacity G'v gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer T ❑ NA Number of Bedrooms v ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units NA Pump Tank Capacity gal ANA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) - gal/day Pump Manufacturer KNA Soil Application Rate gal/day/ftz Pump Model ~NA Standard Influent/Effluent Quality Monthly average*! Pretreatment Unit Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) <_220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/LA4A ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ya in dia. ❑ NA Other: Itl NA Other: A Other: NA *Values typical for domestic wastewater and septic tank effluent. Other: NA MAINTENANCE SCHEDULE Service Event I Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) ear(s) (Maximum 3 years) ❑ NA J Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve ❑ month(s) n': &,year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: / ❑ month(s) 0 NA Inspect pump, pump ❑ month(s) controls & alarm At least once every: ❑ year(s). A Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other. ❑ month(s) At least once every: A ❑ year(s) Other: A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of S1ART UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal' cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or coritact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAIN PR Name Name , X . r~ Gc Phone [ Phone J~ J SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name j / Name - JCS (j Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COIIN`TX SEPTIC TANK IyIAINTEN cE Ac E rr r 01MWI2.9141P CERTWICATIONN FORM ownerB YeT Q- MgAing Address S'j ` - Zoning D r (VerificBtoSl Tstpi Paul Idenfiflcati LEGAL IQE8eR3f U0_N Property Location 14-W 1, , ~ ~ ~ T Y4, Sec. R-C _UW, T own of Subdivision ~ ~ j~ certified Survey Map # Lot # ~i 'Volume page # _ Warranty Deed # f , volume page # Spec house Y no Lot lines identifiable yes )no SYSTEM MAINTENANCE AND OWNER CERTIT+'ICATfO1V lmproFer use and maintenance of your septic maintenance consists ofpumpm$ out the sept the system ic tank ev ry three could years cult in its,pif n tided, by a e to handle WRa~s Proper can affect the fUnction of the septic tank as a treatment stage in the waste disposal s responsibilities are specified i n o ~ P der What you put into system, Ownermaintenance ~P 352(1) and in Chapter .l2 - St. Croix County Sanitary d 3 6 Z Ordinance. The property owner agrees to submit to St. Croix County owner and by a master plumber, Journeyman, Pliuxtber, restricted lumbertclicensedDupaent a certification form, Signed by the wastewater disposal system is in p mper veri less than 1 /3 full of sludge. Proper operating condition and/or Eying that (1} the on-site (2) after inspection and pumping (if necessary), the septic tank is '/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with standards set forth, herein, as set by the De Certification stating that your se tics stem went of Commerce and the Deparhnent of Natural Resources, State of Wisconsin. Zoning Department p Y has been maintained must be completed and returned to the St. Croix County Planning & g par4nent 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 _O IGNA1 OF APPLICANT(S) -z DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &Loning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey nap if reference is made in the warranty deed. (REV. 08/05) i ii DOCUMENT NO. STATE BAR OF. SCONSIN FORM 2 8 0 5 6 0 2 3 WARRAr DEED Tx:4042944 956984 TIRS DEED, made between Richmond Acres, LLC, Wisconsin limited BETH PABST liability company ("Grantor" whether one or more) co veys and warrants to Oevering Homes, LLC, a Wisconsin limited liability company ("Granted', REGISTER OF DEEDS whether one or more), the following described real esta a in ST CROIX County, ST. CROIX CO. State of Wisconsin: , WI 05/24/2012 1:08 PM Lot 14, Plat of Richmond Acres in the Town of Rich ond, St. Croix Comity, EXEMPT#: NA Wisconsin. REC FEE: 30.00 TRANS FEE: 48.00 RETURN M PAGES. I Tax Parcel No: 026-1294-14-000 This is not homestead property Exception to warranties: Municipal and zoning ord Dances and agreements entered under them, recorded easements for the distribution of utility and municipal services, records building and use restrictions and covenants, and further except 2012 real estate taxes. 1l,- Dated this ay of May, 2012. Richmond Acres, LLC, g Wisconsin limited liability company By~Jtt . Williams, Managing Member AU RE, NTICATION ACKNOWLEDGMENT Signatures authenticated this _ day of STATE OF 20 COUNTY Of~ } TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this. day of May, 2012, the above (If not, named Richmond Acres, LLC, a Wisconsin limited liability authorized by § 706.06, Wis. Stars.) company By: Jeffrey S. Williams, Managing Member to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert L. Lober / Lober Law Office Notary Public o y, Wis. 1210726 / a My Commission is permanent. (If not, state expiration. date: (Signatures maybe authenticated or acknowledged. Bothe ) not necessary.) 6 'Names of peixous signing in anycapacity should be typed of printed bebw [Ink aignaturts. IMIASHA A ONMZW/yft NOTARY PUBLIC-MINNESOTA MY Commission Expires A% 31, 2017 r 1 of 7 WARRANTY DEED Perm Nm 1.2003 ' :ion COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, 130TH OBSTRUCTING, ALTERING, FILLING. EXCAVATING OR PLANTING IN ANY tebor or Pipe DRAINAGE EASEMENTS, WATER DRAINAGE DITCHES, WATER RUNWAYS, roadways WATER CULVERTS, BERMS OR GRASS SEEDINGS. ALA TTED LANDS Eost Quarter Corner of - - - - - - - - - - Section 28-30-18 (Found Aluminum County Monument) DRAINAGE 80' RADIUS 7EWPORARY CUL-DE-SAC .sm V9 EASEa/ENT (7U BE REAIoI £D 1949 EASrwvr 7.I8 UPON! £X7ENS70l OF- THE ROAD) 975.E C 527.08' • cn • 425.60' 65.001,66.00' I 974.9 / N89'56'03" o u n>~ 15 1316.71' 6 L_ , o 2.12 acres = t w ~ Cn i 92,174 sq. ft. W ° 1 1.80 acres o rHWE =973.0: C.B. 0. 975.0 I 78,420 sq. ft. a *1 '7 y 589'56'27"W 521.07' V ti r 220.00' 301.07' / • / / ~ N89'56'03"E 441.04' m ~ p ~i 17 ~th co z 1V o / / / ro` Z• ED 7 cores A 1.82 acres 98 sq. ft. 79, 363 sq. ft 1.95 - acres ~N 84,826 sq ft W / fn y N89'56'03"E 503.23' 0 .f-4 ~s 13 / o y - 2.20 acres o I 104,E 196.40 95,760 sq. ft I O Y3 • S8640'24'W 300.53' I O i F8 N86.4624"E _300.53_- _w • i N89'56'03"E 545.92' r^ - N `11 173;7' '187.36 ~ ~ ~ \ ~ I • 12 2.12 acres I P N X. 92,514 sq. ft. a p \ a A N89'56'03"E 477.99' 320.40' 157.59' .68 acres w 1.73 ccrP,a°~ u' to 0 979 sq. ft $ 75,442 sq. ft. \ ~j aw d \ W a L4 m 292.15' ' JJ _a 219.24' 511.39' \ !71 F 584'22'09"W \ ` 31 2.05 acres 10 2.12 acres 89,268 sq. ft. 1.75 cores 92,151 sq ft. 76,369 siq ft. c / S89 53'36"W 80' RADIUS / 519.87' i V CUL-DE-SAC 1 X5.0 (TO BE ROK / J • ' \ \ EX7ENSION G 32 N81~22 45.70 W - z1o.7y . 6) • 2.18 acres i rQ(~r.S..1'3a 270 9,