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026-1114-80-000
STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 1 ADDRESS IS 0-5 ~+H I~ 141"l2 1-7& 1-L, ~ K 45Lto 1-7 SUBDIVISION / CSM# w ~w \ ~~0~~^~•~ LOT # SECTION. T 36N-R WW, Town of ST. CROIX COUNTY, WI CONSIN ~-V-st AN VIEW S~HOW~~ VTH IN 100 FEET OF SYSTEM fi td- O 0 ~ ro71 'Y 3 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this -form- Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING..TANK INFORMATION sAe~ /a Manufacturer: Liquid Capaci:ty• _ v 4X U Setback from: Well' 4P Hous$es Other ~r.~.s~` 7 G T 5~~' 2 Pump: Manufacturer -_0 uu ~ Model# ZiPoWl Size Float separation Gallons/cycle: IL,0 Alarm Location :SOIL ABSORPTION SYSTEM ~ ~ l vrt~n.o Width: Length Number of tty-~*± es Distance & Direction to nearest prop. line: v' Setback from: well: --)4Q House ~)0 2 Other ELEVATIONS ST outlet 7f 9 Building Sewer ST Inlet; &7,7k y PC inlet 46,"7, 29 PC bottom p111 Y g Pump Off 95, Header/Manifold 9 o~ Bottom of system.Ji) Existing Grade Final grade `j DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt i rt n .01.30.1a AfRIVRG990STEM County: or and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitar mit GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village ❑ Town o : State PI X ~I CST BM Elev.: Insp. B Elev.: / BM Description: Parcel Tax No.: _ i 026 TANK INFORMATION ELEVATION DATA A9300162$ TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Pte! ~iie . Q Benchmark 3. 6D Dosing Aeration Bldg. Sewer Holding _ St/ Inlet TANK SETBACK INFORMATION St/k~f Outlet r TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet r Air Intake s (0 3 B~,~S NA Dt Bottom gf<. y7 Septic ~1,26 r 20 Dosing >Ie '76r ~o et >30 r NA W&arbw / Man. Aeration NA Dist. Pipe Holding _ Bot. System 77' PUMP/ SH"MN INFORMATION 6aAe /,/.p Manufacturer, Crete ~s ' 951 Model Number AGPM oss 11 TDH 'lift Friction System TDH ~Ft Forcemain 1 Length c/l~ ' Dia. 3 'r ~DstToWell_7,5, _T71 SOIL ABSORPTION SYSTEM BED/TRENCH Width , length No. Of Trenches PIT No. O i Inside Dia. Liquid Depth DIMENSIONS DIM N I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Man SETBACK CHAMBER INFORMATION Type 0 cse o System: Ccjr)Lj-, V J, /i,J'" - f(Jl7 OR UNIT DISTRIBUTION SYSTEM Header Distribution Pipe(s) „ x Hole Size x Hole Spacing Vent T ke Length _~Z Dia. Length 2-7 Dia. Spacing L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems 0;;77 Depth Over a Depth Over " xx Depth Of xx Seeded/ Sodded xx Mulched Bed / Tcam+-Center Bed / Toen h Edges 3 2 / To ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: RICHMOND 01.30.18.661 (CTY RD GG) Plan revision required? ❑Yes 0XNo 3 Use other side for additional information. L_ V14t, I SBD-6710(R 05191) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: r a u SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY , - .d.~ ,,.e,• ..M.,..,,e- - f- G r o t Y STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 191-31.501-9 8% x 11 inches in size. U Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION D-12 Not r 1 d< C v~ %4 N w'/4, S J T 3 0, N, R g r) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # /go -S 4-9 CITY, STATE ZIP CODE PHORE' NUMBER SUBDIVISION NAME OR CSM NUMBER I11aw W~ 5 YO 17 -1(715 - W low imp a~ o ws II. TYPE OF BUILDING: (Check one) El State Owned VILLLLAGE NEAREST ROAD Ri-- G PO F: ❑ Public ~fl or 2 Fam. Dwelling-# of bedrooms Y_ AR L M III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # 15W O-s Date Issued O 9 V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized-Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) gELEVATION /oZ X02 co i -5 Feet Feet VII. TANK CAP CITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber Plastic Exper. INFORMATION New xistin Gallons Tanks Concrete structed glass App. Tanks Tanks Septic Tank or Holden Tank oZSa W v-uaA-- Lift Pump Tank/Si hon Chamber X I F-1 R R 1:1 El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsits sewage system shown on the attached plans. /Plumber's Nan rint): Plumber's Sign re. ( o Stamps) /MPRSW No.: Business Phone Number: C,4/ v. r. Iy0 c v-2v /$~i~ / f- -5x Plumber's Address (Street, City~SS te, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing A Approved ❑ Owner Given Initial Surcharge Fee) 2 Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber" requires a Sanitary Perrr;?t Triinsfer/Renewal Forin (SBLD 6399) to be submitted to the county prior, to installation. 5. On4ff~, sewage systems must`be properly maintaiiled. The 5 ptir tank(s) must be pu;r*~Pt d f-y a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewaage system, contaci your local code administrator or the State of Wisconsin, Safety &,Buildings Division, 608-266-3815. To be complete anti accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type ca system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1•7. VII. Tank information. Fill in the capacity of every new and/or existing tarn: ist the total ga.l'or,. number of tanks Inc; manufacturer's name. I°ldicate -;refab or site constructed iar.d lank material. Corilr''ete for all septic, pr, inp/siphon and holding tanks for `his system. Check axri~ r= : itai approval only if Tanks received exper.,in ctai product approval from D! ._HQ, Vill ResponiFibility statement. Installing plum h9r rs to fill in name 6,.. nse m tuber with =t„propri lie prefix (e.g. MP, et-.}, address and phone number. Plumber must sign appl'! _,on form. IX. County/i)partment Use Only. X County/Delpartment Use Only. Comr!ele plans and specification: not smaller than 81/2 x 1 t mri:>t be su> r i' r ; +r c,.)unty. The Plans rni;st include ; e following: x)lot p:an, cirawn to s. • r ith compie`p t` r. . ro ~ti:C3n of holding tank(s), septic. tank(s) or (Ahe-f treatmen tanks: build wel s; w „ater service, strearris and lakes; pump or siph(-ri tank distr!bution boxes, ark`4-r)tion systeii-i~-, rF' i' t ernent System areas; and t4i 'ocation of the building snr'ved; B) horizonta i. .a '?Ievation reference points; C) complete specifications for pumps and controis; dose volume, elevation differences; frict un loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if_ required by the county; E) soil-test data on a 115 form; and F) all-sizing. information' - - - - - - - GROUNDWatli; SURCHARGE 1983 Wisconsin Act 410 included the creation of suyc', arees (cr f s} for a nurr'i'x` Cf regUia`e r`'.-irtlces wn C" oar! effE.(;t g.oundwater 1 i t,B rlo`;ie5 u..,,lPCtetJ tS;rr+!C} these _s,r:r:;haryE?5 8r'~ used for mOn t(%.'r^^i,i grCsi Yl'at' l;'.. d+ri c- wa:er "Gontamlination in of ;~;q ations and establishment of standards., SBD-6398 (R.11/88) . M_y. , 1 , , lei A k. • i i ff i , • lei i A!se t .I i t A..-.._... ..1.....,_~. a Q. t t..,__,.' - 1 I 14. I i r S Y 1 -.1 - - `R - 4-4 y 1 I , y 1 i ~ t 1 1 1 ~ • E ~Kpve- 1 _.1____ Y i , f 4 i 1 , f_ --r--- - - - - r' U S S C I U r•1 - _ 1 Ct~~ . o ~ ~ 13 t n S ~ s ~ e • 1 p ( frelA Air Well And ODeerrolion pipe • Mtntm" Ix• ~Approrld V.nt cep Mere lln.i crew 20• ~2' A►e.e Ptpj 4• Ceel Ireq T• flnel 0re.. 1 V.e1 st Plot ►t«en ►t• Or S It c..• 0 4rP Ol Or.peU • x OI W I►„Ilon Tee e . 0e A 1►ePtp. ° P•rfere t. a Pipe b •ter o ce gttnl T•rmt n.tln1 AI aonem Or Sreiem SOIL FILL QISTRIBUT101.1 PIPE 2u OF Y • r APPROVED l1 GRCGATE ~`IUT►+ETIC;COVC nATE1t1A{. op, 9" OF STRAW OR MARS" HAj n LEV, oFFEI:~'---, .L ORAGGRCGATt: 'P•v~ OIS71`1115rUTIOW PIPE TO pE AT AUK AT LCASTtO 11JCHES. F1U7Ll,IOSMOR 1~ IUCHES BELOW ORIGIUAL GRADE ONES OELOW FINAL GRAOC t MAXIMUM r Q P H OF FXr- VA TIo Ff(0/1 4R16WAL 69ADF- WILL 13 rurtlMUM pEPT}i of EACAVAT►01J ~R01~1 e~IGI}aAL 6 _ INCHES SRO WILL BC INCHES SIGIJCO: LIGC1,1$C UUMBEIt: !J~~ SATE 2_3 11o _ r / PUMP CHAMBER CROSS SECTION GE - OF_ AK1D SPECIFICATIONS VCWT CAP 40C.I. VENT PIPC WCATHER PROOF 2S' FRCM DOOR, JUNCTION BOX APPROVED LOCKING WINDOW OR FRESH 12"MIU. MANHOLE COVER AIR INTAKE I GRADE I y„ MIN. CONDUIT IB"Mlu. • IN L.I: T PROVIDE - AIRTIGHT SEAL III 7 APPROVED JOINT A WIC.I. PIPE I I v EXTENDIM6 3' I III APPROVED JOIN ff 0►JTO SOLID SC:;, I III I^//C.I. PIPE t~ B I ALARM EXTENDIIJG 3' 11 ONTO SOLID Sol c I . • I I oN I `~I PUMP D OFF CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURCR HAS SUCH APPROVAL SEPTIC AND SPECIFICATIONS .DOSE T- AMKS MANUFACTURER: TANK GIZE: 7S0 NUMBER OF DOSES: GALLONS DOSE VOLUME PER pAy ALARM MANUFACTURER; L MODEL ►JUMgER: ;.:.[::FLOW: /-50 GALL ON$ SWITCH T.JPC; /oravl, CAPACITIES: A. a 3 INCHCS OR PUMP GALLONS MANUFACTURER: INCHES OR GALLONS MODEL NUMBER: u'8 3 / p C "--~,IIJCHES OR -!60 GALL 0 N $ SWITCH TYPE; D' INCHES OR~ PUMP DISCHARGE N07E: PUMP AND ALARM GALLONS RATE GPM INSTALLED ON ARE TE 8E VERTICAL DIFFERENCE DiWEEN PUMP OFF ANO D15TRIbUTION PIPE SEPARATE CIRCUITS f MINIMUM NETWORK SUPPLY PRESSURE , FEET ~Jc n lM LEO- ' FEET OF FORCE MAIN X FTFEET oofTFRICTION FACTOR.. FEET TOT-A L DyIJAMIC HEAD - FEET INTERIJAL RIMEIJSIGIJC OF TAIJK: LEKIGTH ' f--•iLIQUID DEPTH S IG kJ E D T_.,..~ LICEQSE HUMBER; I C~ 3 DATE; _k. y jlxyy ra* Y` 1 t0: H <<~` w RSIB x G tJ XS SUNM f Y, SVtiIAGE °QND, EFFLUENT PUMPS ,L{fir o .j4 T, y F r~ aJ 7 r '°r t„ EP0311 i F: t.Isr nlsc. h'EP.0311 132 EP0311 115 V Effluent Pulp 1/2" aolidb 256.80 172.10 ••yy, 7t~Y,LK~e . MODEL EP0311 Effluent:,Pump , N , , Merens FEET SIZE % SOLIDS rx r v t y •Ky 1' ~ lt.." it r st - 4 t •b\ 3 v. C! DD p 00 4 6 12 16 24 26 32 36 40. y 20 ~f y GPM 0 2 5 5.0 7.5 mr/A +,Ia; CAPACITY .f y.:. • 'x A • AM- mdMs Performance 3885 Curve ~yr 61r7rr+s ~m -T-1 I A- WE M ti 26 mms, xti ~o taw K 7~3 rL ,6 50 y: a wlow , 7- 1 rats g, 74- wi' 4;t lilt' 1'1 tG 20 ( 7L.1 _ r• ~ w[ox tb7'~.f tx'S'?• 0 00 10 20 20 . 40, 60 60 '70 OD W- 100 110 120 ,OPY ~~K'''111 a Y ; b t.. 0 1G CAPACITY t. Px LISP DISC. Ct3uFrrE0313I. 142 WE0311L 1/3 HP 115 V taw H 3/4' solids 191.55 329.35 <a .it •..00WA 0311M 142 ' HE0311M 1/3 HP 115 V. Mod H 3/4 solids 491 .55 329.35 r~r 3/4".ebllda 704.25 471.85 >L { 1ljyC~~~r :03 mVmO51lH 142 WE0511H 1/2 HP 115 V High H 565.25 843.65 i 3/4aalida~ - :'Ci~l7phrE0712H 142 WE0712H 3/4 HP 230 V Rio Fli. +k i<~r rv t1ti` y ri4 x' r xP "sS+E .FaI t d+ING PACE FCR PERFCWdV= AM SPECIFICAT10m. , 1 L1ATE 10/88 M n 30 PAGE 07u Wisconsin Department ti Industry, Human SOIL AND SITE EVALUATION REPORT P~ 1 of 3 -1. ,".gborwan ond .Relatioru Drvisf Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St . Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. y APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Derrick Construction Inc. GOVT. LOT SE 1/4 PNJ 1/4,S 1 T 30 N,R 18 2 (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1505 I Ty. #65 9 n/a Willow River Meadows STATE P ODE PHONE NUMBER ❑CITY ❑VILLAGE jQWN NEAREST ROAD ew Rchmond, WI. 54~~ (715) 246-2320 Richmonn Co. #GG I [ flew Construction Use M Residential / Number of bedrooms 4 [ [ Addition to existing building j J Replacement Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd/1112 - • 6 trench, gpd/ft2 Absorption area required 1200 bed ft2 1000 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2 .6 trench, gpd1ft2 Recommended infiltration surface elevation(s) 95,10 It (as referred to site plan benchmark) 11 Additional design / site considerations n/a Parent material out-wash plain Flood plain elevation, if applicable n/a It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem 1 ❑ U LAS ❑ U t3 S❑ U )MS ❑ U ❑ S x61 U ❑ S au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bortdary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0-10 1 r3/2 none L. 2/m/sbk mfr c/s 2/f .5 .6 2 10-22 10yrL+/4 none sil. 1/f/gr mfr g/w 1/f .2 3 Ground 3 22-60 7.5 r4/4 none sl. 2/m/sbk mvfr g/w 1/f .5 .6 elev. 99.10ft. 4 60-86 10yr5/4 none Co. S. 0/sg ml n/a n/a .5 :.6 Depth to limiting factor >8611 Remarks: Boring # 1 0-10 10 r3 y /2 none L. 2/m/sbk mfr c/s 2/f .5 .6 Y 2 2 10-21 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .2 .3 3 21-60 7.5yr4/4 none sl. 2/m/sbk mfr g/w 1/f .S `.6 Ground e. 4 60-90 10yr5/4 none co.s. 0/sg s11 7 .8 98.60 ft. Depth to limiting factor >901, . sh Remarks: CST Name:-Please Print Phone: Gary L. Steel - Address: 1554 0th. Ave., flew Richmond, 611. 54017 E Signature: Date: cstm . Der: 6-29-93 PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Depth Dominant Color Mottles Texture Structure Consistence eourxiary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-8 10yr3/3 none L. 2/m/gr mfr g/w 2/f .5 .6 3 2 8-22 10yr4/4 • none sil. 1/f/gr mfr g/w 1/f .2 .3 Ground 3 122-55 7.5yr4/4 none sl. 2/m/sbk mfr g/w 1./f .5 .6 i 99.10 ft. 4 155-84 10yr5/4 none CO. S. 0/sg ml na/ na/ .7 i.8 Depth to limiting i factor >8 Remarks: Boring # 1 10-10 10yr3/2 none L. 2/m/sbk mfr c/s 2/f .5 .6 \ ii 2 10-26 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .2 .3 g/w 1/f .5 .6 3 26-55 7.5yr4/4 none sl. 2/m/sbk mfr I Ground /a n/a .7 .8 ~I~v. ft 4 55-t34 10yr5/4 none co.s. 0/sg ml n Q~• Depth to limiting factor ` >84,, Remarks: Boring # 1 0-9 10yr3/3 none L. 2/m/sbk mfr g/w 2/f .5 i.6 2 9-19 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .2 .3 3 119-65 7.5 4/4 none sl. 2/m/sbk mvfr /w 1/f .5 .6 Ground 9e20ft 4 65-84 10yr5/4 none co.s. 0/sg ml na/ n/a .7 .8 ° Depth to limiting factor >84" Remarks: Boring # Ground elev. Depth to limiting factor Remarks: SBD-8330(R.05/92) STEEL'S SOIL SERVICE 1554 200th. Ave. Gary L. Steel C.S.T. 2298 Derrick Construction, Inc. New Richmond, WI 54017 MPRSW-3254 SE NfI% Sl-T30N-R18W (715) 246-6200 town of Richmond lot [billow River Meadows V- VIV Oar ( ©Z~ ~7.~. tot 61~k ~'A I OD r ?i r 1 Gary L. steel 6-29-93 DI SANITARY PERMIT APPLICATION 0LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY G rc i X STATE SANITARY PERMI-U -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWN PROPERTY LOCATION 5E S T 30, N, R / or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # L;_0 s 14- to s 1' CITY, SATE ZIP CODE PHONE NUMBER SUBDIVISION NAME O CSM NUMBER z 5Y 01 7 ) fS- .Y4 xsac WL11o~ ~%.Q4jr 0)wd1a_jS CITY NEAREST ROAD II. TYPE OF BUILDING: (Check one) State Owned ❑ VILLAGE : ❑ Public 1 or 2 Fam. Dwelling~# of bedrooms PARC TAX NUMBER(S) EL III. BUILDING USE: (If building type is public, check all that apply) Oa( ! f ~,Y 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Hom 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ RestauranUBar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. N New 2.E] Replacement 3. ❑ Replacement of Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Per Date Issued V. TYPE OF SYSTEM: (Check only one) (1 Non-Pressurized Distribution Pressurized Distrib Experimental Other 11 ® Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 430 Vault Privy 140 System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION 6 &0 ~a 00 I oP0 0 •5 c~ S•/ Feet Feet VII. TANK CAPACITY Site in alIons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank 20,50 F1 I [J Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Namernt): Plumber's Sig re: (No Stamps) /MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): L J s a 17t /,-S -Au E 67 IX. C LINTY/DEPARTMENT USE ONLY *tary Permit Fee (Includes Groundwater Date Issued issuing gent Sig No charge Fee) ❑ Disapproved ?W,04aQ Approved ❑ Owner Given Initial Sur Adverse Deter intin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Pib-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ~s . y M 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicab!e. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SB. l 6399) to be subrn;,tted to the county prior to instailatGon. 5. On._ 4e-se'v age systerns must b'e properly maintained. The septic tank(s) must be a licensed pumper.whenever necessary, usually eveyry 2 to 3 years. r 6. If you have questions concerning your onsite sewage system, contact your local code a6rr1 nistrator or thee State of Wisconsin, Safety &,Builgings pivision, K8-266_3815., a To Uee completR and accurate this sanitary permit application must include: c I_ Property owner's name and mailing address. Provide the legal description and parcel tax member(s) of where the system is to be in.stalleci' II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending cn system type. VI. Absorption system information. Provide all informat on requested i^ #1-7. VII. Tank information. Fill in the capacity of every new and/or exist'nc tank, ist the total gallons, number of tanks and manufacturer's name. Indicate prefab or site const~ u::tecl and tank material. Cor +l` etc for all septic, pump/siphon and holding tanks for fhis system. Checi< r x, erimt r "ai approval only it tAnkS received experimental product approval from DILHR. Vill. Responsibility statement. installing plumber is to fill in name, license rlu,nber with appropriv~e prefix (e.g. MP, etc.), address and phone number. Plumber must sign applicatin to-m. IX. County/Department Use Only. X. County/Department Use Only. Comp!etc: plans and specifications not ::rf .Her than B''/z x 11 -rw7,t be submitted to th,s county. The plans must include the following: A) plea ,Iasi drawn to scare r,r ,~,i°h complete d,men•; ens, +(_~,ation of holding tank(s), septic tank(s) or other tanks; bui+.1 ~ wells; walee w i vater service; streams and lakes; pump or siphon tank;, ~i+sfF ibution boxes, ttc- -ir-., =-tion systems. re1piai~,,?ment system areas: and the location of the building se-.ed, 8) horizontal ~lev: lion, reference ;pointy; . C) complete specifications for pumps and controls; close volume-, eievat-on differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system it -:required by tha bounty; E) sail test data on a =t'15,form; and 9 aif':si~Eing`informatton ' ' GROUNDWATE1R SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices whir!h -an effect gra+.erndwater The rrLon+es collected thrc gri';-tese ~1 rcha jey: are ~r<+ r r.::,,?7,dwatc 1 u,,n f in C)C. water contamination investigd.te~.res and establ+shfi r,. of sfalr_ " s _ ! -ye't''` Y SBD-6398 (R.11/88) I + t I i I I I ' I I I I ~ i i I I ( ~ I i ~ ~ I I ~ I , , IL\/ . I ~ , I ~ ~ I ~ I ! t i I • 'ilk II np(~ i I [PT ~ I I I- t 1 - ' I I I ~ I i I ~ i I ~ I I I I ~ I I ~ { I S~ , 4'00~ I I ~ I I I I , I , ~ ~ i I I I I I I 1 i , I I I I -1 , I ' I i I I 1 ~ ~ I I ~ I I 1 : I , I , I I _ ~ I I i I ! 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Vol: STRAW OR MARSH HAy tLEV. of e.LFUT,'•°Y~. 1."OP't P'/= AGGRCGATE DISTR15UTIOM PIPC To BC AT LEAST _ IUCHES BELOW ORIGIMAL GRADE AUU AT LEAST LO IUCHES BUT 1.10 MORC THAW 42 INCHES BELOW FINAL GRADE MAMMUM DEQtH OF F-XC/lVAT100 FKOM ORI&WAL 69Aaa WILL. BE _ IMCHES PVNIMUM 05P 1-1i OF EXCAVATION r'&O^ 04~164JAL 6RnpF- WILL BC 'rsl~ IIJCHEs SIGU CD: LIGCUSC uUMBEI2: DATE 110 ~ r tment of LdboWiscon and Humarn Relationsd"Str'~' SOIL AND SITE EVALUATION REPORT Pagel of Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE; PROPERTY OWNER: PROPERTY LOCATION Derrick Construction Inc. GOVT. LOT SE 1/4 IR4 1/4,S 1 T 30 N,R 18 f (or) W PROPERTY OWNER':S MAILING ADDRESS LOT k BLOCK #r SUED. NAME OR CSM y 1505 IT y. #65 9 n/a Willow River Meadows CjY, STOT.E P ODE PHONE NUMBER ❑CITY ❑VILLAGE ENWN NEAREST ROAD JJew .tchmond, WI. 54( (715) 246-2320 Richmonn Co. #GG ] ,4 New Construction Use rj Residential ! Number of bedrooms 4 ] ) Addition to existing building Replacement O Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd/It2 6 trench, gpol11112 Absorption area required 1200 bed, ft2 1000 trench, ft2 Maximum design loading rate . 5 bed, gpd/ft2 .6 trench, gpd/tr2 Recommended infiltration surface elevation(s) 95.10 it (as referred to site plan benchmark) Additional design / site considerations n/a Parent material ou twa sh nl a; n Flood plain elevation, if applicable n/a it S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem M❑ U LAS ❑ U t3S ❑ U ~ S ❑ U ❑ S XID U ❑ S IOU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounc* Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rtt 1 0-10 10 r3/2. none L. 2/m/sbk mfr c/s 2/f .5 ' .6 1 2 10-22 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .2 3 Ground 3 22-60 7.5 r4/4 none sl. 2/m/sbk mvfr /w 1/f .5 .6 ~e1ev. 4 60-86 10Yr5 9?.10tt. /4 none Co. S. 0/sg ml n/a n/a .5 ' .6 Depth to limiting factor >R6" Remarks: Boring # 1 0-1.0 10yr3/2 none L. 2/m/sbk mfr c/s 2/f .5 .6 2>s 2 10-21 10yr4/4 none sil. 1/f./gr mfr g/w 1/f .2 .3 3 21-60 7.5yr4/4 none sl. 2/m/sbk mfr g/w 1/f .5 .6 Ground elev. 4 60-90 1-0yr5/4 none co.s. 0/sg ml n/a /a .7 .8 98.60 it. Depth to limiting factor >90.. a Remarks: I CST Name:-Please Print Phone: Gary L. Steel_ 715-94h-6200 Address: 1554 00th. Ave., flew Richmond., 141. 54017 ff9Wmber: Signature: 6-29-93 Date: cstm yytci► PRORMYOWNER j)('t:rick Cons. Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. #f Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BourxI3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed' tench 1 0-8 10yr 3/3 none L. 2/m/gr mfr g/w 2/f .5 .6 s 2 8-22 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .2 .3 Ground 3 22-55 7.5yr4/4 none sl. 2/m/sbk rift g/w 1./f .5 .6 elev. (M.1.0 ft. 4 55-194 1.0yr5/4 none co.s. 0/sg ml na/ na/ .7 ..8 Depth to I limiting factor Remarks: Boring # t 0-10 10yr3/2 none L. 2/m/sbk mfr c/s 2/f .5 .6 t`. 2 10-26 l.0 14/4 none sil. 1/f/gr mfr g/w 1/f .2 .3 3 26-55 7.5yr4/4 none sl. 2./m/sbk mfr g/w 11f .5 !.6 Ground elev. 4 55-84 10yr5/4 none co.s. 0/sg ml n/a n/a .7 .8 011.90 ft. Depth to limiting factor >04., Remarks: Boring # 1 0-9 10yr3/3 none L. 2/m/sbk mfr g/w 2/f .5 .6 5 2. 9-19 10yr4/4 none sil. 1/f/gr mfr g/w 1/f .3 Ground 3 19-65 7.5 r4/4 none sl. 2/m/sbk mvfr /w 1/f .5 1.6 elev. 4 65-84 10yr5/4 none co.s. 0/sg PLl na/ n/a .7 .8 00.201t. i , Depth to - ` limiting factor )"4- Remarks: Boring # Ground elev. it. Depth to limiting factor . LT i Remarks: 0) P3301 05!92) i ti I • STEEL'S SOIL SERVICE Gar I, L. ,Sivel ~ 1554 200th. Ave C.S.T. 2298 Derrick Construction, Inc. New Richmond, WI 54017 MPRSW-3254 SF'-,M-? Sl-T301,1-Rl81] (715) 246-6200 town of Richmond lot #9, Willow River Meadows 1 l-~ ( 0 Z f r,~ ,.1 rl- ~~o '-l Gary L. steel 6-79-93 APPLICATION FOR SANITARY PERMIT . STC - 100 his spplicotion form is to be completed in full and signdd by the owner(s) of the toperty being developed. Any inadequacies will only result in delays of the permit esuence. Should this development be intended for resale by owner/contractor, ("spec ouse"), then a second form should be retained and completed when the property is old and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - er of Property W/L.1--ow 'ei vch ~Oi JLJ_ Location of Property 5E Is NW k, Section -3o N-R W Township 146,1 010 "!D . Mailing Address _ j SO S t'wY <o S lve_~ /Qt M n O , \A// S yv / -7 Address of Site Z/ 3 Z 17(o Ave Subdiiriiion nee 4011.-C-0uj /CI v'cg/L /f'/'TA'00LVS Lot Number j Previous Amer of Property _ G?EXl.~'i'l yl pC SC/i M r O 'F Total sloe of Parcel 2C/L65 -7- bate Parcel was Created Are all cornets and lot lines identifiable? x Yes No Is this property being developed for resale (spec house) t x Yes no volume $ b and Page Number 48,10 an recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING= 'A errant Deed hich includes a Document number, volume and page number, and the seal of the Register of Deeds In addition, a certified survey,.if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Hap, the Certified Survey Hap shall also be requited. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - PROPERTY OWNER CERtIFICATION 1 (forI coAl6y that a-ff. ~st4temEnth on th1A ohm me thue to the beAt o6 my (ouk) h"'Cedgef that I (we) am 1aAfl .the ocuner k l 06 the phopeA.ty deAc' i.bed in th,ia '"46pkMa..tton 6ohm, by v.i/ tue 06 a wnlthanty deed necohded in the 064-ice o6 the °vaLsteh 06 Deedsah Document No. '~SSZola : and that I (We) pneben.tty •"d site 60A the eoauage diAP04 eyes em (on I (we) have obtained an the, above descAtbed phopehty, on the c01t6tA"C'(A_ o6 eatd ae been duty necohded .tn the 066tce o6 the County RogiAteA 06 SIGNATURE OF CO-OWNER (IF APPLICABLE) DATM STaxKn i I • ~ SL•°':'.C "~~:fK YALaTL•:fA:fCE ~LC:ZZi:!E:lT 5r.. Cro i» CuunC~r _6"T 1/ ~-/~urLc' OWNZT7IIU'fEZ /utCg4eL. le 37LVEWS MOUTZ190 : ATUMBBF/:: ~//SOS {JWV &s- Fire "lumber f yC-W /CLC:HMC7N~ Z.T.° CITY/ S'IAT" P^0P'ERTC LOC.%TMON: NLV Section Z 30 y, Et lg ~J, :'own a E /C-H/LLoI~D St . Croix CaunC7 , - W/ta.o w vc7Z . Subd_vzsion Mt :~OOLV Lac aumber~. Zmprooer use gad maimcanancs of your sepcic syscam could result i.a ics pt;emacurs la{lurs cc handle %iascas. Proper maincanance con- sists of pumpimg out the sepcic canic aver, three years cc sooner, i! aesded. by a Lic_nsed sea is canic oum ner. 9hac you put Laco the syscam cam shat= the runcc un of the sepcic tank as a c=eac- meae stage La then gasca disposal svseam. Se. Croix Caunc-r rasidencs may be ali.gibla cc recsive a grant for a cnax_mu:m of 60t ut the case uc replacement of a tailing syscam, which ~jaz is ooeracian prior co July L, L978. St. Croix Caunc;r aecspead chts program La ewsguac of L980, vi.eh then requiremwne ehae owners or all ne•.r svss aRrae :o ka-ap cite=r systems properly maiacaiaed. :he proper=? owner ag==es .o submit co Sc. C.oi» Caunc? Zaniag a carti.icac_on torn, signed by Cho owner and by a mas.car plumber, lour:teyeean plumber. resc_isaad plumber or a Licsnsed pumper vert- fyimg chat the on-sica jaseawacar disposal syscam :s.ia propeil operaciaig condicton and (Z) ac'_ar :nsoec:i.on• and pumping.. (i! sec- essarq), chw sepcic canic is Lass char L/3 full of sludge and scum. Cart:!!.Canon fora 4 1 bes sent aporosiataealy 30 days prior eo three year axpiracion. Zi'•+~E. he undersigned, have read the above reauirsmancs and agree co mai.calm.cite gr_vaca sewage disposaL system to accordance •lith cite scaucards sac Eor_:i; herai:t. as sac 6y the '4Lsconsin Deparc- menc uc Vac:iral Resources. Card==cation form muse be eomoLecad and recu;med cc the Sc. Croix Cauncl Zoning Of_ice Jichin 30' days of the three rear axpir~•c_on dace. SZC ~c0 - 1) A T 2- S c . Count? anin:.: U e ° ics I'.U. 30 ?ammo~d. .Z Se(I L.` tii.•_'t t,Z~.. :tn~t ~.~~,r--~ th~~v.. lcid^~y~. :f 17 90 .ts to outlat 07 AG 1 I ' O J~~ h~~ 'r sa o doss o to3 2m *A= M 16 F 18 River • 201 *AM ~r'~tly Meadows .08 ~ A 20 g LWAMM 15 .6 w tts~o.. 14 202 AOM y. ~s 'ss 'o. 21 - 13 - LIB ACM ' N 203 AdM v ~ iw 361.13 ~ ut.ta xoo zs3.ts 9 N 10 tot AS M 200 AQM • a 11 `O s too ACM 2 22 zot too AOM =a M4 135.29 Public ' 2Ci 490.74 • Z a 7 200I23 IVM Z a 200 A&M N 222 A&= O a 2N M.30 24 504 20 C9 200 AGM 6 28 2= A/ .v 227 AsM ~f 42s.2s .n o 2t9.~ °n 5 • 25 - N 201 Aaft 'Cop In 204.099 440.49 d N 27 29 N r 232 ACM 2.3i ACM °w 4 ' • ".Go wi7Ow 2O #a" Rim 0917 ' ".so my at NVO FIIOmmm 26 9 3 ^ so 211 AOM • 84 ZW Al o - 507.04 30 `U am IoM = st 1.os s 22• 200 Canty Ad. GG` 313.20 V N : 3 32 33 CL 2.20 Aan t s4 A9n9 R 2 « 31 «e e « ; 1s1. /IOM 203 joss « « « too.so sss.37 z2s Highway GG D RRICK (715) 246-2320 Route 1 pM W New Richmond CONSTRUCTION Wisconsin • REGISTERS OFFICE St. CROIX CO-0 W1 ' Michael R. Stevens, aCC'd for Record William. M.. Derrick, Thomas. E.. Derzick. a.nd... Ronald L. Derrick as. tenants7ln. mmvn of 8:30 ~1. M rnnct•};e !11111 r.arran!r l,r Willow. River.. ~t.oint....•.. . . .1 (1 J ....Venture R~btfll of defld~ t........ . . a to . ..............................1....... Lh~ htlirnvhu! do^r•1 lk it trill ertnte ht g.t.. Croix ...Cmintyr Bl.nle nt 1~ iaconsirl: Tout !'ateel Nos ~I SoutlleaQt puarter of Nvrtltwest HoWleast of Southwest Quarter of Section 18 West. a iVs7! ~j rut I t '1'1111 , ~-~..hb~.• )Itihll•~lt+ild (rrallePEr• . Ih~r~~inl~'.I•,:L.;.: • ~ I 110 (ill no!) Mi-e chill t1• lr•ntrllnt.leb! Municipal and zoning ordinances, easements ~lnd reetrictiond df reeordt ~I Janu r l ....94. Ifrlthrl llrle . "TJ lin n/ ` C:i/ ~"-11811,Afj . Michael 1't. Stev,~ne William M. Derrick ,r ......i. 1r;rA1.) lilt/,~rl~' a!~ lt~c~'... (9; rA1, (fit! t I`~l.l' " • ~ 7'It oas C r 1)e Ck r William 11. Der.rick............ • 9;...., . 1~U W G~~ M 0 N t . nv'rllnlvrIvATtnN -RSif R h - BrArl; !1F WIBCUMBIR - Wi ttt a 11 berr~aki wi~iam M. o'• t7e K K i tt~iiria t mt.t ck.. R.l t;ounis r • - 7"i1 Up ..jl~....,.~.,. tt if rk Inilitl~i~n It!" ell 11th ...J! ;pt d...... J.ln.uAry_j 10-9 Ilerenttnlly cNlnf✓llelnrd.me llde ,:.,.......•.•..d»~ of r~j • - Judith the nbove nnnrctl f o Y-~t t . "AA- ...................................'..19........ ...A. Rem fig ton . ria't.l~: liilrntnrii 9] A117 trAlt or wftxruNSltf ltutlwtlud 6n A 700.00, hGle. Slnfn.) to me knrrten to Ire the pcrsson wl►n exec ute t re lorrooing inatrunlent dntl nchnowledge the Rome. trlln nlsrnutirrlit vsAs annrten nr RF:MIrNGTQN• i,llW OFf'CS ..Coon No W K ~n,5!10].'1 Nnt1r~-~ t~llltitc (IIminfurry nrnp lip nulhrlrf.irnletl m• orlcnl'Orthefl. Itnl•h M!' mlIIIIII inn In petntnncnt.(I( trot, "Into etplrnli»a me no! Itecc:la»1'x•1 rinl.et 19.........) "'+nvt tit nrrennq •Ir.ttlnp In nnr rn1•nr111 idimtbl he :Ip...l n prlnbd hrlmr Ihrlr rlj!nMtITrq. q'1•rrnn^in 1.1 of Irln„y t'... If.,. a!nnnnnrtt nr-rill etAY~ I•lll of tvtPCnNlItN .1!..