HomeMy WebLinkAbout026-1109-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
563877 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)I.
Permit Holder's Name: Village X Township Parcel Tax No:
Wayne, Elijah City Richmond, Town of 026-1109-90-000
CST BM Elev: Insp. BM Ilt IBM Description: ( Section/Town/Range/Map No:
Vl 04.30.18.617
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic G t t / Benchmark
Cat
Dosing Alt. BM ,4.,,
5 Zip F~
.r 1, 9r-~5
e~ ~1 Bldg. Sewer L
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 9~16S
TANK TO P/L WELL BLDG. CZ!nl)o Air Intake ROAD D*Iftter 47-4. 95
gO~ Y % 3 Dt Bottom y , 7
Header/Man.
Re"Tr r lo
Aeration DD Dist. Pipe g 3
Holding Bot. System C1.1 /G r 3
PUMP/SIPHON INFORMATION Final Grade z.-7 ?v 7
Manufacturer Demand St Cover 7
GPM
Model Number
TDH Lift Friction Loss System TDH Ft
Forcemai Dia. Dist. to well
SOIL ABSORPTION SYSTEM (3) S -r- A- ~^+-a- ^a Eck
Ael-
BED/TRENCH Width Lengtyf No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 L[ eta
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type ~~System:, .O -5 1-7 UNIT Model Number: 14 5
t/tu'rLr' ~LV4~ o'
DISTRIBUTION SYSTEM lad- t L4- /S 4- a /53 /13 s
Head er agjfGldi Distribution x Hole Size x Hole Spac ng Vent to Air IntgV ,
Tf~T Pipe(s) Q/~+ Z2S
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/S ded xx Mulched
Bed/Trench Center Bed/rrench Edges Topsoil
4 No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1175 Carroll Street N w Richmond, WI 54017 (NE 1/4 SE 1/4 4 T N R18 ) Viebro_ck_s,_ River Valley Addition Parcel No: 04.30.18.617
1.) Alt BM Description = ' '1 lz &a.., pl j ( Id I AC,,J
2.) Bldg sewer length = b a Y~ O Otj
- amount of cover = i 4 old k Gp✓[.~.~
J G~►a. e Z _ -ft roe- r~
Plan revision Required? ❑ Yes (No 4
Use other side for additional informs Zn. V
Date Insepctor's gnature Cert. No.
SBD-6710 (R.3/97) ^ TZ~ j r
PLOT PLAN
PROJECT Eliiah Wavne ADDRESS 1175 Carroll St. New Richmond Wi 54017
NE 1/4 SE 1/4s 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/13/13 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857.4 # of chambers 42
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P . Same as Benchmark
SYSTEM ELEVATION 93.4/93.3/93.2 5+' below qrade
Property Line
Fence 2510
'
All piping shall be SDR 30/34, within 10' ents
of tank, piping shall be Schedule 40. -\ON B-1
3-3' X 58' cells
Huffcutt ST with >3' spacing
Old drywell is
to be pumped 10, [5
and buried
ST B-3
A 4x~' Pool
Existing 4
Bedroom 30'
House
0
16
12'
Well 30' 15- -
0.4 30 ' 2
15 B.M.*
Scale is 1" = 40'
unless otherwise
noted
Vent^~-
>6" Quick4 Standard
Leaching Chamber
of Cover r°
wi 20.0 ft2 of Area
ft^2/pair of end caps
Carroll St. Long 12 '53 4" Grade at System Elevation
Property Line
- - County
industry Services Division _
t 1400 E Washington Ave Sanitary Permit Number (to be tilled in by Co.}
P.O. Box 7162
7
Madison, WI 53707-7'162 5/ 3 g / /
Slate Transaction Eb Sani tary Permit Application In accordance with SPS 363.21(2), Wis. Adm. Code, submission of this form to the ttpp gavernunit is required prior
to obtaining a sanitary permit. Note: Application forms for state-owned PdW re subrr a Project Address ierent (hart t cling address) eCf'
the Department of Safety and Professional Servies. Personal information you P1`04' be u§d3orsecon rro
ttr ses in accordance with the Privacy Law, s. 15.04(1)(m), Stats.
I. Application Int''ormation Please Pn I lnf'or" bn___- ~f~ -Parcel u - - -
Property Owner's Name.
Property O is Mailing A?cidre`s Property Location 6/7)
- Govt. Lot
City, State . Zip Code Phone Number 1A ection
) _ -
rein or W
r+
II, Type of Building (check all that a )ly) Lot _
nr 2 Family Dwell ng - Number df Be ooms.-._ Subdivision Narne
r~C~t.v+s a
.00 ❑ Public/Commercial Describe Use - F] City
CSM Number Village of
❑ State Owned - Describe Use ,y-~ 1 Y~ Town of _
14 td6%0%~ rel., _ _
FEBI.U of Permit: (Check on y one box line A. Complete line B if applicablNew System ❑ Treatmentllfolding Tank Replacement Only ❑ Other Modification to Existing System
(explain)
Number and Date Issued Permit Renewal CJ Permit Revision ❑ Change of Plumber j❑ Permitiansfer to New
Before Expiration Owner
IV. Type of POWT'S System/Component/Device: (Check all that u~ply) _ ~ c`?
on-Pressurized ln- rid ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable: soil 0 Mound <24 in. of suitable, soil
[I Holding lank [-1 Otl r Dispersal Component (explain)❑ Pretreatment Device (explain)
- - - - -
gn r (gpea Information:
D - --D-is - i"l A a Pro- Poscri (s1) S, tern Ele ti , -
r • guiled (st)
Design Flow low (gpd) eat Ar Ueslgn soil Application Batt: pdsj Dispersal A Be
1. Tank Capacity in Total got, M utaetur C/,~~ aJ c v
Gallons Gallons Units v U U v 4
y
New"ranl;s Existing Tanks I -
a. U N
Septic or Iinlding'rank
Dosing Chamber U -
Vii. Responsibility Statement- 1, the undersigned, as' -esponsibility for installation of the POWTS shown on the attached plans`-
Plum ignature MP(MPRS Number F3usmess Phone Number
Plumber's Name (Print)
Plumber's Address (Street, City State, Zip Code ~0
--zb -
'V 11 unt /llc artment L)se Ortly_-
Permit I ee Date slud Issuing Agen "nature
pproved ❑ Disa d $ /4//3
en Reason or Denial r - - - -
_ -
SpS 3 ' 43
IX. Condifis?t' RtasUns t'or,Uisapproval A
1 Septic tank, effluent fittefand + e j Z'Q GoQ~ P
,'dispersal cell must all be servtces I maintained Std- ~O
as per management plan provided by plumber. / ° tik rr~ P+
2. Alt set - k requirements must be:,tnaintained D5~ ~N0 ✓e H- d'O _ C
as pey sppkAbW node rtxdwilli s 5 ,f r►~
FLttaCh to complete plans for the system and submit to th ounly only on paper nol less than S 112 _X1 1 inches in size
1:
- R03
SBll 6398 ( )
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/13/13
Owner:Elijah Wayne
Location: NE1A SE1A S4 T30 N,R18W 1175 Carroll St. Richmond
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0) j
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specification Sheet
8.-10. Soil Test
Signature
License number 26900
PLOT PLAN
PROJECT Eliiah Wavne ADDRESS 1175 Carroll St. New Richmond Wi 54017
NE 1/4 SE 1/4S 4 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/13/13 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 857.4 # of chambers 42
BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 93.4/93.3/93.2 5+' below qrade
Property Line
21
Fence
50'
Vents 5 ,
All piping shall be SDR 30/34, within 10' B-1
of tank, piping shall be Schedule 40.
20' 3-3' X 58' cells
Huffcutt ST with >3' spacing
Old drywell is
to be pumped 10' j
and buried
ST B-3
L ~t Pool
Existing 4
Bedroom 30
House 0,
12'
Well 30,
0.4 30' 25'
L15' B.M.*
Scale is 1" = 40'
unless otherwise
noted
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
wi 20.0 ft2 of Area
ft^2/pair of end caps
Carroll St. 4' Long 12" GJ. k
3 4" Grade at System Elevation
Property Line
~L
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 ~n2 pair of end plats P(Z. To be >1' above grade
dCC Finish grade elevation
Typical Installation 98.5'
Vent ACI Grade Vent
4' 4" 4'
,A ~~30/34 Septic Tank
4' Long 5' 4' Long 1
Grade at System Elevation
34" Grade at System Elevation 3499
Spacing 5'
3-3' X 58' Cells
Observation tubeNent
Same on other end To be located on end of Cells
%A
B
System elevations: C
A-93.4
B 93.3 14 chambers per cell
C-93.2 16 1 C 11 (t C~ 1
POWTS OWNER'S MANUAL & MANAGEMENT" PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ice
Septic Tank Capacity 1 o?d'O al ❑ NA
Permit #
Septic Tank Manufacturer L~Ah
DESIGN PARAMETERS Effluent Filter Manufactrrer NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units NA Pump Tank Capacity ❑ NA
al
Estimated flow (average) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate _ al/da /ft2 Pump Model NA
Standard InfluentlEffluent Quality Monthly average* Pretreatment Unit NA
Fats, OH & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ 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 -Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size 16 in dia. ❑ NA Other: NA
Other: Other:
❑ NA NA
*Values typical for domestic wastewater and septic tank effluent. Other: NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ months) (Maximum 3 years) ❑ NA
ear s
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑~month s) (Maximum 3 years) ❑ NA
] ear(s;,
Clean effluent filter At least once every: ❑ monthi s) NA
years;
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
❑ year(s
Flush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other:
At least once every: ❑ month(s) ❑ NA
11 year(s)
Other:
NA
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 (X) 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.
Page of
START 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 Ooerator prior to restoring power to the
effluent pump or contact 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 scrapE,; 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
////11 (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 MAINTAINER
Name r✓
_ Name
Phone 7) J Phone
r~ 6 s
SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY
Name Name V. Phone
r.
L 1 Phone ELI 3Z6", Z)
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MADmANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnexBuyer ,
MOing Address s~•
property .Address >
lbr new .
(vin required from Plammng Zoning Department
City/Stair Parcel Identification Number
~r~Ar . DFS(''R~O~1
Is ec. / T ZjL)N R-/.)W Town of
Property Location 114
Lot #
SLI~dTV1310IIv/~ D
~ Volume ~ Page #
Certi$ed Survey Map
Volume page #
Warranty Deed # .
Spec boase yN Lot l>nw leidentifiab u no
gj STE,yr iur s RMNANCE AND nwlyER CERTII+'ICATION
could result in its promstat bib= to dandle wastes. Proper
Iuvroper use and mammmmaae of yaw Septic tbreem years or seance, if needed, by a Housed Pte. ~ you 1c' Mto .
msintww= conai~ of out &c scQtic tank every in
the waste disposal systeaa O m
the system can affect the futon of The septic tank as a
b33ities are died in. §Camm. 83.52(1) and in C2 qyw 12 - St- Croix County Sammy Ordinance-
-rho Ixoperty owner %"a do aabarit to St. C; ro= County pls=Mg & Zo=8 Dqm~ a c tion fe= signed by the
owner and by a master pbndxn job Plumber, restciow phanber or a licensed paw vaWni8 that (1) the on-Site
wastaaater disposal system is in Vzapm operating condition and/or (2) atbw insPeodm and V=Ving (if the wgAjr- teak is
less than 1/3 full of dange,
f0eft bmsin- as set have lead, the above re4 ts and agree to twiatLn the Paivate savmp disposal with the set by the Dcpanmenx of C==erw and ft Department ofNomal R,esouraa.
state of Wisconsin.SYs C bficabon stating em your Septic System bas been noses amst be copleted returned to ft St. Croix County Planning &
quw&rds
Zoning Dqmmant widen 30 days of *e three year won date.
Uwe M ft dint all atatao MU on this form are to the best of my/our knowledge. Uwe mare tie oovaec(s) of the
property &mibed above, by of a warranty deed in Register of Deeds Office.
Number of bedrooms J 3 it
0 DATE
4SIA APPLICANT(S)
***.Any iaformmtiontlmt is heated my result m the sanitary permit being revaW by the P18,8 ft & Zooming Depart tin
hwhide with this applies ion a recorded VMS!. ty deed from the Register of Deeds Office and a copy of the Mt fMd survey MV If
reference is made in the warranty dee&
ot". 08/05
t'llaTER CARTRIDGE INSTRUCTIONS
Ylis~~a~fta~
:iii- FP I Dry ilt the OW, caw -MW Om tritd of tho auMat pyre to erm uro it 14
cohtwead -4wr tim ►rcererYc ea onrhg. If nea, thm Wow ins'ar•t mom pipet info the
taste through oft auk" 4r• .dvaak ward (vbm) additluhaf phn ahta the uutlei
pipe.
SYeP a WIA an spare as dry mnea on tote aWl1¢'t prioe, awam"W w tiro laaph
of W/-W& Wp nw- Mllrl t**Vaca; tho after to OW tiAlt and *A 0 UdifUWIO the
uptlamw 7wp!°"'~ > sarrp-t. If *ids aseppnrt tnarth,rad is hg4 *14td,
proceed in Aq lour}
y.. Fr 4 Poi if tit lsirip! tha alrttatulaupo oh>,rutAd side support,
sok%*A vMW I~e >fl,-#nch jriyu a:ILu flue *a& air- if We support Maltiod is '"A
utillaed, trra5l did 'ko 0eu atl /y
•l"r yv3;y '
5lrtiry Wall0 NIO Met virse IIMa tha ntllltrt Wtse. lncart tore hitel WNW:;
~eart"ge inu a rewr, P usitl.1 dam MW On £Ilw kv&6 lrttn tlta boar r;, 011
;;'+tw
if a L~ks s>r rar da [rHli ecJ irrecatk isetru tlra It'ker and lurk by turno.tj
clock
Wise 90b. ~ y~,f',:;,~
1~7~+9~iiiIPtCE
L The afgeierril "its, nhouyd be cNWmd avesy tiarrct
5arvicad. the ac►rtfc fclhlt is
1.. Upan the anklet aacas'e opel;ilrp to Ir76prrCt the rupk ahd Hitter, f
riurrtp 1$rq 7Cnrertlc t+enk 'L
c*+rraphttefy, h"kitrg sure to rgrrloV'a L'
1aVa w the iwktarrr of Ole tnk and tW sludy u
hpt
a. ehrcx tl,e affuahr rover r • just the acgrrr ohd et llrarrt.
cam L'aan towwred 7tL
outlet pipe, firma Uh'Up uq rtra triter handle thu IrtvrlYt of till'
rrrtrldyw h'orlr tlrB c'k5v, dltslrtd(ta file
5 s!!de the r'a-irld w It¢ aard ol11 ut thu rrwa r>Y ~rr~Irrbrg, `
G, 118 VHS 5wkrb cah►rerc:rcrl to atru afar r
sad.
hould be reir..LOV60 by torgin. c t t iS 1rhr8dnt. file
with avatar utdy, V Qurrtnrrlscrtwl3ia 9[)- switch
find d'er o d
r WhMe huliliny tsbe MrbYdfie oti its Iade (tarlr s T•%
down) uYer'd7r' bcrbsn. u a rtat• su
arrly, rrrakHty zFUra all lyeralrl r why" aN'the t:IlrtYlr( gca f[yclrrg .
raratortal is drr:ygd track f1 tvitft WtrtriY ,A
fL IY VR& bweftch Is utilized r ►nkrr tlrrr tern .
tuenir ' °'a by Ureurtlrr into Hltrrr rrrrd A~. ,
!p c~adnn4fse rJU°.
J, Yrrsart tore ffltnr c:,v - ••''i~Nb~~.
the rptal, tuafcc Kridek° bank into late • , L" .
Irku the Loy 'mss ltrva;sit 5l Tl
i~plac~ bad SWCifYB Cbb ihutrr tat thar tasa, dnWrr unt►f
cel~m '"hkrk tih w
fife t74nlt.
t:: to- :rr:. •'ri. "yr; r .1 [ tT
~ t ilwt t.I.::aai!rlra
(653.4.6
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank
:=~c~rving the
!i ' c1/1i (,v presently
residence located <3t:
Section
` T 30 N, R '
Upon inspection, T certif ~t W, Town ~,g
the tank and baffles to be y hat r have found
in good condition, and it appears to he
functioning properly,
i-ast time serviced:
1i-d flow back occur
Y e from absorption system?
No . (If . no, skip next 1 ine)
Approximate volume or length of time;
gallons minute:;
~Ipacity:/z&-1-0
Construction: Prefab Concrete
_X__ Steel Other
A91~t n u f a c t u rer : known)
(If
Aee (If known
`
(~/~Plea`se~~---------'
(Name ~(Title)•2
(License Number)
13 _r ~
I-1 , Fe-
o
Porm to be completed by licensed
Statutes) or Licensed Disposer (NR 11lumber (s.14.06, isconsin
Code)
3 Wisconsin5Administrative
- - - - - - - - - - - - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:- _ y
In accepting the above statement regarding existing septic tank
condition, I certify that the tank to the be
conform to the requirements of ILHR 83 Wi of my knowledge will
inspecti n o eni Adm. Code (except for
P/ r~,g over outlet baffle) .
Nam
Signature MP/MPRS ZZ-6t/
U 2 6 0 8 P soy 767633 i~
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
This Deed, made between Thomas J. Green and Jody R. Greens RECEIVED FOR RECORD
husband and wife Grantor, 07/02/2004 09:45AN
and Elijah Wayne, a single person WARRANTY DEED
Grantee. EXEMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE : 11.00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE : 552.00
(if more space is needed, please attach addendum): COPY FEE:
Lot 18, Viebrock's River Valley View. St. Croix County, Wisconsin. CC FEE:
PAGES: 1
Recording Area
Name and Return Address
David J. Estreen
304 Locust Street
Hud-c on, W!, 54016
026-1109'90-000
Parcel Identification Number (PIN)
This is homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this r day of May 2004
tas J. Gre I
* * R. Gre
AUTHENTICATION ~qq ACKNOWLEDGMENT
Signature(s) Thomas J. Green and Jody R. Green STATE OF (W ,'SCJrJ,-.1 )
husband and wife ) ss.
- - ('~u t K County
)
authenticated this day of May '2004
Personally came before me this Sf day of
W _ ~~p +f the above ~named
y 4) 01 r- 5. a * Kristin Ogland ( d 7k 0-ok "I 'In rk CIA TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me 4 own to be the person(s) who ex oing
authorized by § 106.06, Wis. Stats.) inst ent and acknowledged the S.~.
O.
THIS INSTRUMENT WAS DRAFTED BY _ y
Attorney Kristina Ogland t
Hudson, WI 54016 Notary Public, State of S. _
My Commission is permanent. (t~ s '~xt ort~d
(Signatures may be authenticated or acknowledged. Both are not necessary.)
* Names of persons signing in any capacity must be typed or printed below their signature. tnfonnatio and du Lac, W1
STATE BAR OF WISCONSIN 800.655-2021
WARRANTY DEED FORM No. 2 - 1999
5 2
'190, 26
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Addifion Town Richmond
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
I rd ce with Comm 85, Wis. Adm. Code
County
Attach complete site plan p of le an 81/2 x 11 inches in size. Plan rt t ` ~a ~x
include, but not limited to I an zontal reference point (BM), direction and rcel I.D. /
percent slope, scale or di Io , north arrow, and location and distance to r~arest road. ! oa (j /
Please print all information. G r Q Revle by Date
Personal information you provide may be used for secondary purposes (Privacy Law, ifi ~ 5.04 (1) (m)~ G
Property Owner Prop lotion
Govt. Lot 4 1 /4 1 /4 S T-:~'p N R J E( W
Property Ownet"ailing Addre Lot # Block #
Subd. Name CSM# ,-,-e3g Q AY z 2i G~dC/ l
City State ! Zip Code Phone Number ❑ City ❑ Villa a 'Town Nearest Road
14,j =
s / (6~ 6 Goa O
'
❑ New Construction Use Residential / Number of bedrooms Code derived design flow rate ai!9- GPD
eplaoement ❑ Public or oomm F ial - Describe:
Parent material ,cFlood Plain elevation if applicable flies ft.
General oarmati C 1~
and recommendndations: J ` ~!c![
A
System Type Z~
System Elevation-?
MY 3,3/9 30
a Boring # Boring
ILL-pit Ground surface elev. _?L, ft. Depth to limiting factor._ a,2 in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If
in. /M>unsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
lL OJ 1 /
Boring 0'/ L
Boring #
'rel 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
13 Al~w I 1i
I~
Effluent #1 = BOD > 30 1220 mg& and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Marne (Please Print) lure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5 7 715-246-4516
Property Owner _ Parcel ID # Pa9a of
Boring # ❑ Boring
F3_1 9Q ~ I
b in.
pit Ground surface elev. ~ ft. Depth to limiting factor
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
► lr a~~ - i a n a~ ,
Z 7 - ~ lam' , r
a S Os Nl Al +7
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor 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
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
' I
Effluent #1 = BOD, > 30 < 220 mg1L and TSS >30 < 150 mgA_ ' Effluent #2 = BODS < 30 mg/_ 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.
SOD-8330 (8.6/00)
Property Owner Parcel ID # Page of
F3-1 Boring # ❑ Boring
Pit Ground surface elev. Ll~ ft. Depth to limiting factor / b in. Soil Application
Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
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
Boring # ❑ Boring
F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 30 mg/1- 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 (8..6/00)
Soil Test Plot Plan
Project Name Elijah Wayne Sha ird
Address 1175 Carroll St
New Richmond Wi 54017 ' T 26900
Lot 18 Subdivision Viebrocks Date 8/13/13
NE 1/4 SE 1/4S 4 T 30 N/1318 W Township Richmond
❑ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Bottom of siding
System Elevation 93.4/93.3/93.2 *HRpSameas Benchmark
Property Line
Fence 29 50'
5'
rB-
Failed
ST B-3
Pool
Existing 4
Bedroom 30'
House 0
12'
Well 30'
30' 25'
B-2
15' B.M.*
Scale is 1" = 40'
unless otherwise
noted
Carroll St.
Property Line