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HomeMy WebLinkAbout026-1126-22-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 569521 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: Brushy Mound Partner hip LLP, c.o Michael R. I Richmond, Town of 026-1126-22-000 CST BM Elev: Insp.BM Elev: BM _Description: Section/Town/Range/Map No: 9 / .Z 6.5 T 12.30.18.783 TANK INFORMATION ELEVATION DATA all TYPE MANUFACTURER ' s CAPACITY STATION BS HI FS ELEV. Septic � ,( 'Z 5� Benchmark ,0 9 v 7 Dosing ro O I Alt. BM (�v / �4 10O.3 Bldg. Sewer �.� I •�n Holding St/Ht Inlet V g.5� � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. vent Air Intake ROAD Dt Inlet Septic Dt Bottom 13.12. 1q Dosing r Header/Man. l�A)Pr 3Lo 36 Aeration Dist. Pipe Holding Bot.System 7.37 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover G's GPM 6 o,)4A_, 12 -74 /60. 34 Model Number 13 f TDH Lift . Friction Los System Hea TDH D 1 /1 Forcemain Length / Dia. /� Dist.to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / I No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS r � �_ _� SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manufacturer: 1!502— INFORMATION CHAMBER OR Type Of System: Ll�& 3o f , //� _ ` 3� UNIT Model Number: DISTRIBUTION SYSTEM PL j N/�� 7 -7><3 Z Header/Manifold It Distributi x Hole Si e x Hole S acing V`ept to Air Intake 004„7 .I Pipe(") � ` Length Dia 4T 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/Sodded xx Mul hed Bed/Trench Center 3 , 15 Bed/Trench Edges Topsoil ` Yes CJ No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / /a / Inspection#2: Location: 1664 Water's&dge Drive New Rich ond,WI 54017(SE 1/4 NW 1/4 12 T30N R1 8W) Water's Edge Lot 22 Parcel No: 12.30.18.783 v Godr�v �a.t�.s 1F- �o��c..3 1.)Alt BM Description= "� D I^- G n °^�c— Aar-'% 2.)Bldg sewer length= Ro wd[ O -amount of cover= T 7, 5 Plan revision Required? Yes to Use other side for additional information. L 7_�.�—(__I �_ _ Date Insepctor' Signa Cert.No SBO-6710(R.3/97) t ' 1 abdcn �dren yza Pd01� m ( �l n r n rcn I d �' I 7C HO rn r Cl b -1- i ro �-A � � X I H O N n H b (ON ~ =1 z / I r�nrci °o ozn LC rl z :" H xj H C) 7d C7 I oo x trJ I'D zilz° cn / I Ov z ` A � S�� _ `� D ' 1 �' -7-,2 s� commerce.wi.gov Safety and Buildings Division County 20 W. Washington P.O.Box 7162 1 gt Ave., V7CO I�S I I� Madison,WI 5 3 707-7 1 6 2 Sanitary Permi Number(to be_filled m by Co.) Department of Commerce Sanitary Permit Application State Transaction LMber In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if di erent than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 1664 WATERS EDGE DRIVE purposes in accordance with the Privacy Law,s. 15.04 1. m,Stats. NEW RICHMOND, WI 54017 I. Application Information—Please Print All Information Property Owner's Name Parcel# BRUSHY MOUND PARTNERS LLC/MICHAEL STEVENS % 026-1126— Property Owner's Mailing Address Property Locatio P.O. BOX 445 C,q�. o � 0,> City,State Zip Code f Phone Number $, ftW '/., Seal,,12 NEW RICHMOND, WI 54017 715-246-2320 rcleone) T 30 N; R (/ r W II.Type of Building(check all that apply) Q k Lot# 2 Subdivision Name :K1 1 or 2 Family Dwelling—Number of Bedrooms �— WATER t S EDGE NT �le,,,, Block# ❑Pub]ic/Commercial-Describe Use ❑ City of CSM Number ❑ Village of ❑State Owned-Describe Use K]Town of RICHMOND 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 ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS S stem/Com onent/Device: Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground At-Grade ❑ Mound> 4 in.of sui le sotl ❑ d<24 in o swtab sotl 2�11 � ❑ Holding Tank ❑Other Dispersal Component(explai Pre tment evt e p am) V.Dis ersaVTreatment Area Information: , 1 Design Flow(gpd) Design Soil Application Rate(gpdsf) 7Dispersalrea Required(sf) Dispersal Area Proposed{sf) System Elevation 600 Q'�li, .6 1,000 ✓ 1,050 96.0 VI.Tank Info Capacity in Total #of Manufacturer S $ ` o Gallons Galtea� Units New Tanks Existing Tanks J a` U cn H N Septic or Holding Tank 1 2 0 1 WIESER Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' nat MP/MPRS Number Business Phone Number PAUL KOEHLER 25410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII.Coun /De artment Use Only Permit Fee _ Date Issued ,Issuing Agent Signs e ❑Approved ❑Disapproved Cd - ❑Owner Given Reason for Denial $ 7� �7 / �1/ - - IX.Co M��easons for Disapproval ���� y 3�� U (�,q tN l 4) ..Ajt� yt4 1.Septic tank,effluent filter and dispersal cell must be seryi.ced/maintained as per management plan provided by plumber. —7 /r 2.All setback requirements must be maintained f'l �'I- as per apolicable code/ordinances. Attach to complete plans for the system and sukhmlt to the County only on paper not less than 8 t/2 x 11 inches in size , SBD-6398(R.02/09)Valid thru 02/11 , CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: BRUSHY MOUND PARTNERS LLC/MICHAEL STEVENS Owner's Name: BRUSHY MOUND PARTNERS LLC/MICHAEL STEVENS Owner's Address: P.O. BOX 445 NEW RICHMOND, WI 54017 Legal Description: SE 1/4 NW 1/4 SEC 12 T 20 N R 18 W Township: RICHMOND County: ST CROIX Subdivision Name: WATERS EDGE Lot Number: 22 Parcel ID Number: 026-1126-22-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber: PAUL KOEHLER License Number: 225410 Date: 0/07/14 Phone Number 715-24fi_2 LfI Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01 101). Page 1 Q � / / ' 1 9tdw td Jf ON C-1 n r n - bd � m 9 � I o o En z cl I'd 7C H t=i rxj m ,d ` , N n H 1 ' N C Cn o rd II H t7l `C pli r � C) o �z0 <'! I z Ho %dH I d4 °° I:IE: o y OQ I xi ril Ul l o J to � . yo 3a �,�� / ,US r- a 1 � ��� 3 70� lrcrc.Lcs SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page_of Project Name: No.of Cells Per Cell ft Cell Width Total No of 7p ft Cell Length .60 sq ft EISA Per Cell ft Cell Spacing �,0 So._sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator E21203H-5ft 5.0' J 25.0 EZ1203H-10ft 10.0' 1 50.0 Gravelless Leaching Unit Manufacturer: 1) ;d'It,'(to-1 Gravelless Leaching Unit Model: Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent Soil Backfill 2L in ` Geotextile Fabric ft Infiltrative Surface 12 in $9 fi ft Limiting Factor 3�� in Slotted and Anchored Vent[ Observation Pipe with Cap Plum berlDesig ner Signature: License#: Date: D z A 86" 86" m r. 53" z z m c D N 0 ^'s' rrl p UP 52" m 4" CAS m D O 0 ;u N _ rn 3" 47" I 4" 0 I o D �a N ' m � D D UP 49" m r cn 4" CAS I N N v -1 N O D O; o 46 C 50 lr=l po D z m m crD N -i D r CO m --i 0my D Vl -rl-i I ?0;u 0 m O D rn� r xA n x D Z O m n _ � z° D z o xs c: z z ; D --4 z D b e m Fnn rn -n 0�m �� D � 2 DOS n o�D c�.D co:MR m>O 0>� T� Cp 00 "00 z o FN p �g� > �np 0p =p 0==� OF cc to l rnp � W = m D D D m00 mD0 ..r N -iD (nN 0 m D (n r-4Z 0 ANC -� nC mZpo Rl� N -�N z m m x �° D DD i Nl--+ A_,N oG�N O D O p D D� N N (nI O 0 \? a D z of E n� 0' FA I m �wF)°t- Zc� �l A v -Di V N t1MZ N C Npm Dr e s p09 C)CA n << I N D � u n 0 m C C mm N W O b'0 s y o� z °w Vii 0 �O \ O Z �M D mD m8 p v m z o 0W C 0<O y ?p ' =rZ r� o D 1 m m A Z � �v z m O Z � p 0 wo '� p Z r 0 O D D °r Om A w O 3 m c z rn Z °z a0 ui p S n o n° o N Fo 0 o c D 0 z H z r N O Z \ = M250-MR MIENER COOCRETE DRAWN BY: SME SCALE 1 4"=1'-0" RE-POUR: rn REV. Orn mi SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:• POST-POUR: \° REVISED JAN. 2010 800-325-8456 FlLE: IMM-0 ' SOIL AND SITE EVALUA N�R'��T Page 1 of 3 Wisconsin Department of Industry, \ , No Labor.ud Huitbih Relations \ ��'7Q Divisis.n cif Safety&Buildings in accord with ILHR 83.0 �5�•'i4d11� Code U� i Ir i Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz ~ n muga de,but 4 p CEL I.D.# not limited to vertical and horizontal reference point(BM),direction and /` slope,scal;orb 20� �Z�y//2��� dimensioned, north arrow,and location and distance to nearest road. _ \L\�-S� CADY EWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI $t C �UN,GF�G� f=EF3.o 2'�p PROPERTY OWNER: P R CATION, `�`a k •. 1�A 1/4,S 1 T ,N,R 1. 2(or)W Derrick Const. Inc. W �Q, PROPERTY OWNER':S MAILING ADDRESS LOT# UBD.NAME OR CSM# na 1505 Hy. CITY,STATE ZIP CODE PHONE NUMBER [-]CITY ❑VILLAGE [MOWN NEAREST ROAD New Richmond, WI. 54017 (7 246-2-120 Rirhmc)nrl [x] New Construction Use [ Residential/Number of bedrooms 41 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate •5 bed,gpd/ft2 .6 trench,gpd/ft2 Absorption area required 1200 bed,ft2 bench,ft2 Maximum design loading rate .5 bed,gpd/ft2 .6 trench,gpolft2 Recommended infiltration surface elevation(s) 95.60 ft (as referred to site plan benchmark) Additional design/site considerations trenches--r-la paced to code 3.50' below grade Parent material outwash over drift Flood plain elevation,if applicable na ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable fors stem ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U ❑S ❑U SOIL DESCRIPTION REPORT CcQD .,,_, S ( � Depth Dominant Color Mottles Structure Roots GPD/ft Boring# Horizon P Texture Consistence Boundary ged Trer>ch in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. 2m 5 1 0-11 10 r 3 3 .:::::........... 2 11-24 10 r 4/4 none sici F -q Ground 3 24-72 7.5 r 4/4 none _ elev. 'S 98.9 ft. 4 72-84 5yr 4/4 none sl mfr na na Depth to Q S'. a� limiting factor F-T - Remarks: Boring# .S 1 0-12 10 r 2 12-28 10 r 4/4 none sici 2msbk mvfr qw if .4 .5 3 28-70 7.5 r 4/4 none is oSQ mvfr if .7 8 Ground ,s elev. 4 70-84 5 r 4/4 none sl 2csbk mfr na na .5 .6 98.9 ft. Depth to limiting 39• 5.6 factor +84" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave Richmond WI 5M217 Signature: Date: 6-15-2000 CST Number: m02298 PROPERTY OWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT I Page 2 *of 3 PARCEL I.D.#_e n d i n g l i t Consistence Bounda Texture ry Roots Boring# Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu.Sz.Cont Color Gr. Sz. Sh. Bed Trench 3... 1 0-10 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 .j 10-24 Ground 3 24-66 7.5 r 4/4 none is os elev. mvfr if .7 .8 99.1 ft, 4 66-84 5yr 4/4 none sl 2csbk mfr na na .5 .6 •S Depth to limiting factor+84" Z Remarks: Boring# 1 0-12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 1� 2 12-26 10 r 4/4 none sici 2msbk mvfr qw if .4 .5 Ground 3 26-73 7.5 r 4/4 none is os mvfr C1w if .7 .8 } elev. 4 73-84 5 r 4/4 none sl 2csbk mfr na na .5 6 99.6 ft. ,S Depth to limiting 8 g c r factor +84" Remarks: Boring# 1 0-10 10 r 3/3 none 1 2msbk mfr cs 2f .5 1 .6 5 2 10-24 10yr 4/4 none sicl 2msbk mvfr gw if .4 ' .5 Ground 3 24-68 7.5 r 4/4 none is MCI mvfr Crw if .7 .8 elev. 4 68-84 5 r 4 4 none sl 2csbk mfr na na 6 99.6 ft. Depth to limiting factor +84" Remarks: Boring# Ground A elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SE4NW4 S1.2-T30N-R18W New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #22-Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. /1"=40' = to of 1" pvc pipe @el. 100.00' Al _ t. BM = top of culvert C el. 99.10' 0 � z e cam` Gary L. Steel 6-15-2000 s " ' , � rll , •11 � :: - ' � •• ii�l it . ' Mllfll �l�l VIP- ,w�� �iu� 0 ;1 , ,• of 11111 rL^'. • . O • O . of .• 1 OPM IllockwuNIVA O O o '• p � C n , 1 i .M INSTALLATION INSTRUCTIONS Inc. !&!W!JSr.Wa.sr t3��ft-mg n a la PL-525/PL-625 FILTER ProGi.;s -A dmicrt o`°oylak Mu. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: e Rated for 10,000 GPD .PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL.-525 PL-625 •Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently i Built in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS . Potylok PVC Filter Extension Handle IPVI,� � } Risers&Riser Covers ---- _._--Extend& Cok­w-------__ -- — Rise Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend&LokTm Polylok safety screens SinartFilterT"'Control septic tank cover to grade. is a simple, easy is use prevent tragic accidents Potylo This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling,into open and switehs provid visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nesting digging to find tank installation a snap. impending.filter and tank entrance. Fits 3"and 4"pipe_ servicing. For a full list of Polylok products please visit our web site at: www.polytok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page � of�! FILE INFORMATION SYSTEM SPECIFICATIONS Owner BRUSHY MOUND PARTNERS LLC/MICHAEL STEVENS Septic Tank Capacity 1250 qa( ❑ NA Permit # Z Septic Tank Manufacturer WIESER El NA DESIGN PARAMETERS Effluent Filter Manufacturer OLYLQK ❑ NA Number of Bedrooms 4 Q NA Effluent Filter Model DNA Number of Public Facility Units 12 NA Pump Tank Capacity gal 0 No. Estimated flow(average) 450 gal/day Pump Tank Manufacturer In NA Design flow (peak), (Estimated x 1.5) 600 qal/da ❑Pump Manufacturer NA Soil Application Rate .6 al/da /ft2 Pump Model lI NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease 'FOG) S30 mg/L I EJ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ® NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSSI 5150 mg/L ❑ Disinfection ❑ Other. _ Pretreated Effluent Quality Monthly average Dispersal Coll(s) ❑NA Biochemical Oxygen Demand (BUDS) S30 mg/L M In-Ground (gravityl ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) S10' cfu 110Oml Cl Drip-Line 17 Other: Maximum Effluent Particle Size Y in d(a. [it NA Other: ❑NA Other: 15 NA Other: ❑ NA *values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service frequency Inspect condition of tank(s) At least once every: 0 month(s) (Maxinw n 3 years) -❑Nit 3 M ears) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,)of tank volume ❑ Nit Inspect dispersal cell(s) At least once every: 3 0 month(s) (Maximum 3 years) ❑ NEi ®yead s) ❑ month(s) Q NA Clean effluent filter At least once every: 1 t year(s) Inspect pump, pump controls& alarm At least once every. 0 m ar(&) l L7 , ❑ ear's) Flush laterals and pressure test At least once every: ❑month(s) 91 NA ❑ year(s) Other At(east once every: O❑month(s) ] NA Y Other: 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 surfaos. 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 if ie immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entice contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11,1, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerit units,:and any servicing at intervals of S12 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. LgjUI Pago Z of 2' 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 ohemic: that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conten 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 k discharged to the dispersal eel((s) in one large dose, overloading the cells) and may result in the backup or surface discharge r effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t 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 are 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 th 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; ail 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 ii 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 S eptage 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. T E Y CON ING NC PLAN If t WTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant re cem nt system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkon YstOm- 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 Mas and wells. Failure to protect the replacement area K III 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. Th -W/91 ,) alua ' o i^8 ik be a ar �ZO(-t'187TL�D► �Oi�N CONS`77211��� ❑ 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 NC T 1`NTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS r POWTS INSTALIAR POWTS MApVTA1NER Name COUNTRYSIDE PLUMBING & HEATING INC Name PAUL KOEHLER Phone : 715=246-2660 Phone -. 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORETY Name POWERS LIQUID WASTE MANAGEMENT Name :5t" GO r-U- � 2OtJ1 Ai 715-246-5738 Phone -7/S— �e - This document was drafted in compliance with chapter Comm 83.22121(b)(1)(dM(f) and 83.54(11. (21 &(3). wiscomin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM n Owner/Buyer tic -ice L-- R-1 P'1 5 M13,A►_�p - �- Mailing Address .i L" Property Address k n,1c3 — (Verification required from Planning&Zoning Department for new consttuc on.) City/State ), Parcel Identircation Number L }'Z k, - ZZ- QI � LEGAL DESCRIPTION Property Location 5C '/a , W% , Sec. �Z– , T N R j 9' W,Town of Subdivision ���'�-} �1J l=i� , Lot#2�21 Certified Survey Map# , Volume , Page# Warranty Deed# (40 v ' `Z '°( , Volume ��'' 1 , Page# Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its ptemature 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. Uwe,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. Uwe certify that all statements on this form are true to the best of my/our knowledge. b'we am/are the owner(s)of the property descn d above,by virtue of a warranty deed recorded in Register of Deeds Office. Number bed 0 IGffiATTJRE OF._ PLICANT(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 4 reference is made in the warranty deed. (REV.08105) - , ' 2 -7 % STATE BAR OF WISCONSIN FORM 3-1998 KATHLEEN H. WALSH k=ent Number WARRANTY DRED, REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners,LLP,a Wisconsin limited liability partnership,Grantee. Grantor,for a valuable consideration, conveys and warrants to Grantee 06-03-1999 9:30 Alf the following described real estate in St.Croix County,State of Wisconsin{The VARRANTY DEED "Property's: EXRTPT I FEE: See attached Exhibit"A" COPT FEEL - RH L i60 O FEE: Z2.0Q 4 Recordinr Area ' _ _ __ _ _...--_---_- --- ., _ _ _.._.__...._ .__._t•[amcatadStemmaddmu.__ _ Headrick W.Van Dyk {rwDYSy O'B0=&SILER,S.C. PostOdleeBox 127 Ntw-?Jchmood,WI S4017 Pmt of026-tM,3( 6W--026-1037.45000 atuf�tn3�:t!r-coo — Patret Identification Number(PIN) Thls-J=L-homeuead property. Exceptions to warranties:Subject to all easements,restrictions.and covenants of record. Dated this Z th day of May , 1999: *David L.Nuer • _ e r AUTHENTICATION ACKNOWLEDGMENT Signature(:) David L. Nasar STA73OFWISCONSIN._ ' ---- - —3SL — -- authenaw d thy,28 hday of May ,1999, peraona4r oamo before we this day of 29_ the above named ------------_ to=ner knoWa to be.tlra Teraoafr)_who oxeeuvA the,[on goipg a Herrdrik�i�:_Van_DYk-"- a o. ,J TITLE:MEMBER STATE BAR OF WISCONSIN' r (if not, i authorized by 1 706.06,Wis.Sate.) _. --- THIS INSTRUMENT WAS DRAFTED BY Notary Publics State-of Wisconsin Hendrik W.Van Dyk My Commission Is-permanent. New Ri6hinond.WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) . 1�31PAG�170 Exhibit "A" That part of the following described property lying in the SW 1/4 of NE 1/4, the SE 1/4 of NW 1/4, and the NE 1/4 of SW 1/4, all in Section 12-30-18: A parcel of land located in part of the NW 1/4 of the NW 1/4, part of the NE 1/4 of the NW 1/4, part of the SW 1/4 of the NW 1/4, the SE 1/4 of the NW 1/4, the NE 1/4 of the SW 1/4, part of the SW 1/4 of NE 1/4 and part of the NW 1/4 of the SE 1/4 all in Section 12-30-18, Town of Richmond, St. Croix County, Wisconsin, described as follows: Beginning at the W 1/4 corner of said Section 12; thence, on an assumed bearing along the W line of the NW 1/4 of said Section 12, North 00 degrees 47 minutes 04 seconds West a distance of 780 .46 feet; thence North 88 degrees 43 minutes 02 seconds East a distance of 407 . 01 feet; thence to the approximate center line of Paperjack Creek, as said Creek is presently located, North 00 degrees 47 minutes 04 seconds West a distance of 335 .28 feet; thence the following being along the center line of said Creek as presently located, North 73 degrees 13 minutes 39 seconds East a distance of 400 .03 feet; thence North 82 degrees 14 minutes 29 seconds East a distance of 254 .52 feet; thence North 45 degrees 31 minutes 23 seconds East a distance of 116.47 feet; thence North 79 degrees 35 minutes, 57 seconds, East a distance of 218 . 00 feet; thence, North 33 degrees 50 minutes 42 seconds East a distance of 172 .37 feet; thence North 18 degrees 00 minutes 28 seconds East a distance of 176 .13 feet; thence North 73 degrees 30 minutes 33 seconds East a distance of 201.74 feet; thence South 66 degrees 40 minutes 00 seconds East a distance of 422.90 feet; thence South 87 degrees 13 minutes 12 seconds East a distance of 176 . 07 feet; thence North 86 degrees 22 minutes 15 seconds East a distance of 378 .15 feet to the North-South Quarter line of said Section 12 ; thence, leaving said Creek, South 00 degrees 16 minutes 21 seconds East a distance of 611 . 71 feet; thence South, 49 degrees 40 minutes 01 seconds East a distance of 580 .02 feet to a point in Brushy Mound Lake; thence, along a line in said Lake, South 06 degrees 46 minutes 19 seconds West a distance of 1613 .62 feet; along a line in said Lake, South 33 degrees 33 minutes 14 seconds West a distance of 435 . 55 feet, this being the SE corner of the NE 1/4 of the SW 1/4 of said Section 12 ; thence, along the S line of the NE 1/4 of the SW 1/4 of said Section 12, being in parts in said Lake, North 89 degrees 37 minutes 24 seconds West a distance of 1306 .68 feet; thence, along the West line of the NE 1/4 of the SW 1/4 of said Section 12, North 00 degrees 21 minutes 52 seconds West a distance of 1323 .00 feet; thence along the South line of the SW 1/4 of the NW 1/4 of said Section 12, North 89 degrees 34 minutes 56 seconds West a distance of 1308 . 82 feet to the point of beginning. d 1 INI � z N l IV 7— /19 L.A) � � ►Soo ' n , I � � w m / s ca r e STATE OF WISCONSIN BILL NUMBER: 251152 t REAL ESTATE PROPERTY TAX BILL FOR 2013 IMPORTANT:Correspondence should refer to parcel number. See reverse side for Important information. TOWN OF RICHMOND Be sure this description covers your property. This description is for property tax bill only and may not be a full legal description. ST. CROIX COUNTY 630775 ACRES: 2.000 SEC 12, T 30 N, R 18 W, SEX of NW% BRUSHY MOUND PARTNERS LLP SEC 12 T30N R18W PT SE NW WATERS EDGE PO BOX 445 LOT 22 2.000AC i NEW RICHMOND WI 54017 Parcel#: 026-1126-22-000 Property Address: 1664 WATERS EDGE DR AILParcel#: 12.30.18.783 Assessed Value Land Ass'd.Value Improvements Total Assessed Value Ave.Assmt.Ratio Net Assessed Value Rate 25,700 25,700 1.0367 (Does NOT reflect credits) 0.016030489 Est.Fair Mkt.Land Est.Fair Mkt.Improvements Total Est.Fair Mkt. A Star in this box School taxes reduced by $49.40 24,800 2 4,8 0 0 ❑ means Unpaid Prior school levy tax credit Year Taxes. 2012 2013 2012 2013 x Tax Taxing Jurisdiction Est.State Aids Est.State Aids Net Tax Nat Tax Change Allocated Tax Dist. Allocated Tax Dist. 4.16 4.21 1.2% STATE OF WISCONSIN ST. CROIX COUNTY 83,186 78,369 101.54 106.02 4.4� TOWN OF RICHMOND 167,634 167,713 31.87 33.11 3.9% SCH DIST NEW RICHMOND 4,438,629 4,753,142 260.06 237.58 -8.6% ' WITC 21,087 21,738 30.41 31.07 2.2% Total 4,710,536 5,020,962 428.04 411.99 -3.796 First Dollar Credit Parcel#: 026-1126-22-000 Lottery&Gaming Credit 428.04 411.99 -3.7% Net Property Tax Make Check Payable to: Full Payment Due On or Before January 31,2014 Net Property Tax 411.99 ST CROIX CTY TREASURER $411.99 LAURIE A. NOBLE 1101 CARMI CHAEL ROAD Or First Installment Due On or Before January 31,2014 HUDSON WI 54016 $206.00 715-386-4645 And Second Installment Payment Payable To And Second Installment Due On or Before July 31,2014 ST CROIX CTY TREASURER $205.99 LAURIE A. NOBLE 1101 CARMICHAEL ROAD HUDSON WI 54016 7panalty. F, FOR FULL PAYMENT 31, 2014 411.99 paid by due dates,installment option is lost linquent subject to interest and,if applicable, ailure to pay on time. See reverse. i x Vi�aa,, .�i�j9•�j�� �" 1��0 23� 22 •�~ r 1,) � J •4j5 p"I r �¢ 60. .. S1g2.23M rT� r�- L D T 24 TOTAL AREA: 3P. 97,281 SQ. FT o' 2.23 ACRES w _ Z, TOTAL AREA: pa. t L D T 2 5 2.3 ACRES TOTAL AREA: F.F.E. 996,0 82708 SQ. FT. LA °c 1.90 ACRES F.F.E. 996.0 49.5 323.86' -'i N8 42•23" 155;48 ow- 121.58' 494.98' i S82•42''23-,E 500.26.__-- -- - S82.52 •'`" .... n H.W.E. 992.0 Z Or 22 cy`ti TOTAL AREA: H.W.L. ^"a 87,293 SQ. FT. ry� 2.00 ACRES ` ? F.F.E. 996.0 'r 765. _ _-N8p�O'43'1y+.,..439,$8•_� ,�' 274.32- _ L 0 T 2 1 fn TOTAL AREA. � r+ v L 0 T 2 80,020 SQ. FT. + rr f ry TOTAL A1 1.84 ACRES 85,765 SO. FT. F.F.E. 996.0 ,f 1.97 ACMES F.F.E. 996.0 „ 0 . . . -, 257 @ 2+'46' TO ,. _,... �__•� 262..4x6` ..� _... 984'45 `56 W. M�/ ,ors A r c H 7 t