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HomeMy WebLinkAbout026-1294-41-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574317 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: Oevering Homes LLC, aka Clevering Pro ertie Richmond, Town of 026-1294-41-000 CST BM Elev: Insp.BM Elev: IBM Description: 6/� Section/Town/Range/Map No: `I9•�p lv - Z e-5 [ 28.30.18.1523 ELEVATION DATA TANK INFORMATION E L TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt.BM Aeration Bldg.Sewer VP Z • � IdZ • I Holding - St/Ht Inlet <w5. /Oa b , TANK SETBACK INFORMATION St/Ht Outlet S 9 /�d• '�l/ TANK TO P/L WELL BLDG. Vent to Air In, take ROAD Dt Inlet Septic J $ Dt Bottom Dosing Header/Man. G.YS '=?7•S Aeratio Dist. Pipe •4 7.0 7• Holding Bot.System Final Grade • 7 PUMP/SIPHON INFORMATION I'd 3. Manufacturer GP nand St Cover r` / J�� /• / /'d#f Model Nu F./� • C.. �. l C) /D°r �•`P �d/ y T•' TDH Li Friction Loss System IT Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION YSTEM BEDITRENCH Width Length No.Of Trenyches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS �""{ 1--o-z" IC�G� SETBACK SYSTEM TO w P/L BLDG JWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T Of System:L p /� CHAMBER OR r � a� b JGvN ,/6 •� p �f.1 UNIT Mo I Nu be / w // DISTRIBUTION YSTEM UeO- r d S•►-/� �-/ �`� j/ �JS Header/Manifold r, Distribution x Hole Size x Hole Spacing Vent o Air take co 7�'`I ✓ Pipe(s) � �� ��_ 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/Sodded xx Mulched Bed/Trench Center s —7 Bed/Trench Edges �� Topsoil Yes 1 No '1, Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1141 132nd Ave New Richmond,WI 54017(SE 1/4 SW 1/4 28 T30N R1 8W) Richmond Acres Lot 41 Parch eel No: 28.30.18.1523 1.)Alt BM Description 2.)Bldg sewer length /):,- 75 AJ -amount of cover= �Z Zip CIO Plan revision Required? Yes" Use other side for additional information. L__._. ___ Date Insep or's Sig re Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/17/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 IL BENCHMARK V.R.P. Top of 1/4" rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.8/100.2 3.2' below qrade SO 196' Property Line 132nd Ave All piping shall be SDR 30/34, within 10' of tank,piping shall be Schedule 40. B.m.* Scale is P = 40' `B- 12 unless otherwise noted 93' 6% Slope 102' 2-3' X 90' Cells with>3' spacing B-3 104. please note: boring will be � 1 b 5 dug deeper to lower system elevation and 30 80, install system properly B1 /LZ 57' 20' A� � ro 4 Z ' ouse Vent 572' Property Line >6» Quick4 Standard o� of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps 3 4" Grade at System Elevation 202' Property Line �L.;` and Bw'k#ngs Division 201 W.WasMngton Ave.,p.o.Box 7162 SWkWy Permit Ntmtber(no be�in by Co.) 11 Madison,WI 53707-7162 5-2 z �7 Stec T:mvraion Naambor Permit Applicak�o �,^� ;,? omit In accormooc ait6.kk-'.21(2),Ws.Adm.Code, of this Eotm to the s WOFiane is tegnhed P >b obta g a=Htmy P� Note:App icanom Edam'for Stan o��W'zed ndr¢�y Addross(if dim dsa marling ad8 ) mo Deptat�of safety and Pro&Uie°'1 Sa ruts+ Pmsmal iaEflrmstfon ym provide law & I 1 m srats in L n Iaforsmtwn-Pleasc Prfet AU Lforteatb■ p� ply owner's Naw ® 6 -- e • c pmpwtyl.o«tyon / � �2 3> Property owner's Ad Maitcng dress - C 3 3 �P� PhwcNumber V=U,)y, Setxian City.Sufi aazde ) N:�� a W Lot i! / II.Type of B (cheek all that apply) </ Subdivision 1 or 2 Family Dwelling-Number of 4k ►/�a J'S2- Block# °# it ❑pnblidCommmial-Describe Use ❑V3' CSMNmmber ❑VillageoE ❑State owned-Desaibe Use own of eAr III.Type of Permit: (Chock oel one box on lie A. Complete Une B if applicable) ❑Otba Modifiesfiaa to Pxisting SyA-(aPlain) A. Sy (]g s eplaeo next System ❑Tmrtmmt/fiolding Talc Replacement Only f ❑Permit Revision ❑Chtmge of Phamber ❑Pesmir Tom*m New l�Previous Permit Ntanber and Dace lssoed B. ❑PecmitRxstewal Owner LIZJ 71�; Before Expiration ,r IV. of POW CS S Coe eant/Device: Cheek aU that 1 ❑preaurwil ln-(hound ❑At OI& ❑Mooed>-24 in.of sUk"soil ❑Hotted<24 is of srtit�b soil PI t!5 Non-Proasa�od in-Gro�d ❑Pretrostmant Device(�) M ❑ bldiag Took ❑ > (�P ' ) Q V.Dior VIC Area Intormation: Disl►�d Area Rimed(� ��sd (sst)) System Design Flow l>tp Desip soil Application al ' t� , > Manufa� 3 m TOW #of v CAU VI Tank Inform Units 9 I4OrTanks Existing Taale (�V �l % ii C7 Rr t septic cc Hoift Talc 1>omag(]uaotw VII.xespottab Staten I,the t►e■me for iastaiatio■d tie POWfS sbwr w tare attached MGPM Number B�afJ ie%Phone N�Plumber's S' �'s NmPrint) �sl phunber's Address(SaVOL .Stave,zap Cade) VIIIU, eat Use permit Fee Dane Isaumg Sipawre ved Sq /y5 7 Dcxual IX Co for Disapproval 3 J l l c�.J►�''Sept►-Rank;eftkaerarai matte'n lr�p oetiane�� r ,� disprsal eel must all rAces/ as per management plan provided by plumber. 2. ?-A)f k'*.1farnents must be>m�iMaiped ��Code/ordinances. „ .n t��.f =ti toriea:vim Athcl,b t> tee�°nm°•'ad a left Caaot!•ahr "Pw SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/17/14 Owner: Oevering Homes Location: SE 1/4 SW 1/4 S28 T30 N,R18W 1141 132nd Ave Richmond In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specificati2Sh,,,t 8-10. Soil test Signature License numbe 226900 I PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7/17/14 BEDROOM 4 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1/4" rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.8/100.2 3.2' below qrade 196' Property Line 132nd Ave All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. B.m.* 12' Scale is 1" = 40' B-2 unless otherwise 93' 6% Slope noted 102' Vents 2-3' X 90' Cells with>3' spacing B-3 10 Of please note: boring will be 51 dug deeper to lower ;.4 — 30 system elevation and 80, install system properly B-1 57' 20' Pro 4 Bedroom House Vent 572' Property Line >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps 3 4" Grade at System Elevation 202' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 104' Vent Grade Vent 3' 411 3' X30/34 Septic Tank 5' Long 1 79 5' 5' Long 119 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-100.8' B 100.2' POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page ai FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit# optic ❑Dose ❑ Holding Volume: /�s-j(gel) DESIGN PARAMETERS Tank Manufacturer: Number of Bedrooms' ❑NA ❑Septic ❑Dose ❑Holding Volume: (gal) Number of Public Facility Units: Vertical Distance Tank Bottom(s)to Service Pad: (tt) Estimated(average)Flow: (gaUday) Horizontal Distance Tank(s)to Service Pad: l (n) Specific servicing mechanics must be provided if vertical is 2-15 feet or Design(peak)Flow=(estimated x 1.5): (98UaY) ff horimntal is>150 feet. Specific Instructions to be provided on back. In Situ Sod AppGc ation Rate: , 7 (gaUday/R') Effluent Fiter Manufacturer. YL ❑ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,ON&Grease (FOG) s3O.mg/L Pump Manufacturer: Blochemk:al Oxygen Demand.(BODs) sago M91L ❑NA - 4M Total SuawndW Solids SS '9150 m L Punp Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L �A1A Manufacturer. A (BODE) >220 mgd /�'"'r` ❑Mechanical Aeration ❑Peat Filter SS >150 ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑SandlGravel Filter 0 Other. (BODs) s30 mg/L Soli Absorption System (T3S) s30�mgIL ❑ NA n-Ground(gravity) ❑In-Ground(pressure) ❑ NA Fecal Cdffarm( eometric mean) '910 Maximum Effluent Particle Size 36 in dia. ❑ NA �e ❑Mound ❑Drip-Line ❑other: i I I I - Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Settiice Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third(X3)of tank volume ❑When the high water alarm is activated '"7 ❑R1O"ti'(s) Inspect condition of tank(a) -At least once every: (Maximum 3 years) [I NA a) Inspect dispersal cell(s) At least once every: months) (Maximum 3 years) ❑NA Clean effluent filter At least once every: month's) ❑ NA s Inspect pumps pump cols 8 alarm At least once'every: months) ❑ NA ❑year(s) Flush laterals and pressure test At least once every:, month(s) ❑ NA .❑YN►(s) Other: At least once every: 0 month(s) ❑NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying Ghe of the fallowing licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 sc urn and a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third($)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator(pumper)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 S12 months,and be performed by a certified POWTS Maintainer. A service repot shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) 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, solvents or other chemicals or sediment that may Impede the treatment process'and/or damage the soil absorption_system. If high concentrations are detected have the contents of the tank(s)removedY a Septage Servicing Operator(pumper)prior to use. Pump tanks may till above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended,as the excess wastewater wid be'discharged to the sod absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)-prior totestaring power to ft pump or conted a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the indlftrative surface. Do not drive or park vehicles over tanks or the soil'absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes;-cigarette"butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats,foundation drain(sump pimp)discharge, fruit lod vegetable peelings, gasoline, greases. herbicides, meat scraps,medications,oils,painting products,pesticides,sari y napkins,solvents,tompons,'and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steeps shall be taken to insure that the system is properly and safely abandoned in compliance with s.Comm 83.33,Wisconsin AdrliniaVirtive Code: • All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator(pumper). • 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: yZL–A suitable replacement area has been evaluated and may be utilized for the location or 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 linen 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. 'Replacerrrent systems must comply with the rules in effect at the time of their permit issuance. • A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resat • The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a sod 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 blornat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, .PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INST R POWTS MAINTAINER. Nam cc.�/`J /2—K Name - 2 Phone fa Phone �,:2 J� SEPTAGE SERVICING OPERA PUMPER LOCAL REGULAT RY AUTHORITY Name Name j Phone J (� Phone ���f"= () This document was drafted by the staffs of the Green lake, Marquette and Woushara County POWTS regulatory agencies in Compliance with sections Comm 83.22(2XbX1 Md)d,(f)and 83.64(l),(2)a(3),Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUC'i'IUNS SrNP s Dry It the 10"case aeto the awed of tim outlet pipe to ernwe it is centered under the scare opening. If pet,than afher bast mots pipe into the tank througb the outlet or solvent weld(Sire)additional papa onto the oudet Pipe. STEP 2 While the cat$still dry AlbW on the outlet pips,n eseure the h wg* of chi-inch pipe needed to bran the Aker to Mo tank end wall if utliting the optional supplemental aide support.V side support nothod is not uftvad, proceed to stop four. 4 EP 3 For btastdaliopa utillaing the optiond gupplanwatal We support: solvent weld the%finch pipe onto an tt w ease. If side support method is net utilized.proceed to step four. Solvent wad time fter case onto the outlet rr, iNPe. Insert the liter _ �'"• f carbidge into the cape,pnmkV down until the ftw inks into the bottom of the ease. q If a VRS sw*ch is utiihsed:inset kft the Alter and lock by tuffgng ;.;. clodkwlte w. Makitmance 2. The efMlwrt filter should be cleaned every time the septic tank is serviced. r 2. Open the outlet seems opw*wg to inspect the tank and titot + I 3. Pump the septic tank eompkt*,making sure to remove the sludge - War on the bottom of the tank and not just the scum and content. 4. Once the ettlusnt lava Ins ban lowered below the invert of the \ cartridge,�m Coup on the ff2ter handler to dislodge the S. Slide the cutridye up end out of the ease for cleaning. B. V a VRS swN c' aoruecbed to an alarm is Present,the switch T should be MnWW by turnbV aRa terrlodmism We and cleaned f ti r with water only. - 7. While holding the carb'dge an its side(lsree Ast surfau facing a , dower)over the akem opening,ripe aft the cartridge wltlo water maft suet erg$21112111s p 8WW is fkgwd bade into the tank- .{ ,.`• if VRS swrltc-is utiYxsd, ` turning dodwke Me. by irwssrtlwp into titer aril � � : •,,. S. Insert the Akwr carbides bawds Into the case,pressing down until �'' .r •. �°'� the Aka locks into the bolt m of tie cue. ., 10.Rapists and secure the wises Opening on the tank. ra ir••.:nir r'•+mc"tC:aa'er:etk.� ,k�b•'•t r..:c SKt';.e]A'wkft.t v-•. www.Ge �e c:ona 877-1I gRS(653-4583) /2 -(�-- 111111 DocuMENT No. STATE BAR OF WISCONSIN FORM 1-2003 III 1111111{ Il III $ WARRANTY DEED Tx44197210 i 998137 THIS DEED,made between Richmond Acres,LLC,a Wisconsin limited BETH PABST liability company("Grantor"whether one or more)conveys and warrants to REGISTER OF DEEDS Oeveri omes LLC,a Wisconsin limited liability company ("Grantee", ST. CROIX CO., WI whether one or more),the following described real estate in ST CROIX County, 07/03/2014 09.57 AM State of Wisconsin: EXEMPT#• NA Parcel 1: REC FEE: 30.00 TRANS FEE: 825.00 Lots 7,11,17,18,25,26,27,31,34,37,40,41 44,45 and 49,Plat of PAGES: 2 Richmond Acres in the Town of Richmond, t.Croix County,Wisconsin. RETURN TO St.Croix County Abstract&Title Co.Inc. 219 S.Knowles Avenue New Richmond,WI 54017 Tax Parcel No: see attached This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,and further except 2014 real estate taxes. Dated this 27th day of June,2014. Richmond Acres,VC,a Wisconsin limited liability company By:Je a illiams,managing member AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20 1 f COUNTY OF ST CROIX ss. TITLE:MEMBER STATE BAR OF WISCONSIN (If not, Personally came before me this 27th day of June,2014,the above named Richmond Acres,LLC,a Wisconsin limited liability authorized by§706.06,Wis.Stats.) company,by Jeffrey S.Williams,managing member to me known to be the person(s)who executed the foregoing instrument and acknowledge/the,same. THIS INSTRUMENT WAS DRAFTED BY Robert L.Loberg/Loberg Law Office * �o .Lh l� W .1..• Notary Public St.Croix County,Wis. �, IVI D.yS 1417332 I aim jQ1'Q ,• " "' ., p ' My Commission is permanent. (If not,;'s te'e pfration?tia(e'� (Signatures may be authenticated or acknowledged. Both are ) t not necessary.) *Names of persons signing in arty capacity should be typed or printed below their signatures. WARRANTY DEED Form No.1-2003 St. Croix County 998137 Page 1 of 2 i Legal Description: Lots 7, 11, 17, 18, 25,26, 27, 31, 34,37,40,41,44, 45 and 49, Plat of Richmond Acres in the Town of Richmond,St.Croix County,Wisconsin. Tax Id Numbers: 026-1294-07-000 026-1294-11-000 026-1294-17-000 026-1294-18-000 026-1294-25-000 026-1294-26-000 026-1294-27-000 026-1294-31-000 026-1294-34-000 026-1294-37-000 026-1294-40-000 026-1294-41-000 026-1294-44-000 026-1294-45-000 026-1294-49-000 St. Croix County 998137 Page 2 of 2 ST. CROIX COUNJ'y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 06 f i Mailing Address� �j S_ �0/�n�i b-,,1'�_ , �� 14 Property Address Pq l - (Verification required from Planning&Zoning Department for construction.) City/State Parcel Identification Number c� — LEGAL DESCRIPTION Property LoeationSAE-- i/4 ,�g�'/4 , Sec. Z g T 30 N R /l W Town of L,�K Subdivision �� y,,..�Q /�(//j iv , Lot# Certified Survey Map# G - ) ,Volume ,Page# Warranty Deed# / C / , Volume ,Page# Spec house& no Lot lines identiflable(5 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature fOme to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,ii 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 Coimty Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zon:mg 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. Vwe,the undersigned have road 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 Departirmnt 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 form are true to the best of my/our knowledge. I/we am/am the owner(s)of the property described above,by virtue of a 7"anly deed recorded in Register of Deeds Office. Number of bedrooms _ 1 /Y G O 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 if reference is made in the warranty deed. (REV.08/05) • a.y CS ;id 89.25'18" E ,,,.' Q• 1®4.81' AN 89'25`18'* E 392.28' r :.3.211' IV89�518 2801 +�35�2",r-" N $9`251$" E 19fi.57 �Qa8 232 39 : 28. 0 DRAIAIAOF ,� 725'1&'"i!'"' 241.00'! v EASEMENT � �� 5a 8G' 182 4 H. WE.— .359.8 - A3 g 95.x:0 !+3 S2 27.23 „w H. W E.-95,x.0 ! �x 7J 81 T' ' C7 z C3 to 1 N3 As Alft W s �. tai Q 1. 8J acres im 41 79,816 � ai 2.97 acres t q• ft. -� 129,219 sq. ft. ~ 2. 76 acres L..8 0 955 0 720, 151 sq. ft. L-B. 0. 955. 0 200.04' S8! 50” Ecrsr�r"w7 t �, 0 965?5 t for Pmi* Gass (A o o E� - z 967.9 969.6 203.52" q /� 202.81' 589.49' 6 �gp" 40643 (R=N89'49'11"E 406.41) 0 (715)248,3010 TM �il II�VII III J9, �.w c rv� NOTICEI �irs Ilp. :I ;I Oevering Homes 1x07 .I r ELEVATIONS T 986 SO.FT. 766 SO.Fr. 2006 SO.Fr. Al LOWER LEVEL GARAGE FINISHED v I l QjL (715)248-3010 ------------ ---------------- ------------ ----------- ---------- i NOTlCEI II Cl Jl ---------- BRACED WALL LINE PANEL DETAILS Oevering Homes - MAIN LEVEL FT. 14m07 MAIN LEVEL A3 F,I (715)2483010 ------------ ---------------- - ------------- --------------------------- NOTICEI ----------------------- ------_----------$ ----------- ----------------- ------ BRACED WALL LINE PANEL DETAILS Oevering Homes 1a07 FT. UPPER UPPER LEVEL UPPER LEVEL A4 s " Property Owner Gero l& T Sm Ak Parcel ID# Page _of—1Y— Boring# ❑ Boring �•pit Ground surface elev._1 C 3.g 9 n. Depth to limiting factor a0_in. F-sqk8p piication 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 �r —� 5L e� �`Jk r'?CY alt? 2r 77 1,1 p fi l� ❑ a Boring# Boring 9917 ft, Depth to limiting factor 75_in. © Pit Ground surface elev.___!__ .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 L FS. W- M •^ CL w a F 10 0 5 L IM5L-7K. t,F. cw IvF .L/ . 7 H S-y$ 5 yR y/ s L 1 FS5 ,7 S -75 7.SyQs/�' S D- y" t, _ --7 I Cam• ❑ F-1 Boring# Boring Ground surface elev._ ft. Depth to limiting factor _in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30 1220 mg/L and TSS>30:5 150 mg/L 'Effluent#2=BODS 5 30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6=) Wisconsin Department of Commerce OIL EVALUATION REPORT Page of Division of Safety and Buildings accordance with Comm 85,Wis. Adm. Code County 5..{• V Attach complete site plan on paper not less than 8 1/2 x 1fint @@d�ust nn 11 include,but not limited to:vertical and horizontal reference IS��lFtf�a P arcel I.D. percent slope,scale or dimensions,north arrow,and locatdls� d.Please print all informati ( 'ewe y Date Personal information you provide may be used for secondary purpaf�}as(Priv4��aty,�1�.04��{!a)). ACi//t�, //ZU Q E7 Property Owner ST.CR X COUNTY Location Gero- . SM rIk ZONI @*P S� 1/4$w1/4 Saq T30 R E(or Property Owner's Mailing Addre o Subd. Name or CSM# I 90r^ e. NW yI I Pla-t of 'rc m crc City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road F-1K R'."Pt I KIN I 5553010611YI-209 (ZiC-VNM 0 P4 ($ New Construction Use:(a Residential/Number of bedrooms Code derived design flow rate S� GPD ❑Replacement ❑ Pu!lblic or commercial-Describe: Parent material-0�W-, . 11 k" e Y= _ Flood Plain elevation if applicable ft. General comments •X S V S-r a-Trc�J. S ( ?) FO#- G'-t-t-- S and recommendations: SS e T. 1 (,00.71 ) T-3 - - C94,Z3'� Boring# ❑ Boring Pit Ground surface elev.L V 5 ft. Depth to limiting factor_ !?LL 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. I 'Eff#1 I 'Eff#2 l - e, YR 5L �61� -fir c� d 5 rA 411 L -f'0 r r C 1 i a ss '3- �y YY1 L" Boring# ❑ Boring a Pit Ground surface elev._9 r•111 ft. Depth to limiting factor 75 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 1 -la to F s�K m a o) ;4: , 'Effluent#1 =BOD >30:5 220 mg/L and TSS>30 5 150 mg/L 'Effluent#2=BOD a 30 mg/L and TSS<30 mg/L T Name(Please P Signature CST Number {, a.�r-Y, i Y �ddrgss a Date Evaluation Conducted Telephone Number �J Y'D Germs S. Sri 601 $w'/y Sec.a-3, 73W, 19-7 �3 . iota Y �� 1 a pgmI .r�P "t "4 Cs-t as ? Y sty t P:p< T! k-4.04E- �► :- s M Z ; OR Q _ ros.3r ' a 0 V- n1 105.31 63 /a3.$g to V) oil 3 a o3 (so . Iv-1- I:nc) N, f2 97 J 521' Jol ou A. k- c 85 a,�-rA7,%4_3 4•9 a, ;� s o 2, 2. 960.4 AS AB.A\ Z1111, NO 98 OR 2.4,3 �jcr� `,, - - ­aq�tsL , -_- N 963.3 2.23 Ai�;,_ ... ....... N.R.'A. r 1.96 acres ............ .... ....... ... . . .. .. .. .... 7' N 113 966A • -r80.'7EYPOTARY CUL-PE7-,M ...... EAm r(Tv aE REmo tw.. N, UPW CX7VV_7CW OF ROA�? .... .. .. ....... 968.0 Iv- `2 e 6 1 c ac 8 N.B.A' 73 acr "\2. 4(GC es s area 1.4 (.97, O&PS 97?6 1 2 251 crCr S 1.26 V. N.B.A.. N 2.46� 1 .4 . 11 1 N",.. )2. 0 a N .A.�_A W�7 2.2 a 7-- xt '12 Y 964.5 -2 9644 it N. x 963.2 2 18 acre x 3 200 7 41- a1B k 196 acres GC acre M.S.A. 2. 111 IJV.B.A- N.B.A. f8j6 acres 1,8)\jcre + A acres 9-.2 2.11 acres, .. ..... ... 34 acres-- atres ...... ........ ON.19-4. 4 R A 1,62 c 1.90.ocres k, 2 N.B.A. 1.�2 acres 141) S ... ...... A71 ....... ... J 1 f 7 Ij A W .... ...... x 9%7 e 21q x _V. .. ........... ...... .... ...... ...... 4, 46 / V: � ' 44 xg., k 9 6 acres 1 7 79 acres es �7.4g(4CeS 41 x acres I 74\qcre "40 8J 1!0 j - 11� - 97' JR.A. V N.B.A. S .2 yF 1.79 RA Nh Ail acres acres 1.74 a 1�8 N.B.A. 2,63 96&9 01 V. 968,7 284 - 2 63 acres 97L4 01% 7x:,( 080, 0­1 180' 140 1:4.1 ;70.3 —..x 47 x tj. . I \ acres 4 -LOT-1 1.96 IN, SURREY N.B.A. 1, j CERTIFIED 968.7 MAP 967.7 96 acres El, ,-,-20j 20 VOL 8 PG219��._, ❑ 452' Z `NC1.-R 71FItD SUfet!ry'A-fAp L,,-NDllv(,,,., VCHTY MAP W. AeMOANG AUTHQ81 SEC.I&T.30 W.RAS TC"�RI�U n —