HomeMy WebLinkAbout026-1126-33-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 584783
GENERAL INFORMATION 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 Township Parcel Tax No:
Brushy Mound Partners TOWN OF RICHMOND 026-1126-33-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
/61. 3 8- s C-sT 12.30.18.794
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER N~ S CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
640
Alt. BM
Po ak- Z 5 - 'U Go Q .q t o s
Aeration Bldg. Sewer
_ 5. jai, icy
Holding St/Ht Inlet ~j
TANK SETBACK INFORMATION St/Ht Outlet 4.97 c7T. $
TANK TO P/L WELL BLDG. Ven Air Intake ROAD Dt Inlet
a r~ z~t r"-
Septic Z7 ' Dt Bottom
Dosing Header/Man. 7. (a3 cM ,
Aeratio Dist. Pipe
7.v Ct 9 .1
Holding Bot. System .S Z 4k cm, PUMP/SIPHON INFORMATION Final Grade ~ r /6Z
'
Manufacturer Demand St Cover
GPM
~tJr
Model N er
TDH Friction Loss System Hea TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 9 0
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION e CHAMBER OR
T ~Ici.1
yp System: A~Lice} UNIT Model Number:
o .5 z' / v '
12
DISTRIBUTION SYSTEM ( ~'1 >#-C?
Header/Manifold Distributions x Hole Size x Hole Spacing Verlto Ake~O
__Lj i_ _ i 1 Pipe(s)
Length Dia Length Dia Spacing y. % SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 010'6 16 94- 1►t&•-, 4'.4,
Depth Over Depth Over xx Depth of xx Seeded/Sodded Ixx Mulched
Bed/Trench Center Z3 Bed/Trench Edges Topsoil No Yes C No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1409 166TH AV~~
1.) Alt BM Description = 66,T
,S t,..~ l 1
2.) Bldg sewer length = 3 ~fh,
- amount of cover = it S its ZZ _ -
Z c..Q s ue. Plan revision Required? ❑ Yes )No -7'
Use other side for additional information. v
Date Insepctor's
SBD-6710 (R.3/97) Sign ture Cert. No.
RE( w
County
Safety and Bui s D' ision ST. CROIX
MAY 2 6 20 18 201 W. Washington . Bo 16 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-
ST, CROIX COUNTY
OMMUNI7Y DEVELOPMJNT
Sanitary Permit Application State Transactio umber
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Ai 1 or
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
u ses in accordance with the Privacy Law, s. 15.04 l m , Stats. 409 166TH AVE, NEW RI CHMON
1. Application Information - Please P I rmation
Property Owner's Name 1 Parcel #
BRUSHY MOUND PARTNERS 026-1126-33-000
Property Owner's Mailing Address Property Location ' ic, it
P.O. BOX 445 Govt. Lot 33
City, State Zip Code Phone Number
SW NW Section 1~
NEW RICHMOND, WI 54017 N/A (circle one)
11. Type of Building (check all that apply) Lot # T 30 N; R_ E ortgl
a1 or 2 Family Dwelling- Number of Bedrooms Subdivision Name /
Ok Block # WATERS EDGE 12,11 24-t - ❑ Public/Commercial -Describe Use ❑ City of
N/A
CSM Number ❑ Village of
❑ State Owned -Describe Use
'Town ofICT.IMf1TTT1
YV\ !rte(/ N/A
III. Type of Permit: (Check only on ox on line A. Complete line B if applicable)
A. Xk New System 11 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
Replacement System El 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 app y)
I
IXNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Eleva
857 900
-7 1
VI. T nk Info Capacity in Total # of Manufacturer
Gallons Gallons Units o u
New Tanks Existing Tanks u o u v m
O p av ~ y ~ ~v a
Septic or Holding Tank X
Dosing Chamber N/A
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's mature MP/MPRS Number Business Phone Number
PAUL KOEHLER ~ '11-e- 225410 715-246-2660
Plumber's Address (Street, City, State, Zip Code)
321 WISCONSIN DRIVE, NEW RICHMOND WI 54017
Fpproved County epartment Use Only
rov Permit Fee Date slue Issuing ent Signa e
66 0 -
er Given Reason for Denial $ W.
IX. CondidBYA=EAWWW"easons for Disapproval Vt O qVt M,-J yNep4J
t Seph' a tank, effluent finer and 3) Is"I
_ j~~
tiispem. l call must all b2..§e 1c s 1 j0{;!► j ~,J~ NV1CIv,~ dr,1~" EGA.. l svt M cu r
as perlrleragement plan provided by plumber, //►1
2 ' KM tirer►ents leiust,pe t;laintCIr*d 1~ .~-d^
y 5L
Per SPP#CW@ code ofdailm.
Attach to complete plans for the system and sub ' to the Countyonly oa paper sot less than 8 uz x l l i hes in size
S1313-63 8 (R. /11)
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166TH AVE
PROPOSED WELL
BRUSHY MOUND PARTN OT 33
PROPERTY LINE WATERS EDGE
SYSTEM ELEVATIN 96
TWO TRENCH OF EZFLOWS 90FT PER TRENCH
GARAGE
PROPOSED HOUSE
4 BEDROOM
EISER 1250 GAL SEPTIC TANK
O LY LOCK 525 FILTER
B1 ELEV 103.8
o B2 ELEV 104
B3 ELEV 102.9
Qt~
-B4 ELEV 101.3
04
B5 ELEVE-1013
" " M TOP 1" PVC 100
ALT BM TOPI"PVC 98.8
DRAINAGE EASE-
MENT
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name MITCHELL - 1409 166TH AVE, NEW RICHMOND LOT 33
Owner's Name BRUSHY MOUND PARTNERS
I
Owner's Address P.O. BOX 445, NEW RICHMOND, WI 54017
Legal Description SW 1/4 NW 1/4 SEC 12 T 30 N R 18 W
Township RICHMOND
County ST. CROIX
Subdivision Name WATERS EDGE
Lot Number 33
Parcel ID Number 026-1126-03-000
Pagel PLOT PLAN
Page 2 SOIL ABSORPTION SYSTEM
Page 3 R11 TER
Page 4 TANK SPECS
Page 5 MANAGEMENT PT AN
Page 6 MAINTENANCE AGREEMENT
Page 7 SOIL TEST
Page 8
Page 9
Attachments: Soil Test & House Plans
Designer/Plumber: PAUL KOEHLER License Number 225410
Date: 5/25/16 Phone Number 715-246-2660
Signature
166TH AVE
PROPOSED WELL
BRUSHY MOUND PARTN OT 33
PROPERTY LINE WATERS EDGE O
SYSTEM ELEVATIN 96
TWO TRENCH OF EZFLOWS 90FT PER TRENCH
GARAGE
PROPOSED HOUSE
4 BEDROOM
EISER 1250 GAL SEPTIC TANK
O LY LOCK 525 FILTER
B1 ELEV 103.8
1 y
o B2 ELEV 104
B3 ELEV 102.9
4 ELEV 101.3
B5 ELEVF.103:3
" M TOP 1" PVC 100
ALT BM TOP 1"PVC 98.8
DRAINAGE EASE-
MENT
SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-of
Project Name:
No. of Cells_ Per Cell
ft Cell Width Total No of
i _ ft Cell Length S, sq It EISA Per Cell
ft Cell Spacing ®@ sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ1203H-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
Gravelless Leaching Unit Manufacturer: ~'i~fer
Gravelless Leaching Unit Model: _ L~ pry
Typical Cross Section
Finished Grade ft
Observation Pipe with
approved cap or vent
•
Soil Backfill
■
in
Geotextile Fabric
ft Infiltrative Surface
12 in ~ I
ft Limiting Factor
Lin Slotted and Anchored Vent/
Observation Pipe with Cap
PlumberlDesigner Signature:
~f
License : If7,, 211 0 Date: 2 ~0~~
T
M
Inc.
LYA0CNP
Innovations in Precast Drainage Zabel' PL-1-25 Effluent Filter
& Wastewater Products A Division of PoMok Inc.
PL-525 Filter
The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has
525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball
installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off
the system so the effluent won't leave the tank.
Features: 06" Filtration Slots E
Alarm Switch
• Rated for 10,000 GPD (gallons per day). (optional)
• 525 linear feet of 1/16" filtration.
Accepts Accepts 4" and 6" SCHD 40 1" PVC
pipe. Extension Handle
• Built in gas deflector. i
• Automatic shut-off ball when filter is removed.
Rated for
• Alarm accessibility. 10,000 GPD
• Accepts PVC extension handle.
PL-525 Installation:
Ideal for residential and commercial waste flows up to _ 525 linear Ft.
of 1/16"
10,000 gallons per day (GPD). Filtration Slots
1. Locate the outlet of the septic tank.
2. Remove the tank cover and pump tank if necessary. "
Accepts 4" & 6"
3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe
the filter is not centered under the access opening use a
Polylok Extend & Lok or piece of pipe to center filter.
4. Insert the PL-525 filter into its housing.
Certified to
5. Replace and secure the septic tank cover. NSF/ANSI Standard 46
PL-525 Maintenance:
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring £ r
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter,
Gas Deflector
needs servicing. Servicing should be done by a certified;
septic tank pumper or installer. Automatic
1. Locate the outlet of the septic tank. Shut-off Ball
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing.
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted. Outdoor smartFilter ; Atartn Extend & l ok E i
Polylok, Zabel & Best filters accept Easily installs
7. Replace and secure septic tank cover. , the SmartFilterJ switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner BRUSHY MOUND PARTNERS Tank Manufacturer: WIESER ❑ NA
Permit # E] Septic ❑ Dose ❑ Holding Volume: 1250 (gal)
DESIGN PARAMETERS Tank Manufacturer: NA
Number of Bedrooms: 4 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units:] NA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow: 450 (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5): (gal/day) if horizontal is >150 feet. Speck instructions to be provided on back. 600 In Situ Sal Application Rate: (gaUday/ft2) Effluen
t Filter Manufacturer: POLYLOK
❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: 2
Fats, Oil & Grease (FOG) c30 mg/L Pump Manufacturer: ❑ NA
Biochemical Oxygen Demand (BODS) X220 mg/L ❑ NA
Total Suspended Solids (TSS) <150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:] NA
(BODS) >220 mg/L NA
(TSS) >1 50 mg/L ❑ Mechanical Aeration ❑ Peat Filter
❑ Disinfection ❑ Wetland
Pretreated Effluent Monthly aver
age ❑ Sand/Gravel Filter El Other:
(BOD5) s30 mg/L Soil Absorption S System
(TSS) _<30 mg/L ( NA y
Fecal Coliform (geometric mean) <104 ® In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
At Grade ❑
Maximum Effluent Particle Size Ye in dia. NA ❑ i Mound
❑ Drip-Line ❑ Other.
Other: ❑ NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume
When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
3 kkyear(s)
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
3 year(s)
Clean effluent filter At least once every: 1 month(s) [I NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
91 year(s)
Flush laterals and pressure test At least once every: ❑ month(s) (21 NA
❑ year(s)
Other. At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following 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 scum 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 (Y3) 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 <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005 (02105)
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) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill 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 will be discharged to the soil 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 to restoring power to the pump or contact 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 infiltrative 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 pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge.
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 property
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative 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 properly 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:
❑ 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 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 resort.
❑ 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 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 INSTALLER POWTS MAINTAINER
Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER
Phone 715-246-2660 Phone 715-246-2660
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name SERVICE Name
Phone 715-425-1025 Phone /S, d16,80
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(b)(1)(d)&(f) and 83.5401. (2) & (3). Wisconsin Administrative Code.
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SHEET1 OF 4 SH,ETS
3
,1-66TH AV~1~7UE
--R 43~':fl0'' - N41'13'37"W127.48 ' - -
s L=72.21'
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H USE /
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998
L07`33 ,
A63 ACRES /
L.B.O. 989.7 PER PLAT f
'988.7 ON NAVD ! 1
/ f ELEVATIONS 1
1
r
LEGEND
~ DRAINAGE DIRECTION
t =WIRE FLAG SET
® =WOOD HUB SET AT OR 10'
OFFSET OR ON BUILDING _
EXTENSION
FOUND IRON MONUMENT
SETBACK LINE
I, Ty R. Dodge, Wisconsin Professional
Land Surveyor, hereby certify that this
stake-out plan was prepared by me or under /
my direct supervision and is correct to the cA oj, y
best of my knowledge and belief.
06
ELEVATIONS SHOWN ARE NAVD 1988 DATUM. PLAT
ELEVATIONS ARE V HIGHER THAN NAVD 1988. r. ` f
DERRICK CONSTRUC110N
LOT 33, WATERS EDGE
TO.W 0kC.n v_u ST r M
STAKEOUT PLAN lath•tmaltiu6/ueai+la Six W suleft
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer S l v~ ~+ll ~Iz- c 1Z5 (I~/1 l c~-l_ S
Mailing Address R~ bo~ ttp3tfor Propert y Addres t 4- e3 ~t t ` (Verification required from Planning & Zoning new construction.)
City/State 42114 \t\ acel Identification Number
LEGAL DESCRIPTION P
Property Location `~W 114 , V4 , Sec. T10 N R W, Town of P '-4A40 kj
Subdivision wp: Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (0 Volume Page # b
Spec house yes no~ Lot lines identifiable, s) no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, ifneeded, 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 andior (2) after inspection and pumping (if necessary), the septic tank is
less than 113 full of sludge.
Uwe, the undersigned have read the above requirements and agree to n aintain the private sewage dispasal 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 thi arm are true to the best of my/our knowledge. 11we amlare the owner(s) of the
property descry d above, by virtue of a wa my deed recorded in Register of Deeds Office.
Number f bed
ST ATURE OF AIALICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department
Include with taus 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. 09105)
Wisconsin Department of Industry, SOIL AND SITE EVALUATION- REPORT Page 1 of 3
Labor and Human Relations
Division of safety & Buildings in accord with ILHR 83.05, ,W<xdm. Code
- ~ ~ COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. mu `lout St. Croix
PARCEL LD. #
not limited to vertical and horizontal reference point (BM), direction and ofope, "or 1. ,
33-e
dimensioned, north arrow, and location and distance to nearest road. P
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI~ _ V OA~X WED BY DATE
PROPERTY OWNER: ERTY LQ f~Jf
Derrick Const., Inc. VZNT 1 W 1/ /4,S 12 T 30 ,N,R 18 3E (or) W
PROPERTY OWNERS MAILING ADDRESS L07 # LOG # ~ S . NAME OR CSM # t `
1505 H #65 33 na S EO
CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [BTOWN NEAREST ROAD
New Richmond, WI. 54017 b15) 246-2320 Richmond 140th St.
[x] New Construction Use [K ] Residential / Number of bedrooms 4 [ ] Addition to existing building
Replacement [ ] Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2
Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2
Recommended infiltration surface elevation(s) 100.00 ft (as referred to site plan benchmark)
Additional design / site considerations trenches spaced to code 4.00' below grade
Parent material outwash 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 E S ❑ U KI S ❑ U RI S❑ U ® S ❑ U FKI S ❑ U ❑ S ® U
SOIL DESCRIPTION REPORT (;-9 Boring
# Horizon Depth Dominant Color Mottles Texture Structure ConsistenceRoots 06.
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-10 10 r 3/3 none
1
2 10-20 7.5 r 4/4 none sicl 2msbk mfr w 1f .4 i
Ground 3 20-90 7.5 r 4/6 none
elev.
103.8 It.
o S
Depth to loo a. cQ,~
ji. CA
limiting p
factor
+90"
Remarks:
Boring # _
1 0-9 10 r 3/3 _ .5 .6 5
2
2 9-19 7.5 r 4/4 none I scl_ 2msbk mfr 9XT if
Ground 3 19-90 7.5 r 4/6 none cos 9--
elev.
104.0 ft.
Depth to
limiting
factor
+90"
Remarks:
CST Name:--Please Print Gar L. Steel Phone: 715-246-6200
Address: 1554 200th. AY'e-.~, New Richmo , WI 54017
Signature:" - Date: 6-22-2000 CST Number: m02298
PROPERTYOWNER Derrick Cons . , Tnr-. SOIL DESCRIPTION REPORT Page 2 of _3
PARCEL I.D. # pending
Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft
Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
.....3 1 0-10 10 r 3 3 none 1 2msbk mf r cs 2 f . 5 .6 . S
2 10-22 7.5 r 4 4 none scl 2msbk mfr Cfw if .4 .5
Ground 3 22-90 7.5 r 4 6 none cos os ml na na .7 .8
elev. -
102.9ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-9 l0yr 3/3 none 1 _ 2msbk mfr cs 2f .5 !.6
4 2 9-20 7.5 r 4 4 none scl 2msbk mfr if .4 .5
3 20-90 7.5yr 4/6 none cos osg ml na na .7 .8
Ground
elev.
101.3 ft.
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-10 10 r 4 3 none sl 2m r mvfr cs 2f .5 .6 S'
2 10-20 7.5 r 4 4 none ls__! ml if .7 .8
3 20-90 7.5 r 4/6 none Cosos ml na na .7 .8
Ground
elev. j
101.
Depth to
limiting
factor
+90"
Remarks:
Boring #
r9
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD-8330(8.05/92)
PROPEI"OWNER Derrick Const-,_, Tn-. SOIL DESCRIPTION REPORT Page 2 of_3_
+ARCEL I.D.8 peDdi nq
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Baixfary Roots GPD/fi
in. Munsell QU. Sz. Cont Color Gr. Sz. Sh. Bed reach
1 0-10 1 r 3/3 none 1 2msbk mfr CS 2f .5 6
3.:
2 10-22 7.5 r 4/4 none scl 2msbk mfr if .4 .5
Ground 22-9 7.5 r 4/6 none Cos osa m1 na na .7 .8
102.98.
Depth to
limiting
factor
+90
Remarks:
Boring #
.W..K 1 0-9 1 r 3/3 none 1 2msbk mfr cs 2f .5 :46
4 i 2 9-20 7.5 r 4/4 none scl 2msbk mfr if .4 .5
Ground 3 20-90 7.5yr 4/6 none cos osg ml na na .7 ::.8
elev.
D1.3 ft
Depth to
limiting
factor
+90"
Remarks:
Boring #
1 0-10 10 r 4/3 none sl 2mcfr mvfr Cs 2f .5 .6
5
2 10-20 7.5 r 4 4 none is os ml if .7 1.8
Ground 3 20-90 7.5 r 4/6 none cos os ml na na .7 .8
elev.
101.1
Depth to
limiting
factor
+90"
Remarks:
Boring #
Ground
elev.
tL
Depth to
limiting
factor
STEEL'S SOIL SERVICE
Gar), L. Steel Derrick Construction, INC. 1554 200th Ave.
CSTM2298 SWgNW, S12-T30N-R18W New Richmond, WI 54017
MPRSW-3254 town of Richmond (715) 246-6200
lot #33-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.
N
1"=40'
top of 1" pvc pipe C el. 100
t. B top of 1" pvc pipe C el. 98.80
~i
vl~
Gary L. Steel
6-22-2000
I ~X 11-1
E LO 34
~W x
842 6 SQ:FT4.4
1.9 ACRES 992.9 995.8 ~B-1o
(n • /
4Q) B-2
Ll__ I I O 25 YEAR H.W.E.
d ~ 88 - ~Z
• B-1o_
Aj
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Q) i
01
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I ~I+ 1 11446a SQ.~i,6
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X995.2 95'2
11
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99
6 96X SQ.
U7 998 2.22 ES
i loop \
ry C)
a~~ 1
4~
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~ ~ I ~ o~ I ~~1014
a~ o n~kl o
c))~ I
U) 16 z
Q) I ~ ~I~DI I I
U
REV. DATE REMARKS DESIGNED: ACS
1 01/18/00 ADDED ROAD DRAWN: ACS TRD A SC EE
2 03/14/00 ADDED 100 YEAR FLOOD /3 03/17/00 LWCD COMMENTS CHECKED:
4 103/28/00 DNR OHWM DATE: 12/16/99 LAND SURVEYING :,P I 5 04 06 00 CO. SURVEYOR FFI
CADD ME: c: \owc\99066.dwg (stns)
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