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HomeMy WebLinkAbout026-1126-46-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 589733 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)) N Permit Holder's Name: City Village Township Parcel Tax No: Brushy Mound Partners TOWN OF RICHMOND 026-1126-46-000 CST BM Elev: Insp lev: BM q~c i ion: Section/Town/Range/Map No: 1 ,2 1"1 ti • ShC- ° 12.30.18.807 'Se TANK INFORMATION ELEVATION DATA TYPE MANU E.Ei', 1L CAPACITY STATION BS HI FS ELEV. Septic L / G Benchmark / / G Do ' Alt. BM `j• Aeration Bldg. Sewer lv(• 3 Holding St/ Inlet GT~"!Z ok ZS ~f Iao St/ t Outlet V~. TANK SETBACK INFORMATION V TANK TO P) WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I r Dt Bottom r Dosing A ation Dist. Pipe H ding Bot. System w-T F Z ~'S. PUMP/SIPH FORMATION Final Grade 3.y2 161. 78 Manuf urer D Sprg M nd St Cover O 45P TPOL M el Number TDH ift Friction Loss Syste ad H Ft Forcemain Le t Dia. Dist. to Well SOIL ABSORPTION SYSTEM UM / BED/TRENCH Width r J eng~] , No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '7? loe SETBACK SYSTEM TO ( P/L BLDG WELL LAKE/STREAM LEACHING Manufac rer . I ,~J INFORMATION CHA ER OR J K-- TYPe Of S stem:4 J~a I (l ` 2 i t ! UN h, n/~, IT Model N gel DI IBUTION SYSTEM - lj fu ade anifold Distribution x Hole Size Hold"Tp Vent tq Qyr to / Pipe(s) /Uv Length~_ Dia Length Dia Spacing 11 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over epth Over xx Depth of Ixx Seeded/Sodded xx Mulched BedlTrench Center 1 t ed/Trench Edges opsoi Yes N. Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: p tion t f, O~ Location: 1410 166TH AYE * b Vf b1 6(w nme t ehaf~^y L-01C 1.) Alt BM Description=Aikr UVE4-- a&SeVAAt wwp A W«t 1107 it%ts' otki HG ins ~'~t'~ 2.) Bldg sewer length = .07 * rC~l~Aj„r~ Ott so iMiAV, -amount of cover= 1-9 V J w ~xc,assivc cob*4a nokd 404 W.s0, e4A , ~ ~Z p~ COAX On u►Il Cc~rada,IA) Plan revision Required? y ` Yes I No `1 Use other side for for additiona L I informat on. SBD-6710 (R.3/97) Date rs Sig Cert. No. County_ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.) Madison, WI 53707-71 S ST, ~ erY DEV COUNTY N4 5$9 73~ MMUNITY D~1/ELOPMEN , a?~Prransaction Numb Sanitary Permit Application Q't'/,oZ9y3I In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Hs$4 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Prole, ddress (if different than mailing address) the ores in Department of Safety and Professional wSen , s. 1s. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Information - Please Print All Information /#/Z) Property Owner's Name Parcel # Property Owner's Mail Address Property Location , ~ Govt. Lot ~ City, State ZCode Phone Number ,yy / ''/4, V '/4, Section 4rv /h ~~I (circle one ~~A , T ~t N; R l E or II. Type of Building (check all that apply) Lo I or 2 Family Dwelling - Number of Bedroo/ Subdivision Name L BI c e~ n- C •'C t. ❑ Public/Commercial - Describe Use ❑ City of ti►1,0 V 1 4 Y.- El State Owned - Describe Use CSM Number ❑ Village of -Z 6 (!:cd I I ez / ; Town of ~r f l ~ III. Type of Permit: (Check only one box online A. Complete line B if applicable) Zo ✓ e, A. (New System r - ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) i B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that apply) /A C; 4. T to D(Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Q/fl ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gp f) Dispersal Area Required (sf) Dispersal Area Propos (sf) System Elevatto Y111 i `P ~5 R )00 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o Ne" Tanks Existing Tanks `P u Y R w fo L S ~ in r~ ~ a Septic or Holding Tank C-L.~~ C S'C Y Sc'u~t ~ts~ sG. ~ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's tgn ture MP/MPRS Number Business Phone Number , 1,2 Plumber's Address (Street, City, State, Zip Code) VIII. ounty/De artment Use Only Approved Disapprove Permit Fee Date Issu d Issuing v nt Signature r iven Reason for Denial od 7 i+r i ~r IX. Condigy$THfAA0gV"WReasons for Disapproval % _ 1. 'Sjptin tank, effluent 151te, end 3) ~p t t~J 1 (~G O /~•,nAda- I thsperrs,i cell must all be sniic,s !rnalntay`rec' 11s per management plan provided by plurnber. L), 4--& fQ j%!V `gip > k ragyjr aents must be maintE iced a. PW "PANOM cc* / ordinances. I lei / D~ ~Z 1 Attach to complete plans for the system ands it to the County only on pape not les han 8 1/2 tl inches in size aC bf / b~ i ~a.~ SBD-6398 (R. 11/11) ~ ~ - - n LO_.T : -'J - Z A `...L o e 9 S u..e Ot/1LOT 7 oi~"iv s~ i- •p°` ~ - ..,t, ~`Y~,~_,~~,o\on^ ~v~rla~zo~ ~a / s>z'a°T aaa • ~ ~ ^ LOT 45 \ - % SYSTEM ELEVATION 97.4 0 90X3 EZFLOW TRENCHES rc. .eves` - LOT 91 _ A9 r30 8ORIN.G 2 ...BORING 3 .ORING 4 BORING 5 ® o BM1 I~ ALT BM2 ge ROATel 1- WIESER 1250 SEPTIC TANK ROOM OSF OLY LOCK 525 FILTER TWO LOCK DOWN COVERS. INSTALED PER CODE A ROA o WELL se o OR~~F 5 k`~ oat 5016 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: I&I r ~-Z, `t A;°i• j?C t° a' 01, Owner's Name. Owner's Address: "Oe,7 ;7 Legal Description: 7 20 LTownship: County: T ~'sy X Subdivision Name: Lot Number: t Parcel ID Number: 12f Page 1 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. .yam to/r<r/, License Number: Date: ~1" ez Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 I .e o _ _ LOT 3l T 36 - 1 ~ L_O T 3 5 .+c - >^3s. ~ K~ im N E~ rs as.zs ..x . LOT 444 O[/Tt OT 1 na a_ 5 q mac` y Wa f - \ wW ~J~.~ LO•Te45 xz may' YSTEM ELEVATION 97.4 S CD ~ - o 0 90X3 EZFLOW TRENCHES Ne9 < l OT33 o e BORING 1 r c. cee.~ L O T J f LOT 00 L O T 32a. , o...~AEz BORING 2 BORING 3 `:..BORING 4 BORING 5 ® o BM1 I~ ALT BM2 4 ASFO WIESER 1250 SEPTIC TANK eF0 yo \ 'QOO~ OSF OLY LOCK 525 FILTER TWO LOCK DOWN COVERS. INSTALED PER CODE A RoAS~ o WELL O OR~~'F ~2,q y . I~ coo Qc~,w ~ 7 4, ~ `N84°41 09 • r,-' W1>474 f NORTH GALE: 30 60 9DF'3 ~ \ \ I ,n Z ` i t" tio~ ray CV DRAINAGE EASEMENT \ O~ ~ ~ t r ` i 't j01 ,06 3 v L `j / O RAINAGE EASEMENT v i \ /l R c LEGEND DRAINAGE DIRECTION } =WIRE FLAG SET =WOOD HUB SET AT OR 15' ® OFFSET OR ON BUILDING EXTENSION T.O.H.- TOP OF WOOD HUB ELEVATION._. \ T.O.P.- TOP OF IRON PIPE ELEVATION I 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 best of my knowledge and belief. `ELEVATIONS SHOWN ARE NAVD 1988 DATUM. PLAT ELEVATIONS ARE V HIGHER THAN NAVD 1988 SO NAVD1988+1'=PLAT DATUM. DERRICK CONSTRUCTION LOT 46, WATERS EDGE STAKEOUT PLAN 1atL•C0_ffin6/aas &tea UK Lnd 55meyind SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page-of Project Name: Y E-, r Ile J2 - No. of Cells Per Cell ft Cell Width Total No of It Cell Length sq ft 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: l~ J~j`/ fc~~ r Gravelless Leaching Unit Model: /20. 11-1l3,4- Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent a Soil Backfill in ` Geotextile Fabric . It Infiltrative Surface 12 in 0 ____ft Limiting Factor ,LP Slotted and Anchored Vent/ Observation Pipe with Cap ...a:{..... Plumber/Designer Signature:/f= License c -~y%j(J Date:j .Jl( j` ;S Inc. # (=~navar,cerys ~s,age +c Zabel' PL-525 Effluent Filter Ja'astewater PrCuciS A Division of Po`y,ok Inc. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) slaking it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polvlok 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: 1/16" Filtration Sots F • Rated for 10,000 GPD (gallons per day). Alarm Switch (optional) • 525 linear feet of 1/1.6" filtration. 1O~000 GPD l; Accepts 1" PVC • Accepts 4" and 6" SCHD 40 pipe. Extension Handle l., • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: z Ideal for residential and commercial waste flows up to 525 linear Ft. 10,000 gallons per day (GPD). of 1/16" 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. NSFfANSII standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for ~r.. several years under normal conditions before requiring 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 Shut-Off Ball 1. Locate the outlet of the septic tank. 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 o-: solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completer' inserted. Outdoor sn,aztl liter ; Alarm l xtend & t tski F Polvlok, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. the SmartFilterO 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 0 \ :anOd-1SOd :31Va 00/00/00 31Va OSCtiS IM '>1008 N3aIVW OL AMH Sn 9LL£M z wnNVV4 OIld3S :HnOd-38d ,0-,l=„b L a1VOS dOM :A8 NMVNa 313HOUB313531M M-05ZI w ir LLJ C/) W H Q J U of z° coo W W J ZO ^ U ZD ~ J V Q N N 2 LY lJl d M ° :3 O OJ D !n m N N Q m F Li W o r H W ~ Q Q 0 J m Fw- z 0 N 0!pO Op w U E O Q Z~ ¢ w O Q Q Om O Q Z ° 0_ of U H O w o z ~ Fa- 3 > cn O Q F- v W OQ Q=~U J DM z Q mLLI p O W Q Q W d LL p Z Q a O Q _m d0 O mLN JF~LW o ~ j \ O~ O ~ a a o U MO .0 vi i W 0 Mom aJQ WON 00 a U z U) to M a lL U? -~OOtnd' J wF m WWN LO a JU O z ¢ a O FO \a O NU) NF N Q m Q -J OJO Z U'~ U ~LO N 'q-0C14 WQa W Q Ja W O Fa- W U12= n0tO-j 1~ I U ~ZN pU Z N 2 ZZ Y N W ~Lil 00Z m F-J F- OUl YS U p \ UU Zm N~ J.. f/lW zw U ZF-J (n W U FUj0 Q° LLI Z JO ~SSU Op= MUN 000 ~ 0_ FwQ O m d 0~ ~p _j r Y OQO OaWwm-jCyZe Q ZNO U ZOQ Z U V) ~x N~ LLI z Z3m Um=J~mJ3 QUO 20 Q J J c Q Y LWYY Oli z ? zi a: OJ < O>z U F- U Q W N I Q N Lf) I ~ LLJ t- w c) „OS o w n _ N 04 Q l\ J / f cn 1 II m II I. W 0 11 Q p II x Ln I cti I w II Q Of II 0 I W Ld I I ° a w U N Q w Z Q u£5 2 W d' Q .92 a38=32J SV ~s Y Z a F- M POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of ,Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 2.3 al ❑ NA Permit # Septic Tank Manufacturer e ❑ NA Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacture ~4,.--. Number of Bedrooms L ❑ NA Effluent Filter Model J 1 ❑ NA Number of Public Facility Units 4~_NA Pump Tank Capacity al "lo NA Estimated flow (average) f' gal/day Pump Tank Manufacturer? NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer Zt NA Soil Application Rate al/da /ft2 Pump Model e NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit RL NA Fats, Oil & Grease (FOG) s30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) x220 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) s30 mg/L 11111~ln-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) s30 mg/L 4NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size A in dia. ❑ NA Other: ❑ NA Other: NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency mon Inspect condition of tank(s) At least once every: $ earth(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA Q year(s) Clean effluent filter At least once every: ❑ month(s) 1131 year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) 1$ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ANA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) ANA 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 (Ya) 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 <_12 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 Operator 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 scraps; 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 SPS 383.33, 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 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 Name I i eo%~" Phone 71 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name •c r~°.~r J` 7%Gs ' Name Phone Phone 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. Revised 3/29/13 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ' 13c-x- 4+~-; 0_~a.v rja tc.-4._k 1 ~5 4,01 Property Address ` ' l C s `Q-,1c.' i 1-v XN_16 r_4 1 . caw . I _ (Verification required from Planning & Zoning Department for ne construction.) City/State t-vV-XAo \ ! x`~/ Marcel Identification Number Io - cK LEGAL DESCRIPTION Property Location5W' '/q , O'W /4 , Sec. , T ' N RA-- W, Town of ( e_ i -A : "Lc ` t L~ `a'ilbdiViSIGt1 ~N A1__1 ,Lot # Certified Survey Map # , Volume , Page # Warranty Deed L:j -7 Volume Page # 1 Spec house yes nom) Lot lines identifiabl6 (yes uo 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, 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 8 Zoning Department within 30 days of the three year expiration date. Uwe certiabthat all statements on s form are true to the best of my/our knowledge. 1/we amlare the owner(s) of the property descry ove, by virtue of a w my deed recorded in Register of Deeds Office. Number ra SIG T OF APPLIVANT(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) Wieconr Department of Industry, SOIL AND SITE EVALUATION R9 P Qfl T Page 1 of 3 Laaor a ~ Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis Pim. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI t in St. Croix not limited to vertical and horizontal reference point (BM), direction and % of scall PA~C_ L I.D. # dimensioned, north arrow, and location and distance to nearest road. '~QQ icy ~6_ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE BY DATE o 0 PROPERTY OWNER: TY LOCATION Derrick GO . SW4NK t/4,S`12 T 30 N,R 18 (or) W PROPERTY OWNERS MAILING ADDRESS LOT # ~ OCK # SUBD. NAME OR CSM # W 5 c1~,~estKic505SIAHyE. #65 46 na Eoy6 " Nhmond, WI. 5401~CODE PHONE NUMBER ❑CITY [:]VILLAGE QfOWN NEAREST ROAD (715 246-2320 Richmond 140th. St. [x] New Construction Use [ -Ix Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate gibed, gpd/ft2--a--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) 97.80 ft (as referred to site plan benchmark) Additional design / site considerations na 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 CAS O U CtS El U 12S E] U 0 S ❑ U ]EIS ❑ U E] S ] U SOIL DESCRIPTION REPORT (:v& cd q 11 2.066 Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench " 1........ 1 0-8 10yr2/2 none 1 2msbk mfr w 2f .5 .6 S 2 8-16 10yr4/4 none sicl 2msbk mfr yw if .4 .5 Ground 3 16-27 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 s elev. 101- ft. 4 27-90 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to _AJ 12 LL limiting factor S(. +LJ 90" Remarks: Boring # 1 0-10 10yr212 none 1 2msbk mfr gw 2f .5 .6 2 2 10-22 10yr4/4 none sici 2msbk mfr gw if .4 .5 y 3 22-44 7.5yr4/4 none sl T 2msbk mfr yw if .5 .6 S Ground elev. 4 44-96 7.5yr4/4 none co s Osg ml na na .7 .8 102-3 ft. Depth to limiting 54/10 factor +96" Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. New Richmond WI 54Q17 Signature: L Date: 6-16-2000 CST Number: m02298 i LL: it PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2, 0413 PARCEL I.D. # pending Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft" Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '3 1 -8 10 r3,'3 none 1 2msbk mfr w 2f .5 .6 -S 2 -23 10yr4/4 none sicl 2msbk mfr yw if .4 .5 • S- Ground 3 3-38 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 elev. 101.6 ft. 4 8-90 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to _ limiting factor °f S . gl It Remarks: - DBoring # 1 -10 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 S 4 » 2 0-24 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 4-40 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 0-86 7.5yr4/6 none co s Osg ml na na .7 .8 101.8 ft. Depth to limiting r ` factor +86" Remarks: Boring # 1 -10 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 5 2 0-23 10yr4/4 none sicli 2msbk mfr gw if .4 .5 3 3-33 7.5yr4/4 none is I Osg mvfr gw na .7 .8 Ground elev. 4 3-86 7./5yr4/6 none co s Osg ml na na .7 .8 101.2ft. Depth to limiting factor +86" Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) PROP€RTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page_2_tof 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 13mixtary Roots --T in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& `t 1 -8 10 r3/3 none 1 Zmsbk mfr w 2f .5 .6 3 2 -23 10yr4/4 none sicl 2msbk mfr yw if .4 .5 Ground 3 3-38 7.5yr4/4 none s1 2msbk mfr gw if .5 .6 elev. 01.6 ft. 4 8-90 7.5yr4/6 none co s Osg mi na na .7 1.8 Depth to limiting factor Remarks: Boring # ,,N.t,.::_, 1 -10 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 4 2 0-24 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 4-40 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 0-86 7.5yr4/6 none co s Osg ml na na .7 .8 01.8 ft. Depth to limiting factor +86" Remarks: Boring # -10 10yr2/2 none 1 2msbk mfr cs 2f .5 .6 5 2 0-23 10yr4/4 none sicl 2msbk mfr gw if .4 .5 3 3-33 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 3-86 7./5yr4/6 none co s Osg ml na na .7 .8 101.2ft. Depth to limiting factor +86" Remarks: Boring # Ground elev. ft. Depth to limiting factor STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 SW4NW4 S12-T30N-R18w New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #46-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. AN 1"=40' 6-2=top of 1" pvc pipe C el. 1, 0 00' Z~lt. BM. top of 1" pvc pipe C el. 101.20' / ~Y Gary L. Steel 6-16-2000 'X 973.2 LDG• 9 5.3 9 .9 x 75' B' - - r d© 92.7 89.1 99 9\ - X9916 x 6 YT \ -1 © ACS E~ v n ~to - X*$ B • oB _ - 86481 SQ.FT. s © • B 8475~4(~; _ ACRES ~ J~~5 ACRES X 3 991.4 © © Q B-1 © 'B~ 3990. *B-\ !1 4 8 5 1922 SQ.FT. / o9e `p . 0 E` ~ 50 ACRES 6~3F )o B-4 ,S 3x00 ' o / k0T 46 s3.x i R"oo \ 115124 SQ.FTI 9741 x 34 / 2.64 ACRES x ~ sX \ B - FT4.4 oo , 'ES ♦ x 995.8 9 3 v 9 0.6 Q. K, •B_2 Qs\ x 99 \ 25 YEAR N.wc -985.7 • B 1 c~~ Xo \ ~ yy _ \ y \ 0 R ?SO 9+0 10 0 11 + B -4 _ E~ 2 99 x w 99 .5 T_ 3 3 i 997.3 989.1 )'s IgQ X SQ. T. . ~ / 0°997. L ORES 97.i~ X I x a5.2 995.2 ,85748 S T LO T 3 1, A7