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HomeMy WebLinkAbout026-1126-34-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No 592175 . Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] NA Permit Holder's Name City Village Township Parcel Tax No. Brushy Mound Partners TOWN OF RICHMOND 026-1126-34-000 CST BM Elev. jrsp BM Elev: BM Description: Section/Town/Range/Map No. 12.30.18.795 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO PiL BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR UNIT Model Number DISTRIBUTION SYSTEM Header/Manifold - Distr.,bution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Lenglh 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 Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Indude code discrepencies, persons present, etc) Inspection #1: Inspection #2: 1403 166TH AVE Alt Location: 1 BM Descri tion 2.) Bldg sewer length = yf Its s T rt t 41 UJ V `it.i,,,tp - amount of cover = x Plan revision Required? Yes No Use other side for additional information. SBD-6710 (R.3/57j Date Insepctor's Signature Cert. No. f I 1 County RECEIVED Safety and Buildings Division v 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) z. P Madison, Wl 707-7162 R 2 8 2017 ~ t AP lnZ 1,?~ X Y ~ ®M MU + A}~p11eatl- State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropna._ /U is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are sa,,._ l roject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. ///Yo 'T 1. Application Information - Please Print All Inform• o Property wner's Name / Parcel # Property Owner's Mailing Address Property Location iz 1) i~o~- f% Govt. Lot 3 Y City, State Zip Code Phone Number IV iVIZ, y<, Section ~ Z ~'Gi✓ /L/l!/S',L~~/ '2 Y~- (circle one T N; R E o& 11. Type of Building (check all that apply) Lr-3 X or 2 Family Dwelling - Number of Bedrooms Subdivision Name ab ell ~ 1Z /A ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe/Use 3 f 4 f4 3 Town of C ;a- } Ill. 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) g, List Previous Permit Number and Date Issued ❑ Permit Rene ermit Revision Change of Plumber ❑ Permit Transfer to New Before Expirat n Owner IV. Type of POWTS S stem/Com onent/Devlce: (Check all that apply) XNon-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. Dis ersaVfreat ntArea Information: Design Flow (gpd) Design Soil Application Rate(/ 0 Dispersal Area Required Dispersal Area Proposed f) System Elevation y -7 ~7 ,S - z V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units > 2 o v New Tanks Existing Tanks Septic or Holding Tank ~~~"~a • Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's e (Print) Plumber's Signature MP/MPRS Number Business Phone Number 66 k,21 ~T Plumber's Address (Street, City, State, Zip Code) VIII. County/Department Use Only proved i ed Permitt Fee at Issue 1 Issuing ent Signature iven Reaso Denial S IX. Condit easng for Disapproval 1 = rk, eiflt4rr lil W Egli 3> ~2,,,) Ife nc J dispemso cell gust all be sr-=ic?s ;:I -ec / GIs per Marayement plan p o ncieh by plumber. ir 2. reci41w3C•ux►t°s r ne d ►llrst.r e E t rtei n per aodw ! aMirt~lncea, OJT.. J Ga i 1 Attach to complete plans for the system and submit to the County only on paper no lc n 8 1 /2 x 11 inches in ize J 6 2L, pi k-:5 t>je.4- SBD-6398 (R. 11/11) Jlk- L41006 04- BRUSHY MOUND PARTNERS WATERS EDGE 166 T H AV E LOT 34 PARCEL ID 026-1126-34-000 LOT LINE w LOT LINE 493.92 475.15 DRIVE = WAY 0 v ' pROPOSEO R- PROPOSED WELL O Gq HOME B1 ELEV 101.8 B 2 ELEV 101.9 B3 ELEV 101 B4 ELEV 100.0 O ANIESER 1250 SEPTIC B5 ELEV 100.0 O TANK BM TOP OF THE S 90 FT LONG POLY LOCK 5 PVC PIPE 100.0 O S M VTION FILTER ALT B P ❑ F 1" PV IPE 97.0 ❑ DRAINAG EASMENT I SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page_of Project Name: J No. of Cells '7 Per Cell 3 ft Cell Width Total No of 61 n Cell Length S^ sq ft EISA Per Cell S ft Cell Spacing L' 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: ~ell, A Gravelless Leaching Unit Model: z= ? Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent Soil Backfill . ■ Geotextile Fabric . Vft Infiltrative Surface 12 in ~ I 74- ft Limiting Factor % in Slotted and Anchored Vent/ Observation Pipe with Cap ■.aeee...■ee.e.e....a■et~v.■eeee.eecee.ee..s.e..... e. eees■e■■eee.eeeeeee. Plumber/Designer Signature: License Date: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592175 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] NA Permit Holder's Name: City Village Township Parcel Tax No: Brushy Mound Partners TOWN OF RICHMOND 026-1126-34-000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town/Range/Map No: ! 12.30.18.795 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER / CAPACITY STATION BS HI FS ELEV. Septic 116 Benchmark sln 9 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. /Vent to Ai Intake ROAD Dt Inlet Septic x ✓ Dt Bottom Dosing Header/Man. 7-74 Aeration Dist. Pipe _ Holding Bot. System Final Grade PUMP/SIPHON INFORMATION ego Manufacturer Demand St Cover I+ GPM Z 43 1. Model Number } TDH Oft Friction Loss System Head TDH Ft Force main Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth t DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: rQ t_ INFORMATION CHAMBER OR " Type Of System: t F, UNIT Model Number: y! p t DISTRIBUTION SYSTEM Coik Header/Manifold J, Distribution Ix Hole Size x Hole Spacing Vent to Air Intake aa Pipe(s) ~ci6 ~ V Length 4- Dia i Length Dia Spacing ct . SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only p ^ ~✓c~S4- Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~G Bed/Trench Center ' Bed/Trench Edges Topsoil Yes No Yes N. El El COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: i Location: 1403 166TH AVE d . y~01 . ~/V ' ~C ✓ Kr r ti v' d r.' y4-j,, t .o~1-tom., 1.) Alt BM Description = 2.) Bldg sewer length = •x 2• G ~Gd ~G. dti I'A. 5 ' ► .ti G .P..._ - amount of cover = Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Sigw' ure Cert. No. SBD-6710 (R.3/97) ~f dof -,~C)i 6 Count} t Safety and Buildings Division Sf - ~jo jk ti S pf~~U ; 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.) $ l~ Madison, WI 53707-7162 ST. rROIX C©UN ``I" rip ~1. J ll?z t 75 .6 nitary ermit Applica p - r ' State Transaction umber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form SVt 43H33ZH t . is required prior to obtaining a sanitary permit- Note: Application forms for sL- _ T4J~7 0 Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be _ purposes in accordance with the Privacy Law, s. 15.04(l )(m), Stats. 1. Application Information - Please Print All Information ail Property Owner's Name Parcel # laS~ ~~r AK f a2S <fr ~.e / 4 Si chr d Z G - //Z b - 3y_ d o v Property Ow ers Mailing Address Property Location 19 5 Pd t24 YYS ia.~ . ~~e Govt. Lot -TV City, State Zip Code Phone Number SNi 1/, Section /7- X/Ch. RIC41..la ZY6- 2 L60 circle one II. Ty e of Buildin T 3° N: R p g (check all that apply) Lot # D 9 1 or2 Family Dwelling-Number of Bedrooms 3$1 Subdivision Name/~ 61C ob 13lock# W~S G~ 4 t ❑ Public/Commercial - Describe Use 411_ ❑ City of ❑ State Owned- Describe Usef CSM Number ❑ Village of Z ' C( jell,* WTovnof ~ 111. Type of Permit: (Check only ode 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 11 Permit Transfer to N ew List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of PO~VTS System/Com onent/De,,°ice: (Check all that apply) O 1 44:2 Non-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. Dis ersaVTreat ent Area Information: Design Flow (gpd) Design Soil Application gpdst) Dispersal Area Required ( Dispersal Area Propos (st) System Elevation 666 V6 •7 &5? 90 0 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New ranks Esisnn> Tanks ~Z15 o - 2 -2 a~ s ~L7 C_ Sept,, or Bolding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the P ANTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MFRS Number Business Phone Number 1 Ar, 6 6 ~Y7/3 7/f' z yl- Zl~ Plumber's Address (Street, City, State, Zip Code) 3Z/ L✓iftoJJih ~r.i~ /~CV P~iG~i~.o~ ✓ I b~7 VII . County/De artment Use Only Approved ❑ Permit Fee Date Iss ed Issuing e Signature even Reason for Denial 70 6"- IX. Condit , easo for Disapproval J t~ is , e1 uGnt 1t~fe* om~ dicer ai cell must all be smicas ri,'nta°reC (I ~ ss;per Mw.agement plan provided by plumber. kb-v L. O..-toA- t.J • Z Aliekog kriiqullrenents must t o maintF iried JA rA o%_4.k &v% . n per a11ppk Wa cods / crchanca. Attach to complete plans for the system and submi o the County onto on paper not less than 8 1/2 x I I inch SBD-6398 (R. 11/11) r r, jN BRUSHY MOUND PARTNERS WATERS EDGE 166 T H AV E LOT 34 PARCEL ID 026-1126-34-000 N LOT LINE w LOT LINE 493 .92 Of 475.15 DRIVE Ln = WAY 0 v i PROPOSED GAR- PROPOSED WELL O - HOME t B1 ELEV 101.8 B 2 ELEV 101.9 B3 ELEV 101 s B4 ELEV 100.0 O IKWIESER 1250 SEPTIC B5 ELEV 100.0 O 1JANI6. f-- BM TOP OF T THE S 90 FT LONG POLY LOCK 5 PVC PIPE 100.0 O S- M VTION FILTER ; AO- -F B P El r PV IPE 97.0 ° DRAINAG r EASM ENT a L CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Brushy Mound Partners / Michael R Stevens Owner's Name: PO Box 445, New Richmond, WI 54017 Owner's Address: 1403 166th Ave New Richmond WI 54017 Legal Description: SW 1/4, NW 1/4, Sec 12, T30N R18W Town of Richmond Township: Town of Richmond County: St Crox Subdivision Name: Waters Edge Lot Number: 34 Parcel ID Number: 026-1 126-34-000 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: Tim DeYoung License Number: 664713 Date: 1-,1zz 4 Phone Number (715) 246-2660 Signature L Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 BRUSHY MOUND PARTNERS WATERS EDGE 166 T H AV E LOT 34 PARCEL ID 026-1126-34-000 N LOT LINE w w LOT LINE 493 .92 475.15 DRIVE V) = WAY 0 ~t PROPOSED GAR- PROPOSED WELL O HOME B1 ELEV 101.8 B 2 ELEV 101.9 B3 ELEV 101 B4 ELEV 100.0 AMIESER 1250 SEPTIC O B5 ELEV 100.0 O TANK A- BM TOP OF T THE S 90 FT LONG POLY LOCK 5 PVC PIPE 100.0 O FILTER SY M VTION ~ALTB P ❑ ❑ -OF V' PVC IPE 97.0 DRAINAG EASMENT SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page_of_ Project Name: G No. of Cells / Per Cell ft Cell Width Total No of 62 q ft Cell Length S (7 sq ft EISA Per Cell _ ft Cell Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.D EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: n'T i,f ~'rb 'r Gravelless Leaching Unit Model: f g Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent ......®®.t-- / Soil Backfill b in • Geotextile Fabric e . y ft Infiltrative Surface 12 in 0(0 7"5ft Limiting Factor in 7 Slotted and Anchored Vent/ 9Q Observation Pipe with Cap s•■.......c..e.a a...... s..................... Plumber/Designer Signature: O License /1W~Z Date: QG 2~' JEW T M tnc. PIDLYAk Innovations in Precast, Draina9e Zabel' PL-525 Effluent Filter & Wastewater Products A Division of Polylok Inc. PL-525 Filer 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. # 1 Features: 1/16" Filtration Slots Alarm Sw • Rated for 10,000 GPD (gallons per day). (Optional)itch • 525 linear feet of 1/16" filtration. - Accepts 1" PVC • Accepts 4" and 6" SCHD 40 pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. I__ LRated for = iUar i aCCcSSivuity. { 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: j 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. f ` 2. Remove the tank cover and pump tank if necessary. 1 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. =T 4. Insert the PL-525 filter into its housing. 3 5. Replace and secure the septic tank cover. Certified NSF/ANSI Standard 46 i PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring j 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 l 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 solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making Outdoor SmartFiltern % Alarm Extend & LokTm sure the filter is properly aligned and completely inserted. Polyic,k, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. the SmartFflterJ 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 1 W-VIA :3,[J 95b8-SZ~-008 z \ Qgnod-isod 31Va 00 00 00 31Va osLK K `x0023 N3oIVw OL AMH sn 9LL£M idnNbNl 3LLd3S w o :anod-3ad .o-,L=,i L 31vos d0M :xe NMVao 313NDoug 8W-o9zm \ W Q: ~ J N W Ld F-1 Q < U mO W Z M Or J Z V Z) ~ M w cr J w N S d U <0 z a w 0 0 °o o m On m G: w N v1 Q (n : U w o _j a¢ ~ (7 m w o z °o ( It m o F- ca ° a F- z w < W H O w O z O < < o~Q z o (L ~ cr C) J V z J= 't < w w 3 LL F Z " w o< <-U J 0M N D mc~ z d o Q ao ° mvwi < z ~o o a o ILO ~w~~W \ o~ U a n o U_ ►oo o°o t Nm Q< ocn oo J 6 z w N Li FZ ~°°'o d o NI- mvwiw N w aQ -,o o ° EE ? z< O ° n. 9 ~ ` O _j N I N F- < n. w 0 ~ < O N ~ ~ r~S. ww^U(OJ~~ F- 4 U F-Zcn m: V) it C Z n :r ~CZ.9 Z~ N 0- N ~J.. ••OOZI+~ OO<w ~zw U zF-J Fn w U WN <i- Gi ..o w°F-~ ..30= L) ow a <w< w m F ow ►-(n 0!Mzp-J~~U.1 z: < zCf) < ~z W X~ °v Y Nam U2<=J~mg3 <*o Zoa Z v U' ^'cr o ~o Q w w C7 -i < Z it Y O LL F- 0 Z Z J S < o< O U F- U J w V1 I 1 z F cn w < w w w ,OS D o w m n N cn J ~ \ < \ o I I m II W w o I o I .s L4 I_ s F ° r 1 /~l w w ~ o w ir N < F- 4. z Z_ < S9 m w .98 038in03b SV yg Y z < F- an ~zzu► 3,~ 958-SZ~-008 Z \ :anOd-ISO d -AVO 00/00 00 31V0 09L49 1N `XDON N301VM OL "H sn 9LL£M W O ~11~~ B3331M ldnNbYV OlLd3S n3a 313df! -anod-36d dOM axe NN1vaa Y 21YV~0SZtJIA N w ~ I- W F- W Ld H Q < z mO m w C=7 .J Z V D~ W O J U < Z(n CL W W Q. co O _ Z OO Ww m N (n U W I- F- a: W Vl Q o It V' > W o z 0 N Om O -j F: F- Z v Cl z a z = z O w~ OQ 3 O o Ix . . ° MEn wF¢-w C W" Z a zo ~ a o 0 Q = a 0 O wW O M \ O~ U Q a o _U cMiZ o P~m wa <WN a0 3~ o Q z zN Y a LL F ° o V) F- m w N a Z:-) p ° z O U NWO r OF- 'J Cq WQQ W~F -jQ N = Z NF- N EL Ncn~~~rOmz~n °F-i °In Y U J 0 ° \ 2C, <o F- V) Gi ..0 ~Ot= ..3p = O0Y Oow a QW< w m F V) Y r- pZ2z -jv~ Z. Q zE a p z w x° w~ a~0 ado U 0 0 ca Q cn ~x N Z Z3m ()M=~ m~ F- F- p - z U o0 0 Q J J _Q O Z ~Y F p Z Z J 2 J F- O Q O U F- U J Q W N I Q F- F Z (n w W U - W O Q W M t` N N Li (n I/ w II N m I w I U C) p w ~I ¢ U CL 2 ` cv r- I O W N Q t- w W Z J Z Z_ S9 W Q .,99 a38lnO38 SV .~t s Y z Q F- I ST. CROIX COUNTY SEPTIC TANK MAINI'ENANCE AGREEMENT AND OWNERSI11-P CERTIFICATION FORM C►wFtec/I3nyer t'.ir.~ _ t t r i Mailing Address Property Addres (Verification required from Planning & Zoning Departtn or new construction.) City/State ~ € 4 t °vt .y x'J kparcel Identification Nmnber Z ` i [A C? C LEGAL DESCR11"HCON Property Location "/a , VVI/4 Sec. T N R ! W, Town of C" t-J . Subdivision, L,ot # ~ Certified Survey Map # Volume Page # Warranty Deed # Volume-1 - t Page! Spec house yes no Lot tines ideutifiable~yes = 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, ifr=ded, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage inn the waste disposal system. Owner maintenance responsibilities arc-, specified in §Comrti. 53.52(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 phimber, 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. 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 Nanual Resources, State of Wisconsin. Certification stating that your septic system bas 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 oil this form are t e to the best of my/our knowledge. Uwe anvare the owner(s) of the property described bove, by virtue of a warranty deed r orded in Register of Deeds Office. Ntitniber of , 'drr•oo i s G N 'TUBE ICANT(S) DAfE ***Any information that is misrepresented may result in ibe 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 snap if reference is made in ills: vrarranty deed. (IiE V. 0 S/OS) - N8 *12'02"E43-7-'-- 433.9' . ~V i III ` I I a~ ~---~I - ( - .GA~AGE Li.l 111' F~OUSE LIJ. 4., cl) III 0 1 I vLOT 34 w y f.93.ACRES . LEGEND 4jFNr DRAINAGE DIRECTION ~ =IMRE FLAG SET t~ =WOOD HUB SET AT OR 15' ! L y OFFSET OR ON BUILDING EXTENSION =LATH SET T.O.H.- TOP OF WDOD HUB ELEVATION T.O.P.- TOP OF IRON PIPE ELEVATION E\ ` FOUND IRON MONUMENT t, I SETBACK LINE 100 FROM RIGHT OF INAY-PER PLAT 25' REAR 25' SIDE TOTAL, 10' MIN. 20' FROM TOP OF 25% SLOPES NORTH I SCALE: MINIMUM BUILDING FLOOR 0 30 60 ELEVATION• 988.7 i *ELEVATIONS SHOWN ARE NAND 1998 DATUM. PLAT ELEVATIOP45 ARE 1' HIGHER THAN NAVD 1988 50 NAVD19R8+1'=PLAT DATUM. s DERRICK CONSTRUCTION LOT 34. WATERS EDGE STAKEOUT PLAN 6utL•Cacs Iu anocides SBN Ind Some' W fconsln-Department of Industry, SOIL AND SITE E V A L U AT I 'E P O R~ Page 1 of 3 Labor and Human Relations r, Division of Safety & Buildings in accord with ILHR 83.05, ode 0 TY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. P n ust irw but St'. Croix not limited to vertical and horizontal reference point (BM), direction and % o ~o e, scale or PARCEL I.D. # . Della l` dimensioned, north arrow, and location and distance to nearest road. 6- 7 Ggpdaig APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION }~1 EWEQBY DATE p ,p PROPERTY OWNER: P LOCATION W 1/4 NW 1/4,S 12 T 30 ,N,R 18 J(or) W Derrick Const., Inc. Gr111 S PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBO. NAME OR CSM # t 1505 H #65 EAR- S CITY, STATE _ ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [2FOWN NEAREST ROAD New Richmond, WI. 54017 (71$ 246-2320 Richmond 140th St. [ New Construction Use [x ] 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 tre , ft2 Maximum design loading rate .7 bed, gpd/ft2____~Ltrench, gpd/ft2 Recommended infiltration surface elev7renches. (s) 11/97.90 ~ ft (as referred to site plan Inchmark) Additional design / site considerations spared to code 4-00, _be row--gzade Parent material outwash Flood plain elevation, if applicable rya ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U KI S ❑ U F7 S ❑ U DM ❑ U 37 S ❑ U ❑ S [2U SOIL DESCRIPTION REPORT Ct&c A.~hA a,o J tr Z CM Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft 2 1-id Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.Y Bed 'Trench 1 1 0-9 10 r 3/3 none 2msbk mfr r_ 2f -5 5 2 9-30 10 r 4/4 none sicl 2msbk mfr QW if .4 .5 Ground 3 30-96 7.5 r 4/4 none cos os elev. 101.8 ft. p Depth to limiting factor L +9011 T If Ao&_"k Remarks: Boring # 1 0-12 10 r 3/3 2 12-32 10 r 4/4 none ic1_j__2msbk Ground 3 32-96 7.5 r 4/4 none cos os • elev. 101.9 ft. Depth to limiting factor +96„ Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave., N~rw Richmond 54017 Signature: -7 Date: 6-22-2000 CST Number: m02298 1 PROPERTY OWNER Derrick Const., Inc.SOIL DESCRIPTION REPORT Page'2.of--.3 PARCEL I.D. 0 pending Depth Dominant Color Mottles Texture Structure Consistence Bajxlary Roots GPD/ft Boring # Horizon in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .__3...... 1 0-12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 2 12-30 10 r 4/4 none sicl 2msbk mfr if .4 .5 Ground 3 30-96 7.5 r 4/4 none cos os ml na na .7 .8 elev. 101.0 ft. Depth to limiting factor 3 4,2-/7-7. 2 +96" -4, Remarks: Boring # 1 0-12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 4 " 2 12-42 7.5 r 4/4 none ms sl 2msbk mvfr w if .5 .6 Ground 3 42-90 7.5 r 4/4 none cos os ml na na .7 i.8 elev. 100.0ft. (A A Depth to limiting factor +90" Remarks: .5 .6 Boring # 1 0-11 10yr3/3 none 1 2msbk mfr gw 2f 2 11-1 10yr4/4 none sicl 2msbk mfr gw if .4 j .5 3 17-9 7.5yr4/4 none co s j Osg ml na na .7 .8 Ground elev. 100.0(t. Depth to limiting factor +90" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: _ SBD-8330(8.05/92) PROPERTY OWNER Derrick Const., Inc.SOIL DESCRIPTION REPORT Page 2_of_3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench ...3.... 1 0-12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 • S- 2 12-30 10 r 4/4 none sici 2msbk mfr if .4 .5 Ground 3 30-96 7.5 r 4/4 none cos os ml na na .7 .8 .3- elev. D1.0 ft. Depth to limiting factor 3 a-2 ~ 3. Z +96" Remarks: Boring # 1 0-12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 S 4....2 12-42 7.5 r 4/4 none ms si 2msbk mvfr if .5 .6 .5 Ground 3 42-90 7.5 r 4/4 none cos os m1 na na .7 .8 fi elev. 100.Oft. (ANo Depth to limiting factor +90" Remarks: Boring # 1 0-11 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 11-1 10yr4/4 none sici 2msbk mfr gw if .4 .5 3 17-9 7.5yr4/4 none co s Osg mi na na .7 .8 Ground elev. l00.Oft. 1 Depth to limiting factor +90" Remarks: Boring # Ground elev. i ft. i Depth to limiting factor Remarks: SBD-8330(8.05/92) 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 #34-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- -111=401 (I to of 1" pvc pipe C el. 100.00' t. Bm. top of 1" pvc pipe C el. 97.00' c 1 ~C 7+G%~'~~ ~j C a llk~ Gary L. Steel 6-22-2000 'E 00 ~I LO 34 (w x sX 842 fi 1.9 ACRES 995.8 ,G 992.9 B-l f O g-~4 B- 2 25 YEAR H.W.E. ~N~ 88 985.7 --c), I o0 T 33 ~ 1144 ~5\ SQ.~i- T l l !1 -\2.63 XCRES997.1\1 x V 995.2 995,2 99 L9 4.9 6 96*9 SQ. cf) i 998 2.22 ES~9\ 1 002 Q) EI ~ 4-' to v ry C) I a ~~L - n 4-j I ~ - QI ~I-Iol a lol 8 - - - - Q) Q ~I t I 1 °14 ~~.J I N I~ 0 Q) I I ~I I I I - - - - - - - oI ~ o i l I 1621 \I~i~,loi I i U REV. DATE REMARKS DESIGNED: ACS 1 01/18/00 ADDED ROAD DRAWN: ACS/TRD E 2 03/14/00 ADDED 100 YEAR FLOOD 3 03/17 00 LWCD COMMENTS CHECKED: 4 03/28/00 DNR OHWM LAND SURVEYING & CI``. 5 04 06 00 CO. SURVEYOR FFI DATE: 12/16/99 ~w