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HomeMy WebLinkAbout026-1127-44-000 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: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 - Permit Holders Name: City illage 2Wn- i~ Parcel Tax No: CST BM EI No-C)D p. BM Elev. Description: I Section/Town/Range/Map No: p ~ i 5.3 0_17_ TANK INFORMATION LEVATION DATA TYPE MANUFACTURER ~IS CAPACITY STATION BS HI FS ELEV. Septic n Benchmark~c V. Dosi g Alt BM ~T C J fr- io Aeration C .i Bldg. Sewers c(4 Holding St/Ht Inlet '3q-5q . TANK SETBACK INFORMATION -illp a utlet t.0• l05•t1'5 o Q 31 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Inlet / S ,l , Septic 6) ZtVXy D~_Po~ m-- l Dosing- Header/Man. Astat~n Dist Pipe Hol¢fing / Bot System . 7Q(4 97-51 Final Grade d PUMP/SIPHON INFORMATION Manufacturer Demand St Cover `h GPM V ( a'- Model Number T_rp. TDH Lift Friction Loss System He TDH Ft Forcemain Length Dia. Dist. to Well - SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS Ndt OAF Ins ia. Liq ep ('[l /X\~~1 \/J 1\ DIMENSIONS 2? SETBACK SYSTEM TO P/L S BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type Of f CHAMBER ORv~~lL~ -7~ System; UNIT Model 6) t4 rL DISTRIBUTION SYSTEM ll lJ (I i-( 4-1+ (i = L4 Header/Manifold Distribution x e x Hol cing Vent to Air Intake ` tt Pipe(sT Fiofe~~ s(1U.► Length_~~ Dia_ Length Dia Spacing \ S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over l Depth Over jxx Depth o(,,,,\ xx Seeded/Sodded r Mulched Bed/Trench Center Bed/Trench Edges--,, Topsoil Yes D No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Locatior.. 1.) Alt BM Description c6VA'r 2_) Bldg sewer length = /4-1 - amount of cover = '71V, Plan revision Required? 0 Yes E] No wUse other side for additional information. d t -f _ b SBD-6710 (R.3197) Date Insepctors _ Cert. No. Ji %W County > y Sj ~ C2d c ~ Sanitary Permit Number (to be filled in by Co") D`S r MAY l ~U!t t _ -vu., r.v. oax 7162 PS Madison, WI 53707-7162 'tWAA1 IN DOrm n"', .4r-'CROIX COUNTY State Transaction, Number Sanitary ermit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit p' is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to ro.ect Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary f purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats" C~ 14 1. Application Information -Please Print All Information 30 1 1 ~j Property Owner's Name Parcel # - qq Vt4YNe- W, P.Ar veY 3rcl; HUr~v~Y' G - It ?_-7 Prope Owner's Mailing Address Property Locatior~ a? 2f~ 'I~ r~~~ `r 5 r1G~,r l ~Vtti Govt. Lot City, State Zip Code Phone Number ~ 1(y Section ~j J mo 51f& cucle one) IV T 3 d N; R 1~ E m 6u) It. Type of Building (check all that apply) Lot #i ❑ 1 or 2 Family Dwelling - Number of Bedrooms / q14 j Subdivision Name Block# K-ILYlrYITj ~~1 ~J ❑ Public/Commercial - Describe Use ❑ City of ` CSM Number ❑ Village of ❑ State Owned Describe Use t ! ❑ Town of kti_.6-nr,n . III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) I KNon-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 ersallTreatment Area Information: 405 w 1 U 111 aio ii I'Ci~ 5 ~ O'~ov t Des gn Flow (gpd) i Design Soil Application Rate(gpdsf)/ Dispersal Area quired (sf)-' Disper al Area Proposed (SI) System Elevation 96; oa, x 17 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o U °2 New Tan U~ Existing Tanks 72 -2 H 0 o r,.y, 'n v~ 2 a. U Septic or Holding Tank If 3 U f i-ahor 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 Signature MP/MPRS Number Business Phone Number se- Plumber's Address (Street, City, State, Zip Code) 1 c) e 1 ~ uC' lSo ,n ✓ fJ VIII. County epartment Use Only Permit Fee Date Issued Issuing Agent Signature Approved ❑ Disapproved $ q ❑ Owner Given Reason for Denial (Q ' 2,- IX. Condit; easons for Disapproval 1 .Septa tank, crrit", lifter IM 3 aisperv*u cell r:ulat all §Lwnress rNijnj&r;,g,~ J 4 *s per ~rtgr,0emeM plan p!eridert by plumber. 2. °Ad rilarGt s tntsst le rlirintr irE d as per vxkws C46.t / y~Minartam>E. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD-6398 (R. I1/II) I f SE4SW4 S25-T30N-r18W town of Richmond lot #44-Richmond Hills 'N .,1"=40' 7 = top of 1" pvc pipe @ el. 100.00' t. BM top of 1" pvc pipe @ el 1-01.5 s• ~ Es ~ r) 01, << ~k IKI UWT i I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE i Project Name: Owner's Name: Jltwloa m. Q,-ye .r, Owner's Address: t~~~~-gyp !~JV~ __Az?i✓ le, G ~ r?IdJ)Z~ !i✓% T Legal Description: G//~~~~ '/.~ltV!f' r✓s1~li/ ;~G~j/~rrn~Y e ~J5 l~ t {~~013C Township: ,lCy C~17/hpZ7 County: Subdivision Name: Lot Number: Parcel ID Number: Zj-/Z-"7 Page 1 Index and title Page 2 Plot Plan i 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: E uC W e License Number: Date: ©S / 1 ! 7 Phone Number W/5 7la /r 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 w _ SE-jSW-k S25-T30N-r18W town of Richmond lot #44-Richmond Hills 'N .,1"=40' = top of 1" pvc pipe @ el. 100.00' t. BM top of 1" pvc pipe @ el 101.50' 0 x~ b° c U I Ind wm W pw v7m O cn o ! rn rn a zo, 2 r i~ Y F- _o i rNY 0 O JJ UU O Z C) O:Q YW Q m ry) I y p Y ai owc~ Z~ 2 2 ~ o o, F L I ~ Q Ica? c47 m ! U) E Lam- W u~ Ol m U) :g N 3 J I L Y I ~ O U 0 O a a~ Qw Za W `~j~ ~rnH W tq d Q p U N ~r.: Z y r m N t- a as > o U co O z v U It o y Z, VOIT J ~ - tQI W(7 =F- W m 0 _ w Z O F m~ S y o _ w w alp w W a O° W O 0 0 0 z F- o°al T 4 (n ui 0 _ n J? U (0U~ a W d U = w Y a 0WY U) o ~t 4 2 J 0 0 0 F ~ ~ a ^ a z0 a d UW 0 w (D ~ a a FuO^I~~i v z 4 e ~ -Z } r0= x W N W O a 0 W W Z to~WQ z S J °J 0 X3 ~ 2S (nW JN 4 tq~ W Q w ~ W W N a H ~j 2 0 ! Z J S p o w y O . ~CT O v O ¢ I o f 0 a 0 w Ln ~ ~ I O n w 2 N U Q N 0 J X W d ❑ L1 o W I y W a a Z J ap~-I NLLf=/J~ Z O~ m co Q l u J O N U Z Z W Q = z (n 0~ ~ N 0 O Q Z Z W I W~ J f~ c~_7 w 0zc)W Z U !1 Z U z -W O= Z o w 0 a rn?~v~Oa m QOQ2W o p a0 ¢ Q R'JUWD a: tD Z J r n 0 w 3 w z OLL OQQ F-S 0 x W O.-, O w20Z~ (i C~7 W [7 _ F t- F- a W m W z o c°o Q w0 N W wu wJ LL F- aZ o j! to J~F-U~2 ~U J ^ E Y R720-,T U W IQL Q .-:Z ILLL z 0 0 O v-OM w Z O Z m O Z co J 2 = ~ z< W ~ Q Q Nr- ZU 61~ a ~ ao ,o,zE-a, D U w . O _ fn W O :5 W~ (o Q -j Q F ZdZ U~ [nU m- o a Qw a~ U W ~OODH~O= a o1H DUZ(nW -j F- < j H C~(QiaZQWD EZcfl~❑ @a? Z QZ~~OmmO-w0 LL 1L'iU~QwF- © 0 W Z Y Q Y a J 0 (n JXdQQQ?Q~ W W <W U.I-U22F-QOJ Q 0 z N "i vN(Or- wof fIO9H 11NN18VdwOOZONV 1:)!a]N9UOE9I-NI/OgL-WV~uclPaployy-uoil~a~ul/sruoUSIJ(1(~OJd ISI-ZO/maN sa»nosey lo~iuy~alp Quick4 Quick4 Plus Standard Chamber ,2" 48" _ I EFFECTIVE LENGTH Quick4 Plus All-in-One 12 Endcap PRESSURIZED PIPE DRILL POINTS LOCATIONS (2 PLACES) - 18° 13" A 8" INVERT 33" FRONT VIEW SIDE VIEW Quick4 Plus All-in-One Periscope INFILTRATOR WATER TECHNOLOGIES, LLC ("INFILTRATOR-) pa Infiltrator Water Technologies, LLC STANDARD LIMITED Drairdield WARRANTY (a) The structural integrity of each chamber, endcap, EZfiow expanded polystyrene and/or other accessory manufactured by Infiltrator ("Units', when installed and operated in a leachfield of an QUICK4 PLUS onsite septic system in accordance with Infiiltrator's instructions, is warranted to the original pur- ALL-IN-ONE PERISCOPE chaser (`Holder") against defective materials and workmanship for one year from the date that the / (360° SWIVEL) j septic permit is issued for the septic system containing the Units; provided, however, that if a septic r permit is not required by applicable law, the warranty period will begin upon the date that installa- tion of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/ a Q 12.7" INVERT or installation of the Units. (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to 6'I the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the instal- lation instructions; failure to maintain the minimum ground covers set forth in the installation instruc- tions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws, and Infiltrator's installation instructions. 4 Business Park Road (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No P.O. Box 768 warranty applies to any party other than the original Holder. The above represents the Standard Old Saybrook, CT 06475 Limited Warranty offered by Infiltrator. A limited number of states and counties have different war- 860-577-7000 • Fax 860-577-7001 ranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in INFILTRATOR 1-800-221-4436 Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and www.infiltratorwater.com should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4, and Side Winder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, Microl-eaching, PolyTuff, ChamberSpacer, Muth Port, Posil-ock, QuickCut, OuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. © 2016 Infiltrator Water Technologies, LLC. AN rights reserved. Printed in U.SA. PLUS05 0816 Contact Infiltrator Water Technologies' for assistance at 1-800-221-4436 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of '2' FILE INFORMATION SYSTEM SPECIFICATIONS Owner It Y/I< I-rp tir _ p5ri 4 At 14KV Septic Tank Capacity ~ gal ❑ NA Permit I b Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ~jLryl{-~~ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model L j of ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal I ,NA Estimated flow (average) D ' gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ~+®D gal/day Pump Manufacturer NA Soil Application Rate 17 gal/day/ft2 Pump Model RNA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ja NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L IQ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L Xln-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L! NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: 11 NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 0 year(s) Clean effluent filter At least once every: y ❑ month(s) ❑ NA q year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ANA ❑ year(s) Flush laterals and pressure test At least once every: ❑ year(s)month(s) NA Other: At least once every: ❑ month(s) );~`NA ❑ year(s) 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 (Y3) 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 512 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 2 of v 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 calks). 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 Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property 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. r The site a sal'i: T.' e~Lal a o ding~ank be i e ailed t~f2Dg115 s~L. JD 2- A/e;1nj Can1577zc1~tt7 ❑ 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 ? L ~,~q,~ Name Phone 1 1 - `2 Iv- „ S b~ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST, G l d U A/ Phone Phone 46 EEO This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I Soil Absorption System Cross Section ft } 4° Schedule 40 Final Grade PVC Vent Pipe with Vent Cap ft Leaching 71"' Chamber ft Y System Elevation 3 ft ft ft Soil Absomtion System Plan View ft ft { i ft Leaching Trench 1 Chambers 4°Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leachina Chamber Saecifications Manufacturer And Model EISA Rating -;O sq ft per chamber Soil Application Rate _ gpd/sq ft gpd Design Flow , 7 Soil Application Rate EISA Chambers 3 rows of chambers each. Page of ~v I I I I!i ~aa a~ <r M I 6646 540..00' r r O ~i a 7 55'11 E 349.48' o LOT 43 6 187 03' 1 C:) TOTAL AREA: BENCHMARK: ELEVATION-1018.00 I 108,000 50 FT g o° 2 48 ACRES 1 ; $ MIN FF.E 1014.0 r" GRAPHIC N SCALE IN FEET 1 i, I rn , NOTE: 1 S89'43' 24"w 1 , LOT OWNERS ARE HEREBY N07 540.00' OPERATION ADJACENT TO THIS " LOT 10 NOISES AND SMELLS ASSOCIAT 'ate, rY 1 BE PRESENT ON LOTS IN THIS ,n TOTAL AREA. LOT 44 z 93,344 S0. FL • QI® 1 4 IOTA{,. AREA. BENCHMARKS: ?14 ACRES -`705,702 S0. FT, g ~•I\ 8 ~ ALL BENCHMARKS ARE TOP OF 243 ACRES ~ m~ Rio l N \ ~ LTj N S89'43'24'W 1 I In ro • 501.38' Q 51 a, z + • 61 • o Z LAJ S89'43'24" W - LOT 45 4 © 218.93 n, Y n T07AL AREA. 98, 406 S0 FL o 0 5 S89-43-24-W m ~ 1 LEfrF.C1Q.. 1.26 ACRES ~ 6 __-218.87'------- Le) CN (0 8 Secil~n :ome of Record y d •~J3 ^o,/ v Q. Set 173/16' ' v1n' % N o S89'43'24"W LaJ 0 minimum o A N 1 N l z hneol foot 509,12' 19 Set I' x 24' r y^ 1.13 pounds g • ~i ^ f7 LOT 5 s' LOT 46 r + / O O found 1' Iron • 1 TOTAL AREA. 1 O TOTAL AREA. 98,417 S0. FL g (n 8ulldmg Setbc 95,753 50. FT 61+•w 2.26 ACRES a0 1 r - - - 220 ACRES • 5 /'}•m ~~I F.F£ 1010.0 Proposed Driv ; 1 - - - Denotes Drain H. W. E High Water Et r+ I 589'a3' a"w l 0 h H. W. L. Wqh Water Li, 540.00' ; 6 F. F. E Finished Floor $ LOT 47 TOTAL AREA, 12' Utility Eat o 9 98,280 50. FT ; W -.--x Fwceline Y 2 26 ACRES 8 $ nwc. FEE. 10100 19.32' O v.~ o BENCHMARK: 1 T N ELEVATION-1028.00 295.05' 1 N01'43'55'W w ~ w w 1 L" 66' ,;G/NT DR/WWAY S89'43'24"Wj ~n t :n in ' FA SFAdFNT , . 540.00' 33.01' j- it ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 14 rVe br-t n M, Oprye_, ' / Mailing Address Oleo Zk~_.~rnf7nk' W'i '67Uut-7 Property Address'` (Verification required from Planning & Zoning Department for new, construction.) City/State Ne Parcel Identification Number (),?j 12,-7,qq -L)o' LEGAL DESCRIPTION Property Location 5'E '/4 S enf '/4 Sec. 7S , T ~~-o N RTown of d~.mOn Subdivision Plat: Lot # (4 4. Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yesOno Lot lines identifiable ❑yes0no 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 §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Safety And Professional Services 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. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of, Deed" 01,01ce. Number of bedrooms SIGNATURE OF APPLICANT(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. 04/12) Wisconsin-Department of Commerce SOIL EVALUATION REPORT Page _I-- of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.DJ-(A_ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. g J- L/~idQU Please print all information. Re ewed by Date /Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). I Property Owner Property Location R J C Develooment, Inc. Govt. Lot SE 1/4 1/4 S T 30 N R 18 or) W 9 5 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1868 Cty, Rd. C 44 na Richmond Hills City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Richmond WI.154017 H715 ) ® New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 6Q0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material glacial drift Flood Plain elevation if applicable na ft. General comments and recommendations: trenches 3.50' below grade, spaced to code F Boring # F1 Boring 1 60 pit Ground surface elev. 100 - 90 ft. Depth to limiting factor +86 in. [Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10 r 3/3 none sl 2 2 10-86 7.5 r 4 none Ms OSQ ml na na -7 1-? s~ F Boring # Boring 2 ® Pit Ground surface elev. 100 90 ft. Depth to limiting factor +84 in. Fsoil A lication 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 1 0-8 10 r 3/3 none 2 8-84 7.5 r 4/6 none ms os ml n 1 ' Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 150 mg/L Effl nt #2 = BOD 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address ate Eva ation Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10-18-2000 715-246-6200 i Property Owner R J C Development, Inc. Parcel ID# endir~Page - Boring Boring # ❑ Boring 3 [ pit Ground surface elev. _ 1 01 5(V)ft. Depth to limiting factor +86 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 0-11 10 r 3/3 none L 2msbk mfr CS if .5 .8 2 11-30 7.5 r 4 6 none sl 2csbk mvfr if .5 3 30-86 7.5 r 4/6 none ms os ml na na .7 1.2 Boring # Boring 101 .50 +88 in. 5:1 ® Pit Ground surface elev. ft. Depth to limiting factor - 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 0-12 10 r 3/3 none L 2msbk mfr cs if .5 .8 2 12-27 7.5 r4 4 none scl 2msbk mfr cs if .4 .6 3 27-88 7.5 r 4 ncne ms os ml na na .7 1.2 ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 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 altcrnate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6100) I j Property Owner R J C Development, Inc. Parcel ID# pending Page 2 of _3 3] Boring # Boring pit Ground surface elev. 10 1 .50ft. Depth to limiting factor +86 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 11-11 10yr 3 none L 2mSbk mfr cs if .5 .8 2 11-30 7.5 r 4/6 none s1 2csbk mvfr if .5 . 3 30-86 7.5 r 4/6- none MS Os mi na n .7 1.2 Boring # ❑ Boring 4 ® pit Ground surface elev. 101 . 50 ft. Depth to limiting factor +88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10 r 3/3 none L 2msbk mfr CS if .5 .8 2 12-27 7.5 r4 4 none scl 2msbk mfr cs if .4 .6 3 27-88 7.5 r 4 none MS Os ml na na .7 1.2 a Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. El 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 Effluent #1 = BOOS > 30:E 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 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 (RAM) I STEEL'S SOIL SERVICE Gard, L. Steel RJC Development, Inc. 1554 200th Ave. CSTM2298 SE4SW'~ S25-T30N-r18W New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246-6200 lot #44-Richmond Hills 'IV '1"=40' = t op of 1" pvc pipe @ el. 100.00' T t. M, top of 1" pvc pipe @ el -01.50' v x fr b" A~' O P5 f % UT OM 6 Gary L. Steel 10-18-2000 l