HomeMy WebLinkAbout026-1064-11-100
Yvlsconsir Depanme-I OrComme'_e PRIVATE SEWAGE SYSTEM C^.n.y. St. Croix
Bu di•g Division
INSPECTION REPORT Sanitary Perron No
lip' TACH TO PERN11T) 615397
GENERAL INFORMATION St::te Plan ID Na
POfSc-a ntc•n yCU prp'.Oe ma t aerypbrp' q:Pe'datyL .1`":4111in 11
Permit Fr Je-s Name. City Vtl age TCi0 p PirceI -a. No
Ron and Kathy Derrick TOWN OF RICHMOND 026-1064-11-100
CSI UM Llev T77p Btl I e. IS6a Ire4rr .br.- Seclm'v Town+RangeMap Nc
21.30.18.3188
TANK INFORMATION ELEVATION DATA
TYPE IdANUPACTURFR CAPACI lv STATION BS HI FS ELEV.
Seplic Benchmark
Dosing Alt BI•A
Aeration Bldg. Sewer
Holds;; SVHt Inle:
St.'Ht OW el
TANK SETBACK INFORMATION
TANK 10 P!L VLLL ULOG. ':erCC Air ln:a.c ROAD Ot Inlet
Sectic or Bottom
Dosing Heade0Aan.
Aeration Dist Pipe
HoWi•.q B-t. System
Final Grade
PUMPISIPHON INFORMATION
N9aru`aclu•e• De and St Cover
GPM
Mode' Numoer
TDH LA I -icl or. Less Sys:,_. n Ncad TDH Ft
Foicemar Leratn Cia. Gist x ^:al
SOIL ABSORPTION SYSTEM
BEWTRF:NCH ;dlct- tenri No 2 T=nr -es PH DIMENSIONS Nu. O'Pts nsme Do Lqud CePV'
DIMENSIONS
SETBACK SYSTEM TO III BI DG ::TELL LAKErSTRFAM LEACHING DAanufa_t_rc .
INFORMATION CHAMBER OR
Type Cf 57slem' UNIT rvieicl N-miCcr
DISTRIBUTION SYSTEM
t-eader+tvla ri`c J Di,:r ou'inn x -tole S ze Hole Spacing Vert :c A.r PdeFc
°ipcis
Lenglr Dia !.rrth _ C a Sp;tiin•;
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
r.
Dcplh C.m Gepth n.' r 0 Dvp:h CI xx Sec dc:l+Sadrea . `dplcFerl
Bee!To:ne' Cede Iie,I -,C, I Cale; Tc psoil Yes I No Yes No
COMMENTS: ;Inc tide code discreoer.cies. perscrs present. etc.; Inspect or Inspection #2:
Location: 14152 112TI I ST
tAt WO Description =
2.; B og sev:e- length =
- amount of cover =
Plan revision Req.lireo? Yes No -
Use otner side fo• addi: onal mformatior. L
Dare Insepclors S gralure Cert. No.
SBO 6710 iR 3597)
County
• ~ Safety and Buildings Division ST CROIX
,r r~l 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit NumM (to be filled m <o )
Madison, WI 53707-7162 ~
S:t
W539-7
Sanitary Permit A lic t10n_ Sam Tramamton Number
In accordance with SPS 38 3.2](2), Wis. Adm. CO(IC, winni>sion of this form to the apprnip can t
is required prior to obreinmg a simiuuy pcnnil. NOW, Application forms for statcowncd POWTS me s 'toed m PmjeeI Address (if different than mailing address)
the De(prtment of Safety and Professional Scn•ies. Pemnal information you provide may be used fix seooodsly i
u es in accordance with the privacy I~w s. 15 04(1 xm) Seals L
I I a 1 s S),r I _ _
.
1. Application Information - Please Print Information
t
Property Owner's Name / Parcel a )
RON AND KATHY DERRICK 0 f~ p
Property Owner's Mailing Address Property Location
1462 112TH ST
tout. Lot
Ctry. State 7rp Code Phone Number
NW ti, NW A. Section 21
NEW RICHMOND 54017 30 (circleone>
11. Type of Building (check all that apply' Lap 7 N; R 15 F. M N
9 1 or 2 Family Dwell ng Number of Bed, .4 1 Suldivision Name
l a
❑ PublicK'ommercial - Describe Use C Block
❑ City of
❑ State Owned Describe Use _ CSM Number ❑ Village of _
z 4J J ~z / 7 Z E) IOwoofRICHMOND
in. Type of Permit: ('heck null Inc IA. Complete line B If applicable)
A. ❑ New S
yslnn ~ Replaccmrnt System lteannrnN{ukliog Tank Replacement Only G Other Modification to Existing System (explain)
B• ❑ Permit Renewal ❑ Permit Revawn ❑ Change of Ptumber ❑ Period Transfer to New List Previom Permit Num and D m Issued
Before F.xpuatroo Owner 38 y l1 Z ~~36731
W. ~ em/Coo nenUDevCheck all that a l •
NoFP- ed In<!! ❑ Prcasmzed In-Groand ❑ At-Grade ❑ Mound?_ 24 is of suitable soil ❑ Mpmd <24 in, of suitable sod
oth er Dispersal Com (explain). _ ❑ Pretreatmrnt Device (explain).
V. Di enal/Trea eat Area Inform on:
Design Flow (gpd) Design Soil Applic on Rale(gpdsQ Dispersal Area Req ' (st) Ihcpenal Area (sf) Syncm Elevation pr~ 600 .7 857 900 93.00 auk
VI. Tank Info Car-icy in Tout a of Maoufacmrc
Gallons Gutioas Units 2 u
New Tanks t!ximag lists L hh
1(117' e ~ N T.. vx, ii :7 6
Septic or holding Tank X 1250 WIESER X
ixxirag ('hamper N/A N/A N/A -
VII. Responsibility Statement- 1, the undenigued, assume enponsibility, for installation of the POWTS shown oat the attached plane
Plumber's Name (Print) Plumber's Signature MP•'MPRS Number Business Phone Number
PAUL R KOEHLER 225410 715-246-2660
Plumber's Address (Sweet, Cary, State, Zip Codc)
321 WISCONSIN DRIVE NEW RICHMOND WI
Vlll. nh!I)e artment Use Only
Approved ~yia.ppnr,eoF/-p~. Pennit l x 'am 1, ixd Issuing eat SignatuK4wl-
As Vw an rv-t~ra itcac~~n fo[I reel s566, c / ~q
IX, Condi ~easons for Disapproval
1. >n tank. aAksn liker nN Lie- ~e p c ,nar.3gemen! plan p• o ,~aen Lv plume:.
2- AN mO.tw:k mru"nenm must tv r...rtcit t
felt per Wk Mi tax;: 1;r(frnnrsct.
An a mpht porn for at rynem and mbmf(io the Coonry Only on poptr sot her than a W a 11 inches to au
SBD-6398 (R. IL, 11)
RON AND KATHY DERRICK REPLACMENT.
SEPTIC SYTEM NJ
I
Well 50 ft plus away
PARCEL 026-106410-1D0
Maintained yard
NWl/4NW1/45EC20/21T30R18W TOWN OF RICHMOND
Woods and unkempt part of yard
Current Wieser 1250 septic tank zabd Current infiltrator chamber two trenches Slope 5%
home filter existing
0 o 0
Diverter Valve
0
Proposed ez flows two trenches 90 ft long
each.
System elevation 93.00 J
a
LL
0
m
w
Z
O
i
O~
LOT LINE 275 FT
i
i
t
CONVENTIONAL COMPONENT DESIGN
t Residential Application
INDEX AND TITLE PAGE
Project Name: RON AND KATHY DERRICK REPLACMENT
Owner's Name: RON AND KATHY DERRICK
Owner's Address: 1462 112TH STREET
NEW RICHMOND WI
t
Legal Description: NW 1/4 NW 1/4 SEC 21 T 30N R18W
Township: RICHMOND
County: ST CROIX
Subdivision Name:
Lot Number: 1
Parcel ID Number. 026-1064-10-200
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 Cry Septic Tank Maintenance Form
Page 8 _ Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
t Designer/Plumber: PAUL R KOEHLER License Number: MP 225410
Date: 07/25/2019 Phone Number (715) 246-2660
i Signature
Designed pursuant to the In-Ground Soil Absorption component manual for POWTS Version 2.0 SBD-10705-P (N.01101).
Page i
I
RON AND KATHY DERRICK REPLACMENT.
SEPTIC SYTEM
NJ
Well 50 ft plus away
PARCEL 026-1064-10-100
Maintained yard
NW1/4NW1/4SEC20/21T30R18W TOWN OF RICHMOND
Woods and unkempt part of yard
Current Wieser 1250 septic tank zabd Slope 5%
Current infiltrator chamber two trenches
home filter existing
O o 0
Diverter valve
0
Proposed ez flows two trenches 90 It long
each .
N
System elevation 93.00 a
tz
g
W
Z
J
0
J
LOT LINE 275 FT
SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Ppe_m_
Project Name: RON AND KATHY DERRICK
2
No. of Cells 9 Per Cell
3 t Cell width 18 Total No of EZ1203I
90 n Cell Length 50 sq ft EISA Per Cell
3 e Cell Spacing 900 sq ft Total EISA
Manufacturer No" La In Len N EISA Raft
E2
Infiltrator Q1203H-5ft 5.0' 25,0
1203H-ton 10.0' 50.0
Gravelless Leaching Unit Manufacturer: INFILTTRATOR
Gravelless Leaching Unit Model: EZ1203H-
Finished Grade ft Typical Cross Section
Observation Pipe with
approved cap or vent
Geotextile Fabric
ft Infiltrative Surface
LObservation Soil Backfill
12 in
_ft Limiting Factor
in Slotted and Anchored Ventl
____-------Pipe with Cap
Plumber/DesignerSignature:
License 225410 Date: JULY 25 2019
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ot?
FILE INFORMATION SYSTEM SPECIFICATIONS
owner RON AND KATHY DERRICK Septic Tank Capacity 1250 al ❑ NA
Permit t
Septic Tank Manufacturer WIESER "NA
DESIGN PARAMETERS Effluent Filer Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Fher Model ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity al X NA
Estimated flow (average) gal/day Pump Tank Manufacturer 10 NA
Design flow (peak). (Estimated x 1.5) al/d Pump Manufacturer 11 NA
Soil Application Rate al/da /ft' Pump Model QNA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit 0(NA
Fats, oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODr) 5220 mg/L ❑ 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 (BODs) 530 mg/L X In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Colifomi (geometric mean) 510' cfWlOOml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Yr in di a. ❑ NA Other: 0 NA
Other:
❑ NA Otfbr. ,
❑ NA
'Values typical for domestic wastewater and septic tank effluem. Other: El NA i
MAINTENANCE SCHEDULE
Service Event Service Frequency
nthis)
Inspect condition of tank(s) At least once every: 3 ear
ls) mler(s) (Maximum 3 Years) El NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y') of tank volume O NA
Inspect dispersal cell(s) At least once every: 3 ❑ m arts) l (Maximum 3 Years) ❑ NA
PQ year's)
Clean effluent filter - ` ❑ month(s)
At least once every: 1 ♦ X Year(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ ears (s) $,I NA
Flush laterals and pressure test At least once every: ❑ month(s) X NA
Other: ❑ year's)
At least once every: ❑ month(s)
❑ Year's) CXNA
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 rankle) 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 pending 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 pending 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 (Y) 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 fitters, 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 Z or
' 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 tankis) removed by a septage servicing operator prior to use.
System start up shall not occur when sell 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 cellW 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 calls. 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 rife of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants: fat;
foundation drain Isump 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
property 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 POINTS.
alua ' o mg `ank
dulu v be' a era 1'R D418 rTEI1 ni2-NM / CO&JSTXtlC-Apnl
❑ 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 IO -r/
gyp
POWTS INSTALLER POWTS MAINTAINER
Name COUNTRYSIDE F Name PAUL R KOEHLER
Phone 715 246 2660 Phone 715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name DARRLES SEPTIC Name s L' I ZO/~(l tl
Phone Phone -7/S- 3SCo- l0
This documem was drafted in compliance wnn chapter Comm 83.22(2)(b)(11(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that 1 have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) located
at: NW 1/4, NW %4, Section 21 Town30 N, Range 18 W
Town of RICHMOND , St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of SPS. 384.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service JULY 24TH 2019
Did flow back occur from absorption system? Yesx No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: 1250
Construction: Prefab Concrete X Steel Other
Manufacturer (if known): WEISER
Age of Tank (if known): 18 YRS
Permit number (if known) 384112
PAUL R KOEHJLER
(Licensed Plumber Signature) (Print Name)
MASTER PLUMBER MP 225410
(Title) (License Number) MP/MPRS
JULY 25TH 2019
(Date)
Form to be completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(NR 113 Wisconsin Administrative Code)
Rev. 2,12012
PL; flPt.x~ag}
eIII tlMslon PRIVATE SEWAGE SYSTEM County:
INSPECTION REPORT SL Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sturflarypemitho.:
Personal wonnason you proNos my be used for seoonG,y P„pow (P,Mcy Law. s.15.01 (1)(m)1 3841 12
rm s Name: ape i o : late n No
Derrick, Ron Richmond Townshi
CSTSME v: QF!M v.: 8 Deturptgn: Pwcel Tax NO.:
D/ OD o, Qdc- 1 = CST- ewe I 026.1064-10-A9'
TANK INFORMATION ELEVATION DATA 04. 30, (81 1l6R20
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic tt Stxt 2Sp Benchmark 7.3 ta2,3 1 ob, v '
Dosing Alt. BM S3S' o .bi'
Aeration - Bldg. SewerQ
"ding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 8 3S 9B•bz'
TANKTO P/L WELL BLDG. ventto ROAD Dt Inlet
Airlntake
Septic > /oD n 116v3' 6 ' NA Dt Bottom
Dosing NA Header/Man. 10 ° 41.35-
Aeration NA Dist Pipe I q j-3Z r
Hold? Sot System 11.35 11.30 •0
Olt'
PUMP/ SIPHON INFORMATION Final Grade Z DD •(,s'
Manu urer Demand St Cover
Model Num
TDH Lift Fn tefn TDH t
Fore ain Length Dia. obt.Towell J--
OIL ABSORPTION SYSTEM
NO E width 3/ Le }S No Of Trenches PIT No. Of Pits Inside Dia. L; Depth
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHIgG t
INFORMATION Type , CHAMBER um r.
s em: >.To ~ qfl 7 (Id 7 S OR UNIT > _ • c
DISTRIBUTION SYSTEM
Header I ni o u Orrtn ution Pipes-- X Hole size I x Hoe pacwq nt To Air Intake
Leng u-- Die. _ wg _ I I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Dire, m Depth Of xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed /Trench Edyes Topsoil ❑ Yes ❑ No Ores No
COMMENTS: (Include code discrepancies, perspnspresent, etc.)
Tnsocction #1: OBJI Il DI Inspection #2: -7-
Location: 1462 112th Street, New Richmohd, W1 54017 (NW 1/4 NW 1/4 21 T30 RI 8W) - 213018318A
l.) Alt BM Description vk-~ ~ SE L u%- t
2.) Bldg sewer length= 36' / a 1
-amount of cover = o_JC---•'-°~~J
bese„x,r;" /0" w u.c~ d Srkcl.r...1~•~ t5- W.dxa e•r.~. ac,Y/ ,,Y,>r„Ot~.
Plan revision required? ❑ Yes ON*
(
Use other side for additional information. pgj Mid
S80-6710 (R-347) Date inspectors Signature can. No
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109 East Third Strwt, P.O. Boa 325
- - - New Richmond. W 54017
1 I Z FAST LOW 0' JW SW 114 aaBEAMOS ARE RETF7"CM To TIC E45r-1lS7 1/4
JSI 'D ff )WNW M- UNE OF SECTM 2q TOMNSNIP 31 FL, RANGE to
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asr f14 Lawn NOTE: The parcde Shown on thle map are subject to State, County and
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VOL. 15 PACE 4112
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
~j OWNERSHIP CERTIFICATION FORM
Owner/Buyer ole% b,o ioricX
Mailing Address ~~121i F0.ug~ ~D W&W A6AWt "'W' W1 5,401-1
'fkF
Property Address X~XX hi `sC'"ror New I7it, ,W' VLA
(Verification required from planning Deparhnent for new construction)
City/State AhVK&Kd rWS_ parcel Identification Number t>Z(f, ^lo
~O- 00
LEGAL DESCRIPTION
Property Location v-, 1/4, 1v u~ Sect Z) T pN-R 5_W, Town of .
Subdivision _ Lot #
i
Cer flied Survey Map # 3s.0 .&-A- P-±440
lume Page #
Warranty Deed # S 3154 Vollune /3,/ ` 4 page # 5_.
Spec house 0 yes lk no Lot lines identifiable X yes O no
USTEM Arnrr N E
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.
The property owner agrees to submit to St. Croix Zoning Department a caffication form, signed by the owner and by a
master Plumber. Journeyman Plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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.
Uwe, 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 s m h n maintained must be completed and returned to the St. Croix County Zoning Office within 30
days the a year xp do te.
NATURE OF APPI.ICA DATE
OWNER CERTIFICATION
I (we) certify that al atsteme on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
AAG desc b ed y f a warranty dad recorded in Register of Deeds Office.
E E OF APPLICANT DATE
Any information that is mis-represented may result in the sanitary permit being revoked by The Zoning Department.
Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
rat TRI P4057
583159 WARRANTY DEED
Uurumene Numhr
REGISTER'S OFFICE
ST. CROIX v0.,
Wt «
Rerum Address aseey
Hank of New Rfchmnu JUL i s ( ,
e v 128 1
Ne W
yr 2;00
New Ri R!chnond, Wf 56017 F
yyy;:; '1(+714.. `tf tJer,J., ,
Parcel I.D. Nueuz 26-1060.10.000 b e' 0aµ
t
Glenn A. Buel, aWa C' A Basel and Karen M. Beset. busbudd evil wife,
conveys and warrants to Ronald L. Derriely and Kalhv Derrkfw_ • N d nail Wife /k/a Kathleen
7. Derrick _ the following descnbed real estate m St. Cmlx County. State of Wisconsin:
A parcel of land located in pan of the SW114 of the NWU4 of Section 21 and in pen of the SEI/4 of the
4^, NEI/4 of Section 20, all in Township 30 North. Range 18 West, Town of Richmond, St. Croix County.
Wisconsin, further described as follows:
Beginning at The West 1/4 earner of said Section 21; therwe S89°36'37"E, along the east-west 114 line wfsnid
Section 21, 1299.63 feet to the east line of said SWIM of the NW I/4; thence NOO°13'01"W, along said cast
line. 626.77 feet; thence N89036's7"W 1302.00 feet to the east line of said SEI74 of the NE.I/4 of Section
20: thence N00e26'02"W, along said cast line, 521.30 feet' thence S89033'58'W 232.27 feet; tixnce
s S39°45'23"R' 691.34 fen. thence S15°15'37"W 630.03 feet to the east-west li4 line, of said Section 20:
thence S89%1'37"E. along said east-west 1'4 line. 848.94 feet to the point of beginning. Above described
pp~~ parcel contains -35.00 acres and is subject to right-of-way along the east 33 feet for town road purp"ses and
subject to all other easements, rcstriclions and covenants of retard.
r 1 his is no! homestead propeny. ;J rjs)'7 60 -
~J o`FFypbt.~+ f,
Exception to warranties: Easements, restrictions and rights-of•way of record. if any. v
Dated this 27 day of July, 1998.
H• s ISEAL) r/I• lc3Q.~tr (SEAL)
Glenn A. Basel, aWa Glen A. Bose] Karen Bait
4
AUTHENTICATION
Signature(s) Glenn A. Basel, a/h/e Glen A. Base4 and
Kama M. Basel, husband and wife, authenticated this
day of July, 199S.
Y~
Kristian Ogiand
TITLE: MEMBER STATE BAR OF WISCONSIN
i
THIS INSTRUMENT WAS DRAFTED BY-
j Attorney Kristin Oglind
Hudson, WI 54016
~ III
i
it -L1fM.wP`- - -"''rlndusey, - - - - - .
iurtnan RNations SOIL AND SITE EVALUATION REPORT Pape 1 of-!-
n iv eioof SaNty a eu td gs in accord with ILHR 83.05. Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than St. Croix
I l i i 0) Thi~e. Plen must include, but not limited to vertical and horizon tal reference drection and 71,of slope, scale or [VltwEO~DATE J.D.
a
dimensioned, north arrow, and location and ` to neat road. din
APPLICANT INFORMATION-PLEAS ARINT AILrINFGRMATIO.N
*0 lea
PROPE
RTY OWNER.
. P ERTYLOCATION
errick i.. LOT NW 1N NW ito21 T 30 N.R 18 54or) W
PROPERTY OWNERS MAILING ADDRESS - ra BLOCK s S OR CSM N r5
1505 H #65 - 1 na csm S3
CITY, STATE ZIP CODE PHONE NUMBER LJCRY QVILLAGE EJGWM~ NEAREST ROAD
New Richmond, WI. 54017 (115)246-2320.
,k) New Construction Use Ix) Residential I Number of bedrooms 4 - I) Ad6tion loexisting building
l I Replacement I I Public or commercial describe _
Code derived daay now 600 gpd Recommended design loading rate .7 bad, gpdm2_,$_trertcfn, gpdRt2
Absonpfion area nequired 858 bed, It2 750 bench, 112 Maximum design loading tale __,,,7 bed, gpt*_.D french, gpdrtl2
Recommended infiltration surface elevation(s) 96.10 R (as referred to sues plan benchmark)
Additional design / site consideradors trenches 4.00' below grade
Parent material o r wash Flood plain elevation, if applicable fi
S :Suitable for Syslem CONVENT04AL AtCIrVD INGRCUND PRESSURE AT-GRADE SYSTEM N FILL HCLDMD TANK
U Ureuitable for stem IRS O U ®S o u 68S ❑ u [RS ❑ U 2[]S 0 U ❑ S O U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture structure Consistence Bar1Wy Roots GPD/ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerdt
1 1 -20 10y r3/3 none 1 2msbk mfr cs 2f .5 .6 s
2 0-32 10yr4/4 none sil 2msbk mfr gw if .5 .6 s
Ground 3 2-45 lOyr5/4 none sii M na gw na n~ .2 p
elm _
gZ kat 4 5-110 7.5yr4/6 none fns Osg ml na na 7 B Z
Depth ID
Willing
- -1C-- -
leclor
+1101,
.2
Remarks: 15"x36" sii lens 10Yr5/4-mot7. r5/6- non-contiguous i H-4
Boring N
1 F7.5yr4/6 none sl 2mgr mvfr gw 2f .5
[2] 2 none sl 2msbk mvfr
if .5 .6 3 none me Osg ml na na .7 .8 a
GrouwnW
elev.
97_601
Depth to I 1 _ -
f _ - ar - -
limiting
+100"
i t
Remarks:
CST Name:--Pease Print G L. Stcel Phone: 715-246-6200
Address: 1554 200th. Av ew Richmon W] 54017
i Signature: Date: 5-11-2000 CST Number: m02298
i
r
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- gip' ` '~k; I zLb•~. ry~~ ~i_ '
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Por~~J~r l
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I PROPERTYOWNER Ron Derrick SOIL DESCRIPTION REPORT _
PARCEL LD.I Pending
BoringR Horizon Depth Dominant Color Mottles Texture Structure consislenceBarrdyy Roots GPD/tt
in. Munsell Qu. Sz. Cont. Color Gr.Sz.Sh. Bed randy
1 0-20 10yr3/3 none sl 2mgr mvfr 9w 2f .5 .6
3 ,Y
2 20-99 7.5yr4/6 none me Dag ml na na 7 .8
Ground
elev.
99.5 n_
Depth b
W*ng
bw . M' I 11 &A- +
i{o.O ~G.6
Remarks:
Boring N 1 0-12 10yr3/3 none sl 2msbk mfr gw 2f .5 .6
.s
4 2 12-24 10yr4/4 none sil Zmsbk mfr gw if .5 .6 S~
3 24-88 7.5yr4/6 none ms Osg ml na na .7 '.8 k
Ground -
elev.
100.1
Depth b
imiGrp
factor
+88"
Remarks:
Boring 8
1 0-8 10yr3/3 none sl 2mgr mvfr gw 2f .5 .6
5 2 8-86 7.5yr4/6 none ma Deg ml na na .7 ~1.8 }
Ground - -
elev.
99.9 it
Depth to - -
imiting `fS.b
tactor
+88"
Remarks: _
Boring B
Ground
elev.
n. _
D" to -
imcng j
taaor
Remarks:
SBD-SM(R.0542)
STEEL'S SOIL SERVICE
Gary L Steel 1554 200th Ave.
CSTM2298 Ron Derrick New Richmond, WI 54017
MPRSW-3254 to sty-R18w
town of Richmond (715) 246.6200
lot #1-csm
✓~„=40.~ f rqt
tQp of 1" pvc pipe @ el. 100.00'
t• =top of 1" pvc pipe @ el. 96.05'
~~0 1
614 r
e~
Pry' e P ~
d 1 og )p' ~
~ p.
62~
81 k. 4
71,
~r,if 2~s ' ~ p p' 4
sv'r
Gary L. STeel
5-11-2000
w -
STEEL'S SOIL SERVICE
Gory L. Steel 1554 200th Ave.
Ron Derrick
CSTM2298 New Richmond. WI 54017
MPRSW-3254 NW;4NW4 521= 30N-R18W (715) 246-6200
town of Richmond
lot #I-csm
1" 40'
top of 1" pvc pipe el. 100.00'
t. =top of 1" pvc pipe C el. 96.05'
~h35k~r 4X,/br
J~
rn5 , Ijcc~-
~ JG~
-C~ vy~k d
Gary L. STeel
5-11-2000