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HomeMy WebLinkAbout026-1118-18-000 R Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488296 0 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)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Koch Zachary & Ange I Richmond, Town of 026- 1118 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16 Z . &a - 01.30.18.698 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,�5 CAPACITY STATION BS HI FS ELEV. I Septic t /ZCQ Benchmark c� � z . gz Alt. BM ea 0.Z 0016• 1 Aeration IBIdg.'Sewer Holding St/Ht Inlet � la•3� c� TANK SETBACK INFORMATION St/Ht Outlet b -77 / • 6 $ TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet -� 0 Septic 7 /5 ' s Z_ / / Z , . Dt Bottom •-� — l Dosing Header /Man. Aeration Dist. Pipe "� 7 • 1 >� to Bot. System Z Holding -07- PUMP /SIPHON INFORMATION Final Grade S(W3 lab. zz- Manufacturer Demand St Cover Model ber TDH rft Friction Loss System TDH Ft Forcemal Length Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIM NE SIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS ? S6 3 ve —` `— SETBACK SYSTEM TO P/L WELL LAKE /STREAM LEACHING Manufacturer: / INFORMATION CHAMBER OR Type Of System. UNIT Model Number: 6SAJe,%+ ,b61& (P3 9 6 A DISTRIBUTION SYSTEM Header /Manifold ,� Di t rib x Hole Spa uti x Hole Size cing 1 Vz , !!fLVake / Pipe(s) ! � elo.s_^ Length Dia Length Dia ` Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of 1 7Seeded /Sodded xx Mulched Bed/Trench Center 3 . It---" Bed/Trench Edges \� Topsoil \ es No ><</f No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: Location: 1402 174th Av Unknown ' W 1/4 SW 1/4 1 T30N R18W) Willow Valley Lot 18 Parcel No: 01.30.18.698 1.) Alt BM Description = i ce >,F 6 2.) Bldg sewer length = Z4 / - amount of cover = / - - - -- - -� l_ Plan revision Required? , Yes NoI Use other side for additional information. � z5 0� Date Insepctor's S nature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County S 201 W. Washington Ave., P.O. Box 7162 BIND ��R Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by CoJ Dep artment of Commerce (6 266 -3151 1 Z9' (O to Plan I.D. Nu Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you Pro ect Address (if different than mailing address) may be used for secondary purposes Privacy Law, sl 5.040 Xm) I. Application Information - Please Print All Information Property Owner's Name Parcel # Lot # Block # ttJ IVEp Property Location Property Owner's ailing Address - �1l� y., /., Section City, State Zip Z� ne Number TY or one) � FO COUN T N; R E or W • ��� II. Type of Building (check all that apply) ok ► Subdivision Name CSM Number X I or 2 Family Dwelling - Number of Bedrooms N / MA' -) r Ltd ❑ Public/Commercial - Describe Use a - ❑City_ ❑Village �fownship of [I State Owned. - ,Desc •be Use Drt� III. Type of Permit: (Check only one box on line A. C mplete line B if applicable) A. VNew System C) Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. [I Permit Renewal 11 Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. TVDC of POWTS System: Check all that a pply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe ❑Other (explain) V. Dis rsaUTreatment Area Information: / Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal ArU f) System Elevation / 71 is 1010 VI. Tank Info Capacity in Total Number Site Steel Fiber Plastic Gallons Gallons of Units onstructed Glass New Existing t./ �a r a/L ' l Tanks Tanks 7� Septic HokiingTank ✓ v <_ tir Aerobic Treatment Unit /t Dosing Chamber VII. Responsibility Statement- 1, the undersigned responsibility for i of the POWlrS shown on the attached plans. tuber's Name (P 'nt) Plbees Si cure /MFR umber t3siness Phone Number Plumber's rddress (Street, City, State, Zip Code) (D J " Q IV 4 i W o VIII. Coun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Is eel tssuin gent Sign lure o S pproved Surcharge Fee) LZAA Od $ a(p en Reason ial IX. Conditions of Approval/Reasons for Disapproval $Y3 - - i &M*lk: I. Septic tank, effluent filter and dispersal cell must all aintained as per management plan provided by plumber. 2. AN setback requirements must be maintained as per a)pk" rode I ordinarIM. Attaeb camOtte plam (to the Comely only) for tbesystem on paper not less than 8112 111 inches in size SBD -6398 (R. 01103) 1 R�YIV1(O M3T8Y8 iM ri "Y7 Z of . w a 4r ALL �Ko C� N w `/l 5 w.Qy �c� a o g 7 ;"c ip oZ5a c�4 S�e��` w��es.�ks�� I 5�-: 37 0 f� / gym �,.�„ P r �► ►a ,,� toT cn r ►.u�. �� l� p A0 � X � fl I � 0 0- I� � �Q M I I Ca � Q I A? ti u N w `/� 5 w 7� 5 0 36 N P, l� ��tby � , � e V� �',' W t �1ow �I.4 o �� ,[J ( \ '2.,r �4 v1�i�w � �' a O $' 7' 1� tC11 r'M1 O P1�L � ►� ! c3v�(o -1 t —IFS, � oZ� � s-e � � 1 � o0 w� �es.nrs �{�, fy �o�C �oZ�� -: o°l. sego � z S Ya i Pam �°e � P ; �. N.,.3la cnr ►va, �� bpd Aoo-o ow a o I a= r I i M 1 I I I O �b �Qu.se- i i P� �', Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis..Adm. Code Envimmmental By Design Attach complete site plan on paper not less than 8;h x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Pair;el I.D.# APPLICANT INFORMATION - Please print all information. , =. e26- f DU 0 Personal information you provide may be used for secondary purposes (Privacy Lavv{ s -1$.04 (1) (m)). BY G D p Property Owner _ ropertyt6cat n -` Derrick Construction Inc. vt. tot ST ChiC>sx y l/q,! $W 114 S I T 30 KR 19 W Property Owner's Mailing Address ubd, N a or CSM# 1505 Hwy 65 '' ,x., ' Willow Vall City State Zip Code PhoneNumber f e; Town Nearest Road New Richmond WI 54017 1 140Th St. ❑ New Construction Use: ❑ Residential 1 Number of bedrooms 3 ❑Addition to existing building U Replacement L J Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd& .6 trench, gpdff Absorption area required 900 bed, fts 750 trench, fl Maximum design loading rate .5 bed, gpd/f 2 .6 tr ench, gpd/ff Recommended infiltration surface elevations) 98.26 It (as referred to site plan benchmar Additional design / site consideration 2 y Par material Loess Over Glacial OutWash Flood plain elevation, if applicable na It S= Suitable for system Conventional Mound In Ground Pressure AT Grade System in FBI Holding Tank U= unsuitable for system OS u U I Ei S El U E S u U I . 0 S u U ❑ S 0 U u S FJ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure I GPD/flz Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. C Boundary Roots Bed Trench 1 1 0 -7 10yr3/2 - sil 2msbk mfr cw 2f 5 6 2 7 -18 1 Oyr4 /4 - sil 2msbk mfr cw l f .5 .6 Ground 3 18 -31 7.5yr4/6 - ifs 2msbk mvfr cw - .5 .6 elev 100.171t 4 31 -90 7.5yr5/4 - I ifs Osg ml - - .5 6 Depth to limiting r 5 factor >90 Remarks: 2 1 0 -10 1Oyr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 10 -24 10yr4/4 - sil 2msbk mfr cw if .5 .6 Ground 3 2440 7.5y r4/6 - is 2 msbk mvfr cw - .7 .8 elev 100.90 ft 4 40 -90 7.5yr4/4 - Ifs 2msbk mvfr - - .5 .6 Depth to limiting factor >90 Remarks: CST Name (Please Print) Signature: r �� Telephone No. Thomas C. Nelson 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 1/20/99 227387 189 PROPERTY OWNER: Derrick Construction Inc, SOIL DESCRIPTION REPORT 189 Page 2 of 3 PARCEL I.D.# Environmental �; Horizon Texture Depth Dominant Color Mottles T Structure onsistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -12 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 12 -31 10yr4/4 - sil 2msbk mfr cw if .5 ? .6 Ground elev 3 31 -94 7.5yr4/6 - s Osg ml - - .7 .8 101.1 ft Depth to limiting factor >94 Remarks: 4 1 0 -12 1Oyr3 /2 - sil 2msbk mfr cw 2f .5 .6 - 2 12 -33 10yr4 /4 - sil 2msbk mfr cw if .5 ' .6 Ground elev `Ct 3 33 -51 7.5yr4/6 - ifs 2msbk mfi cw - .5 .6 101.76 ft 4 51 -96 7.5yr5/4 - l s Osg ml - - 7 8 Depth to v� limiting factor $ lr >96 _Remarks: 5 1 0 -8 1Oyr3 /2 - sil 2msbk mfr cw 2f .5 .6 2 8-23 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 23 -41 7.5yr4/6 - is 2msbk mvfr cw - .7 .8 100.33 ft 4 41 -96 7.5yr5/4 - s,l Osg m1 - - .7 .8 Depth to limiting •Z� " 0 factor > 96 I I I I I I I I Remarks: 1 0 -8 10yr3 /2 - sil 2msbk It cw 2f .5 .6 2 8 -22 10yr4 /4 - sil 2msbk mfr cw if .5 .6 Ground elev 3 22 -40 7.5yr4/6 - is 2msbk mvfr cw - 7 8 100.02 ft 4 40 - 94 7.5yr5/4 - s Osg mi - - .7 .8 Depth to limiting factor >94 Remarks: E BY DE51GN 1432 120"' STREET, NEW RICHMOND, WISCONSIN Last saved by Thomas Nelson 71S-246-2454 Willow Valley l Y� PAGE 3 NW '/ SW 1 /, SECTION 1 T 30 N, R 19 W TOWNSHIP Richmond CouNTY St. Croix Wisconsin V QAZ 2, 0 0-W .' g5 105 � ac re- 5 slop, t4: ct Q SCALE 1" =40 Tom Nelson BM 1. Top of iron Pipe NW lot Corner ELEV. 100' 227387 'rte BM 2 Top of Electic Service Box ELEV102.92 V g,4c� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of t E 1FOM TION Permit # a. Septic TaMc Capacity © DNA Septic Tank Manufact}rar ' ❑ NA 0EGIR PAMMEMM Effluent bfcer Manufacturer NtR nbw of.&*ooms I . 13 NA Q NA. Effluent FAw III Q NA Number of Public Facility Unite 903 NA Pump Tank CapaciTy DNA Estlnated flow (average) 0 Pump Tank Manufacturer. © NA Design flow (peak), (Estimated x 1.5) Pump Manufacturer Q NA Sod Application Rate a tfta Purnp Model -Q NA Stwhdard:lrhfhuernt/Effluent Cb:atity Monthly Pretreatment. Unit Q NA Fats, Oil & Grease (FOG) 530 mg/L © SOW/Gravel Filer ❑ Peat Fi B10chemical Oxygen Demand (BODJ 5220 mg/L Q NA 0 Medical Aeration Q Wetland Total Suspended Sobs (TSS) ; 5150 nafL Q Disrfection Q Other: Pretreated Effluent Quality fly average 6e+" 0 NA Biochemical Oxygen Demand (@ODsy s30 mg/L X"round (gravity) D In- Gr+uund (vrassuxhed) Tout Shed Sao" fmi 530 'mg/L 0 NA O At -Grade O Mound Fecal Coliform (9e0m1 mean}, 510 cfu/100mt Q Drip -Line a Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other I3 Other. Q NA Other. 0 NA res "Vak typical for domestic wastewater and septic tank effluent. Other: Q NA KMMPAM =MM Sqndos Chrartt Sethilce Fhownc/ .In spect condition of tank(s) At least once every I bxbnum 8 treera3 Q NA Pump out contents of tank(s) When combined sludge and scum squats we-third (Y of tank volnne Q NA Inspect dispersal cNi(sl At beast once every: Q ( W 8 Vow ) 0 NA earls) Clean efflwuent fitter At least once every: Q morrdn(s1 ❑ NA s1 Inspect Pump. pump controls & alarm At least once emery. Q (s) O NA Flush laterals and pressure test At least once every: Q months) ©NA Other: Q earls) At Deuce Q Other 13 NA MAM1TEMAI11OE MISTMACTIO1" kMfttiars of tanks and dispersal cN(s shall be made by an kWWMual carrying one of the follower tenses or certifications: Mash Plumber. Master Plumber Restricted Sewer; POIf{t1S Inspector, b'OWTS Mainta&ner, inspections must include a visual irwpecUM of the to nkfal to . wee 9 Operato o TAI - measure the volume of combined sludge �Y 9 or broken hardware, identify any cracks or leaks, The sl uige and scum and to check for any bank up or ponding of effluent on the groin surface. of effkrern� {al shall be visually bn m. aback *9 shunt isvela in the - observation pipes and to check for any ponding ground surface. The ponding of effkrent'on the ground surface . may indicate a faiMhg, condition and mquprm the immediate notification of the local regulatory authority. When the combined accumulation of sdge and scrum In any tank squab one -third 1Y or more of the tank volume, the entire conter►ts of the tank shall be removed by a Septa" SWIvicing ,Operator and disposed .of In accordance with .Chaptw NR 11 Wisconsin Administrative Code. ' 3, All other services, including but not limited to the servicing of effluent filters, mechanical or pressuur€zed components, pretraaarnem units, and any servicing at intervals of 512 months, shag be Performed by a certified POWTS Mainta, A service report shall be provided to the joist regulatory authority. within 10 days of completion of my service event. 7 - START uP AND OPERATION of that W impede the treabraer eat prj er use the hOWTS check treatm8nt tankts) for the presence of nt prooese and/or painting Products or:other. chernicak Of the tank(al femoved _by a the � cis). It huh are detected have the contents opwator prior to tom. System Startup shag -not occur when sod condemns Sae - ozen at the dative surface. �g Power outages pump tanks may fN abo ve discharged. to the dispersal ceN cme roman hi�nwater teveN. When Power is restored the excess wastewater win be fttrent. To avoid this situatiorf have the , overloading the ceNtsl and may result in the torntw is of the backuR or. Su face discharge of Power to the effluent PUMP or for t a Pksnbw or POWTS Maintainer to a age Servicing Operator prior to resiorMg MOM n0mW levels within the Pump tank. � ly operating the 'Pump controls - to Do not drive or park vshirdes pyW mks and dispersal cob Do not drive or park over, or otherwise disturb or c within IS fleet down slope of any mound or at odrnpact, the area -grafts sod. absorption area. ii�cti n or u m elimination of the following fr the wastowaw stream may improve the Performance and prolong .doe Ife of the POWTS antibiotics beefy wipes: cigarette butts condom. cotton Swabs; dam; dental floss: diapers; disinfectants: fat:_ P foundation drain isump pump) water, fruit and vegetable POO&W 908011ne:. gr ; herbicidesr: meet scraps: medicatiorm oil; ing Products: Pasafades: sanitary .=ns; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanency taken out of service the following steps shell be taken to mmura that the system is P►oPwlV and safeiv abandoned lo carpliance with cheater Comm 83.33, Wisconsin AdMinistrativw Code: • All ph** to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shag be removed and properly disposed of by a 9eptege Servicing Operator. • After Pumping, all tanks and Pits shall be excavated and renamed or their covers removed and the void space filled with sod, gravel or another inert sold material. CONTWGENCY PLAN If that POWTS fails and cannot be repaired the following measures have been, or must be taken to provide a code compliant replacement System: A suit" rq*"n ent arts has been evaluated and may be utilized for the location of a gall System The rephowwn area Should be Protected from di stur b ance and pe and tshotdd na:bp W"A&d +>po,; b required Setbacks from aftohg and -.Xb=bNS. to lines and weft. FWurs to profit the--rapbooment area wig result in the need for a now and site evalustim to establish a nit area. systems must comply ,with the r in effect at that tine. ❑ A suitable rephamient area is not available due to seek and/or sod limitations. earring 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 Wentify a Suitable replac area. u pon failure of the POWTS a soil and site evasion must be perfomned to locate a Suitable raptacament and. If no replacement area is available a holding tank may be installed as a lest vesort.to ngAmcs #0 fared POWTS. D Mound and at-grade sod absorption systems may be reconstructed in Mace following removal of the bicrnat at the infiltrative surface. Fieco MU s of Such System must comply with the rules in effect at that tine. < <� >> SWM. PUMP- AND OTHER TRE04TAMM TANKS MAY CONTAIN LETHAL GWUNM AND/tM t111SU ItT OXY8811. DO NOT ! A SOP=, Pump OR OTHER TREI►Tt I1T TANK t ANY TAN[ . DEATH MAY RESULT. IWSCUE OF A PERWN FROM THE .MTERM OF A TANK NAY eE DMVMXXT OR INPOSSIBM ADMIGNALC "�S Ifl16TALLEB PE�fS AtI1ER . Name r - Name tie Plume IMTA SBi1f Q ATOR I. LOCAL R ATORY AUT1106M. E Name Nam S�, Phone c sv n>� "10 dratted In cmwfianw .rim dwow Q=M 83.22 IW&M a1d W."" i21 a (3), "vw rs ►, s . code. START UA AND OAERATM For new construction of that de MW impe the construction, Wo o the POWTS check drat tank Presence of s) for the pre Paocass ai#d /or damage the _ A B products or:othe Chemicals Of the tankW removed by a Seinta9e 9 l to use (sl. if hula canrsentratdOns are detected have the corafenis System Startup shall -not ocrxu when soll caaditions we. frozen the ayy surface. During Power pump s 'MY � above discharged to the dispersal c tanklank � One large -dose normal highwater levels. When power lo restored the excess wastewater wyi be tent. To avoid th(s situation: have the the. cellsl and may result in the - backup ou suita a discharge of ell(s) overloading Pow to effluent Pump ttlrtk rarnaved by a Septage Servicing Opamtor prior to restoring Motors normal levels within the pump PAP or contact tank. k Or POWTS M to assist m manually operating the - to PUMP controls . Do not drive. or park vehicles over tanks and d ispersal ' CON S. Do not drive or park over, or otherwise disturb or compact, the within 15 feet down slope of area anY tttocm<t or at -grade "sad. a area. Reduction or elimination of the f ay improve the performance and from the wastewater Stream m POWTS: antibiotics; baby wipes; cigarette butts- c0nd0Ms - Prolong .the if i of the fetwrdation drain (sump p ; dam; dental floss; diapers; �; fat: Punn� water; fnait and ;P 9 e:" grease; herbicides;: meat scraps; mac8cations; oil; Pllii� products; pesticides; sanitary nos c-tannpons; and water softener. brine. ABANDONMENT When the POWTS fails and/or is parrraanently taken out of service the foNowm# stews shall be taken to Insure that the system is Wope►ly and safely abandoned in fiance with diepter Coruna 83.33, Wisconsin AdiviledstraRive Code: • AN piping to tanks and pits shag be disconnected and the abandoned pipe openings sealed. • The contents at all tanks and pits shall be removed and properly disposed of by a _ SeFmge Servicing Operator. a After pumping, all tanks and pits shah be excavated and removed or they covers removed and the void space filled with . gravel or another inert solid material. CONTMOGfNCY ALAN If the POWTS fans and cannot be repaked the following measures have been. rep�oement systerrn: or .must be taken, .ro provide a soda compliant _ A suMlbie fePlecemeni area has been evaluated and may be utilized for the location of a replacenvwx Soil abewpbon system- The replacement area should be protected from disturbance and a0l and should inset :#!e n -oy wed froth strtic3ise� lot fines and wells. Fame to protect th mat area will result in the need for a now 80 andaits -eva -to estabfieh a •replacement area. "R �tema cOMPIy with the rules in effect at that tine. . must A suitable replacement area - is not available due- to setback anxl/ar sad fanitabons. t m replace the failed technology a holding tank may be installed as a last resort POWTS. g advances in POWTS El The site has not been evaluated, to identify a suitable nWFacetment area Upon failure of the POWTS a mV and site mev be installed as ust a �t � f k�ro a suitable onignt area. if no replacement area is avails a }mfg tank cesWt - -ta replace POWTS. 1 Mound and at -grade son Sbs systems may be reconstructed in place foNowlng removal of the biome: at the infi}tratnve surface. Reconstructions of suc systems must carrq* with the rules in effect at that tine. < <MtAail> > SM'f'1G AUIYW AND OTHER TREAT4 MIT TANKS MAY CONTJ4 t 4ETf1AL GASSES /M 1#ISiIFf ICE" T OXYGEN. 00 NOT A SEPTIC. AUMP OR OTHER TRFAT�T TANK t W�DR ANY C A LtAI1ST ES A DEATH MAY' RESULT. PERMN t�M THE SUE OF A OF A TANK tiilAY BE D�lCULT OR 11411POSSIBLE, AODnWNAi. WIS r"pgVt$ MTA� i.ER MO Ai Name C� t.o `k. r� - Name " Phone . C ,�.,. �. phone �'A9E SERVX=W OPERATOR i LOCAL it66UtATORY AUTHQRiT1i! WaNrae roams" �^ Phone a �-__[) 'n phone his dmanem was dralmd in canw6ance with chapter -�. l2l Comm 83.22f211b1('! }td)&ifl and 93.fi41i), E4(3), lllWOnsin Admiidsttative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT RECEIVED AND OWNERSHIP CERTIFICATIO O . �� � JUL .3 12006 Owner/Buyer A CH A-t4�O ArN4y a l.. A ' CO UNTY Mailing Address I Z(c 44 b1� E�2' df, 4)— (AS -AA Property Address _ _ 1 4<31 — 1_ pry (Verification required from Planning & Zoning Department for new construction.) �— City/State Dom- Q 9t4- yU0 W tS, Parcel Identification Number LEGAL DESCRIPTION Property Location RW t /4 , S� %4 , Sec. , T N R P W, Town of C -Annd +.f 1D Subdivision \/V lxx-o W VA 1�� �'`� , Lot # too Certified Survey Map # , Volume , Page # Warranty Deed # , Vol 1 , ',6 7 9 , Page # G-9 Spec house yes no Lot lines identifiable 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, 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 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 Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on 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 Deeds Office. Number of bedrooms �/ � OC14 . 1 - 7 /2.1/O� SI OF APPLICANTS) 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. 08105) LOT EZ1203H • ♦ttv9VV ,•' *••:;; ••�,'. ., , ls �. •OVtOtvV t t t VWV VWV ft vvv vvo vvv vvv 4.625" v V o vvv TVV o 1 " 1/2 circ. = 18.84" vov ttv ova tot tvvVVVV tt VVV VVVVVVV V V t o V VVV VVVVVVVVVOtt vtvVOty V VVV v vvvvvvvvtvvVV vYvv vvW O Vtv vvvvvvvvvvvvOV VVVVOtt " 24 9 Bottom 3 61r 12 -1/2 DIA. (typ.) Void Yolume _ Soij, Interface Area Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewa)ls) 2 � 18.84in = O.D. of 4" pipe - 4.625 inches 12in 3.14 Ift Void volume per linear ft. = 3.14 • l 2J 125in l' 12in *]ft -0.117 ft' Bottom 2 l Total Soil Interface Area 5.14 SQ.FT O.D. of centercyiinder = 172.5 inches Void volume in aggregate of center cylinder =(3.! 4 • ( 6.25in 1" _ 3.14 f2in /ft l • ( 2.3125in l') • .574 = .422 tt' 12in /ft J O.D. of outside cylinders - 12 inches Projected Trench Area Void volume in outside cylinders - 2.3.141 bin ) •.574 - .901 ft3 Sidewall Height = 12 in. •2 - 2.00 Sq.Ft. 112in /ft Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders = 24m • 6in bin (12in/ft 12; ft) - 0.215 ft' Projected Trench Area 5.00 Sq.Ft. Void volume at outside bottom corners (112 of void volume between cylinders) 0.21512 - 0.108 ft' Total void volume - 0.117 + 0.422 + 0.901 + 0.215 + 0.108 - 1.763 cubic ft / ft Gallons per ft - 1.763 X 7.48 - 13.2 eallons ner linear ft. it EPS Aggregate Trench System ED 203H EzflOW Ring -lrldustrial Group 65 Industrial Park Rd. Oakland, TN' 3,8060 SCALE FILE NAME EZ1 203H -vs t SHEEP: 1 of 1 11 -27-01 1 i w \ 777Z+62 U 7 8 P 5' 9 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This indenture, made this 1 3th day of October, 2004 between Wm. RECEIVED FOR RECORD Derrick Construction, Inc., a Wisconsin Corporation, duly organized 10/19/2004 10:00AN and existing under and by virtue of the laws of the State of Wisconsin, located at New Richmond, Wisconsin, party of the first part and WARRANTY DEED Zachary W. Koch and Angela M. Koch, husband and wife, as EXEMPT # survivorship marital property, part'I� of the second part. REC FEE: 11.00 Witnesseth, That the said party of the first part, for and in consideration TRANS FEE: 112.50 of the sum of to it paid by the said partoss of COPY FEE the second part, the receipt whereof is hereby confessed and Recordina Area CC FEE acknowledged, has given, granted, bargained, sold, remised, released, Name and Retu aliened, conveyed and confirmed, and by these presents does give, grant, bargain, sell, remise, alien, convey and confirm unto the said Wm. Derrick Construction, Inc. partigs of the second part, higi_r heirs and assigns forever, the following PO Box 445 described real estate, situated in the County of St. Croix State of New Richmond, WI 54017 Wisconsin, to -wit: Lot Eighteen (18), Plat of Willow Valley in the Township of 026 - 1118 -18 -000 Richmond, St. Croix County Wisconsin. (Parcel Identification Number) Seller, Wm. Derrick construction, Inc., a Wisconsin Corporation, is an affiliate of Derrick Homes, LLC. Seller develops land and Derrick Homes, LLC is a home construction contractor. Seller agrees to sell this lot to Buyer on the condition that Seller's affiliate, Derrick Homes, LLC Will be the builder of the home for Buyer. If Buyer does not commence construction with Derrick Homes, LLC as the contractor /builder within two (2) years of the date of sale of this lot to Buyer, Buyer gives Seller the irrevocable right to re- purchase the lot for the same price as Buyer paid Seller for it when Buyer bought it from Seller. If Buyer desires to sell the lot to another purchaser before constructing a home upon the lot, Busier gives Seller the right of first refusal to re- purchase the lot for the same price as Buyer paid Seller for it when Buyer bought it from Seller. Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said party of the second part, and to thgi[ heirs and assigns FOREVER. And the said Wm. Derrick Construction. Inc.. party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said partg of the second part, t heir heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said partiga of the second part, their heirs, and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it Will forever WARRANT and DEFEND. In Witness Whereof, the said Wm. Derrick Construction, Inc. party of the first part, has caused these presents to be signed by William H. Derrick, its President, and countersigned by Mary Ann Derrick, its Secretary, this 13th day of October, 2004, Wm. Derri Con struct n I Corporate Na e c , William H. D ck President Mary An ck Secretary State of Wisconsin, S t. Croix County._ Personally came before me, this 13th day of October, 2004, William H. Derrick, President, and Mary Ann Derrick, Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President and Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the deed pf sai rporat lority. pAM J. RUTLEDOE otary Public THIS INSTRUMENT WAS DRAFTED BY 1 J. Rutledge k su 9 o f wiaCWol Wm. Derrick Construction, Inc. Notary Public, St. o x County, Wi . New Richmond, WI 54017 My commission expires July 27, 200 Parcel #: 026- 1118 -18 -000 10/06/2005 12:54 PM PAGE 1 OF 1 Alt. Parcel M 01.30.18.698 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KOCH, ZACHARY W & ANGELA M ZACHARY W & ANGELA M KOCH 12644 GREY EAGLE CT #42 GERMANTOWN MD 20874 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1402 174TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.991 Plat: 2633 - WILLOW VALLEY 1 99 SEC 1 T30N R18W PT NW SW WILLOW VALLEY Block/Condo Bldg: LOT 18 LOT 18 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 10/19/2004 777462 2678/590 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.991 31,500 0 31,500 NO Totals for 2005: General Property 1.991 31,500 0 31,500 Woodland 0.000 0 0 Totals for 2004: General Property 1.991 31,500 0 31,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00