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026-1121-20-000
` 0 ? o � � ■ ; � k o 2 0 S ƒ S/ 7 E 3 m 9 2 Sr =§ 9) ®� 2 §` N § § 7 I a -4 ■ § C ; k o C,3 \ r � ■ 7 / >£ C E \ \ 2 8 \ 4 §§2 CL « § § m S S § E §- \ 000 - § \ \ § § § E o f 3 0 r , k § i ® D E ...� � � 7 , E z c @ z pr , q \ 2 G E / § & § m CD k [ \ z m k2 w a o k -Z m k k / 0 0 CA ■ q ) / . 0 } q k 7 z % � a ■O> ] ow n, ", ���o ;� 5.5 cr . = c CA 5� CL - , )� » § ƒ\} 0 . m F ' o, (D , R22nE fEgo It . C Im a a� > m@E,CO ƒ_( +, �= =3 - 0 ( : § � \-§ c§cr @ f , 0 cn 2 Cc mE 2 ; » I ® § \ § \i �7 Wisconsin De'partmenf of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S4 and Building Divisior, , INSPECTION REPORT Sanitary Permit No: 430012 0 INFORM (ATTACH TO PERMIT) State PI GENERAL ATION n ID No: a Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Richert, Fred I Richmond Township 026- 1121 -20 -000 CST BM Elev: jInsp.BMEIev: BM Descriptio Section/Town /Range /Map No: °4 1 � s, 05.30.18 TANK INFORMATION ELEVA ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ko Z Septic ` � '\ Benchmarks_ Dosing `-) ) /O ✓ Alt. BM ` Aeration Bid Sewe Holding Lt/Ht Inlet SG}-( b , TANK SETBACK INFORMATION St/Ht Outlet S q O` TANK TO P/L WELL BLDG. Vent to Ai a ROAD Dt Inlet Septic / / Dt Bottom Dosing Header/ an. f ' f o. �3 Aeration Dist. Pipe Z� -(o 4 7 0,0 0 +O Holding Bot. Sy em (p D 4 f .7., b Final Grade PUMP /SIPHON INFORMATION ►� , 3 Z� Manufacturer Den St Co er GPM Model Number {eta e j��i o2• 61 TDH Lift F ' ion System Head TDH Ft Force a Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Z 4- Z 3 — 3 � BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 9 DIMENSIONS / �" 7 iI ` _/ SETBACK SYSTEM TO P/L - BLDG WELL LAKE /STREAM EACHING anuf IN Typ f System: CHAMBER OR i ��! 2 ✓ / UNIT Model Number: D RIBUTION SYSTEM / 1 / G� Header anifoA Distribution x Hole Size x Hole Spacing Vent to Air Intake Length Dia l l_ength ' _ - 7` 1 s [)ia � •• y �Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over De th Over xx De th of xx Seeded /Sodded xx ulche V 14-1 Bed/Trench Center Bed /Trench Edges Topsoil P L/ P P 7 [ � Yes �.,,] No e r V . COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / i Q-- Inspection #2: / / Location: 1721 107th St New Richmond, WI 54017 (SE 1/4 SE 1/4 5 T30N R18W) Partridge Run Lot 2 Parcel No: 05.30.18. L 1.) Alt BM Description = Sr• coV it—P- t � altfL4 u_,o_ 4 2.) Bldg sewer length = / U - amount of cover = Plan revision Re quired? Use other side for additional information. �� Yes , ' No SBD -6710 (R.3/97) Date Insepctor's ignature Cent. No. J _ j I I I �I I II - ' I I - '_ - 1 - _. -^ I __ _•' - - -._. � i __ l i _.� 1_ _I � I _. __ _ � _ _.. - - - 1- ..-._- i -.. _ _. J I I I it _.- J I I II I j I I � I I I � I i I _ I I - - - -- -- I - 1- A4 - J I �I I i t i � I � l I I i i I j j i i I V J I I I I I I I J r I - 1 J �, I I- � - I Y 1 . I I t ' I , I I J I _ � J � ��- f�n,�✓ �,u-� ,ern j I I I I I I _ 76 Safety and Buildings Division County �, W . � consin 201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 �� \ SiteAddress O Department of Commerce t Sanitary Permit ApPl ca EIVED Sanitary Permit Number .1 300 / L In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy , s15.04(1)(m) I. Application Information - Please Print All Information MAY 2003 State Plan I.D. Nym D Prroacrty Owner's Na ST. CROIX COUNT', Parcel Number hJ 4 .41e� ZONING OFFICE 112 WQO rty Owner's Mailing Address Property Location oas L A: t w 7+4 � ,4� k S S T 3� N, R IO E City, State Zip Code Phone Number Lot N Block Number Subdi ' ' e CSM Number II. Type of Building (Check all that apply.) ❑ City ❑ 1 or 2 Family Dwelling - Number of Bedrooms 3 ❑Village LL ❑ Public /Commercial - Describe Use -) ❑ Towm ❑ State Owned 3 7G /YN ✓'� 1 Nearest Road I -z 2 /3 III. Type of Permit: (Check one ox on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. V2rWew 3 O Replacement of 6 ❑ Addition to System 1 2 ❑Replacement System Tank Only Existin System For County use B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT Systems: (Check all that apply. Numbering is for internal use.) 4C-AT,,Non - Pressu ' 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ er V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevition Final Grade Required Proposed / Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Z. Elevation V I/ � Aso /I 2s W. 3 ✓ " VI. Tank Info Capacity in Total Number Manufacturer !!ll Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks �/ Concrete Constructed Glass New Existing Tanks Tanks Septic r Holding Tank Q �G` /boo Dosing Chamber 6 [f� b0 VII. Responsibility Statement 1, the undersigned, assume responsibility for install f the POWT sho wn on the attached plans. Plumber's Name (Print) Plum ignature MP (ZjP ber Business Phone Number Plumber's Address (Street, City, State, Zip C e) 3 � - 1 �/v 7 s'7` Am -ee Lvl aO/ VIII. ount /De artment Use Onl Disapproved D Issued suing Ag t Signatur tamps) C Approved ❑ Owner Given Initial Adverse SamtarygPerme Fee) Feecludes G water �� Surchar � -� Determination �/ IX. Conditi of Approval/Reaso for Disapproval o, vit ��a�m • DUrnA�/ 1'h� LA ��e �ur� - c�►�s a�i�t's -c�O -P ,Y I OU P q l M�{"iYtsLCh P� fis (to th e Coulity only for the system o per not Tess than 8112 x 11 inches in size 03 SBD -6398 (R. 05101) A jp1�1j1j_C- : I � I I j I I I I SP /V7 I i I i I Z -01 I I _ �• �►'t �'�u �� e� �� I / �if� ( ! I I ' _ III � ��1 u ' � L °�'� ,fix r I - j 1 I i I I I I i T i I I i I I i I : I I I i rQ F I I � ; I i � , I ' P /7`C.+K: i '` r I I I I �' _ _ � _ i f I _ _. 1. � _ -_ -' ___� i � � � I i I _.. r _ � I I I � � � � �i i - I . __ I �I _ i ` I. _ i I . _ _. i _. _ _. _�.._ I { 'r _, _. � I � � i i � � l i, i � � ! � �� _ '. _ -. � _ �, � � - I - � -- - �- � � - I I i i _� - � _� -_ - ,- _ �._ � � _ - r. - r__. i i r _ � !� - i - -- I '� h I � I� I � I, I - i,- -_ '� _ � f _���, i i � i :. �. �� i ', i I _ r - j I _ I I � , _ 4 - -- � - _,_ � � I ' , � � i I I � I, � i II r - i � � > - - -- -- r _ j I : f I I j - II I � I I I � i I � i I I � i � � _ i II __ I- - __. r ----L - - �- I i I L I i I !, I � � I i I li � i I it i i- i �i i i � � - I i -� - r_ I I I ! I �, � i I I �: . I I � , I I ' _. _ _ I - � �- � � � � - - � - � -� -- � � -- I !� ' � i I' � I I � I ' i - -. I � � � -'!- � - _ .. ___ _ .__V - � � I ,. L I II ( t � �� � � � i � I i I I I i � ._ � i i I I I I I � _ �. I I L _ I _ _ I � �� � I I I I � li � I I _ I � — __ _ I �� i I I � I. - � � � _ �. I I -r -- - � r- � - - I � - I I f �- -� � - �� � � � � �, - - � - -� - �- - � � � -- � I ' if E f � �� � � - , � �� - - �� i i � � - � � _ I — - � — - - -�- - -- - � = � - � �� ! _ � i I I � I I I � _� I � # � I -� I - �- -�-- -� I ! I - � � - � I � I - -' I I, �� _ � � I I I _ I � �I i � i_ � I � � I I ( ; 'f 1, � i � �� �� I -, -�- I _ _�� � � � � I �i I l I I r I I �- -_ i � - - - � � _ �- �- ', I � � i l� r _ I, I I i I I � I I I I � I - I :� ' l i ;, - �� I � � l �� - '; - - �- � � - -� i l � I� I � I I � �� �_ �i � I� l i I -- - - � _ _ - - - -� - j r -- ,_ � _ I �I - �- � -, ! - - �� � - -� ��- - -�I � � I I I �. _ _. . � _ � �� ���.. - -- - �- -- � _ _��,L. _ _ � _ �_ I �___ .. � . _ - - -, __.0 I i I -- I i I I , � � I I I � � � � _ � � I,. t ._ _ _ � � _ �� _ � � I �.. � ! � -- I i I i � I _ i I _ - � r - � � � � � - -- I - � -- �- - - - -- �.. _ I - r i - I i I I III ,_ � I I I i ._ f I � I I I, - I I i r -r F S- - II I I -� i I 1 � 1 I � � � � � __ � Ir - r - r �__ I _ �� I � I � I � I I I I I I i i I, � i I t I I J a_ y I _ _ _ _ __ � f � ( _i I I I I I I I j i i II I . I �_ I � I � + i � I I I I I i � � I I z � I �- r ;- r �- - I � I I I I � I I I � I i i � � I I I I I II I � I .- I I I _ _ � -- i I I I � I � I I � I i � I } II f j I -I -- �. �� � �I � � � � I - - - - - � - I I I - I - r _ - - - -- I I ,. ': � I ' ' �, '. I I I � � _ � -.L _ _ l r _ f.- � - I I I i � r � I ' I ! I � � � � - � � -I- i � r - ; - � �. _ I . _. f I I, I C I I i I V I I I !! I I � I t 2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division o7"s afety and Buildings ` in accordance with Comm 85, Wis. Adm. Code _ County S TO t Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. (��— + a I - o)Q Please print all information. eviewe by Date Personal information you provide may be used f p , ( Law, 15.04 (1) (m)). Property Owner erty Location Halle &% � s 100,p. Lot 1 1/4 SF- 1/4 S 5 T 36 N R II? E (o W Property Owner's Mailing Address ,, PA - )ui t # Block # Subd. Name or CSM# 1113 q b4 ' r +r; j a 0 Ro City tt State Zip Code PhonE j 9 City [] Village 50 Town Nearest Road MW I�ichneowe� WI 1 5401 7 ( iR ( Q - 6 - - 6 %13 R iC(MaA� 107 5- f- 19 New Construction Use: QK Residential / Number of bedrooms 3 Code derived design flow rate q 50 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Q I a- C i C., ( -- I I Flood Plain elevation if applicable ft. General comments Z' S u t S << S ca ay - '} S , d ` T "fit a s Fo i -e- G L, 5 . and recommendations: �� 0- ' 1 - S ;� c. d . - r.5 ( 9 Y.651 �,L e- 1 T, f91.3R' T� ( 93 .3 8') .5m F11 Boring # ❑Boring QQ c� q 6 1 ' -- X Z• T. 19 Pit Ground surface elev. "1 Q o ft. Depth to limiting factor 10 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 (3--9 I (S - gR 3 1a L. a l:& cls� us a F , s 1 % q a, -3 -,s y R 4 1q ------ ......d. S L - a Fs U d SA-\ aW 1 , j F, S .9 �k q4 - )s olo Fa-1 Boring # ❑ Boring JL (� r� a . 13.6 Pit Ground surface elev. q ft. Depth to limiting factor /0 in. Soil Application 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 6 -9 la 1R * a L. a FA 8 s\ Us a F 6 A 3 1 •� � ,5 yR `� +� -- - ,. L a & \i 0- Iv I~ .5 , 4 1 -30 ,sy v lN aP S (3K 6s�N QVj ,9 a. 1 , 3z L:::] 1 5 L FS LdrnvA7 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L r CST Name (Please Print) Signature CST Number Address U Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) , f r Property Owner HQ Ile 81.1 i I0 errs Parcel ID # Page _ of 3 [31 ❑ Boring Boring # ' Pit Ground surface elev. �� ft. Depth to limiting factor �_ in. Soil Application 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 I *Eff#2 / O - ioyR 3 1a L / ,c& d as a Ir ,y .4 a -9 10VR -- L i'FPL ds Cw II- ,y 3 q -�I �.Sy� yl� "S QM S8 K C VJ IVF ,5 19 W - ,3+ 33 1.5 1 1 4 SL aFS ds a4J I ,5 S 33 -I 5 VR 5 L 1)FS6K q 1 6 1 Fq -1 B oring # Boring [oyPit Ground surface elev. 93. T 9 ft. Depth to limiting factor I in. Soil Application 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 I *Eff#2 J o - ►o A 3 1a L- 1 F6R - ds� as a P .y A0 CA s -9 V 3 1q L. )rPL 6 SI i CW I F , y .6 3 9 - 1 y 10 4 R sly ---- - � . �.�.. �._,. L. a FS8 k d 5 c W I v F , S . H -30 15v y ll, -- s"L a M5 6 d� C yj Ivy , 19 S -51 75Yk 4 ) 4 FSL aF5 qkJ — .5 5 1.3' ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 * 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) i 11 {. eve s I , i9y a. G ► C$tWl aaI7y�, 5 - NC> T a'5 4,1 i aG � a1D 1 C A. 5a v open I j J % 14- C . 4 C � J ®� 6m � vc t { a ca oo-H V • �� �` f Wisconsin Department of Comm f rce F EB 1 3 SOAP EVALUATION REPORT Page of Division of Safety and Buildings 20� ST accordance with Co m 85, Wis. Adm. Code fL X CU County ST . crQ X Attach complete site plan on pap nth T x Y l l in es in size. Plan must include, but not limited to: vertical and horizon ce p nt (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locatio and distance to nearest road. Q 6 Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location H G 1e &1 � efS Govt. Lot -SW 1/4:SE 1/4 S S T 3Q N R E (or l�v Property Owner's Mailing Address Block # Subd. Name or CSM# )113 aw `4 a+ aaii6a e Rv City State Zip Code Phone Number ❑ Village [Town Nearest Road f>-J R ic l,w+o.,c 1 A I WIl 1 5461 (115 ) ON 6 - 0 13 Rica MOO %8 1 l v ' 7 5+ U New Construction Use: 69 Residential / Number of bedrooms 3 Code derived design flow rate TS-0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material atld -GI R- I rt . E ( Flood Plain elevation if applicable ft. General comments S { - to P.5 ' 0. . 5 TR Gke 1 to V. itA.f-1�, and recommendations: -r,I (9S,a3') - T,3 (9N.77 - rS (94.59 ?.7 (95 .9111 "k �', F� `S:� -� • - rat�S5,p5'� 'T''1 �9Y,5t7` - r. to )1 be M i Boring # ❑ Boring Pit Ground surface elev. 9.g ft. Depth to limiting factor D J' in. Soil Application Rate Horizon Depth Dominant Color Redox Descrip Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I `Eff#2 o -H )C) 4R 3 1a -- L ! P&R ast• Q a F .4 6 9 s yR y16 SL arnsis ds�% Lis W F ,5 y 1y -a5 -?. b �--- -� 5 a FS6K d� A\J t� 1 �5*5 5 4 R 4 )q S L. 1 FSS k Boring # ❑ Boring pit Ground surface elev. O D ft. Depth to limiting factor / / D in. Soil Application 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 I *Eff#2 1 O -5 16 4g 3 1a L IF6R 3s�\ as aF .y .6 a s- It, 101 R 3 14 `°-- L, 1 FPS. ESL C W 1 , t 3 )0 -13 I01K 51 4 L, o»Sak as Cw 1v F 1 - y 3 ay �,svR Ib � amSgK d� Cpl tv F . 5 5 0 - 1(4 - 45 I'S A 4 1 to ----- ----_� .�� ..�.... 5 L d FS Q K 6 5k\ G(W .5 b q5_11 Syg y)y I -� SL 1 rS6K 6%k I q , b Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L ` Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number 1 O tnnq T 5� q �t as 1" 1 LA 6 Address Date valuation Conducted Telephone Number a` b aao A s-�. Sfat' SgQZb la- I�t 715- a�8 -35 4 SBD -8330 (1107/00) Property Owner 4a l le AUA Parcel ID # Page 2 of 3 F-31 Boring # ; Boring p Pit Ground surface ele . 7.I5 Depth to limiting factor 05 in. Soil Application Rate Horizon Depth Dominant Color Redox De ption Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. CUor Gr. Sz. Sh. 'Eff#1 I 'Eff#2 0 -4 )O IR 31a L hC & as a F . y .6 a y -8 IoyR 3 14 L IFPL dst, c -w i F . y .6 3 � -►q � .s �lR y�b `a� amsa� d cw �u� •s .9 q 1 9- 36 7,s ---- - L a FUk d S�N awl .9 s % -%S s -q 4 1q SL FS6 K as . y . 6 F41 Boring # [] Boring Q 1 9 Pit Ground surface elev. p . ft. Depth to limiting factor 9-5 in. Soil Application 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 I 'Eff#2 I b - Ica\(R L i ;=& R d s Q S a .L4 . a . 6- 11 ►d A 3 1 q L , FPL a s c I F . 6 3 13 - 16 io SIR S ly L a Fs6K as c%J IV 1: . S .9 16 -�$ 1.5 q R q 1 -- -- -� ---- -� si amsin 8�' .► F ,9 5 aB -36 _7,S 1 b __ S L 3 PSgk J sl aw w .9 _16-9 s 4 R `'ly SL 1 FSIQ c S\r\ - ❑ 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 /ft 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) POWTS OWNER'S MANUAL & MANAGEMENT PLAN page / of FILE INFORMATI- N j SYSTEM SPECIFICATIONS Owner Septic Tank Capacity �p a l 13 NA Permit # Ll 3 v Septic Tank Manufacturer 0 NA D1rWIN RARAME. ER /S Effluent Filter Manufacturer © NA Number of Bedrooms ❑ NA Effl Fi lter Model ❑ NA Number of Public Facility Units CIA Pump Tank Capacity a l ❑ NA Estimated .flow (average) 30 gal /da y Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1 -5) - Pump Manufacturer ❑ NA gal /day /frz Pump Model ❑ NA Standard Influent/Effluent Quality Month ave rage'" Pretreatment Unit ❑ NA (FOG} S30 mg /L ❑ Sand /Gravel Filter © Peat Filter Biochemical Oxygen Demand (SOD <_220 mg /L ❑ NA G7 Mechanical Aeration E3 Wetland Total Suspended Solids (TSS) _ -159 mg /L ❑ Disinfection E3 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) [3 NA Biochemical Oxygen Demand (BOD 530 m91L, ❑ In- Ground (gravity) "In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA [3 At Grade ❑ Mound Fecal Coliforrn (geometric mean) 51 p° cfu /100 t ❑Drip -Line Q Other: Maximum Effluent Particle Size y in di L3 NA Other: El NA Other: 0 N Other ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other; DNA MAIN:TEIIIANCE SCHEQUI.E Service Event Service Frequency - - -- r- nonth(s) (Maximum 3 years) NA Inspect condition of tank(s) At least once every: Z '3 ear(s) Pump out contents of tanks) When combined sludge and scum equals one -third N of tan vo ume 17 NA ' © month(s) {Maximum 3 years) E3 NA Inspect dispersal cell(s) At toast once every: Z 3 y ears) mcnth(s) E3 NA Clean effluent filter �S��D At least once every: EA month(s) ❑ NA Inspect pump., pump controls & alarm At least once every: lwl earls) ❑ .month(s) ❑ NA Flush laterals and pressure test At least once every. ❑ year(s) a month(s) 0 NA Other: At least once every: fO yearls) CJttioi: ❑ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certif3eations; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Saptage Servicing Operator. lank 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 pending of effluent on the ground surface. pipes and to check for any pending The dispersal call(s) shall be visually inspected to check the effluent levels in the observation of affluent 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 M 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. GMW (4101) Page -2, ,f v START UP AND OPERATION For new construction, prior to use of the ! POWTS check treatment tanks) 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 deteoied 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 htghwater levels. When power is restored the excess wastaWpter will be discharged to the dispersal call(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 um tank, p p 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 slops 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; peatioides; 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 63.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septaga 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.n0t be I-htr)nged 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 now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A su - ab replacem area Is not avails a d"a to se ack nd /or soil imi tions. 8 in adve s in POWTS tech of g a ha)ding a m e installs as last resor o repla the f ad PO S. ❑ The to ha not een taste to entify a u)tsb replaoeme t ea. Upon fa re of the POWTS a soil a d site evaluation a performed to a placement area. if no replacement area is av d' tank may be i al(ed a last resort to replace the fall WTS. © Mound and at -grade soil absorption systems may be reconstructed in piece 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 ANDIOR 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. ADDIT IONAL COMMENTS POWTS IN R POWTS MAINTAINER blame ,$►•,,,� Name Phone 24 -L- SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S7 ZAAi.I Phone phone 7 4j-', 6 , l/6 JEO This document was drafted in compliance with chapter Comm 83.22 (2 )(b)(1I(d) &(f) and 83.64(1). (2) & (3), Wisconsin A&Wrilitrative Code. r T ST CROIX' COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 0 1 La S _JA P IJ sSCq a property Address +1 S4 (Verification required from Planning. Department for new construction)_ City /State JY �C t-1 o �� W Parcel Identification Number �Z ���°� "�� —� � LEGAL DESCRIPTION P Y Locatiom' W %, 64- ' / <, Sec. _ , T 30 N -R2 W, Town of �lG�h+� - n� o Subdivision 1 ls`c , Lot it Certified Survey Map # , Volume , Page # Warranty Deed # 7 a O Volume Page # Spec house ❑ yes E'-no Lot lines identifiable M ❑ no SYSTEM MAINTENANCE 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 function of the septic tank as a treatment stn can affect the fun eP a in the waste disposal system. g The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masWplumbcr, 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. Uw% 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 leted and returned to the St. Croix County Zoning Office within 30 stating that your septic system has been maintained must be comp days of the -threcy e iration date. y SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described bo , b virtue of a warranty deed recorded in Register of Deeds Office. . S i /Yi o3 SIGNATURE 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 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., MI RECEIVED FOR RECORD This Deed, made between Halle Builders, Inc., a Wisconsin 05/20/2003 09:30AN Corporation, WARRANTY DEED EXEMPT # Grantor, and Frederick M. Richert, a single person, and Melanie K. REC FEE: 11.00 Henricks, a single person, as joint tenants, TRANS FEE: 82.80 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 20, Plat of Partridge Run in the Town of Richmond. Recording Area Name and Return Address Halle Builders, Inc. 1113 Highway 64 New Richmond, WI 54017 026 - 1121 -20 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances, easements and restrictions of record. Dated this 14th day of May , 2003 HALLE BUILDERS, INC. ) � - -" Q, * * By: Marc G. Halle, Vice President AUTHENTICATION ACKNOWLEDGMENT Si nature s STATE OF WISCONSIN ) Signature ) ss. ST. CROIX County ) authenticated this day of y �� � day of Personally came before me this May , 2003 the above named Marc G. Halle as Vice President of Halle Builders, Inc. * TITLE: MEMBER STATE BAR OF WISCO P6 ,0 L IY44` a known to be the person(s) who executed the foregoing (If not, t4 . ment and acknowledged the same. authorized by § 706.06, Wis. Stats.) NOTARY THIS INSTRUMENT WAS DRAF — — Judith A. Remington - Remington Law Offices of ublic, State Wisconsin P.O. Box 177, New Richmond, WI 54017 (715) ommission is ennanent. not, state expiration date : (Signatures may be authenticated or acknowledged. Bo * Names of persons signing in any capacity must be typed or pn 1gnature. information Professionals company, Fond du Lac, wi WARRANTY DEED STATE BAR OF WISCONSIN eoo 655 FORM No. 2 -1999 I THIS INSTRUMENT .XE RUN F THE SE 114 OF SECTION 5, MON, SIX COUNTY WISCONSIN. UNPLATTED LANDS NORTH LINE OF THE SW1 /4 OF THE SE1 /4 80' RAD. TEMPORARY CUL -DE -SAC N 89'59'01" 643 7 TO BE REMOVED UPON ROAD EXTENSION. 343.27' ,� 0. vu r4 234.10' 1 9 ! I 1.065 ACRES 1 1 1 �: -• -• - 46,370 SQ. FT. N89'55'31 "E 341.43' I I I 1,194 ACRES 52,011 SO. FT. {- •- •- •- • -• -•I- 18 I I ,. I, Douglas J. S89'55 31 W 237.65 j W that in full cc 1.090 ACRES 100 I 47,496 SQ. FT. I I 100 N Statutes, and � � w I N89'55'31 "E 339.53' ; ! ! described on o that such p • I subdivision o 21 the SW1 /4 7 58' RA . v Croix Count I 1.006 ACRES w y, 1 7 I j 43,837 SQ. FT. 1.024 ACRES I I Beginning of 44,582 SO. •FT. j 33' 33' I • south line o, I I I - ► .. w SE1 /4; thenc i - ' - ' - - - '_ j S89'55.31 W 240.60' z line of said S\ N89'55'31 "E 240.20 ! I ! 1 N 643.37 feet; i I I w feet to the r L._._. -._. -j I south 1 /4lir : parcel contai- 16 I LO 0 00 j CD I 1.032 ACRES M 1.004 ACRES 1 I I 44,967 SQ. FT. 43,714 SQ.: FT. I • I I • • I ! S89 31"W 243.60' N8955'31 "E 2 j � 15 o o ! °' Ci N 1.009 ACRES I ^ I :23 o M rn n , 43,948 SQ. FT: L N~ N 6 N r- PAGV OF PUMP CHAMBER CRO55 SEC T IOIJ AMD SPECIFICA VENT CAP 'i"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKMIG > 25' FROM DOOR, ,lUKICTION BOX MANHOLE COVER WINDOW OR FRESH 12 "MIU. AIR INTAKE I GRADE ........ . . I y "MIN. COIJDUIT 18 "/"TIN, ---- - - - - -- INLET PROVIDE I - - - -- AIRTIGHT SEAL I I I i I * �l I */ A I I I I i I I I I ALARM I *APPROVFn I I o N JOI t I I ELEV. FT. APP► \ u 1 __j 3 G � •� l ,� OFF O SOLI ► lJ� l V`' RISER EXIT PERMITTED ONLY I ..rjK MANUFACTURER HAS SUCH APPROVAL. SEPTIC E SPECIFICATIOAIS OOSE TA NKS MAN UFACTURER: WMBER OF DOSES: PER DAH TANK SIZE: GALLONS DOSE VOLUME ALARM MANUFACTURER: IMCLUDING BACKFLOW: GALLONS MODEL IJUMBER: CAPACITIES: A= IKICHES OR GALLONS SWITCH TYPE: g = INCHES OR GALLONS I PUMP MANUFACTURER: C = INCHES OR GALLONS MODEL NUMBER: D- IMCHES OR GALLONS SWITCH TYPE: MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET ♦ MINIMUM NETWORK SUPPLY PRESSURE /� .. , , , .. , , 2.5 FEET ♦ FEET OF FORCE MAIN X F /pp FxFRICTION FACTOR. FEET TOTAL Dy1JAMIC. HEAD = FEET INTERNAL DIMENS101101; OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH S1G1�1E0: LICENSE NUMBER: DATE: