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HomeMy WebLinkAbout026-1126-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488195 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 Permit Holder's Name: City Village X Township Parcel Tax No: Brushy Mound Partnership Richmond, Town of 026- 1126 -04 -000 CST BM Elev: Insp. BM Elev: BM Descr' lion: Section/Town /Range/Map No: M y 12.30.18.765 TANK INFORMATION EffIEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � � Benchmark Dosing �,y Ql !� l>�✓ Alt. BOM, 'j 6 ' 0 Q Aeration Bldg. ewer Q � W Holding St/Ht Inlet 7 St/Ht Outlet 5� G TANK SETBACK INFORMATION TANK TO P/L WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic -t/ Dt Bottom Dosing ead an 7• 2 GY1'3 Aeration Dist. Pipe L �/ i ` Final Grade Holding ul l # Bot. System ® G '7' Z "79'9 97 3 T t 3� /,•�,/ PUMP /SIPHON INFORMATION /0 /. Manufact r Demand St Cover GPM ` 1 Model Number TDH Lift Friction Sy Head TDH Ft Forcemain gth IDia. Dist. to SOIL ABSORPTION SYSTEM 07 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '3/ r SETBACK SYSTEM TO J V P/L BLDG WELL LAKE /STREAM LEACHING Manufac /^ INFORMATION CHAMBER OR Typo Of System: 1 UNIT Model Number: I cy UTIO SYSTEM Head / nifo d Distribution / G x Hole Size x Hol Spacin to Air I Len th Dia Length D t1 Dia S acin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center S Bed/Trench Edges Topsoil 0 Yes D No Q Yes [ffl No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ �O/ 0 6 Inspection #2: Location: 1663 Waters Edge Dr New Richmond, WI 540117 (SE 1/4 NW 1/4 1 \ 2 T30N R18W) Water's Ed be Lot 4 Parcel No: 12.30.18.765 1.) Alt BM Description = ` OT 0� 4) A �G�+�• lG� �v I 2.) Bldg sewer length = ZD 'y/ Q - amount of cover = 3 Plan revision Required? Yes Use other side for additional information. SBD -6710 (8.3/97) Date Insepctoes Sign ture Cert. No. I 0 " &UA 'Me A pct, -+,"o /�, �ti4�f �v��� sE7 `f Vi il� s ► a T30AJ .p O P i u lago :s`��- v w ` l ZD � 03 f bo 3� 3� . . 2 2 C! % j 2 } \ , ƒ � ] . � . 2 ƒ . � z / § % C,4 § $ a m § B � � _ ■ � 2 k k 9 N l ew E . N k r a ® ƒ ` Q£ \ % > § zRz ® � ƒ E) E § w / o . E § § � $ / a a a § C! 00 z C) § £ ° � z / ■ « :¥ , a § % C Cd J u) & 2 5 5 e 42 \ \ 0 \ / LO @ \ \ CD . 00 \ a2 a \t CD :_ # o z _ 0� z C IL ° » Q ua22v Safety and Division County 20 . Washin n Ave., P.O. Box 7162 �K ■ �0 �� M WI 707 Sanitary Permit Number (to be filled (n by Co.) Department of Commerce (6 66 - 3151 O� 9 Sanitary Permit 3ppficatji RECEIVELE State Ian I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informatio you provide N may be used for secondary purposes Privacy Law, s15.04( )(m) MAY 0 1 2 0 Projec Address (if different than mailing address) ers ul`i I. Application Information — Please Print All Information ST. CROIX COUN Property Owner's Name t # Block # µ' %Q ✓-s Q K OQ to P Ownef s Mailing Address J Property Location ' ` City, State Zip Code Phone Number �h, Section I d� < Lot s < 3 N; treo 71,5 H. Type of Building (check all that apply) clS �a�Jb `�' a W C m � Subdivision Name v CSM Number 1 or 2 Family Dwelling — Number of Bedrooms / I txe lneL ? O " Public/Commercial — Describe Use p ❑ State Owned — r ibe1Jse I ❑City ❑Village Down hip of M III. Type of Permit: (Check only one box on line A. Coin One B if applicable) p ' O �> A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl Non Pressurized In- Ground ❑ Mound 2:24 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 ersaVireatment Area Information � Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Require7(s Dispersal Area (sf) System 'on c� ,5 ✓ ! oe V VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic Holding Tank � ! t -2 C YS Aerobie Treatment. Unit Dosing Chamber VII. Responsibility Statement - I, the undersigned assu asibility for is f the POWTS shown on the attached plans. P mber's Name (Pri t) Plu her Si ature / !IPRS tuber Business Phone Number vd is Address (Street, City, State, Zip e) S (, L IM - _�j O VI otm /De artment Use Onl Approved ❑ pproved Sanitary Permit Fee (includes Groundwater Dat Issued Issuing t Signa S sj?�N Surcharge Fee) ❑ ' en Reaso rl3enial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3) 8,) S r<t1CQ, 1. Septic tank, effluent finer and `,� dispersal cell must all be services / maintained as per management plan provided by plumber. lJ t 2. All setback requirements most be maintained as per q*111006 Mode / WdkWl=. L' OLA Attach complete plans (to the County only) for the system an paper not leas than 81/2 x rhea ii n /\ o i l Gc / lL l / SBD -6398 (R. 01/03) K y- E_ ,� �.; �I� S ► a T3ory yS R i c_V � / Sr C m Q,< rs A: 4f z I foa,ac v l 0D � Q � D 0 s 1 j rn apartment of Industry SOIL AND SITE E V A L I N TY 3 O R Page ? of 3 Lauan Relations Diafety &Buildings in accord with ILHR 83 is. Cod2 TY , Attach comple site plan on paper not less than 8 1/2 x 11 inches in siz n mu�t`ilTClc�ut Croix not limited to vertical and horizontal reference point (BM), direction and ° 6 ope, scavuo F %Gtr EL I.D. # dimensioned, north arrow, and location and distance to nearest road. �, nding APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION 6?`t -Z - VIEWED BY DATE PROPERTY OWNER: PROPER t46 Derrick Const. , Inc. GOVT. LOT SE 1i4 NW 1i4,S T ,N,R 1 R I (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # WA 1505 Hy #65 4 na Bril e CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE [MOWN NEAREST R D New Richmond WI. 54017 115) 246 -2320 1 Richmond 140th St. [ New Construction Use Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement ( ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 1200 bed, ft2 1000 trench, ft Maximum design loading rate • 5 bed, gpd /ft .6 trench, gpd/ft Recommended infiltration surface elevation(s) 97.80 ft (as referred to site plan benchmark) Additional design / site considerations alt. site = el. 97.40' Parent material outwash over drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem I K7 S ❑ U :R7 S ❑ U I KI S ❑ U 5S ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT �) no T.�y t� � Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -12 10 r 3 2 12 -32 7.5 r 4/4 none sici 2msbk mfr QW if .4 .5 Ground 3 32 -84 7.5 r 4/4 none is /si 2msbk mvfr na na .5 .6 S elev. _ 1 Depth to limiting nn factor +84 ._ ----- Remarks: Boring # none 1 2msbk mfr cs 2f .5, .6 2 2 10 -28 7 .5yr 4/4 none sicl 2msbk mfr gw if .4 .5 • `f Ground 3 28 -88 7.5 r 4/4 none is sl 2msbk mvfr na na .5 .6 elev. 10 ft. Depth to limiting Z factor 2 +88" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. 4a, New ' h d WI 54017 Signature: Date: 5_30 -2000 CST Number: m02298 PROPERTY OWNER Derrick Const. ; In c. SOIL DESCRIPTION REPORT Page PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `4`....3.....` 1 0 -9 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 s . ~ ~.... 2 9 -30 10 r 4/4 none sicl 2msbk mfr CFw if .4 .5 Ground 3 30 -60 7.5 r 4/4 non s 1 2 mvfr Fna .5 .6 . S elev. — 10 ft. 4 60 -88 7.5 r 4/6 none ms os mvfr na .7 .8 Depth to limiting facto 8" Remarks: Boring # _ 1 0 -10 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 S 2 10 -22 10 r 4 /4 none sici 2msbk mfr aw if .4 ` . 5 Ground 3 22 -69 7.5 r 4/6 none cos osa ml Crw na .7 .8 elev. 4 69 -84 7.5 r 4/4 none sl 2msbk mvfr na na .5 .6 S 1 4 ft. v Depth to limiting factor + Remarks: Boring # 1 0 -12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 S U 2 12 -29 10 r 4/4 none sicl 2msbk mfr 9w 2 f .4 `:.5 Ground 3 29 -37 10vr 5/4 c2d7.5vr 5/6 sil m na C1w na no .2 elev. 4 37 -84 7.5 r 4/4 none. sl 2msbk mvfr na na .5 :.6 , S� 10 ft. Depth to limiting factor +84" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER Derrick Const.. `. in c.,SOJ j L DE$QRIPTION REPORT Page 2 PARCEL I.D. #ending _ Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Ba.ndary Roots in. Mynsell Qu. Sz. Cont. Color, Gr. Sz. Sh. Bed Trench 3 1 0 -9 10 r'3/3 none 1 2msbk mfr cs 2f .5 .6 .l 2 - 9 -30 . 10yr 4/4 none sicl 2msbk mfr Qw if .4 .5 • `� Ground 3 30 -60 7.5 r 4/4 non s 2msbk mvfr f .6 elev. _ " 10 ft. 4 1 60-88 7.5 r 4 6 none ms 0sq mvfr na na .7 �.8 .1 Depth to fimiting �8811 Remarks: Boring # 1 1 0-10 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 S 2 10 -22 1 0yr 4/4 none sici 2msbk mfr C1w if .4 1.5 - 1 Ground 3 22 -69 7.5 r 4/6 none cos 0sa ml Qw . na .7 .8 elev. 4 69 -84 7.5 r 4/4 none sl 2msbk mvfr na na .5 .6 S 1 Depth to limiting factor + 11 Remarks: Boring # x 1 0 -12 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 S 5. 2 1 12-29 10 r 4/4 none sicl 2msbk mfr 9w 2f .4 .5 4 .v: Ground 3 1 29-37 10 r 5/4 c2d7.5 r 5/6 sil m na CFw na no ` .2 elev. 4 1 37-84 7.5 r 4 4 none. sl 2msbk mvfr na na .5 `:.6 , S� 10 ft. Depth to limiting factor +84 Remarks: Boring # ~ 4 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, .Inc. 1554 200th Ave. CSTM2298 SE4NW4 S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #4- Brushy Mound Lake . This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. 1 - 40' top of 1" pvc pipe C el. 1004' �= top of 1" pvc pipe C e 1. 102.20' .� � y r s IG� (V 0' �1 Gary L. Steel 5 -30 -2000 r 3 �9 99 . x 999.4 /\ / / x I 0--/ e -� / oa 9963 LOT 2 \ 991. 4343 SUT. . / 2.17 ACRES O 993.5 / B -2* X 992-7 I 992.7 • B -5 / / / g_4 B�3 0 x 8 -3 �� / / g_ 4 . • 2 45 13 - 1 2.4 970 UMI OF RAIN EASEM OH / 970 SQpFT. 03 / 2.23 ACF' X 991.3 O / B -4 g� —4 —4 / / • B -5 v 89462 S .FT.x • a / Q i 99 205 ACRM.5 B� Q) / X -\ 999 \' 990.5 / 100 YEAR FLOOD E i x ` AS SHOWN ON A 1982 V -L Q . ` J B 4 - 5 © DRAWN BY THE CORP! ?98 s 99077 S • • ` I O 2.27 ACRES g 3 B-24, � L T B x O T Building Setback Line (100' from R.O.W) (75' from Shoreline) _IMINARY PLAT OF BRUSHY MOUND LAKE jo ZPTI - 0 - _ -Res Un tatted Lands ~' .,. * Dave Naser � �, • ��d.c -- •- -""` f .. New Richmond z r-' r • T i > � 12 ,,, k kix• _ 1 1 1 NO _J JIM tai i' - - t x n ti x I 4.�a' n ♦ `` �� `� ° ` ��,a.� 4.97 ACRES • >- _ .r. -v .�-•- 913 �P+'"r >xiMi'_. 7►�'Mj a7 - - r T ' 3 r � 2 is NM !Y 40 t -•a Nab t' � �O � f t � '- .:. -�� � r ~� ( � •: A Mg 44 - F f x b _ r fipe j_ « 5 .49' N /'r Y72bt F? «► X..1 ' iT \ .� �.. .».. _ >< .:.: - .. LOT 44 r «r r i Q FT # s %M :w. r ' , LOT 2.17 ACRES ` � f ` ♦ I '`r Nx. 1 .7c Nii x Nil LOT 22 , �j ; LOT - -� aim S*.F . a , . x C� 07002 SOFT. -12,' , ZOO ACRES � �. x � � Nss LOT 28 Of 1.95 ACRES / ant r!••`'"� 4' ti is �� O al x «., � a • ads �� 01 I a ••• L�l I t .-..t r LOT 20 aoozo . l a'j •7ttS SOfT , . �.'...,. - x `-1 N'W AS ON A 06 THE CORP t r ( - -LOT-! f y �c 1 8 � � � � � �� rr• w Mn sue. 227 ACRES �,,� rn:• � � PROS Tpwa Roru _ _ t J • �.- _.._...,, �` - �, � ' L x' w • 91675 SQit JAI 2.10 ACRES VMS , i4/ , '�• • ! as �C T LQT 49 , , i _ � sa i ,` t.Ele �iLs ot LOT 8 , 1 3 047x0 S&FT_ 3 s 1 cst. 6 rs G � O �Z1203H vsoesTV � ' �i •, " }��' r ;, •. vvvTVOV ' vOV7Ttt ' � t,' M. t7tv9t0 OOOV Vt7. '' ♦t 4007e tt7 ..t'.. •`•r, f ' �' vvevvTv 12 if 777 '.� ^. v9t. l eTT , i . WVt v e v • v e vv7 vav 4.625" o: W vev /� pp,t tvv vvv I ff 1/2 CirY• = j O.OY n tTV TV V. sdo tvt T7ty 777 e0 Oet7 tt1- TV. O V tvvtvvv ♦ vv9tttteT VTT t77tTt0 'V tv790v ♦.ttTTtOPVt7tTt tv70 tt0 e 7Tte00 t T 9 v 77 tet7tt7tT 7ttOt ♦t 24tt+ 1 Bottom 26ff Void Volume oil Inter A rea In. to & so E Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalls) 2 * 18 ^84in _ O.D. of 4" pipe = 4.625 inches 12in - 3.14 to Void volume per linear ft. = 3.14 • 2.3125 Ift = 0.1 17 if Bottom 12i./ft � 2.00 • O.D. of center cylinder - T2.5 inches Total Soil Interface Area 5.14 SQ.FT Void volume in aggregate of center cylinder = 3.14 • 6.25in ( 3125ia l �12.1ft} 3.14'1 12i.,fft I••574 =.422 W O.D. of outside cylinders - 12 inches l J Projected Trench Area Void volume in outside cylinders - 2.3.14 ft�^ •,574 a ,401 Sidewall Height = 12 in. •2 = 2.00 Sq.Ft, Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders - 24in 6in / 6in 12bi /ft • 12intff) 12inih) ) -0.215 f' Projected Trench Area 5A0 Sq.Ft. Void volume at outside bottom comers (111, of void volume between cylinders) 0.215/ 2 - 0.108 ft' Total void volume - 0.117 + 0.422 + 0.401 + 0.215 + 0.108 1.763 cubic ft / ft Gallons per ft = 1.763 X 7.48 - 13.2 eallons per linear fr- t! EPS Aggregate Trench System EZ 2203H EZ Ow Ring - Industrial Group 65 Industrial Park Rd. Oakland, TN 18060 SCALE fAE WWE: EZ1203H -vsl SHEET: 1 of 1 11 -27 -01 FILE INFORMATION POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page T of Owner SYSTEM SPECIFICATUMM r An Permit # a Septic Tank Capacity ❑ NA al Septic Tank Manufacturer 4 S 13 NA DESlt3N PARAMETER Effluent Filter Manufacturer r p ❑ NA Number of Bedrooms ❑ NA Effluent FitterModel f` ❑ NA Number of Public F llity Units ❑ NA Pump Tank Estimated flow (average} Capacity ❑ NA 0 g al/day Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x 1.5) Oo al/ Pump Manufacturer Soil Application Rate urer ❑ NA Pump Mods IL- J� el/da /W 13 NA Standard Influent /Effluent Quality Monthly average • Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L 0 NA ❑Sand /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (SOD 5220 mg /L D NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Calt(a) Biochemical Oxygen Demand (B(?D } 530 m iL ©NA s 9 in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L DNA At -Grade ❑ Maund Fecal Coli #arm (geometric mean) <_10° c#ul100ml ❑ Drip - Line ❑ Other. Maximum Effluent Particle Size Y in die. ❑ NA Other. Other: D NA ❑ NA LOt r. ❑ NA * Values typical for domestic wastewater and septic tank effluent. r D NA MAINTENANCE SCHEDULE Service Event Service Fnmpmcy Inspect condition of tank(s) At least once every ❑ month(s) y ear(s) (Maximum 3 bears) 13 NA Pump out contents of tank(s) When combined sludge and scum equals ore -third (Y) of tank volume ❑ NA Inspect dispersal cell(s) At least once every; ❑ month(s) (Mm 3 year(s) 1►ears) ❑ NA Clean effluent filter At least once every: ❑ month years) 13 NA Inspect pump, Pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) Other: D years) ❑ NA At least once every: ❑ month(s) Other: ❑ year(s) r NA ` 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 %) 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, end 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. START UP AND OPERATION Page -- of For new construction, Prior to use of the POWTS check treatment tanks) fa the presmce of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cen(s). 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 cells) in one urge dose, overloading the cents) and may result in the backup or surface discharg of efflu p g efflue 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 properly 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. Jnn A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption I 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 fines 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 BASSES 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 E!LALLM POWTS MAMTAMER Name ' , —� N�rne Phone S Phone SEPTAGE SERVICING OPERATOR tPUMPER) LOCAL REGULATORY AUTHORITY Nine Name ` Phone Phone This document was drafted in compliance with chapter Comm 83.22(21fb)f 1 l(d)&(f) and 83.54111, f2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page _ of For new construction, Prior to use of the POWTS check treatment tank(s) for the presence of painting that may impede tf a treatment process and /or damage the die Products or other chemicals of the tank(s) removed b a Persil call(s). If high concentrations detected have the contents Y septage servicing Operator prior to use. System start u shall not P occur when $oH conditions we 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 Ross; 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 properly 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: Ann 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 fines 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace 1pe failed POWTS. ❑ 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. < <WARMNG> > 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 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MIST. POWTS MAINTAINER Name Name Phone rS Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name c Phone Phone ILS This document was drafted in compliance with chapter Comm 83.22(2)ib)111(d) &(f) and 83.54(1), (2) & ( 3), Wisconsin Administrative Code. y 1431PAG' 169 STATE BAR OF WISCONSIN FORM 2. 1998 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners, LLP, a Wisconsin limited liability partnership, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee 06 -03 -1999 9:30 AM the following described real estate in St. Croix County, State of Wisconsin (The VARRAHTY DEED "Property'D: EXEMPT 0 CERT COPY FEE: See attached Exhibit "A° COPY FEE: TRANSFER FEE: 1047.60 RECCORDING FEE: 12.00 Recordinr Ara Name and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE k SILER, S.C. Post Offiee Box 127 New Richmond, WI 54017 pmf 0f02&I037.90.000. 026. 1097.95 -000 and 026,1098- 10.000 Parcel Identification Number (PIN) This Is not homestead property. i • "h Exceptions to warraatiest Subject to all easements, restrictions and covenants of record. Dated this 28th day of May 1999. i *David L. Naser I AUTHENTICATION ACKNOWLEDGMENT Signatures) David L. Naser STATB OP WISCONSIN• ) as. County ) authontioat d this hday of Me , 1 999, Personally came before me this day of 19_ the above named v to me known to be the person(s) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same. i TITLE: MEMBER STATE BAR OF WISCONSIN (If not, j authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAF'T'ED BY Notary Public, State of Wisconsin Hendrik W. Van Dyk My Commission is permanent. VAN DYK, 0 s BOYLE & SILER, S. C. (If not, state expiration date: Post Office Box 127 (Signatures may be authenticated or acknowledged. Both are not necessary.) • )'i. 14 31P AG�1 �Q Exhibit "A" That part of the following described property lying in the SW 1/4 of NE 1/4, the SE 1/4 of NW 1/4, and the NE 1/4 of SW 1/4, all in Section 12- 30 -18: A parcel of land located in part of the NW 1/4 of the NW 1/4, part of the NE 1/4 of the NW 1/4, part of the SW 1/4 of the NW 1/4, the SE 1/4 of the NW 1/4, the NE 1/4 of the SW 1/4, part of the SW 1/4 of NE 1/4 and part of the NW 1/4 of the SE 1/4 all in Section 12- 30 -18, Town of Richmond, St. Croix County, Wisconsin, described as follows: Beginning at the W 1/4 corner of said Section 12; thence, on an assumed bearing along the W line of the NW 1/4 of said Section 12, North 00 degrees 47 minutes 04 seconds West a distance of 780.46 feet; thence North 88 degrees 43 minutes 02 seconds East a distance of 407.01 feet; thence to the approximate center line of Paperjack Creek, as said Creek is presently located, North 00 degrees 47 minutes 04 seconds West a distance of 335.28 feet; thence the following being along the center line of said Creek as presently located, North 73 degrees 13 minutes 39 seconds East a distance of 400.03 feet; thence North 82 degrees 14 minutes 29 seconds East a distance of 254.52 feet; thence North 45 degrees 31 minutes 23 seconds East a distance of 116.47 feet; thence North 79 degrees 35 minutes, 57 seconds, East a distance of 218.00 feet; thence, North 33 degrees 50 minutes 42 seconds East a distance of 172.37 feet; thence North 18 degrees 00 minutes 28 seconds East a distance of 176.13 feet; thence North 73 degrees 30 minutes 33 seconds East a distance of 201.74 feet; thence South 66 degrees 40 minutes 00 seconds East a distance of 422.90 feet; thence South 87 degrees 13 minutes 12 seconds East a distance of 176.07 feet; thence North 86 degrees 22 minutes 15 seconds East a distance of 378.15 feet to the North -South Quarter line of said Section 12; thence, leaving said Creek, South 00 degrees 16 minutes 21 seconds East a distance of 611.71 feet; thence South, 49 degrees 40 minutes 01 seconds East a distance of 580.02 feet to a point in Brushy Mound Lake; thence, along a line in said Lake, South 06 degrees 46 minutes 19 seconds West a distance of 1613.62 feet; along a line in said Lake, South 33 degrees 33 minutes 14 seconds West a distance of 435.55 feet, this being the SE corner of the NE 1/4 of the SW 1/4 of said Section 12; thence, along the S line of the NE 1/4 of the SW 1/4 of said Section 12, being in parts in said Lake, North 89 degrees 37 minutes 24 seconds West a distance of 1306.68 feet; thence, along the West line of the NE 1/4 of the SW 1/4 of said Section 12, North 00 degrees 21 minutes 52 seconds West a distance of 1323.00 feet; thence along the South line of the SW 1/4 of the NW 1/4 of said Section 12, North 89 degrees 34 minutes 56 seconds West a distance of 1308.82 feet to the point of beginning. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S /;1oUJL4p �af"tX,. (.kfAG-L. Q 5TIEy <KLS Mailing Address co /el (.41Al ©tt o C(J',� S y l ( Property Address `(Q (a Aj — cPLS (.:;c ArZ&ve (V required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number c m D oc) Cl LEGAL DESCRIPTION Property Location '/4 AIw /4 , Sec. , T 77 0 N R 1 W, Town of 1 � Subdivision V , Lot # / Certified Survey Map # , Volume , Page # Warranty Deed # `0 `T ZS - , Volumc Iq 3 , Pagc # 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 purnping 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 subunit 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. Itwe, 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 f bedroo z y / o �o TLTRE OF LI ( 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. 08/05) Parcel #: 026- 1126 -04 -000 05/02/2006 09:50 AM PAGE 1 OF 1 Alt. Parcel M 12.30.18.765 026 - 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 - BRUSHY MOUND PARTNERS BRUSHY MOUND PARTNERS C - LLP LLP PO BOX 445 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description • 1663 WATERS EDGE DR SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.060 Plat: 2589 - WATERS EDGE LOTS 1/49'00 SEC 12 T30N R18W PT SW SE & SE NW WATERS Block/Condo Bldg: LOT 04 EDGE LOT 4 2.060AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 30N -18W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 09/29/2000 630775 8/13 PLAT 2006 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 2.060 56,700 0 56,700 NO Totals for 2006: General Property 2.060 56,700 0 56,700 Woodland 0.000 0 0 Totals for 2005: General Property 2.060 56,700 0 56,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 11 St. Croix County Affidavit of Storm Water KATHLEEN H. WALSH Document Number Management & Maintenance REGISTER OF DEEDS ST. CROIX CO., WI Real Estate Owner ( "Owner "): Thomas G. and Vicki A. Nagel RECEIVED FOR RECORD Local Municipality ( "County"): St. Croix County, Wisconsin 1119/27/20% 10:55AN On this Nd�ay of September. 2006 the Owner agrees to ensure that the storm water management facility(s) located on the property described below AFFIDAVIT continue serving their intended purposes in perpetuity in accordance with the EXEMPT # storm water management plan and operation and maintenance agreement filed as a requirement of the special exception permit approved by the Board REC FEE: 11.00 of Adjustment on J uly „28, 2006 File # 5E0086 , a copy of which can be TRANS FEE obtained at the St. Croix County Planning and Zoning Department. COPY FEE: Recordin Aree This Affidavit applies to the following real estate, herein referred to as the Name and Returttk§ 1 "Property ": Derrick Homes, LLC PO Box 445 Lot 4 of Water's Ed" f1663 w ater's Edge Drive) Town of New Ricbmond , WI 54017 Richmondd, St. Croix County. WI 026 - 1126 -04000 Parcel Identification Number Through this Affidavit, the Owner hereby subjects the Property to the following covenants, conditions and restrictions: 1. The Responsible Party shall be responsible for the routine and extraordinary maintenance ofthe storm water management facility(s) in accordance with the operation and maintenance agreement on file at the St. Croix County Planning and Zoning Department. 2. The County, or its designee, is authorized to access the property as necessary to conduct inspections of the storm water management facility(s) to ascertain compliance with the intent of the storm water management plan and the practices and procedures prescribed in the operation and maintenance agreement. 3, Upon notification to the Responsible Patty by the County of maintenance problems that require correction, the specified corrective actions shall be performed by the Responsible Party within a reasonable time frame as set by the County. 4. The County is authorized to perform the corrective actions identified in its inspection report or its notice if the Responsible Party does not make the required corrections within the specified time period. The costs and expenses of such corrective actions shall be the responsibility of the Responsible Party. 5. The terms and conditions contained in this Affidavit shall run with the Property and be binding upon the successors and assigns of the parties to this Affidavit. Upon the conveyance of the Property by the Owner or by any of the Owner's successors in title to the Property, the grantor of the Property in any such conveyance shall be relieved of the obligations provided for herein. Dated this .ZQ� day of tember Th om s G. Nagel —a - lh&.� 'Vicki A. Nagel AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY �1, P came before me this day of September, authenticated this _ day of 011) the bove Th as G. Nagel' and Vicki A. Nagel tom kn to be th persons who executed the foregoing ins en nd ackn edge the same. signature type or print name signature MELA 1 . RUTL.EDGE TITLE: MEMBER STATE BAR OF WISCONSIN type or print name P I R Pub �C TITLE: `tom V 1�n Notary Public St. Croix County, Wisconsin. authorized by' 706.06. Wis. Stars.) My Commission Expires: July 27th 2008 THIS INSTRUMENT WAS DRAFTED BY 'Names of persons signing in any capacity should be typed or printed below their signatures. Brushy Mound Partners PO Box 445 New Richmond, W 1 54017 loft