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HomeMy WebLinkAbout026-1126-05-000 Wiscons I! of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499164 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: DeGear, David & Kath I Richmond, Town of 026- 1126 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: r � 12.30.18.766 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 5 CAPACITY STATION BS HI FS ELEV. ,N Septic Benchmark Dosing Alt. M Go `7 S g� LoJ �l • lP 88 . 9' PO la k- SZS Bldg. s THI ewerng St/Ht Inlet 17 toy B7 3 , Z TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / /J4- /) / t [ / _ Dt Bottom b 7 7'• 4 r7 Dosing Header/Man. 1 6 1 ��9 -. jy 6 •�$ y y• / 7 Aeration Dist. Pipe c ° D `( Z. I rz .8! Holding Bot. System Final Grade / 2, O d g PUMP /SIPHON INFORMATION 1. 5 �• Manufacturer ` Demand St Cover G GPM �J Model Number t l { , 7' TDH Lift Friction Loss System Head TDH Ft 14. 33 3.3 17- — f - _ 1,13 9L , °Z. � Forcemain Leng�h D it Dist. to ell 1 00 t 7 .13 ?z . SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length j No. Of Trenches PIT DIMENSIONS No. Of its Inside Dial Liqui Depth DIMENSIONS 3 �� ��I _ 1 \ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: 45:. Z o`,J INFORMATION CHAMBER OR Type Of System: r UNIT Model Number: A /0 NA Aso DISTRIBUTION SYSTEM Header /Manifold 11 Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) \ \ \ ill( l t raw Length Dia Length Dia Spacing \ ` /6 ' Fro C SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed /Trench Center [� (�� Bed /Trench Edges \ Topsoil \ \Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1661 Waters EAge Drive New Richmond, WI 54017 (SE 1/4 NW 1/4 12 T30N R18W) Water's Edge Lot 5 Parcel No: 12.30.18.766 1.) Alt BM Description = 2.) Bldg sewer length = / 4 - amount of cover = / / Plan revision Required? Yes No 2 DII Use other side for additional information, Date nsepctooignature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Divisio County 201 W. Washington Ave., P.Q. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Nummber (to be fill in by Co.) l Vis conS%n (60 151 9 ! l Department of Commerce S to Plan I.D. Number Sanitary Permit Applical 'on In accord with Comm 83.21, Wis. Adm. Code, personal inform lion you rovid ject Address if different than mailing address) may be used for secondary purposes Privacy Law, s 15.)4(1 P 1 Z 0 0 6 ( `' f (0(0 LOC& �a e L Application Information- Please Print AllInformatian ST.CROIX000NT r t 414 rcel # Lot # Block # Property Owner's Name rty � -p0 Property Owner's Mailing Address0 , �.h V /O W /+ Section City, State Zip Code Phone Number C rcle o � T N; R�E or IL Type of Building (check all that apply), Subdivision Name C9loffilmrrbel It* �K or 2 Family Dwelling - Number of Bedrooms �7_" " ❑ Public/Commercial - Describe Use r ❑City Village *o ship of ❑ Slate Owrkc4 - ribe Use 1II. Type o Permit: (Check on y one on line . oilliplete fine B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. [I Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a f kN - Pr essurized to -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in, of suitable soil ❑ At-Grade ❑Single Pass Sand Fitter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter [I Aerobic Treatment Unit El Recirculating Sand Filter 11 Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ravel -less Pipe ❑ Other (explain) V. Dis ersal/I'reatm cut Area Information: Desi Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal AreaProposed (sf) System Eleva / C) l O O 1 Fiber Prefab Site VI. Tank Info Capacity in Total Number Manufacturer Concrete Constructed Steel Glass Plastic Gallons Gallons of Units New Existing Tanks Tanks Holding Tank Aerobic Treatment Unit y ` Dosing Chamber ©Q W ► �S !� /\ VII. Responsibility Statement- I. the undersi , time responsibility for a of the POWTS shown on the attached plans. Plumber's Name (Prin Plum ignatu /R4P Number Business Phone Number c Plum is Ad ress (Street, City, State, Zip Code) � �1, � VIII. Coun /De artment Use Onl Approved 11 Disa roved Sanitary Permit Fee (' ciudes Groundwater Date Issued [ssXgA t S gnature fN tamps) Surcharge Fee) _ • /� CIO even Reason or Denial 1X. Conditions of ppro a 1 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all . be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) far the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) !" . ;)' � o. �AKcAN, `! Pia � d - L �/p ,�� /���; P, oa Uoo /V 3 `T+1 11\z �v Cofn6 9� o • a� �o � as '• _ ifo C� � t oV 1 �So I o�`�kla7e1r� Q.G 3 ocv �g �J i0 �a W`es � r; d �a. 1Qo�C� � ca..l �►^S � d�, e �.���- S 1 7 G000 f$o-:�, S�e ;c./ ' ,If �C;dh /to 4.5. .� Pk n C)d(o- t� ab- b�- ooz ' C'o�n6 • o f l0 5 9 fo A $:y1 .d k vt n1 1 Q 99.8 t 3 (vD 95 0 _ j �aN4 - �aoe SOIL EVALUATION REPORT Po / or in 1 wAn tin M wf. ACML CM* Ccu" s ,� na �. buc, �oe�rsao, woof+�aao�r��oaMrEte�,y.dr.m�s� �.a _ o� vdoi��o.r.tp� �o�1 ►aaoiwanaloa.aRaaea�ao.oa.«enet pares print wU &Ommftm `°s' i � ar�..rw,r..w...,► .rw1s.. sf o•df!{+ Sir• r ©� tt AJ�x s ! v 3� N R � w mm lapGoft If -121 - DM TIM"Fe T um f tv-t I s o 171 ` CA 4 r £ z` lftwCarslupios um Rrdd�eiY /Wwybard tanderawlred fiawoEe �-�Y'- tip' ti pboNaurt AnetwA ft" f�harw�iva� tap iwals �U /A Wd El s� D06 Deals" Al 1 F045CAMGM Team 't eft / D -/D w / -„I/ r / .5- al f* 5 rn CI 17 �. S3 S OS Yh r g Of . so 0 app, ate., ... a"Woomofto Team stiear. m p o gbK mfr a -� Z - _w S /S S rhV h — 6. clFr"ww= vs lskwbor 4 .0 3• 'Huw�ttrl= >a0�31DnplladTB&�11k <t5D 'E�+tQ= <�9 and't8B <�OngR. dr.as ?i5 r -J � s i i W .' 7111 �� a ����� r.�_ ' ■ 1 's w. •. t v�. s S tit, . 0 1),�,-Ga, f- r3o lu As L-or N. iQ Awvovi�, W Y 7 �� �o� c S7- tow r\ se� < L o , DS3 7 r c s m T'd /1 A- 8 m ? crL R g j tS' � � �CI EZ9203H vvvvvv0 •�', ° •i .• • ' S �. •� :` "� ..a vv ►v ►vv 'TV vovvv ►v ' ' i "r �'` 1 ' "��,�h�• • vvvvvvv vvvvvvv t ' '' �'' vvvvvvv v00.yN'�w�.f i J' v0v vvv 12" ov x ` •, vvv vve 24 v ,,•: vev vv vv° 4.625►► vvo vvv TV VLJ vvv oov • • • ° TV 1 " 1/2 Circ. = 18.84" vev vvv vvv vvv vvv vve vovvv v vv v ° vvvvvvv v vovvv vvo v ♦ova vvvvvvv VVVO►vOVV►vvvv vvvvvvv vvvvvvv vvvvvv♦vvvovvv vvvvvvv 2411 --- q Bottom 36 12 -1/2" DIA. (typ.) XCLYolu -e Sol Interface Area In. x F• —sa a Void Coefficient in Aggregate given at 57.4%. Sidewall (2 Sidewalis) 2 * 18.84in = O.D. of 4" pipe = 4.625 inches 12in 3.14 2 Void volume per linear ft. = 3.14 • l J 12in 125in / • 'fit = 0.117 fN 18 Bottom 2.00 R Total Soil Interface Area 5.14 SQ.FT O.D. of centereylinder = 172.5 inches Void volume in aggregate of center cylinder = 3.14. 6.25in )2 -3.14 ( 2.3125in J •.574 =.422 f1 72-i;/ 12in /ft, O.D. of outside cylinders = 12 inches Projected Trench Area Void volume in outside cylinders= 2.3.1 6in •.574= .901 fN Sidewall Height = 12 in. •2 = 2.00 Sq.Ft. \\\ 1 Bottom m 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders = (( 24in • 6in 1 _r 1 6m Lll2inift t2in /ft I J12iniRj )] =0.2i5 ft' Projected Trench Area 5.00 Sq.Ft. Void volume at outside bottom corners (1/2 of void volume between cylinders) 0.215 12 - 0.108 fN Total void volume — 0.1 17 + 0.422 + 0.901 + 0.215 + 0.108 = 1.763 cubic ft / ft Gallons per ft - 1.763 X 7.48 - 13 : Eallons,Per linear ft. 36 EPS Aggregate Trench System ED 203H Ow Ring-4)dustrial Group 65 Industrial Park Rd. Oakland, TN 38060 SCALE FILE ttptt[ Q1203H —vs1 SHEET: 1 of 1 11 -17 -111 i k" Cl VENT PIPE 12" MIN. ABOVE GRADES WEATHER PROOF _ 25' FROM_DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR WITH CONDUIT MANHOLE COVER W1 PADLOCK S WARNING LABEL 4 21 MIN. 18" Li _ N tj 14LET "WATER TIGHT SEALS GAS � t PH _F TIGHT$ V ` H� I A SEAL : APPROVED ',I PIPE 5as --f-- i ALM JOINTS W/ CI ' PIPE 3' ONTO SO TO i ON SOLID SOLID SOIL 30I L C ; f nit RISER EXIT PUMP OFF ELEV . FT. -- ►' OfF PERMITTED ONLY D IF, TANK . MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC 1 DOSE LP s- TANK MANUFACTURER: ; �s C ©m6D NUMBER DOSES PER DAY: TANK SIZES SEPTIC ! A GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER: S- CAPACITIES: A = /?,< INCHES = IJ /, 7 GAL. MODEL NUMBER: ^ o . SWITCH TYPE: cxt B = 2 INCHES = 2, GAL. PUMP MANUFACTURER: �5_ C = &,3 INCHES = 7 GAL. MODEL NUM � NUMBER �,SC SWITCH TYPE: . A D = /b, 2., INCHES = al____� 2 GAL. REQUIRED DISCHARGE RATE _ GPM 17S PUMP ALARM WIRING AS PER I LHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP 0.FF AND DISTRIB TION PIPE . �O FEET + MINIMUM NETWORK SUPPLY � . dcrr��l7/�a� A FEET + FEET FORGEMAIN X i FT /100 FT. FRICTION FACTOR •. ,t _ FEET TATAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH 3 � '' � GOULDS PUMPS Submersible Effluent Pump MODEL .. WE Seri PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. __. � K a, LET � APPLICATIONS ■ Shaft: Corrosion- resistant, Single phase (60 Hz): can be operated continuously Specifically designed for the stainless steel. Threaded • Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. • Homes to guard against component • Built-in overload with ■ Bearings: Upper and • Farms damage on accidental reverse automatic reset. lower heavy duty ball bearing • Trailer courts rotation. • SJTOW or STOW severe duty construction. • Motels ■ Fasteners: 300 series oil and water resistant • Schools stainless steel. power cords. ■� Cable: Severe duty • Hospitals •'A –1 HP models have rated, oil and water resistant. Capable o pa f running dry E sea{ on motor en • NEMA three prong PAY d Industry damage to grounding plugs. provides secondary moisture p g Effluent systems components. g • 1 rA HP and larger units have barrier in case of outer jacket ■ Designed for continuous damage and to prevent oil SPECIFICATIONS bare lead cord ends. operation when fully Three phase (60 Hz): wicking. Standard cord is 20'. Pump submerged. Optional lengths are available. MOTORS must be provided in 9 • Solids handling capabilities: ities: 'Class 10 overload protection ■ O-ring: Assures positive . maximum. • Discharge size: 2° NPT. ■ Fully submerged in separately ordered starter sealin against contaminants � •Capacities: up to 140 GPM. high -grade turbine oil for unit and o il l leakage. STOW power cords all have AGENCY LISTINGS • Total heads: up to 128 feet lubrication and efficient heat TDH. transfer. bare lead cord ends. Tested 1n UL 775 and • Temperature. ■ Class B insulation on m for° S g ® By s 104°F (40 °C) continuous 'A -1'h HP models. O perat i on: Pump ratings are 140 (60°C) intermittent. ■ Class F insulation on 2 HP within the motor manufacturer's c us Fk #ma y • See order numbers on models. recommended.workingg limits, Gouws RmWs 6 eo 9001 mod. reverse side for specific HP voltage, phase and RPM's METERS FEET available. 130 a� seraes: WE 120 s FEATURES 35 _E �n: 3/, 500 D5 & ` sc�M 3 3 ■Impeller. Cast iron, semi- 3 t00 sFr , open, non -dog with pump - 90 ► out vanes for mechanical 25 seal protection. Balanced for a smooth operation. Silicon 20 70 i bronze impeller available as o 60 an option. 15 so ■ Casing: Cast iron volute ° 40 — type for maximum e#fidency. 10 30 _ * NPT discharge. 20 ■ Mec hankal Seal: SILICON 5 CARBIDE VS. SILICON CARBIDE sealing faces. ° ° 0 10 20 30 40 50 1�� — — 60 70 so 90 100 110 120 130 140 150 160 GPM Stainless steel metal parts, i , BUNG N elastomers. o s 10 1s 20 25 30 35 Wfiw CAPACITY Goulds Pumps e 2004 ri www eceno Technology, Inc E <& ITT Industries frecwe necen,ber, zoos .goulds.com MUS aw oot g5 *g - 5ZF -008 90OZ 'NVP 'A38 ` WW kvvnwr ova osc S 1% VW NMVM oLmH sn gu lvnNVtN 0tLd3S i \ � JAS-AS NMd� 31�,a ®e� 6 3tva ON a .� =.i c 7was HY4 009 /00Z td M U W CL m O V!v ~ W n ix I F=l V) Q. V- v O .� N C Q C9 o z �� N U d U o 00 n 00 a a z a p Nr m ��' Chd = N z s J z r o 0 V O �O N m MN t U rn a. W a a to N O O W a N°F -...;o o{_a ~ a M m cn w U W N M tD(jj� ..�_WmU F' 1 C O � Q 1. x Y r QO z J50 z °.' °`'W' Q ° Z LL Q W3mU�S��mJ 4 N N O O O x X LL z a zav o z ? � of }- �o O Y N W O� f " U � a U wm O z a E. W w „B£ a N O Y O Z Y I LLI a � s g N � O m z ' O „lb .96 S9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Palle of � �A TtoN s� � permit Tank Capacity 0 NA Septic Tank Manufacturer I.V �S e m NA 00 FAAA MM Efflu t Fl1Mr MamufacWrur Number !� 0 DNA N 3A, Effluent Filter Model (� Q NA Number of Public Facility Units Estimated flow (average) Pump Tank Capacity (� Q NA 00 9�aVday Pump Tank Mararfaciurur(u S r� cs © NA Design flow (peak), (Estimated x 1.5) Pump M�facttm S NA Soil AppNcaticrm Rate Pump Ma t 9 C7 3 t L -[3 NA Standard:1 t �ni� Y Pretreatment unit D N(A Fats, Oil & Grease (FOG) 530 mgtL � Sandltiravel Filter a Peat d�dtur Biochemical oxygen Demand emend iSO 5224 mg/L DNA ©Mechanical Aeration Q Wetland Tote Suspended Solids (TSS) 5150 mg/L Q Di�rtfectimt p Other: Pretre cued Effluent Qua lity Mar�thly average GeN(al Q NA Biochemical Oxygen Demand (800, 530 WnWL In-Ground (gravity) D In-Ground (pressurized) Total Std Solids. JTSS) :S30 mg1L 0 NA Q At -Grade ❑ Mound Fecal Coliform ( - gemnetrtc mean) 5104 ofu /100m1 d] Drip.tJm D Other. Maximum Effluent Particle Size Y in die. Q NA odor: Other. U K& Q NA ' © NA 'Vakw typical for domestic wastewater and septic tank effkaent_ Other !3 NA #!l11dN'[HIIAI�ICff SftflS . sgrrltre: event -Inspect condition of tarik(s) At least once every: s) Mochms a 3 yews) 0 NA Ptimp out contents of taMds) When combined sludge and scum equals one -thad (V of tank volume ❑ NA Inspect dispersal cents( At least rears 0 rgornth(s) ri a NA Clean effluent fitter _ D motslthfe) At least once every Q NA . aj Inspect pump. pump controls & alarm At least once every: Q mo t W Q NA Flash laterals and pressure test At least once every: Q months) l3 NA` O Cl ears) :At`teast vthas etrery: ►" Other.- - 0 NA MANTENANCE Non RUCTIONS kMPSC m of tanks and dispersal ceft shell be made by an individual carrying one of the following licences or certlf Cationr Mash Plumber;_ Master Plumber Rcetrictetf Sewer, POWTS Inspector, POWTS Maintainer Septage inspections must include a visual Servicing Operator. Tank . inspection of the tenlcis} to.identify any missing or broken hardware. identify any cracks or leaks, numm rre the volume of combined sludge and srxim and to check for any back up or ponding of effluent on the f The dispersal cen(s) shall be visually Imsp 10 d check *9 effluent levels in the -fi s �d to n for po of effluent on the Wound surf ace. The ponding of effk t Y Indicure a failltg. condition nt�on the ground surface. don eg uifires the t h e immediate notification of the local ition and: reqhe regulatory authority. - When the combined accumulation of sludge and scum i any tank equals one- third (Y or more of the tank volume, the entire contaMs of the tank shall be removed by a Septage Servicing ,Operator and disposed of In a con kffm with ,chapw NR 115,' Wisconsin Administrative. Code_ - All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretleatnulnt units, and any cervicing at Intervals of 512 months, shall be performed by a certified POWTS Maintakw. A service report shall be provided to the local regulatory qty. within 1 0 days of completion of any service event. START UP AND OPERATION of For new constr pr to use of the POWB Ct►erk t<Bat<r�nt remi(s) for the presence of p . that mad► impede the treadnent pm ,ndfor die the ' among F or surer Ghetnicals Of the tank(s) ramoved,by a age sl. If high cones are detected have the contents 9 oFerattsr prior to use. Systwn stars up shad not occur when soil col "m a we frozen at the infiltrative surface. During power outages PUMP tanks nwY 1111 above normal bigh discharged to the Why Power is restored the excess wastewater Will be Cedis).in Orw .dOSs, overloading the CWRs) and may result in the le no baclwF or. Surface discharge of power to the eff effluent. To avoid this situapon have the conm tg of the pump tw* removed b a Servicirg Operator Prior to res toang reet w O vla pump or contact a Pknriber or POWTg by to assist in manually operating the .p�F controls 'to ere normal le within the punk tank. ' Do not drive or park vehicles over tanks and dioparsal cells. Do not drive er park over. or otherwise disturb or coctE **hin IS feet down slope of any mound or at -grade sod. are® Fart, the area . Reduction or elimination of the following from the wastewater sarearn may improve the Performance and prolong the Its of the POINTS: antibiotics; baisy wipes: cigarette buttr, condor sz; cotton n swabs; degreasers: dental floss: diapers; dis&ifeCaer►ts; fat;. drain tsump Fr+rnp) water fndt acid vegetable Fes: Vie;. 9 ; herbicides;: meet scraps; medications: oil; P*WM Prouc dts: des; sanitary rt"kl=, ns; :twnPo and water sofhm r-bdm. ABAINDOINNENT When the POWTS fads and/or is psrrrgr mn* taken out of service the following steps shad be taken to moms that. the system is ProPeriv and sufaiv abandoned in c0ffW1w ce with dWPtw Comm 83.33, Wisconsin Admirrfabsshrr: Code: e AN Pi to tanks and pits shad be disconnected and the abandoned pipe o W*W mew. e The corrtarta of all tanks and pits shad be renwwad and Properly disposed of by a Septage Servicing Operator. • After purnping, all tanks and pits Shad be excavated and removed or their covers rsmieved and the void apses filled with sod, gravel or another bmwt sow materiel. COMTNGEUCY PLAN If the POWTS fails and cannot be repaired the following meaeixes have bean, or must be taken..to provide a code compliant replacement system: _A SUItMbls i613100eriMA aMe has been evaluated and may be utfted for the location of a replace Wil sys lv- The placement arse should be protected from disturbance and c�rtipactioit and should =bo upon-by re**md saftacks frorn +rod PVosedvtrudhim. lot lines and weds. Fescue to protact Umrspbownent area will result in the need for a now soil and aita.ev on.4 eatabliah s suitable-repiacernent area. FAqplqc6nwm systems rust corky with the nil" in'effect at that tine. E3 A suitable repinownent was is not evadable due. to setback and/or soil li nitations. Barring advances in POWTS terstinologY a holding tank may be waded as a last resort to replace the faded POWTS. E The site has not been evakuated -_ to id en tify a suitable r�facerirent area. Upon falsire of the POWTS a soil and site evaluation must be formed to locate a suitable replacement area. if no replacement area is available a holding tank mray be iatadad as a last 1080t to replace the faded POWTS. 13 Mound and at -grade sod absotlotlon systems may be rsoonstruo i<f do place following rarrwval of the bimm at the infiltrative surface. Raoomstructioris of such systems crust Comply with the nA3s in effect at that time. < <WARNBNe> > SEWIV. PUMP' AND OTHER TREA'fill M TANKS MAY CONTAW LETNAR SASSES AIr10/OR B�18iJF�CIQNT OXYGEN. DO NOT EII1T8t'A SEPTiC. PUMP OR OifMR T1EAT IIT TANK UNDER ANY CMCUMSTARCES. DEATH MAY iM$ULT. MCUE OF A PFASON FWU THE WTIBf1OR OF A TANK MAY BE DwfKXXT CM IIUPOSSMtIE. COMMENT ADWIWNAL , IllNiT PEWd1IS M E___1 Nareie ® a Nary Phone S 5/ Phone EPTAA83E c ►TOa 1UMAL tMG LATaI,r AUTHORITY Name H,wne , Phone E Phone wo c was drafted in canoe wm Conn 8 &=2)M(l J d1&M and $3.5+utt ►.' (2) (31, Vft=mWnA&mnNm&e Code. Wisconsin department of Industry SOIL AND SITE E V A L U I RE � Page 1 of 3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 83.0 Adln'�18 / r Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. must include,jut- not limited to vertical and horizontal reference point (BM), direction and % pe, or r�a� P I.D. # dimensioned, north arrow, and location and distance to nearest road. 'R� DAN 4F�G ndin CI APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION�`��, toNNGU =ED DATE PROPERTY OWNER: PR iL T Derrick Const. Inc. GOVT. L ."-� 1/4,S 12 T 30 N,R 18 %(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # ` 1505 W . #65 5 nab CITY, STATE ZIP CODE PHONE NUMBER [ ❑VILLAGE [MOWN NEAREST ROA New Richmond, WI. 54017 115) 246 -2320 Richmond 140th. St. [x] 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 .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 tre ft Maxirp esi to i rake 7 bed nod/ 2 8 trench, d /ft Recommended infiltration surface elevation(s) 7.5 `}'�� ft ( refeFred t te�pl�beChfia c "" g �� / Additional design / site considerations trenc ' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem I ®S ❑U [36 El ®S El ®S El I ®S El ❑S ®U SOIL DESCRIPTION REPORT P tA &L A [, ae 3 1, 2ceo Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '.....1.....` 1 0 -12 10 r 3/3 none sl 2mcrr mfr QW 2f .5 • S 2 12 -30 10 r 4/4 none s1 2msbk mvfr if .5 .6 S Ground 3 30 -90 7.5 r 4/4 none ms oSCI mvfr na na .7 .8 elev. 1 Depth to q j .su limiting factor +90" Remarks: Boring # 1 0 -12 10 r 3/3 none sl 2m r mfr qW 2f .5 .6 -S 2 12 -44 10 r 4/4 none sl 2msbk mvfr C1W if .5 .6 Ground 3 44-100 7.5 r 4/4 none ms osg mvfr na na .7 .8 elev. 1 Depth to limiting I ` f 'T b0 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. Richvapnd. W1 54017 Signature: Date: 5 -31 -2000 CST Number: m02298 --- �Aft� I f PROPERTYOWNER DPrric -k C- onst_. Tnr_ SOIL DESCRIPTION REPORT Page 2_ of 3. PARCEL I.D. # pending Depth Dominant Color Mottles Texture Structure Consistence Roots G P D /ft Boring # Horizon in. Murisell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -11 10 r 3 3 none sl 2m r mfr cs 2f .5 .6 3 • S' 2 11 -36 10 r 4/4 none sl 2msbk mvfr 9w if .5 .6 .S Ground 3 36 -90 7.5 r 4/6 none ms 0sq mvfr na na .7 .8 elev. 10 ft. Depth to limiting factor 3 ji. L ha �' O . +90" Remarks: Boring # 1 0 -14 10 r 3/3 none sl 2mgr mfr gw 2f .5 .6 .S 2 14 -39 10 r 4 4 none sl 2msbk mvfr if .5 .6 •5 I none ms os mvfr na na .7 .8 Gr ound 3 39 90 7.5 r 4 4 . � elev. 99. ft. Depth to limiting factor +90" Remarks: Boring # > > >< 1 0 -12 10 r 4 3 none sl 2msbk mfr 2f .5' .6 5 2 12 -29 10 4/4 none sl 2msbk mfr gw if .5 .6 •) 3 29 -90 7.5yr 4/4 none cos osg ml na na .7 .8 .7 Ground _ 9 8.5 ft. Depth to limiting factor Remarks: Boring # 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- T - R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #5- 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. �N 1 =40' BM.= to of 1" vc i C el. 100.00' p P pipe �- ,Alt. BM.= top of 1 pvc pipe C el. 99.50' too' I c Gary L. Steel 5 -31 -2000 O ' • ��� =_� • • • w :fir ���: �� ���,� - ��• �� i ter -�' '�== ::: ' p cif � = __�'_ : • ' . � �J p iii/ e� ► .fi . �r I •• • • YEAR x 990.5 99 x AS SHOWN % �r ii D : • - • � A 99077 SQ. �► 2.27 ACRE 3 CT B-2 i• i Building Setback - •• from - • fr om • - - k iA-;i for and at ftw requed 4*. EM Dwrk*, Sr. i 15 05 Highway • New Riplyn Weconsin 54017 2462320 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer — DAB! / d r�� A ®c k.— Mailing Address l Z �l(l e' /�A -t7 14eL ' 1 c-4. -M tit jo Property Address 1 (Verification required from Planning & Zoning Department for new construction.) City /State &W & -1 Mdf4 Parcel Identification Number O )–k b LEGAL DESCRIPTION yU Lo Property Location '/q , `/a , Sec. 1 Z ; T 7IQ N R `F? W, Town of Subdivision �S ( , Lot # S Certified Survey Map # , Volume , Page # Warranty Deed # g® , Volume �$� L , Page # Vo 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 13 full of sludge. 1 /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 bas 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 certi fy that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue o a warranty deed recorded in Register of Deeds Office. Number o edroo / (0 CI SIGNATURE OF APPLIC S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) 8055 2 P 4 0 3 KATHLEEN H. W ALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD THIS DEED made between Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership ( "Grantor") and Dav id 0. 09/06/2005 10 :45AI'1 DeGear and Kathy A. DeGear, husband and wife, as survivorship W DEED marital propert ("G rantee "), ANTY # WITNESSETH, that the said Grantor, for valuable consideration EMPT conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: REC FEE: 11.00 TRANS FEE: 238.50 COPY FEE: �Five ,Plat o f Waters Ed a in the Townshi of Richmond St. Recordin Area CC FEE: g p Name and Return ty, Wisconsin. Brushy Mound Partners PO Box 445 New Richmond, WI 54017 026- 1126 -05 -000 (Parcel Identification Number) This is not homestead property. Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee 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 Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this 2M day of August. 20Q6. E ' I D rick Michael Stevens AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 29Ah day of August 2005, authenticated this _ day of , 20_ the above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a in Limited Liability Partnership to me known to be signature he pers ns who e e foregoing instrument and type or print name acknowWe ge the s PAME J. RUTLEDGE If TITLE: MEMBER STATE BAR OF WISCONSIN (If not, signature Wary Public authorized by' 706:06, Wis. Stats.) type or print name P J. Rutled9 StaN of WIw4nialn Notary Public St. Croix County, Wisconsin. THIS INSTRUMENT WAS DRAFTED BY My Commission Expires: Jul 27 h, 2008 Brushy Mound Partners *Names of ersons signing in an c should be PO Box 445 p g y p b typed or printed below their signat New Richmond, WI 54017 r 11b/33 SMFi:- 447 ACP43 INS .36 n. s? ox" a u •s3M r as 37 8621 - .�°•° -- 1 99 ' {0O_ Nast, `"•. ° 1-00 B J2 � +w 233 47 • .2S 1 �- x LOT $4 `� j{ Kin 3 5Q FT- i i Nat -ate . t � M ft544 $0 \ J , �� � �n� t � y� ♦ ♦ (� � N , - - i, x t /i: LO T 2 Z17 ACRES BM3 SO. Pt -^- s B . LOT Of 3 _ Cir r / . 4 0 , LOT 20 ; 2�s ,roltcs a; ` t CO LOT- AS SHOSW 19M Mrv. CWAWI 8Y i►E OQRPi ,p 70V ar Wt . 6-3& ; sta � 19 ./: ..... - i 8./ d�l._n►x_ - B to 21 LAT� 1 ..�.. \ O+ ` r 8 - 2 6 � • ! •\ �� /w•!a .� 1 � Ise nas � '• " f x 1 1 LOT g a! x son. s f � ! i I ,j ' 1 - 2 5 ACRM yatdoSillT 1 1 ,Z' S ! 221 A B -37 1 I _ ✓ / i , i t rl 1 I x 1 \ \ 1 1 x ,.t,. LOO't • 4 t 1 i 07424 I Of ACRES -27 X i4i l } ,�• l ', ,.M "mo --- ». , 1 t \ )r � / t1` 1 � . la.a r "`=*'_'.�� ' .t:•a AFT j ' .� I / loosJ,'• ♦ i `�s 4' �p� s . " -NOR rH 11 CORNER ` SECTION 1 ? -JO -18 FOUND ALUMINUM COUNTY MONUMENT I i I N83 ' 0 3 'ss " MA T C y L/ V e I 3 I''� 1 88 e ool ! po •� LOT 5 - -_ _ AREA TO SHORE: ` ( — vt 99,515# SO. FT 3 r ls 39, i ' i V AREA TO MEANDER LINE: o� 6 4' ly I ( 93,315 50. FL '� ! t 2.14 ACRES I I N89'59'31 "W 522.70' 44'1 _ — _ _ _ _ - 4jl- - - - - -- °y5 ;64s 4� < OVERALL EAST -WEST 1/4 LINE: L O T 6 / j --- S89'34'56 "E 5265.07' - - - -- AREA TO SHORE: 9 j 5' \ - — �— 85,700± SO. FT. — i SsOy lSS9� S89 '34'56 "E 3956.25 - -- AREA TO MEANDER LINE: 77,867 S0. FT, ` p. & / F 1.79 ACRES 53'* _ - -- rNp n N8512'02 "E 372.44' �Is$ Jq, i �✓,l. + 1 `\ �`� "' ,/DINT - I .y" `O \ DRIWWAY I 0 1L- - - - - - L o T 7 p a t g e•' •/ a �r Q�' ,/ •, \� ` I �` AREA TO SHORE: 2 '•� I M i E &` a 85,791± S0. FT. 2 Q o I I C` h b ` y a oQ ��•��a' I •" I �- i 1971 ACRES a AREA TO MEANDER LINE: m I+ r c O &;r� 4 �i ++ rv � f • i ! r t 70.206 50. FT. 2 N i. N s a w 1 1.61 ACRES Q � � p �D � �..prti , i� Zg fn D O JJ'-, ' W t y 1 0) O r 6 ` e ` lc `° IL O T 49 I ` S88 354.69' 6± — ._ i c.E D - ` 2 V' tiry TOTAL AREA: i cl 1 \ 14 i " v ' - D i 88,035 SO. FT. 2.02 ACRES F �... Q i o o b 7 4 t N75• } o � , L o T 8 `� �'& a g g � o•,< 5809 "W 1 i to I m i AREA TO SHORE: x II min � I, * 378 % < 1 d r, N ? 84,974t S0. FT. 8 m & ; 1.953 ACRES Y :f M I ! AREA TO MEANDER LINE: I 73,106 SO. FT, Z 4 f t i t < i/ 1.68 ACRES C LOT 48 ` j ! TOTAL AREA: S82 '18'31 "E 355.00' I L ? 96,187 S0. FT, i a S 2.21 ACRES q j i I 73'1 00 N nl -- -- Ln 1 444. 61 i i i AREA TO SHORE: e 3 ,.�a•�5'17• W i i0 i 1 RR RRQ+ Q(1 rT i :I Ck