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HomeMy WebLinkAbout026-1126-07-000 f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM �Q County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420642 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: Sager, Steve /Linda I Richmond Township 026- 1126 -07 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: 12.30.18.76$ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark c -ry Dosing t^ Alt. BM / .3,517 loo- Aeration Bldg. Sewer CouAv 1k Holding St/Ht inlet 4.83 97./1 TANK SETBACK INFORMATION St/Ht Outlet - 7. Z 96,7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f I Dt Bottom A - Dosing Header /Man. 6. 64 q6.33 Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade `(E3 4�.I Manufacturer Demand St Cover GPM Model Numb r.,,, TDH Lift Friction toss. System Head TDH F Force in Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t 21 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: r� INFORMATION CHAMBER OR E Z t� 1oU,: � r__,._ Tvpe Of System: m h 7 N / h i UNIT Model Number:_ � / c s�v�- DISTRIBUTION SYSTEM Header /Manifold Distribution +,„ x Hole Size x Hole Spacing Vent to Air Intake lPipe(s C ) Length ( 5 Dia length L Dia Spacing t '� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �' Bed/Trench Ed es .� Yc 9 Topsoil Yes [ _] No ! Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / , `S / 0 3t- Inspection #2: ! I Location: 1636 Waters Edge Dr New Richmond, WI 54017 (NE 1/4 SW 1/4 12 T30N R1 8W) Water's Edge Lot 7 Parcel N0Q.. 12.30.18.768 c 1.) Alt BM Description = Mai* y,,A A-V dOo /r Co a c r %, N ,t/ 2.) Bldg sewer length= — 2 10 / A C r f l y. 63 _ y C�J Q i r . I �Z- +' � l - amount of cover= r►-3C" c` "�^'�11{,�/3' (.�. 57 Yes _ No Plan revision Required? � -, Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. J 201 W W 7092 Gasety * fls a wsln Madison. WI 53707 - 7082 Sanitary Fm Nwaba (% be fiMd iin by Co.) Department of Commerce (60) 26145" Z o (O `FZ- Sanitary Permit Application Stat Pit` I. N+unher In -cmd srit6r Comes 8321, Wis. Ada. OwK personal information you proms may be used for aeoaadery purposes Privacy Low, s1 S."i )Ere) Project Addrae; (if dirlo eet 14® nailing address) _ L Apptiada bMwaafl" -Man PrW An lohrmid w K E k , n I V E D I Co3Co � Fa p Property OWOWS Name Pond sr Lot fr k r I ; 2003 S� ������� O to Propellsat>waer's Mailing Addtem _ Properly Location _ city. Stale �1 Cade Phoec N ow. � �• � Secaerr ©I7 -t�sa �,yy� l 7�0 T � +4; it — "E� i o II. Type of Btdtdft (check � don apply) (` at 2 Pwn ly Dwdiiag - Number of Bedrooms j 8ubiliviioe Nsme tSM timber Q Pui liciCommcircisi - Describe use -7 I L © safe Owned - neaoribe Use ocitI! III. Type of Pwmk: (Cheek ody one boat ea ilac A. Cottttplehe Mae B if appificable) A. VNaw system p R"busmmt system 0 TrannooWMI&M Teat Repaceaca 0.4 ❑ other Madifiartien to Fxisaeg Sysceao 8. 0 permit Renewal ❑ P Revision Q Chrsge of O Permit Transfer to New List Previous Peak Number and Dow lscwa I Before n Phmbber Owner V 7 LOVA IV. 1M of POWfS (-twit art drat �iVan - P ritual En -Omwad ❑ Mamd > zs u of vjmbk snit O Irtomd < z< in, orasibhie sod ❑ At crude ❑ siaoe Pses sia [tiffs ❑ Caestnsclod wetland Q Pressaited In- Gcewod O Holdios Tank ❑ Fat Fiher Q Aerobic Try t)" ©Reeiavokumg swid Fiber ❑ Rociremiating Synthetic Media Fdtw Q ' am awber DIQkWLJme X(iraveWessP © Other V. t Area IsfenwatWez. s � Z O� DCWV Flow (ad) Design SO � RxWWd f) Dispeiial Atom Rupked is td) ystsm Mevation � � 00 c) VL raalt We capeckX in TOW Number MaatLbct eer site Sued Fiber Plastic Gw k mt callow of Units Connell Constructed Ghm ear Teaks Teats err Taal (( Amebic Traalmeal Usk r Ilan l'�sa6a VII. R s teaseat- D. doe r tar tie PK)�yTS stawa as tie atbrdcd ptwws 7 7" Phase Number era, s 3 s s r Plumber's A kcss tom. City, Slate. Zip Cade) 1 SL N VUL atest use Given R 1� A Q Ssaitsry Psee� Fee inclodes 11, d.aaler nee Immed A�at Q Owner Stamps) yam- SwdW p Fee) �0 . I T 2eo r Reason Dix Denial DL Caudkim of ApprovaURmems for �Disapproval at1l.Ct . Aaich c+awwPirl►Pinn fie ms Caeaty 4aw tar drc syMar r pw� alt las wan tit2 >< I D Haias y tree SBD -6398 (R. 08/02) ; � I f ` , 1 I I , /. /. I - ---._ _ I �,-_ _.i�! r I _--�1 - -._rQ k_ I I i i i I y i I I - .- rC-- GL33G- 4- .��L.. -- �- -� - - -� - � - � - -- - � - � I I- - •-- ' I-- -_>-_� _ J��l r11._ � _ - --- ' -- 1 -- I , ll I ` I i i 1. I I I I 1 i i ! t , i I ' ' i , I 4 � � i I ! I I l I I ! R . y 3 R n Is A Wa" L PI N a� �a s� �r rMtP 1 a xldw c i i __ _ __ _� __ - __ _ __ _ _, .� I � �� - JJ f i syZssVvr t f * *ms � �r, � � -s tY � ry. ..` r 1 )tar f 4_6`fa* ss• r �•+ �y� » •s te* •sr rrrs s " rss'►srsrs w* 1 r 2 C -Irc. r rs rr fsri i °. t r +ii rw r srrr �`` 36 1, per Ftae,l R, . a . � tt+Mks ryjj� �, f:.5 rr, f,Zm l s 3.r - _gin i' SaiS fattsface Are*-- - -- _.. - >xtea » fam a r , 4zz 3, ' "a* ►wn F F'ru TrLyCA Area f �XCK] aat� taiiat° �C>•'aiF � 'art �'R'xm f � F Fita lad Ft ar °i tNracorn tas. a " if „3 tY 3a5 aaa xoaat F >a+rs (a? ar„ � � (¢¢¢ °ro asq �'ataaat>r r+'ewtA Area a. 5.66 $ af#,raxas. aacr ti = + 4. I 1 7 . O. 422 f t5 .It J t>erar�n crass a {D : I.S .. fl a tf$ ft 4Ft, f 763 X ? dg i, ggre trench gaLe �a Ys e 203H rrs ndUgtriu! P a "k Rd ! F SCAQ I: nu _.._ t#. POWTS OWNER'S MANUAL & MANAGEMENT PLANT Page Of ZME H4;01VMTM slrs>rl A Owner c ` Tank Manufacu" L3..) © NA J�Ane Permit 0 nose O t ang val. DENIM PARAN I IIBM I Tank Mawfaetraar O NA Number of Bedroorrns O NA O Septic 0 Dome O Haklinhp vol. 3ial Number of Pubic Faci ty Units O HA Ef&m* Faber Mwwfacturer 0 NA Estimated aaverage) flow oc') Effluent F aw Model Design tpeak) flow - $Extirmate d x 1 <51 QQ 8 . w ft Pump Mannufadturer 0 NA Sod Application Rata Pump Model Standard WAmWEffiu,nt Ouality Monthly average' Pnouswnenrt Unit O NA Fats, 08 A Grease (FOG) S30 mg& O SandlQuvel Filter O Peet Fifter Siocheredcal Oxman Derrhand (80DJ 5220 mglk. O NA O Medtvncal Aeration 0 Wetland Total Suspended Solids (TSSI st So nigh. O O Other. Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand $8013 s30 mgll Dispersal Ceft) D NA Tote{ Suspended Solids (TSS) s30 nrplt. O NA M- Ground 1grav€ty) 0 k -�d {pawed) Fecal Colifrxm (geometric mean) 510` clutloorrd O At -Grade 13 Mond Maximum Effluent Particle Size Y, in die. 13 NA 0 Drip-Cithe O Other. Ckher: Q O NA • Values typical for domestic wastewater and septic w* eff uew. ❑ NA MAFfNTENANCE SCE 5erwk s Evwnt Serriae Inspect condition of tank(s) At West once every = 3 rna nwa) Owdrnum 3 Vee 13 NA Pti mp out contents of tank(s) OWhen combined sludge and amm equals one -third W of tank vahime O NA When the high waW ah m is acllvabad Inspect dispersal call(a) At least once every: nnontln , meadimm 3 years) C3 NA Clean effluent fitieir At least once event: i O O NA Inspect pump, pump controls a alarm At learnt once every: O month(s) O NA Rush taterals and proem" test At least once every: � O NA other: At least once every: 0 � ( s) O NA Other— O NA MAINTENANCE NSTfRICTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the fallowing licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS h W, POWTS Mang; Septage Servicing Operator Spumperi. 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 a check for any beck up or ponding of effkwd on the ground surface. The dispersal caNs) slash be visually inspected to check the effluent kesrels in the observation pipes and to check for arse ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition am requires the immediate notification of the local regulatory audxwity. When the combined accumulation - of Mudge and scum in any treatment tank equals are -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113 Wisconsin Administrative Code. All other services, inducing but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatrner 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 (2102 Rage START UP AND OPERATION lo oducts, solvents or other For new construction, prior to use of the POWTS check treatment t s) tar the Sal c erec lace ts}. t f hi of th Pr corncerhirati , sins are detected chess that mamay the treat and p and/or the dispersal have the contents of the tank(s) removed by a op°mtw prior to use. System start the shag not occur when sod conditions are frozen at the infiltrative surface. During extended pow mmiges pump tanks aratl 0 above normal highw'atw levels. When power m restored the excess wastewater will be charged to the dispersal s in one urge do and MY overload them reseltinB in the backup or surface discharse of effluent. To avoid this abortion have the C oMmft of the pump tank removed by a Septage Servicing Bator Pte+ to restoring power to the affmant Pump or contact a pkm*w or POWTS Maintainer to assist in manually operating the PufM controis to restore normal levels withw► the pump tank- Do not drive or park vehicles over tanks and dispersal calis. Do not drive or park over, or otherwise disturb or compact, the area within 1 6 feet down slope of any mound or at -grade sod absorprtion area• the ilia of the Reduction or of the following from the wustnviiiter stream may improve performance the p and prolong e butts; condoms; aca3itton swabs: degreasers: dental floss: ate: diskhfectMW, fat; POWTS: antibiotics; ( baby wipe: cigarett herbicides: meat arxaps; medications: oat, foundation drain (sump putrm) d'iscthatge; fruit and v r34a� ale � gasol °► Painting Products: pesticides; sanitary napkins; tampers: and water softener brine. ABANDONMBff When the POWTS fait and/or is permaneMfY taken out of service the following steps shag be taken to insu m that the system is property and safety abandoned ire compliance with chapter Comm 83.33, Wiscormin Administradw Code: • Ai! piping to ire tanks and its shall the dWwnnected and the abandoned pipe openings seated. • The contents of all tanks and pits stmil be remaaved and p disposed of by a Septa" servicing Operator. d and removed or their covers removed arad the vac space filled with • After pumping• all tanks and pits shag be excavate . sod, gravel or another inert solid material. CONTMGF.NCY PLAN a code compliant If the POWTS leas and cannot be repaired the following measures have been, or must be taken. to Provide replacement system' d may be utilized for the location of a t sal absorption 04 A shatabte replacement sires has been evaluated an grid not De infringed upon by system. The replacement am Oxhrid be protected from disturbance and COMPaction tat fines and weft. Failure to t the cement area will re�nad setbacks from ehasti� arid proposed 'e a suit ble went area. peplar meM ads must result lo the reed for a new WA and site evalsraRiorh to cot*Wf1► with the ides in etYact at thaR time. 13 A suitable replacement area is not available to setbaric ancUor soft limitations. B advances in POWTS technology a hoidin9 tank malt be installed as s last resort to raxrlaoe the faded POWTS. to . a suitable rep area• upon failure of the POWTS a sell and site © The Bite lass not been avalualed rderhMY evaluation must be performed to locate a suitable resa t am. If no replacement area is avafable a thohlirhg Leila may be kntallad as a last raM, to replace the faded POWTS. ❑ Mound and at -grade SON abaurpbon systems mall be reconstructed on Place following removal of the Monet at the infiltrathm sue. Reconiirbuct o f such syg must cortnply with the rules it effect at that tithe. < <WARNMtG> > OXYGEN. DO NOT same. PUMP AND OTHE#i TREATMAENT TANKS MAY CONTAMi LETHAL GAS TA �, "y �T, RESCUE OF A ENTER A SEPTIC, PUMMP OR OTHER TREATMENT TANK t>NOER Any tM![XfIYEISTANCtofi• PERSON Flail THE MTTVKM OF A TANK MAY BE p*FICNLT OR NWOSSiLE. ADDITIONAL COMMENTS POINTS eW AUJM POWTS MANIiTTANNBt Name cyc3' Name _ Phone `'J Is S' ( MMM SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Marne Name Phone Phone t S ith This document was drafted by the staffs of the Green lake, Marghaeite and wiludwa C"" Zonkhg and Sanitation agencies in cornpfi"cs w chapter Comm 83.22(21(b)(1)tdMr(f) and 83.5411). (2) & 13). Wisconsin Adrnristrative Code. 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FAR IFA1� eeee ee�nee eses ��e�ee��eee weir eeere� eeeee� � +� e�e�e a erie ®�eieeee��ee eeee� �eeieMe �eee � � rs� se �ee�eeieie�eer eietei � � r � � caeca ■ , �reieeeeeee�ee�e��� e�e�ee �� �eerereMee�eer� r ■ree�eee�e � � ■■s � � � eieee eeee e�eee�e ��� � � er r eeree e eNeee eeee �er■e�e®eeer � � eeeef � � � eie� � � �� � e�eee� � ■ee1 lace eier eee® _Sta,T oti Li to c.E l7 P 6\mo A& 7 C ro :fir N oac� �caca -o7 -ate zo 7 5 1 To r P.S' / a 90 3(p �f4 9ks __. _ � _ ___. __ _:. _ _. _.: • Wisconsin Department of Commerce Count Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 420642 0 GENERAL IN (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: Sager, Steve /Linda Richmond Township 026- 1126 -07 -000 CST BM Elev: sp. BM Elev: BM Description: In J , 7G l J v TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO PIL WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMB OR Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil g p � Yes M No �] Yes L�J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1636 Waters Edge Dr New Richmond, WI 54017 (NE 1/4 SW 1/4 12 T30N R18W) Water's Edge Lot 7 Parcel No: 12.30.18.768 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? (' j Yes (- No Use other side for additional information. � ) _ _ SBD -6710 R.3/97 Date Insepctor's Signature Cert. No. I l AAA uo.04 mt 110 Jd 4566 ST CRX CO ZONING 001 t li Sa81ty awd Btt Ditiitioa cwr 201 W. WN*Wgbm Ave. P.O. Sm 7082 c 1166uea. WI $3707 - 7082 g y pq,r (ro be i11ei ig by Ca) D* tm*nt Of Comm erce (SM 261 .6s" ✓ Sanitary Permit AppReation to accord w1a C — il.2i. NH. Adis. CWk PMMd sTiew mdm ro Pa. M" be wad far —dwy 1 n-xv _.a,_ W Project Adkm (it &Awed dm MWIMS addrwt) i. AppDooko labruw&ft - pim" print A• Gtlbrtlatiett d P4 s 9 c Reply ow e'rNOW e S� '� i� 3 2003 a _ Ak oweer`s AWN" ( ,, Cft. f S 1- 7 6 T3_C R Ear IL Type at (el+eek A d d apply) '�1 er Tbartbw of Bedroarla's 'vieiae• Tfrna CSM ]Nwbr OlrbliolCe4Atrnelel- ltae (3 &mow*" -- f dl f� _( 11yM adlp et UL Tree if teca inns as Mae A. if '� raw s�qs O x syo- 0 TVwW=Woidw Teeb 001, D O*W MOMMUM to SMAiRs s ptaa s• R D Cb=p of O Toafir W Ww t yt Prsvioer > rrltgt>•Mednr eDd Drtc , M. TYM .f towns Chak A ow, Sian - tnenuieee ip-oioroe 0 Mara >_ lv a of la jai A < 21 a_ atwda�6k mdt M Cl p� P,r+s s.na Wka Co WM WOW 0 Ftwmuind %4mmd ❑ HeNtir do sow moot vow ❑ am6a fwavd Pim " ( • V. WmwcnWffftmtmwt Area 1 DIP �w i� O D*m Sa Appkod Ruder Regeirat id1 GO s t o I oo ✓ YI. Ta sk Ido Crdeciv in Tact 8w olub a ogi of CjFft lop = Www T«r 1� r�..w... Ll" Vil. Rts Starr eeft- 1, the Irr aM+m ea the elpebea u ex '. Nane Besioerr Pboae Nwba = S3 `7' 6 Sl3S ,ramtbw't ", �Qrde o l vin, c rttttast cam G I CI Diwppreved serer Paeam Fee(" oea t>,0ed A1se1a ) �l t?reerGiwa, gasial fX CosdlNor of A� I�roiMtM �el�!«rMsNa�MVVWeMNft*AWfl2xl1 hdr SBD -6398 (R. 08/02) i i �. �. L �� +� 4 � �'} ��,� �► f �� �� ,� � j;_ �' n� �''' J' ¢ i "' T . �� t � EZ1203H t rMrr'!~ r ..,s.♦ 24" RR «, 4 �' •�i�s 1 t . ( :: Vw It 24 #1 t �('� 'Tom Coc1� LJ, ,m �` 7" ) 1 Mont �, kaM rod a r e pa 14"W R t t. ra • 2 St25 r S' watt (. �) �9 1 -a, of CYh , TOW -e taltrlaa 3 -u Aa ou"Ide L. . t7' l t2sortt ]',S3a. ^122 t#+ f VoM# j 1 11 `mac p K#c ^3•).t ( 12wiftj '.SFa yti3 ��p)erialTrescOarea t+ i Sbdsw � 1 i o rc re` a Latkta b`n.�� c r a1# He t a 12 in, 'x 2. Bottom � •Fl _ r �a,a vo)'Mc k ' 36 to :300 SK f romi vaK# Vp bOttpetr S tr2 of Y.ff# P" elected T�c6 Area 4 bcr ` u+etersl Q, ' 5.8i �V.tt. t r Ga##ags Acr t 1. X64 X ?,,a • i32,y»¢ Q. #Og e J 7 661 q,bc h P f, j f f r` 0 f `-- --- 3 x to SC3 n Trench A94regvte EZ1203H S ystem t R 9 Andust Gra ri�#1 p� ��' 65 lndu�# '0pktcnd TN r k Rd. B060 P SCALE -•ar men. 1 i I _ 301 W. •ate- AW. PAL lba 710 in sm - im i AMOM ofCOWANA M i 1oa - Q oo �r ar snowd .dlr +CJ am. WAL AO ee. stele. ko nwm vm a -Aft memo i cot eeri RECEIU p��o - t I acs -C>7 oo v ia�IN" A lien 1AMMI . 102. 3o • • Z 6 JAN 0 2 2003 !U oS s 4.2- r3 ©N s IS �►. sr� zir+� w..ra�ee Mr.r sr. cRC couNrY ZONING OFFICE a t"MIi� o1� 7IS a 0 a� c� `�Qes, 7 � IL Iry" 4r VC aid tAw Clstne 0 Rod 1 2.5 HI. "n" ltll fcbm* wrt Mr oo A 1 sdMW Ow 61e� on). irs R AWNU O L 1 oeeuet 3 0 n of A D Adm w r Zm& i_ Q Estee! it �� IMewit � � der 1leee irtnrd M at llseteM: l teelt eti t1Yet sdsw Y 4 ieueenl eeee� ` �y( 4WANM - Nwou"M ft a - o o $ - Pa. � SQ �enswortd �Ytiir� ��(f u [7 N sa ©1swie a D am* Aee Stan* e ar� o M-4m* *E A.eelio um 00 3t1 oo.er AV" boomm ism 1 % Ar AS Aegis Awe A0L. weaMa. soft&^ pad aerie oC � dc�yf fa,�,� ,S �,� .�� cArovivb TANd stiles ad#m C*mWw w NOW .b rm . mar I !leeAue►s 7 , — a 1 5 t -45 o t > D owtrtiimb w As..ee. 2 J� 7-7 Rompbu—im uv � s 1 thd� d i l3� ✓co�u - 33o r 3S TF�v��e�� �d o,- Sys - G ' Jh - h 5 sue- r avc d.e- add I }; o n u.t9 So t l �lrr sc i ,ti' - 4 - ° 6"0 S-YS4-&m e iOV• � Sub c f- ,,cJl � v� �� e e��' s-r.- . T��vf o ,r Wi l/ W �ri.f -4o �i /cal v�? 1ri�y v I llam �-Wmu-s-t- pro q'i VJ1 COV 1 4 OlAaV� M 41 A4 C 2)- crnnt.�c� rxt !Klll1 r �`- ►` , !� ���dr%n y�-� -, . s.P�1�'da,c� s�,,o,,vr,,,rm,�,�- `✓ , ��r., cY 3. +�3— / I ___ r � k �, } Y J, e , �! � ,� � r _� - ' P/ot Pi B �u � wv a � t� .1s tic -��-' 5 /a 73 P, w T A rCl .,)-5 ip`4 i c Za(�� -1cSa Wi s � S �a :�e�Z ` Oa(,o 3 39 Chamb� �S -jo / Luc � a ao, a y �5p Iro a 3 n z { f n a° i �. �. .� . . � �,� ��: 11 i.: 4 �, 3. »F.'. �1 9$ ��.. d. �� � ��.,.., ka T ,� :�` ,� ,�. �Pe e�1 �� I .. 9 N ot Pi ck Y-�- ru N R s 7 C ,X O u`� n °41 t ��¢ "� Gb W e S t'a ;�c C'>oZ(Q - d b 0 o -39 eu w�b 1\ 9q 9 floc ' ,� r r A Tn WA f I o _ I r _ lip � .p I I i �I 2 Wilco and Hum n Relations Ind ustry , SOIL AND SITE E V A L U Page _I_ of � Divisidn of Safety 8 Buildings in accord with ILHR 83. Adhr e . �, \�1�, t rst. QQ Cro o p P paper Attach complete site Ian on a er n t less than 8 1/2 x 11 inches in siz n must includ # not limited to vertical and horizontal reference point (BM), direction and _ lope, s�lebr O�y EL I.D. aZ(o_ dimensioned, north arrow, and location and distance to nearest road. ��• SS G N Tt `G � u Y FF DATE cP O B APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATIO PROPERTY OWNER: ""0' X41 FAR Derrick Const. Inc. GO SW 1i4,S T N,R S(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 1 505 11y. #65 7 n= Rrnsqhy Mniind_TAkq CITY, STATE ZIP CODE PHONE NUMBER E]CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond, WI. 54017 715) 246 -2320 Richmond 140th. St. [x] New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow » 600 gpd Recommended design loading rate _ bed, gpd /ft trench, gpd /ft Absorption area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 96.50 ft (as referred to site planbenchjnark) Additional design / site considerations trenches spaced to code 4.00 , below grade 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 [IRS ❑ U CR S ❑ U f:1 S ❑ U [kS ❑ U ❑ S CCU ❑ S 0 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench 1 1 0 -12 10 r 3Z3 none 1 2 12 -29 10 r 4`.4 none sil 2msbk mfr UW if .5 Ground 3 29 -70 7.5 r 4/4 non elev. 1 00.5 ft. 4 70 -96 7.5 4/4 Depth to limiting factor +96 Remarks: Boring # 1 1 0-9 _ 10'r 3/3 none sl 2m (4 mfr cs 2f .5 .6 2 9 -24 10 r 4 4 none s i t 2msbk mf .5 Ground 3 24 -42 7.5 r 4/4 none s 2 msbk elev. 4 42 -90 7.5 4 1 00.5 ft. Depth to 5 90 -96 7.5 r 4/4 none sl 2msbk mfr n na 1 .5 .6 limiting factor +96" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. New Richmond WI 54017 Signature: Date: 5 -31 -2000 CST Number: m02298 II ' PROPERTY OWNER rrirk f on9t SOIL DESCRIPTION REPORT Page 2 of -_ PARCEL I.D. # _Pending Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /fib Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 sbk mfr cs 2f .4 .5 3 2 4-43 10vr 4 none qij Icsbk mfr civ if .3 Ground 3 3-96 7.5 r 4/6 none ms /sl osg mvfr na na .5 .6 elev. 99. 8 1t, Depth to limiting / factor h +96" Remarks: -r�y.� S Si�2 Boring # 1 -14 10 r 3/3 none 1 2msbk mfr 2f .5 .6 4.... 2 14 -65 7.5 r 4/4 none 65 0 Y ............... . -9 7. r4 6 none cos Os mi na na .7 .8 3 5 g Ground elev. 99 ft. Depth to limiting factor + 7 t-- Remarks: 0 a -S 5 — i s ctS Ia*. ( uV Boring # 1 0 -10 10yr3 /3 none 1 2msbk mfr gw 2f . «: 2 - Q29 - - t:r done sl 2csbk mfr gw l f . 11 J 3 29 -84 10yr4 /4 none ms sOg mvfr na na .7 .8 Ground elev. 99 ft. Depth to limiting 2 �1 4 factor + Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) • STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NEaSWa S12- T30 -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #7- 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.= top of l" pvc pipe C el. 100.00' Alt. BM. = top of 1 pvc pipe C el. 99.90' 1 JV I c fp'- � O - Gary L. Steel 5 -31 -2000 POWTS OWNER'S MANUAL & MANAGEMENT PLAN P� _l of � fIl E `t �• � Dq �S SVST M 816 V ATWW Owner Permit t Septic Tank Capscky / o� s C� ❑ NA Z / Septic Tank Manufacturer e5 S E3 NA PARAMETERS Effluent filter !Manufacturer ❑ NA Number Of Bedrooms ❑ NA Effluent lamer Model 10D ❑ NA Number of Public Facility P Tank Capacity Estimated flow aaverage) D Pump Tank Manufacturer ❑ NA Design flow (peek). (Estimated x 1.5) 0 Pump Manufacturer ❑ NA Soil Application Rate . W"L M L Ife P Model 0 NA Standard 1n writ Effluent Quality Monthly average ` Pretreatment Unit Q NA Pais. OR & Crease (FOCI 530 mg& Q Sand/Gravel Rter ❑ Past Filter Biodnerruicai Oxygen Demand 49ODj 52213 mglL E3 NA ❑ Mochanical Aeration ❑ wetland Totai Suspended Solids tTSS) 6150 a*n E3 Disinfection ❑ Other. Pretreated Effluent O usky Monthly average Dispersal CGH(s) 0 NA Biochemical Oxygen Demand (BOD 53O mg/L X in Ground (gravity) E3 1n Ground (pressurized) Toad wed Salads (TSSI 530 mgt ❑ NA ❑ At -Grade ❑ Mound Fecal Cokiform igeorn tric mom) S10 cfullOOrnl ❑ Drip -,I i ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: Othsr. C3 NA ❑ NA `Valens typkxW for domestic westewow aryl septic tarok effkwnt. Other: ❑ NA 11ilAMITFIi)ANCE SC"EDULE Service Event Inspect condition of tank(s) At least once every: 3 �, morn � f (�danuin 3 years) 103 NA Pump out contents of tankls) When combined sludge and scum equals one -third IY,) of tank volume ❑ NA Inspect dispersal cads) At bast once every: ❑ month(s) WeAnum 3 years) ❑ NA Ckw effluent filter At best once every: 1 E3 month(s) ❑ NA Inspect pip. pump controls & alarm At least once every: I 0 (s) L7 NA s) Rush latereb and pressure test At least once every: ❑ month(*) ❑ NA ❑ yearlad Other. At least once E3 morith(s) Y= D year(s) ❑ NA Other: 13 NA MAINTENANCE UMTR lCTIONS Inspections of tanks and dispersal omits shall be made by an individual carrying one of the following licenses or certifications: Master Pkanber; Master Plumber Rsatricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must kxdude a visual inspection of the tankts) to identify any missing or broken hardware. identify any cracks or leaks, measure the volume of combined sludge and skier and to check for arty back up or ponding of effluent on the ground surface. The dispersal cells) shat) 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 imrnedueta notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third fY 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 laroti I 4 FART up AND wERArION Pao ar For n construction, Prior to use of the POWTS check treatment tank(s) for the presence of painting that chemic the tank(s) tar th et f tro stmOnt P andiar darnage the diap err COWS)- If high trstionS are detected have � by a $0MS99 servicing operator prior to iesa. SYsttsm start up shall not occur when bead conditions are frozen at the intftstnre surface. COWS, in am large do Dun Power outages P � un" Po map tanks may fill above normal highwater . When �scharged to the dispersal se, p IS restored the excess wastewater will b+ effluent. To avoid this situation have the p� the co ft) and � �p�� surface discharge pnr power to the effluent ai the pump tank removed e o pump ar contact a Plumber or POWTS Maintanor to assist in t° controls restore normal levels within the pump tank. Y operating flee pmm�p contras tt Do not drive or Park vehicles over tanks and dispersal cells. Do not drive or within 15 feet down slope of any mound or at-W=W Sol! Park over. or otherwise disturb or com►pact. the brat area. Reduction or eGmir►ation of the following from the wastewater stream POINTS; antibiotics; baap may improve the P and prakmg the fife of the facmxiatian drain. # y w �' cigarette butts; condoms; cotton swabs; degreasers,; dental fbss; diapers; P pump) water; fruit and vegetable pOelmegs; g asoline . neeret sc raps . disin rree ddo fat; painting Products: Pesticides: saeeitary napkins; tampons; and water softener brine catins; oil; ABANDONMENT Wha n the POWTS fails and or is POrrnansntly taken out of service me foNawing steps stead be tauten to ensure that the systare is Properly and safely abandoned in c0"W§8n0e with Chapter Commn 83.33, Wisconsin Administrative Code: e An Piping to tanks and Pits shall be disconnected and the abandoned pipe openings seebd. a The contents of all tanks and pets shad be removed and pY disposed of by a Sap"" Sam*" Servitdng Operator. e After pumping, all tanks and Pits shad be excavated and removed or their covers removed and the void space filler! with soil,. gravel or another inert solid rnstenal. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken reT t system: , to provide a code comcompliant suitablereplacement area has been evaluated and may be utilized for the location of a �t soil � tem. The replacement area should be protected from disturbance and Cornpaction and should not be infringed required setbacks tram exist" and Proposed stnu m". lot dries 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 was R eplacemen t systems must comply with the rules in effect at that tune. ❑ A suitable replacement area is not available due to setback andlor soli limitations. Saffing technology a holding tank may be installed as a last resort to replace the faded POWTS. advances in POWTS ❑ The site has not been evaluated to identify a suitable replacement area. U pon f iAue of the evauaRiorb must be performed to karate a suitable POINTS a soil and site may be installed repTlacxhrrhent area. H no replacement area available a hold' as a mg tank lost resort to replace tube tailed POINTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inNrative surface. Reconstructions of Mich systems must comply with the rubs in effect at that time. < <WAFWWW> > ENM P ANp TRIIIT A OThMR OR OTHE TREa►T# �KT TANK MAY INF ER MN ANY CiRCt1MSTANCES OEATHpgOXYGEN. t� OF�A SON FROM THE OF A TANK MAY SE DpWMT OR MYIPOSS BLE. ADDITIONAL COL MENTS POUITS INSTALLER POWTS Warne : Narrhe Phone W S [ Phone serTA CIPERATOR -- Ry UWP LOCAL 1T01tY AurnowrY Name Name S'i` O ro L � Phone Phi'° 15 This d0cwnent was drafted in corr PhOnco with chopw Comm 83.22(2Mf1"WO sand 83.54(11. (21 & (3). WbconWn Administrative Code. T 7o7 � ' ST CROIX COUNTY EPTIC TANK MAINTENANCE AGREEMENT ST. C[�OIX COUNTY zoNl AND NG OFFICE OWNERSHIP CERTIFICATION FORM Owner/Buyer �° S A ��L A-►� �-1 ©� � ��. Mailing Address j':> $ At. t Ay` , Ab-o WL4~ ao, W-C S yo t Property Address `ig (.6 C.&TOIN C50 E iM VC (Verification required from Planning Department for new construction) See_ z City/State Parcel Identification Number 1 0 1 0, 3 LEGAL DESCRIPTION Property Location t1h Y4, s V4, Sec. A', T 30 N -R 12 W, Town of Subdivision 6LA&-�� C� , Lot # �. Certified Survey Map # . Volume . Page # Warranty Deed # Z.�S (ea Volume g . Page # Spec house ❑ yes )<no Lot lines identifiable JK yes ❑ no E SYSTM MAINTENANCE � AINTENANC ' Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman pljunber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, asset 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 Zoning Office within 30 :Xe three year expiration date. .� 0 1/ 0 / a3 SIGNATURE OF APP ICANT DATE OWNER CERTIFICATION I ( we) cert that all statements on this form are true to the best of m our knowle I we am are the own s ( ) fY Y ( our) g ( ) ( are) r( ) of the p perry described hove, by virtue of a warranty deed recorded in Register of Deeds Office. ov / 0 7 / a3 SIGNATURE OF APPLICANT DATE * * * * ** An in f o rmation Dep artment.****** Any ormation that is mis- represented may result in the sanitary permit being revoked by the Zoning Dep ** 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 i U 1888P 175 STATL BAR OF WISCONSIN FORM 2 1998 6 7 e16 Z a WARRANTY DEED KATHLEEN H. MALSH REGISTER OF DEEDS 'Jou,meni Number ST CROIX Co., WI RECEIVED FOR RECORD This Deed, made between - - -- -- 05-10-2002 9. AM Brushy MounttParfners, L1 7 ; a Wi §consinT.Ttff ji- WARRANTY DEED - Liability _ility part nership , Grantor. EXEMPT 1 and _ - - - - -— - - -- - ... REC FEE: 11.00 Steven J. Safer and Linda R Sneer husband and wife, _ TRANS FEE: 214.50 as-s urvivnrs marr al nr COPY FEE: ^ - - " CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described teal estate in St. Croix County. Slate of WISC'OIISIFI. Name and Return Aooress Steven J. Sager 438 Rounds Avenue . New Richmond, WI 54017 02 6- 1 -07 -000 Parcel Iden(ihcaron Number (PIN) Thlsis not homestead property. (isJ (Is not) Lot Seven (7), Plat of Waters Edge in the township of Richmond, St. Croix County, Wisconsin Exceptions to warranties: C''ated this 24th April 2002 /^ day of -- . -- -- - - - - -- -- -- - -- (SEAL) _- f (SEAL) 7RonalL. Derrick -- -- - - - (SEAL) L_ Gti.1.� EAL) Michael R. Stevens AUTHENTICATION ACKNOWLEDGMENT `+ignautre (s) _ State of Wisconsin, l St. Croix 1 S _ - . authenticated this day of _ Persxon came before me this [[fill day of the above named Michael R_ Steven& ;md $onald I , Derrick-, as artners of , -a— --- - - - - -- - - -- -- Wisconsin Limited Diaiyitity Rartnershilr" I (TLE. MEMBER STATE BAR OF WISCONSIN — to (If not _ __ -. -- me known to be the person S who executed the foregoing authorized by §706.06, Wm Stats.) instrume acknowle the same. 1. J HE:IDI L. DILLEY TFIIS INSTRUMENT WAS DRAFTED BY CL � N ota ry Public -- Brushy Mound Partners state of 'disconsin PO Box 445 I -leidi L. Dilley New Richmond, W1 54017 Notary Public, State of Wisconsin My eornmi is pcnn (If .raent- not, state ex i 00io n date: _- -- _ -_ -- -_ March 2fiit hlgnetures may be authenticated or acknowledged. Both are not h necessary.) iv.nue� n( P"—' "fe'i"g In any capacity must Ue typed or primed below t1w., s gr, ti— WARRAN "f l' UEEU STATE BAR OF WISCONSIN whsc cnsm teyui eWnti Ca. inc. FORM No. 2 - 1998 nnawauwue, ws. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM Owner/Buyer l� SH 114-641 "O 1"/ ��Y a Mailing Address � � � � �-A�c� �-E� LCJ� � / ) Property Address eyA7 � (Verification required from Planning Department for new construction) C(7 City /State A - )04 " Parcel Identification Number LEGAL DESCRIPTION Property Location ' /a, 5 ' '/,, Sec. ' . T 30- N -R � W, Town of Subdivision �:TZ'i�S V Lot # Certified Survey Map # Volume , Page # Warranty Deed # W "Z —7 Volume V Page # `0 4 Spec house Yyes O no Lot lines identifiable >(yes O 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 can affect the function of the septic tank as a treatment stage in the waste disposal system The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and* by a master plumber, journeymanplomber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e e ear a da . GNATURE OF APPLICANY 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 owner(s) of the pro de ribed above, b vi a of a warranty deed recorded in Register of Deeds Office. /L- //1/ J"t SIM&UICE F APPLIC� 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 �Z r. STATE BAR OF WISCONSIN FORM 2.1998 � KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Noser, 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 WARRANTY DEED "Property"): EXEMPT N CERT COPY FEE: See attached Exhibit "A" C TRA SFEER FEE: 1047.60 RECORDING FEE: 12.00 PAGES: Recordint Area Name and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 New Richmond, WI 54017 Part of 026.1037- 1 0.000. 026-1037- nmti1039_1&000 Parcel Identification Number (PIN) This is not homestead property. I "h Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May , 1999. ;David Naser " •' i * AUTHENTICATION ACKNOWLEDGMENT Signatures) David L. Naser STATE OF WISCONSIN. ) ) ss. County ) authentleat d this 28 hday of ma , 1999 , Personally came before we this -- day of f W - , 19— the abRve named to me known to be the persons) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same. i TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats,) * THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Hendrik W. Van Dyk My Commission is permanent. VAN DYK, O'BOYLE & SUZR, S.C. (If not, state expiration date: Post Office Box 127 --)' (Signatures may be authenticated or acknowledged. Both are not necwaary,) 'lette Way ► mush ��u � � �� �y h use Z w r U�ts 34 x ?d,. rac ..,_. xx greater x or cor Ve - a ' 01 �eiq/ The mc u nmasked 0 Provides p the 'blective is a ant n'rnasked sr to Provide a' Its desi Vilar dewa to al c a tfflun botto gn 'hieved ti ton in all directions. 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