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HomeMy WebLinkAbout026-1126-16-000 s :onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety and Building Division 4 INSPECTION REPORT sanitary Permit No: 408209 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 Partnershi I Richmond Township 026- 1126 -16 -000 CST BM Elev: linsp. BM Elev: BM Description: S . q I I S �d n'l 4h- z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS EV 1 13 - 7-8 3 9 'C/ Septic � Benchm.j;irk . � Dosing Alt. B / � y► � 6-o • — 4�4 via (v�' 0 3 Oa� 5 Aeration Bldg � hv Holding SVHt Inlet J , TANK SETBACK INFORMATION SVHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / �� �� Dt B tom Dosing / Header /M 2.3 ioo. 9L Aeration Dist. Pipe V 0 Z.3 Holding Bot. System .O � l00- , Final Grade / PUMP /SIPHON INFORMATION I �S , —� 10 - Manufacturer Demand St Cover fJ� GPM Model Number �� r, 31, 1(0 3 3 TDH Lift i Friction Loss Syste Head TD Ft 7 3.47 10-5 1 1 .1 s Forcemain Le ' th Dia. Dist. to Well ' N ,j SOIL ABSORPTION SYSTEM B DIMENSIONS Width t Length s No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 t SETBACK SYSTEM TO P/L BLDG WELL T LAKE /STREAM L C G Manufacturer: INFORMATION CH R OR Type Of ystem: 1 -7 #7 01 !N v� UNI Model Number: DISTRIBUTION SYSTEM 0 rnauti.d / `„Ms C' d VA-1U4 -V' S �i Header /Manifold Distribution t x Hole Size j x Hole Spacing Vent to Air In ake �L Length I Dia h L ngtl- Dia�� Spacing / O 1 `' �` d �► � 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 / t!J Topsoil # Yes ❑ No j -1 Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspecti n #1: / /�Z Inspection #2: / ) / Location: 1654 Waters Ed a Drive New Richmond, WI 54017 (NE 1/4 SW 1/4 ©'T30N 18W ater's EIge L6 Parcel No: 12.30.18.777 1.) Alt BM Description = " `/ (X9W rok: b y "0 � p Vh V g0F 2.) Bldg sewer length 0 - amount of cover = L' 3.) Contour = Ll 1 -M1 Plan revision Required? Yes /No _ G " -! ✓!4 J - Use other side for additional information. Date Insepctor's (g6nature Cert. No. SBD -6710 (R.3/97) Safety and DwIdop Drvtsion cow" 201 W. W Ave.. P.O. Box 7162 ST, C d`o t FVIs�6 Mdbm W1 33707 - 7162 iio Adder Department of Commerce 7- z- 3 S Szd F.. SAnita" pp s�rr Number Permit A �ication yEg�j In accord .rich Corm 83.21. Wis. Adm. code. peraesi i0 0 = 1322100 You Pm" Q Cbeck if Revision be wed for isw sts. 1 m � l�f' 1080oai _ "em Pod A8 Iafoet Stare Pun LD. Number L Parod Nouiber ( `1 Property Owner's Name e ® E � V (� -1 b - I (v- o D t T Propem IACWM perty ' Maihag MOM 5 ZDOZ. GA SW � P.O c• Bp 1 a Block Number Qw. See Cau Pbaste Nmnbtr T, 'F Oom COUN (Y Nam Number ZONI NG OFFICE S o f EL hL Type of Bn�at t an mat $P*) pv � ". S � or 2 Fsmdy Dwellin - Number of Bedrooms 3 •w �e Dy®age y ❑ State owtd r « ` z s '1` �' x �S nl� JIL Tate at Pam (Chak asst am bassi as One A ( •meat far blernd me)' �t� use A. 3 a cf 6 way m Far Coaol7 � 2 o R,epaoetoent system T Date Issued t. ❑ CIM Sunimy P ��' �a Perini` rrmo IV. of Y+erra>m c a)i tbac )( ng ate is for bder2 1 me) 44 ❑ Non Preemsind Ia�Gra�md 21 1= 47 D Sand Fftf so Comsaucted wetand 22 ❑ Pnwimd k Qaaaoa 410 Holding Tank 48 n Single Peas 510 Drip Line 45 0 At -Grade 46 ❑ Aerobic Treatmen unit 49 O lt 30 O oiler V Aims Area Son Application P6oe Rua Syseem» Fiml tirade Design, Fla"'' (gpd) 1' Proposed cr/� R,*0akJDaY�9 -FQ Btev'do° Pub She Steel P1ber Plastic VL Talc Info Ei.!!a� (was of Taroks Concrete Comtrocmd Glass Wm i Tub Posies CbMWIM �l VII. far iaahllatien of Nro POWTS SAWN& INS the s#taelted Plumber's Name of Pbome Number o 's Addcda (. e�iy. sate. zip cj I , 5 o l s IV VEU- ire Date Issued Ismmg Agent Sigaatmn (No Stamps) R Approved O DisWpraved S � aY Suc>ssrge Pee) Fee tine 6V s c own" lewd Adverse 3 s, 02 Zan DearmicedW 1B. C of ApprwoURewuns fw DIUPFIGTVI 'CJ-k cads /CnLII�Au . At s� Arn& complete 116w ee tie Cmmip► wb) for *1e 011— • F"w � rest ar. tiU2 :11 reebm In doe cumAAQR !R OV011 19 02 0EJ:04a CHLVIN POWERS P,2 �,� � plo R,N, 7 iar30Np18- C-0 Ro CcY,�� as A13.1 aao A cl a gS A� OUT TV 0. W' �m • Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.wisconsin.gov i n.gov isconsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary June 19, 2002 CUST ID No.220537 A7TN. POWTS Inspector CALVIN W POWERS JR ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/19/2004 Identification Numbers Transaction ID No. 757137 SITE: Site ID No. 646103 Brushy Mound Partners / Michael Stevens Please refer to both identification numbers, Lot # 16 Waters Edge above, in all correspondence with the agency. Town of Richmond St Croix County NEIA, SWIA, S12, T30N, R18W Lot: 16, FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 856014 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal Condl are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption APPF area. chs. NR 811 & 812c RTMENT OF • A Sanitary Permit must be obtained from the county where this project is located in accordance with the � 'G requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CORRE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. • The changes made to this plan on 6/18/02 by this reviewer were acknowledged and approved by the system designer. j� CALVIN W POWERS JR Page 2 6/19/02 NOTE: The scaled plot plan has contours in the system area that calculate the slope to be 2.5 %. The designer /soil tester indicates the slope to be 6% for the same area. This discrepancy is noted, but no changes are being made, as this will adversely effect the construction of this system. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 TITLE SHEET DATE: PAGE _LOF 7 �. c+� . � , � • �d�Q� i MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepare in accordance with the Mound Component Manual SBD- 10572 -P and the Pressure Distribution Manual SBD -10573 P. CIL 6199) (CR- 6199) LOCATED IN THE � 4 OF THE 50 114 OF SECTION t RW, TOWN OF , ST. CROIX COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 PLOT PLAN PAGE 3 OF 7 PLANVIEW CROSS SECTION PAGE 4 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 7 PUMP CHAMBER CROSS SECTION PAGE 6 OF 7 SYS'T'EM MANAGEMENT PLAN PAGE 7 OF 7 PUMP CURVE PREPARED FOR 0-0 ec;v' Y'IS PREP BY POWERS EXCA A ING IN _R - I. - S 3 1969 l BS AVE. NEW RICHMOND, WIS. 54017 PHONE: 715 -246 -5 DPW FAX: 715-246-5135 0 , eY C040 %NG 3polvo Jun 19 02 OB:04a CALVIN POWERS p.2 � l�flr.�n� 1"n: ►.�.s�m:c Q S�e�::,u Alf p K •� s � a � 30 �� r, t� <<� X1.9 %i -Q V -S a L 5 C , E5 E ✓ �pmklC / Zctb(sc: as n - 13.1 a-a 1 � g0 a e! 99.1 ��'� N 6a - m Page Of Z Synthetic Cov.ring A TM- C33 Distribution Pipe Medium Sand Topsoil G F �Q ' 3 % Slope Bed Of 2 For Main Plowed Aggregate Layer u D la Ft. Cross Section Of A Mound System Using E Mo. 3 aFt. A Bed For The Absorption Area F /O A. G (� Eb:�• A H / Ft. i,inear A.oadi i� rc te= �:.�f l � 2 g t. Design �oadinu Rcite= ;;PD/'�Q FT K 9, 0 11 7 t. L .agFt. J S. Ft. Position I 9,9 Ft. of Force Main W Ft, L Observation Pipe G10 --------------- - - - - -- ---------- - - - - -- - e s A a v. Distribution C7 Of i 2 2 Pipe, Aggregate Observation Pipe QACt+o� Sacyn.1 Pion View Of Mound Using A Bed For The Absorption Area DiaCributioa Pipe Layout P # $ e ! of Place the holes at the bottom of the di3tribution pipes at equal spacins. ReacTe all burrs fr an the pipe and hales. Eg med the e d Of dch kftd ap Oft that on of k ft cam or 1r Sun m a point > W s X whr 0f *M ;cwt VWL Teams dw w* of 6g jaals with a vvfM. beajird aaip a per. i° rnvidc amen fed pladre i6c the thoaaded aaap or O per. Lao" j j�L ACt„�sS t�a>� *yam o .�v G Lao" s s 7 7 P L.+►N V ♦fr�7 — rs- _ !lCt�s Sao, r3�tC� new P =--� -- Ft. bole Diameter Inch S Ft. Lateral a IM*( x - inches Manifold • a. i, Force NNn 6U inches oaf holes/pips-'d— Invert Elevation of Laterals Ft. Juan 19 02 09:04a CALVIN POWERS p.3 - ..,,,� v rvr�r �nnntstK I:KUJS 6EC AND St'k(:It l Pay- 7 4" CI VENT PIPE 12" MIN. ABOVE GRADE f; WEATHER PROOF 25' FROR.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR - INTAKE WITH CONDUIT MANHOLE COVER 4" Cl RISER W/ PADLOCK E 6" MIN. WARNING LABEL ABOVE G AD E —L---4" MIN 18" f2 IN ~ I id LET , I . WATER TIGHT SEALS GAS- 1 ' 4 1, TIGHT ] �, V z�b1 A000 A SEAL APPROVED CI Pi PE �;1��. 3' ONTO ALM JOINTS W/ CI B PIPE 3' ONTO SOLID C i ON SOLID SOIL SOIL /� PUMP OFF ELEV . A FT, , _ # O �4�t RISER EXIT D PERMITTED ONLY IF . TANK . MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: Ld I v NUMBER 'DOSES PER DAY: .S TAN SIZES SEPTIC /d'•a GAL. DOSE VOLUME INCLUDING DOS GAL. FLOWBACK: ��L.3 GAL. ALARM MANUFACTURER: S CAPACITIES: A = /$ INCHES = 301 GAL. MODEL NUMBER: SWITCH TYPE: -S- B = 2 INCHES = 33.-5 GAL. PUMP MANUFAC'T'URER: Cj p,.`�t C = a INCHES = 9 1 5 GAL. MODEL NUMBER: _ yam _ SWITCH TYPE: Flew D = Z INCHES = /,eI GAL. REQUIRED DISCHARGE RATE GPM PUMP f: ALARM WIRING AS PER ILHR 16.23 VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /0 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . * _ /4" FEET FORCEMAIN X .9 FT /100 FT. ' FACTOR FEET .fb TOTAL DYNAMIC HEAD ET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 4lIDTI� ; DI TER LIQUID DFPTH ? ,, POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 (2-- of 7 FEE MtFORMATION SYSTEM 8P CATIONS Owner r, d Septic Tank Capacity / O NA Permit # Septic Tank Manufacturer D NA DE81t311f PARAMETERS Effluent Filter Manufacturer �3� O NA Number of Bedroorns ❑ NA Effluent Filter Model `T (per 0 NA Number of Public Facility Units ❑ NA Ptanp Tank Capacity O a l O NA Estimated flow leverage) t ©ice aUd Pump Tank Manufacturer f O NA Design flow speak). (Estimated x 1.5) t 1 4 - g allday Pump Manufacturer D NA Soil Application Rate al/da /W Pump Mode D NA Standard Influent/Effluent Quality Monthly average • Pretreatment Unit O NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (SOD,) 5220 mg/L O NA D Mechanical Aeration O Wedand Total Suspended Solids (TSS) 5150 mg/L O Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Ceil(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg/L ❑ In- Ground (gravityl ❑ In- Ground (pnHwurized) Total Suspended Solids (TSSi 530 mg /L rNA O At -Grade "mind Fecal Co(iform (geometric mean) 510• cfu /100m1 O Drip -Line ❑ Other: Maximum Effluent Particle Size Ye in dia. O NA Other. D NA Other. O NA Other: O NA "Values typical for domestic wastewater aril septic tank effkwd. ate: ❑ NA MAINTENANCE SCHEDULE Service Event Send Frequency Inspect condition of tanks) At least once every: monthls) (Maximum 3 yam) ❑ NA D si Pump out contents of tanks) When combined Aid[ge and scum equals one-third 1Y of tank volume ❑ NA Inspect dispersal cells) At least once every: DO Y month (Mmxknwrn 3 years) ❑ NA Clean effluent fitter At M D yearls)s) ast once every: • marl) E3 NA • months) D NA Inspect pump. pump controls &alarm At Mast once every: O earls) Rush laterals and pressure test At least once every: ❑ mont O yearlsl rts) l O NA Other: At Mast once every: 0 monthls) D NA Other: O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following Nc0lum 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 o pondang of sffkwnt on the ground surface. The dispersal ceills) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pending 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 lY 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. Ali other serves, including but not lunited to the servicing of effluent filters. mechanical or pressurized components. pretreatment units, and any servicing at intervals of ::0 2 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 (4/01) ,Jun 19 02 08:04a CALVIN POWERS p.4 I r UP AND OPERATION For new cortatnrction, prior to use of the POWTS check treatment tanklsl for the presence of Page � of L pai of the tank(s) removed by a septage servicing o �e the disperse! cell(s)_ )f high concentrations a d•�ected hr other chemical that may impede the treatment process and /or dam 9 Perator prior to use. eve the content System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwatur levels. When power is restored the excess was discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o effluent. To avoid this situation have the contents of the Pump , yank removed b a tewater will b, Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually ly operatiing he pump to pump controls ntrolsit( restore normal levels within the pump tank. 9 c Do not drive or a i p rk vehicles over tanks and di within 16 feet down slope e o mn dispersal cells. Do not drive or park over, or otherwise Y nd or at -grade soil absorptio l area. disturb or compact, the aret 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 Septaga Servicing Operator. • After pumping, all tanks and Pits she(( be excavated and removed or their covers removed and the void space filled with soil, gravel n another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measure replacement system: ;: have been, or must be taken, to provide a code compliant ❑ 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 lines 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 ue to setback and /or soil limitations. Sarin edv technolog a holding tank may be installed as a last resort to replace the failed POWTS. g ances in 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. 'A 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 GASSES AND10R INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY STANCES. DEATH MAY RESULT. RESCUE OF A CIRCUMSTANCES- PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT R i Y CIR UM ADDITIONAL COMMENTS POWTS INSTALLER ` POVfTS MAINTAINER Name \ U 113 7 C� Qf Name Phone S ( �hone SEPTAGE SERVICING OPERATOR (II WpERi l LOCAL REGULATORY AUTHORITY Name E Name C Phone FF' hone ( S (o (9 (J This document was drafted in compliance with chap ter P Comm mm 83.22 2 ( I(b!(11Id1 and 83.54(1), 12 a, I (3), Wisconsin Administrative Code. WisconsiC. Department of Industry SOIL AND SITE E V A L U N FEE Page 1 of 3 Labor and Human Relations e Diw,ision of Safety & Buildings in accord with ILHR 83. Ad C t c LINTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in si n must include, f St. Croix not limited to vertical and horizontal reference point (BM), direction and o slope,al9of�� P EL I.D. # dimensioned, north arrow, and location and distance to nearest road. )�} ` t C �p►X cn ' n - PLEASE PRINT ALL INFORMATI S Go APPLICANT INFORMATION v ,CE I ED BY DATE !, LNG 0? Z PROPERTY OWNER: LOCATI ` Derrick Const. , Inc. G �i �1 1/4,S 12 T 30 N,R 18 X(or) W PROPERTY OWNERS MAILING ADDRESS LOT # FZL0CWj SUBD. NAME OR CSM # 1505 Hy #65 16 1 na I Brushy Mound Lake CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE :DOWN NEAREST ROAD New Richmond, WI. 54017 (715 246 -2320 1 Richmond 140th St. [ :4 New Construction Use [x ] Residential / Number of bedrooms 4 [ ] Addition to existing building I ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Recommended infiltration surface elevation(s) 100110 ft (as referred to site plan benchmark) Additional design / site considerations system el. based on contour line of el. 99.10' Parent material glacial dirft Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem ❑ S ® U aS ❑ U I EIS ®U EIS ®U ❑ S ® U ❑ S ® U SOIL DESCRIPTION REPORT 0,j S [ 2000 ; . # Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft �- 1Y \j Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Y Bed Trench 1 0 -9 10yr 2/2 none sil 2msbk mfr cs if .5 .6 �- 2 9 -17 7.5yr 4/4 none sicl 2msbk mfr gw if .5 Ground 3 17-28 5 r 4/4 none scl 2msbk mfr gw if .4 .5 elev. 10 ft. 4 28 -5 5 r 4/4 c2p7.5yr 5/8 scl m na na na np .2 _ Depth to limiting factor 28" Remarks: Boring # 1 0 -6 lO r 2 2 n ' 2 `' 2 6 -15 7.5 r 4/4 none sil 2msbk mfr if .5 ':.6 ,S U Ground 3 15 -29 5 r 4/4 none scl 2msbk mfr aw if .4 1.5 •`� elev. 4 29 -45 5 r 4 4 c2 7.5 r 5/8 scl m na na na n .2 " 1 Depth to limiting factor 29" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. 4M, New Richmond 54017 Signature: Date: 6 -13 -2000 CST Number: m02298 1 PROPERTYOWNER Derrick nnGt. Tnr. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # peending_ 1 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench .3......` 1 0 -10 10 r 2/2 none sil 2msbk mfr cs if .5 .6 S 2 10 -19 7.5 r 4/4 none sil 2msbk mfr gw if .5 .6 S Ground 3 19 -32 5 r 4/4 none scl 2msbk mfr 9w if .4 .5 `{ elev. 9 7.8 ft. r 4/4 c2 7.5 r 5 8 scl m na na na n A 2 — Depth to limiting factor 32" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # i Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NE4Sw4 512-- T30N - R 18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #16- 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 1" pvc p ipe C el. 100.00' Alt. BM..= top of 1" pvc pipe C el. 95.40 A k (1� ►,d, ^bG � 0 � QQ� Gary L. Steel 6 -13 -2000 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER FORM Owner/Buyer Mailing Address Property Address � `{ Lua �� Win D' c j (Verification required from Planning Department for new construction) City/State /�� � `'�" V& Parcel Identification Number _ LAko ' °!'/ Z(o _ /(d —o Q LEGAL DESCRIPTION Property Location %,, ' /,, Sec. / , T �1� N -R W, Town of Subdivision Lot # l rO Certified Survey Map # , Volume , Page # Warranty Deed # & Q - , Volume �� 3 / . Page # l� Spec house9yes ❑ no Lot lines identifiable,<yes ❑ 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, joumeyman plumber, restricted plumber 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 tyat your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the t / hree ear a e. - S NATURE OF APPLIC 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 prop Krty described above, b of a warranty deed recorded in Register of Deeds Office. S16I&TURE dF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1131 169 X60425 STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH DRED REGISTER OF DEEDS I ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD t artnershi , Grantee. nsin limited liability P / W co P Panne rs LLP a is Y 0 and � _ M � 9.30 A M 99 Grantor, for a valuable consideration, conveys and warrants to Grantee 06-03 1 9 the following described real estate in St. Croix County, State of Wisconsin (The WARRANTY DEED "Pro erty„): EXEMPT M p CERT COPY FEE: COPY FEE: See attached Exhibit A TRANSFER FEE: 1047.60 RECORDING FEE: 12.00 Recofdini Area Name and Rerun Address Hendrick W, Van Dyk (� VAN DYS, 0 & SILER, S.C. l Post Office Box 127 New Richmond, WI 54017 0 2% Pmr of 026 -I037-30- 00:026- 1037- 9S-D an d 026 Parcel Identification Number (PIN) This is not homestead property. Y . Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May , 1999. *David L. Naser * AUTHENTICATION ACKNOWLEDGMENT 0 Si David L. Naser STATE OF WISC N SIN• ) ss. (',(�es IOU alB g10S ' polpolmo upR 10 polvolluoglne oq feut 2*3MIUSIS) L (-- . LZZ xog 00 Isod :olzp uopzndxo olms 'lou ;l) �'S `2iarIIS v aaxoa,o `3Ua NVA 'luoueuuod sl u01sglu:ta00 AN �IAQ TMA 'M T4UQH UISaoost,N ;o alms 'o?Tgnd KsmoN XS Q914vau SYM i N3wI ULM SIHI ('sling s,M , 90 , 90L § Aq p 'IOU JD KISHOoSIM do - avg alv LS - dagwaw :a I.LI.L 'arms aq1 a$polmouxoz pul luamnaisul )1 Q u$A 'M 4TapuaH 2MoSazo; aql palnoaxa o qm (s)uosaad aql aq of Umoml aui of ((� paureu anoge aql �0 Czp sTgl om oiojoq omso AlTmosiod 666 T a } � SZS?ti1 P 1B0Yluaglne I D LAKE ;- 4 of the NW 1/4, / 1/4, the NE 1/4 I rC is SW 1/4 of the ® ly N° sE'w '�., H / NE x County, Wisconsin. Z' �a � I • ��' L O T d r I = AREA m SIMMER 94515* Sm FT. I�\ 3 Tk� M�FA r[NOE11 uLM �I 26x.46 .e " I 9]716 sa FT. 564' \ 1 'K 214 ACRES \ �-- --.�`� � � �•. N89�J9'31'W 512.74 • / EAST-VEST .L Fasr -ar i/4 Lord - ' 4 . ,[ ` Sa934 02ftOr - -- AREA T O 24C s J /\ \ -- - t EA 60,700 54 FT. •: _ — — fAsr wesi i/� cis — / r - 0014 - - ~ REA m YEANCES UIM ; J 667 90. FT. ATOH T L/NE 77, t / �\` \\ _ 1.79 ACES N657102'E 77244' l LOTif` LOr>a I H.W.E. 91M \? MAL AMA TOTAL AREA: � � / • �� I� 9 2 H1 S0. FT. 94.766 90. FT. \ \ - - -� 2.17 C •• L ..� 217 ACRES l ACRES AM To �._ F.F.E 00. 100 n .,•' , i b � �f e i 65,791* 90. Fr. ry I.M ACRES AM m ERFx15E11 L9e: �7j'3 41l t N.WL / / / 1 ; 1 70,406 SM Fr. 1.e1 ACR LO T ' sr 7M.8 o4ar �' a AREAS IMO t Z02 A Fr. E ....1 zm AcrES i 1 LOT /7 L / N�ea I ` $ I AM ,o 9 y MAL AREN } Cr 669743 50. FT. 3 A 9a FT. / ®/ 1• 4 I � � AwA o 01 M WE: 1 1.92 1.91 ACIE9 / 77.106 sa rT. + , 1.66 ACRES I I/ I +1 t LOrde ! 1571 I 1 7 35 00• I I 9415 1 QI® 221 ACRES LOT a L o r l e 9 • "" . 1 ; AAA m 9HaE 79TAL Al" Sl 1 649691 RE F7 i 64907 Sa Fr. `!!{ i A N U ACRES gal ACRES I ® , 00.040 �M�1 1 1.61 ACRES LOT 47 /I e' >a AA a +7' �l TOTAL AW* / ?a*e 94772 SM FT. 113 ACRES 'WOO \ .w. LOT 10 AREA 10 84M I L o T 1d \` ��` �\ — "� 1 .y� 1 AMA �NO AER 1 AREA to •101E! ti `� 64611 90. FT,, 131.664k SM Fr. - 1,� \� �1 / /� / \ '� 1.56 ACRES 1 02* ACRES ,• �' � •fir ' F.FE /0020 ANLA 10 MEM4M LM 119.175 s0. FT. COMLL.''ti 299 ACRES — _ - -6'69B SL5w "� * �4 �'Q$, ` LOT f1 f I ARG m omm �! 2. 166 se Fr. 2.Qft ACRES pp •••..•..• . • • ... • • • ARG IIEAICE71 L9e3 � 94717 S0. FT. Am m SNORER a F.F.E. 10010 '� ••'� / 143,417* SM FT. LOT 1 f ` AREA m lRORG WA ACRES q 'K 14 m M FT. uNLt �. of / 95,230!: S0. FT. 9C A ACRES 7.11 OiEB • / ' ��A� � � �� �AN�11 L9 d' A 4 /` '168.71'. 74x84' • 51 i� 51 15' y, � � u1RAT1E0 LIJos_ �� � �,�. uH0 •4 KF I r` 8 c 3 .. i i 1"JIS 440V L v bA p¢ U G p V A y N V N v O O 'C3 Q. ¢ V O cu m v t 7 03 7 5 v U O 'r1 O U x cG V O ++ as V 4J "O w N '�, w V N G O 41 '."' •V. v 4J aa + m 9