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HomeMy WebLinkAbout026-1126-19-000 o m o.■ 7 c k g § < $ ƒ 2 ƒ_ m ^ \ 2 4 � § / � / ƒ f } 0 + 2 ( § \ $ = n / / = \ ; - . / }I ƒ0 42 \ »G / / k ! 2 ƒ @ w §_ 2 \ / CL \ CA 2 E Eƒ K §& o k ( a ° ` mvy \� = E ; c ( �I . / \ \ - 2 &� a f / Q ] / 2 § a n r CA ee� � M \ 0 0 0 , CD ƒ < G / o o (D $ \� �kfl $ � § - . ■ 2 � . \ E 0 CD © m :3 / z § > % \ PL k { 2 a $ / f o § T } k w . % ( v 3 2 \ \ n k§ 2zm ` } i k ) \ ' Q § q / CD CD \ § c k \ $ . . # % / > ®E `E ® � r . �mE- egqg . \�0z ,g CD 2D I � ~ \� 7 . CO [[ I . . � CD CL \ CL o \ CD) { E _ o / 7 § § \ \ƒ �\ Wiscon*§' i Qepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetyt Building Division INSPECTION REPORT sanitary Permit No: 395237 '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 Partners I Richmond Township 026- 1126 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: 9 0 Vb M *%' TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. is Benchmark V. /ad Dosing Alt. BM /: !ID3•i Aeration Bldg. Sewer yob IDO•�f Holding St/H let r TANK SETBACK INFORMATION St/Ht Outlet b'�T Q •8 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet epti 18� Z � Dt Bottom I N14- Dosing Header /Man. `•� { e� 3 0 Aer Dist. Pipe 0� 0� Holding Bot. System 7.0Z Mo �— p PUMP /SIPHON INFORMATION Final Grade h' Manufacturer Demand St Cover GPM 3. 3f. 106 Model Number e •� `� r �•� TDH Lift Friction L System H TDH Ft VAtY e� a�/w{'i�'1 Gt �� 3$ + � -J Forcemain Length Dia. Dist. to Well < �oN aaserro Cr a�1 o Z SOIL ABSORPTION SYSTEM C M &P .00 K K DITL� BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 4 zV SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR / ,ALAN i...'7✓&+ Type Of System: UNIT Model Number: arM '* t 'y - /cam DISTRIBUTION SYSTEM Header /Manifold Distribution — role Size I x Hole Spacing Vent to Air Intake r5'/ Lf w Pipe(s) �•I•t 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 Bedrrrench Center Bed/Trench Edges Topsoil � Yes * No �] Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:/�/ tv/ s Inspection #2: Location: 1627 Water's Edge Drive New Richmond, WI 54017 (SE 1/4 NW 1/412 T30N RI 9W) Wate 9 Parcel No: 12.30.18.780 -7,, 0 Jjp kv ✓ 4t Kda vr1 /0'Jiv 1.) Alt BM Description = -44 9 C)10"if 2.) Bldg sewer length = 30 �w'� ow� f Ve rt ) �� a `�� - = W► " /ik4 wve r An qk t°4 7 7 . 0 9 amount r l cover b - 1'0 i w a-f'5 5 ilia dacif u �/ S/s.� .c K's ✓ci �cy(c� f;Zrt pshc( is ��c Plan revision Required? ❑ Yes W No Use other side for additional information. Date Insepctor igna ure 0 • SBD -6710 (R.3/97) f - at � � � � elk-) s,► Pa m* Applicatk safty a Dwaim I.WiLA&oc 1 201 W. 'r Sam reveroe silo Ax � " Liw. i �� �� i �t b Iiaat . . as not & �c iaohee fhge b L Avubtafta e < r+opati► O�nra axaaRaties - Pose Mat all Iaiarmsties S ' �,► r8' o IL Q C IMF L $ T R W •2w 1� i � � �� Phony 1�o�ba won brae ar CBi�t t �s a c� a. a m of t3aitdtps; ` fchsdt aaej I at a Ckv 2 Fatally W of Be*"= © wracd RTO" 9N c O tit Rad -� nL A °i � aye t►o®c os fiae A. Cbe* bas on HOC B it Wa A) 1. *w 2 3. 4. S. sj Ta* 3 D d on ft —%Tkm IS Iv ry a aimutt sy�: (Cho* an t apply a3 7 a7 a .. M MOwd Taot< o s � � D ca oa D Duane" tJalc D F DD Odler Y, eat Area IatWmdoa- 4- SWIAji Fift 1 Find 0" (COO 0 de V WT ORk C*ftb t /ai i� s,I�e sw Fria nag& :uaa T� toow cxs. ueec suneacd '0 Za / D. D D O D VIM qty sbtemeat M7WT3 as tha atbdied AM 14FOM NA !i"�3°4 Addte�s ea, S�Mt mp OAWOWd ZFV tb� lien (bdn o a DNI so, of Approval jaeGUM for D r l A�:�p �s o� re., -- .� cru S•ti,� - �`'f A 9 . &o s - ap-L- u �o - Rcz V -�,. AlZ 'f y Sw 1 /4S 1aT3oN�Ri�W n ll 5yoJ7 N.e,� ��Chvrond. i Pa����� oab- Ilab- �9 -o oU Lo qw s i n 3 97 A ` 3q C\oLw.b .Q e--5 4 M T ©�� Y oat 8m k T� P t� �; @�¢.97•�, t - Af \ �kX 4 �w 1 aT-Ba N,P, I w yes ���� � ����P �d�-#- t 9 AR: 3\rnof 4 J LO-1 5y 0 17 n 1't i f Yl vno ✓� �� ST C to ' c ' x 1 a5� SAY ;c�zc��o� ) CPO 6 m�TO�� � lafl•` aa 6 nu R Tm �" ��,p�,C��. Q7•�S s 'E a r ; CL X • N i W! N O T A C '0 3 o J r O l v, V) C/) s i s 3 ! t � :4 cc W + + V t i * u t CL S P . C) T ♦ i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page- _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper no t less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 026 - 1126 - -000 Please print all information. r i r e�ffb Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Derrick Const Inc. Govt. Lot NE 1/4 SW 1/4 S 12 T 30 N R 18 K(or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 19 1 na Waters Edge City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Richmond I WI 1 54017 (715 )246 -2320 1 Richmond I 140th A [R New Construction Use: M Residential / Number of bedrooms 4 Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: / Parent material qlacial drift Flood Plain elevation if applicable General comments and recommendations: 1 3^ trenches @ el. 97.08' - c� F 1-1 Boring ^ Boring # 100 72 in. ' Pit Ground surface elev. _ ft. Depth to limiting factor _ �' ^� oil A to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary dt4 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#2 1 0 -10 10yr3/3 none L 2msbk mfr cs 2f .5 .8 2 10 -22 7.5yr4/4 none scl 2msbk mfr gw 1f .4 .6 3 22 -72 7.5yr4/4 none Wins 2csbk mvf na .5 9 4 72 -90 7.5yr4/4 c2d 75. 5 6 ms .7 1.2 9 •�8 2 F Boring # �Rt Boring 100.00 71 L Pit Ground surface elev. ft. Depth to limiting factor �_ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fY in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-10 1 Qyr212 none L 2msbk mfr cs 2f .5 .8 2 10 -22 10 5 4 none si I M na gw 1f .0 2 3 22 -71 7.5ry4/4 none sl /ms 2msbk mvfr 4 71 -90 7.5yr4/4 c2d 75. 5 6 sl .5 .9 (.o Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluepr42 = BOD < W mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel ' 4 1 02298 Address Date-EValuatidirr Concluded Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 9 -27 -2001 715 - 246 -6200 ' I Property Owner Derrick Const. , I nc . Parcel ID # 026- 1126 -19 -000 Page 2 of 3 Boring # ❑ Boring 3 �] pit Ground surface elev. 99. 75 ft. Depth to limiting factor 88 in. T — Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0 -12 10 3 3 none L 2msbk mfr cs 2f .5 .8 2 12 -22 10 4/4 none 2msbk mfr qW if .4 .6 3 22 -88 7.5yr4/4 none sl /ls 2msbk 1 mvfr na na .5 9 9 32.oY .04 i F Boring # ❑ Boring pit Ground surface elev. 99 ft. Depth to limiting factor 7 5 _ in. Soil Application Rate Horizon,4 , Depth , Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 1 0 -11 10 3/3 none L 2msbk mfr cs 2f 2 11 -23 7.5 4/4 none sil 1csbk mfi 3 23 -75 7.5yr4/6 none ms Osg mvfr qw na .7 1.2 4 75 -90 7.5 4/4 wet al /ms 2msbk mvfr na na D Boring # E] Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD, > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.600) STEEL'S SOIL SERVICE Gary L. Steel Derrick Const., Inc. 1554 200th Ave. CSTM2298 NE S <4 S12 T30N - R18W New Richmond, WI 54017 MPRSW - 3254 town of Richmond (715) 246 - 6200 lot #19 Waters Edge el " =40' iBM.= top of 1" pvc pipe @ el. 100.00' , 'alt. BM.= top of 1" pvc pipe @ el. 97.25' n. �lI 2 i� pt 9 ,2 � YS fc- ��t VO >v-o Gary L. Steel 9 -27 -2001 Y Wisconsin•Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 'Safety and Building Division INSPECTION REPORT Sanitary Permit No: • 395237 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 Partners I Richmond Township 026- 1126 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA 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 P/L 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 BED/TRENCH 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 CHAMBER OR Type Of System: UNIT 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 Bedlfrench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1627 Water's Edge Drive New Richmond, WI 54017 (SE 1/4 NW 1/412 T30N R19W) Wate Parcel No: 12.30.18.780 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No ❑❑❑❑❑ Use other side for additional information. ❑� �❑❑ Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) �Z Y , a //o 00 SaaiW7 Pav* Appkatioa ra accord wM Cw= 63.21, Wis. nab. CO& X 201 v Soe RvCM dit lbr i fi com p idi ng ft swi�oa PQ Boot 730 �partes. rat P'craoaal � � be teed for ae p fin. Wi 5370? -73;02 . s 13. Od{t)(m) (Suit tDna to coneny if M tke state Darted. dre an not rt+an L x 3 Stars atvhioa b S S�sPw>_ i n ttartfote W HER - Pf"n Print all Information A'aP�' O+eaes t#boa � Location: �C e r ala,3c� �I� w Lot Norldw e,.stft ^ fv : ,, DP Cede now t o a CM t+te*r Typ of Bniitit ; °teiteck one) O - 1lS to v ' I or 2 Fardtp DwqUk . W �g � /" D D � bHCd lQM ,— T --- �' Cr P 1 c��j S(� C)W� c FCC3 0 or T ` owsor , 'v1* n ( l/ 'v S G/lrc�P r l ROeA UL T f ermft; t k 3 C r A) 1. orrt box oat lice A. t�Wck boar on I B if a Iicable 12 . Rapleoma�nt 3. T 13 Rapiaormsnat S, Ad on b B) N T"o of POWT Syxkm : all that ) D \ O d 11 Sand Fr7tcr D C ntn�d Watiaad ❑ r ❑ A ? iJtsit OD Skq* Pass 0 c V. D t Area Ixtormatlon: O i. .1 URN lnto7 9 sS (4 NP ,$ V W tank sa atbn a in i°f P sire SW » nook NOW � con- Con- dw r pip VM 'mss rya D ❑ D O O Regmu tiity Statement I the obr ofOte POWTSaboaraaatireattaetwYi PUM -ob �, o rs 3 MM LA. COnn#P�Dapartaseu TJae Unly Approved p SaaAtiay Pmudt Pee (tadudm Qroiedaiarrr Date taar:d ❑ NU Adverse �) _ IQ4 66493M 1 der ✓�c"'C( f,pr �m�av� �l'taf��r�rtts vCCoh�a�evq�h`ntiS. lea Fv` ` p - ve c} tCi G��Q G4L t se g r� c -5 5 -S -e DT 3o N RIK w �o Pox Ifs � � _ I �� i �� 19 r SCA '= y oV lh last 1 S ` � aaos 4 �. 0� r s , Brt� Tc)p BS a� a s, v O& o i i I C2 y� . tU i• �E�o� ° •— iC '{7 C i x cn d �fl,n t x-0 O) Crj X • c7 � i1t 3 W c O c1 Y N C 4>. O 0 r3 .� n�a� W a = i �. of r_ x z Ur � .D J O 0 d b e r � , C V1 •��. 1 J• { fl r ®Z cc wee LLrt��� • Y J r Wisconsin Department of Industry SOIL AND SITE E V A L U A CSR Page 1 of 3 Labor and Human Relations \ - y ' j Dition-of Safety &•Buildings' In accord with ILHR 83.0 drt�,CO�e NTY RR�� ��, Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in size P1 mus{ t ude, b qLRIEL I. D. # not limited to vertical and horizontal reference point (BM), direction and ° iii lope, scale pry dimensioned, north arrow, and location and distance to nearest road. ,V\k. 11 G AD\X ` ndin APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATI 5�� 7�V DBY E PROPERTY OWNER: EMATION Derrick Const. , Inc. WGO 1/4,S 12 T 30 AR 18 f (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # SUBD. NAME OR CSM # 1505 Hy #65 CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE [TOWN NEAREST ROAD New Richmond, WI. 54017 (715) 246-232 Richmond � 140-F-'h q-F- New Construction Use [ 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 .5 bed, gpd /ft .6 trench, gpd /ft Absorption area required 1200 bed, ft 100 trench, ft Maximum design loading rate _ y 5_ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 95.85 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material glacial drift 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 Cis ❑ U [2S ❑ U I :E1 S ❑ U ® S ❑ U ❑ S Fx ❑ S 6cl U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft oid Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench cob 1 _ 2msbk mfr cs if . S 2 .9 - 24 10 r 4/4 none sicl 2msbk mf Ground 3 24 -84 7.5 r 4/4 none S1/1S ' elev. 9 Depth to limiting factor + Remarks: Boring # 7 1 -0-9 10r 33 .2.. 2 Ground elev. 9 9.45 ft. Depth to limiting factor 3 � � 2 Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 . Ave. New Ric and WI 54017 Signature: Date: 6_15 -2000 CST Number: m02298 i PROPERTYOWNER Derrick Const. Inc. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # pendi na - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnrich klo av`...3 1 - 0 -10 10 r 3/3 none 1 2msbk mfr cs if .5 .6 , 2 . 10 -28 10yr 4/4 none sicl 2msbk mfr 9w if .5 .6 Ground 3 28 -84 7.5 r 4/4 no sl /ls 2ms bk mvfr na na .5 .6 elev. 9 9.8 ft. Depth to limiting factor _ +84" .f s Remarks: @ 60" a 4 11 x20" mot. sl lens non - contiguous in boring Boring # 1 -10 10 r 3 3 none 1 2msbk mfr cs if .5 .6 <...4_. 2 10 -28 10 r 4 4 none sicl 2msbk mfr gw if .5 .6 Ground 3 28 -84 7.5 r 4/4 none sl /ls 2msbk mvfr na na .5 .6 elev. 9 9.3 ft. Depth to limiting qs p factor 11 Remarks: Boring # S -10-10 t .. > . : ._.... none 1 2msbk mfr cs if .5 .6 r 2 10 r 4 4 none sicl 2msbk mfr gw if .5 .6 ::: .. - Ground 3 17 -90 7.5 r 4/4 none is osg mfr na na .7 .8 elev. 99 ..$_ 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 NE4Sw4 S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #19- 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 pipe C el. 100.00 Alt. BM.= top of 1 pvc pipe C el. 99.55' l b>� t Zip a5 , p r�•� �` b �C) Gary L. Steel 6 -15- 2000 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM Owner/Buyer &4S4 /uo N O I M <<- +��"Z- !� 57E/�'?Lfi Mailing Address �� A K ��s, �Z-J K` qua til�J, (A& S Vo l7 Property Address 2 Gc1 S 4e,:D t4, vim.. (Verification required from Planning Department for new construction) City /State # e" O Parcel Identification Number LEGAL DESCRIPTION Property Location Sc ' /,, �`� ' /4, Sec. , T 3 � N -R �g W, Town of Subdivision "Sy f Lot # Certified Survey Map # Volume , Page # Q Warranty Deed # 6 O (1Z S — 7 Volume k / 3 / Page # ! 7 Spec house >(yes ❑ no Lot lines identifiable ,Byes ❑ 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 masterplumber, joureymanplomber, 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 in the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce a atural Resources, State of Wisconsin. Certification . stating tjfit your septic system has been maintained in omp ted andtom to the St. Croix County Zoning Office within 30 days the three y e r . NATURE OF APPLICAIft lr — DATE OWNER CERTIFICATION i Z ' (we) certify that all stateme is on this form re to the be our) knowledge. I (we) am (are) the owner(s) of -� the p e -descri d b e of a warranty dee ob�df r of Deeds Office. 9 ?/© S NATURE OF APPLICA 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 a. 4xn cv cunz Wool Private Onsite Wast"Ot Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuit to Comm 83,54 Wis. Adm. Code each Pnivate Onsite W astewa ter Treatment System (POWPS shall include information and procedures for naintainirag the system within the Pammews of COMM 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system we on fib at the county zoning or health department. This management plan complies with Comm 83.54, YNis. Adm. Code, and the In- t3round Soil Absorption Component Manual for Private Oralte Wastewater Treatment Systems 10567 -P (R.61"). SBD- Table 1: ben Permit rMMY ter Number of Bedrooms Peak ( ) o p Estittated ryaw - 8nm f "0 Tank Capacity (901) 1 Soo T of Minstar Domeac TOW 2: Soil C . l.irnita of Reliable lioet SOOVC TaMt gab 4 um �` " M Parade Size 118 22n Maxkmnn 733 ( 150 Table Manenw" Stele Tanis andAw service once 3 years Qtmet FMer t once a r and dart at least once 3 yms Soil ortce ever ry 3 yews §8c Tank The sePUC tank shat be maic"nsd by an individual certified to service septic tanks under s. 281.48. Stats. The contents of the sepflC tank sharp be disposed of in accordance with N 113, Wis. Adm. Code (Servicing Septic or Folding Tanks, Pumping Chambers, Grease Interc ol�• Beds. Seepage �. Seepage Trenches. Pdvies. or Portable The operating condition of the septic tic and outlet fitter shall be assessed at least once every 3 years by ice. The ocdt filter shall be cleaned as necessary to ensure Doper caperatlon. The filter cartridge should not be removed unless proviskxus are made to retain soikle in the tank that may slough ,off the filter when Mmoved from its enclosure. If the ManagwnOM Plan for a SOPOC Taf* and So* Abswptmn Component PWOrip of doW40016d tv " dvubs di OM O " r or W*Iin IM feet of the should be &vo kl@d SWM "XA Wmision kft ft COF"POrWO fnsy ()bWW VM1%**#MW W%MWMMft jT. vrWiA plumber - Calvin Power. - .'4n -1 R e p 1 a c erlf� YI L 6 i t ,' w r ) t thci t 3 0 i I t e S t t? d area by heplace.ment site .-.iust be le-ft undistarbed, r management/ contingency plan must be modified C) and piled with the zoningx offic outlining the steps to be taken in event of sept,ir ; failure. 3 �.2 1 , 1 31 PAG r 169 i6.o4:Zs 7 STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners, LLP, a Wisconsin limited liability partnership, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee 06 -03 -1999 9:30 AM the following described real estate in St. Croix County, State of Wisconsin (The WARRANTY DEED "Property "): EXEMPT # CERT COPY FEE: See attached Exhibit "A" COPY FEE: TRANSFER FEE: 1047.60 RECORDING FEE: 12.00 PAGES: 2 Recording 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 -30 -000. 026 - 1037 -95 -000 and 026 - 1038 -10 -000 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May 1999. *David L. Naser * * AUTHENTICATION ACKNOWLEDGMENT Signatures) David L. Naser STATE OF WISCONSIN. ) ss. Wetland t _ 4 t � k 4 € H� rt L - t r �� rt Of th'e NW 1/4 of the NW 1/4, f the NW 1/4, the NE l /4 of and part of the SW 1/4 of the l ' ichmond, St. Croix County, Wisconsin. c CORNER V )2- .30 -18 i ' \ -- S84'45' 262.46 - UM /NUM ®• ------- - - - - -- -- I ONUMENT ^ � AL ' a `L p`� , 4 84-45'56"W 262.46 10' - 80.96 — — 04'56 "W .. 1308.82'--- L INE — \ AAA T C y L I NE t t \ ................... ....................l...jr Z� o \ ; LOT 19 , LOT 18 / <' N H.W.E. 996.0 TOTAL AREA. TOTAL AREA: j ��" 92,691 SQ. FT. 3 94.358 SO. FT. f 0 Lul 2.13 ACRES F ' N 2.17 ACRES t�gs''Q9� \ �''� F.F.E_ 1000.0 J a ti cF \ � �� z i 2 ' \ t D' H w L fI f � S� 03 5 F 790 o 0 481 L N L O T 17 1f / TOTAL AREA: ; ° j� / 83,452 SQ. FT. 1.92 ACRES N LOT 16 -4 01 M z o TOTAL AREA: A j J _J i M 88.607 SQ. FT. i 1 o f i 2.03 ACRES 41 . i J� rn N z� 41513 _' 5'526.32