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HomeMy WebLinkAbout026-1126-36-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479391 bl� f 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: Brinkman, Andrew I Richmond, Town of 026- 1126 -36 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: V r 1 ` C,5 ; 12.30.18.797 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark L I ' estA/ 62-50 11 / 473 16y.75 /on Alt. BM Aeration Bldg. Sewer 1a r I Y 6 3 Holding St/Ht Inlet 77 J�, S 9y•z3 93 � TANK SETBACK INFORMATION St/Ht outlet 4 ,710 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / 3� Dt Bottom 42- U ice. 1 Dosing Header /Man. Q3 L� Aeration Dist. Pipe ') ys Q3 . zS Holding Bot. System JZ 1Z 9 2- •3 1 alp 5 3 PUMP /SIPHON INFORMATION Final Grade Manufacturer GPM and St Cover r\ 3 , < 100 Model Number S , TDH Lift Friction Loss System He TDH Ft Forcemain ngth Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� – 1 !� �_ —_ _ 1�� SETBACK SYSTEM TO P/L BLDG 1 WELL LAKE /STREAM CHAMBER OR Manufacturer. INFORMATION Type Of System: 2 -4 i f UNIT 4 • C Model Number. Ca� �e�a T' J w.� DISTRIBUTION SYSTEM I�r` I,,,�� -c�. �-- 9 er" �� - o-Q. Header /Manifold �� Distribution x Hole 'Size x Hole Spacing Veto Air take„ Pipe(s) I Length Dia Length Dia \ Spacing \ \ C3 5 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 11 xx Mulched Bed/Trench Center q • 62 - Bedrrrench Edges\ Topsoil Yes L] No es r] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1406 166th Avenue New Richmond, WI 54017 (SW 1/4 NW 1/4 12 T30N R1 8W) Water's Edge Lot 36 Parcel No: 12.30.18.797 1.) Alt BM Description = � l �(, a�- 2.) Bldg sewer length - amount of cover = i 7 Plan revision Required? A Yes No —r Use other side for additional information. " I 1 Date Insepctor's Si ature Cert. No. SBD -6710 (R.3/97) L t ` Safety and Buildings Division County Or Ol W. Washington Ave., P.O. Box 7162 .4�nANiVin Madison, W1 53707 - 7162 Sanitary Permit Nu mber filled in by Co.) (to De artment Of Commerce (608) 266 - 3151 '/7� n 0 Sanitary Perini P State Plan I.D. Number !n accord with Comm 83.21, Wis. Adm. Code, per ni imatio �R Q May be used for secondary purposes Privacy taw, 15.04(1 xm) Project Address (if different than mailing address) I. Application Inforuration - Please print Ail Information t Pro perty Owner's Name 5 i CROIX COUNTY Parcel # t# 3(V Block #p Property Owner's Mailing Address ZONING OFFICE + Property Location Cr la /_i Code 'y v ' Section P Phone Number Ct S 0o trc! iI. Type of Building (check all that apply) T N: RE ors or 2 Family Dwelling - Number of Bedrooms of , It ell ' Subdivision Name CSM Numbe Public/Commercial - Describe Use Al ❑ State � � ' . be Use ❑City_❑villageVfo ship of t j al n tA III. Type of Permit: (Check only one box on line A. Co to line B if applicable) A. New S stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System 8 ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to N List Previous Permit Number and Date issued Before Expiration Plumber Ow ew J ner �7 i :? Q/ IV. T of POWfS S stem; Check all that appl Non - Pressurized In Ground 1 1 Mound _> 24 in. of suitable soil E] Mound < 24 in. of suitable soil ❑ At -Grade 11 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ 'w-� Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line Gravel -less Pipe - V- Dis malfl Area fafermation: El Other (explain) r Design Flow (gpd) Design Soil Application RaWgpdst) Disperse: Area Required (sn Dispersal Area Proposed (sf) Sys Elev 1 i ✓ g $ ✓ `D VI. Tank Info Capacity in Total Number - Gallons Manufacturer Prefab Site ee lactic New Existing Gallons of Units Concrete Cons ed Glass Tanks Tanks gxic Iding Tank Aerobic Treatment Unit (} `•^•' ` `G2S `E' e=5 Dosing Chamber VII. Responsibility Statement - 1, the nndersga nsibil'ity for in the POVV / S shown on the attacked pines Plumber's Name { Plumber's Si nature PRS N bcr Business Phone Number umber's Address (Street, City, State, Zip C 6�) VIII. Cons J rtment Use On Approved ❑ isapprov Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signature o S Surcharge Fee) ❑ •r Given Reason for nial . DO /b 10 prj IX. Conditions ofApproval/Reasons for Disapproval (� iV><T>EM MOtant 1NIer artd 5 j+�.�•- Am" Al �?� 1a 1.. eeplh:.tirsrc, J dispersal cell must all be nodga / maheined (}, �/- as per management plan provided by plumber. 2. AN selback requirements must be maintained as per applicable code / ordinances. AKb cottspkte pram (to the Cotmty only) tar the system oa paper trot tan tban St2 x t t iachp is sin SBD -6398 (R. 01/03) :��wo Matava qd HE !aLin% nay iu"gmb 190 rc ; - •� �. � r �i rte �' 4.,2Q�r cxr� d S `• W� .Es � av 9. #� Ddto _lt �(a -3fo 'Oo6 j 166 �� Sae. • ` ri4 � ���U '' /�' /����(� r o j I a I I I I : I , . i • : I ' I I ; : ; I I o i , • i I : : i I I : ; I f • I : i I , i I i I i I � :. •�" I � 1 I i ; r I I �I I � I i I I : i i I i I j I i i ; i I i i I I i y \ R-p— L) J2 J v�cLr�u J a ►n�rc�q �. . R ' k C'IMD 11 IST 0-' r`O d a6 r� : O!R ' `� g , t. 44 y \ : ----T : , I � ' I I I I I I , I I : I I I , I I I I : I : t i I I I I I I I I I I : ' I i , I r I, i : I I , : : a Safety and n , n t ' County 201 W. Washington Ave., P. Visconsin Madison, WI 53707 - 7l Sanitary Perm Number (to filled in by Co.) , Dep artment of Commerce (608) 266 -3151 I � U 3 c I Sanitary Permit Appli ati - # state Plan I.D. Number l In accord with Comm 83.21, Wis. Adm. Code, personal i ormation you provide may be used for secondary purposes Privacy Law, s15.04 t ; g `; l i i,i4 Project Address (if different than mailing address) (A� �ti MV I. Application Information - Please Print All Information ' 4[ otp � I. GRUIX COUN FY i Property O er's Name Parcel # # 3 (p Block #u to - Property Owner's ailing Address Property Loc"n � mar}: � 0 %,, Section t Cr fate Zip Code Phone Number Q S UCI N; RE or II. Type of Building (eh all that aPP ctd �2.'S "�'� Y Por 2 Family Dwelling - Nu j Sivision Name CSM Numb ubliGCommercial - Descri S ❑ State Des 'be Use ❑City _❑VillageVo ship of t t,J III. Ty of P rmit: (Check only onkbox on line A. OoM line B if applicable A ' New System ❑ R lacemen Y ep ystern ❑ Treatment/Holding Tank Repl 'cement Only ❑ Other Modification to Existing System B. List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pe it Transfer to New Before Expiration Plumber O � r IV. Type of POWTS System: Check all that s tK Non - Pressurized In -Ground ❑ Mound ? 24 in, of sui le soil /e$ < 24 in. of suitable soil 11 At-Grade ❑ Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground ❑ Holdin Tank ilter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 11 Leaching Chamber rip Pipe ❑ Other (explain) V. Dis rsaUTreataknt Area Information: _ Design Flow (gpd) Design Soil Application Rate(gpdsf) Disiftal Area Reqrsal Area Proposed (sf) S em Elevation O� I / 5 uired (sf) Dispe ) I 9'.5, 9 VI. Tank Info Capacity in Total Numbf nufacturer Prefab Site Steel Fiber Plastic Gallons Gallons o7"s Concrete Constructed Glass Neiv Existing Tanks Tanks ctMic (ding Tank y i Aerobic Treatment Unit �A l W Dosing Chamber VII. Responsibility Statement - 1, the ande assntae risibility for is the POWTS shown on the attacked plans. Plumber's Name ( Plum s S nature RS bar Business Phone Number C v T , W umber's Address (Street, City, State, Zip C n 1 N _QA3p C, �Mond\� VC) I VIII. Conn Partnient Use On Sanitary Permit Fee ( ludes Groundwater I Issuin Agent Signature (No Stare Approved El Disap(pr_o Surcharge Fee) ❑ Own on for Dania �{ (� . IX. Conditions of prov — SYSTEM OWNER' 1 Septic tank, a uent filter and dispersal ce ust all be serviced / maintained as per ma gement plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not Ins than 8112 x 11 inches in size SBD -6398 (R. 01/03) H -hc��� J ° �� ✓��rc�� � sw tJ w �� S t � i 30 N !� l� �,1 CCL r � j �.� ��C08 7 iC.l�yY�Or1 S� s �. w �s � C a dare <<a� -3 ©� k-Q n f � l p I � r I i , , o y I , i i I ay � i : t , : I I _ I I , i I I , V I I �I 0 ' V �sZ` C ro ;mac c., lu l k s *,-3z A: L GL VC� 9J • 'ro � Vv�i C E I� � . It S rv\ - ' V C.. � ' (Z Ek 97. b T - - - -- �— 3 a F I WisconsirwDepartment of Industry SOIL AND SITE E V A L U l I� T Page 1 of 3 Labor and Human Relations ,- _ —. 9iv6ion of Safety &Buildings in accord with ILHR 8 COUNTY ` ~ Gtit St. Croix Attach complete site plan on paper not less than 8 1/2 x 11 inches in � 1 Ian include, byl not limited to vertical and horizontal reference point (BM), direction a of slope, scjleior20 RCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. , ��1 ` . r I ndin E EWED BY DATE APPLICANT INFORMATION - PLEASE PRINT ALL INFORMA Gov o tG� �;�, �9 PROPERTY OWNER: YM LOCATI Derrick Const. , Inc. 1/4,S 12 T 3e N,R 18 (or) w PROPERTY OWNER':S MAILING ADDRESS LOT 4 SUBD. NAME OR CSM # r 1505 Hwy #65 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE (MOWN NEAREST R New Richmond WI. 54017 (71 246-2320 Richmond 140th St. [xJ New Construction - Use be ] Residential / Number of bedrooms 4 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 7 ench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.80 ft (as referred to site plan nchmark) I -� 6- ' Additional design / site considerations trenches Spaced to code LAt n Parent material stream terrace 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 M El :91 S El CAS El U &S El k] S E:] U EIS ® U SOIL DESCRIPTION REPORT GA�Q_ tJz oo J am- (� ZWO Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench #� ................. .................. ................. .................. ................. 1 1 0 -6 10 r 2/2 none 1 2msbk mfr cs 2m .5 .6 •S 2 6 -21 7.5 r 4/6 none sicl 2msbk mfr CTW lm .4 .5 •`] Ground 3 21 -36 7.5 r 4/6 none sl 2csbk mfr' S elev. .� 9 9.8 ft. 4 36 -58 10 r 5/4 none cos 0SQ ml C1W na .T .8 Depth to 5 58 -88 10 r 4/4 none ms osa mvfr •� limiting factor Remarks: Boring # S 1 0 -10 10 r 2/2 none 1 2msbk mfr cs 2 10 -23 7.5 r 4/6 none sicl 2msbk mfr Ground 3 23 -30 7.5 r 4/6 none sl 2 k m ' 98 ft 4 30 -50 10 r Depth to 5 50-80 limiting 6 80 -88 7.5 r 4/6 factor +881, 3 �• 2 - �3 L Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Av N w Richmond I 54017 Signature: Date: 6 -16 -2000 CST Number: m02298 PROPERTYOWNER Derrick Const. , Inc .. SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # Pending " V r Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. MunSell Chu. $z. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -8 10 r 3/3 none - 'r«: << >.< 2 8 -36 7.5 r 4/6 none sl 2csbk mvfr C1W lm .5 .6 - 5 Ground 3 36 -48 7.5 r 4/4 none c OS Q ml Crw na .7 .8 elev. 93 ft. 4 .48 -80 10 r 5/6 none ms osa ml aw na Depth to 5 80 -96 5 r 4/4 none Cos osa m •} limiting factor +96" �c - s Remarks: Boring # _ 1 0 -9 10 r 2/2 none 1 2msbk ' mfr 2m .5i .6 2 9 -24 10yr 4/4 none sl 2msbk mfr 9w lm .5 .6 S� 3 24 -84 7.5 r 4/6 none is osg mvfr na na .7 .8 Ground elev. 90 ft. .. Depth to limiting factor +84" Remarks: Boring # 1 0 -8 10yr3 /3 none 1 2msbk mfr caw 2f .5 .6 S 5 2 8 - 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 25 -80 7.5yr4/4 none ms Osg mvfr gw na .7 .8 Ground � elev. 4 80 -90 5yr4/6 none ms Osg ml na na .7 .8 9 1.4 ft. Depth to limiting factor 90 Remarks: Boring # Ground elev. ft. Depth to limiting factor ILL[ I Remarks: SBD- 8330(R.05/92) r - v STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 Sw4Nw4 S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #36- 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 e permnent lot lines vere not established at the time the test vas conducted. N i1 =40' (!I�D= top of 1" pvc pipe C el. 10 0.00' /A1 L' topof 1" pvc pipe @.el. 97.60 ; Gary L. Steel 6 -16 -2000 i rr _ ■■ sir..- �y�`!� • — �-�- -- fan Wimm go NONE fin its ��_JC�\ ..I� ■��C■ ■i md IF _ - �` O •^ � Q O - 4 T �4`� t1 kw' 1n EZ1203H voasvos .•'. "'' '`r'` *�•`' %'':.`.`',ir..' vesvvea sav `' :• c:' vvvvasa 241t vas ..i. '� •�'' ' �;•�, .�. vi a 1.2 avo, vva L vvv • vvv 4 vvv Vav LJJ ve ovs vvv vav VVT WVW 1 it • •' 1/2 Ciro. = 18.84" VV soV PVT VVVTWT f V V v v 0 a as V VWVW V�vaV a O Va aVPPao O�aV VeaV OVOVpO 7a V9 VaV V eeV VVVVPOV.OV 7VaTVaa OPV VVVV r 24 Bottom 3611 Vold Vnlume 12 -1/2" DIA. (typ.) Void Coefficient -in Aggregate given at 57.4%. oil interface Argo In. IQ Ft. O.D. of 4^ pipe = 4.625 inches Sidewall (2 Sidewalls) I * 18.84in Void volume per linear ft. = 3.14 0 2.3125n1 12in — 3.14 12in / f, • Ift ' 0.1 17 fV Bottom If 0. D. of center cylinderai2.5 inches 2.00 Total Soil Interface Area Void volume in aggregate ofcenter cylinder = 3.1a• T ( 2i.1f 2J125in ll2in /ft) ].14• � 5.14SQ.F ,l•:57{ =.422 ft' IZinlfl J O.A. of outside cylinders= 12 inches Void volume in outside cylinders = 2 • ].14r _ projected Trench Area l bin I2in l f) --574 ft, Sidewall Height = 12 in. *2 = 2.00 Sq.Ft. Void volume at bottom between cylinders = 24'0 Bottom = ( 6n` 21n /1}) ( bin 36 in. = 3.00 Sq.Ft. ll2in /ft 1 112in/ft) =0.215 W Projected Trench t4 ( Void volume at outside bottom co h Area 5.00 Sq.Ft. comers (1/2 of void volume between cylinders) 0.215 12 = 0.108 fN Total void volume = 0.117 + 0.422 + 0.901 + 0.215 + 0,108 = 1.763 cubic ft / ft Gallons per ft = 1.763 X 7:48 = 13.? oattorta ner Itnear ft 1/ Erj A gg r egat e Trench Sy gem EZ1203H Rin 65 In ustrial Park Rd. Oakland, TN 38060 SCALE 'LE wwt: E2t2t>3ti — vs1 SHEET: i of t 11_27_01 ( 11 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa —� or ff�ORMATN�f. SYSTEM SPEC�FICI► t �Q [] NA k Manu owner J , rti rt l Permit i {-�- `� 3 `� I sel�t;c . Dose ❑ fading vol, l _ �+ Tank Marlu"Kaurar D NA 7S;i RARAiNE1 F.RS O Do" O Holding vol. gal Num of of Public Facility of Bedroorrhs Q NA a ity Units 13 NA Ef kxmt Filter Manufaczwer' t p k Q` NA t+ad (avtel fbw - U Effluent l (peak? flow - (Estimated x 1.51 pump Marwfect+xet pplication Rate ► /tt' Pump Model A Standard i fknrent/Efflaerd Quality � average' Pr etrea t me nt Unit Q Peat Fitter Fats, ON & Grease (FOG) 530 mg!( 13 Sandy FNter 8iochennical Oxygen Demand (BOD 5220 mpll E3 NA E3 Mete Aeration ❑Wetland Total Surspsndad lids so {7 SS) 515o TOIL 0 Disinfection O Other. Pretreated Effluent WOW Monthly average Manufacturer Qlspersai Cell ❑ NA 8iocthemical Oxygen Demand (BOD 530 mg/L ❑ NA �� ( ) © ln- Ground (Mewed Total Suspended Solids tTSS) mgg- ❑ Mound Fe" Cofffrmm tgeemetric mean) 510' c d' OOmI E3 At- Grade [3 other: Maximum Effluent Particle Size Ye in dia. ❑ NA O Drip -1 r NA 0 NA Walues typical for domestic waste vvew and s�tic tank effluent. NA MA1MTEf�ANt ECff UtF S NE Sw i,w Event � 3 Yom) 13 NA Inspect cond of tows) At least once every: $4 When combined sludge and scls one tl�) of tank vatuma ❑ NA Pump out contents of tankts) ❑ When the high water alarm k activated maMt►teh (Nlandrran+s 3 Veers) ❑ NA Inspect dispersal OW(S) At least once ewsry: s) © mahthts) 0 NA Mean effluent filter At Massa once every: 1s1 O month(s) *NA Inspect :pump. pump controls & alarm At least once every: El mWW Gl rrhonthta) kT NA Flesh laterals and pressure test At Mast once every: O yemis) ❑ month($) qL NA Othei: At lea xt once every: Ci 1 � mawrENANCE YISi'Tf1UC7iO is of the foNowing licenses u certifications: Inspections of tanks and dispersal calls shall be made by an individual cep one Operator (pumper)• Master Plumber, Master Plumber Restricted Sewer, POWITS Inspector, Pt3WTS Maintainer, Septage any cracks or Tank inspections must include a visual inspection of the terddsl to identify any missing or broken hardware, identify of effluent on the ground leaks, measure the volume of combined sludge and strum and a check for any back up or Pat check for any the surface. The dispersal cell($) shall be vi ill � to check the effluent levels sueface irx a e falling c�� and ponding of effluent on the ground surface. The Poedie9 of effluent on the ground requires the immediate notification of the local regulatory the the acxurhhslatson o f sludge and scurn in any treatment tank equals tube - Laird (Y or more of the tank volume. yawn Sthtaga ServiCrhg OPefe for and disposed of in accordance with chapter NR 113, entire contents of the tank shall be removed by a Wisconsin AdrWhIstrative Cam nts, prstreatmen' All other services, including but not Iknited to the servitdr►g of effluent filters, mechanical or Mein rited compose units, and any servicing at intervals of 512 months, shall be perform days 10 of performed by a days certi f completion authority within amelet completion of any service avant. A service report shat( be Provided to the local regulatory GMW (2 /02} Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chernhcais that may invade the treatment process andlor damage the soil dispersal cell(s). if high concentratio6s am detected have the contents of the tank(s) removed by a aeptage servicing operator prior to use. System start up shall not occur when sod conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal )aghwater levels. When power is restored the excess wastewater will be discharged to the dispersal coNs) in one large dose and may overload them resulting in the back -up or surface, discharge of effluent. To avoid the situation have the contents of the pump tank removed by a Septaga Servicing Operator prior to restoring power to the effluent pump or contact a Pkm*w or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal ceps. Do not drive or park over. or otherwise disturb or compact, the area Within 15 feet down elope of any mound or at -grade soli absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts. condoms; cotton swabs; degreasers dental floss; diapers; disinfectants; fat, foundation drain (surer pump) discharge; fruit and vegetable Peelings; gasoline. grown; herbicides; most scraps; medications; oil, painting products; per; sanitary napkins; tampons; and water sof[enar brine. ABANDONMENT When the POWTS fells and/or is permanently taken out of service the following steps shad be taken to insure that the system is ProPeft sad safely abandoned in compliance with cuter Conan 83.33, WdKwsinn Adm nsdrative Code: e AN piping to tanks and pits shad be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or Mother inert solid material. CONTINGENCY PLAN If the POWTS fade and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 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 weft. Failure to protect the replacement area will restdt In the treed for a new soil and site evaluation to establish a suultable replacement area. Replacement systems must comply with the riles in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the felled 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 perfornad to locate a suitable replacement area.. if no replacement area is ova#" a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomet at the infiltrative surface. Reconstructions of such systems must comply with the rules in affect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR MWAA"CIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS TALLER r POWTS MANiIIAhNER Name ` rS Name Phone [S S� Phone . SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY mama Name M u V) VA c�t Phone Phonon tS 3 This documant was drafted by the staffs of the Green Lake, Marquette and Woudws County Zorft and Sanitation agencies in compliance with chapter Comm 83.22(2)(b)(1)(d) &jf) and $3.54(1). (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 3 • &Ij aN/ le-M &- t4 Mailing Address _ S AP-JC- S J LJrc'7�'2 �A:iZ4e. W r 5 q0 4 " Property Address/ 4o (, o ( -an Av;;-z- (Verification required from Planning Department for new construction) City /State �ic , e4 4 4A 4 -0 &J-0 Parcel Identification Number Gvt LEGAL DESCRIPTION - Property Location 5\" /a, 6 W Y4, Sec. 12 — , T 340 N -R `g W, Town of " : ,0 Subdivision WA- G�0 t.►y Lot # 3 ( 4 . Certified Survey Map # �- Volume , Page # Warranty Deed # 7'5 o $ 1 - . Volume ? -"7 L O . Page # V1 S Spec house ❑ yes )<no Lot lines identifiable)Yqes ❑ 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, journeymanplymber, 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. 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 the three year xpiration te. G ATURE OF APPLICANT 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 r erty describe above, bty deed recorded in Register of Deeds Office. 8 $ O SIG ATUR E OF 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 J 2 3 2 0 P y 1 5 -7 Z -3QIa ` DZ- 2 1, I STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTS` DEED , REGISTER OF D EEDS Document Number RECEIVED FOR RECORD I t .. - - -. 3 _ .... .. .. . _ ....... ___. _. Brush 07/18/2003 09:30AN This Deed made between y Mound Partners, LLP , a Wisconsin Limited Liability partnership WARRANTY DEED EXEMPT # _ Grantor, REC FEE: 11.00 and Andrew J. Brinkman and Tammi J B rinkman, husband TRANS FEE 127.50 and wif e, as survivorship marita property —_ COPY FEE: CC FEE: PAGES: 1 Grantee. i Grantor, for a valuable consideration, conveys and warrants to Grantee the following i described real estate in St, Croix County, State of Wisconsin: Recording Area i Name and Return Address Lot Thirty -six (36)� plat of Waters Edgy in the f Township of Richmond, St. Croix County, Wisconsin Andrew J. Brinkman; 201 Park Street Deer Park, WI 54007 I I i i I 026- 1126 -36 -000 I Parcel Identification Number (PIN) This is not homestead property. (is) (is not) i Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an j affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor devel land and Derrick Homes, LLC is_.a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction with Derrick Homes, LLC as the contractor /builder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as I Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to it sell the lot to another purchaser before constructing a home upon this lot, Grantee gives i Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Exceptions to warranties: j I i! I I! Dated this 17th day of JulY 2003 I I (SEAL) (SEAL) ald e c } (SEAL) SEAL) Michael R. Stevens AUTHENTICATION ACKNOWLEDGMENT I i I Signature (s) State of Wisconsin, 1 � I I Ss. St. Croix County. authenticated this day of Personally came before me this 17th day of July 2003 the above named Michael R. Stevens and Ronald L. Derrick, (. as partners of Brushy Mound Partners, LLP A Wisconsin Limited Liability Partnership ' TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person S who executed the foregoing authorized by §706.06, Wis. Stats.) instru t and acknowl the sa m g n REIDI L. DILLEY Notary Public THIS INSTRUMENT WAS DRAFTED BY -- 8 mte o f wisconsin i Brush Mound Partners ;I y Heidi L. Dilley I, I PO B ox 445 Notary Public, State of Wisconsin County of St. Croix 1 I ' New Richmond, WI 54017 My comm p i�e (If not, state expiry Qr} date: (Signatures may be authenticated or acknowledged. Both are not 11 b L Ub necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. a rn c Y i IaaJIS MWVL 0 v m o L1. +. 0 v. o 1 ae a, a) u 5 of +' 0.7 w 0. cu CD cn 0 b0 0 CU " .�4 u o O U � "d N O O O O u v b0 cn (n at a3, 0 o b al �' o ° ai O W O = (n � Ts O , r. 0 3 0 .� ,x`oa o U al o *. r '� o o o u ^� N _0 0 N u O Q Q4 b0 .� O to 1.4 � 3 m r z pbp "' G a ' N i, O �' F+" • �+ O O .. c� N 0 0 �, v b O O ca +• +• � T3 :-: u v 'Z3 p0 al "t� u F. p ++ as z iC v awi U S �—] W i a 1. • • • • O En tu • y O • • • • Cl. u as 0 ca v Vr> , part oT the Nt l j4 at the NW 1/4, the St 'I/4 of the NW 1/4, the NE 1/4 of 4's�� �lsk ,3 n tya�_din the SW 1/4, part of the NW 114 of the SE 1/4, and part of the SW 1/4 of the NE 1/4, OIL in Section 12, T30N, R18W, Town of Richmond, St. Croix County, Wiscor OWNER BA MOUND S L. Y �� PARTNERS, NOTE: THE PARCELS SHOWN ON THIS MAP ARE SUBJECT TO STATE, COUNTY AND TOWNSHIP 4+J, A.. i<. -pl1 f 1505 HK*4WAY NO. 65 ETCS� BF RULES FORE A PURCHASING I OR OE VELOPNG WETLA ANY PARCEL. CON ACE THE SS CROX ��'`,+N Rcpj3tr(1I(.ileedl NEW RICHMOND, VIfl 54W 7:NJ OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADNCE. .'�1- r ".Cl� _'�•� -.-� NORTHWFS't CORNER t'tF'p 4 N S, SECTIOIV 12 -JO -78 ` FOUND ALUM %NUM COUNTY V01VUME,VT �E E K E 2100C at I " r° long N7 9 � 35'57 ^ , cap A( AG /�y�1 ,�• A ? G M ?���PROy.,N��CwB CF ���,PY � - - vOkr„ "'Nj of xE sw , : of , �� �w ; . •P?Pf= k 9 E. I / / oy' - r OF vF _ - j RNLY M n fol" 4V ' N82'14 G 29 H poP ° E 254.52' - c Z J I u \ . 40 �•E 0 ��.% N L L Nj3 \33 R MARK rn_ .N'I3015 �� H , AR yyA TE N R t �....._ �63.. ..._ f 13E j y HIGN 8r V E 3.; o _ ORDINATARLISHED i '� L N , AS 9 " 00 ' �1 ^ �,..... - I ":OODPi 901 /NDARY PCR O .. m rL �p 110 18T $ ` C; M 0! 4AIN RICHNOND EL �" , �e�� f1IX10 PL AlN MAPS N LOT 38 AREA TO SHORE: o� A T.R LOT 37 2 ° 328 CRS _ ..' .. •'� �,p AREA TO SHORE: .'' 3 ,,,,,,,,,,_. AREA TO EANDE LINE: 96,316x 50. FL M O . •- - 2.21± ACRES t 88 S0. FT. A .S_v v - ^ "" °' N REA TO MEANDER LINE: N 1.88 ACRES 9 Y ,,,�.......... ' L O T 3 6 74.109 S0. FT, 8 C L O T 3 5 AREA TO SH 170 ACRES �, 8 FT� y / ? F o AREA TO SHORE. 1.95± ACRES S`.lL S OS, Q 86,7161 SO FT. ro AREA TO MEANDER LINE: 08 1.991 ACRES 68,361 SO, FT. I A5 UNP �N1 , c• A R 945 0 MEANDER LINE,, 1.57 ACRES S89'52'44'W m 1.56 ACRES \ .e1 95 39' N LO "W 6 0/, T 44 �,N89'14'35 "E- 407.00' -- '1'yAC D 174.'4 _ m TOTAL AREA S• 9• +�`'.� a - 33.00' 374.00' ` 7 PtL _ 81,870 S0. FT. i 0 -. N89'12'02" --4395*-- E TOTAL AREA R a 7 y 6 E}ti " o �3aw} 1.88 ACRES 33' ._OUILOT / 986.0 21 - D o . ; F.F.E j c> -- ACRES a �N E� �� r ti 514 �! 739 50. F1' �l 9ENCHMARKaD O _ 0 50 90 �V' ,� ,'ZI b�eK 9g� �- s1 i ✓2 N�% t/ �. �� I j �, �993.19 LOT 46 N i ' q 1A TOTAL AREA: J M ` ^t 0 _ y Q 6• ? �\ 115,124 SO FT /� \` 2.64 ACRES \'A > Z` c F E 97, 3 J- �a��� W '02 ^ E N89'12 _ ` \ �'• d 43.97' ��1 H WE 973.3( O� P rL w.L�.� A w '1 r LOT 45 " O O - LOT 3 4 f /j J `?7 S�t1 �ti m TOTAL AREA ` Z 82,607 S0. F TOTAL AREA. ^'�..� 9 j, �. 'jj� `. J 'P. h 1 Ii. E. 976.O \ 7 / 84,246 S0. F T. ,\ l� ,� p y 'G 7 90 ACRES l O I 1.93 ACRES ' \ �p Y.i ; - .F.0 966.0 r W ° I F.F.E. 989.71 2 0t^ ^• ...._ ......... i � ' H. W.L. 0 9.63 I } VJ Z �` °� ? ©N89'52'44 "E 194.75 10 M Ir ,i j . qGE �7T'"" 41r B 1 94. 75' 9 - \ p 9• fgs . � �� _ , Q N89'S2'44 ° E I 3 I A e M �7 - s41.38' --- a rr' 0 I •✓ N.W.E. 985.)ll,'• y H.W.L . JA' \\ 2 3 , yAJ r I LOT 3 3 � � � , � s� & t � � ,�� 0 1 p 3 Z I TOTAL AREA: 0 0 g° _ 3 •....� 1 \ 2 114.465 S0. FT, ...._.__..._....._...._.___ »__._ ____._..____..____..._- ..... -- ? • p .� H.W.E. 987.1 \ Jt I 2.63 ACRES ... v F.F.E. 989.7 1 H.W.L. n a f \ J ' T1 • N\ I E v� L0T31 J' LOT.29 H / /7 T .2 7 ��' ..;}. TOTAL A ol:- o LOT A. O 'i, TOTAL AREA: TOTAL ARik- o` o. \`C