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HomeMy WebLinkAbout026-1126-38-000 I — - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 42 637 0 GENIERAL 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: Preece, Michael/Tracy Richmond Townsh ip 026- 1126 -38 -000 CST BM Elev O Insp. BM�EIev: BM Description: S`i� i / TANKINFORMATION ( ^/ � � ION DA d TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM U1 S'r Co D/- lv Aeration Bldg. Sewer Holding St/Ht Inlet �• 3 2 TANK SETBACK INFORMATION St/Ht Outlet b•GZ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7D i , Dt Bottom / Dosing Header /Man. Aeration Dist. Pipe g 71 Holding Bot. System q,5 !� - Final Gr PUMP /SIPHON INFORMATION t�'ll�( 5 S S•Z Z Manufacturer Demand St Cover q // GPM Z �) /d • (O Mode umber TDH Lift ti oss System Head TDH Ft Force main ngth Dia. SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ' o. Of Trenc es F T DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 -S SETBACK SYSTEM TO P/12 JBLDG IWELL LAKE /STREAM Man�c r. INFORMATION rllA OR Ty Of System: f D t / b0 / �1 I UNI Model ber: 'V 1rav DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake J/ Pipe(s) Length Dia Length Dia Spacing 5 — 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 Y/ Bed/Trench Edges Topsoil Yes Fri, No I Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:� / j � �.3 Inspection #2: Location: VOL � Parcel No: 12.30.18.799 1436 166th Ave New Richmond, WI 54017 (SW 1/4 NW 1/4 12 T30N R18W) Waters Edge Lot 38 1.) Alt BM Description = ST �� 0/�R- b ,t�.9 ,t ca 74 2.) Bldg sewer length =3tj / f uind&t/� - amount of cover = �O / �1' I UU Plan revision Required? Nd Yes ikNo Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's 'gnature Cert. No. Yv, •� . ..a ua.o+ r rtA 110 JOU 4ff86 ST CRX CO ZONING Qj001 Y aid HUMAP DiVMM 101 W. Waal kWm Ave, P.O. Boot 7M ` #h ww% WI 53 707 - 7092 SNOWY taaot is by Ca) 9 ln� M ont of Commerce (6M 261 -6s" Sanitary Permit Applicatia R E C I v a.aoawl with Caaoa &Ml. Wl$. Ada Cady va•••1 iafranaia. >" tart' be Wad far>8000dwy parraaaa Ptiv.cy LAW.. 6 3 S.ttt(1 P-jed AA& — (if da. Ur M addraa) 6 L Apasa It�.onaatiw — Z+r�t Aa iafiaraaaon. K 03 r / FMPNW 0aasar s �_,r<t_�,x C;OU s trw a 8bokg Owaa a na. Add _ poiJ figK+O' 1�orataa. 5 Ciq. St - S w - Nw Y..S.D. ate IL "P o[srElft (ebeek aN dot "b, I ac 2 PaWily Dwsbin#- Nwabw of R0*Q0 a - ' A Zaa Name fSM Nam" y 7_� O stag own" - ( c Ckst� HL Type of OvifteaP or hraaib +Chwk q* oate box w Use A. B ifappacamo A. sysuot ❑ R s y.W. 0 '11Naa►Wbibt We T ask Rapiaxa "0.y 0 0*. M.&MOea. to S�i�e� syaa. R. FUMO Rmewai Pewit Rariaioa ❑ CMa r of 0 Taadt Tttwtfu as New UN Pwr io.a POW Nw"w ad Drat wool IK ofMWTS Chwk a8 tba mufti Oa - haattind boOmwad 0 Mwia _ 24 h. uiauitaMte sell a M&Md <C N a. d aui aa0 O A kale O Stele F= Saari Pinta O cosomrnw w 0 Pns uM3Wd M4k* sd CJ HOMag Took O Pas Fiitta 0 AMbk rieaaaaM LbA 0 Recut AMr* SWA Kira 0 M@ft Paa QLANdraff0aubw ❑ u« kaa I > Y. ttatltl0aI Area t Deaiga IRaw W4 Design &A Redd Ato. R".iaed (.4 Ate. (an Syataw Ek Loco + - 7 po VI. rink I wfo capeciv is TOW NwaMa Sate Sad Fatiar Ploatie 034001 dolls,, d'vww (Coaate C =kwaa (IN" tkrae.r r..t 1 e rs a Tamps* tya+ YII. Syatesaaat- 1, aMc the FOW1S AMM w tMc.p.ehad I& P a Nase a ewsw a fh.ae NuwOa rr �t-S V PlWMWa AMMU (Baca. CMI. Saw. zip Go* — D N IU rtmaat Use Or► w.tvrad © tlia pMovad SNOWY Pewwit Fee 0WININ Dac feared I latiog Sierra (Na ) Singe Fee) ,r Z q D 0 O-n,ar 0i.'" R. M kr Deem I A, J 2'-� i M / cettditim of App for Dkopprevai E � ' Y/7 ` VVI 01A— Vt �4KI�l A-tb e.ig4le Pb - tea aaa o"" saw for do ava M POW am tea taas win a 11 ow N Yar SB ©-6398 (R. 08102) EZ1203H Iry VW VW errs ► ► ►.. , -. ' !1l rlrr � !!rw 4.6 • 1 !1 w1! T ►w •w ► !! 1w► Y: ; W: 1/2 Girc. ov'r WW r 1 i Wr 18.84 .. •rlrwlii�sr s1 • *�ii1► 6 +�n ►ws1!!1 W J 3 ! 12 -112" DIA. VOW Ctxfrt ,t is Oven 't mat O 2 15 7,4%. P �'� +tar � 1.� �� 1[}i 1Q EL -j__ r ! = $�dew2 P•► lirtar R - 114- /_..,S_ (� S { 1 ? 18 34en t2w /k, •th <0 .il + fta = 3. 41 O.O. oFoetaercylkwer r2.S meka i 2in Bottortt tR 4aed volum in aM' o €�� 3.l c • jw ' TOtat Snit Interface Ar lo0 Ltzdr `9.ia• 3J125u�=� S.IJSQ. � fl -D. o£ I t2 r 4Z2 ft, �a12 g )' STa - outsid` cyttedera a ► � t� ( e uout ru} outside : "3.If1 - Pr ojected Tr (13mrft j '.STa. 901 fi. each Arcs t oic! onl �� Sidewa }l "eight - 12 in_ •2 t between cyt"u><rs . 1 Sot 2.W $Q.Ft. !`OW valumc at 12iarR )- ).eal t2o�. ft� ' 0,.213 fi. 36 in. = 3.00 Sq.Ft. botmm JJJ Projected Treacb Area void a Tatat was {tn, of void volum b 3.86 SV.Ft. *o}urae - 0. 117 +,o t 0 tiveca `S` t S 2 ' 1 R' l Galbtts '90, ! 4 .763 X 7.4$ •• 1.7tii -'b" h Per tt a @ r � o 2& x /�� �6 E ' S Aggregate Trench System EZ 1203H Rtn9- lnduStrjG crow l ow 65 lndus#rittl I P ark Rd. �?takdand• TN .18()6 J SQkE 1 Ste: i Ot 111- 27•-Di 1 I �i�!► eV �iir�t FV 301 W. M�,AW. t.Q lout 710 � c � iriie�, wif 33791 - 71i3 ie / d6w � L9wmftw7 Per lawfiv o Naubw � �3 fa.a..et wi1►Q..w .li.. Arles. tad.. lwarrd 1ee■.e Mm Vm rw Wft ❑ L "am " *W r j ja l,- Itar3E� _JO °' minis JAN 0 2 2003 team " c/ OW. y s N� r 3 ftft ZONING OFFICE who* Jv lle trot Nlrwier MIA e- I nft -- in Dundhe tin 1 wr 1 lr�r OwiY� - l�rnies d\.ireewe ©!e! 43.75 ��e ML 's 4c lriret ww w bw ire lwrn I _ wirrlre ter ftft d am* Cqqkft Atka* W T" QW RAM s_. D u.dR � �4 llroae li..ie.ripr �� 1�eri.. 1�w./ 1Y 'gyp et!llit to___ ai flt alone b I II in 1 r< law -#"mo "hka.ua 0 s..r raw C7 rs ln.r.. m © T a ❑ WM* lae. SID mo Await ur. • © n o Awe 1�.ri A.. 1l.rs sjerrr.11ewMlse 1ye�l bade �+ l�eMd IhMrldrr. tliJir•1i 1ae.�ue 95�. " 9`�, In �� t�. � rip" l" f rasbc awma tiirw� �� t)wwnre R7.er.r... a1..ee f z�; VIL MWwwvdMWz l ii �'i1RRSrn.a a.le areid z flmbw*sJirll. IaMr..R C&#,. lrrerS. ciMle) �s K �A S r uw OOL [I a'ae aw" bftA A*... s - • " � P4 - 4 I +nr�w.Rir.eWOW ttilll i od �k/ w.s- wct_�a Lj l SP . 4 P-% I f iIf I (y ' I iT Is o i 7 _' I l -1 - I - -- t' �I - -- - — ! - - - -- i L li _ 1 —� -- f I ( I I to i � I ! I ! - _ L- F- -� - it -- , I_ J- 1 ; I l 1 I I I j � ' l _J.__♦ �_-- �._- 1�- ��1 -J -- '. - I I I I I 1 T Fla n o � k5 �ou Al Pq A O vs 5w c� N w ` -5 a.. T 3 c0 ti K oir W sas 14.E Y !¢s 3 Qro ko O o -off, B M Yop « @ I icy' � D IF Ali' J21 \� tp „t 1 66, a. ' _ _ _. f t 'V vAWonsin Dep'irtrne or Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 and Human Relations Division df Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code OU Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Cro:LX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. i APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION WED BY ATE ok • 0? 3 PROPERTY OWNER: PROPERTY LOCATION Derrick Coast. Inc. GOVT. LOT SW 1/4 NW 1/4,S T ,N,R X(or) W PROPERTY OWNERS MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1505 Hwy-#65 38 na Brush MQj" CITY, STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE [MOWN NEAREST ROAD New Richwnd, WI. 54017 1115) 246 -2320 Richmond 140th St. Ll [.)i New Construction Use be ] Residential ! Number of bedrooms 4 f ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily n 600 gpd Recommended design loading rate .7 bed, gpd19 .8 trench, gpolft Absorption area required 858 bed, fit 750 trench, ft Maximum design loafing rate _ bed, gpd/ft gpd/ft Recommended infiltration surface elevation(s) 95.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material f -um Rh Flood plain elevation, if applicable iia ft S Sui table fo r System CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U- Unsuitable for system a S O U u s O U ®S O U IRS O u ® S ❑ U I 0 S Ci SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 8artdary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0- 2 10 -20 7.5 r 4/4 non Ground 3 20 -96 .5 r 4 6 elev. 99 ft. �� , S� r ►`^ S os I Depth to limiting factor +96 Remarks: � - 3 O O D 3 Boring # a< ;x — 22 1 8-17 10 r 4/4 none sicl 2msbk mfr if .4 .5 Ground 3 1 17-33 7.5 r 4/4 none scl 2msbk mfr CM If -4 i.5 elev. 4 1 33-96 7.5 r 4/4 none 1S 0SCI mvfr na na .7 1. 9 8.4 ft. Depth to limning +96 -1 t ---I- Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. 6 New Richmo WI 54017 Signature: Date: 6 - - 2000 CST Number: m02298 PROPERTYOWNER Derrick Const., Inc SOIL DESCRIPTION REPORT p age ?pt 3 � PARCELl.D. I Pe ndin g Boring # ron Depth Dominant Color Mom Texture Sere Consistence Bo rxiary Roots GPDIft ren in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ds 3 - 1 10 -24 7.5 r ;4/4 none scl 2msbk mfr 1f .4 .5 Ground 24 -96 7.5 r 4/6 none cos 08Q ml na na .7 .8 elev. 9 9.0 ft. Depth to limiting factor +96" Remarks: Boring # 1 0 -9 10 r 2/2 none 1 2msbk mfr if .5 .6 4 9 10yr 4/4 none Cai C-1 2msbk Mfr aw if .4 .5 Ground 18- 1 2msbk mfr if .4 ? .5 elev. 24 mvfr na na .7 .8 9898,7— ft- Depth to limiting factor +90" Remarks: Boring # 1 0 -24 l r 2 2 none 1 lcsbk mfr 2f .4 .5 5 2 24-38 10yr 4/4 none sil 2msbk mfr 9w if .5 .6 Ground 3 38 -90 7.5 r 4/4 none cos osg mvfr na na 1 .7 .8 elev. 9 8.8 ft. Depth to limiting factor --T _+90 Remarks: Boring # Ground elev. ft. Depth to limiting factor t`ta .t� OW . s ,F < <.t / `r 19� lOc'`. 1,xz�..p5+2 Fes, NO 44t ABB al AP 6 0-1 CA : , t" , � Wisconsin Department of Industry SOIL AND SITE E V A L U ATWN - 9 1 5POR T Page 1 of 3 Labor and Human Relations % ' ... '- kd Division of Safety & Buildings in accord with ILHR 83.05 � m Ode � UNTY Attach oomplete site plan on paper not less than 8 1/2 x 11 inches in siz musfe, but _ t . Croix not,liritited to vertical and horizontal reference point (BM), direction and ° Qf lope, scale o r 2 00 EL I.D. # dimensioned, north arrow, and location and distance to nearest road. - -- ndin , D BY DAT 1 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATIdI 1GE D(_OS 3� PROPERTY OWNER: R ION Derrick Const. , Inc. - 114,S T N,R R H(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # C D. NAME OR CS M # 1505 Hwy #65 38 na Brushv Mound Lake CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE QrOWN NEAREST ROAD New Richmond, WI. 54017 715) 246 -2320 Richmond 140th St. [ New Construction Use be J Residential / Number of bedrooms 4 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft • Recommended infiltration surface elevation(s) 95.00 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material ol,twaGr Flood plain elevation, if applicable n ft tU= uitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK nsuit able for stem M S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ® S ❑ U El [RU ' SOIL DESCRIPTION REPORT �� I Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I .................. ................. .................. 1 1 0 -10 10r2 •17 2 10 -20 7.5 r 4/4 none •14 • Ground 3 1 20-96 7.5 r 4/6 none • } dev. 99 ft. u Depth to .limiting fact 9S- o � og Remarks: Boring # A 2 8 -17 10 r 4/4 none sicl 2msbk mfr CrW if .4 i.5 •`� Ground 3 17 -33 7.5 r 4/4 none scl 2ms elev. 4 33 -96 7.5 r 4/4 none is osa mvfr na na .7 . .8 9 8.4 ft. Depth to limiting factor +96" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. A New RichmoV, WI 54017 Signature: ��`' Date: 6 -21 -2000 CST Number: m02298 PROPERTYOWNER Derrick Const., Inc SOIL DESCRIPTION REPORT Page 2 of 3 I, 4 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourdwy Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ` rerxh 3 1 0-10 1 2msbk mfr Cfw 2f .5 .6 .2 10 -24 7.5 r 4/4 none scl 2msbk mfr 9w if .4 .5 � Ground 3 24 -96 7.5 r 4 6 none cos 0SCI ml na na .7 .8 elev. !� 9 9.0 ft. Depth to limiting factor +96" Remarks: Boring # 1 0 -9 10 r 2 2 none 1 2msbk mfr if .5 .6 4 f .4 .5 Ground 3 18 -24 7.5 r 4/4 none scl I 2msbk mfr if .4 .5 elev. 0sa mvfr na na .7 .8 98 ft.:, . 4 Depth to limiting factor +90" Remarks: Boring # 1 0 -24 10 r 2 2 none 1 lcsbk mfr 2f .4 .5 2 24 -38 1Qyr 4/4 none sil 2msbk mfr gw if .5 `: .6 .� Ground 3 38 -90 7.5 r 4/4 none cos I osg mvfr na na .7 .8 elev. 9 8.8 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gar; L. Steel Derrick Construction, Inc. 1554 200th Ave. tSTM2298 SW,NW4 S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #38- 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 vas cmducted. N ." 1 11 =40 1 BM.= top of 1" pvc pipe @ el. 1 00.D , Alt. BM.= top of 1 pvc pipe C el. 98 80 n�, PU h loo 2 s- Gary L. Steel 6 -21 -2000 Better Wa y! &U - S k y mo,,wL MODI ser .x76 =II" ♦ tic L ouvers KOPM " t� sidevr ♦ .S'id Very � ed u'Unasked Provides 'blective is we leaching the amount , nmed to provide an o ' Its design spillar ma n } n l o allow efflu M and SP d actin via S P E CIF IC -hiev b d irec tion °"' C�IT�� Y c ornbinin This has be �n8b�et S`la�py� r: r �Om with a sell S the tra ditional U10 nal, oh.._.._.....76- ` ., tow Pry Unit went inside the of louvers alo Pen I afore the tta t he Sides. Wh..... .....34- L�9th .......76- design lmh of each to uncomp Height ..........14- ' ..... 34- .om�cted t° allow effl #ode. The l��, �nvert ...............9- Hef ght...........11- ratis�g Into 1cfi11 while pteven into the Bi°p�hirt��. Invert ......._... �aMber. 8 #from o1 �r�d and of a U m. wt� fir ed or 17- sue, h �. withstanrJ H- 10 HID ver factors 3t, t POWTS OWNIM'S MANUAL. & MANAQBIENT PLAN Papa I of MO M AATM SYSTm l!°ICA TOON6 Pent i Sapdc Tank Capacity a5� O NA `;Z o 3 septic Tank Manut —I IIII 0 NA L ��s �s l �« Ef luent Flow Mnwfacttmrsr 0 NA [ Number of Bedrooms 0 NA Effluent Fi11r Model A p � j 0 NA MAnber of Public Facer Units O NA Pustrp Tank Capacity � ❑ NA Design Estimaesd (tour tavaraps! O� Pump Tank Marwfactwer 0 NA flow 1peslti. (Estimated x 1.5) Pu" Manufacturer 0 NA gaUdav Saoif APPOcation Rate t 9swavifie Ptan m 0 NA standard In Quality (Monthly average Posting" Unit 0 NA Fats, CM & Greaft (FOG) 530 mp1L 13 Sendl ravel Fiber 0 Pest ifker &ochemical Oxygen Demand toot)j 5220 mg/L O NA 0 Medwrtical Aeration 0 Wetland Total Suspended Sorrds (TSS► L 5180 P"p& 0 Disinfection 13 Other. Pvetreated Eflkient Quaky Mond* aA►erege Dispose CeMB) O NA Biodternie:M Oxygen Demand t800 S30 mgA WW- Ground {ww*yl 0 M- Ground iDruegurized) Total suspended Solids (TSSi S30 mg!(. 0 NA 0 At -Made O Mound Fecal CWiterm igsomobfn +Wert) St0` ciWtooml 0 Drip -Line 0 Otter: Maximums Effluent Partible Sire % in dis. 0 NA Other: 0 NA othill 0 NA orfw: o NA • yroMIS tyPicel for donnasRic westewatw anw wptic tank alMuaru. Oaten: 0 NA MANMREMAMN SCHOXAL mertrk Event Service Fisipisiny / t condition of tankis) At least once every: s a 3 �) 0 NA Pump out contents of tenkls) When combined sludge and scurn squab one - third Uhl of tank volume O NA ktapect disposal col ta) At bast once every: 13 Y 31rws) 0 NA (lean Offuertt filter At least once every: � 0 scour ifs) O NA In spe" pump, pump Controls & alarm At least once every: 0 monthw O NA Flush (iterate and pre"ure test At least once every: mo tel 0 NA 0 At best once ewrY= 0 mon"s) D yawliq 0 NA t)efer: 0 NA MAEIITENANCE INS I LWTIOW Of tanks and dispersal Gags shaN be made by an wmkvkkW caff"V one of the foNowklg Noenses or certifications: Mastw Pkwd)Sr. Master Purnber Reaericted Sewer; POWTS kuspector. POWTS Mairrtaer. Septage Servb** Operator. Tank in F - w oonB mu st isnolm % a visud inspection of the tankts► to kkw& ihr MY rrissing or bnrkan hardware. identify any cracks or leeks, maeMtare the volume of combined Mudge and scum and to check for any back up or ponding of ef►kmm on the ground surface. The dWP"aM COMB) She" be vi uWV inspected to check the effluent busle in the observation pipee and to check for my pondkug of Willuertt an the ground surface. The port,&IS of eft Went an the gro" surface may indicate a tadb g nor ditior+ arid'rsgree the if In I di to notification of the focal regulatory authority. When the condoned accunxilation of Mudge and arcs+( in any tank squats one -third 1%) or more of the tank volume. the entire contents of the tank shaN be ren ived by a Septags Servicing Operator and disposed of in accordance with diapter NR 113, Wkiror►aln Administrative Code. All otter services. including but not Nrr to the servicing of stffuent fikem. rnecharacM or presonued components, pretreatment unfit, and any swvick* at intervals of 512 months. Shan be performed by a co Wied POWTS Makttaatiner. A service report shah be provided to the local regulatory authority within 10 days of Completion of any service event. GMW (4/01! i �T�* . 1 th at may new �' Prior to use . of the p tw u�n" da fitment tanks! for the System shag not kV Operator Prior t . ra8fsl. tf detec or hontert W Power outages pump t are frozen at the irrfiltrativa surface. Y /ill nw W effluent. To avoid s► k"M dose, Overloading the th Power is restored the power to the effluent pump or the OO � ^ ts of the pump tank�y end may reakrlt in the eaosas Wastewater win t restore levels within aCt a nail by a or surfaC41 dam rnd the PUMP tank. Plumb or POWTS Maintainer to saki ?apt Bator Prior to c Do not drive or Park vehicles over tanks and rnanuagy opsratlrrg the Pump t co n t rols within 15 feet down abpa Of MY mound or m�Persal cabs. W net drive or park �, O r Otherwis dish or a4amption eler�� of compact, the from soil Reduction a S: k �: baby wg� a wastew stream area drain { Oondorns: cotton improve the performance and Prolong the We of Me aunt ng st > tP) water; fruit and degra�ra, den AUNDO Y R+rPkJns; tar softener b ; trarbk - ""*t t�ta( o Water When the es fa and/ i h and d saf ils r le Permanently taken out of service the ely abartdonad in compliance with fOa O f ""'rg shall chapter Comm 83.33, W be taken to insure that the system is • AU Piping to tanks and Pits ahab be disc Adrninistrative Code: e or�cted and the • The oonteats of ell tanks removed f Pits shall be rem and ° sealed. After pumping. aft tanks and pits s by a Servicing Operator. �' N artier inert solid material . exc avated and ren and or their. covers removed and the void apace filled with If�mS� and cannot be fePaired the toNovring measures have been. or A mast be taken. to Provide a code compliant the _ re p la cement area has been ev may be utilized for MKdred k ° should be pratac�tst}a n disiurbar sand Madan of a t golf f rom WdKing and Proposed result in the need fora ahvoture, let lirrsa and t should not be infringed y with the rules in effect at that Sift time. anon to establish a aeritabia raplaeart arer area will O A suitable replacement area is not available � systems must e a holding tank may be installed as a last to setback arvdlar sob lentations. CJ The site has not been evaluated to idea fesort to replace the UNed POWTS. Barring advances in POWTS May be inSta"d � � failure mmsd to locate � � � Upon faure of the POWTS a soil and ate resort o ovate the faded POWTS. rVincernOnt area is available a holding tank 0 Mound and ai -meads sog may e W ARMW$G Mace. absorpt � systems p removM of the 6iomm at the 3EPM, PUMP AND rule in effect at that time. p � MAY CONTANI! LETHAL PMM M THE FOR OF A TAM( MAY ME DWF MT ANY � DEATH OxYti� *. DO NOT 1AL TSJLT OR RESULT. RESCUE OF A WT'S TAii Name POWTS MANTANIN9t Phone « S Name Ta i m O�Raroft { Name LOCAL R tATORY AUn#aR"y °hone Name, Phone lS Wcunant was drafted in conWosr Cogan 83 . 22 121fb)i1 )1"1q end 83 chmpter 4 M. f21 A 131. Wlscoruin A**"bative Cods. co:\, lc ST CROIX COUN TY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ,D Owner/Buyer i C b 4 .p• E L �..LA �r f; Mailing Address _ I Qb" 1 1 I b Tot `�- , V6 Pi C.N nn.d t& N , \^/I 5 11 Property Address _ti 5 '�d t "o �OT4 (Verification required from Planning Department for new construction) City /State _ �� ��/ V-1arcel Identification Number to - 1 f :3 _ �' C • �� �) LEGAL DESCRIPTION Property Location Sur %., %,, Sec. T N -R W, Town of Subdivision t c. &rt - GIN ( I"E . Lot # a) � Certified Survey Map # , Volume Page # — Warranty Deed # _ 60 1 '+P 5'x'3 . Volume _ g . Page # (57-0 Spec house 0 yes )Kno Lot lines identifiable Kyes 0 no SYSTEM MAIN'T'ENANCE 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, journeymanpbimber, 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE 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 property described ove, by virtue of a warranty deed recorded in Register of Deeds Office. tLA.. 0 SIGNATURE 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 |i U l8 8 8P 0 2 0 . smas BAR cn WISCONSIN FORM x 1998 WARRANTY DEED REGISTER OF DEEDS m""="."="= , ~^ ~'~^~ `~'' ^^ RECEIVED ron naconn � D� a ^'''^~` -- 05'10-2002 9.45 AN Wisconsin � � WARRANTY DEED ---�-� ^.°"`",, EXEwPTx '^^' mw �� '- : 1a�.mm COPY FEE: --- � � -�--- -- --------'-- �-�-� u rso` - _--- --��--��---���--�---- ^�"`=� p^sss' / c��^ to: ^"�'ab+ ^m warrants to Grantee the followin ,'"/°`.".,."_ St. Croix --�__c""mv. State wm""""" � "=" and Retur ^dd°" � First National Bank of New Richmond � Po Box 89 Lot ��irty-ei . plo� of in the New Richmond, WI 54017 � t of 8iuho nd. St. Croix County, Wisconsin °� � 026-1126-38-000 �~ U �0 V �� � Pa — Number (PIN) ^� This is not ^=""".eauprope not) Gruntoc. Brushy Partners LLP a giau000io limited liability partnership, is on affiliate of Derrick Construction Co. Inc., a Wisconsin corporation. Grantor develops land and Derrick Construction Co., Inc. is u home construction contractor. Grantor to sell this lot to Grantee on the condition that Derrick Construction Co., Inc. will be the builder of the home for Grantee, If Grantee does not commence construction with Derrick Construction Co., Inc. as the contractor/builder vldzio two (2) years of the date of sale of this lot to Grantee, Grantee give, Grantor the irrevocable right to re-purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. If Grantee desires to sell the lot to another Fmcchaacc before constructing u home upon this lot, Grantee gives Grantor the right of first refusal to re-purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. c`° Dated this 2 nd__- da ,/ 'lay �-�'_-_�__�- (sc«u /�`�\���_./���___-__mc»u Ron�jrid L. Derrick osx� (SEAL) '-mich.ae1_R'_Stev_ens_---------- «oTusmT/cAr/nm *cxwo*ccocwomT sm,e of Wisconsin, �-- ---�----�------- St. -[rOiz-_- Count ) authenticated this __---day u-__---___-_'�___- Pe ca bef _ _ '- __ ( lay of May —, 002 the above narned Michael R, Stevens and Ronald.L. Derrick, as Partners of Brushy Mound Pa_rtners_, w nn's. MEMBER STATE BAR orWISCONS --------__--- x"".. ��____�____ �__� me known ."bethe. ,°°""-a_- who executed 'hem°9o'"o ""m=.zouv'9mo na w.`a^u) jl,�cknovde(: r".swx,nvw*NI WAS DRAFTED o` -~---'TVstx[D UZE/ -- Brushy Mound Partners . Notary Public ro�ox�449- -- �-----'---- --------- x".",,p..m^a"°.,,Wisconsin ~`~'~ ~' '''~—'-` New Bichnomd, WI 54017 w """m.o"," ^ �""iarmi'_ (x not, state "",.w."" ./"u 2UO6 �-' '��*—�"�� -- ^-� k������ _�g���Z6� � m °"`""`' '""�""~' ��" " �--- --�--��-----� ,cc°�r � mxv^m,o,c» , �\���� oy =^~"����� � �� .�. 8 o ill C TG � s }: 4 �e�AS 4J01► t' ' $ c v �O 7 5 11 o ¢'U c k ' 1A u •1°"' �p w z y, y v w 'o s., f. c� bA R. cn rn o N 0 to D •.. U G 41- - w N � ° � aD � �°J o pip � � � co 6b Q a. • • • • +V ��- • • • • • 0 V574Y AofOUNO LAKE - Sek 1—, /4• a 30 to. Red wl 1 Located in part of the SW 1/4 of the NW 1/4, part of the NW 1/4 of the NW 1/4, eare 0/ 4n d. port of the NE 1/4 of the of the NW 1/4, the SE 1/4 of the NW 1/4, the NE 1/4 a Sot V . 94• Rmn n garde Pw of the SW 1/4, part of the NW 1/4 of the SE 1/4, and port of the SW 1/4 of the a nirtm m of 1.13 e1ed fat NE 1/4, oil in Section 1P, T30N. R18W, Town of Richmond, St. Croix County, Wisconsin. nain. o Fa.a r iron ripe NoM wE FA%Ms SIOMI ON IM MAP ARE > AMM 10 STATF. OOlJ11TT AND lONWr • • • Buldw WIND& Lkw (100 Fran R.O.w.t LAMB IIUTA! ANTI REOIlLA510N5 E MEaMA!< PARC CO ACT 1M !To PMiA, .. �- Orlv..ay - (7 � wuf�) CEMELOPING LNilo M T1APPNOPItlAS 10NIOOMIOPoR AaYKL AE Sr. Oqx CO{N1Y p ... — Dawkn Orairwee iawrralb Flail PIN Bamday E C ky of Mw MdmaK Drtal 0.4 -e FF]lA crepe pw !L Qa6i Caudy Dww" wdlala OTf k4 ML E. High wdw L iaaaaai Ml N. L Hlyi wstw lire pM INA h00 tan R.O Q wwft= « I AL AL ALL L AN elm ,&�. 1i 2 2000 if µ n „op �; •• _ :... - '1t! OEAro6k IJ�IE•'•..., Sr (" ROiX ty3aB9 Ia Fr COUNTY M ACRES ts' . - .... 2pNINGOFFiCE 87 101 lee& BD. rT. AREA 1a aim m' ACRES • Me s A 00.710& B0. FT. >R FT. 9 Z A,FA nw UM ACES f .•• 1r 1{111' EArtMNT. L Lor so 74.100 SM FT. T ds a'`T�J'9� faxa. . l�E. AREA 10 ,SANDER k0E` • E• 1M� `' �� �- �® .CRES 69-B5 B4 ". o 10011 uxg IM ACRES �— im Mw try LOT 44 IM ACRES ,���,• T0111L ARFx � i �/ / . ..... K 5 F.F.E. N16.0 j Q T 2 Q ' e WAL AREA: 1 4 •�~ TOM AREAc Q H.W.L. i / I //� FT I MIN Ma I 1.114 M71ES •• �'ti F.F.E. Jl N 1rE fflSS �s LOT 4S // 1 / / I SSE - -- / M910 ARFJL H wE as o 19.007 RE FT. \� FF QKO '' // , / ;'L O T 27 fl4T ............................. / / : TOTAL AIM M713 54 FT. Kw£ MIZO FF� MILO WE 104.73• / ,' \ TOTAL AK* IM ACRES ` _ O MNMr 44'E 194.714 O / _ i \ F.F.E. "ILO MALL '• •' ............; .................................. H.w.E 987.1 Lor TOM ME AT a n' L o r O ��� '6 L o r. 9 1 97 A ^ 18 =A�s. FT. SK L 0 SO. FT' F.F.E. 0047 F.F.E. 901.1 \?. FF£. MA \ 71l !I1! Q•' lIL S'e' 7 f � AB AnF 1 • • F a 343.55' 382 yy' / /Y M w a rae 1973 w1' CWHIC SCALE — — $OY�4 — - 130dl2'- — — SCALE N FEET: i bKh — 100 fact ' BEARINGS ARE REFERENCED 70 TIE TOM 1111E OF TIE NORTHMEST aJARTEH OF SECTION T$ L3w1., R.1BML WOW 5 A091 M 70 BEAR NW'47 AI O U N Y }l�d.AlLlt D =<. � � OL.OBAL POS,10rww ars1E71 NETWORK MONUMENTS. A K E SHEET 1 OF 4 SHEETS