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HomeMy WebLinkAbout026-1053-20-000 ,iscrnsin Department of Commerce PRIVATE SEWAGE SYSTEM c ounty: St. Croix ,Safetyrandt- tAding Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515141 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.16.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, William K. I Richmond, Town of 026- 1053 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16 �A& ( 18.30.18.274E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I, 71 / Benchmark Alt. BM (� u Aeration — 3 Bldg. Sewer Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet � 74 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 17.0 '7.3 S Se tic `5 Z t Z f Dt Bottom �d Coe/ L SJ•5 Dosing 7 / '93 / 2- / / Header /Man. �` Z Aeration 7/L10 / � 3 � Z � ` � � ---, Dist. Pipe -6 7. - Holdin Bot. System O•q I S• a � Final Grade PUMP /SIPHON INFORMATION A Manufacturer Demand St Cover 6 ` GPM � �- ,� I — y /b✓. 75 Model Number /� 6� rt0ti / TDH Lift Friction Loss System Hea TDH Ft 26,25 0.74 A' . Z/ r 03 Forcemain Len gt Dia. �� Dist. to Well / o z 53 SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length i / No. Of Trenches ( PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 01 rf SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: 1 /� INkORMI�TION CHAMBER OR 1 elYl Ty pe Of System: 73�✓ UNIT Model Number: DISTRIBUTION SYSTEM S 2 3 d'o ZZ bt.ADa,, `/S Header/Mani fo� / / Distribution x Hole Size I x Hole Spacing Vent to Air Intak Lengt Dia Length Dia Spacing ` 3 ���- � SOIL COVER x Pressure Systems Only xx Mound Or At - Gr ade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched G Bed/Trench Center 3 , S Bed/Trench Edges ` Topsoil 'S vas Ej No -- TS<es [D] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / /Of Inspection #2: / / Location: 942 150th Av New Richmond, / W 54017 (SE 1/4 SW 1/4 18 T30N R18W) NA� Lot j 3 Parcel No: 18.30.18.274E 1,) Alt BM Description = ✓ �� �." ~ It bj " / " " ` Q 4 n �•�-"' 2.) Bldg sewer length = L v� - amount of cover = �." �, �-�""`-�► �� �if/�- / Plan revision revision Required? Yes No T Use other side for additional informatio Date Insepctor's ignatur Cert. No. SBD -6710 (R.3/97) _ J $ PAID R CYO- e�,-�- aammem o vw.griv and Buddha Division county 201 W. Washington Ave., P.O. Bolt 7162 SOP S ✓Q �' S� . sin Mtldtsott, W. 53707 -7162 Sanitary Permit Number (to be i3ped is by Co,) Stathuw;c7finn Sanitary Permit Application T In acmWence with a. Comm. 83,21(2), Wis. Adm. Coda, submission of this form to the appropriate gave mne" unit h rwptired prior to nMaining a sanitary permit. Note: Application fetrrts for state -owned POW'fS rte Pj*°a Adhm (N•illabra" Atom mailing addreae) submitted to the Department. of Cmomerm. Personal Wbrntuion you FWf&LzM OMIKY in accordance with the Pti Law s. I S. 1 m Ste, Ct V 1 � If� GU2 e 1. A lest lea IafornMen - Pleaee Prhnt Ail t fl � ' 77 Property Owner's Name SEP 112009 Panoeld G- ioS3- as - a �d 4 11 Properly Own is Mailing Address Si CRUIX t; UUN ► Y Property Loom" L / , ,� P� jl PLANNING & ZONING OFFICE � lac City, State Zip Code Phone NUtnbor s'� y,, �'� 'A, 3octint / foww o* � /o �7 gat# 3 3 d �3 T 3Q It R 1 CiE U . t a Bn1lWA08 (Cheek all that apply) Family Dwelling •- Number of 8vftamGD ? Svbdivbtioat Name Publie/C mmereiel - Describe Use City of State Owned •- Describe Use CSM Number a l 3 Yilltgle of 2 Toaotof Ill. Con lice B � of Peni tt: Cheek se ape box ea liar: A. plate trppilcttble) '�Y A New system R eplaceme nt Ttawrrtrm *MWjt Tank Replacement: Only OttnxModUiotiam to 13xhttir� n (explaat) 4ysaem — R. Permit Pemtit Revision Change of Permit Transfer m LiW Pt VMW Permit Number r� and I»a bsued Renownt Befbm Plumber New Owner Par raUM Q r IV. of -rOWTS S ot/Devttx: Check all that Plop PrG+srudaed In O nd Press<uiae d Ind3round AtA Mound? 24 in, of subaMe emit Mound <7A in. of auinrble soil Flolding Tank Otter Dispersal Corttponent (explain) �]Prelttatattatt 1kf1'La+(e°tplain) V. er selfri na tmest Area xafotrna doer. 1 Anx ( gy Boll A i ion R Disposal AM Requited (� Dimp" sign Flow (gpd) I?eatgn So pp1 Let gPds�, Vi. Task iafo L'apecity in Total iR of Irlar Mtttetal halloos Gallons [Snits New Tanks Existrng TetkR n r , Septic or linlding Tank x 2� X 1A G e d Dosing ehuntrer tlflr grgatiatfon of the PriiV'f8 tt]tmwa � Vii, ResPOWNiINty Statt*#tient^ 1, the edr an„lpgt phnnller's Name (Prlatl a y- 3 em City, State 7' X/ LC 's Addtt� Street , .M Cob) Pinmber ( ty, .47 :5 - c: r�,lei s�o i YnL COs PQC t Use O Permit 1?aCe lasted taepi Si r!�lA' mar r Dowel s 4 „ / �Y 4175 M. C Mditbaa of pops for Disapptnpvrt) � 1. Septic tank, effluent filter and dispersal cell must all be services / maintained <- p as per management plan provided by plumber. S I - f / 2. All setback requiCements must be maintained __ _ �_ syAtsar and saMaiM a rue Cgraty s"t! w sat Ma GW s t t t 4se Spt)-6998 (It. 01W) Valid thni OU09 �l 1y, �/. fie h,� ��o.� .cam' 3 e f caE�e �YG 19j'l� 10�o F F &4 11 , IxS D .c /ono ���r•� a Ay l7c�copy �Ui'l�l.' ae l�l �4 iJ.d �`'or1 /�a/ 3 e �!✓L DL�J.d D Oi i 4 /Y zo 7U7� D ? o 0 e- O a r Qc; a P sconsin .� S EVALUATION REPORT #1616 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 6 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 026- 1053 - 20-000 . )L G Please print all information, evi I Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner RECEIVED Property Location Johnson, William And Nicole Govt. Lot SE1 /4, SW1 /4, S18, T30N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 942 150th Ave AUG 31200 3 CSM Vol 3 Page 789 City State Zip Code 3 i PMpA"Ogr, ❑ City ❑ Village ❑ Town Nearest Road New Richmond WI I 540 NNIN¢� Richmond I 150th Ave ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe �� 2 Yt�c L 7�1 7 16:2 Parent material Outwash Sand (Burkhardt Flood plain elevation, if applicable na tt. General comments and recommendations: Area is suitable for a conventional system with a 0.7gpd /sqft rate. The system will need a lift pump. Possible system elevation is 98.8'(high trench) 97.7' (low trench). _ h am / h �j 8/0 �QyLS ❑ Boring # El Boring 2zt ❑ Pit Ground surface elev. 99.33 ft. Depth to limiting factor 38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3 /3 none sil 2mgr mfr cs 2f .6 .8 2 11 -19 10yr5/3 none sil 2msbk mfr gw 2f .6 .8 3 19 -38 10yr4/4 none sl 2msbk mfr gw if .6 1.0 4 38 -64 ,J 10yr5/3 m2d 7.5yr6/6 sil lmsbk mfr - - -- - - - - -- .4c .6 7.5yr6/2 2] ❑ Boring # El Boring Pit Ground surface elev. 99.93 ft. Depth to limiting factor 105+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3 /3 none sil 2mgr mfr cs 2f .6 .8 2 7 -22 10yr4/4 none sil 2msbk mfr gw if .6 .8 3 22 -35 10yr4 /6 none grsl 2msbk mfr gw - - - - -- .6 1.0 4 35-47 10yr5/6 none s Osg ml cs - - - - -- .7 1.6 5 47 -68 10yr5 /4 none grs Osg ml cs - - - - -- .7 1.6 6 68 -105 10yr6 /4 none s Osg ml - - -- - - - - -- .7 1.6 Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s mg /L and TSS < 30 mg/L CST Name (Please Print) Signature: r CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 8/28/2009 715 - 247 -2941 SBD -5330 (R.07 /00) Rroperty owner Johnson, William And Nicole Parcel ID # 026 - 1053 - - 000 Page 2 of 6 a Boring # Boring pit Ground surface elev. 102.03 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3 /4 none sl 2msbk mfr gw 2vf .6 1.0 2 6 -18 7.5yr5/6 none grs Osg ml cs if .7 1.6 3 18 -22 10yr3 /3 none sil 2fsbk mfr gw 2f .6 .8 4 22 -31 10yr3/4 none grsl 2msbk mfr gw 2m2f .6 1.0 5 31-47 7.5yr5/4 none Is lcsbk ml gw 2f .7 1.6 6 47 -110 10yr6 /4 none s Osg ml - - -- -- - - -- .7 1.6 4� F Boring # El Boring Pit Ground surface elev. 104.13 ft. Depth to limiting factor 107+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sl 2fsbk mfr cs if .6 1.0 2 8 -13 10yr4 /4 none grsl 2msbk mfr gw 21' .6 1.0 3 13 -25 10yr4/6 none grls Osg ml gw if .7 1.6 4 25-42 10yr5/6 none grs Osg ml gw - - - - -- .7 1.6 5 42 -107 10yr6 /4 none s Osg ml - - -- - - - - -- .7 1.6 Boring # Boring pit Ground surface elev. 106.43 ft. Depth to limiting factor 116+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 none sl 2mgr mfr a 2vf .6 1.0 2 4 -12 10yr4 /6 none Is Osg ml gw if .7 1.6 3 12 -116 10yr6 /6 none s Osg ml - - -- - - - - -- .7 1.6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <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 alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD - 8330 (R.07 /00) Schmitt Sod Testing, Inc. Property Owner Johnson, William And Nicole Parcel ID # 026 - 1053 -20 -000 Page 3 of 6 F Boring # E] 6] Boring Pit Ground surface elev. 102.93 ft. Depth to limiting factor 102+ in. Soil Application Rate Horizon Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3 /3 none sl 2mgr mfr cs 2vf .6 1.0 2 9 -20 10yr4/4 none Is Osg ml gw if .7 1.6 3 20 -34 10yr4 /6 none s Osg ml - - -- - - - - -- .7 1.6 4 34 -102 10yr5/6 none s Osg ml - - -- - - - - -- .7 1.6 U. 1 �r tt 7] Boring # Boring Pit Ground surface elev. 98.18 ft. Depth to limiting factor 93+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /4 none sl 2fsbk mfr CS 2m,2f .6 1.0 2 8 -16 10yr4 /4 none grsl 2msbk mfr gw 2m,2f .6 1.0 3 16 -31 10yr4/6 none Is lcsbk mvfr gw if .7 1.6 4 31 -93 10yr5 /6 none s Osg ml - - -- - - - -- .7 1.6 8] Boring # Boring pit Ground surface elev. 95.55 ft. Depth to limiting factor 96+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10yr3 /4 none sl 2fsbk mvfr cs 2m,2f .6 1.0 2 7 -15 10yr4/3 none Is lcsbk mvfr gw 2m,2f .7 1.6 3 15 -19 10yr3 /3 none sl 2fsbk mfr gw 2f .6 1.0 4 19 -28 10yr4/4 none sl 2msbk mfr gw 2f .6 1.0 5 28 -37 10yr5/6 none grsl 2msbk mfr gw if .6 1.0 6 37 -60 10yr5/4 none grs Osg ml cs - - - - -- .7 1.6 7 60 -96 10yr5/6 none s Osg ml - - -- - - - - -- .7 1.6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <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 alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -8330 (8.07/00) Schmitt Soil Testing, Inc. Property owner Johnson, William And Nicole Parcel ID # 026 - 1053 -20 -000 Page 4 of 6 F91 Boring # Boring P8 Ground surface elev. 95.83 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 1 0 -8 10yr3/3 none Sil 2mgr mfr cs 2f .6 .8 2 8 -15 10yr4 /4 none Sil 2msbk mfr gw 2f .6 .8 3 15 -31 10yr5 /6 none sl 2fsbk mfr gw if .6 1.0 4 31-46 10yr5 /4 m2d /8 7.5yr6/2 r6/2 A 2msbk mfr gw - - - - -- .6 .8 5 46 -85 10yr5 /3 m2d 7.5yr6/8 sil lmsbk mfr - - -- - - - - -- .4c 6 7.5 r6/2 F io - ]Boring # E] Boring pit Ground surface elev. 92.15 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10yr3 /3 none sl 2msbk mfr cs 2f .6 1.0 2 12 -28 10yr4 /3 none sl 2msbk mfr gw if .6 1.0 28 -52 10yr5/3 m2d yr6/2 / 7.5r6/2 8 Sil 2msbk mfr gw - - - - -- .6 .8 4 52 -82 10yr5 /3 m2d 7.5yr6/8 Sil lmsbk mfr - - -- - - -- -- .4c 6 7.5yr6/2 ❑ Boring # Boring F] pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS <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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 100) Schmitt Soil Testing, Inc. Page 5 of 6 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: William and Nicole Johnson Thomas J. Schmitt, CST 227429 Address: 942 150th Ave. 1595 72nd St. City, State, Zip: New Richmond, WI 54017 New Richmond, WI. 54017 Phone: 715.247 -2941 Subd.Name: CSM Vol 3 Page 789 s; — A Vr . Lot No.: 3 Date _. eq / �—?R / Legal Description: SE l /4 SWIM S18 T30N RIM ■ Backhoe pit Township, County: Richmond township, St. Croix County A Bench Mark El. 100.00' Top of 2" pvc pipe A Alternate Bench Mark El. 104.43' Top (center) of air conditioner unit Slope= 14% Scale I"= 40` /Vo Pr.,04, Z'Wa / A 7r 4 1 98 ,Y � 7/?Cvc4 9' 7o X t� 7` a/ GM -9{ All j. _ w T x y f3 f t l! k i t 0 00 y ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer //: _Mailing Address _ �'�� /, z> R.- c- e ` J toff Property Address _ � 4- - (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number /'5,;7 e�. - l4 LEGAL DESCR Property Location 1 /4 , �Cy %a , Sea �_, T 3Q N R /,? Vlr, Town of /F. ` C ! Subdivision �___ _ , Lot # � Certified Survey Map # , Volume Z , Page # 8 Warranty Deed # �/3 T T. , Volume ! G ',? 0 , Page # S ,2_____ _ . Spec house yes 60 Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - at. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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. Ihve, 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 Planning & Zoning Department within 30 days of the three year expiration date. L /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 above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of 4edrooms _ — ///, /,�_ a ;./, - I/ I I / P17 IGNATURE JQVP LICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL, & MANAGEMENT PLAN Page of FILE INFORMATION X JTT SPECIFICATIONS Owner .lr:ae fn �o�i,v p #RtiC Tank Capacity dal ❑ NA Permit # Septlp Tank Manufacturer l.�J�G�/ ❑ NA DESIGN PARAMETERS effluent Filter Manufacturer ` ❑ NA 6000 , Number of Bedrooms N,t~* fflusj nt Filter Model �`."' ❑ NA Number of Public Facility Units Q NA Pump Tank Capacity g p R al ❑ NA Estimated flow (average) p p I d Pump Tank Manufacturer W ie- S @- R. ❑ NA Design flow {peak} (Estimated x 1.5) i Pum Manufacturer G © Vl` 41 ❑ NA Soil Application Rate dll If Ifuin p Model ❑ NA Standard Influent /Effluent Quality Monthly aveispl3" Protrostment Unit ❑ NA Fats, Oil & Grease IFOGi 530 mg /L Q Sono. /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD i 5220 mg /L Q NA Q Mechanical Aeration ❑ Wetland Total Suspended Soli (TSSi 5150 mg /L CI 0.1slnfection 11 Other: Pretreated Effluent Quality Monthly average Qis*,sal Cell(a) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L 0 In4rqund (gravity) ❑ In- Ground (pressurized} Total Suspended Solids ITSS) 530 mg /L P NA Q At -grade ❑ Mound Fe Coliform (geom etric mean) 510" cful100ml Q prip•Irne ❑ Other Maximum Effluent Particle Size Y in dia. Q NA ther'_ ❑ NA Other LlthAr. N 1:3 NA A *Values typical for dornestic wastewater and septic tank effluernt Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency M month(sl (Maximum 3 earsi 17 NA Inspect condition of tank(s) A least pnae every. K years) — y Pump out contents of tank(s) — When aAl'1lbirled s1440e and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal .sills) At le oneea every. ❑ month(s) (Maximum 3 years) ❑ NA _ R year(s) _ �-' Clean effluent filter At least tins a eve ❑ month(s) I-] NA ry; r, _ Styearls) _ Inspect pump, pump controls &alarm At lea ❑ monthis) 13 NA lea s t , once ever ^—' ❑ years) —T ❑ months), ❑ NA Flush laterals and pressure test At least gngq every; ^-- ❑year {s) Other: At leash 0npel esu L7 month(s) C3 NA rY ❑ years) _ Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and disperse[ cells shall be made by an indwlr ual carrying one of the following licenses 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(o) Wa.Idehtify a missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum stall, to pbook for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to cheek the ffluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equate one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of offlueent: filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of s12 months, shall be performod by a Certified POWTS Maintainer. A service report shall be provided to the local regulatory authority Within 1Q days of completion of any service event. Page ____ of ..._.._... START UP AND OPERATION For new construction, prior to use of the POWTS chi ok #06jlrtfii►rlt tlihkja) fear the presence of p a intin g Products or Other chemicals that may impede the treatment process and/or da ;i high concentrations are detected have the contents of the tanklsi removed by a septage servicing ope6>Rllgt�_ `ullb System start up shall not occur when soil conditions Vii t of #104 �1EM itive surface. During power outages pump tanks may fill above its M,, b��� I 0t±>�I� r When Power is restored the exce wastewater will be discharged to the dispersal celltsl In one forged {g �� {�td may result in the backup or surface discharge of 1. effluent. To avoid this situation have the contenfs i � l 0 C *0 by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumbed ;1: 11IIY #d assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and lisp t* .i01fi a rk over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -gradt 00 '106all 060 o 00. Reduction or elimination of the following from the w# # IIfio fOoy. Ifnprove the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts / ai degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; frult and ve it ) l!f grease; herbicides; meet scraps; medications: oil; painting products; pesticides; sanitary napkins; ten flhd „ ►il { NII�h Trine• ABANDONMENT When the POWTS fails and /or is permanently taken 00 W4ng steps shah be taken to insure that the system is properly and safely abandoned in compliance with blf dElN! #i> 11 *401 V4{f�onsin Administrative Code: • All piping to tanks and pits shall be disconriilq W, Ahd Ir{IP I bl {lal tllfil pipe openings seated. • The contents of all tanks and pits shall be till ,4t1 ;la� 0 .0`nly d10pased of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be art# i'i3} gvoo or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the fcillipyirl' r� .I i)i ll hdvill b+�en, or must be taken, to provide a code compliant P i Wl+ ,. Ilia ., replacement system: A suitable replacement area has been evfil p it 4l 1 l {>fqq for the location of a replacement soil absorption p ttl system. The replacement area should b® I{ilp~1ri1CIlnlr compaction and should not be ihfringed upon b required setbacks from existing and propafi l 1 � 1 ,:. { 1' wells. Failure to protect the replacement area will result in the need for a new soil and site ev�lp,�llti�itt f'+YNl�1 iii #fable replacement area. Replacement systems must comply with the rules in effect at that time ❑ A suitable replacement area is not avali I! l 400 10 'li 00k fh0VQr soil limitations. Barring advances in POWTS technology a holding tank may be installed �Itllt r t Ilq CAP{ i the failed POWTS. 13 The site' as not en evaluated to identl sifi t.area. Upon failure of the POWTS a soil and site h d. �1 evaluation be performed to locate a if no replacement area is available a holding tank may b ails s a last resort to replace tbb �d 0 Mound and at -grade soil absorption systeri i .1 yi {fir t I �1 M in place following removal of the biomat at the infiltrative surface. Reconstructions of such ey % a rdUll }44 ►ly v Rh the rules in effect at that time. < <WARMING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS iWf' l ES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT . t, ; � STANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE �,, I � :, ADDITIONAL COMMENTS PQWTS INSTALLER TAiNER Name \ ip ab l S a �O.R.'R.. Phone '7 / � ­ 8 ^, J I -QJ SEPTAGE SERVICING OPERATOR 1PUMPER) t;ATORY AUTHORITY Name Phone rat — S(o — O This document was drafted In compliance with chapter Comm 800.4 (11111l O . ,$441), (2) & 431, wisconsin Administrative Code. J . SEPTIC TANK PUMP CHAM3 ON AND SPECIFICATIONS 4" Cl VENT PIPE 12 MIN. ABQY9 Q►.P 4 WEATHERPROOF THERPROOF JUNCTION BOX APPROVED >_ 25' FROM DOflR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK & 7. .:.,. ,.... WARN ING LABEL FIN ISHED GRADE FIN n �� RIS' 4 MI N 4 G I � ...� --- 19" IN. �6" MAX. INLET .,_, • . i ,' • WATER TIGHT SEALS iGHT i � APPROVED EAL WITH S JOINTS ALM APPROVED PIPE APPROVED ON 3' ONTO 'IPE 3' , SOLID Solt. )NTO SOLID RISER EXIT ;OIL n V . FT V.. OFF ELEV. OFF PERMITTED ON V. PERM IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BF, PIN SID + CONCRETE PAD SEPTIC / DOSE S PER DAY: T TANK MANUFACTURER: W e 1hl�Mpg DOSE .� ---- TAN SIDES SEPTIC %d /a GS_ GAL. A4 XQ,iME FLO{NBACK_._ GAL, DOSE �, ,,.,_. _� INCHES = y6 GAL. ALARM MANUFACTURER; A o! MODEL NUMBER: D t- B = 2 INCHES = � GAL SWITCH TYPE; i'r%t0.r - C INCHES = [_��GAL PUMP MANUFACTURER : � MODEL NUMBER: Rc� p INCHES = GAL SWITCH TYPE: q 0 GPM I'uMl AWM WIRING AS PER ILHR 16.23' WAS REQUIRED DISCHARGE RATE !� FEET DIFFERENCE B E PUMP OFT Xjp DI$TR1$UTION PIPE • • � FEET VERTICAL . + MINIMUM NETWORK SUPPLY PRESSURE - """9"' FRET + � FEET FQ CEMAIN X ;b� F" � I � R TION FACTOR . _ • = ��FEET f TI+ .A'NAMIC HEAD WIDTH r.•° DIAMETER --'_' INTERNAL DIMENSIONS OF PUMP TANK: LIr1'I'I �' ---- --- -- ������. �' 3 ,._. —g - ---- -• � � Cr,�L pert l �' ,f LICENSE' NUM0Iw?-: DATE: SIGNED: ino [QGOULDS PUMPS Submersible Effluent Pump EPO4 4 g ' 3871 EP05 1 -- r APPLICATIONS • Fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • for automatic and Homes Available superior strength and corrosion • Farms manual operation. Auto- resistance. 1 Cariadlm standards Assodaft • Heavy duty sump matic models include m Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical Float Switch • C .) • Dewatering assembled and preset at the for efficient heat transfer, In F or factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps is ISO 4001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1 /4 " maximum. ■ EPO4 Impeller: Thermoplas- N Power Cable: Severe duty • Capacities: u to 60 GPM. tic Semi -open design with rated oil and water resistant. Pa p • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40cC) continuous METERS FEET 140°F (60°C) intermittent. 10 _ _.. - .. • Fasteners: 300 series stainless sleet. 4 30. ___ _ -► �-sGPM • Capable of running - dry without damage to B zs Fr components. 25' ' ..... _ Motor, s _ • EPO4 Single phase: 0.4 HP, u 6 20 ___.... 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with 5 is _..: .... o automatic reset. a a _. 1 - EPOS • EP05 Single phase: 0.5 HP, c 115 V, 60 Hz, 1550 RPM, 3 10. built in overload with EPO4 ._. automatic reset. _ { • Power cord: 10 foot 5. t _, . .. standard length, 16/3 SJTOW with three ron - r grounding plug. Optional 20 ° .. ° 0 10 5o GPM foot length, 16/3 SJTW with three prong grounding plug 0 z 4 6 10 12 m) /h (standard on EP05). CAPACITY Goulds Pu ITT Industries ®2000 Goulds Pumps <& Effective February, 2000 83871 p YQI- .1630PAGF 528 644352 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED RE OF D EEDS This Deed, made between Quentin R. Boucher and Bar J. RECEIVED FOR RECORD Bou cher, husband a n d wife, _ 05 -02 -2001 10:30 AM — - — WARRANTY DEED - EXEMPT N Grantor, and W illiam K Johnson, a single person, CERT COPY FEE: COPY FEE: _ - TRANSFER FEE: 540.00 _ — RECORDING FEE: 10.00 —� PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the SE1 /4 of SW 114 of Section 18, Township 30 North, Range 18 Name and Return Address West, St. Croix County, Wisconsin, described as follows: Lot 3 of Certified Survey Map filed May 1, 1979, in Vol. 3, Page 789. !" �L 026 - 1053 -20 -000 Parcel Identification Number (PIN) This is _ homestead property. — - (is) Nxx) -- Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2 4/L^ day of April 200 „ + Quentin R. Boucher + + Barbara J. Bouch r AUTHENTICATION ACKNOWLEDGMENT ) Signature STATE OF WISCONSIN s) Quentin R. Boucher and Barbara J. Boucher, _ ) ss. husband a nd wife, -- _ - - - -- County authenticated this U day ot Ap 2001 - — Personally came before me this _ _day of the above named r Kris tina Og TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY — Attorney Kristina Ogland Notary Public, State of Wisconsin Huds WI 54016 _ My Commission is permanent. (if not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- -) LW + Names of persons signing in any capacity must be typed or printed below their signature. mto mason Protess c«nwny, t an 6 55 - 2. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1999 0 0 Er it CD 722 ; . >(k $ A / x: ° k 5 � ^ ` co3 §, ma) § \ 3' to 00, k G X33 #2) CL n } jC 0 �\ /2 § �d P }(D UI . N O O �D OOO o ! : \» ( O \% ! ` �7 a k °E•, ■ Ir &■ 7` ■ E 17 i QL � , ■ CL �" E D . § # ® IL J c - COD ■ & k M � � � ■ & ■ w � FORM NO. 985 -A� IAQMNI'.rCdprry® ...rem I I U ST. CROIX COUNTY 356548 SURVEYOR'S RECORD • • CERTIFIED SURVEY MAP 1 N I/4 CORNER _? R.R. SPIKE FOUND a UNPLATTED LAND w - 3o I I I LEGf?14D No N89 616.00.' 6 3 33' 0 1" X 24" IRON PIPE WEIGHING 00 583. t0 o 1.68' LBS. / LINEAL FOOT SET ~ p "" 0`' O U ` . - POND z o I I� o I 4.002. ACRES INCLUDING RIGHT -OF -WAY M M I w N 3.787 ACRES EXCLUDING RIGHT -OF -WAY N N APPROVED �o (Dv N 89 0 28'06 "E 616...00' �, I ALP R 2 6 1979 a v 583.00' I woo m -z 1 2 -- ST. CR•OIX COU:•1 w z N � � I 0 p o •o I at COMPREHENSIVE PARKS PLAN, -ii = z1 0 'n 4.002 ACRES INCLUDING RIGHT-OF-WAY I 1,0D I J AND ZONING COMMITTEE w Q Q I o 7 A CRE S EXCLUDING RIGHT OF-WAY N N W 78 A QHm Ji N 3. N 8 1 A- r"�.VHI of liiib Mi1v� K jUjUiVISION = LO 1"_'1 DOSS NOT MtAN APPROVAL FOR N 89 28'06 "E 616.00' I O1 I BUILDING SITE OR SEPTIC SYSTEM: , ►_- 308.00' 275.00 x = w o o .20. I. H62 z o 1 _J REFER TO SCALE IN FEET a� _J1 � IN a,. �� 0 200 400 I o I o I SE- SW 3 �0 4 I = 4.016 AC. INC. R-O-W � � 4.016 AC. INC.R•0•W �, �QI 0? 3.808 AC. EX. R -O -W M 3.386 AC. EX. R•0 -W " g 01 . x in to I- I to X ID 0 In 10 NT WAS DRAFTED BY SCOTT B. LOHMAN S Q THIS INSTRUMENT zz 1z, Owner & Subdivider: Richard Jones i C> R t. 4 c__c o New Richmond, WI 54o17 It °� NORTHERLY o S W 83.06' , RIGH_T _ W_AY_ LIN e 3 8. 275.03 1 POINT OF LINE- W 1 4 - 8 .19 - •00 � SI /4 CORNER ,= 308.00 BEGINNING S SW CORNER S89 06 W616.00 I SECTION 18 --- -- TOWN - -- ROAD - - - _--- - - -__- - - - - -- I P.K. NAIL T 30 N, R 18W 133 33 FOUND P.K. NAIL FOUND ----- LANDS I I DESCRIPTION A parcel of land located in the SET of the S4_,� of Section 18, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin described as follows: Beginning at the Su corner of said Section 18; thence S 89 W (assumed bearing referenced to the North -South Section line, bearing recorded North) 616.00' along the South line of said SW1; thence North 1134.00'; thence N 89 E 616.00' to said North -South line; thence South TT along said North -South line 1134.00' to the point of beginning. Subject to existing Town Road right -of -way along the East and Southerly sides of the above described parcel, as shown on the attached map. Containing 16.0356 acres, more or less. I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the St. Croix County Subdivision Ordinance to , the best of my professional knowledge, understanding and belief. 1 , < <�a00tN4'�r�� James E. Rusch 6 9 ,abet �4G de Wisconsin Land S - eyor 5 -137 Stevens Enginee , Inc. • 1409 Coulee Road -Box 321 �O FIL S JAMES E. '! :9 O Hudson WI 54016 MAY 1 1979 R 1 17& = J_ S- 1376 ib►AES 0 C ONNEL L River Falls, +� March 30, 1979 554 Crdx Core � Z� W �' 4e � e 1Z w110000A S < -l0 ee Volume 3 Page 789 �` 7, w k*" ��SUR4 %Iklw,se O ^' O G CD CD 0 G �� U (D d C/1 ID � O h O N cNi� 0 V O o O N �< CD ,x 3 0 o j c 3 w �-. ro o r ° rn n v rn s 3 c O Z ,� o t �+ CD .. (D W O fD (b (T O C D N L N Ca < N ° V N O Cy O Q 0 c O O CD (D O_ o (D 0 A O rn c ° Rt 3 0 O� D) K = O N w a �1. n CD D m � a .. cn `: 0 3 = N N D lot CL O N (D 80 CD CD V V CD CA (.0 0 � X e, v =r 0 0 0 3 D ° N N ° o w c v v p CD CD -P CO !V w o z w z CD CD [n "m e CD CD CD 03 C COD N 3 a CD ID c .a L1 M 7 O N Cn - A 0 OD (D --t Z fA 0- 0 3 p z7 ^. Cn O co O 3 3 z m � m z = o r iI ° m 50, CL R Qa-0 a T y CD CD N G co 7 n. 0 z a 'C C) Wv(D 0 0 -° a c CD y 53 � CD m a 0 a_�= 3 m O r m "Fn y ga N a C (D � X - 3 (7 O N Cn a O CD O CL O O O EA 0 O 4� 0 (D O i .- r,.. '�r �a �� O ' �O O� ?�,. d� .? A cic ` �i' j + „ 1 �., ..- !' AS BUILT SANITARY SYSTEM REPORT KER ��w�r'�'� , TOWNSHIP SEC.j_ T_N, RZXW 0. ADDRESS j "SC , ST. CROIX COUNTY, WISCONSIN. .13DIVISION LOT LOT SIZE / CS '�� •-J `U2 PLAN VIEW /T1 -Distances S dimensions to meet requirements of ,H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I s i i —f ; 4 i a s '_ I I i ` i Indioate 1VoXthj Arrota j 1 • SCALE tPTIC TALK (S) MFGR. �,� (�� ; CONCRETE X STEEL NO. of rings on cover Depth bRY WELL :ANCHES NO. of width length area r no. of lines -_7 widt length -:.J area rK-� „dept f �to top of pipe ,�/�''�`�— AGREGATE I ' C RATE AREA REQUIRED C, /( ` AREA AS BUILT ' Itsclaimer: The inspection of this system by St. Croix County does not imply complete ,opliance with State Administrative Codes. There are other areas that it is not possible , inspect at this point of construction. St. Croix County assumes no liability for ystem operation. However, if failure is noted the County will make every effort to iitermine cause of failure. AEASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED L- //-- PLUMBER ON JOB �!'o411 d✓ .Pc Jt, LICENSE NUMBER �S(` Z - R €PO'RT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itany Penm.i.t� � • State SPp.tic/ / NAM€ l'awn6h.ip ' S$. Cno.i.x / County Locatiox' '6 _� ection l SEPTIC TANK y- Size ga.Ltonb. Numbers o6 Compan.tmenth ViAtanee Fnom: Wett it. 12$ on greaten stope 6t Bu.itd.ing it. Wez.Lande H.ighwazen a it. R DISPOSAL SYSTEM D.iatanee Fnom: Wet �44j 6t. 12$ on greaten 6tope Bu.itd.ing 6t. W e F t. • H.ighwaten. 6 t. FIELD DIMENSIONS: -. Width o6 tneneh ix. Depth o6 noek be.Low tite - . .in. Length os each tine it. Depth o6 naek oven ti..Le .i n. Number. o6 tine4 Depth of ti.Ee below grade .in. Totat teng.th aj Una it. Stope of theneh in peh 100 it. D.iatance between tine6 = d z. Depth to bedrock Totat aba orb lion area r( ' NL . jx Depth to gnoundwaen �. Requited area it 2 Type of Coven: Paper on StAaw PIT DIMENSIONS: i Numbers o6 p.i.tb . Ghavet around p.it4 yea no Out.6 ide d.iameten S Depth be.Eow .inte.t S . 2 Totat ab area it A Area %equkned it2 ^' INSPECTED TILE AP VED Ci/ ,DATE / 2-11 197 , 2. REJECTED P DATE 197 Yew I rme�...:......._. m..m:.....:�. ........ .:. -.. d - •. H 115 Rev. 9/78 REPORT ON SOIL BORINGS AND PERCOLATION TESTS _ WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION:,SZ_'/., %, Section 19 ,TSOLN,R � (or) W, Township or Municipality Lot No. , Block No. County -S r CAI Z S ubdivision are Owner's %Buyers Name: CIloGaALL��,��ilL�TCrIJ Mailing Address: & a,4A.e c sr k L/ TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW _� REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 3 - 7 9 PERCOLATION TESTS 79 SOIL MAP SHEET .35� NAME OF SOIL MAP UNIT a�1>��Dr r1,CE /�n.. PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEP INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— / P j D.J Z' III P- P—. P— P— SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- > - � i B- � B— > B- > '-S 9 B- S �L s - - B 4 -_2 e" — PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the�ogation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy ' Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. • ���' n ace - /� - F . a l i 1 _ - - N AL £ I . r - m 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Certification No. Address .Name of installer if known Copy A — Local Authority CST Signature i ' State and County State Permit # 7- rB 7 Per it A lication County Pe i # m NN for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: r CS ✓h 3 � 7� 5' B. LOCATION: �� % t! X Section f&, T N, R (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Towns C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family _C Duplex No. of Bedrooms _� No. of Persons D• SEPTIC TANK CAPACITY .10,00 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top of Trenches Seepage Bed: — X Length�Width Depth 1 Tile depth (top of Line � Seepage Pit: Inside diam Liquid Depth No. of Seepage Pits S Percent slope of land _ Distance from critical slope WATER SUPPLY: Private D? Joint ❑ Community El Municipal ❑ Owners name as listed on EH 115 if other th pr esent owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Cert' ied Soil Tester, NAME C.S.T. # t , 'S`3� and other information obtained from (owner /builder). Plumber's Signature P /MPR�# Z `� G��� Phone �� — S /3.S Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. m , . e • w mti� . -.. . . . u a-,ro...,. .,.._�...... _..P , t l E jo � ®.: ,.e. ..,� �_ ...... _ ....... ._ € .e w e s.. . , r.. _..:» g a_ ...... P R a ..._.... w , ®m.. .. . . m. .»....j.,....,a. .. N..�.. � t � -• x 3 ( ti ppppp' Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY / Q Date of Application / _ 1 8 7 Fees Paid: Stat Count n Dat Permit Issued (date) ll - — Issuing Agent Nam Inspection Yes No State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 i 2. state (pink copy) 4. plumber (canary copy) Revised Date 7 /1/78 1 S r FORM NO. 985-A! Ll � P t I I Si. CROIX COUNTY SURVEYOR'S RECORD ��f �4� CERTIFIED SURVEY MAP rw N 1/4 CORNER' s z R.R. SPIKE FOUND ��-� -- + Q 3 I UNPLATTED LANDS W o j LEGEND 11 No N 89 28'06 "E 616.00' 0 I X 24 IRON PIPE WEIGHING o o �o° 583.00 �p 1 1.68' LBS. /LINEALFOOT SET f - p vi, ]/ ti n o I * POND 0 $ 11 J 0 0 1 z irZ m 4.002. ACRES INCLUDING RIGHT -OF -WAY M M LL _J a 3.787 ACRES EXCLUDING RIGHT-OF -WAY N N APPROVED N UJ 1 Cr I zw= N 89 °28'06 "E 616..00' I I APR 26 1979 L 0 583.00 to z ST. CR�OIX COU w �I ,1 r Z I 01 I COMPREHENSIVE PARKS PLAN..iIJQ Z� Z O Q I Z I AND ZONING COMMITTEE Ewa GI m 4.002 ACRES INCLUDING RIGHT-OF-WAY CO N gj J a m JI N 3.787 ACRES EXCLUDING RIGHT OF-WAY - FO N d I N r,;:,VAI Or ii-115 Mllv�,k ':IUOU'VISION - Li o I M I DOGS NOT McAN APPROVAL FOR °_ N 89 28'06 "E 616.00' - — I BUILDING SITE OR SEPTIC SYSTEM. W i 308.00' 275.00' _ = I ° w I REFER TO H62.20. SCALE IN FEET ai z =o �I Q 01 JI 0 200 400 z 1 o i �I I SE- SW 3 o 01 _ 4.016 AC. INC. R-O-W 0 1 '4.01 6 5 AC. INC.R•O -W, �<1 110 3.808 AC. EX. R-O -W r' 3.386 AC. EX. R•0•W N OI m = I"n M o I L� a: 1 THIS INSTRUMENT WAS DRAFTED BY SCOTT B. LOHMAN I z �zl Owner & Subdivider: Richard Jones / 13 Rt. 4 New Richmond, WI 54017 ,� vc �o, .1. � I NORTHERLY 0 4 S 9 1'13 "W 83.06' a I RIGHT UN e 3 8.03 275.03' � I POINT OF S LINE- SW 14 8 .19 _ 8.00 -30.60 308.00 d j BEGINNING SECTION 8 TOWN S 89 28 06 W 616 00 -- I S I/4 CORNEA - - - ---- ---- - - - - -- - --� IRK. NAIL T30N, R 18W f I II FOUND P.K. NAIL FOUND UNPLATTED LANDS 33 331 DESCRIPTION 1 I A parcel of land located in the SE% of the SW, of Section 18, T30N, R18W, Town of Richmond, St. Croix County, Wisconsin described as follows: Beginning at the Su corner of said Section 18; thence S 89C'28'o6" W (assumed bearing referenced to the North -South Section line, bearing recorded North) 616.00' along the South line of said SW1; thence North 1134.00 thence N 89 0 28 '06" E 616 .00' to said North -South line; thence South along said North - South ; line 1134.00' to the point of beginning. Subject to existing Town Road right -of -way along the East and Southerly sides of the above described parcel, as shown on the attached map. Containing 16.0356 acres, more or less. I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes and the St. Croix County Subdivision Ordinance to the best of my professional knowledge, understanding and belief. James E. Rusch $ 9 ` +e ea p �C��i ©/��� Wisconsin Land Stz eyor S -137 ^ l ' +`$, Stevens Enginee , Inc. 1409 Coulee Road - Box 321 dD F I L E �' JAMES E . �Y Hudson, wI 54016 MAY 1 1979 RUSCH ►Ea a CONNELL � S•1376 � hoWN of � Z River Falls , March 30, 1979 54 y,� '�► f WI o �'� ,,41- , Volume 3 Page 789 g 7 ����� SURJ e�