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HomeMy WebLinkAbout026-1137-10-000 PL: SGT., Q.J - seonsin bepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �_:fety Eirr} Builr' -;rg ,',, s • Sanitary Permit No: INSPECTION REPORT 404977 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Ta Hillvale Development LLP Richmond Township 026- 1137 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Lab I D ` (pD -1-- ,r,*v. TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �tQJ� Benchmark -- l 3.1 Dosing U Alt. BM oi. Aeration Bldg. Sewer / •Q / 4 �,�} Holding St/Ht Inlet }•3 Its / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic S� t Z i �1 Dt Bottom Dosing Header /Man. �•3Z qs . (,o Aeration o,,.�t , tv 9S• 2� Holding Bot. Sys m T- 31•` Final Grade i PUMP /SIPHON INFORMATION Manufacturer Demand St Cover v GPM 5 3 • 6 1 Model Number TDH Lift Fricti Loss System Head T H Ft For ain Length Dia. is . o ell SOIL ABSORPTION SYSTEM i N Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dep DIMENSIONS b�•�S �� SETBACK SYSTE T P/L BLDG WELL LAKE /STREAM LEACHING Manufact rer: INFORMATION CHAMBER OR .Tr.l Type Of System: UNIT M;del Number: K DISTRIBUTION SYSTEM Header /Manifold bl Distribution x Hole Size x Hole Spacing Vent to Air In ake (� t Pipe(s) ---� �' Length 90 Dia Length Dia Spacing k SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil '1 Yes ] No I — Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 q / �4 / GZ - Inspection #2: Location: 1494 111th St. New Richmond, WI 54017 (NW 1/4 NW 1/4 21 T30N RI 8W) Golf View Acres Lot 10 Parcel No: 21.30.18.966, 1.) Alt BM Description = T'� /mow 2.) Bldg sewer length = Zt /1�lp� d4 7 f t �•aD2. p I amount of cover = > �j(„ ,,,- V� e.�+banJYV tip �. -- - - -- -- T— — — P n revlslo Re ui e Use other side for additional inf SBD -6710 (R.3/97) Date Insepetor's Signature Cert. No. t ® t i 1► w Y,' . � .� J!•�. • �,w -'(� r �` ►11 * •.A ft � .�` . � •Y -44 .T , ^�r��•,�� t X11. `'., „� r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 C i � isconsin ., 'son, WI 53707 - 162 Site Address De artment of Commerce ( Z * `f 7 ( 4-- Sanitary Permit Application' Pe t Number In accord with Comm Wi 83.21, s. Adm. Code, personal information you provide 9 may be used for secondary purposes Privacy Law, 315. 1 m ❑ Check ' Revision I. Application Information - Please Print All Information Plan I.D. Number RECEIVED - ------ Prope ner's Na e e_ P 1 Number 2 t. 30 , 1 1W C �(J r MAR ozb- 1t3�- �o -otw Pro Owner's Mailing A petty Location i J 2 t I ST. N1UG_ COUNTY ; S T 0N, R Ls City, Stan 111 Zip Code Phone K*alte h 6 0 ) Block Number Su vtston / Tame CSM Number H. Type of Building (check all that apply) °s P&., S '" " ❑City i or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use wttship ❑ State Owned X N cad III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. ew 2 ❑Replacement System 3 ❑ Replacement of 6 ❑ Addition to Foc Couniy use stem Tank Only Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. of Permit: (Check all that apply)(numbering scheme is for internal use) -1 14-- (00 ' 4 44)1PIp n - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressuozed In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip ` I� ue l 45 ❑ At -Grade 46 ❑ Aerobic Treatment t 49 ❑ 30 ❑ Other + /3c lei✓ v TCtC�W V. D' ent Area Information: 6 - 2 - Design Flow (gpd) Dispersal Area Dispersal Area oil ApoMation Percolation Rafe System Elevation Final Grade Required Proposed Rate(Gal..r_'ays/Sq.Ft.) (Min./Inch) Elevation �T(O _-� L 2 lr-- /00' VI. Tank Info Capacity in Total Number Manufacturer Prefab Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Hoklieg Tank Dosing Chamber 6 VII. Responsibility Statement- 1, the tmd responsibility for htstallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' MP/MPRS Number Business Phone Number Plumber's Address (Street, Cily, State, ) VIII. /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse C Determination 2,ZS 2 EK. Conditions of Approval/Reasons for Disappr �cm�l Attach complete phws (to the County ouly) for the system on papa not less than SM x 11 inches In size SBD -6398 (R. 05101) f j WlscowhDepartrrtentof Comrnette SOIL EVALUATION REPORT Division of sa>aty and Buildings in accordance with Coma 85. Wis. "n. Code Attach complete site plan on Paper not less than 81/2 x 11 Inches in size. Plan must + include. but not knited to vertical and horizontal reference point (BM), direction and percent slope. sole or dimensions, north arrow, and bonbon and distance to nearest road. Parcel I.D. Please print all information. Rriewe by Peacoat Womobon you Provide mw be used for secmdwy purposes (Privacy Law. s. 15.04 (1) (m)). owner PropertyLocallm C o I Govt. lot , i4�( /4 S T 30 N R E( W /'\ s 9 Address L # Bfo&# I &h& Warrhe U ) C g 14 � ekj ) City State, zip Code Phone 0 city ❑Nearest Road Construction rMial / MWunber of bedrooms Code derived design no rate _ J Q GPD ❑ Repfaoanwt //((``''''��� PubGc or oomrnercial - Parent material U/ 4 . x / , �d if app Plain licable GsnwW MW �.�� �' © B0rhv # Bonng Q it Ground'surfaces elghf 4- 2. 1 Depth to hailing factor} in. Soil Application Rate Horizon Depth Dordttant Cokx Redoa Description Texture Struckne Consislance Boundary Roots GPOW In. Munsell tau Sz. Cont. Color Gr. Sz. Sh. •011#1 •Eff#2 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to tin it ng factor in. Sod Application Rate Horizon Depth Dwftvd Colof Redox Description Textwe Structure C.onsWence Boundary Roots GPDW in. Munsell OLL Sz. Cant. Color Gr. Sz. Sh. TdW *Ei<#2 • < 30 nVL Eftm t #1 = BOO > 30 < 220 �- and TSS >30 S 150 • Mwnt #2 = BOD < W SS (� mg& and T T M /1 • , ; PLOT PLAN PROJECT P.C. Collova Builders Inc. DRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1/4s 21 /T 30 N/ 1 w WN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/28/02 BEDROOM 3 CONVENTIONAL )00( IN -GROU P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1" Iron Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 95.0 B.M. #1 150' Property Line B -2 B.M. #2 20' -1 5' 0' Property Line B -4 50' 60' Vents B -3 20' 2 -3' X 69' Cells System is with >3' Spacing T > 100' from well 25' Pro 3 Bedroom House 111th St. Vent >6 „ Standard infilrator of Cover Leaching Chamber 31.1ft ^2 Plans Designed Using Conventional Powts 'Long 16 Manual Version 2.0 34" Grade at System Elevation K t RECEIVED JUL 1 5 2002 Wisaorsm Departrrrentof Commerce SOIL EVALUATION REPOR ST. CROIX COUN b y Divisionof Safe and Ekiddrgs ZONING OFFICE of in accordance with Corrrrn 85, Wes. Adm. code Att c h eornplele site ptan on paper not lass than a IM x 11 inches in size. Pare meat C","y ixiuds. but not irrrilad to vertical and horn s reference point (BM), drnrcbon and Parcel J.D. Pin elope, scale ar cr— snsiors, north arrow, and bcalion and d'isterrca to nearest road. Pieria Print aN inibrmat/on. awed by Dam Peeamul kd mutton you Pm"M may es uasd rar p pewas avndry pur (Privacy lave g . 15 (1) (m)). �� Property C O r. GwL mA L--314 T N R Z 9 E W s Maling Address r Lot # # Subcy Name U Oly stall, zip code Pfwrnber city v 5` ne M Nearest Construllion / Msnber of bedrooms code derived design now rate 6-0 GPD ❑ R�aoerrtent Pebric or aormneraial - eaibe _ l Parent material �(� �? .t /± Flood Plain► °" if a wcw* _ � J� g aind Ge neral oor vidsli . �' - �• m Boring # eonng 3 it Ground surface eX = 2 R DePw to 6nbM fsctor R Sol Apploallon Rafe fkxb= Depth Darttlriand Cokw Redox Desaiplion Tedtre Structure Consistence Boundary Room GPDW kL Munse/ Qu. Sz Car& Color Gr. Sr- sh - 'Eff#1 'Ew -- ❑ ❑ Pit Ground surface allow. R Depth ID Ong taclor in. Sal Appkalion Rate lloriaon Depth Dominant Cokm Radon Deseriptiion Texture Structure Corsistence Boundary Roots GPQW la Muset Qu. Sz- Cart. color Gr. Sz- Sh. 'EM 'Etpl'2 Eflkrent #1 = BOD 3, 30 =0 mglL and TSS X30 < 150 • Eftmwrt #2 - BM < 30 mg& and TW < 30 r gl- �T � Pima ✓U Address EvaMon Conducted Telephone Nunber T-d dbS = * 20 ZS ZnC f PLOT PLAN PROJECT P.C. Collova Builders Inc. APDRESS P.O. Box 489 Somerset Wi 54025 NW 1 Richmond ST. CROIX 1/4 NW 1 /4S 21 /T 30 N/ W WN COUNTY MPRS Shaun Bird 226900 DATE 3/28/02 BEDROOM 3 CONVENTIONAL X00t IN -GROU P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top Of 1" Iron Pipe ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL 'H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0 B.M. #1 u.- • t L A AM '[ fee- 150 Property Line B -2 B.M. #2 20' -1 5' 0' Property Line B -4 50' 60' Vents B -3 20' 2 -3' X 69' Cells System is with >3' Spacing T >100' from well 25' i Pro 3 Bedroom House 111th St. Vent >611 Standard infilrator of Cover Leaching Chamber 31.lft ^2 Plans Designed Using Conventional Powts 6' Long 16" Manual Version 2.0 34 11 Grade at System Elevation z-CI d * =f►0 20 zi Inc < PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1 / 4 NW 1/4s 21 /T 30 /R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/28/02 BEDROOM 3 CONVENTIONAL )= IN -G OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 1 Iron Pipe ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 95.2 B.M. #1 � 150' Property Line B -2 2 -3' X 69' Cells B.M. #2 J— with >3' Spacing 5 20' 1 ' Property Line Vents 50' 60' CO 20' - T zyoA-G BYO,, 15' Pro 3 Bedroom House I 111th St. Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber Plans Designed Using Conventional Powts 6' Long 16" Manual Version 2.0 Grade at System Elevation 34" I r PLAT PLAN PROJECT 'P.C. Collova Builders Inc. !ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1/4s 21 /T 30 /R 18 w TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 �A DATE BEDROOM 3 /28/02 3 CONVENTIONAL X)oC IN -G OUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 1" Iron Pipe �, ASSUME ELEVATION 100' Filter Zabel A -100 c ❑ BOREHOLE O WELL H.R.P Same as Benchmark SYSTEM ELEVATION 95.2 B.M. #1 Tot ,zf 150' Property Line B -2 2 -3' X 69' Cells B.M. #2 '_ with >3' Spacing , 5 20' B -1 Property Line Vents 50 60' 20 , 1 T 15' Pro 3 .. Bedroom House 111th St. Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber Plans Designed Using Conventional Powts 'Long 16" Manual Version 2.0 po 34 " Grade at System Elevation V*=rvsin 9epartrnent Qf Commerce SOIL EVALUATION REPORT Page of Division of $afeRy and EhAldings in accordance with Comm 85, Wis. Adm. Code County r not less than 81/2 x 11 inches in size. Plan must S4 C Attach complete site plan on papa - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and loca ' stance to nearest road. Please prirrt all i � ! ' " _` Reviewed by Date Personal information you provide may be used for saw 1 (Pri y Law. s. 15.0A41 (m Property Owner Propovation R t „t . _d e S� tz ,,, Govt WfiAlW 1 /4pW 1/4 S Z( T 3Q N R f E(org Property Owner's Mailing Add�llress r .. t # -: ock # Subd. Name or CSM# City 7 - °�1., sr c��R la��.. C- roi���ev� Acres Stale Zip ne _ 0A1NfNG OFFIC . , ❑ Village aTown Nearest Road 1l. 155110 ® New Construction use: ® Residential / Number of bedrodme - 4 Code derived design flow rate 4 5D CcAU GPD ❑ Replacement ❑ Public or commercial - Describe: 6 V -� Flood Plain elevation if applicable ,,ji I�� fl Parent material wq General comments Sj $ f e tr C(2 J - and recommendations: 44d, c(e v • 95 90 I F- 1 F1 Boring Boring # ® Pit Ground surface elev. 9!Z -� —ft. Depth to 6ml6ng factor - 1 =t in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 `Eff#2 o- lu 2 51 ZrYU.bk m c tvG 5 8 Z 12_ 1 3 �- -7 i S� 90 2 Boring # E] Boring ® Pit Ground surface elev. 99 d ft Depth to limiting factor I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPDM in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. `Eif#1 'Eff#2 t b - 1 1 ►D r 31 Z- V-C S $ Z 1 1-38 1b (A1 S`F g d ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Ado -n Sch k e,r o 2533CA Address Date Evaluation Conducted Telephone Number Property Owner N e 150r, Parcel ID# Page 2 of 3 F 3] Ong # ❑ Boring (> pit Ground surface elev. Q9 � ft. Depth to Hmiting factor 1,�_ in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 0 -12 Si I mfr c (vf • 5 - 2 c s `� $ 3 .39 05 r 'i li DS m l • 7 / Z- 40 F-1 Boring # ❑Boring ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. 1:3 pit Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Cola 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•833o (t.07/W) Properly owner NP-1-Son Parcel ID# Page 2 of 3 E] Boring 3 Bonne # © Pit Ground surface elev. 0f, '76) _ ft. Depth to limiting factor / 3 in. Sod Applicstion Rate Horizon Depth Dominant Color Redox Description Texture Stnxlure Consistence Boundary Roots GPD/ft= in. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 10-12- Si I mkt c (vf . 5 .8 2 /2 3`f C- S — . " • a — 7 /- Z 40 o Bodng# ❑ Boring ❑ Pit Ground surface elev. ft Depth to fanning factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EfF#1 'Eff#2 Boring # ❑ Boring E3 Pit Ground surface elev. ft Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 rng/L and MS >30 < 150 mg& ' Effluent #2 = BW, < 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 - 2648777. SBD -8330 (R.mroo) PAGE 3 OF -_ N AME 4j C f So n LOT# /O LEGAL DESCRIPTION,Uw '/4W14,S z/ T36 , NX 1 (or)g ,,-SCALE: fBM I ELEVATION /UCH • O BM I DESCRIPTION -bjQ o-C I " I Ko r. e ,Pe -" + BM 2 ELEVATION BM 2 DESCRIPTION � GC /L pyc P•'Ot SYSTEM ELEVATION f CC) ALTERNATE ELEVATION 9S . 9 0 t CONTOUR ELEVATION ALo � Off_ Bm A16 S fo�c 13 • Cfi f � c SIGNATURE DATE Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 Shaun Bird #226900 FROM P C COLLOUA BLLRS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07:33AM P1 } t ST CROIX COUN SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owncr/Buyer _ R C+ �b I10VA B Iii Y Mailing Address T", ©J O X $ q 5'0MEIN'_ Si5T &LI 'S �'z,,57 Property Address ' (Verifi required f Planning Department for new construction), City/State �tf' Q'1tAKMJ W . T Parccl Identification Number LEGAL DTBC__RIPTIQN Property Location hLg�. _ t/,, N E '/4, Scc. Q T2LN -R kj W, Town of V LCd 11 vp Subdivision (/7� V o 1t't' V 44-c c o Lot if VD . Certltied Survey 1VIan It Paea r Warranty Deed # �6 Sz P3 Spec house ❑ yes ❑ no Lot a-- identifiable ❑ yes 7 no SYSTEM MAINTENANCE Iagwper sue and mainteamce of your septic system could resuit in its prensaturefaihue to Landic wastes. Proper rnaiatcaaa= consi,su 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 fimcdon of the septic tank as a treatment stage in tha waste disposal system. The property owner agrees to submit to SL Croix Zoning Department a certi5cation form, signed by tlra own. and by a masterplumber, jo=ey=phuuber, restricted plumber or a licensed pumper verifying that (1) the on -site wastcwaterdisposal system is in proper operating condition aadlor (2) after inspection and pumping (if neccs=j), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements Lad agree to maintain the p&eate sewage disposal systt_tn with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Ccrtification stating than your septic system has beta maintained must be completed and returned to the St. Croix County Zoning Office within 30 der f the three year exp Lion date. CI /a l SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that aII statements on this form are true to the best of my (cur) knowledge. I (we) ant (are) the ownet(s) of th= described a ove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE •'e Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •' "" •o Include with this applicalten: a stamped warranty deed from the Register of Deeds otTtce ■ copy of the cartified survey map if reference is made in the warranty dccd 03/31/2022 10:08 6517483441 LAKES AND HILLS INC PAGE 03 FROM : PC COLLOJA BLW LBROT•HERS EXC FAX NO. : 7VS29Q6,V Mar. 29 2002 10:01AM P3 P'C -- ST CROIX cou"ry SUPTIC TANK MAINTEWNCE AGREB3 W4T t D lly 4WhtURStIP CgR't`CA7NgN MUM �1v►rmtxr'Eu�►et , , . C I LOVA A U VS, t 6V l�daeititss Add A 0. �a � � � 8 9' ...� 50 tie 5E„�. LsI: ' ftopM Aar t e- 4 L4 `�.\ 'YodSealita Lmm3b.est Cmm m miat: Depwtwa fvr now aoatsevs iisns� cwssm n 3 1 ,.l Ptah IdbC ndacatka tqumtwx ropceY 90 — o :sdaylown cs� Let 4 ,.�,.. spy oo Lot unbe idasurl 0 ntf � i7���eAYOCaa��'gri �' tta+rt+d[aCniain stx �# nare•tkiJuKe r4 #,lilllsiLC �Y'45tEa. Pto��r>s�a� aaied= etp =q a sra! AM attpiis htaj Wray t— yeah ae mWort; 414 by a Ul' EM PamV W int YIN VId hft ft lydem =&swrattRo man at'tlto sep& yak as a w amtw =p in dw mmw d wwd o vz= Ica +r Wag atp"to sabot to Ss. Cm ix Zmace Depw�n a o+�tu'irrlivtLtt+dn� ei�awd b!' filN dam Str3 by s aaaisrCghmuba,}aaLa giarttbac. Aud pbUnbbr rKaDOM=dp {t�the4asib�rrstLc+ ats�rblltts7 ;e k PMPW ap.rad�ea aa�tdWrtcr �ad14eR1 +�►ae+�p.ak* +wad ! { a+aa�xb eSa arpde mt is Lrss thaa in ttrif of lF+ra, iTie t;aod b� � tAr � � � atlicpyrtb► the pdv�ae � ays�n wa}b cb:: act ut dhA h:4, u ttat: by do Tl asof Ew d a Dquwm.4 of Nwag zmqgno, sto at Wima"i CoWdled smft dotyer;'sapft q*mk" beIm i minedm o t>4 tomptredwA 30 bys of do $rtes I= rspkwm state, OATS d.!Bmff wit • I, ,�ti} acrtG�y thts! t719Alra� 4i4 ! lk0n SW UM ao ttra b'W "Y W' w6,4• tYf4} i!L! `tip} AWMIt{s 0� chi daetabad atiara by **too of a VM=ty d mooided in 14iider of Dt"k Oatiee, DATR AV t69Wmadm*U Is MR-m? mW i3 the t. RkmY Prgsadbu%mw*rA br dr. 7.srr1ft 11tl�rat�l. +'t umtwta %4(lt'mix mu"d", a iWmpg& *wtsmy Arad aum tk h 4t O&Ab e4to a emw of the eps dfW ww7 mm if mh owe is mum in the wa'MgIY 44Cd 1652*4 647260 KATHLEEN H. WALSH Document Number Document Title REGISTER OF DEEDS T. CROIX CO., WI ct RECEIVED FOR RECORD 06- 03-2001 11:00 AM WARRANTY DEED EXEMPT N 3 CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 14.00 PAGES: 3 Recording Area Name and Return Address Northwest Title & Escrow Corp. 4255 White Bear Parkway Suite 11300A Vadnais Heights, NN 55110 0'�?6 -/t) 60 -iO -00,x, 0.2(0 — / O —S —000 Parcel Identification Number (PIN) ��( - /Gfo3��if -Goo oar - io�v- /o -000 This information must be completed by submiucr: docu title Lme R return address and PEN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of tlrc document or may be placed on additional pages of the document. No% Use of this cover page adds one page to your document and 2 QO to t recordine kc . Wisconsin Statutes. 59.43(2m) WRDA 2/79 xhsax lxrevt Val. 1652 208 FotmNo.9 -,M– WARRANTY DEED Minnesota UniformComeyancin Manks 197R Itolstad.@Larson.F . f..C. • Copporzdion or Partnership to Corporation or Partnership No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed( ) not required Certificate of Real Estate Value No. 19 County Auditor by Deputy STATE DEED TAX DUE HEREON: S (reserved for recording data) Date: Apfil30 20 01 FOR VALUABLE CONSIDERATION, Lakes & Hills, Inc. a Corpor under the laws of Minnesota Grantor , hereby conveys imited Liability Partnership , Grantee, a Partnership under the laws of Minnesota real property in St Croix County, Wisconsin, described as follows: I See attatched legal description "The seller certifies that the seller does not know of any wells on the described real property: I together with all hereditaments and appurtenances belonging thereto, subject to the follo«ing exceptions: Easements, covenants and restrictions of record. Lakes & Hill By: chard S. Ttelson Affix Deed Tax Stamp Here Its: President STATE OF Minnesota ss. COUNTY OF Ramsey The foregoing instrument was acknowledged before me this 30 day of April 20 01 by Richard S. Nelson and the President and of Lakes and Hills, Inc. a Corporation under the laws of Minnesota ot\ behalf of the Corporation NO - PAR .. .. RANK) DEBORAH L. TEICH .q,,y„u_ 1`407ARYPUBUc- WNNE9oTA �- SIONAICRF.OFITRSON "rA :INGACKNOWLEDGMENT MY COMUISSION �• EXPIRES JAN. 31, 2005 Tux Scat, — L, for dk real prol><•ny descnb.cd m this in.,"n A 0—Id be xnt to (hxlu k name and address of Grantee). Hillvale Development Limited Liability THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS) Partnership 1611 Highway 10 NF. Northwest Title & Escrow Corp. Spring Lake Park, NN 55432 Suite 01300A 4255 White Bear Parkway Vadnais Heights, MN 55110 ID O ` 100 ' ` --'r� ;� 4 F - - - -_ 4 63 8 , E W I C14 1 M 00 I 87,580 sq.ft. V Z I 2.01 acres — — 89,782 sq.ft. 2.06 acres 00 J I \ � I o�a I � �/� h \ O - - -- > I I c, \ CT C 12 I o I i a,Og" d . — — Ai 1, N00` �o o ?� ST Ip — C12_ 'OOK I C C13� , _ — — _ SO( —50 50' I \ C14 1 -- 0' I 9 \�- o I. T 1 I � ' 90,218 sq.ft. I I 2.07 acres - ry �0 87,231 sq.ft. ' 2 2.00 acres ►� i to A I N 2 i 100,724 sq.ft. I A- 0�O sp 2.31 acres h \ 1 S03002'59 "E I� rn� 329.45' z ` �� h West line of the ner io NW 1/4 of Sec. �18W — — — — 6.roaA ��@ — — — �? — — — —^ �\ N00 °54'45 "V1I 1251. s e �e��e ' � y N �� - - -- East line of the NE 1/4 of Sec. 20 Ir ^ f '' > 2 1 C4 04 ��� ��� \i o y // �� 95,555 sq.ft. I W 00'a �e '� 2.19 acres 0(/) e fo >> 1 5- t z z GENERAL NOTICE STATEMENT: q S1 The parcels shown on this plat are subject to State, County and Township laws, rules and )17 � � regulations (i.e. wetlands, minimum lot size access to parcel, etc.). Before purchasing or developing • any parcel, contact the St. Croix County Zoning office and the appropriate Town Board for advice. This statement put on this plat at the direction of the St. Croix County Planning, Zoning and ST. CROIX COUNTY WISCONSIN ZONING OFFICE N t N u w • Nouns ST. CROIX COUNTY GOVERNMENT CENTER - 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 FAX (715) 386 -4686 Friday, July 12, 2002 Hillvale Development LLP 1494 111th St. New Richmond, WI 54017 Regarding septic inspection for Hillvale Development LLP. Location of Property in St. Croix County: Municipality: Richmond Township Subdivision or Plat: Golf View Acres I Certified Survey Map: Lot: 10 Address: 1494111th St. Dear Applicant: A septic inspection of the above reference property was conducted on April 19,2002. This property is located in the NW 1/4 NW 1/4 of Section 21, T30N R18W, Golf View Acres (Lot 10), Richmond Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 3 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely, Rod Eslinger Zoning Staff cc: file rk • i Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must `� a include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. �p� 6 7l Q d4 d Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.14 (1) (m)). P Owner Property Location e Dl Ovc✓ Govt. Lot 114 Sa/ T N R E Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State, Zip Code Phone Number [3 City ❑ Villag Nearest Road 1 Y /���( ) fo ew Construction Use esidential / Number of bedrooms Code derived design flow rate �5z -fcJ GPD ❑ Replacement ❑ Public or mercial - Describe: Parent material Flood Plain elevation if applicable �'L /� ft. General oomments and recommendations: S ys p�Ier/C� /� S V Boring # Boring Pit Ground surface elev. � U ft. Depth to limiting factor in. Soil Application Rate Horizon th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff �P P rY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) iggdiure CST Number Address Date Evaluation Conducted Telephone Number Property Owner Parcel ID # Page of F —1 Boring # E] Boring Pit Ground surface elev. ft. Depth to limiting factor in. C] pit ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 E Boring # ❑ Boring ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. F Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = BOD > 30 1220 MOIL and TSS >30 1150 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. SOD -8330 (Rb/00) w. PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 NW 1/4s 21 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX _7 MPRS Shaun Bird 226900 DATE3 /02 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1" Iron Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0 B.M. #1 150' Property Line B -2 B.M. #2 20' -1 5' 0' Property Line B -4 50' 60' Vents B -3 20' 2 -3' X 69' Cells System is with >3' Spacing T >100' from well 25' Pro 3 Bedroom House 111th St. Vent >611 Standard infilrator of Cover Leaching Chamber 31.1ft ^2 Plans Designed Using Conventional Powts 6' Lang 16 Manual Version 2.0 34" Grade at System Elevation