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Home My WebLink About026-1173-40-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487917 k GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 10 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: New Horizon Homes Inc. I Richmond, Town of 026- 1173 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: Joy /I 1 a5 j 21.30.18.1394 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic ` Benchmark 0' / Z ,n Alt. BM d Yct' f out- Aeration Bldg. Sewer Holding St/Ht Inlet $ ' 2 • r ✓ 1p TANK SETBACK INFORMATION St/Ht Outlet IA g q3 • 2 ' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i I t Dt Bottom Dosing Header /Man. Aeration Dist. Pipe °L� f `�Z • Holding Bot. System 0 t� Final Grade PUMP /SIPHON INFORMATION 4, Manufacturer Demand St Cover Z q GPM t Model Number TDH ift Friction Loss Sys ead N Ft , - Forc Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ! Length I No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 to u Z //e�G SETBACK SYSTEM TO I P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. QQ INFORMATION CHAMBER OR N 11 O Type Of System: / / , 1� �� UNIT Model Number. JV 2�t e a DISTRIBUTION SYSTEM (, Header /Manifold � Distribution x Hole Size x Hole Spacing Vent to it Int e Z Pipe(s) \ o w.. Length Dia Lengt Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth o[ xx Seeded /So d xx Mulched Bed/Trench Center 8edrrrench Edges\ Topsoil \,1 Yes L,;] No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1109 145th Avenue New Richmond, WI 54017 (NE 114 SE 1/4 21 T30N R18W) Waldroff Meadows IV Lot 40 Parcel No: 21.30.18.1394 1.) Alt BM Description = �1 (f 6J4A- 2.) Bldg sewer length = 142 / - amount of cover = t Plan Yes 5 II ' Use other revis for information. o ZS 05 ! G 1 Date Insepctor's gnature Cent. No. SBD -6710 (R.3197) Safe d B ')din ivision County , 201 W. Ave .O. �c7162 :`.0 / ) �- NVisconsin Madison, f••; Sanitary Permit Number (to be filled in by Co.) Department of Commerce .� S Plan I.D. Number Sanitary Permit Application 1 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Address (if different than mailing dress may be used for secondary purposes Privacy law, s15.Q4(l)(m) ect 1. Application Information - Please Print All Information Parcel # — Lo • y Block # Property Owner's Name J/ Property Owner's Mailing Address Property Lo-Cation Y 7,:r %, Jam- Sectio / City, State Zip Code Phone Number / / l 7 U ! T GJ N ; / S crrcl ne} C 13� /v, P.a.tJ (�L� E W II. pe of Building (check all that apply) bk uo (`1 S' A Subdivision Name CSM Number or2FamilyDwelling- Number of Bedrooms J +A�— ❑ Public/Commercial - Describe Use / ❑City ❑Villa Township of ❑ State Owned - Describe Use UL Type o ermit: (Check only one box on line A. r line B if applicable) ` e m ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only — 0 Other Modification to Existing System B. ❑ Permit Renewal ermit Revision ❑ Change of E] p Transfer in New List Previous Permit Number and Date issued Before Expiratio Plumber Owner ` IV. Sype of POWTS System: Check all that appl o essurized in- Ground ❑ Mound >24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ --- Constructed Wetland ❑ Pressurized In and ❑ Holding Tank El Peat Filter El Aerobic Treatment Unit 11 Recircul n�Sand Filter Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaliTreatment Area nformation: ersal Ar Pro s p°sed � f) stern &1 s S Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dr p L Z , �/ � • ,� ` C in ✓ Total Number Manufacturer (/J Prefab site Steel Fiber Plastic VI. Tank Info G nY Concrete Constructed Glass Gallons Gallons of Units New Ddsting Tanks Tanks Septic or Holding Tank t I Aerobic Treatment Unit Dosing Chamber V11. Responsibility State t- I, the undersig ssume responsibility for installation of the POWTS shown on the attached plans Plumber' Name (Print) Plumber' gnature MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zi e)� d� g L VIII. our /De artment Use Onl :�Sanitary Permit Fee (includes Groundwater Da Iss lssuin A nt Signffiur (N Approved ❑ a arge Fee) I - ❑ wnerG f o �� ' dC� ro lX. Conditions of Approval/Reasons for Disapproval � SYSTEM OWNER: � V 1. "Septic tkrllt,emu rltaterN - 4 (� � r�e,� w�eo�.✓v> dispersal cell must all be services / rrliMMatl>rd r as per management plan provided by pkM*W y 2. AN setback requirements must be aGk**Wd �t /d t ( f �5�� . as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/1 111 inches in sire SBD -6398 (R. 01/03) l Rr.6 �qNt! Nnuitft9 +tnK! ,efq!!':: � �f`•IfsPl�:Rti "'�t7 U.'^..t9 9 -. '.^ i'A : t/ O PROJECT New Horizon Homes 1475 Hwv 65 New Richmond Wi 54017 NE 1/4 SE 1 /4S 21 / W TOWN Richmond COUNTY ST. CROIX _ MPRS Shaun Bird 226900 DATE 1 0/10/05 BEDROOM 3 CONVENTIONAL XXX IN -G ND 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 IL BENCHMARK V.R.P. Top of Survey iron ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.4/91.5 6' below grade setbacks required by WDNR Plans Designed Using 458' property line Conventional Powts Manual Version 2.0 Pro town road Pro 3 15' Bedroom House 25' B -120' 35' ST 80' 5 B -3 2 -3'X 69' Cells With >3' Spacing 2% Slope 70 Vents B -2 Vent >6" Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 405 Property Line 6' Long 11" Grade at System Elevation 34" PLOT PLAN PROJECT New Horizon Homes AD ESS 1475 Hwv 65 New Richmond Wi 54017 NE 1/4 SE 1 /4S 21 T - N t 1 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/10/05 BEDROOM 3 CONVENTIONAL )00( IN -G ND 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 Survey iron ASSUME ELEVATION 100 , Filter Zabel A -100 ❑ BOREHOLE 0 WELL *H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.4/91.5 6' below qrade setbacks required by WDNR Plans Designed Using 458' property line Conventional Powts Manual Version 2.0 Pro town road Pro 3 15' Bedroom House 25' ST 20' 35' B -1 80' S B -3 2 -3'X 69' Cells With >3' Spacing 2% Slope 70 Vents B -2 Vent >6" Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 405 Property Line 6' Long 11" 34 Grade at System Elevation RAJLD Wisconsin Department of Commerce PORT Page of Division of Safety and Buildings in accordance ft5, Wis. 'Ar1m 'de County s" /f + Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan mist 4 include, but not limited to: vertical and horizontal reference point (BM), direction and 1 Parcel I.D. ` percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z iP — Please print all informalfon. .v r ti Reviewe y Date ,{ Personal information you provide may be used for secondary purposes (Privacy law; a.1is, Property Owner Property Location f ti z Govt. Lot 1/4S 114 S T N R E (or Property Owner's Mailing Address Lot # I Block # Subd. Name or M# City / State p Code Phone Number C1 CRY ❑ V lage T Nearest Road ? ew Cons�ction Use: esidential / Number of bedrooms Code derived design flow rate �� GPD 0 Replacement ❑ _Public or commercial - Describe: Parent material Flood Plain elevation if applicable A/ General corrunents and recommendations: s s e /g,>, P Boring # Boring jj f Pit Ground surface elev. i ft. Depth to limiting factor / -3 (0n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7 eAl -;> ti l JG .4 / 2 t << TZ !j Boring # ❑ Boring �f Pit Ground surface elev. [ Z� ft. Depth to limiting factor / 3 4 in. Soi Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munselll Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �-Qs 715- 246 -4516 i Property Owner _ Parcel ID # Page of a Ong # Boring pit Ground surface elev. M It . Depth to limiting 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 F] 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 a Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA_ ' Effluent #2 = BOD < 30 mg/L. and TSS < 30 mglL 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. seo -8330 (x.6/00) i Property Owner Parcel ID # Page of ® Boring # Boring / pit Ground surface elev. �� t. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 r Bori Bonng # ❑ Ground surface De t limiting F E) pit Grou su ce elev ft. Depth o factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 F-1 Gr Boring # ❑Boring ❑Pit ound surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 ' Effluent #1 = BOD > 30 720 nwyL and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 wQ& and TSS 130 mglL 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 (8.6/00) t Safety and B ' vision ro 201 W. Was " Ave., 7162 County w Madison, 07 - Sanitary Permit Num (to be filled in by Co.) sconsin (608) 4E7 ! / VV i Department of Commerce State Plan I.D. Number Sanitary Permit Applicati n - — I i l P (if different than mailing address) In accord with Comm &321, Wis. Adm. ses Priva Laws�ati oj Add 1)(m) Pr'1 � ` e � /\ may be used for secondary purposes T. CROIX COUNT I. Application Information - Please Print All Information t # Block # arse # Property owner's Name t\J 1 ' U r`I Property do property Owner's Mailing Address i s 6 > / Seedon Zip Code Phone Number circl city, State T N ne ; E W aye telex /e( N umber p� S v.� N e 'l. pe of Buildin check all that apply) CM _ _ Subdivision r 2 Family Dwelling umber of Bedroo S ownship of (3 PublidCommercial- Desc u s e ` � S ❑City ❑Village ❑ State Owned - Describe Use III. Type of ermit: (Check only a box on line A. lete line Bo Tank Placement Only [I Other Modification to Existing System A ew System ❑ RsP>a Sys' ❑ TreatmentlHoldin> List Previous permit Number and Date Issued ❑ Change of ermit Transfer to New B. [I Permit Renewal ❑Permitgevision plumber r'bt"ner Before Expiration e of poW' S stem: soil ❑ Check all that a ? At-Grade ❑ Sin pass Sand Filter ❑ IV. TS <24 in. of suitable - pressurized In- Ground ❑ Mound ? 24 in. of s a soil []. rpGiound ❑ Recirculating ❑ Pressurized In and ❑Ho lding k � Peat Filter ❑ Aerobic Treatment Unit � Sand Filter ❑ Constructed Wetland hing Chamber Line ❑ Gravel -less Pi ❑ Other (explain) ❑ P L Recirculating Synthetic MediaFiltsr lr'' Elevation information- s D ers Require (sf) Dispersal Area Proposed (sf) System V. Dis ersareatinent A 6-6 Design Flow (gpd) Design oil Application Rate(gPtlf? rea ` ncrere ,—/ � � � Nu' fob Site Steel Fi Plastic 0 ufacnrrer Constructed Glass Capacity in Total ber VI.Taak f Gallons lJni la Gallons I New Exiscn$ Tanks Tanks Septic or Holding Tank Aerobic Treaua— Unit Dosing Cbarober OVVTS shown on the attached prams urn responsiblTit Y for installation of th Business Phone Number VI'.'Responsibility St$ meat I, the Plum uurnit afore MP/MPRS Numbe �� J Plumber's Name (Prigt) n� k Plumber's Address (Street, City, Zip ) � Date ed Iss • eat Sie}iature III o Stamps) V. Coun /De artment Use On Sanitary permit Fee eludes Groundwater Approved ❑ Dis Surcharge Fee) 7 , A ❑ O en It n enial 7 IX. Conditions SYSTEM OWNER: 1 Septic tank, efflu nt filter and dispersal cell m t all be service d / rr as per management plan provided 2. All setback requirements must h as per applicable code /ordinar only) for the system an paper not less than gia z I t inches in sire Attach complete plans (to the County Y) SBD -6398 (R. 01/03) LOT PLAN PROJECT New Horizon Homes A RESS 1475 Hwv 65 New Richmond Wi 54017 NB 114 SE 1 /4s 21 /T 30 NI 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9124/05 BEDROOM 3 CONVENTIONAL XXX IN -GRO RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 .."" ' . 84 " # of chambers 22 IL BENCHMARK V.R. Top of Survey iron ASSUME ELEYATION 100' Filter Zabel A -100 ❑ BOREHOLE O LL * H. R. P. Same as Benchmark / SYSTEM ELEVATIO ' 95.5/95.4 4' below qrade Well is to meet all setbacks required by Plans Designed Using 458' roV WDNR Conventional Powts p , anual Version 2.0 B -2 Pro 3 Bedroom House 1 %Slope 30' ST 0 160' -3 2 -3' X 69' Cells with >3' Spacin 405' Property Lin Vents -1 Vent 160' > 6» Stand a Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11 " 80' 3411 Grade at System Elevation 43 ' ' �V% () C p l y - 130N/ OT PLAN PROJECT New Horizon Homes A RESS 1475 Hwv 65 New Richmond Wi 54017 NE 1/4 SE 1 /4s 21 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9 BEDROOM 3 CONVENTIONAL )00( IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK qgE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of C bers 22 hL BENCHMARK V.R.P. Top of Survey iron ASSUME ELEVATION Filter ZabelA -100 ❑ BOREHOLE O WELL *H.R.P. Sameasl3enchmark SYSTEM ELEVATION 9,5 &/b5.4 4' below grade Well is to meet a setbacks required b Plans Designed Using 458' property 1 W DNR Conventional Powts h Z � Manual Version 2.0 B - 2 Pro 3 Bedroo 1% House 3' 30' ST -- 160' B- 2 -3' X 69' Cells with >3' Spacing 405'Prope Line Vents -1 160' Vent >6 " Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area 6' Long 11 " 80' 3 499 Grade at System Elevation 43' ' Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 o f 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County St. Croix Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include but not limited to: vertical and horizontal reference point (BM), direction and F"arGe! I p dhdin percent slope, scale or dimensions, north arrow, and location and distance to nearest road. QZ — O- 0 U Please print all information. R Date Personal inrormation you provide may be used (Privacy Law, s. 1504 (1) (m)). Property Uvmar Property Location �9 • David Waldr W. Lot 1/4 1/4 S 2/ T 3 N R 1 (or� Property Owner's Ailing Address SE Lbt # Block # Subd. Name or CSM# 398 River R d t ` Ill ` 40 - Waldroff Meadows N City State Zip Codq Pfi&CNt I r aity Qvllage • Town Nearest Road Hudson Wl 1 5401 Z 516 144th Avenue Q New Construction Use;] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement ❑ Public or oommerciai - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable XTA ft. General comments and recommendations: 171 Boring # 11 Boring Q pit Ground surface elev. 99.45 • ft. Depth to limiting factor >-6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munse Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 1Oyr3/2 sil 2msbk mfr .ss 2f ..6 .8 2 10 -28 10 4/4 sil 1 2msbk 1 dsh cw if .6 .8 3 28 -96 7.5yr4/4 s Osg dl - - .7 1.6 gs•sa F- 9 f3onng # ❑Bering 98.95 >96 0 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. *EN#1 *Eff#2 1 0 -10 10yr3/2 sil 2msbk mfr as 2f .6 .8 2 10 -20 1 4/4 sil 2msbk dsh cam' if .6 .8 3 20 -96 7.5yr4/4 s Osg dl - _ .7 1.6 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = B D < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1.132 120th Street, New Richmond, WI September 8, 2004 715 -246 -2454 Property a Own r Waldroff Meadows N Parcel I D # Page Pending P e 2 of 3 BM orin # Boring Boring Q pit Ground surface elev. 99.50 ft. Depth to limiting factor X94 3 in. 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 I *Eff#2 1 0 -7 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 7-17 1 1.4/4 - sil 2msbk dsh cw if .6 .8 3 17 -27 7.5yr4/4 - Is Osg dl cw _ .7 1.6 4 27 -94 7.5yr4/4 - s Osg dl - - .7 1.6 a.l 95• SO F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. it icatian Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Golor Gr. Sz. Sh. *Eff#1 *Eff#2 Boring ❑tn9 pit Ground surface elev. ft. Depth to limiting factor in. Soil A icatton 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 '01#2 * Effluent #1 = BOD > 30 < 220 mg/- and TSS >30:5 150 mg/t_ ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/1- The Deparknent 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. SM- 8330Test (R.07 /00) e Waldrof Meadows IV Lot 40 O 45 8 40 5 83 . -53 .2 37 ski a� �o Scale 1 = 40' BM1 Top of iron pipe 100.00' S l a BM2 Top of base of utility pad 100.25' o R+^ eR 13199.45' 62 98.95' B3 99.50' Thomas Nelson 7 227387 PREPARE ow 1v DAVID WALDROF 398 RIVER ROA t HUDSON, 1WI 54 OUARTER, PART OF THE SOUTHEAST QUARTER OF (715) 549 - 6601 E NORTHEAST QUARTEA, PART OF THE NORTHWEST K)ARTER OF THE SOUTHEAST OUARTER, AND THE AND PART OF THE NORTHWEST QUARTER OF THE )F RICHMOND, ST. CROIX COUNTY, WISCONSIN. C. IN VOL. 15 PO_4112 LOT 1 _ IN A 4 T 1!4 36 "E 1299. s OF SEC. 21 "Ar ' •i: t•}s ♦ 1 ` X 941.4 ''Ya , 'r• i ff '�i • i C J,� R ♦ !ri i r Y 982.7 4 X x 980.7. 1.1 a �. A •� LOT 4 981.1 .a.' lfl' s CO I \ x I � a 981.0 x 9e9. ' \ \ x 985. 2 •. ...; ; '"�: • :ti.; ;• Y' ' fib.• .''? • ` \ 8 OF � •x, AC / .8 7} !•• • t • S!b 6 AC.) x 983. Al . y Y ' ,'i • 'Y �Y I i : • A • L , Y •hit 91l t ' Y•'•';� 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 ency Plan Option # . If system fails, determine cause of failure, use alternate area and install new ste in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 t ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer ly✓f��1 /.tv,2 / 2 ry /.f /�5 ,RAJ C— Mailing Address •� Property Address (Verification required from Planning & Zoning Department for new construction.) 0.24 - /0da- Ga - Gav City /State &jfd J2 1a j4-,w ar%*j Parcel Identification Number G2 C. - /o r. c j- yD - 0 cas)_ LEGAL DESCRIPTION Property Location t/ , ,2 , Sec_ , T j N R _L'�-_ W, Town of Al a kn a.vn Subdivision r s. ' a t- p,do,cr i"ezda a 'O. s 2' , Lot # y o Certified Survey Map # � , Volume p , Page # Warranty Deed # d 7- Z ,Volume Z 0 9 ,Page # S Spec house es no 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 - St. 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. 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 Planning & "Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN 7 0F ANT(S) 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. 08105) Z'd dSStLO SO ii daS I U 289? P 533 810 -7 -7 -7 0? State Bar of Wisconsin Form 3 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS QUIT CLAIM DEED ST. CROIX CO.. WI Document Number Document Name RECEIVED FOR RECORD 09/28/2005 11:15AN QUIT CLAIM DEED THIS DEED, made between Jesse Leaders and Ida Hinterberg EXEMPT # REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 106.20 and New Horizon Homes, Inc. COPY FEE: CC FEE: ( "Grantee," whether one or more). PAGES: 1 Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area profits, fixtures and other appurtenant interests, in St. Croix County, State of nsin ( "Property") (if more space is needed, please attach addendum): Name and Retum KOSTINA 0 Lot 4 , Waldroff Meadows IV. St. Croix County, Wisconsin. ESTRE-EN & = a 3 � HUdW ", Part of: 026- 1062 - 604100 Part of: 026- 106440 -000 Parcel Identification Number (PIN) This is not homestead property. Dated _ T A2 S 4QS l�►. .� ,�.,� (SEAL))• * Jesse Leaders (SEAL) �� L�� ✓ &AL) ° � w * *Ida Hinterberg� •• I , � AUTHENTICATION ACKNOWLEDGMENT 4 Signature(s) 41.E authenticated on STATE OF J&j i Se •U S t A/ ) U ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on /7 –& � Z , (If not, the above -named Jesse Leaders and Ida Hinterbere authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: A L Attorney Kristin% Oleand * / Ar Koo A Hudson, WI 54016 Notary Public, State of (,r.! % SC�c� ^'S/ K. K(VO!¢ My Commission (is permanent) (expires: b Public Eau Claire Co. (Signatures may be authenticated or acknowledged. Both are not necessary.) Aug IZ 2W NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 3-200. Type name below signatures. 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