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HomeMy WebLinkAbout026-1155-29-000 ` Wisconsin Department of � Comm County: erce PRIVATE SEWAGE SYSTEM St. Croix Safety and Buiiding.Divi`sion f INSPECTION REPORT Sanitary Permit No: 4 018 0 GENERAL•INtFORMATION (ATTACH TO P,F_RMIT) �' a�EP� Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village X Township Parcel Tax No: Noll, Ryan I Richmond Township 026- 1155 -29 -000 CST BM Elev: + Insp. BM Elev: BM Description: Section/Town /Range /Map No: ° 16.30 `jro. 1 CS; Pik-. -- )vo+ 22.30.18.1192 TANK INFORMATION (#LEVA14ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z q(o, A E�kS 12 o s V"- 3 0 53 Dosing ABM , n , gy p Q9 . 3s + Aeration Bldg. S er N• /y '7 • 2 Holding SUHt SUHt Outlet `�' Inlet L - / ?5, 11 / TANK SETBACK INFORMATION 'Is 9s ST I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic O �+ 29 Dt Bottom Dosing Header /Man. '7 r Aeration Dist. Pipe I O • D 93• Holding Bot. System /).,I `!Z •.3 Final Grade �(�• ° 13 + PUMP /SIPHON INFORMATION © Co• 4b Manufacturer errand St Cover , 99.9 + 3•v «3cs 3 • Model Number TDH Lift Fri ' Loss System Head TDH Ft Forcemain I L rrgth Dia. Dist. to Well SOIL ORPTION SYSTEM �/ RENCH I Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME �+ 1 (2) SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufactur INFORMATION CHAM � O Type f System: / t UNIT Model Number: It DISTRIBUTION SYSTEM Header/Ma Distribution x Hole Size x Hole Spacing Vent to Air Intake U Pipe(s) L_ Length Dia Spacing 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 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: U / 2- /D - Inspection #2: Location: 1283 146th Avenue New Richmond, WI 54017 (NE 1/4 NE 1/4 22 T30N R18W Pondview Ivjeadows II Lot 29 Parcel No: 22.30.18.1192 1.) Alt BM Description = Ca. u.Se- S . i . tn�e,�.l � c,�r�r( Cw �� 51 Aa-j 2.) Bldg sewer length = 30 - amount of cover = +/ Mn ef qu t evasion eired? Yes 'No 5 Z3 � � ( 4� Use other side for additional information. Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) ` _ c•'r Z2'20.y ?-, --"D O-% qkl t e s m PLOT PLAN �_ PROJECT . Ryan` Kndll ADDRESS 1258 7th Ave St. Paul Mn 55075 NE 1/4 NEB 1 /4S 4O UND 30 N/R 1 $ W TOWN Richmond COUNTY St. C roix MPRS Shaun Bird 22690 DATE 5/21/04 BEDROOM 4 CONVENTIONAL XXX IN- ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 7 ABSORPTION AREA # of chambers 28 872 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.3/92.7'4' below grad Vent Standard Biodiffuser Plans Designed Using >6" Conventional Powts of Cover Leaching Chamber Manual Version 2.0 p o = W with 3 1. 1 ft2 of Area j cn U M J LL 6' Long 1 1 Well i t meet LU s o mee a Grade at System Elevation V o z 34" setbacks required by w Cn - N lI) Replacement Area See original soil tot Property for subdivision Line I B -2 2-3'x 88' cells 7% Slope 45 , with >3' spacing 146th Ave 25' B -3 Pro 4 Bedroom 5' House 45' 30' O O - 1 0 50 Vents 60' Replacement area B. M. Alt. B.M. is top of su ir @ 96.3' Property Line oil Test and S PLOT PLAN PROJECT '-Syan,Knoll ADDRESS 1258 7th Ave St. Paul Mn 55075 NE ' 1/4 NE 1%4S 22 /T 3 0 N/R 1 $ W TOWN . Richmond COUNTY St. C roix MPRS Shaun Bird 226900 DATE 5/21/04 BEDROOM 4 CONVENTIONAL XXX IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 7 ABSORPTION AREA # of chambers 28 872 BENCHMARK V.R.P Top of Steel Fence Post ASSUME ELEVATION 100' Filter label A -100 ❑ BOREHOLE O WELL * H. R. P Same as Benchmark Vent SYSTEM ELEVATION 93.3/92.7'4' below grad >6 „ Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts of Cover with 3 1. 1 ft2 of Area Manual Version 2.0 6' Long 11 Well is to meet all Grade at System Elevation 34" setbacks required by WDNR Property Line B -2 2 -3' x 88' cells l pe 5 , with>3'spacing � 146th Ave S lope � 25' Pro 4 B-3 Bedroom 5 House 45' ° O o l d - 0 50 Vents 0' B. M. Alt. B.M. is top of survey iron @ 96.3 Property Line f _ l Safety and Buildings Division cc / wl9�liti$tCa AvC., S A Q, Box 7082 t Numba (to be 8lied by Co ) 201 w. 7082 anitary p I ! Madison. wI 53707- � a (608) 261-65 Plat n PAID $tart 1:D. Number Department of Commerce i1C �o — r D ere°[ than mailing address) ]Permit �` p famution You prarl pr cct d ass (if dlff �, t� ► S a nitary .Cade. P� m / /, rd with Comte 83.21. Wis. Adtft Ptti Z trety Law, s) 5.040 x ) / �`� /IV i acw U' y 1 may be uaod far secotsdatY ? 1 i t Block tioa — please Print Ali Information parcel # I, Applicatfoc Informa i P Owner's Name p Stead Y section section Property Owners Mailing �� 1 f (ci e one) l zip Code ZONING 4 Stale ry CSM Ntaaba v sane �Ha1.'7 alt that app Y� II. .ype of 13stildSag (check 2 F1e Iy Dw•oll ing — Number of l3odroom' �YilLage�n�tp of ,• ❑City ❑ PublidCottsmaciel— Re Describe Use - wed — Dm=vc Use 11eable) son Com late l B it app Type of Pertnitt (Cheek only one boa on Ilea line A• p cldiag Taalt p lacentant Only � Orber Modifieatioa to Ettisting SyRan Trrsttnenc/H A. 9YstesO)aceatept System List Previous Permit Number and G Parmlt Traxtafu to New��� n � i CO3 F-cp ❑ Ohattge of Owner l/ g, ❑ permit Renewal ermit Rtvision plumber Before upisstion `�� D Single Pass Saari Filter 1 e 24 in. ficablc so osuil e ❑ Iy s Of PO S stem: Cheek all that a Mound ❑ Rpcixulatiag Sand Filter > 24 in. of a yiylble soil ❑ Aerobic ?zestatmt Unit utissd ia- Ground ❑Mound _ G �Iding T� 0 ?eat Filter lain Wt ) n _per round [l Other (ezp ('gasnveted eland Pressut>tad ❑Gravel -less Pipe Sy yt n ❑ D Line p (// tin Filter i yal A, PfOp°a RacirculariR Synth Mod" 1 Ares Re4 � ('� "� 3 nfortnaTt : dsf) V. Dla snalRr�tmDo a f Soil ApPlieation Rat '77754 Site toe] c law a Plastic POI / Fl (gpd) 3 MRautaet�er . C00=1. I Constructed Glesa l / T Nt>er Cspa; is of Units VL Tank Info Gallons (}sllons New Tanks Tanks Septic or Raising Tank Aerobic TroatMat Usk I last rlon of the POwTS'hawn on the attached Dea (;ysml,er responsibility for ios iaa calla I Business Phone Numba� `me rasp lgp/MPRS Number J VII. Itesponslbtlity gtatemoat I, char uaderalanad. ber's re Plum i Name (print) � i e ' `��� Plutttber'a,sddress (Street, Cit)', S o Date ) ued Issuing Agent t Coun AD a rtmeat Use Onl SanirarY pattait Fa (includa ^GrCr d" t J o I � n DisapPro`W Surcharge Fee) �� (j/1 ✓ {,( � I APProved Q� S / G1 Qwner Given Reason `ot Denial rova IX. Condit!* � ons of Approvmsons for Disapp j ea! dde lad se !pl I, o�apod alq I as ./ I s uaulallnbal �iaegl�/ pau!�lul old ue!d luaula6eueul sari se aaquln�d_Aci a Ism Ileslads!p . j Islas aq 11 an I ue olldaS 1 �, " Q Paul Iu. Pue I IIIluanl}}a'�I � W31SIIS :?!3N MO to sixa t less than i Inc At Ulk t *mPlete plats {te the Cossq only] for the sYsutn art p� G44-' w,fln_��4 �R. 081021 oil Test and System PLOT PLAN PROJECT, Ryan Knoll ADDRESS 1258 7th Ave St. Paul Mn 55075 NE 1/4 NE 1 /4S 22 /T ; 3 0 N/R 1 $ W TOWN , Richmond COUNTY St. ----- MPRS Shaun Bird 226900 DATE 5/21/04 BEDROOM 4 CONVENTIONAL XXX IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZ 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 7 ABSORPTION AREA # of chambers 28 872 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter label A -100 ❑ BOREHOLE O WELL * H, R. P. Same as Benchmark ent SYSTEM ELEVATION 93.3/92.7'4' below grad V >6" tandard Blodlffuser laps Designed Using aching Chamber onventional Powts of Cover th 31.1 If of Area Manual Version 2.0 6' Long 11 Well is to meet all Grade at System Elevation 34" setbacks required by WDNR Property Line B -2 2-3'x 88' cells 7 % 45 , with >3' spacing 146th Ave Slope 25' IF Pro 4 B-3 Bedroom 5' House 45' 30' 0 50 Vents 60' B. M. Alt. B.M. is top of survey iron @ 96.3' Property Line Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ... C � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. 62 Z q,6190 Please print all information. viewed b Date Personal inforrnaGon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 �j P Owner Proper Location RECEIVE Property r Govt. Lot A115 1 /J�V� 1/4 Q— �— T3 N R E (or) Property Owner's Wiling Address Lot # I Block # Subd. Name or M# i MA�� ,2 - 2004 P , - C)' l� City State Zip a Php�e N� ❑ City Q Village own Nearest Road �i �It T! N , �N -S- Lj F-ONIN(� OFFICE rr. 6`�' ► IV New Construction Use Residential / Number of bedrooms Code derived design flow rate 6 © Q GPD ❑ Replacement Public or commercial - Describe: __— Parent material to r�' � �- Flood Plain elevation if applicable General comments and recommendations`' (2 r? ✓� �Mti ,3. -3/ f a- 7 F T] Boring # E1 Boring Q� Pit Ground surface elev` ft. Depth to limiting factor L_ 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 a Bori ng # Boring pit Ground surface elev. /, ,> J? ft. Depth to limiting factor/ / 1"a 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 �- �-.31 - �a 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 Effluent #2 - BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 I l ' Property Owner _ Parcel ID # Page of ❑ Boring 1 3 - � # Pit Ground surface elev ft. Depth to limiting factor 12 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 2 V Z /t S IVI} "/J 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-1 Ong # ❑ Pit Boring ❑ 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD < 30 mg/_ 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 (8.6/00) Safety and Buildings Division CountXi i 201 W. Wgshington Ave., P.O. Box 7082 S=1 Permit Number (to be filled in by Co.) Madison, Wl N Ep � 0 • r hicon . sin ( 608) 2 1-6 Department of commerce State PlanL Number Sanitary Permit Applicatio ,� g 200 in accord with Comm $3.21, Wis. Adm. Code, P n� information ou pro Npoa Proje ress if different than g aiw as) may be used for secondary Purpose Privacy IBw, x15.04(1) m) ST OROIX COON , r��� I. Application Information - Please Print All Information ZONI Parcel # Lot Block # Prope ow ner's Name �r t� Property Loca n property er's Main dress �' ., Section City, State Zip Code Phone Number 1fC1 r / ow-oc) c J , 1� N. rR � E o IL ype of Building (check all that apply) 6=5 S division Nl me CSM umber - or 2 Family Dwelling - Number of Hodrooms ❑ PublidCommercisl - Dacribc Us ` (] State owned - Descr Use 3� 3 K Oho. 2 s city � 'vi,la wnsb;p of �. LL Type of Permit: (Cheek only one box on line A. Co lete line B if applicable) - -'2 - , V — c1» Z A ow System ❑ Replacement System ❑ Tree olding Tank Replacement y ❑ Other Modifi n to Existing System nag B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transf to Ncw List Previous i umber Before Expiration Plumber Owner IV. T of POW'I System: Check all that a 1 _pressurized in- Ground ❑ Mound > 24 in. of suitable soil ❑ Moun 24 in. suitable soil ❑ At Grade Sing t Pass S filter ❑ Constructed Wetland ❑ pressurized !n round ® Holding Tank ❑Pmt Filt Aerobic Treatment Unit ❑ RecjrCaJlan i3 � filter 1. Recireulatio Synthetic Media Filter hie Cbuunber ❑ Drip Line ❑ t rn -less Pi Other (explain) �`// V. Dis ersalrl reatment Area I formation: - I 1 S Ele stion Des. Flow (gpd) Design Soil Ap lication Rat Q51) Dispersal Area Req ed (s Dispersal Area Propos {sf) yseem ��r� �� S3 S � '� Capacity in Total Number anufacturcr Prefab Site Steel Fi Plastic VL Tank Info Concrete Cons Gallons Gallons of Units New F.aistiog Tanks Tank$ Septic or Holding Tads Affable Treatment Unit Dosing Cbamber VII. Responsibility State ent- 1, the unders igned, me rea nsibillry for installation of the POWTS sbown on the attached plans. m 's Name (Print) #for s S' re MP/MPRS Number Business Phone Number . Number ss (Street City, ta 1 VIII. Coun !D art rneni Use nary Permit Fee (includes Groundwater Date issued s ng Agcnt Si re (No Stamps) Approved ❑ Disapproved urcharge Fae) r C] Owner Given l IX. Conditions of Approval/Reasons for DZ*e oval SYSTEM OWNER: 1 Septic tank, effluent filter an dispersal cell must all e s as pe r management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach comp;'- pleas (to the County only) for the system as paper not kss than 81/2 s I I Inches In sine SBD -6398 (R. 08102) 40NX1 OT P AN PROJECT Rvan 4Knoll AD ESS 1258 7th Ave S. St. Paul Mn 55075 NE 1/4 NE 1/4S 22 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/6/04 BEDROOM 4 CONVENTIONAL XXX IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 BENCHMARK V.R.P. Top of 1/4" Rod ASSUME ELEVATION 100 Filter ZabelA -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 95.3/95.2/95.1 3.5' below qrade J6'Long nt Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 Well is to me et all Grade at System Elevation 3 4 99 setbacks required by WDNR Please note: further testing will be done to Pro Town Road find more AL suitable soils 20' Pro 4 Bedroom ST 40' Vents House B -2 3% Slope copy B -3 80' B.M. #2 's top of steel rod @ 40' 3 -3' X 107' Cells 99.5' with >3' Spacing To be >5' from 09 B B.M. #1 1 `� O o property Line Vent B.M. #2 Property Line 35' 10' ;�,. 40NX1 OT P AN PROJECT Rvan`Knoll AD ESS 1258 7th Ave S. St. Paul Mn 550 NE 1/4 NE 1/4S 22 /8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/6/04 BEDROOM 4 CONVENTIONAL XXX IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51 BENCHMARK V.R.P. Top of 1/4" Rod ASSUME ELEVATION 100 1 -� Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 95.3/95.2/95.1 3.5' below qrade Vent >6" Standard Biodiffuser Plans Designed Using Leaching Chamber Conventional Powts of Cover with 3 1. 1 ft2 of Area Manual Version 2.0 6' Long 1 1 Well is to meet all Grade at System Elevation 3 4 19 setbacks required by WDNR Please note: further testing will be done to Pro Town Road find more suitable soils 20' Pro 4 Bedroom ST 40' House Vents B -2 3% Slope , B -3 80' B.M. #2 is top of AL steel rod @ 40' 3 -3' X 107' Cells 99.5' with >3' Spacing To be >5' from Vent s B- B.M. #1 c?O property Line �� B.M. #2 Property Line 35' 10' i Wtsc ons'in Department of commerce SOIL EVALUATION REPORT Page _' of —� aivision'of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ' minty Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must C 1'Ut 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. Date Please print all infot'mation. y '� Personal infonnatron you provide may be used for i econd 4 (1) (m)). 3 /o 03 Property Owner Pro rty Location �t C Go Lot AJE 1 /4 �L'r 1/4 S ZZ T 3(j N R I k E (orQ. L o oe Property Owner's Mailing Address Lot Block # Subd. Name or CSM# �3 I U �fi� Co7 2 I j nJ Y1 eacl6wS City State Zip Code Phon u ❑ ity ❑ Village 8 -Town Nearest Road _ ZONING OFFICE / � i t � 1 T (� New Constnfction Use: Residential / Number of bedrooms 2- Code derived design flow rate _ 'l —__ GPD ❑ Replacement ❑ Public or commercial - Describe: _ - - -- -- Parent material _— � _ _ __ ____ —_— Flood Plain elevation if applicable L — /U � � ft• General comments $�/ rh 2��tJ � f 7.3 a �44t �S w7 l' and recommendations: IX " O S /�� Z l � f 4 1-tiLt rv` Boring (� F Pit Ground surface elev. Boring # L �,d ft. Depth to limiting factor ��— in. _ — Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I * •E 1 1 Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 6 - 2 ( c ) r Sr' 2m c,13k, m�r^ CS Iv� 5 �' ( JCQ — mS • Z ?a „ b �c, Boring # Bori g Pit Ground surface elev. ft. Depth to limiting factor 7 5 — in. Sofl li Rate Horizon Depth Dominant Color Redox Description Structure Consistence Boundary Roots GPD/fF Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I O -Z +O r313 Si'/ 2-rnckbk mfr --S 1v� 5 C `{ $ -75 l0. /4' -- Sc .3m5bk C� — i 7 3 * Effluent #1 = BOD > W5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pfint) Si CST Number zs Address Date Evaluation Conducted Telephone Number 211 �. 4 f J e f C k - Page -- of _ Property Owner Parcel ID # _� _ - -- --- - -' Boring # Boring ® Pit Ground surface elev. �U _ ft. Depth to limiting factor -- in. Sod Application Rate Frizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 I cr 10 r. �3 — 5 0 2 r jrr C5 I v 5 • $ 2 r" 2rn k c 3 7 _cj — s c � I F] F1 Boring # F1 ring ❑ Ground,surface elev. ft. Depth to limiting factor _— in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. _____ —__ ft. Depth to limiting factor _ in. F ❑ Pit Sod 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 Effluent #1 = BOD 30 < 220 mg/L and TSS >30:S 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 -$330 (R.07/00) Pa 2 of- 3 Property Owner Parcel ID # —_ — _--- - - - - -- - - -- F-51 ❑ Boring p _ (} in. Boring # ®Pit l — Sol tan Rate Ground surface elev. _ /� _ ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsei Qu. Sz. Cont Color Gr. Sz. Sh. 'Efl#1 I 'Eff#2 er2o 5 . $ 2 3 7- Z ❑ Boring # ❑ Boring ❑ Pit Ground.surface elev. ft. Depth to limiting factor r in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. 'Etf#1 *Eff#2 E] Boring Boring # Ground surface elev. __� —__ ft. Depth to limiting factor — in. F El Pit Soi icatxxn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lf in. Munseil Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'EfF#2 Effluent #1 = BOD > 30 220 m91L and TSS >30:S 150 m91L ' Effluent #2 = BOD 30 mglL and TSS < 30 mg1L 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. ssD -8330 (8.07/00) - PAGE 3 OF NA ME D c ( r , - c ic- TOT# Z 9 LEGAL DESCRIPTION . XNJ5 Y ,S LZ T 3C .N.R. E(or)� SCALE: I"= y� - - - -- I BM I ELEVATION /00 • d BM I DESCRIPTION — BM 2 ELEVATION �• .�3 BM 2 DESCRIPTION -( - k 54 �o � � �,� h - S ec. Z_Z SYSTEM ELEVATION Q O SYSTEmTYPE Co�,,er�-E�'csti••� CONTOUR EVATION qq °° 0 4' G _ 3 y6 a� a 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 Co cy Plan �ion. If system fails, determine cause of failure, use alternate area and install new system 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 ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND owNERSHIP CERTIFICATION FORM owner/Buyer A Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION '� S 2 — TAN -Rj1W, Town of Property Lo: 1 � Lot # Subdivision Certified Survey Map # Volume Page # Warranty Deed # Xq , �� Volume Page # Spec house O y o Lot lines identifiables 0 no SYSTEM MAW MNANCE remature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its p 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 ed by the owner and by a The property owner agrees to submit to St. Croix Zoning Department certification ' site wastewater by t owne sal system a masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying 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. ements and agree to maintain the private sewage disposal system with the standards Uwe, the undersigned have read the above requir Ce set forth, herein, as set by the Department of Commerce t be completed a�ad ent r o the Croix County Zoning Office wi i thin 30 stating that your septic system has been main of the three expiration date. _ DATE iGNA" OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I {we) am (are) the owner(s) of the property describ d above, by virtue of a warranty deed recorded in Register of Deeds Office. n iV -- DATE GNA OF APPLICANT Any information that is mis- representedmay result in the sanitary permit being revoked by the Zoning Department. * * * * «« ** Include with this application: a stamped warranty survey map Regi ster of in the warranty deed a copy of the Y U 2y61P 1`i3 74726`9 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Loren D. Derrick. Rose H. Derrick, Richard L Derrick Joan L. Derrick and Robert J. Derrick 11/24/2003 10:30Att Grantor, WARRANTY DEED and Ryan W. Noll and Shannon M. Noll EXEMPT # _ Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 132.00 the following described real estate in St. Croix County, State of Wisconsin COPY FEE: (if more space is needed, please attach addendum): CC FEE: PAGES: 1 Lo 9, Pond View Meadows II. St. Croix County, Wisconsin. Recording Area Name and Address . ^+ 7 t . A.ND A�1 f LAW 11 39 �, ,HUDSOi4, W154016 Q 026- 1065 - 10- 00.026 -1 - 30-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and right -of -way of record, if any. Dated this v d of November 2 003 ✓ 10 i or D. Derr * Richard L. D errick * e H. Derrick * UJoan L. D errick AUTHENTICATION ACKNOWLEDGMENT Sionature(s) Loren D. Derrick, Rose H. Derrick, STATE OF ) Richar L. D errick , Joa L. Derri and R obert J. Derrick ) ss. _ County ) authenticated this of Novem 2003 — Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kri Ogland Hudso WI 54 016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I .) * Names of persons signing in any capacity must be typed or printed below their signature. 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