HomeMy WebLinkAbout026-1165-34-000 (2) r
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety acid Building Division
INSPECTION REPORT Sanitary Permit No:
499158 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)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Oevering Homes Richmond, Town of 026- 1165 -34 -000
CST BM Elev: Insp. BM Elev: Description: (� - r Section/Town /Range /Map No:
/� BM to f d �— (:�o ^ -O`er'` ` a 22.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER �� CAPACITY STATION BS HI FS ELEV.
Sefttic Z Benchmark
Alt. BM
o.bs 79 •z5
Aeration Bldg. Sewer S • D q4
Holding St/Ht Inlet
5.� 9y,1
TANK SETBACK INFORMATION St1Ht Outlet Ip� b 93 • `�
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
/Ja 1
Septic 3(m AJ n /Z i Dt Bottom \
Dosing Header /Man.
!o • 3 93 • (�
Aeration Dist. Pipe ( 3 9316
. 173.5
Holding Bot. System 7• Z 1 7Z . 7
92.5 d �
PUMP /SIPHON INFORMATION Final Grade � c (
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH
Forcemain th Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 9a Z tre,.�
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR [} l r
Type Of System: UNIT Model Number:
c oy, =�a. lz 30 A- r0 hiz 3co
DISTRIBUTION SYSTEM et ! r f- / V -3 (o vLdt
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air ntaly;
i N Pipe(s) \1
Length 9 Dia y Length Dia Spacing e
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 1 Bed /Trench Edges Topsoil
5, T Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / ZS / o t Inspection #2: / /
Location: 1465 129th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 22 T30N R18W) Lundy Meadows Lot 34 Parcel No: 22.30.18.
1.) Alt BM Description= F. Co�u� 1 d---
2.) Bldg sewer length = Z
- amount of cover = 3 i N
Plan revision Required? Yes No
Use other side for additional in rmation. Date (J(Q In ctor's Si ure Ce
SBD -6710 (R.3/97)
' Safety and Buildings Divi ' n County
` 201 W. Washington Ave .> P. . Box 7162
Madison, Wl 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
;S,
(608)266 -3151
Department of Commerce
State Plan I.B. Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide project Address (if different than mailing address}
may be used for secondary purposes Privacy Law, s 15.04 I C D
1. Application Information — Please Print Al formation # #6 5
0 Parcel # Block #
Property Owner's Name ll iea_ A+
ST, UR ��t,�Qt► 4..��— Y to
Property Locati
Property Owner's Mailing Ad n ,
d JAL "h ✓t Pi! / �7 '/4, '0 / Section
City, State Zip Code Phone Number �
l rcle e)
E
II. ype of Building (check all that apply) 6k ..a S�or�% _�` � Subdivision Name /�CSM N
or 2 Family Dwelling — Number of Bedrooms _ 0(a �. 6 �` �'"� �� l`/
ED Public/Commercial — Describe Use
�,n boo z
1! �. ' ❑City_ ❑Villa wnship of I
C] State Owned— Describe Use Z �� ad ' '
111. Type Permit: (Check only one box on line A. Complete line B if applicable) OZ �� J� —
A ' ew System ❑ Replacement System ❑ Treatment(Holding Tank Replacement Only [I other Modification to Existing System
B. ❑ Permit Renewal Permit Revision ❑ Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner L
TV. a of POWTS S stem: Check alt that appl
— Pressurized In- Ground El Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil El At-Grade ❑ Single Pass Sand Filter ❑
In- oun ❑Peat Filter ❑ Cl Aerobic Treatment Unit ❑Recirculating Sand Filter
Constructed Wetland ❑ Pressurized d El Holding Tank
Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVrreatment Area Informs on: Di Area Proposed (sf) System Elevation
D i Flow (gpd) Design Soil Application Rate(gpdsf) Dispgrs�ea�Required (sf) p p
Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site eel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks r ,
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersig ssume responsibility for installation of the POWTS shown on the Attached plans
Plum s Name (Print)
Plumber' ature MP/MPRS Number Business Phone Number
Z— Z-6 1
Plumber's Address (Street, City, S ,Zip V t✓ A S 7
Coup eriartment Use Onl
Sanitary Permit Fee (includes Groundwater Date B ed Issu' Agent Si a (No ps)
Approved El Disa rove Surcharge Fee) }�'jl 16 16
a(O
❑ Owne Reason for Denial v� ((((
1X. Conditions of Approval/Reasons for Disapproval � r
SYSTEM OWNER: 3) �ao?,yw.
1. Septic tank, effluent filter and
dispersal cell must all be services / maintained
as per management plan provided by plumber.
2. AN setback requhaments must be maintained'
as per appflaabie coda / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in sire
SBD -6398 (R. 01/03)
Soil T t and System PLOT PLAN
PROJECT Oeverina Homes LLC RESS 838 Summer Pines Circle Hudson Wi 54016
N 1/2 SE 1/4S 22 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/26/06 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRE URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers
BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter BEST Filter
[:]BOREHOLE O WELL *H.R.P. Same as Benchmark
Property Line SYSTEM ELEVATION 92.7/92.5
Plans Designed Using B-2 0'
Conventional Powts 0'
Manual Version 2.0
B.M.*
25'
ST Vents
12'
Pro 3 10 40'
Bedroom B -3 B -1
House 2 -3' X 90' Cells
with >3' Spacing
Well is to meet all 25,
setbacks required by Scale i s I" = 40'
WDNR
unless otherwise
noted
B -3
458' B -2
Property
Line 5' Replacement area
Vent 45'
35' Hig way E
> 6" ARC 36 Biodiffuser B -1
of Cover Leaching Chamber 45' ,
with 25.0 ft2 of Area
4%
5' Long 1 1 Slope
Grade at System Elevati n 150'
36"
M.
B.M.
1
Soil T t and System PLOT PLAN
PROJECT Oeverind Homes LLC RESS 838 Summer Pines Circle Hudson Wi 54016
N 1/2 SE 1 /4S 22 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRE URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers
IL BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
Property Line SYSTEM ELEVATION 92.7/92.5
Plans Designed Using B -2 0 ,
Conventional Powts 0'
Manual Version 2.0
25'
B.M.*
ST Vents
12'
Pro 3 40' B -1
Bedroom B -3
House 2 -3' X 90' Cells
with >3' Spacing
Well is to meet all
setbacks required by 25 Scale is 1" = 40'
WDNR
unless otherwise
noted
B -3
458' B -2
Property
Line 5' Replacement area
Vent 45'
35' Hig way E
ALo ARC 36 Biodiffuser B -1
Leaching Chamber 45' ,
with 25.0 ft2 of Area
4%
" Slope
Grade at System Elevati n 150
36"
M.
B.M.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code /���� c
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must county �/// C ,-� I
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. v Zfo oOc�
Please print all information. Review y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /0 A P / It) �" I
Property Owner Property Location
e J 2 f Z Govt. Lot • j 14 S k 1r �� N E( W
Property Owner's Mailing Ad ss Lot # Block # Name or M#
City State Zip Code Phone.Number ❑ City El Village Too—( Nearest Road
New Construction Us�esidential /Number of bedrooms rived design flow rate .>2� GPD
❑ Replacement ��❑ Public or 99mmercial - esc� r�1yE(�
Parent material 1 Flood Plain e evation if applicable /V ft.
General comments
and recommendations:
!J
System Type 'LA- ST. CROIX CO� %Aem Ele ation ter.
M Boring # [] Boring /
&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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 - Eff#2
.1 12
® Ong # Q Boring L� J
Dk Pit Ground surface elev. 1 0o 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 1 `Eff#2
F Z U 3D • 7
,z2
zv
Effluent #1 = BOD > 30 1 220 mg1L and TSS >30 < 150 Tq Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Alamo (Please Print) Sig re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516
11M/Mr.
1
Property Owner _ Parcel ID # Page of
Boring # Boring / Qa / l 3 7 �
Pit Ground surface elev. / /� l� ft. Depth to limiting factor C J �n• 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
` JIL_ --<
Z �3 loll-
m 9
i
M
4 5.2
a Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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.
❑ Pit Soil lication 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
i
Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 150 mgA_ ' Effluent #2 = BOD, < 30 mg/L and TSS 130 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.
Sa - 8730 (e.6/00)
Property Owner Parcel ID # Page of
Is] Boring # Boring D / /
pit Ground surface elev. �/` td ft. Depth to limiting factor ( � in.
Soil ication 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
Z
1
�d
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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Boring
Cl Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Oepth 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/L ' Effluent #2 = BOD 130 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 (8.6/00)
Safety and Buildings Division County
` 201 W. Washington Ave., P.O. Box 7162
��� Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
(608)266 -3151 5 8
D nt ommerce
S itary Permit Application State Plan I.D. Number
n accor Comm 83.21, Wis. Adm. Code, personal information you provide AA
may be used for secondary purposes Privacy Law, s I S.04(1)(m) Pr ject Address (if different than mailing address)
y/ �� 1a `
I. Apprication Information — Please Print All Information . Z 16 — 3q— CTt)'O
Property Owner's --e ` Parcel # Block #
Property Owner's Mailing Add 0 06 Prgperty Location
'/4, ,� %4, Section Z
Z
City, State Zip Code n I one Numb 2 2 n�
(.G y N; RE rW
11. Type of Building (check all that app p� a d Subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedroom
❑ Public /Commercial - Describe Use n �, • 1^
C1 State Owned - Describe Use 2. (6 .QA r -d A 4eS2 Gl►o�r"locl ❑City_ ❑Vill a o�ynship r
C
III. Type of Permit: (Check only one box on line 1 k , Complete line B if applicable)
A. ew System ❑ Replacement System reatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. El Permit Renewal ❑Permit Revision El Chan of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner t
r
IV. TVpe of POWTS System: Check all that a I
on - Pressurized In- Ground El Mound > 24 in. of suitable soil ,C` ❑ Mo < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground El Holding Tank El Peat Fi ❑ Aerobic Treatment Unit ❑ R ' cu -7n and Filter ❑
Recirculating Synthetic Media Filter Ching Chamber d Drip Line [I Gr el -less Pipe [I Other (explain) 3� /
V. Dis ersal/Treatment Area Information:
De ign Flow (gpd) Design Soil Application Rate(gpdsf) a" 1 Dispersal Area Required Dispersal Area Pro os el (sf) System Elevation tS
�-- � ��. 4170 � mar, ��•' iv�s' � 3
VI. Tank Info Capacity in Total i "Number Manufagturer Prefab Site teel Fiber Plastic V
Gallons Gallons ;' of Units Concrete Constructed Glass
New Fa fisting { 1
Tanks Tanks 4 -
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the uni e i d, assume responsibility for installation of the POWTS s wn on the attached plans.
MP/MPRS Number Business Phone N
Pr' Name (Print) P s Signature J
Plumber's Address (Street, C1 State ' Code)
VIII. oun /De artment Use I
Sanitary Permit Fee (includes Groundwater Date Issu Issu ent Signatu (No ps
pproved ap Surcharge Fee) q1) C1 7 bI
Own tven eason for enial �
IX. Conditions of ApprovaVR asons for Disapproval (� 51 D
SYSTf�lli OWNS 3) �J � ale w
1. Sq t#C tank, ent filter and f nQ
dispersal cell st all be services / maintained
as per management plan provided by plumber. 4 fPZL
2. AN $@ & a & M q u kementa must be maintained
Attach complete plans (to the County only) for the system on paper not less than /2 x 11 inches i s ( �- C..
SBD -6398 (R. 01/03) �J J 1� p L a � 6�p
a
1
�l3kWQ NI�T�Y7!
,. ' '' ' J Kin
OT PLAN
PROJECT Oeyerina Homes LLC ADDRESS 838 Summer Pines Circle Hudson Wi 54016
N 1/2 SE 1 /4S 22 /T 30 N 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE9 BEDROOM 3
CONVENTIONAL )00C IN- GROU4 ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑BOREHOLE O WELL *H.R.P. SameasBenchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 100.5/100.0 3.7' Below qrade
WDNR
Alt. BM Top of 2" Pipe @ 101 ' V nt
Plans Designed sing ARC 36 Biodiffuser
"
Conventional Powts >6 Leaching Chamber
Manual Version 2.0 of Co r with 25.0 ft2 of Area
5' Long 11 "
Pro 3 Grade at System Elevation
Bedroom "
36"
House
Scale is 1" = 40'
unless otherwise
5 noted
ST
25'
B -3
458' B -2
Property
Line 5'
45'
35' Higl way E
Vents
2 -3' X 90' Cells
45' B -1 with >3' Spacing
4%
Slope
150'
M.
B.M.
3. l�,LZ.005 -- a o aui so o adid 00-/r o
t' /l 3S 4/ 1 / l 3
91 IpiLZo00S m59. AVMHJIH )IIV HI �1d1S
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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 Plan
Option #1. system fails, determine cause of failure, use alternate area and install new
sys em 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 �L° P�e
Mailing Address
Property Address
(Verification required from Planning & Zoning Department for new constru )
City /State
Parcel Identification Number v
LEGAL DESCRIPTION
,t -Z Z- T N R _W, Town of ��
Property Location / `� ' a , 1 /a , Sec. ,
,Lot #
Subdivision !�•
Certified Survey Map # .— , Volume , Page #
v Z ,Volume Page #
Warranty Deed #'
Spec hous yes no Lot lines identifiable ye 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 am/are the owner(s) of the
prope described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE APPLICANT(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. 08/05)
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
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. 0 Z (o
Please print all information.
Revie d by Date
Personal information you provide my be used for secondsry purpotes (Pri�acy Law, s. 15.04 (1)
Property Owner Property Location
j T-� C// i�a fir; Govt. Lot 1 / 5 , 1 - - - 114 S T N R E (o W
Pro
Owner's Mailing Address "' Lot # , Block # Subd. Name or M#
City Pe .
Number Villa
tale 'p Code: Phone umbe City '(] e T Nearest Road 9
J
New Construction Us • Residential / Number of bedroom Code derived design flow rate GPD
❑ Replacement Public or p9nmercial - Describe: _ -- -- - --
Parent material Flood Plain elevation if applicable _ 1/,L�[T ft.
General com ments � 446
and recommendations: � & /, 2 L / wr-t ./ /0 D. J /Cl Mv
Boring #
Boring
Pit Ground surface elev. _�j�y Depth to limiting factor �/ v - 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 �v/
tr �D
®Boring # Boring
Pit Ground surface elev lff. Depth to limiting factor � 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
t I
Z
, 3 <)
' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' §06ent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, In Shaun Bird 226900
Address / Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 — 1�° Q 715- 246 -4516
3
Property Owner _ Parcel ID # Page of
F31 Boring # ❑ Boring
Pit Ground surface elev. �ft. Depth to limiting factor �n Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
g
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 GPDM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Etf #1 •Eff#2
❑
Boring D Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots tE GPD Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Effluent #1 = BOD, > 30 < 220 rnglL and TSS >30 5150 mglL • Effluent #2 = BOD, < 30 mg/- and TSS 5 30 mg(L
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SBD4330 (8.6/00)
+ Soil Test Plot P1a
Project Name William Stock/Steve Dalton Sha
Address 1748 112th St.
New Richmond Wi 54017 C M #226900
Lot 3 Subdivision Lundy Meadows Date 8/11/03
N 1/2 SE 1/4S 22 T 30 N /R W Township Richmond
n Boring Q Well PL Property Line County ST. CR01X
BM or VRP Assume Elevation 100 ft. Top of Survey Iron
System Elevation 100.5/100.0 *HRpSame as Benchmark
Alt. BM Top of 2" Pipe @ 100.2'
Scale is 1" = 40'
Please note: Installer must unless otherwise
verify all lot lines and setbacks
before installation. noted
Please Note: Tested area
may not be suitable for
desired building area.
Check system location
before excavating.
B -3
458' B -2
Property
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KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX Co., WI
RECEIVED FOR RECORD
Document Number Document Name 09/05/2006 03:10PN
WARRANTY DEED
EXERT #
THIS DEED, made between Dalstock. LLC REC FEE: 11.00
TRANS FEE: 285.00
("Grantor," whether one or more), COPY FEE:
and Oeverine Homes, LLC CC FEE:
( "Grantee," whether PAGES: 1
one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address
interests, in St. Croix County, State of Wisconsin (=`Property ") (if more space WMem AMMd TM. UZ
is needed, please attach addendum): 11"o CrW TAW D*W 119
Lots 34, 35 and 36, Lundy Meadows, Town of Richmond, St. Croix County, W1 54016
Wisconsin. ST , ^ ,�a�
026 - 1165 -34 -000: 026 - 1165 -35 -000: 026 -1165- 36-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated 0 1 1 Dalstock, LL1
(SEAL) -- (SEAL)
* *By: Bill Stock, Member
(SEAL) JA� VVI �� (SEAL)
* *By: Steven M. Dalton, Member
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dalstock, LLC
By: Bill Stock. Member and Steven M. Dalton, Member STATE OF WISCONSIN )
) ss.
authenticated on ST. CROIX COUNTY )
L ' Personally came before me on ,
*Kristina O land the above -named Dalstock, LLC, by Bill Stock and Steven M.
TITLE: MEMBER ST 4E BAR OF WISCONSIN Dalton, member
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Attorney Kristina Ogland Notary Public, State of
Hudson. WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
+ Type name below signatures. INFO-PRO" Legal Forms 800.6552021 www.infoproforms.00m
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Parcel #: 026 - 1165 -34 -000 09/07/2006 11:01 AM
PAGE 1 OF 1
Alt. Parcel #: 22.30.18.1300 026 - TOWN OF RICHMOND
Current *X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
06/0912004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - DALSTOCK LLC
DALSTOCK LLC
1748 112TH ST
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description " 1465 129TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.510 Plat: 10 /08 -LUNDY MEADOWS 026/04 LOTS 1/36
SEC 22 T30N R18W PT NE SE BEING LUNDY Block/Condo Bldg: LOT 34
MEADOWS ('04) LOT 34 (1.510AC)
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
22- 30N -18W NE SE
Notes: Parcel History:
Date Doc # Vol /Page Type
06109/2004 765401 10/08 PLAT
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/21/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL_ G1 1.510 24,300 0 24,300 NO
Totals for 2006:
General Property 1.510 24,300 0 24,300
Woodland 0.000 0 0
Totals for 2005:
General Property 1.510 24,300 0 24,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00