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HomeMy WebLinkAbout026-1160-05-000 Wisconsth Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463357 0 (ATTACH TO PERMIT) 1s GENERAL INFORMATION 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: Verhasselt Construction Richmond, Town of 026- 1160 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: G M 1 C, 23.30.18.1211 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se (�� '3 9 �� Benchmark /0-6 o Dosing /� \ Alt. B a� 0 . 9 Ida , cis Aeration Bldg. S wer 5.15 95 . Z Holding St/Ht Inlet 9 3 TANK SETBACK INFORMATION St/Ht Outlet 4? `� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet IN Septic 4fZ l A - 4Z ) y Z / Dt Bottom Dosing Header /Man. , 92 Z Aeration Dist. Pipe `�; 45 9 : _ Holding Bot. System S Final Grade '90.5 PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 7 GPM Z •�" Model Number TDH Li Friction Loss System He TDH Ft Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width 1 Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 3g (3) 2 ' 1 � til 1'e.� SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: / a CHA UB OR 1 o j 1 Model Number: Go y wf, a �� Z7 iAr �� 54 -ai DISTRIBUTION SYSTEM Z 2 � (o Header /Manifold Dx Size x Hole Spacing Vent to Air Intake Length / g Dia 1 4 Length \ Dia ~ Spacing \ SOIL COVER x Pressure Systems O nly xx Moun Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center '5 �j Bed/Trench Edges Topsoil � � � o Yes No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1344 146th Ave New Richmond, WI 401 (SE 1/4 NW 1/4 23 T30N R1 8W) Whitetail Meadows Lot 5 Parcel No: 23.30.18.112 1.) Alt BM Description 2.) Bldg sewer length = 51 - amount of cover = ,4i L qZ t� Plan revision Required? Yes No G _ ( 3 q 7 Use other side for additional information. ® Date Insepctor's nature Cert. No. SBD -6710 (R.3197) T11 nd System PLOT PLAN PRWECT Verhasselt Construction InS P.O. Box 489 Osceola Wi 54025 S 172 NW 1 /4S 23 /T W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/23/05 BEDROOM 4 CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •3 ABSORPTION AREA 2052 # of chambers 66 IL BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.1/90.7/90.3 4' below qrade setbacks required by Vent WDNR >6„ Standard Biodiffuser of Cover Leaching Chamber Scale is 1 " = 40 with 3 1. 1 ft2 of Area unless otherwise 6' Long 11 noted jo 3 4" Grade at System Elevation Plans Designed Using 294' Property Line Conventional Powts Manual Version 2.0 Pr perty I J e Pro 4 B. M. * Bedroom 15' 20' House 25' 45' ST 3 -3' X 138' Cells with >3' spacing 0 ' 40' -1 130 -2 Ve 30' 105' B -3 6% Slope Please note: Pockets /Bands /Pocks of massive SL found in 3rd 100' horizon, using .3 to compensate for this, sands o Town Road were also found in pockets in 3rd horizon, a true till. Safety arJ Buildings Division County )t 201 W. Washington Ave., P.O. Box 7162 S ` «������ � Madiso -., WI 53707 — 7162 Sani Pe Number (to be filled in by Co.) M) 26 3 3 (ire artment of Commerce J State PI D. Number Sanitary Permit App ' In accord with Comm 83.21, Wis. Adm. Code, personal infor iatlon y provi d 6 may be used for secondary purposes Privacy Law, s 1:5 04(1)( ) t R R G oject dress if different than mailing address) , I. Application Information — Please Print All Information ST. CR ZONING OFFI E �Jzu /2{" a Property Owner's Name Parcel # Lot If Block # Property Owner ailing Address Property Locati / C� 3 6 _ 1 \I ( /a, Section City, State Zip Code — Phone Number ` /� n (circle II. T pe of Building (check all that apply) Subdivision Name CSM Number Family Dwelling — Number of Bedrooms ❑ Public /Commercial — Describe Use ❑ State Owned — Describe Use /JE ❑Clty ❑Vdla ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ew System ❑ Replacement System ❑ Treatment'Holding Tank Replacement Only ❑ Other Modification to Existing System - - -- List Previous Permit Number and Date Issued B. El Permit Renewal ermit Revision El Change of ❑ Permit Transfer to New Before Expiration Plumber Owner / __7 ZS IV. Type of POWTS System: (Check all that apply) / T on — Pressurized In- Ground El Mound > 24 in. of suitable soil V %Sound < 24 in. of suitable soil El At -Grade Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Gr d El Holding Tank 1 Peat Filter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter g Chamber El Drip Li nc ❑ Gravel -less ❑Other explain) V. Dis ersaUPreatment Area formation: 1' 1 _ _ 6T.D Design Flow (gpd) Design Soil Application Rate(gpdsf)/ Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Eleva Oro ' 3 J/ 2llz�r� Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site feel Fib lactic Gallons Gallons of Units Concrete Constructed G s New Existing Tanks Tanks _ Septic or Holding Tank J /Z s _ Aerobic Treatment Unit f:1 Lk Dosing Chamber VII. Responsibility Statement- 1, the undersi d, assume responsihility for installation of the POWTS shown on the attached plans. PPIber s Name (Print) Plumb Signature — MP/MPRS Number Business Phone Number - , (em 1�� _ 6� O O �iJ �Z U' /� Plumber's Address (Street, City, State, e) 80 l f, / % .� l VI Coun /De artment Use Only Sanitary Penmt Fee includes Groundwater Da Issued uing Agen Signature tamps) Approved El Disapproved Surcharge Feel ❑ Owner Given Reason for Denial �� a b D IX. Conditions of Approval/Reasons for Disapproval //p S . Attach complete plans (to the County ooF fur the system on paper not less than 91/2 x 11 inches in size SBD -6398 (R. 01/03) jSo' est and System PLOT PLAN PROJECT Verhasselt Construction Inc. DRESS P.O. Box 489 Osceola Wi 54025 S 1 - 12 NW 1/4S 23 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/23/05 BEDROOM 4 CONVENTIONAL )0(X IN- GROUND P ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 2052 # of chambers 66 BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 91.1/90.7/90.3 4' below qrade setbacks required bALong Vent WDNR Standard Biodiffuser Leaching Chamber Scale is 1 �� = 40 with 3 1. 1 ft2 of Area unless otherwise noted 3499 Grade at System Elevation Plans Designed Using 294' Property Line Conventional Powts Manual Version 2.0 Pr perty I J e Pro 4 B. M. * Bedroom 15' 20 House 25' 45' ST 3 -3' X 138' Cells with >3' spacing 20' 40' 130' -2 Vents 30' 105' B -3 6% Slope Please note: Pockets /Bands /Pocks of massive SL found in 3rd 100' horizon, using .3 to compensate for this, sands o Town Road were also found in pockets in 3rd horizon, a true till. Wismnsin Department ofCommerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S .,� /1 r Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must cJ ` ` 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. OZ� " ��& 0 S —� Please print all information. Re ' D Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). / 7i Property Owner Property Location Ve ' - eo t Govt. Lot 11 AJ14 S I T 3 t) N R E (or VQV Propertyer s Mailing Address Lot # Block # Sutxi. Name or CSM# r. v > -+� 5 fir/ , "at&tI14 City State Zip Code Phone Number ❑ City ❑ Village To Nearest Road Construction U Residential / Number of bedrooms Code derived design flow rate � of GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain evation if p/p�licabblle ft. General comments recommendations: 9t�t 9(>> ✓ ' , �n . ' �3 J/ a Boring # � Bonng S/ pit Ground surface elev. � ft. Depth to limiting factor in. App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Dots r-Eftl GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 Boring # Boring pit Ground surface elev. g " � / 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 Coy. ,S Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 1 ' Effluent #2 = BOD 5 30 mg/L and TSS < 30 mg/L CST Name (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� /�j� 715- 246 -4516 Property Owner _ Parcel ID # Page of Ong # C] Boring a 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 'E V2 1-0 31 - P Z I6 U 5 )k AJ Ja4 , F-1 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 •EINQ I F-1 Boring # E] Boring Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPQM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD, < 30 rrgA. 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 -9130 (8.6/00) Safety and Buildings Division County ` 201 W. Washington Ave., 162 i seo�nsin Madtson, WI 5370 - 716p E E I t Number ( to be filled in by Co.) Department of Commerce (608) 266 -31 1 3 3J� Sanitary Permit Application MAR 2 state Pl I. .Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you p vide 2U�5 be used for sewn purposes Privacy Law, s15.04(1)(m) t Add (if different than mailing dress) �, y � purp° ST. CROIX Co y E (3 y�_l I. Application Information - Please Print ll Inform ion E2222 2t t 42(0 -.� C) Property Owner's Name 5 Parcel # Lot # lilocic # Property Owner's Mailing Address Property P , 0 r ' J t✓ � � A W , Section City, State Zip ( Code Phone Number 1� // 'L T 3 3; &' E r W 11. Type of Building (check all that ply) _ • / Subdivision ame CSM Number ] or 2 Family Dwelling - Number of Bedr ms / ❑ PubliclCommercial - Describe Use L(/ ❑ State Owned - Describe Use ❑City ❑Villa e own ip of III. Type f Permit: (Check only one box on like A. Complete line B if ap icable) A ' a stem 11 Replacement System C1 Treatment/HoldinVReplacement Only ❑ Other Modification to Existing System B• ❑Permit Renewal ❑Permit Revision hange of o w List Previous Permit Number and Date Issued Before Expiration Pl er TV. Upe of POW TS System: Check all that apply) on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ M d < 24 in. of suitable soil 11 At-Grade El Single Pass Sand Filter El Constructed Wetland 11 Pressurized In round El Holding Tank t Filter El Aerobic Treatment Unit 11 Recirculating Sand Fil r l i Recirculating Synthetic Media Filter ching Chamber ❑ Drip Li ❑ Gravel -less Pipe ❑ Other (explain) 1 V. Dis ersal/Trestment Are nformation: Design Flow (gpd) Deign Soil AOcation Rate(gpdsf) Dispers Area uired (sf) Dispersal Area Proposed (sf) System Elevation a Q �q JAR g elge, VI. Tank Info Capacity in Total Number Prefab Site Steel Fi Pl e M re7 Gallons Gallons of Units Concrete Constructed Gass New E)asting Tanks Tanks Septic or Holding Tank Z s Aerobic Treatment Unit Dosing Chamber VII, R esponsibility State - he undersigntd a responsibility for installation of the P S shown on the attached plans. Plum Is ame (Print) Plumber's MP/MPRS Number Business Phone Number ,� 7 7 /J° Plumber's Address Street, City, State, e� / VI oun /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee includes Groundwater Date Issued uing Agent ignattne ps) Surcharge Fee) ❑ Owner Given Reason for Denial V 0 r L IX. Conditions of Approval/Reas Disa proval / � G U /� 1�1 �� %�✓t �/�-- S1'�E11d - -- Septic tank, effluent filter and nnr� dispersal cell must all be serviced / plumber. 3 • Cam . as per management plan provlumber. (.�'1'1� ided y p 2. Ar requen s di ��\ /�_�_ I T7 �rlc &x as per applicable e Co codelordinances v (�fJ �t �'/�'( Attach complite plans (to the Cou qoo oo-Pap_.seQeq#ftn 8112 11* hes in size SBD -6398 .01/03) �- - tS47 ki -� �, -���e d c�ci s GPs . T P AN PROJECT Verhasselt Construction Inc. ADD SS P.O. Box 489 Osceola Wi 54025 S 1/2 NW 1 /4S 23 /T 30 N/R W TOWN Richmond COUNTY ST.CROIX 3/23/05 4 BEDROOM MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND - HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 2052 # of chamber 68 IL BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE SWELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 90.5/89.8/89.1 /88.4 4' below grade setbacks required by Vent Top of 2" Pipe @ 100.2' Alt. BM WDNR >6 „ Standard Biodiffuser Scale is 1„ = 40' Leaching Chamber Alt. B.M. of Cover with 3 1. 1 ft2 of Area unless otherwise B.M. 6' Long il l, noted Grade at System Elevation 34" Plans Designed Using 294' Property Line Conventional Powts Manual Version 2.0 5 130' - Vents 4 -3' X 107' cells with ' >3' spacing -3 B -2 65' 10% Slope 15' Pro 4 15' T Bedroom op rty House is being Please note: system g oversized for the pockets of massive sandy loam found throughout this subdivision, at the time of installation, the system may be downsized if ro Town Road soils are found suitable. Also, a additional boring may be dug in or o ins a1T"� trenches instead of 4. T P AN PROJECT Verhasselt Construction Inc. ADD SS P.O. Box Richmond la 54COUNTY ST. CROIX W TOWN S 1/2 NW 1 /4S 23 /T 30 N/R 4 3/23/05 BEDROOM DATE MPRS Shaun Bird 226900 CONVENTIONAL XXX IN- GROUN^ RESSURE CONVENTIONAL LIFT HOLDING TANK DOSE TANK SIZE 1255 gallons LIFT TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE •3 ABSORPTION AREA 2052 # of chambers 68 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION im FilteT Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all V SYSTEM ELEVATION 90.5/89.8/89-1/88.4 4' below grade ent setbacks required by To of 2" Pie @ 100.2' WDNR Standard Biodiffuser Alt. BM " _ 40' , Scale is 1 Leaching Chamber Alt. B.M. of Cover with 3 1. 1 ft2 of Area unless otherwise B.M. 11 " noted 6' Long Grade at System Elevation 34" Plans Designed Using Conventional Powts 294' Property Line Manual Version 2.0 5' 130' - Vents 4-3' X 107' cells with ' >3' spacing -3 B- 65' 15 10% Slope Pro 4 15' T Bedroom op rty House Please note: system is being oversized for the pockets of massive sandy loam found throughout this subdivision, at the time of installation, the system may be downsized if ro Town Road soils are found suitable. Also, a additional boring may be dug in or r o ins a ^, trenches instead of 4. M Bird Plumbing Inc. 1008 192nd Ave New Richmond WI 54017 715 -246 -4516 Subject: Whitetail Meadows Soil Tests To Whom it may concern: I Shaun Bird did the soil tests on this subdivision known as Whitetail Meadows in Richmond township. Aftbr a couple of installations, some of the soils were found to have a more weak structure than what was found in some of the borings. In order to protect home owners and contractors, it is my recommendation after discussing the issue with Pam Quinn from St. Croix County Zoning office that the systems be oversized using a.3 loading rate Instead of the original .4 rate. On the lots that were originally sized for a.5, I recommend using a.4, not the new .6 that the state has suggested. The soils are what the tests indicate but the large areas tested did not reveal some of the weaker structures that were found upon installations. If a installer can prove otherwise, that the weaker structures do not exist, then the installer should proceed with the soils that he /she believes are present. Shaun Bird CST #226900 Z . d d64 = T T 40 'so Jdu ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT " �� / / M / N M r ■ r���r. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File From Pam Quinn Date. 4/27/2004 Re. Sandy loam structure misinterpretation on subdivision soil reports Recent soil on -site determinations have brought a problem to our attention. During these on- sites, borings were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zonidg department review. The soil profiles, evaluated by myself, Dave Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that massive (structureless) sandy loams were encountered in horizons that were described as having either moderate, medium subangular blocky (2msbk) structure by Adam Schumaker or weak, medium granular structure (I mgr) by Shaun Bird. There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness, but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive ". Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist), Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the original soil report described the third horizon as sandy loam, "1 mgr". On Lot 6 we checked soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy loams in question were a weak, coarse to very coarse subangular blocky structure, where planes of weakness were just discernible when peds were parted from the profile. The peds separated with very li pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9 soils, which supported the determination that some structure existed to allow water to move through the upper portion of the sandy loam horizon. However, below the weak - structured soil we found massive (structureless) sandy loams and the boundary between these horizons was irregular, which would mean a distribution cell could encounter alternating weak and massive sandy loam. Shaun said he would amend his soil reports with a memo recommending that any sandy loams he identified as "lmgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to provide a larger dispersal area. Page Two — Soil Memo 4/27/04 Massive sandy loams have been assigned a soil application rate of 0.2 gpd/ft with the code changes in Comm 83.44 -2, effective as of 2/1/04. The application rates listed on the soil reports were higher due to the structure having been described as either weak or moderate, which affects the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon had been described on the soil report as "lmgr" with firm consistence. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on -site verifications for any lots with this potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as its structure will be required to use a design based on the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise. Wisoonsir Depar�lentof 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 8 112 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. • evie Date Please print all information. _.._.._ Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). C� r ✓� Property Owner Property Location G/'✓ (/ // ,J Govt. Lot 6 1 /4 S3T N R E ( 06W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip 4✓ode hone Number City i lage own Nearest Road New Construction Us� Residential / Number of bedrooms Code derived design flow rate �� d u' GPD ❑ Replacement ❑ Publip or commercial - Describe: - - -- - -- - -- Parent material ��,1iC ,CA:. Flood Plain elevation if applicable C_ ft• General oornrnents `� Its r and recommendations: r # ❑ Boring j l ce elev. ' ft. Depth to limiting factor / Z �� 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 r L 0? � �' S' Z -3 J sal - /Z " AU 77 ,' /�19— - 4U 1 CeZf1 i ❑ f Boring # Boring / Pit Ground surface elev. V J ft Depth to limiting factor " in• Soil Application Rate A r 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 2 3 7 tl � L j rvt, ✓ �� �� Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mAl ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Narne (Please Print) Sig re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 r ' .— � 715- 246 -4516 S Property Owner _ Parcel ID # Page of Boring # Boring ❑ fi Ground surface elev. " ft. Depth to limiting factor /v in. Sal A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM y� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 0 0 l -D ( / t - � L ( KGs 'S I Z 0 3d [o F] Boring # El 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 # 11 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A0011cation 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/l. ' Effluent #2 = DOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. sBD -8330 (RAW) L r Soil Test Plot Plan Project Name William Stock/Steve Dalton Shaun Address 1748 112th St. New Richmond Wi 54017 C #226900 Lot 5 Subdivision Whitetail Meadows Date 8/15/03 S 1/2 N W 1 /4S 2 3 T 30 N /R W Township Richmond F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 86.5/85.5 *HRpSame as Benchmark Alt. B.M. Alt. BM Top of 2" Pipe @ 100.2' B.M. Scale is 1" = 40' unless otherwise Please note: Installer must 294' Property Line noted verify all lot lines and setbacks before installation. 5' 130' 1 Please Note: Tested area may not be suitable for 45 desired building area. Check system location before excavating. -3 B -2 65' 90' 10% Slope 88' tr o Town Road ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer e r h s se I -E Con uc4 -bo Mailing Address �� �aX �P t b SC.co�h i w_I `��Zd I 5 +h N ew �i�.h Property Address I --a'`" 5 Iry �i I-� �w Ak—e d o r4 S.� xx (Verification required from Planning Department for new construction) City /State New R i c,h m o N t LA Parcel Identification Number EGAL DESCRIPTION 1 S r S%4 y. Z 3 T_ b N -R�� Town of sU . � Property Location `L- /., , Sec. Subdivision w S Lot # . _ _, Volume _, .Page # Certified Survey Map # / l Warranty Deed # Volume Page # b Spec ho <yes ❑ no Lot lines identifia es ❑ no SYSTEM MAINTENANCE 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. The ro rty a grees to submit to St. Croix Zoning p pe owner a Department a certification form, signed by the owner and by a mastorplumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on - s it e wastewaterdispo sal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards State of Wisconsin. Certification set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Office with 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning days o the three ear expiration date. r? ,E / D DATE SI A OF APPLICANT OWNER CERTIFICATION the owne r(s) of I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the p operty described above, by by virtue of a warranty deed recorded in Register of Deeds Office. /•Z�/ o DATE SIN OF * * * * ** Any informs P informa that is mis -re resented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *' Include with this application: a stamped warranty deed from the Register of Deeds office deed a copy of the certified survey map if reference is made m warra ty I ' 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: the insp ections pipes at the ends of 3. Once every 3 years, cells are to be inspected via p 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 cy Plan - � -9mate �r� and install new ptio 1 ystem fails, determine cause of failure, use a 3.. system in tested replacement area. 1�1� fib 12-1 Aj �S - rb ej6 is n tj Gf T by removing chambers, removing biomat, ption #2.' stall system at a lower e levation, O � � 6� ' S� pep t rr-j `� ewsystem. N O T ^' �����' 0O1'Jp ` -n°3S ' O tion#3. Ie uate r is suits for rep ac t area, a ste vs#ion P cannont In st hof 'n nk as sort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -45 St. Croix County Zoning 715-386 -46 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ` Parcel #: 026- 1160 -05 -000 03/25/2005 08:33 AM PAGE 1 OF 1 Alt. Parcel #: 23.30.18.1211 026 - TOWN OF RICHMOND Current i X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/02/2004 00 0 Tax Address: Owner(s): * = Current Owner * VERHASSELT CONSTRUCTION INC VERHASSELT CONSTRUCTION INC 2391 HWY 35 PO BOX 636 OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description * 1344 146TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.880 Plat: 09 /97- WHITETAIL MEADOWS 026/04 LOTS 1/30 SEC 23 T30N R1 8W PT SE NW BEING Block/Condo Bldg: LOT 05 WHITETAIL MEADOWS ('04) LOT 5 (1.880AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23- 30N -18W SE NW Notes: Parcel History: Date Doc # Vol /Page Type 07/16/2004 768968 2617/612 WD 01/02/2004 750596 09/97 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/0812005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 2617 612 /1 ?Ea89Ea8 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between Dalstock, LLC RECEIVED FOR RECORD Grantor, 07/16/2004 09:35AN and Verhasselt Construction, Inc. Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEIPT t the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 144.00 Lot 5, White Tail Meadows. St. Croix County, Wisconsin. COPY FEE: GC FEE: PAGES: 1 Recording Area Name and Return Address ATTOnMEY Xf Uffl P.d, C'-tx 039 HIJDSi_ �, VVI 54016 I 026 - 1068 - 90-000 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 this I day of July _ 2004 Dalst , LL * * B AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dalstock, LLC STATE OF ) By: ) ss. _ County ) authenticated this l day of July 2004 Personally came before me this day of -- _— the above named * Kristin Oghwd _ 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 Attorn Kris Ogla Hudson, W 5401 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 2 -1999 acres LOT4 7 > L. B. 0. = 1003.75' 139, 016 sq. ft. J. 19 acres 1017.2& (D 0 )5 5.72 X33 s1j 0C) LLJ S75- 06' 0 E , 00 224 .60".P\ Join Driveway L OT I ; N / 1 1, "1 Easement 0) 0) LC) (14 46' 1 251 sq. ft. C 0 0 2.55 acres U) L. B. 0. = 1003.75 c:; C_: 2 4") C_- CC C CD C C, '0 2 LC) (6 W Co 539.41' 00 C) 26 N L15T 6' --- — LOT 5 b_ 0 2.$2' C � Cc;) 83,465 sq. ft 81,871 sq. ft. . C) (N 0 88 acres-.- C3 Lr) -1.92 acres LLI 1. C) 0 C) z En LOT7 6,4J2 sq. ft. Co 2_.4 acres = 1003. 0 Driveway location t (T)PAC0 Ci join MORA Drive -323.60' 55' N89'49'25"E 647.20' A HSWE Mew S89*49'25"W 237.82 -9'25�W- 343.38' 20 81.02 �56.8O' 24- —P,98 '6 6' — _ 1 " - — V, . 1> Jo int 33 .00 0 0 Drainage z Drive way Easement 1 Ebsem en t ,_ _ - -- � � 0 0 tQ. 0. — rz Cq r YIZ N 0 . 108, 8; r26 LOT 25 LO; 2.5t LOT 24 l 65 sq. ft. 89,879 sq. ft. 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