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Home My WebLink About026-1160-25-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453347 0 (ATTACH TO PERMIT) GENERAL INFORMATION 41 State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, A5,04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Fer usson, Reid I Richmond Township 621 - 11&4 - Z S — 106 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 0(, 166 � � �`�� 23.30.18. /Z f TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �- Dosing Alt. Aeration Bldg. Sewer l00 r Holding St/Ht Inlet 3 -g IT TANK SETBACK INFORMATION St/HtOutlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > j t Dt Bottom \ /Zp S9 Dosing Header /Man. `1 y.s Aeration Dist. Pipe -7, 2- 8 Holding Bot. System 7 O J` Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Numbe lb 7 TDH Lift . Friction Loss Syste d TDH Ft Forcemain L ia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width j Length # No. Of Trenches PIT DIMENSIONS No. Of Pits Inside ia. Liquid epth DIMENSIONS SETBACK SYSTEM TO I P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. G INFORMATION CHAMBER OR + J Type Of System: /� _ UNIT (k /� f'f Model Number. DISTRIBUTION SYSTEM 3`i ion- 1,3 Header/Manifold Distribution x Hole Si e I x Hole Spacing Vent to Air Inta� Pipe(s) ` \ ` L Dia Length \ Dia Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded r ulched Bed/Trench Center Bed/Trench Edges Topsoil \ ! Yes No Yes I � No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 1341 146th Ave Unknown (S 1/2 NW 1/4 23 T30N R18W) Whitetail Meadows Lot 25 Parcel No: 23.30.18. 1.) Alt BM Description= Q'�' ��, ; �� - -cS ✓� 2.) Bldg sewer length = -r - amount of cover 30 -- - - - Plan revision Required? Yes e i�lo U f LZ� � se other side for additional information. L ' ? _� �` � b 3.-� 7 __ -. ___ _� SBD -6710 (R.3/97) Date Inse or's S' ture Cart. No. Safety and Buildings Division County _1 201 W. Washington Ave., P.O. Box 7162 1 JV- " Madison, WI 5.3707 - 7162 Sanitary Permit Number (to be filled in by Co.) Nvl'sconsin LLr--? 7 Departm of Commerce (608) 266-3151 I N - I= -1 Sanitary Permit Applic State. Plan I.D. Number OR!7 br In accord with Comm 83.2l,Wris. Adm. Code, personal i tion you � CEIVE vide may be used for secondary purposes Privacy Law, 5.04(lXm) Project Address (if difIbmat dm mailing address) 2 I. Application Information Please Print All Information 4 ZY/ F, Parcel ft Lot # Bt6ck # Property Owner's Nam Property Owner's Mailing Address G7 Property Location /1 ?/" Z7 Section City, State Zip Code Phone Number cir s- (/ 1) A 3� N. 11 Type of Building (check all that apply) Subdivision Nam CSM Number r 2 family Dwelling - Number of Bedrooms A r - Describe Use State Owned - Describe Use _(3�) N, ch 'Plat I City_ vid��washi' of'�,�one . I1L Type of Permit-. (Check only one 1 -- on line A. Complete line B if applicable) A- - System Replac System TrestumvRokfing T'm* Replacement Only Other Modification to Existing System Permit Renewal Permit Revision Change of t Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. of POW TS System: (Check all that apply) a -Pressurized In-Ground Mound > 24 in. of suitable soil Mound < 24 in of suitable soil At-Grade Single Pass Sand Filter Constructed Wedand Pressurized In- Ground Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter Recirculating Synthetic Media Filter :��g Chamber Drip Line Gravel-less Pipe _ Other (explain) J L ,OCX V. DispersaIlTreatinent Area Inf6rusation: Design Flow (gpd) Design Soil Application Raw(gp&O Dis Am Required spersal Area Proposed System Elevatjon / ac / K06 1 1 7 /,-; 7 VI: Tank Info Capacity in Total Number Manufacturer Prefab site / 'Steel Fd(er Plastic Gallons Gallons of Units concrete Constructed Gins New I Existin Tanks Tanks 4 Septic or Holding Tank �2 Z Aerobic Ticauncat Unit nosingatardw VII. Responsibility Statement- 1, the undersigned, M&-n-T—Onsibility for installation of the POWIS shown on the attached plans Plumbers 1 a (Print) Plumber's Si MPIMPRS Number Business Phone Number J �� Plumber's Address Street, City, State, Zip3o/r/. S / VIII. CounlyADepartment Use Only 4No.S tartups) Surcharge FCC) Sa nitary Permit Fee (includes Groundwater Date Issued k �gerit Signature (A��rvvc� S - j Disaptinmcd- =in Reno r Denial 2- OMAk UL Conditions of Approval/Reasons for - Disapproyal SYSTEM OWNER: >� _ 0 ®� 1 Septic tank, effluent filter and dispersal cell must all he serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances Attach complete plans (to the County only) for the system on paper not less t SO 111 inches in Sim P OT PLAN PROJECT Reid Ferausson ADDRESS 14773 197th St. Marine Mn 55047 S 112 NW 1145 23 /T 3 N /�. 18 W TOWN Richmond COUNTY ST. CROIX 6/15/04 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN- ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 3 9 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P Same as Benchmark SYSTEM ELEVATION 93.7/93.2/92.7 4.5' belo q Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Conventional Powts Well is to meet all Manual Version 2.0 setbacks required by Scale is 1" = 40' WDNR unless otherwise noted E�F1WE a JUU ! 2 5 2004 Pro 4 Bedroom 'zctilNS Fi3' operty Line House 30' S 30' 'B-1 0' - operty Line 7% Slope B-3 3 -3' x 83' cells with >3' spacing Vent >6„ Standard Biodiffuser B Vents of Cover Leaching Chamber with 31.1 ft2 of Area 3 6' Long 11 " Grade at System Elevatio 34" n Alt. B.M. B.M. 250' Property Line P OT PLAN PROJECT Reid Ferausson ADDRESS 14773 197th St. Marine Mn 55047 - S 1!2 NW 1 /4S 23 /T 3 N /$. 18 'W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6 /15!04 BEDROOM 4 CONVENTIONAL XXX IN-G4 � VND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39 kk BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P Same as Benchmark SYSTEM ELEVATION 93.7/93.2/92.7 4.5' below qrade Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by A L Scale is 1 " = 40' WDNR unless otherwise noted (),FrFI Pn i f .iiJ�d <s 2004 Pro 4 Bedroom 3' o ert Line P Y House ---� -� �-- 30' S 30' 5'B-1 0' •ope rty Line 7% Slope -3 3 -3' x 83' cells with >3' spacing Vent >6 " Standard Biodiffuser B-2 15 Vents of Cover Leaching Chamber with 3 1. 1 ft2 of Area 30' 6' Long 11 " 3 4" Grade at System Elevation B.M. B.M. 250' Property Line Bird Plumbing Inc. 1008 192nd Ave New Richmond WI 54017 715- 246 -4516 Subject: Whitetail Meadows Soil Tests To Whom it may concern: I Sheun Bird did the soil tests on this subdivision known as Whitetail Meadows in Richmond township. Aft& 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, 1 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 a.d ds4 =z �o so add ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ~ ST. CROIX COUNTY GOVERNMENT CENTER s Stinso r�. 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, boiings were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zoning 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, "lmgr ". 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 light 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 "Imgr" 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. r 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. 4lfosconsinDep6trfnent &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. Please print all information. Re 'awed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)), Property Owner Property Location ^ J Govt. Lot 6 1 /4 S N R E( W Property Owner's Mailing Address Lot # Block # Subd. PJame or CSM# City S to Number 11 City ❑ illage • own Nearest Road . Zip Code Phone � S ( ) 2, IS( New , Construction Useig Residential / Number of bedrooms Code derived design flow rate 5�. O GPD ❑ Replacement ❑ P bi or commercial -Describe: ^ - - -- - -- �i --- Parent material — 4_W X r. ,� Flood Plain elev lion if applicable General co n ti _ J��+,/ �� ).3 v and recommenda ->�' Boring # E] Boring Jr it Ground surface elev. . ft. Depth to limiting factor in. Soil ication Rate U Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ # Boring Ground surface elev. � ✓ 3 Depth to limiting factor ---f —= in. Pit ft. Soil Armlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D * -- ..� , Effluent #1 = BOD > 30 220 nVL and TSS >30 < M& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg11. CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r .. —� 715- 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring f �"lV it 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 ❑ 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/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDlfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mg& • Effluent #2 = BOD 5 30 mg/L and TSS 5 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) Soil Test Plot Plan Project Name William Stock/Steve Dalton Sha Address 1748 112th t St . New Richmond Wi 54017 QXfM #226900 Lot 2 5 Subdivision Whitetail Meadows Date 8/15/03 S 1/2 N W 1/4S 23 T 30 N /R W Township Richmond F1 Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 93.7/93.0 *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 a a 0 Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. 5' -1 45' a 0 ' a 7% Slope -3 0 ' B -2 15 96' 98' 30' .M.g .11A .M.g 250' Property Line M aintenence and Contingency Plan for a Septic System Maintenance Plan mps d once every 3 years. 1. Septic Tank is to be pu 'tter is to be cleaned once a year. Please note: a larger filter is being installed in 2. Effluent fl order to extend the maintenance interval of the filter actions pipes at the ends of 3. Once evj:ry $ years, ceps are to be inspected via t he inspections the cells. 4. Owner agreas 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. Wa te r shed is to be diverted away from system. omm. 83 8. Discharge into system is not exceed those required as per C Contingency Plan op #1. if system fails, determine cause of failure, use a lternate area and install new �sst=jn tested replacement area. O tion #2 Install system at a lower elevation, by removi ng chambers, removing biomat, P and install new system. Option#3. rJo 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- St. Croix County Zoning 715- 386 -468 Pumper Tom Mondor 715 - 246 -5 Shaun Bird #226900 ST CROIX COUNTY CE AGREEMEN SEPTIC �'T� NI�AIN"I'ENA . AND' OWNEg,SHIP CERTIFICATION FORM t o Owner/Buyer of 2 Mailing Address construction) (Verification requir from planning Department for new ` parcel Identification Number city /State LEGAL DESCRIPTION r�N_RW, Town o prop Location _.._..__ � Ll. Sec 3 ._— S � P Lot # 2=L Subdivision page Volume Certified Survey Map # .. 2��- Page # I Vo lume --- Warranty Deed # Lot lines identifiable7�es ❑ no Spec house ❑ YeS ° NANCE remature failure to handle wastes. Proper maintenance SYS TEM M�,INTE of your septic system could ree ne e its p a licensed pumper. what You put into the s tem ys Improper use a maintenance every three Years or sooner, if needed by out the septic tank at stage in the waste disposal system. consists of pump as a treatme can affect the f inction.of the septic tank at a certification form, signed by the owner and by a t to St. Croix Zoning Departmen , that (1) the on -site wastewaterdisposal system The proper owner agrees to submit 1/3 full of sludge. er, journeyman Plumber' restrictedplumber or a li pu mpe r (i necessary), the septic tank is less tha. is in p d/or (2) a 1 condition anfar inspection and pump g C is is proper operating private sewage disposal system with the standards have read the above n rements and agree to maintain the Uwe, the undersigned artme_nt of Natural Resources, State t Zoning in. Ce rtificati on a s set by the Department of Commerce and the Dep artment St. Croix County set forth, herein, system has bee. maintained must be compl�ted stating that your septic y r three wear expiration date. da of the D / . ATE SIGNA APPLICANT W a bove, the pro perty O NER CER ICA TION the best of (our) knowledge. I (we) am (are) th owner(s) of I (we) certify that all sta on this form are true to by virtue of a warranty deed recorded in Register of Deeds Office. L described ._ _.....,_. ....m_ M.��... ; r DATE r SIGNATURE 0 P i ° ' > 2004 De partment. " «« result in thelsanitary penrut being revol�ed by the Zoning p Any information that is m i s - re p re sented may Y r n deed from the Regist'e� °o� r rtan deed '`• Include with this app a copy of the certilication: a stamped wawa tY if reference is made in the wa tY ce rtified survey map ST CROIX COUNTY E1viENT SEPTIC -TANK M �NTENANCE A� ANA : WNERSHIP CERTIEIC�'Tlgly FORM OwnerBuYer - -- sS Mailing Address A dress D arlment for new consttucdon) Property eP (verification re ed from Plana$ Parcel Identification Number — , City /State - - - - -- x LEGAL DESCRIPTION W, Town ! \ ti ` o \ T 3 O N - R Sec. a p Location Z. j,pt # Subdivision �L C / / volume Page # Certified Survey Map # ;r:: ' � e ; Page # Warranty Deed # s ❑ no lines id tifiable e es o ❑ i� ous Y ec h S � i P NANCE � pre maintenance failure to .handle wastes. Proper maintenance SYSTEM � of your septic system C01114,14 salt its p needed by a licensed Pumper, What You put into the system Improper use or ncr, if o t the septic tank every three a in the waste disposal system. consists of Pump g as a treatmea g fuaction.of the septic tank Si ed by the owner and by a can affect the t to St. Croix Zoning Department a certification form, gn owner agrees to submi er veri an 1/3 fu fying that (l) the on -site wastewater disposal system 112C Prop lumber or a licensed pump the septic tank is less thll of sludge. masterplumber journe3�PlumbeT' mctedp ri necessary), er operating condition and/or (2) after inspection and pump u prop sewage dis posal system with the standards ements and agree to maintain the private State of Wisconsin - Certification Uwe, the undersigned have read the above requu erce and the Department of Natural Zoning Off within 30 set forth, herein, as set by the Department of Comm kted and returned to the St. Croix County stating your septic system has been maintained must be comp days o three expiration date. !S!� DATE IGNA:SM OF APPLICANT O WNER CERTICATION our) knowledge. I (we) am (are) the owners) of I (we) ce that all st atements on this uty forn deed corded in Reoter of Deeds Of the p erty des 'bed above, by virtue of a wfice. arranty i DATE SIGNATURE OF APPLICAN D * *'* ' - represented may result in the sanitary permit being revoked by the Zoning p * « « * «« A information that is mis «* eeds o ffi ce 11ty deed from the Reg ister Include with this application: a stamped watra eferenceDs mad m the warranty deed a copy of the certified survey maP Safety and Buildings Division County, �� 201 W. Washington Ave., P.O. Box 7162 D N v r sconsin Madison, — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (.0.) ) 266 -3156-315 1 to Plan I.D. Number Sanitary Permit Applicat n -' �i�` In accord with Cotton 83.21, Wis. Adm. Code, personal info on you provide maybe used for seoo es Privacy Law ism) ; ' • J J sect Address (if ditlerent titan mailing address) L Application at All Ipf rmatio t�, j ( [3q- - ( `�(o � Av 6 • J i Property owner's .- - P * Lot # Block tt Property owner's Mailing Address prowty Eocation �' -2 Section l � �. city. State Zip Code Phone Number /n T ��j'N. 4 h; o' IL Type of Building (check aA that apPty) as S N k /(1 1 4 7 ision Name CSM Nu , 2 Family Dwelling - Number of Bedrooms S l Publrc/Cotnrnercial - Describe Use G� State Owned - Describe Use CSty_ Village hip of IIL Type of Permit: (Check only one box online A. Complete line Rif applicable) A ew System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B. Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S ystem: (Check all that apply) - Pressurized in- Crround Mound Z 24 in. of suitable soil Mound <24 in. of suitable soil At -Grade Single Pass Sand Filter Constiucte d Weiland Pressurized la- Ground Holding Tank Peat Filter Aerobic Treatment Unit Re rc Iating Sand Fil� Recirculating Synthetic Media Filter ' g Chamber Drip Line Gravel -less Pipe Other (eat ) J V. DispersaVEreatment Area ormatr n: Design Plow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Ralaired (d) Dispersal Area Proposed 40 System El 'on C 1- S Z.00- 7- Z, tF � � Pc7, VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel fiber Plastic Gallons Gallons of Units Concrete Constructed Gass New Existing Tanks Tanks Septic of Hok6ng Tack 7- 6 O ! Aerobic Tirauneut Unit Dosing Chamber VII. Responsibility Statement- I, the and er1, a bility for installation of the iPOWTS shown on the attached Plumber' Name (Print) Plumber's S' MP/MPRS Number Business Phone Number J7: r ZZ6 061 6- Plumbees Address (Street, City. State, Zip QW TyDC2 VIII. Cotm me artment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issaiog Agent Signature (No Stamps) Surcharge Fee) Owner Given Reason for Denial IQC. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER, 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Atheh eomplete plans (to the County only) for the system ua paper not less than 111/2 x 11 inches is size ER �^2Jld rO r2l �D / f 3f,, _ - E , To: W (Ll_e w C"C k S Fro C--v I A Fam (o 1 qS 7 . 5 1-f �v Page (� Phone ? Da te: u M E 2 1 , Re: CC ❑ if this box is checked please submit a check for a $5.00 fax fee made payable to "St. Croix County Zoning' along with a copy of this fax sheet to St Croix County Zoning Department, 1101 Carmichael Road, Hudson, WI 54016. • Comments: ' l L L IS P AJ Y ' �fo 0 , 2073 e4CiAQ -m /IV (, P6i� Ak LO 2 �� v►� E.� a w S 4 STATE BAR OF WISCONSIN FORM 2 - 1999 -7 657 1 8 WARRANTY DEED ED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX Co., WI This Deed, made between Dalstock. LLC RECEIVED FOR RECORD Grantor, an _ eid Ferellson 06 /14/2004 09 : 00AII ------ Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXERT i the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 i pace is needed, please attach addendum): TRANS FEE: 141.00 Lot ite Tail Meadows. St. Croix County, Wisconsin. COPY FEE: CC FEE: PAGES: 1 Recording Area Name and k �1s4 OGLAND Al ORNEY AT LAW P.O. 60)( 359 WI 54016 026 - 1068 -80-000 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 day of June 2004 Dalstock, LLC * * By ' -- - -- -- + * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dals LL C _ STATE OF — _ —_ _ ) _ — -- — ) ss. County ) authenticat this day of June , 2004 Personally came before me this day of the above named * Kristin 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 Kristin Ogla _ *! _-------- __ - - -- - Hudson, WI 54016 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 800-655-202 WARRANTY DEED FORM No. 2 • 1999 S L6 . . . . . . . . . . . . . . . 75 N Joint )' 216.55' 107.05' Drivewoy £osement 89'49 25 " E 647.20 343.38' S89'49'25 "W 237.82' G 15 — 200.98' 6 6' 181.02' 56.10'�s I Join t 33' 33 ��• Drivewoy —'A �. S Easement 1 , Droinoge Ir Easemen t ms `^ O o -° o o ; . ... a � P` N • C14 : \ c^ s LOT 27 f — w 108,818 sq. LOT 24 LOT 25 LOT 2B ft. 2.50 acres I 89,879 sq. ft. 3 W 79, 652 sq \ 2.06 acres to ,�� 2.11 acres w 1.83 acres • p O N �\ 0 \ OO O J!". ;,\ N89 49 25 • Z 33' (O N89 F9 3 Bf 4 3.60' 33 • _ o E c o� i 3 p N :W • ' C, 6 o o o $I — 840.98 8.32 Z ' I 229.16 220.00' 66.00 250.00' 15748 ».s8' o S89 49 25 n W 1646.46 V ti UNPLATTED LANDS EMEND to cord — X Existing Fenceline 3m R —O —W) - - Proposed Driveway Location 12' Utility Easement (typical) — — — Drainage Easements foot) _ — — — — — — Driveway Easements 100 0 — — Vision Easements HWE = High Water Elevation GRAPHIC j LBO = Minimum Elevation of Lowest Building Opening SCALE IN FEET: 1 it (4' above 25 —year High Water Level) III