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HomeMy WebLinkAbout026-1288-04-000 Wisconsin 136partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515127 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: Marek Todd R. I Richmond, Town of 026- 1288 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /66 1 8 M 1 26.30.18.1447 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER �� CAPACITY STATION BS 5 HI FS ELEV. Septic O Benchmark lJ; �,� � �z�� � 55 dog.. ✓dd Dosing // Alt. BM Aeration 5 ZS Bldg. Sewer a 15. f03 STS Holding St/Ht Inlet 4 M0 '91 \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 661 A— / g Dt Bottom I Z Dosing / 1 Header /Man. ,Z m ' Aeration Dist. Pipe %L 5 3 Holding Bot. System O Id / 35 PUMP /SIPHON INFORMATION Final Grade 3A Z 1 f3 Manufacturer Demand St Cover q,43 / L cYj GPM Model Number P / Z4 �� 5.6 f a3 , 4 G ors o.rC TDH Lift Friction Loss System Had TDH Ft Forcemain Length r Dia. :r Dist. to Well k7a��tG la�� z 4 SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Tre has PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7, 5 � 13-y /� 11 \ \ ", � U C" SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Ty�f. Systerp: 3 A / /i _ UNIT Model Number: DISTRIBUTION S YY S ( / TEM c: r /V�j" /"fT Header /Manifold Distribution x Hole Size x Hole Spacing Veto Air Intake Pipe(s) 3 jj ' `� Length Dia N-1. Length � Z Dia Z Spacing � L SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center a Bed/Trench Edges Topsoil - es 0 No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 / Z Z - 1 O q Inspection #2: Location: 1380 134th Ave ew Richmond, WI 54017 (NE 1/4 SE 114 25 T30N R18W) Stone Run Estates Lot 4 Parcel No: 25.30.18.1447 f . I4-c�, G(j i ��� 6 P/Ow 1.) Alt BM Description = 2.) Bldg sewer length = �/ (; t�• �c+G 11�� �/ - amount of cover = �► 0 uek Plan revision Required? N Yes No Use other side for additional information. - -- - Date Insepctor's Sig ure Cert. No. SBD -6710 (R.3/97) commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 CY c co n sin Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) l t j� e af C ■ am me rce . 5/5/2-7 Sanitary Permit Applieatio State Transaction ; Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental / 4 / #3S O unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different thatimailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04(1 )(m), Slats. /��� /�j/ 0- L Application Information - Pl ease Print All Inform ation �7``-- Property Owner's Vame Parcel # AUG 212009 0 Z ( — 17— g$_ 0 cf — 8 6 t7 Property Owner's Mailing Address D Property Location ^ Z ST G & Z NING OFFICE Govt. Lot _ City, State Zip ode Phone Number 1 A , Section 61j( p �Zt2 S 3 7- 6 �, Z circle one) T N; R l( II. Type of Building (check all that apply) Ck Lot # Su V1 or 2 FamilyDwellirrg - Number of Bedrooln Name. ' vis 15�i �o� Block # S— �ve� uN ❑ Public/Commercial - Describe Use /// ^--� 11 1 1 It El city of ❑ State Owned - Describe Use / CSM Number ❑ Village of _ I t KTownof iel cP't-ta-A)p II1. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' X New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner fV. Type of POWTS System/Component/Device: Check all that apl 1 v ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground KAt -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreat ntArea Information: Design Flow (gpd) Design Soil Application Rate( sf) Dispersal Area Required (st) Dispersal Area Proposed (s System Elevation ,cV�/V� f C C 3 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 c New Tanks Existing Tanks y a� j U Pr a 0 in y w 3 G4 Septic or Holding Tank e r c Dosing Chamber V: '1 � ( ���� •L � ` , ` r� V1I. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /rMorrNumber Business Phone Number >✓`n ���5©� zZ 6 7 is Z 7 PI be s Yddress (Street, City, State, Zip Code) L L- 5 -.v GcJ VIII. County/ e artment Use Onl )9, pproved ❑ Permit Fee Date issued Is sui gent Signatur Given R n for Denial $ 475• IX. ConditiitSytt for Disapproval / /�� 1 1. Septic tank, efflGtnt filter and ov i ij-r l & fr x l V dispersal cell must all be services / maintained �J as per management plan provided by plumber. W ` "�-�� �'�'°'' �•^'� -• l 2. All setback' requirements must be maintallted Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x I I inches in size SBD -6398 (R. 01/07) Valid thru 01/09 J + 171' property line 105' 103' 101' BM 061 0 2 oB3 7% Slope 0 0 °- o aq o -a CD o m CD B2 CD 0 0 1 , �i 0 0 Todd Marek PO Box 228 New Richmond, WI 54017 Stone Run Estates lot # 4 NE 1/4, SE 1/4, S 25, T 30 N, R 18 W o Wieser Richmond Township o 1200/800 St. Croix County tank 2.06 Acres BM= 100' top of 1/2" pipe 4" PVC Scale 1" = 40' K-- ao Garage 4 Bedroom P O PY House 171' property line - BM 105' 103' 101' oB1 0 Z oB3 7% Slope Ln Oq o0 -a - o fD W B2 m 0 „ I r a, 1 1 Todd Marek PO Box 228 New Richmond, WI 54017 Stone Run Estates lot # 4 NE 1/4, SE 1/4, S 25, T 30 N, R 18 W o Wieser Richmond Township , 1200/800 St. Croix County tank 2.06 Acres BM= 100' top of 1/2" pipe 4" PVC Scale I"= 40' KE ao oM Garage 4 Bedroom House Well Driveway 134th Avenue Page 8 of 8 Y ...i Safety and Buildings 141 NW BARSTOW ST FL 4TH commerce WAUKESHA WI 53188 -3789 Contact Through Relay t (Deparbnent of C sco n s i n v�vcommerce.wi.gov /sb/ www.wisconsin.gov Jim Doyle, Governor R ichard J. Leinenkugel, Secretary August 16, 2009 CUST ID No. 226497 ATTN.' POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Ntunbers PLAN APPROVAL EXPIRES: 08/16/2011 Transaction ID No. 1694380 SITE: Site.ID No. 750432 Todd Marek Please refer to both identification numbers, 134TH Avenue above, in all corresponder>tce with the Town of Richmond agencyo St Croix County NE1 /4, SE1 /4, S25, T30N, R18W Lot: 4, Subdivision: Stone River Estates FOR: Description: At- Grade, 4 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1236590 Maintenance required; 600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, SBD- 10570 -P (8.6/99); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "At- Grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD - 10570-P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (8.6/99). (NOTE: The At -Grade Component Manual does not allow for utilization of the Version 2 Pressure Distribution Component Manual.) ), A of • The pump chosen for the design is at the limits of its capacity. If the total dynamic cad ik b higher, at the time of construction, a pump that meets or exceeds the system flow wi eed d. In the AVent this soil absorption system or any of its component parts malfunctions so as t a, hazard, the property owner must follow the contingency plan as described in the approved plans. In a ' the owner must comply with the operation, maintenance and monitoring duties as described in section VII f the at -grade component manual. A copy of this information must be given to the owner upon completion of the project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. ROGER D NELSON Page 2 8/16/2009 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of on c struction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. rely, Fee Required $ 250.00 k46-� Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis - Osborne POWTS Reviewer 2, Integrated Services WiMT <cocle..7633 (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis@wisconsin.gov Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For filrther information, go to our website: iv< vw. cominerce. wi. gov/ SB/ SB- Building_Cg&actorProgram.html i RECEIVED AUG v 3 2009 SAFETY t. 3u►LD SAFETY & avlu)lNW RESIDENTIAL AT -GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Todd Mark 4 bedroom Owner Todd Marek Address P.O. Box 228 New Richmond WI 54017 Job address: 134th Avenue Legal Description NE 1/4, SE 1/4, S 25, T 30 N, R 18 W Township Richmond County St Croix Subdivision Name Stone Run Estates Lot No. 4 Parcel ID Number Plan Transaction Number Index sheet Page 1 Calculations Page 2 At -grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump curve & spaaflc Dons Page 7 Plot Plan Page 8 Designer Roger Nelson License Number MP 226497 Signature Phone Number 715 - 821 -4444 w Date 07/31/09 fi Designed pursuant to: ✓ �� At -grade Component Manual for POWTS SBD- 10670•P (R.6mg), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01101) . version 5.0 (10/05) Page 1 of yOF PRESSURIZED AT -GRADE DESIGN At -grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flaw (gpd) 7.00 % Site slope 103.00 Contour elev. below lateral (ft) 36.00 Depth to limiting factor (in) 0.60 In -situ soil application rate (gpd/ft^2) Dk&Nxdion Cell Information (1 or 2) 1 Influent wastewater quality 4.50 Linear loading rate gpd/ft 7.50 Effective absorption width (ft) 7.50 Max. effective width permitted (ft) 134.001 Aggregate length (ft) Pressure Distribution Dabs Entry (c or e) a Center or end lateral connection 1 Number of laterals No 0.125 O diameter (in) e.g. 0.25 Cal culation a final 2.00 Estimated orifice spacing (ft) cal 2.00 Forcemain diameter (in) 2.86 Forcemain flow velocity (ft/seo) 140.00 Forcemain length (ft) y or n y Does forcemain drain back? 90.00 Pump tank elevation (ft) y or n y Are laterals at highest point? 6.5 System head (ft) x 1.3 NA 12.67 Vertical lift (ft) 22.8 Forcemoln drainback (gal) 2.39 Friction loss (ft) 1 107.51 5x Lateral void volume (gal) 3 0.00 In -line Filter Loss (ft) 1 130.31 Minimum dose volume (gal) 21.56 Total dynamic head (ft) 28.0 System demand (gpm) !� L' Lateral Diameter Selection Gatiora/inch Calculator (optional) diameter oesim opwo o6wr Ctw** Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gal/In (enter result in cell G46) one lateral 1.5 in diameter 2 1, x x Treabnent Tank Infbffno* n 3 in x 1200 Septic tank capacity (gal) Wieser I Manufacturer Effluent Filter Information Dose Tank Information Zab Filter manufacturer 800.0 Dose tank capacity (gal) A100 Filter model number 22.2 Dose tank volume (gal/in) Wieser Manufacturer Project: Todd Marek 4 bedroom Transaction Number: Page 2 of 8 Ague ohm ffma" nmnce mug %Amreruun oavcmcauvrra Service Provider's Name Installed q Nelson Plumbing.] Phone 715- 273 -4444 POWTS Regulators Name St. Croix County Zoning Phone 715 - 386 -4680 Systwn Fft and Load PlMmoten Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 f? Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Conform >10E4 du /100 mL Service Freauencr Septic and Pump Tank 1 and/or service once every 3 years Effluent Filter Inspect and clean at least once every 3 years Pump and Controls Test once every 3 r 2rs Alarm Should test months Pressure System Laterals should be flushed and 2=ure tested every 1.5 Mound In for i and once ev 3 ears Other UftWisnegin Gon:tna n and Mate Stnndutb 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have it watertight cap, and are secured in as shown in the at -grade component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements In Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downsknpe toe will be protected from compaction. 7. All other construction details are as per the at -grade component manual SBD•10570 -P (R. 6199). Viral Tgrfl -ue DetaN Finished ...•......•••. ............... Grade 6 Diameter Lawn Threaded Cleanout Sprinkler Valve Box . A Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 103.50 ft 45 Degree Bends Same Diameter as Lateral Project: Todd Marek 4 bedroom Transaction Number. Page 5 of 8 [ (VGCXJLDS PUMPS • Submersible Effluent Pump PE MOTOR MOMS _ General: • Corrosion r�txt • 0ischar1'h" • fhw cortsww ion. • Te gmktura:104•F (4WO • W Hertz a Cast iron body. mortmnaa, c"Nuous when • 11 S von: ■ Thexhnopilaftic anpeller and tuNy subrnaged. • &&m d naei averked pro- cover. • S006 hanrkng: h• section with ahq mokfaet. ■ Upper skew and lower modmunn sphere. • Class 8 WAAAN L hlay duty ba n bw % A�LIGTpNS • Automa* models Wude a • 00-f Md dssighc. man, float swisth. • High soongth carbon steel ■ Manor is germane * SPWWy for the • Manual models avaiial k, shaft iubrirated for erdtr" Wng • Pumping range: see PE31 Moor sorviae lik. h pw(wn%ww d=art w curve. • .33 HP, 3000 RPM a Powend for coognuous • HfkwOoft Sysle to PE31 Pump: ' 12.0 Mw*roum am" olleffift• • taw Pmssura Pipe systems • Mau hum nxrFheclty: so GPM • Sheded pok deslgn • AN ratings an wNW the ftwrerrt Draining ' Modna head: 2S' M 11 Moser ng limits of the raow • Maadrmath ' 1DH • W design � d" 160 SJTW with NEMA 5.1 SP, bw prong, PSI P Wqx PEST Mobw 115 vdt gmwdng plug. • Mauamhlm cope*. 70 GPM • .50 HP, 3100 RPM M Comploift w* Is heavy may, • MNninNrrl hwd: 37' TDH � � • seal is arlhorh, amens and stainless L- .. :...�.: I�oon,Q :rei1.re41, lo1 :tell. I FT CO us 35 .. `::;...''.. ° + :: - :.`- �...;...;._ w:.�, .,�. so • Staahkss Ssed fasteners. ..fi�rr! .. ...�.. ;... ..+- .:......,... �. .- f..{...F..« ..L_�.�.. _.r..�...;... _. .. ....i, .. ,. ' .. 20 _ ; , . �..�_,.;_ _,.......4.. To"JoUL77111and N 13A22.2 106 Sfifmb* 10 ' �..:. ' :...�.. ;�.+ t »a i011�1Mp11nlf8leal }.x..... - ,_ ... ,._,.. �. .,.... �.. LZ o0 10 za as 40 sa o GPM 80 e- 0 e S 10 I s rns/h GOt�dS PtattlEaS CAPACITY V11311141 �� W ITT Industries '� - ,,��.> r`... .. .� F 1. .�. ,.�. ...� I -- � + �- t ... ♦ *� t 3 .v�, � .. y.. ���. - r .... ' .. k. ..�.- �e , .. r . f r\, � + JAN 0 3 2005 _--� Wisconsin Department of Commerce F CR8i% 'ALU TION REPORT Page of Division of Safety and Buildings ZONINGi in accordance wWCo mm 85, Wis. Adm. Code County�"T 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. Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date Please print all information. ( Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). 6 U Property Owner Property Location /-, -- --- ^ Govt. Lot 1/4 �" 1 /4 S � Tom() N R E ( ) Property Owner's Ma• ' Address Lot # Block # Subd. Name or CSM# /I e City 5tat Zip Code Phone Number City ❑Village Town Nearest Road New Construction Us Residential / Number of bedrooms Code derived design flow rate b GPD ❑ Replacement Public or commercial - Describe: - - - - - -- - -- `— Parent material - Flood Plain elevation if applicable General comments and recommendations �S IQ ✓ct-� ! 0 ' 04 Boring (� / Boring # Depth to limi ting factor in. Pit Ground surface elev. � Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 V2 -39 Boring # Floo ring it Ground surface elev � `' "n• Depth to Limiting factor � r^• Soil lication Rate GPDlf • Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 Eff #2 > < 1 Effl f2 = BOD _< 30 mg/L and TSS < 30 mg/L • Effluent #1 = BOD > 30 < 220 mg/L and TSS 30 - CST Number CST Name (Please Print) ignature 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number Address Date Evaluation Conducted P New Richmond, WI 54017 �_ 715- 246 -4516 1008 192nd Ave, / I i . Property Owner Parcel ID # Page of F Boring # Boring / it Ground surface elev. AOq! lft. 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 b I � O Vi- i- U L �- r 2 i- 0 ms s' C � a 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. I 'Eff#1 'Eff#2 E Bonng # El Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Sal Applmdon Rate . Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 1150 mglL ' Effluent #2 = BOD, <_ 30 mglL and TSS 5 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. seo4330 (RAMr • e Soil Test Plot Pla Project Name Bryan Schaefer Sh ird Address 1336 140th St. New Richmond Wi 54017 TM #226900 Lot 4 Subdivision Stone Run Estates Date 12/1/04 NE 1/4 SE 1/4S 25 T 30 N /1118 W Township Richmond R Boring 0 Well PL Property Line County ST. CROIX Ji BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 102.3' *HRPSame as Benchmark Alternate Benchmark Top of survey iron @ 99.7' Alt. B.M. * 171' Property Line 30' B.M. Scale is 1" = 40' 5' unless otherwise 70' B -1 noted 50' 7% Slope �13 -3 120' 105' B -2 30' 508' 103' Property 101' Line 08' roperty ine h .0 �uacuaso3, ��6+ 0 r N y •. 494 • \ ,''•a cO- I o CID 0 i i LO + N as N Q 510 ; I ^ / X. . /� O 1J ^ \/ / / o 08� O n / O co i / I � 1002 -- 00 506, 1 I / `� / to ai ap \ \ \ Un O \ \ \ � \ \ \ cr 0 ,« _ _ — Y ,8 Z'886 3„Zl,91.00N —'\• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer `E - (� Mailing Address D X Z 2 g j0 55 V( - 5 7 Property Address 1 39'0 j4 V-r, (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number (2 Z( l Z 2 y O Y 00 0 LEGAL DESCRIPTION Property Location 10 '/4 , �5 C '/4 , Sec. T 3 &N R l W, Town of Vv-- C `x4P Subdivision 'y � ,C�-�- - S , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # 2 D 7 / , Page # Spec house no Lot lines identifiable (ff 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. Uwe, 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms_ V/T-I-U / r) �lZvl SIGNATURE OF 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) I Jul 28 09 05:10a Todd Marek 17152469341 p.4 MINARY FLAT OF STONE RUN ESTATES (A COUNTY PLAT) 114 of the Southeast 114 of Sect/o,-7 25 7 0 -7sh1)9 .30 /`forth, Range 18 West, Town of Richmond of 2 of a Certified Survey biap recorded in Volume 9 Pcge 2557 in the St. Croix County Register' Of Deeds Office. (/ �{ V� �t - (iyLi�;yvta car_ w \ _ r-, «- I � ' I UPiP_A rTEIJ_LANDS � , u i� _�! CER,G ,ED SURI!c , MAP I t vOLLLMf -9 PACE 2452 '3 \ r t \ � \ l \ t \ � �� � ` 999.47. e7. � •' 171' 'ti' t ill' •\ i57' t " ! / ,a� o ?, \ '\ 1 i i \ tea' .. e / 7 I / 1 i t �,a,�j I \? 1 \ 13J 12}:20.1 sq\ ft , 29 1 4 , \ L3� ` \\ !— :2.97 'R.resi �.. ,,, i r. I \2 . I o \ i �.m \ •- o' � . / 1 89,821, sq. 3.D2 acr s[ fi :�3 89,821\sG. ft. - 88,9 5•sq.,ft. i 12.06 acres 2.05 &z \2.04 01 '/ ! I ED `\'.`�\ fi t.. �\ �� ��\ � / -\..\ �` \ ' � ®1 !•- \'7 - :::'I `........ \........... ......... =C' —`\ 17, 194,067 sq. ft. 197✓ HQ - . ��9 •:\ \ 1 i ^ ^ 1 '� — •- \ I AF 77,330 ft '}77;330 sq. ft. i a 77,330 sq. !fi. + 717,33 sq. ft t 90,649 s ft. t ! 1.7,9 acres 1.78 acres j 1 2.08- acres \ Lab core$ 1.78 acres ', i t 1 1 \ \ r • • �,\ 185' 185' \ � 77 7 10 � ` 209' 11 i. cor 3 rER77FIED SURR Y ,b1AP CERTIF /ED SURVEY MAF VOLUME 9 PAGE 25�; I r J I r I/O_UME 73 PAGE 3620 vo - t ':o Slate, County and T —rshlp .m tot size, access to parcel. - contact the St. Crcix county - I hereby ce:tlty that this map was prepared by me or under my direct supervision, advice. _ that A is true and ccrrect to the best of my knowledge and that 1 an a duly Registered Land Surveyor under the Icws of the State of Mscons:n. .,- DATUM. 1 R. uCCGc, RcG1S ER - cD LICENSED SURVEYOR NO. 2454 DATE 3� AREA UNLESS OTHERYhJSE SKCIFIE7. reinLot 2 of o Certified Survey Map recorded in Volume' 9 Register of Deeds Office., R = N89 '4257 --J L I UN PLA TIED LAN I I S89'55'08 "E I ° 171.0 � 238.75' 7' 171. W r ` .N �C X II W 2 X 0 131,549 sq. ft. ` 89,821 sq. ft. (n 89,821 st U) 3.02 acres 2.06 acres 2.06 ac U N TY, N ' 00 N SHED U 00 O 00 i I a) O certify: that a ° o Q I ......... ............ ,nsin Statutes L J X . l Lichmond, OI xibed on this ?S; that such a � ° �I / � • o Q in of the land ° 282.881— 184.97 11 if the j w � I ' o — S89'52 26 E — 04W A VE Town of — i Survey Map c I 1.16 fib. HBO' N89'5226 "W ;r of Deeds - 185.00 a 1 -18,51 00' / 85.00' — e, on an "w A Section 26, N _ .l. 1 �1 feet to the I ............... ............. .. ...... .... ............... 25 minutes 35 p ►f said 0 degrees 52 X Z 3 e of said Lot 3; _ s 8 econds West o N O N O O survey Map ineandthe ^ 77,330 sq. ft. ', 77,330 sq. ft. r°o�^ 77,330 sq. ft. e 9 page 2551, 1.78 acres 1.78 acres 1.78 acres 88 feet to the ace, along last stance of t a distance of �. � . I NIIl IIIIIIIIl IIIIIIIIINIIIIIIIIIIIIIIIINII lIII * 8 5 2 0 7 1 1 State Bar of Wisconsin Form 1 -2003 85207 WARRANTY DEED KATHLEEN N. WALSN Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/06/2007 01:35AM THIS DEED, made between 6-G Corporation WARRANTY DEED ("Grantor," whether one or more), EXEMPT M and Todd Marek a married person REC FEE: 11.00 ( "Grantee," whether one or more). TRANS FEE: 405.00 PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Recording Area Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lots 4, 8 and 9, Stone Run Estates, St. Croix County, Wisconsin Vol Estreen & Ogland uj I — 304 Locust Street AoV9 ( Hudson, WI 54016 026 - 1288 -04 -000: 026 - 1288-08-000:026 - 1288-09 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. Dated 6-G Corpor ` (SEAL)B : Y (SEAL) * *Kevin lkell c r en (SEAL --"EAL) * *Jo runner, its resident AUTHENTICATION ACKNOWLEDGMENT Signature(s) 6 -G Corporation, by Kevin Kelly, its Vice President and John Brunner, its President STATE OF ) ss. authenticated on COUNTY ) Personally came before me on , *Kristine O and the above -named TITLE: MEMBER STA TE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Kristine Osrland, Estreen & Oeland My Commission (is permanent) (expires ) 304 Locust Street, Hudson, WI 54016 (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 ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 • Type name below signatures. INFO -PROT" Legal Forms 800 - 855 -2021 www.(nfoprofortns.com 1 of 1