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HomeMy WebLinkAbout026-1099-60-100 0 eoa ti O tl a' I 0 N N 'V I I (El I C / 7 LL I Cl) ! y I E00 Z !'' £ O `Z ali ai ! a m O Z �'_(D Z � �m w III N N y as •� N p N f0 O ° ` ¢ Z S Z N d to ! E a ! CL ° a�i a� 0 0 a a .0 z >° E a F 0 0 0 •N _m � a a a a � lil!. Z U 7 0 N M M O O N } Of O W J O O N N N p (p O N N O U CO R O 7 O c m a v N co d Q n in 0 gn ID+� 0 3 Y 0° . • y o C n E� to oo o u o 0 ci 0 0 l MQ O Cl L N N ~ O E - Y 'O �' t: 7 C L f0 U O cli LO O � � = I a. a t`1�l E ` 'c c ;: r t A 0 (L 0 vii U Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building livision , INSPECTION REPORT Sanitary Permit No: 430545 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)l. Permit Holder's Name: City Village X Township Parcel Tax No: Lallensack, Kevin I Richmond Townshi CST BM Elev: Insp. BM Elev: BM Description: Se tion/Town /Rang ap No: 35.30.18. S TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Benchmark Dosing �j y Alt. BM Aeration < Bldg. Sewer boy. SS Holding j ._......._..... _---- .,_._..._..__- .,_.- __..... St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet 3 i/V io 3.7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ] s t� t ' / Dt Bottom t c� Dosing Header /Man. �. Aeration Dist. Pipe -� 97• Holding Bot. System 5 iv • `% •7 , e� r o - 2i �7 .`rte PUMP /SIPHON INFORMATION Final Grade T. rS Manufacturer Demand St Cover GPM 0.0 f 107. Model Numb ,, TDH Lfft ric Loss System Head TDH Ft Forcemain Length bfa:. ,. Dist. to Well SOIL ABSORPTION SYSTEM (, • 3 BED/TRENCH Width _4A. length o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacture INFORMATION r, CHAMBER OR T n � : (•1" Type Of System: N lr_� T UNIT _)[ Model Number: DISTRIBUTION SYSTEM Pte^ 4 y <.n CA , v Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake -7 r y •� Pipe(s) _ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ~ d ,� ,, / Bed/Trench Edges Topsoil U Yes No i ]Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: f t / / V. i Inspection #2: Location: 1268 140th Street New Richmond, WI 54017 (SE 1/4 NE 1/4 35 T30N R18W) NA Lot 1 Parcel No: 350.18. 1.) Alt BM Description = 2.) Bldg sewer length = i� ` � cc, - amount of cover = -j ' { C. r C - - - -- Plan Use other de for additional informati X No 1 q 0 3 SBD -6710 (R.3197) Date Insepctoes Signature Cert. No. Safety and Buildings Division C�tY 0. LrO�X 201 W. Wash —UUIV iseonsin Madison, 1 53 Permit Number (to filled in by Co ) ( 266 -3151 3 o S De artment of Commerce p an I.D. Number Sanitary Permit Applicat on WV 10 /J A In accord with Comm 83.21, Wis. Adm. Code, personal inform 'on you provide ay be used for secondary purposes Privacy law, s15. 1X4T. CROIX CO tr Address (if di erent than mailing address) 1. Application Information - Please Print All Information �a �Y l�o�' sT• Parcel H Block a Property Owner's Name w ovv✓ Property Owner's Miuhng Address Propetty location section 35 Lj City, State Zip Code Phone Number D Y le one) �h�i9�S s L D T N; R � y E circ or� 11. Type of Building (check all that apply) r�Q� Subdivision Name CSM Nurnbe 1 or 2 Family Dwelling - Number of Bedrooms � �� �� po nt� iJ� / Z$ i 7 q& El Public/Commercial - Describe Use (:7 R ❑Village ;rownship of ❑ State Owned - Describe Use g W I Ill. Type of Permit: (Check only one box on line A. Complete line B if applicab e) A j t New System ❑ Replacement System ❑ Treatment/Holding Tank Replace nen er Modification to Existing System Y ------ list Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision - ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. Type of PO System: Check all that apply) ❑ Non - Pressurized !n- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 m. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized In-Ground 11 Holding Tank ❑Peat Filter C] A Treatment Unit C3 Recirculating Sand Filter Cl Recirculating S thetic Modia Fiber Chamber Doi line ❑ vel - less P ❑ Other lam) V. Dis ersal/Treatment Area In ormation: ki s Di Area Prop S stem Elevatio Design Flow (gpd) Design Soil Application Ryte(gpdst) Dispersal Area equued (sB Persa (� Y b � t in Glass Total Number Manufacturer Prefab Site Steel Fiber Plastic V1. Tank Info C apac ity Concrete Constructed Gallons Gallons of Units New Exi+niag *,r/ Tanks Talcs / �� � `/ 0 Septic ink p Aerobic Treatment Unit 1 W i During Chamber VII. Responsibility Statement - 1, the unde ned, res nsibUi for installation of the POWTs shown on the attached plans. Plu Natne (Prin PI s t MP/MPRS Number Buness si Phone Number /Coto L �/it/?� p 3'�� �- /.s Plumber's Address (Street, City, State, ZZ L;6de ) j r si ill. unt /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued lss ' g Agent ignature ( S s) proved ❑ Disapproved Surcharge Fee) �J ❑ Owner Given Reason for Denial v l N o3 IX. Conditions of Approval/Reasons for Disapproval YSTEM OWNER: 1 Septic tank, effluent filter and C6-M kV1 • 8� S z dispersal cell must all be serviced / maintained as ana ement Ian rovided b 2. setback requirements must be ma' tained as per applicable code /ordinances. kn q 3 J � Attaeh complete plans tto the County only) for the rystcm oo paper rot less than &I f2 s 11 inehn in riser SBD -6398 (R. 01/03) f I 11' �Y 4 � An N w y J m � cr. c_ w � f n 1 11' 1� G � n N �- �� 1 .t In .� y � � v , C 4 as fi � r 'ORIGINAL 1853 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D 3 air S Date Please print all information. viewed Ir Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / // Property Owner Property Location Bonte, Ron Govt. Lot SE 1/4 NE 1/4 S 5 30 N 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CS ZONING OFFICE 1011 170th St. 1 City State Zip Code Phone Number ''j City Ar Village g Town Nearest Road I -7 Hammond WI 1 54015 1 715 - 796 -5240 Richmond 140Th St. t% New Construction Use: j Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install conventional trench system w/ system e levation 3.0' below surface contours @ 0.5 gpd /sq ft loading —� 0 ---- -- F Boring # .J Boring Pit Ground Surface elev. 99.1 ft. Depth to limiting factor > 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -6 10YR 2/2 - sil 2 m gr dsh cs 1f /m .5 .8 2 6 -16 10YR 2/2 - sil 2 m sbk dh cs inn .5 .8 3 16 -35 7.5YR 3/4 - sl 2 m sbk dh cw 2m .5 .9 4 35 -42 10YR 4/4,4/6 - s 0 sg dl aw 1 m .7 i 1.2 5 42 -44 7.5YR 3/4 - sl 2 f sbk dh cs - 5 .9 6 44 -76 5YR 4/4 - sl 0 m mfr - - .3 .5 horizon 4 is 33 -48" in places; horizon 6 has common 10YR 5/4 s (0, sg, dl) inclusions Boring # .-j Boring ✓1 Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -6 10YR 2/2 - sil 2 m gr dsh gs 1f /m .5 .8 2 6 -16 10YR 2/2 - sil 2 m sbk dh cs 1m .5 .8 3 16 -38 7.5YR 3/4 - Is 1 m sbk dsh gs 1 m .7 j 1.2 4 38 -51 10YR 4/4,4/6 - s 0 sg dl as 1 m 7 1.2 5 51 -53 7.5YR 3/4 - sl 2 f sbk dh cs if 5 9 6 53 -80 5YR 4/4 - sl 0 m mfr - - .3 .5 3 q horizon 6,h occasional 10YR 5/4 (0, sg, dl) inclusi ns all * Effluent #1 = BOD 30 < 220 mg /L and TSS >30r 150 mg /L ' Effluent #2_7— BOD < 30 mg /L and TSS < 30 mgr CST Name (Please Print) Signatu e: I CST Number Henry F. Grote / , - :bL� 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 9/13/2003 715 233 - 0398 Property Owner Bonte, Ron Parcel ID # 2.83 acre CSM pending Page 2 of s • F3� Boring # Boring e'' Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 90 in. Soil Application Rate 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 0 - 10YR 2/2 - sil 2 m gr dsh gs 1f /m .5 .8 2 6 -22 10YR 2/2 - sil 2 m sbk dh cw 1M .5 .8 3 22 -47 7.5YR 3/4 - sl 2 m sbk dh cw 1M .5 .9 4 47 -83 10YR 5/4,4/4 - s 0 sg dl as Inn .7 1.2 5 83 -90 5YR 4/4 - sl 0 m mfr - - .3 .5 i ❑ Boring # __j 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 ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i ❑ Boring # -.j Boring — j Pit Ground Surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P ' _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i I i " Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 < 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. S B D -93 30 (R.07 /00) Certified Soil Testing i 0 k � g Ok 2 cl t D c X11 Ol ag o d I y 41 X , d Nib � n b a p 0 b / 6 0 � 1 � C�l _ - s f o w�, tgs J.. 10/17/01 WEL 07:23 FAX 713 386 4686 ST CRX CO ZONING 002 POWTS OWNER'S MANUAL IK r�rarti..i�.� «,� • • �-.. 'NFORMATIOIN s1fSTl M SPE CIFICATIONS ri't �y S/� C,([ Septic T y l r NA ## Septic T acturer �" ❑ NA Effluent ufacturer L,E o NA DESIGN PARA ?r1MIRS 1 pp C7 NA number of Bedrooms N O NA. Effluent e /� / A Pump Tty p` Number of Gornmereiai Chits A -- KW — ma t e d now (average) gal / day rump Tank Manufacturer D e s ign ma flow (w(aiv) ag e mated x 1.5) gaVday pump Manufacturer fA S gal /day /ft Pump Model p ' Soil Application Rate ' ,, pretreatment unit O NA InfluentlEffluent Quality Monthly average Sand/Gravel Filter Q Peat Filter Cats, Oil et Grease (FOG} s30 mg/L o Mechanical Aeration D Wetland Biochemical Oxygen demand (DOD,) s= mg/L 0 Disinfection 0 Other: Total Suspended Solids ( TSS) -.5150 mg /L Manufacturer ,.. Pretreated Effluent Quality 0 NA Monthly average Dispersal Cells) Biochemical Caxygen Demand {fl ©Ds) s30 mg/L In -Vound (gravlty) C) in- grounr� (pressurised) ❑ At -Fade a Mound Total Suspended Solids (TSS) s;30 nig/L Q Other: fecal Cotfform (geometric mean) :510 cful loom) ❑Drip -line Maximum Effluent particle Sire ,� inch diameter „ Values typical for dome* (non- commer&l) W&new;kw and septic rank effim4nt. * * ya(ues typical far pretreated wastewirat. MAINTENANCE SCHIEtIULE Service rrequency Service Event inspect condition of tank(s) At least once every 173 months year( :) (Maxlxuum 3 yrs ) pump out contents of tank( :) When combined slu a and scum equals on( -third ()6) of tank volume At least once every 0 months ear(s) (1"laximum 3 �') inspect dispersal cell(s) At least once every � El months year(s) Clean effluent Otter NA Q months D year(:) Inspect pump, pump controls aLalarm At feast once every L3 months b year(s) NA Hush laterals and pressure test At least once every O t h err: At least once every Ca months D Year(s) NA Other- At least once every © months ❑year( :) NA � MAINTENANC11 INsmuci IONS Inspections of tanks and dispersal cells shall be made by an Individual S c arryi ng M a in tainer; Septa ServianR Operator. Tank inswecd the f licenses or Certifications- Ma ' Plumber Master Plumber Restricted Sewer; P4WTentify a P cracks or leaks, measure i must include a visual inspection of the ta nk(s) to Id any missing or broken hardware, identify any vo l u me of combined stodge and scum and to check for any back up oervatio p;pesand for any ponding of The oan cell(s) shall be visually Inspected to check the effluent levels in the o the grouted surface. The pondin$ of effluent on the ground surface may indicate a failing condition and requires the immedi notification of the local regulatory authority. Servicing Opera cor and disposed o f In accordance with ch. NR 113, WiScor When the combined atcumulatlon of sludge Arid scum in any tank equals one -third (Yi) or more of the tank volume, en tire contents of the tank shall be removed by a Septage S S Administrative Code. The servicing of effluent filters, mechanical 0 r 11 shall WS components, be performed by certified poWrTS Maintai er.ny other maintenance or monitoring at intervals of 12 iiCynthS or A service report shalt be provided to the local regulatory authority within 10 days of completion of any service event. 5't AND PE or to t Lions are detected have the coat Fo r r n ew c co nstr OP prior to use of the ��$ check treatment tank( :} fo i f h� h eo ten r painting products or other then that may Impede the treatment process and /or damage the dispersal cell(: . g mr r1+e r)krtk(1:1 ramovfd by x sentaRe servicSnw apervor pekor to use. 10/17'01 WED 07:24 FAY 715 386 4686 ST CRY CO ZONING 1 003 Pate 2- System start up shalt nor. Occur when sal conowns are from at the I tmtrative surfacer is rrrstonQ die exeesS wastewater will be During po rn wer oUUges pump tanks aY flit 00'4e rsannal hl"ater COWS When P Qf disdwrgt4 to the distsersat cell(:) In Ong large dose, averioadlrtg the celi() W 4 may result in else baekstp ar oaf di�Fa tng effluent. To avoid this situation have the contents of the pump tank MMOved by a $Vp W Servking C'fpe P r"estl3� poorer to tht effluent pump or contact a Plumber or po%TS Mainulmr TO 404t In manually operitlrtg the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over ranks and dispersal cells. Do not drive or park vvt;r, or otherwise disturb or rarrtgact, the Area within 15 feet dOwr) slope Of SOY mound ar at -grade soil absorption are:. lted teedon or eliminatlon of the fpiiowirtg from the vastewater ¢nt i#+"tarrt amy it"rovo %1W ytrFOrttsar►ce and I o a u fa r the swabs de wrs; detptai Aoss; dlapef%i POWTS: antibtotla; babY wipes; clgarette butts; cOMOms; . foundation drain M)Ml) PUMP) water frttlt and v*g�le peetlnVj guoilinef grease; hedAdduf melt scr>Ps; m%dicatwcK; alt; laal ntinst products pv$j ic1cl4s, sanitary napkins: tampord) and wist#r softaCner being• ARANDOWMENT shall be taken to Insure that the system is When the POWTS Cans and/or is permanently taken apt or service the follawing steps properly and safelY abandor" in cOmPilan" with ch. Comm 83.33, iNiscottstn Adnrlsntttradve Codet i • All piping w tanks and Alts shad b+ disconnected and the abandort+td pipe ► n4's ssaitd, • The contents of all tanks and pits snail be -moved and prt+periy dt%xn" of by a septa¢* Ser Adng Operator, Aher pumpint,, all tanks and pits shall be excavated }nd removed or t heir covers removed and void space fllleQ with sal, gravel ar another inert solid material. CONTINGENCY PLAN If the POWTS falls anct cannot bey repaired the Wtowing measures have been, or must be liken, W provide a code Compliant reel omen W WM' A suitable replacement area has been evaluated and may be utilized for the location of & replacement soli absorption system. The npiocemcnt area ihouid be prat,itcted from dI$Wrbance and compaetivn and should «at be Infringed upon by required setbacks fr*M Wllt;ng and proposed wvcwm, lot Ones. and welis. Failure to protect the replacement area will result in the need for a► now soil and site evaluitlon to tstabllsh a su replacement area. Replacement systems must lrs ffe comply with that rues: a ci at that tune. O A suitable repiacerpent area b not aavallable due tit setback and/ colt limiatlans. barring adwrtsss in POWTS tecllnc�lggy ( a holdlog tank may be Installed as a last resort W replace the failed POW?7• a soil and :lie N e Ito �!� d to I a � Po • . • U al R °f tFte ! 4 d - - e te plat ar ea, rep Grct e i b #Yi able j idiri¢ tank may /I Ins rt to replKe the failTS• to l ace following removal of the b+emat at the Q Mound and at -Vade sail absorption systems may be rftbnstrti+cted p inFltuatfvk su Re construction of SUCK SYSterns tttlast.CVm with the rules in effect it that LIME• < C WAItNiNG> SEPTIC, PUMP AND OTHIR TRIAT"ENT TANKS WAY CONTAIN ;LETHAL GASi>i"3 AND /OR INSUFFICIENT DEAATH MAYY REWIT. E RE GLtiti Of A� Est# Tat FROM Tai 9 lIT ES. RIOR Of A TANK MAY RE DIF ICUIY Of IMPASiiR) i. ADDITIQNAL COMMENTS POWTS INSTALLER PC?ttF1TS MAIWTAIN R Name l Nam N v AIL, Phan* r- VI �PFwme - 'Zb SEPTAGE SERVlCINO OPLRATOR (PUMPER) RlytrrLlLATtiRY AUTHORITY Name J� n ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer kc r r (:, l e ►. s kt k Mailing ddress g oZlo� w 54ail property Address mss"* y ° }` s {� �. M 4 ^ d (Verification required from Planning Department for new construction) City/State tie- t? l j m %m a w S Parcel Identification Number DESCRIPTION ►v • , 3 S' , T 3_" NR ►i W, Town of f�; �.,-� Q d property Location S f. /4, �. /4, Sec. _ — Lot # 1 Subdivision s M 2 N t '7 . Page # y sr `i o Certified Survey Map # 14 S + Z S . Volume - Z Page # ��° Warranty Deed # �D . Volume Spec house ❑ yes o Lot lines identifiable X yes ❑ no M_A MM.NA1�� p failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its b a licensed pumper- What You put into the system consists of pumping out the septic tank every threw years or sooner, if needed Y can affect the function of the septic tank as a treatment stage in the waste disposal system ent a certification form. signed by the owner and by a The property owner agrees to submit to St. Croix Zoning verifying &At (l) the on - site wastewaterdisposal system masterplumberjourncY�p , restricted a licensed pumper the tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping (if necessaTS')• SeP is and agree to maintain the private sewage disposal system with the standards U have read the above req,riremen ent of Natural Resources. State of Wisconsin Certification set forth, herein, as set by the Department of Commerce and the p Department ed to the St. Croix County Zoning Office within 30 stating that your septic system has been maintained must be completed and return days of the three year expirapOu date. DATE SIGNATURE OF APPLICANT OWNI;i R CERTTIFICATIO of my our knowledge' I (we) am (arc) the o wner(s) of I (we) certify that all sY tements on this form true �to�� Reg i s t er of Deeds Office• die property described bone, b virtue of a warranty ,�� DATE SIGNATURE OF APPLICANT Any information that is mis- represented may result in the sanitary pmt being revoked by the Zoning Department. ssssss •• include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2452P 266 -/ .4tsiia 1i STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. VALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., VI This Deed, made between Hombuilders. LLC RECEIVED FOR RECORD Grantor, 11/07/2003 02:15PH and Kevin Lallensack Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # 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: 120.00 That part of SE 1/4 NE 114 Sec. 35- T30N -R18W described as follows: Lot CC 1 of Certified Survey Map recorded in Vol. 17 of Certified Survey Maps, PAGES: 1 page 4640 as Doc. No. 745128. Recording Area Name and Return Address The First National Bank PO Box 89 New Richmond, WI 54017 26- 1099 -60 -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 NOS' , 2003 Hombuilders, LLC J * ' J y W. Fletch, Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ) ) ss. County ) authenticated this day of —i— _ _ , _ —. — -- — ---- - - -..— _ Personally came before me this �'' _ day of November , 2003 the above named Homb LLC byJ ]etch, M emb er — — — — — i mb 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. Slats.) instrument and ackn wle G �tb1 O THIS INSTRUMENT WAS DRAFTED BY A` Kri Ogland, Attorney at Law ' �� • L1_ O � _ 304 Locust Street, Hudson, Wl 54016 — Notary Public, Ste w _ My Commission israanat (if nQt, start zpiration date: (Signatures may be authenticated or acknowledged. Both are not necessary [ VV 8 L�CC rr • Names of persons signing in any capacity must be typed or printed belo BAR s WISCONSIN ,'���rrrtBtlllttt��� 35 -2021 www.infoproforms.eom STA TE WARRANTY DEED FORM No. 2 - 2000 r ORIGINAL i 1853 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 2.83 acrE CS Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Rr Bonte, Ron Govt. Lot SE 1/4 NE 19 S 30 N 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CS 5 ZONING OFFICE 1011 170th St. 1 City State Zip Code Phone Number City ,Aa Village 0 Town Nearest Road Hammond i WI 1 54015 1 715 - 796 -5240 Richmond 1 140Th St. ✓i New Construction Use: je Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD W ... ; Replacement Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install conventional trench system w/ system elevation 3.0' below surface contours @ 0.5 gpd /sq ft loading FT] Boring # I Boring Pit Ground Surface elev. 99.1 ft. Depth to limiting factor > 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10YR 2/2 - sit 2 m gr dsh cs 1 f/m .5 .8 2 6 -16 10YR 2/2 - sil 2 m sbk dh cs 1m .5 .8 3 16 -35 7.5YR 3/4 - sl 2 m sbk dh cw 2m .5 .9 4 35 -42 10YR 4/4,4/6 - s 0 sg dl aw 1m .7 j 1.2 5 42 -44 7.5YR 3/4 - sl 2 f sbk dh cs .5 .9 6 44 -76 5YR 4/4 - sl 0 m mfr - - .3 .5 I _ horizon 4 is 33-48" in places; horizon 6 has common 10YR 5/4 s (0, sg, dl) inclusions a Boring # Boring I Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10YR 2/2 - sil 2 m gr dsh gs 1f /m .5 .8 2 6 -16 10YR 2/2 - sil 2 m sbk dh cs 1m .5 .8 3 16 -38 7.5YR 3/4 - Is 1 m sbk dsh gs 1m .7 1.2 4 38 -51 10YR 4/4,4/6 - s 0 sg di as 1m .7 1.2 5 51 -53 7.5YR 3/4 - sl 2 f sbk dh cs if .5 9 6 53 -80 5YR 4/4 - sl 0 m mfr - 3 5 horizon 6 has occasional 10YR 5/4 s (0, sg, dl) inclusions ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30r 150 mg /L * Efflue t %= BOD < 30 mg /L and TSS < 30 mgr CST Name (Please Print) Signatu e: CST Number Henry F. Grote 22277 / , A���F�x )m Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 9/13/2003 715 - 233 -0398 Property Owner Bonte, Ron Parcel ID # 2.83 aae (SM pending Page 2 of 3 ' ]Boring # j Boring 16 Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 90 in. SON Application Rate 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 0 -6 10YR 2/2 - sil 2 m gr dsh gs 1f /m .5 .8 2 6 -22 10YR 2/2 - sil 2 m sbk dh CW 1M .5 .8 3 22-47 7.5YR 3/4 - sl 2 m sbk dh cw 1M .5 .9 4 47 -83 10YR 5/4,4/4 - s 0 sg dl as 1 m .7 1.2 5 83 -90 5YR 4/4 - sl 0 m mfr - - . 3 .5 I ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 I I F-1 Boring # - Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 I I I I Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD <30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07100) Certified Sal Testing fj g s IL 9 � i � o jk V O d � 4 S / 0 S t U d 6 0 �1 f � o cj - 74!5 5 28 p, VOL AT 1 - 7 - P A G E L-bn REGISTER OF DEEM ST. CROIX CO. RECEIVED FOR kECORD 10/29/2003 11:00AM CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP COPY FEE= 3. ee PAGESs 2 LOCATED IN THE SE I -o OF THE NE 1 i4 OF SECTI 35, T30N, RISK TOWN OF RI CHMOND, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: RON BONTE NE CORNER OF SECTION 35. ( FOUND 314' REBAR�_ NOTE: BEARINGS ARE X11 REFERENCED TO THE EAST LINE NOTE NO ADDITIONAL PLATTED LOTS AMY OF THE NE 114. (ASSUMED TAKE ACCESS THROUGH THE 66' WIDE BEARING BASED ON GLOBAL PORTION OF LOT 2 UNLESS ALL T POSITIONING OBSERVATIONS). STRUCTURES CONFORM/ TO APPLI y Q l 4 SETBACKS AND COUNTY ROAD STANDARDS o APPROVED ARE ACHIEVED. 8 ST. CROIX COUNTY ftNnO Zonkw and Po ft Committee �i o�► �� OCT 2 9 2003 uryP 4 arrE O.4A�lQs .........;�.�•:........ EAST LINE OF THE NE 1/4--fl ( '� If pot reCwded whhin 30 days of I 133 anal dale approval shall be S89 15 968.81' 597. 5 7' 371. 24' 3 564. 57' 33. 0 a o LOT I 3.00 ACRES =: . 130, 716 S0. FT. 0: 10B. M. TOP OF PIPE 00 2.84 AC. EXC. R/W �* 10.80 O 123, 507 SO. FT. ....................... a• LOT 2 2 LBO.993. 0' :33. 564. 48' 5.21 ACRES N89 09'W 59T. 48': " " "' " ' "' _ 226, 930 S0. FT. S89 °53' 09 "E 597. 45' : 5. l6 AC. EXC. R1W 3 � 224. 752 SO. FT. , 564.45 ro 33. • :a LBO.988. 0' •+ 0 L 3 Nlro 21 2 ;y • w' 3.00 ACRES n m ro rn a; Ac 0 0; 130, 894 SO FT. -4: o,,j at O v _� ro s�'� $ N 2.84 AC. EXC. R/W y: QI' :r '�._ .E ` 2 123, 684 S0. FT. x; O :2 oD b 3 72. 19' °�o. 564. 37' 0 33.0 ml w S89 0 53'09'r - 969.56' 597. 37 ' c h DRAINAGE WAY /,y �` I l \ �l' w LOT % . , ' •: :�� w I W ........ Q........ aj. fOS �% 7.48 ACRES ``\ F r� • F' �: ~ 325, SO. FT. 7.23 AC. EXC. R1W io , bh , • '^ `! ~ J*.Qr...� 0 �� �\ `. 314,736 S0. FT. 0 � A ,� ��\ : I 001,. � I 4261. 39 ' LBO.981.0' 3 s� 33. 00' 937.06 0:34. b2' ..................... . S80 NOW 53' 08' W 970. E -W QUARTER LINE W 114 CORNER OF E 1/4 CORNER OF O SECTION 35. (SET SECTION 35. (FOUND CONCRETE MAIL). SURVEY NAIL). 8. M. 998.00' NOTE NO OWNER OF RESIDENT SHALL 00 ANYTHING WHICH WOULD :W INTERFERE WITH OR CHANGE THE WATER DRAINAGE EASEMENT. THIS • INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING, GRADING, EXCAVATING, OR 9ERMING. co �✓I�► JAMES M. O • SET 1' 0. D. X 18' 1 RON PIPE WEBER {� WE 1 GH I NG 1. 13L BS PER LINEAR FOOT. 3.1404 8NlYi011/111.lY. ® PROPOSED DRIVEWAY LOCATION � VA O Q 1 ' • 200' tiQ SHEET I OF 2 JAMES M. 804 O 100 200 400 LANDMARK SURVEYING, INC. Z003071A THIS INSTRUMENT DRAFTED BY JIM WEBER DATED C � - O'� "d 3 ;keo%-S•eb q- %\s -oS Vol 17 Page 4640