HomeMy WebLinkAbout026-1172-15-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CTO[X
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 463098 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:
Davidson, Ron Richmond Township o L b - // 7 Z - /S - 66
CST BM Elev: Insp. BM Elev: BM Description: ' Section/Town /Range/Map No:
CS T 3 # 35.30.18. /
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY = , _0ATION BS HI FS ELEV.
Septic Benchmark i 3.3 !o 3.3 too . n
/2 �v �� =�w t
GG . r. h d � {3 L 3 7 v 3
Dosing Alt. BM
Aeration Bldg. Sewer
L.U� �P7. 3c�
Holding St/Ht Inlet 7 1 01`7 U�
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic �) N o - J Dt Bottom
12. >LG q 1.
Dosing 1 N c> T 3 �r ) J Header /Man.
3
Aeration Dist. Pipe
3. 1 4� �o a . rte•
Holding - Bot. System
Final Grade
PUMP /SIPFION INFORMATION
Manufacturer Demand St Cover
GPM C� .. r.✓ P,.Z /G /. / j
Model Number , It, '/
i �� 4 9-It-3 4 .2-l'
TDH Lift Friction Loss System Fje ad TDH Ft
Forcemain Len th I Dia. IDist. to well ,
SOIL ABSORPTION SYSTEM Dv _ J .� t ..— o ✓ c� �F� r
V
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside ta. Liquid Depth
DIMENSIONS' 7 '1T
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEAC Manufacturer:
INFORMATION r" 1 // t T % CHAMB O
Typ
C. & d /'Z_ �'- 6 T fa iL A U T Mode
DISTRIBUTION SYSTEM ! S ' , t "; 3 ' 27 'S' 3
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) i J J-7 j
Length y J Dia < Lengt Dia / 1 2 _.Spacing � S'
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over )t Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center �, / Bed/Trench Edges �. r Topsoil 1711 Yes 0 No Ell I I Yes No
COMMENTS: (Include code discrepencie persons present, etc.) Inspection #1: is // L7 1 Q Inspection #2: /v / 2 � 7 1 C'
N I1 �1.. —rai . lam � VV e �C 1 VW V— r , ( na{ C
Location: 1389 128th Ave. New Richmond, WI 54017 (S 1/4 NE 1/4 35 T30N R1 8W) Sunset Hollow Lot 15 Parcel No: 35.30. 8. Ole ^'
/ & JC� ck �
1. Alt BM Description = 0 !' e6 °<. to,,.,I a - aL o S� G h s c e C
2.) Bldg sewer length= z q 4 � J.., c t
- amount of cover = --! 5 ` -f ; f e , -- re ve
,n revision Required? 0 Yes '. No �� 1
other side for additional informs '
Date Insepct.e Signature Cert. No.
,710 (R.3/97)
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
OF 1 1.sco nafn Madison. 53707 - 716 Sanitary Permit Number (o filled is by CoJ
(608) 26( S 1 i 3
Department of Commerce State Plan I.D. Number
Sanitary Permit Application Q 6,- 4213
In accord with Comm 8311, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address)
maybe used for secondary purposes Privacy Law, x15.04(1
..
1. Application Information - Please Print All Informa ion
aroe Block M
Property Owner's Name
/A o 2G
Property Owner's Mailing Address Property Location
i � r
S ( —!2�`� _ Section 5
City, State Zip Code Phone Number
(circle one)
T N; R or W
IL Type of Building (check all that apply) / /� Subdivision Name CSM Number
O 1 or 2 Family Dwelling - Number of Bedrooms `7' QOw td�t
O PubliciCommeroial - Describe / ' C
O State Owned - Describe use
X 77 � CG ►'l amity ❑Hillage �1'ownship cf
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A New System O Replacanatt System ❑ Tteatment/Holding Tank Replacement Only 13 Other Modif+cation to Existing System
- - -�'
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
IV. Tvpe of POWTS System: Check all that aPPI
ON - Prcssurized_In -Ground Id Mound > 24 &&[Zd hte wit _ ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank [] Peat Filter [I Aerobic Treatment Unit ❑ Recirculating Sand Filter 13 it /
Recirculating synthetic Media Filter ❑ beaching Chamber ❑ Drip Line ❑ Gravel -kss Pipe ❑ Other (explain) V `
V.Dispe lll rtstment Area Information: Dispersal Area Requi 1 11 Dispersal Area P ed (sf) System Elevation
Desi Flow(gpd) Desi t il AW te(gpdsf)
o /Sav
Manufacturer Prefab Site Steel Fiber Plastic
YI. Tank Info ity licatio Total Number Concrete Constructed Glass
Gallons Gallons of Units
Ncw Ertis %
Tanks Tanks
Septic or Holding Tank
Aerobic Treatmnd Unit d
Dosing Clamber
VII. Responsibility Statement - I, the undersigned, assume responstbtlity for Insta of the POWTS shows an the attached plans
Plumber's Signature RS Number Business Phone Number
Plumber's Name (Print) t Jr . S .— Z O
4- z 2 6
Plu ber's Address (Street, Ci . State, i e
�I � 4g C / o �GJI� ' / 2 r
Vill. unt v /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issue Issuin ent S• na o Stamps
Pproved ❑ Disapproved Surcharge Fee) �v, Q — d li
❑ Owner Given Reason for Denial
Ice. Conditions of Approval/Reasons for Disapproval S {�
STEM OWNER:
(n il Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as Der a licablecode /ordinances. sot ka a,anatnsItinch - insiu
Attuh complete ptaas (to the�unty aaly) for syskm an papa'
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SBD -6398 (R 01/03) 41 COp P—
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Safety and Buildings
C0111111 @CCe.WI. OV 141 NW BARSTOW ST FL 4TH
g WAUKESHA WI 53188 -3789
4
TD #: (608) 264 -8777
i sco ns i n www.commer isco sin.go /
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Cory L. Nett Se cr e tary
September 28, 2004
CUST ID No.224617 ATTN: POWTS Inspector
LYLE 3 MYERS ZONING OFFICE
NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA
E1556 STATE ROAD 64 1101 CARMICHAEL RD
BOYCEVILLE WI 54725 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/28/2006 Identification Numbers
Transaction ID No. 1060213
SITE: Site ID No. 689665
Ron Davidson Please refer to both identification numbers,
140TH Street above, in all correspondence with the agency.
Town of Richmond, 54017
St Croix County
FOR:
Description: Mound 4 Bedr
Object Type: POWTS Component Manual Regulated Object ID No.: 981031
Maintenance required; 600 GPD Flow rate; 57 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version
2.0, SBD - 10706 -P (N.01 /01)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD -
10706 -P (N.01/01).
er scale, the slope appears to be 9 % in the area designated for the mound installation, not 6%
% as indicated in the
plan submittal. (The 6 slope appears to begin downslope of the mound area.) This will need to be verified in the
field prior to installation of the mound. If the slope is 9% in the mound area, some of the mound dimensions will
nee to be increased in order to meet t e 3:1 slope requirements. With a 9 % slope, the downslope and�ll depth
(E) would be 20.64 inches, the minimum required endslope width (K) would be 9.5 feet, and tJ e mid numirequired
downslo a toe width (I) would be 12.4 feet 'Z The pump chosen for the design is at the limits of its capacity. If the total dynamic heaceii Ealculate o be h�gh.t
the time of construction, a pump that meets or exceeds the system flo ivhe i ns tall&
In the event this soil absorption system or any of its component parts malfunctions so`ag t 1)3reate a health hazard, the
property owner must follow the contingency plan as described in the approved plans. In addition, the owner must
comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component
manual. A copy of this information must be given to the owner upon completion of the project.
All holding/treatment tanks are to comply with Comm. 84.25(7)(a).
LYLE J MYERS Page 2 9/28/2004
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.
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.
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
construction /instal lation /operation.
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.
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.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Julia A Lewis - Osborne
POWTS Reviewer 2, Integrated Services WiSMART code: 7633
(262) 548 -8638, Fax: (262) 548 -8614
jlewis@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Mound System Cover Page pg 1 of 6
MIESER _ c®nclETE
Project Name: Davidson -Mound
Owner's Name Ron Davidson
Owners Address 1868 CT Hwy C
Somerset, WI 54025
/4
Legal Description SE ' NE %4 Sec 35 Tr R 18 W
Township Richmond
County Saint Croix
Subdivision N/A
Lot# 15
RWCEIVED
Parcel ID#
SEP 1 2UJ4
Table of Contents SAFETY DLDGS. DIV.
Pg-
1 Cover page
2 Mound Sizing Calculations
3 Pressure Distribution Layout and Dynamics
4 Dose Tank
5 Management and Contingency Plan
6 Plot Map
total # of pages: 6
Designer Name: Lyle J. Myers
MP /License #: I. D.# 224617
Date: 9/10/04
Ph. #: 7156432520
Signature:
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01)
per Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01/01)
Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715- 643 -6068 email: 3ba @3badv1sement:com
Mound System Page 2 of 6
Mound Sizing Calculations
Project Name: Davidson -Mound
Site Con Design of Entire Fill
Project Type: 1 or 2 Family Dwelling V Cell depth at upslope edge (D): Q2.O % Slope: 6 % Cell depth at downslope edge (E):
# of Bedrooms: 4 Z
6 Distribution cell depth (F): 9.5 in.
Depth to limiting factor: 24 j� Cover thickness over edge (G): 6 in.
Absorbtion rate of fill material: a in. l /ft 2 /day Cover thickness over center (H): 12 in.
Absorbtion rate of in -situ soil: 0.4 gal /ft /day End slope width (K): 9.1 ft.
Effluent quality Eff #1 • Fill length (L): 93.2 ft.
Max BOD effluent value: 220 mg /I Upslope width (J): 5.9 ft.
Max TSS effluent value: 150 mg /l Downslope width (Toe) (1): 12.0 ft.
Fill Width (W): 25.9 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 600.0 gal /day Basal area required: 1500 fe
Distribution cell width (A): 8.00 ft Basal area available: 1500 ft
Distribution cell length (B): 75.0 ft
Area of Distribution Cell: 600.0 ft Observation Pipes
Contour Elevation of Mound: 99.30 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 100.30 ft
Final Grade of Mound: 102.09 ft
Mound Plan View
Observation Pipes
4 Z-yl�
W K A
B k—K
I Tilled ArealFill Material
L
Mound Cross Section
Final Grade 777 Observation Pipe
Synthetic Fabrics : G
Distribution Celt/ Y
e
System Elevation "" b ¢ 1
d
Cover Material
Fill Material
Tilled Area
Slope "' � Forcemain System
Contour �� 3
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System Page 3o s
Pressure Distribution Calculations
Project Name: Davidson -Mound
Lateral Layout Lateral /Manifold Design
Lateral elevation: 100. ft Lateral diameter: 1'i2 In.
Rows of Laterals: 2 Lateral spacing (S): ft
Manifold type: center w Lateral to cell edge: 2 ft
Orifice diameter: Fr0.125 In. Lateral discharge rate: 12.36 gpm
�_
# of Laterals: 4 System discharge rate: 49.43 gpm
Distal Pressure: 5 ft Manifold diameter: ,2 . In.
Lateral Length: 37 ft Manifold length: 4 ft
Orifice Spacing /Distribution Forcemain Friction Loss
Orifice spacing (X): 15.05 Inches Forcemain length: I 80 ft
Orifices per lateral: 30 Forcemain diameter: 2 7 In.
Avg. ft /Orifice: 5.00 ft Friction loss in forcemain: 3.906 ft
Lateral Side View
M anif old Lateral � Lateral
x x x x x x x x x x x x
2 2
Lateral Length Lateral Length
Lateral Plan View
Lateral Length Turn -up w /ball valve or cleanout plug
°
( G )T
I S
° o i
Orifices on bottom of
lateral equally spaced PVC laterals and Forcemain to comply with
specifications per Comm 84.30(2)(e)
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail Observation Pipes
Clean -out plug
Final Grade or ball valve
Water tight cap
or plug
Lawn
Sprinkler
Box
Slot
Note: Closet Collar
6" Minimum may be used in
Long Sweep 90 I place of 3/8" bar
or two 45's L 3/6" Bar
Lateral
Mound System Page 4 of 6
Septic, Pump and Dose Tank
Project: Davidson -Mound
Tank Information Dosage Volume
Pump tank manufacturer: W ieser Concrete Forcemain drains back to tank? Yes O No
Pump tank size /model: j jM /750 -MR � Lateral void volume: 15.6 gal
Pump tank gal /inch: 16.12 Dosage to absorbtion Cell: 78.2 gal
Actual Pump Tank Volume: 758 gal Forcemain volume: 13.9 gal
Tank bottom elevation (inside): g0 ft Total dosage: 92.2 gal
-------.._----- - --
Septic tank size /model: � 50/75o - MR
Pump and Filter Total Dynamic Head
Pump Manufacturer: Zoller Are laterals highest point? y
Pump Model: BN153 if not, enter highest elevation: 0 ft
Effluent Filter: Zabel A100 System head (distal x 1.3) 6.50 ft
Vertical Lift ( "D" to lateral) 10.13 ft
Note: Access opening of sufficient size to be provided to allow
removal of filter. Opening to terminate at or above grade. Friction loss In fOrCemaln: 3.91 ft
Pressure loss from filter: ft
Total dynamic head (TDH): 20.54
Pump Tank Diagram Dose Tank Levels
Watertight Locking Cover In. Gal
4 Inch With Warning Label
Minimum Finished A Reserve 31.3 504.6
Grade B pump off to Alarm 2.0 32.2
Alternatez C Total Dosage 5.7 92.2
Outlet
Location Elect. per Comm D Effluent depth for pump 8.0 129.0
16.28 and Total Capacit y' 47.0 758.0
i � NEC 300
Weep Hole A
or Anti-
, Siphon 8
Device
C
D
Pump must be capable of: 49.4 GPM
and head pressure of: 20.6 Feet
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FROM : NORTHLAND PLUMBING, INC. FAX NO. 715- 643 -2520 Sep. 27 2004 02:58PM P2
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T:med closing panels avetlable.
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an araml
Variable level control switrhips are availabia for controling angle phase r
syA49rna. '
Dwbis Pigg0ack variable low boat swltchft are avallabio for variable
lev9i long and short cycle controls. }
5aaled Qm"ax ava4bis for outdoor installations, 5" FM1420. I I
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Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6
Owner's Responsibility:
The component owner is responsible for the operation and maintenance of the component. The county,
department or POWTS service contractor may make periodic inspections of the components, checking for
surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and /or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approved individuals when
necessary in accordance with their approvals. The use of chemical /biological "treatments" is not required or
recommended. If such additives are used, make sure they are approved by Department of Commerce,
Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep
solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied
by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be
emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved
individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified
of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely
inspected to be watertight and of good repair.
Pump /Dose Tank
If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as
necessary, with provisions to keep solids from passing to the mound component during removal.
The pump, float switches and alarms must be inspected at least every three years for proper
operation. Pump /dose tank should be routinely inspected to be watertight and of good repair.
Mound and Lateral System
The mound system component must remain free of ponded surface water prior to pump operation. If 4
inches or more water level is detected in the observation pipes, the owner must be notified of possible
problems /failure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the installation or at the time
of a problem, complaint, or failure.
Contingency Plan:
If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc)
become defective, the defective tank or component must be replaced immediately to ensure that the system
can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the
surface, the component must be repaired or replaced in it's current location by either: extending basal toe to
provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in order to return system to proper working order as
required.
Sep 30 04 04s45p Ronald F. Davidson 651 -436 -5684 p.l
FR[r. : NORTHLAND PLUMBING, INC. FAX N0. : 715- 643 -2520 Sep. 30 2004 05:18P"9 P2
ST CROIX CO N 1'Y _
SEPTIC TANK MAWMANC E AORZEMEW
AND
r� .A_'r FORM
OVJNL�t25fi11' CERTiF1 .
Mailing Address Ave �::' �' d�T
Property Address 1 3 1 �-� �'"� Y �.
(VeAfk4tioa squired freer. Planning Deputmcat Tor nt:ry coastructioa; �.
/s a Parcel IdcntifioWion Number Di - .ouv T
r.t~ rsL n�:sc�
> ros rty Locsaoti S . ���,1 f., seq. Tjq.N- Rj&- Town of
Subdivision 9 t . Lot /•�
Certified Survey Map # � Volume _, l � . page #
WamAty Deed # f Volume 0 7 2 e #
Spec house d yes VU0 Lot lines itienmabla yes 1 tea
evert iw�iNTEN
V i V i
Improper an and alakteaa"o of yow septic aytteas t0uld [atom in iti pmou ure failure to Mae wad". Proper gyaisteaance
Consists of Pw=pinj out she soptie tank every d6tee years tx sooatr. if tw"ded by a lieaassd pine*. W>sat you pot into the rystem
can affoot tto funadou of the eW do %w%k at a treatment ata;e in the waste disposal system,
r" Drop M ow= &goes to &ubtalt to 5t. Csoix Zoaia8 Degxu bmaitt s cWAOadoe fomm &igmsd b dse owner ad by a
la1&9CTpI�r> j0etuaylrsattpiwasber ,mstriosedplvraborcra liotxawdpua�+� �yi�'� {U � ow :ite waatcvrakrdispoasl aystern
i4 is ptropes opesatiag ceaditiott aatL'or (�} after iaspectian sad pttatping (if twoasasry), dw septic tusk is lest than 113 full of dodge.
Itwa, the ua�rsigaed br<ve toad the above teertit atxeat& seed ogres to tsYtmtsia the private sewage disposal s"WW with the etaaaard,
at fettl6 bertha, u sot by the Dqa= at of Cammerct and the Deputoiect OfNadural Rasourcea, State of Wisconsla. Cerdf Caticc
ata ' at p6e eyeless a amintained must ba completed v1d rctr nM to the St. Croix County P.ontag Office widdu 30
dtay:i
*( *a
5i QF APPLICANT DATE
nttxrtvattt Czst'r=ATION e I (we) am (us) she owrter(s) of
Card that Au asoats it lotto aro tstda to tbs bast of my (out) lmowitdg .
y v a artaaty deed reeoated Lis Rc6iftor of D "& Office-
7
d .
SI TM OF APPLICA DATE
•• +••• Any iaforrttatloa that is 0%i6- rt:preseated may retutt in the &&meaty lxtmii being tavoW by the toeing Dapartmem • •" "�
••
Include vritb tbla applleatloa: ` � she e a p it Rosist" Of DOOds 0046
nibmwe is mad in dte wattaaty deed
III
f
` RECEIVED 1383
Wisconsin Department of Comm rce SOIL EVALUATION REPORT Page t of 3
Division of Safety and Buildings NO Vi accori :J"ith mm 85, Wis. Adm. Code Steel Soil Service
Attach complete site plan on paper ens ' sins' . Plan must County St. Croix
include, but not limited to: v 'cal an int (BM direction and
percent slope, scale or dime nce to nearest road. Parcel I.D.
Pending
Please print all information.
eviewe By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ��iL'dyY� 2 D o
Property Owner Property Location
R.J.C. Development, Inc. Govt. Lot na SE 1/4 NE 1/4 S 35 T 30 N R 18 W
Property Owner's Mailing Address Lot # Block # �S�ubd. Name or CSM#
1868 CT Hwy " C " 15 na Sunset Hollow
City State Zip Code Phone Number J City _J Village iol Town Nearest Road
Somerset WI 1 54025 1 651 - 488 - 3051 Richmond 1 140Th St.
New Construction Use: Vj Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement _ Public or commercial - Describe:
Parent material Benches and large drainageways of ground moraines. Flood plain elevation, if applicable na
General comments 0101ft and recommendations: Mound design, system elevation based on contour line elevation 98.30ft. Minimum I'j ' of ASTM
C33 sand.
a Boring # I Boring
16 Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 48 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Muns Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr8/2 none sit 2msbk mfr cs 2f .5 .8
2 10 -20 7.5yr4/4 none sl 2msbk dfi gw if .4 .6
20-48 7.5yr4/4 none scl 2msbk dfr gw if .4 .6
4 48 82 5yr4/4 none sl /scl om /1m 1 mfr na 1f .0 .0
w y 5 82 -96 10yr8/2 c2d7.5yr5/6 sand ston residuum mfr na na .0 .0
stratified layer of sl and scl are in Horizon 4
Boring # I Boring
e Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 48 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
1 0-9 10yr3/2 none sit 2msbk mfr cs 2f .5 .8
2 9 -19 7.5yr4/4 none scl 2msbk dfr gw 1f .4 .6
3 19 -32 7.5yr4/4 none cos osg dfr gw na .7 1.6
4 32.36 7.5yr4 /6 none Is osg mvfr gw na .7 1.2
5 6-48 5yr4/4 none scl 1 m I mfr gw na .2 .3
6 48- 2 5yr4/6 none sl om mfr na na .4 .6
* Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD :130 mg /L and TSS <30 mg /L
CST Name (Please Print) Signature: CST Number
David J. Steel - 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 11/11/2003 715- 246 -5085
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 1564 Cty Rd GG
CST - POWTSM RJC Development Co. New Richmond,WI 54017
Llc #248956 SE1 /4,NE1 /4,S35,T30N,R18W Bus.(715) 246 -6200
Town of Richmond, St. Croix Co. Fax.(715) 246 -9372
Sunset Hollow, Lot 15
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
♦ = Benchmark Ele. 100.00Ft
Top of 1/2" pvc pipe
• = Alt Benchmark Ele. 98.85Ft
Top of 1/2" pvc pipe
❑ = Borings
Boring Elevations
BI = 99. 1017t
( B2 = 99.1 OFt
B3 = 94.60Ft
B4 = OO.00Ft Z
J7�
15 G
0
G 13
3
/�
S'
\ _ 289
0'8 h -_ LOT 9 -
-
78 , 8 sq. . 51 ft. _ 78,851 sq. ft.
no - -- _ --
° 1.81 acres `1.81 acres
�O
N \
! N 79,426 sq. ft.
/------------- 1.1.82 acres ------ - - - - -- . - .............
1 \—� 33'
— 289 � � \
` _ •� f / / '
968
' 230 230'
I '
----------- ---------- - -- - ` -- .. - -- - -- �� - -�� -. -- ..... ...- - - - -- --------- - - - -.\
/
LOT 14 \ \ LOT 1 .I
121,901 sq. ft. `� 121, 90) sq. ft. `� \121,901 sq. ft.
—
-2.80 acres \ 2.80 acres \ \ \ \ \2.80 acres \ \
i99 4 / 230' 230' ` 230' \
�S89 *49'15"E \ \ 968.88' \ \ \
LOT 2 I \. \ \ \ LOT 1�
— — — — C. S. M . IN VOL. XX \ \
PG._XXXX
�I'` r
U 2592P 054 - 7 6:1sa1 8
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. NALSH
,. Document Number
WARRANTY DEED ST. CROIX
RECEIVED FOR RECORD
This Deed, made between RJC Development, 1qc. 06/09/2004 09;30A1f
Grantor,
and Ronald F. Davidson WARRANTY DEED
EXEMPT it
Grantee. REC FEE- 11.00
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 145.50
the following described real estate in St. Croix Colin State of Wisconsin COPY FEE :
ty. CC FEE:
(if more space is needed, please attach addendum): PAGES: 1
Lot 15, Plat of Sunset Hollow in the Town of Richmond, St. Croix
County, Wisconsin.
Recording Area
Name and Return Address
KRISTINA OGLAND
ATTORNEY AT LAW
P.Q. BOX 359
HUDSON, W154016
026- 1099 -10- 000.026- 1099 -60�t1
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 dune 2fl04
RJC Development, Inc.
n � J,
* * By: Ro erta J. Car on
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) RJC Developmen Inc. STATE OF
By: Robert J. Carlson ) ss.
• -------- - - - - -- - - - -y --- ••--------------- -• - - -- --------•------- • - - - -•—
County )
authenticated this of June , 2004_
Personally came before me this day of
the above teamed
* 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
A K ristin d
-- - - - --- ....... --- ------- --------- -- •---- •---------- - - - --- ....
H udson, 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, Wl
STATE BAR OF WISCONSIN 800 -655 -2021
WARRANTY DEED FORM No. 2 -1999
'15 "W_ 33 L 190.00' 190.00'' 0,01' 200
- 49 N89'49'15 "W 58 289.02' - - 128TH- A PEM E
230:00' -°: S89'49'1 5 "E 935.12'
23 .00' 45.12
2
• f0a u� o0 230.00
2A " ` e y
I
Z
N fN O O
Lot
(� LOT 9 o w
Z W LOT
121, 901 sq. ft. w o LOT 1
(" 2.80 o acres ( .'t 121,901 sq. ft. 130,1 os
LOT 15
oI c.e.a -99 0' ° 2.80 acres w 2..9.9 0-
35
121,901 sq. ft. o 0
2.80 acres
i o
�` ,
,,�. �e,� � y9y
Drainage
£asemen t
H. W. E. = 8
994.0' S89'49'1 5 "E 935.88' 24:
0' 230.0
230.0
230.00 968.8a'
N89 49 "W - 9sae�)
�9.� 67
I LOT 2 C.S.M. IN VOL_ 17 LOT 1
- - -- P 4_640 E.
• Sec
JRVE BEARING TABLE
CHORD CHORD 0N13*46'31"W BEARINGS �;
40.29' S06'50'51 "E S13'46' BASED ON GP
2 "E ELEVATIONS ARE USGS NAVD 1988
55.32' S06'57'28 "E S00'08'25 "E BEARINGS ARE REFERENCED TO THE EAST LINE 0
39.65' N06'57'28 "W N13'46'31 "W OF SECTION 35, WHICH IS ASSUMED TO BEAR SO
56.21' N06'50.51 "W N00'04'49 "E THE PARCELS SHOWN ON THIS MAP ARE SUBJEC'
COUNTY AND TOWNSHIP LAWS,
RULES AND REGU!
W MINIMUM PURCHASING L ACC
OR DEVELOPING ANY PARC
BEFORE
THE ST. CROIX COUNTY ZONING OFFICE AND THE
TOWN BOARD FOR ADVICE.