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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' _ INSPECTION REPORT sanitary Permit No: IF (ATTACH TO PERMIT) 405014 0 GINERAL INFORMATION state Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Buechler, Brian Richmond Township 026 - 1139 - 05-000 CST BM Elev: Insp. BM Elev: BM Description: /06/ 1 ' CS-r &t TANK INFORMATION V V ELEVATION DATA TYPE MANUFACTURER CAPACITY ST TION BS HI FS ELEV. 2 4 p Z Septic a- D Bench l7 PL 1 Dosing 1 O V At fy _ ►' SlgC• ,5 016 ,7 Aeration Bldg �Se�w Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMA I TANK TO P/L WEL ,BLDG. Vent Air Intake ROAD Dt Inlet Qp Septic } 0M 0 15- i �- Dt Bottom p � r' 3. � Dosing , Header /Man. t { d Q . -7 7 Aeration Dist. Pipe Holding Bot. System Final Grade (� I y ✓J PUMP /SIPHON INFORMATION I o Std ' Aalr& A;ex,—, / O Manufacturer Demand St Cover & _ �✓'bULVS GPM .� S.� � a Model Number eAo 6 / TDH Lift Frictign Lo s,5 System He TD 7 Ft C .� Forcemain Len t Dia. �� Dist. to Well 2 > d b' SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trenches. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (/� / r Q SETBACK SYSTEM TO P/ BLDG WELL KE /STREAM tSACHIAG Manufacturer: INFORMATION CHA OR Type Of System: / � y > U Model Number: DISTRIBUTION SYSTEM 0S od &LIs- Header /Manifold Distribution "� I i x Hole Size x Hole Spacing Ven v Intake ,qpQ J n pip 1 I f� Z � !. All Length - Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only G6, A rn, piti( Over Depth Over xx Depth of T eded /Sodded r ulched ed ench Center Bed/Trench Edges Topsoil Yes ] No [� Yes No _� COMMENTS (include code discrepencies, persons present, etc.) Inspection #1: / r' / Z_ Inspection #2: 7 / 1 / —r Location: 1285 140th St New Richmond, WI 54017 (NW 1/4 NW 1/4 36 T30N R18W) Torey Pines L Parcel No: 36.30.18.1000 1.) Alt BM Description = �""°'" uduld, FZtr44,W _ < f rA 1 11,1 r . S �yt {>� � ,• 2.) Bldg sewer length = ZS vjq�-hc-'I"'E�� - amount of cover = _— a revision Required? Iral Yes [moo — 7► Use other side for additional information. Lr "s_ + D ____ _ Date Insepctor's Si nature Cert. No. SBD -6710 (R.3/97) e r 2 l -72A X-LA Safety and Buildings Division Coin 7 201 W. Washington Ave., P.O. Box 7162 i e�insin ' L Maw► WI 53707 - 7162 Site Address �7 Department of Commerce -- K 0/ O — r • Saaitaty Permit Number Sanitary Permit Applicaflon In accord with Comm 83.21, Wis. Adm. Code, perso tfo f p ❑ Check MR a be used for Priv .315.0 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number /l 3 _ ® S C J� ST. CROIX COUNTY O 6 - Pro. rty Owner's Mailing Address J� Property Location Q J 7 � �/ \ r NLU-JJW1i:S t0 T30 N, R/9 E City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number r of Buil ' (check all that apply) °K � p, ❑ChtY b (1 or 2 Family Dwelling - Number of Bedrooms C ❑Village ❑ Public/Comme scribe Use * Township ❑ State Owned Ca ° 9S. I /r N r D M. Type of P : (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 1 New 2 ❑Replacement System 3 ❑ Rcplacernem of 6 ❑Addition to stem Tank Oil Exis ' stem B. ❑Check if Sanitary Permit Previously Issued I - i - _A Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) --K, qAd- 44 ❑ Non - Pressurized In- Ground 2lkMound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' rsa]/'lYeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(G ,/Days/Sq.Fyll (Min./Inch) Elevation 0 5 � 7 / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 8 1C --s / �? O Dosing Chamber OO -- VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tion of the POWTS shown on the attached plans. Plumber's Name (Print) / p Plumber' igna RS Number Business Phone Number Plumber' ddress (Street, City , State Code) A 44f�_ 4. 4!�� 6z-e� Gv VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse g I �-�✓ Determination ' IXConditions of APPro - --s o ns � ro val � � e� "M ..u.n ++►X '� cJIto �- /A'o -z'�T vuk it .11 �F� �c I,d l lanpl.S sPctt`1►Z. 'lam i Attach complete plain (to the County only) for the system on paper not less than 81/2 x 111aches in size SBD -6398 (R. 05101) Y Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 s TDD #: (608) 264 -8777 ,scons n www.commerc .wis ons www.wisconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Ed . rt, Secretary April 01, 2002 p : POWTS Insp ector S 341 AT77V T CUST ID No.267 p e � ARTHUR L WEGERER ZONING OFFICE ZpN�NCO�oI� ��Ol WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA FicFT}- PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2004 Identification Numbers Transaction ID No. 720742 SITE: Site ID No. 642618 Lacasse Custom Homes Please refer to both identification numbers, 140TH St above, in all correspondence with the agency. Town of Richmond St Croix County NW1 /4, NWI /4, S36, T30N, R18W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 834767 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (8.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (8.6/99). • 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. • Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. O rana&J, • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption ?0W area. chs. NR 811 & 812c OF COMMERCC • A Sanitary Permit must be obtained from the county where this project is located in accordance with the f'Bt 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. Stat • Comm 83.22(7) 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. ARTHUR L WEGERER Page 2 411/02 Owner Res P onsiblities: • 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 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construct ion/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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us TITLE SHEET Page of 3 MOUND SYSTEM FOR A Ll BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P CcZ- b /qa Cam, 6 14g LOCATED IN THE ti W 1/4 OF THE N W 1/4 OF SECTION 3A ,T - 1D N,R 1 9 W, TOWN OF 7�Z LC4M0� ,1\- , ST'- C COUNTY, WISCONSIN. Lt: T S O F INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR 'F 9� + � I I? Ii �k . �O �4 PREPARED BY WEGEFzzER SL7 I L TESTS M AND. DES = G�i S1ERV I CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 Phone 715- 425 -0165 Fax 715 - 425 -6864 � -1 4 •-•.. Co n � WD-975 P a , 6 ELLSI.- OR7w ' APPI j OF S I o ® 0 0 , - 8 1 G 420 1I4 Lim SEE CORREZ' 1 , -L-7-0 'Z JOB NO. O Z-:S 7 Mound System Management Plan Page Z of -] Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank ' The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. Theoperating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure PropeLgeration. The filter cartridge should not be removed unless provisions are made to retain.solids in the Fa that may slough off the i ter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and - pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L 6005, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SSD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning - Office at — 115- 3�b gGSo. S'1"'• C2UhC The system installer at The tank manufacturer at _3Z:S, The effluent filter manufacturer at `6 _ ZZ,�,— S7�(Z Z The pump manufacturer at PLOT PLAN Scale 1 "= L� 0' - Page 3 of 7 Z�1,00� YBD" A a 0, _ a 0 YTUM U F dkLL. I I — - - - - - - — 1 O 0 6L fj4' i q p0 NOT CZMPf)QT ✓ orz Dt s- U\'a3 �►^ ( LrL 100 _IQML_1 j W Pwl� kYFth6. Mum L of 112- COy WCr wlFtrtGr . -. NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be N /800 gallon capacity manufactured by tiv t � kz:�7vr_ Cali etZ - e - w / i9 - L S Da Z+kBgZ_ Fi L 1102 4. Bench marks 5. Divert surface water around system to prevent ponding at the uphill side. Page 4 7 Approved Sy._thetic Covering ASTM C33 Distribution Pipe Medium Sand - � Topsoil F ev . IG F1 , . � 3 D E , b y . % Slope Distribution Cell of Force Main Plowed 2" to 2 Aggregate From Pump Layer 0 1. PC. E 1:96 Ft. CROSS SECTION OF A MOUND SYSTEK F p, Fj Ft. G CG. S A 9 Ft. N Ft Linear Loading Rate= 2 - SGPD /LN FT B Ft. Design Loading Rate= o- 3gGPD /SQ FT I N Ft. J 8 Ft. K 11 Ft. Aitarmtts Position L Ft. of Force Main W 1 Ft. L . I ' Observation Pipe O - rr--------------------- --------- - - -_ -- - - - -� Ao- �-- - -� - -_ - -- --- - - - - -- -------- - - - - -- - - - - -- /6 -g W - -,-- ,1 iCistribution 1 „ 5 I Cell of z to 2 Pipe � aggregate Observation Pipe (Aachbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page S of - j Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of Iong turn or 45 fitting to a point within six inches of the final Pgade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. - T `i PVC FuC PV Lateral Manifold C Lateral x x x x xQ x!1 x x x x Lateral Lenoth — Lateral Lenpth —" Distribution Line - -- • — —o S C3— -- Cz? f o-- - - `o 1�VC ` vZCt Y1tr;N P 3 Ft. Hole Diameter a lt Inch - S 3 Ft. Lateral I Inches) X Zy Inches Manifold Z - Inches Force Main " z Inches of holes /pipe 11 Invert Elevation of Laterals CJ Ft. ��Ko•yl = b•a7X 6 - yl. & G>*l Combination SePt'4c: and l PUMP CHAMBER CR055 SECTION AND SPECIFICATIONS ' PAGE OF NEWT CAP WEATHER PKOOF JUIJCTIOU BOX . '1 C.I. VEEIT PIPE APPROVED LOCK IMG 1 FROM DOOR. NWHOLE COVER AJIV 1►J$p��0� PIPE :iIUDOW OR FRESH 1 w AptJ11JG t -N%EL. wlt�tcZlZr. E-f•p Arm IUTAKE cor�D�tT FIIUL$k}© 'L6 S Y'Alm. GMo� INLET i " PROVIDE AtKTIGHT SEAL I I : " ( I Approved zfl8�- t-t� A I I Approved joint w/ I I I joint w/. PVC pipe - �} -18 .� 'I ALARM PVC pipe 6 I I I om C I CLEY E P u MP —�, ` OFF 0 COUCRETE 9LOCK V R15CR EXIT PERMITTED ONLY IF TAUK MALWACTURE HAS SUCH APPROVAL 3 "ApPRotiFD ' — 8fc00 i N4 SEPTIC F SPCGIFICATIOUS OOSE TAW MALI UFACTUR CR: w L QL CO) JCfe NLlMbER OF DOSES: S`O / P is R Q>~., w TA WK :Azc : L l bo < 8 00 GALLOIJS DOSE VOLUME z ALAR#% t S•S• `7 - Zo Ski S`fe 4% IAI CLUDIIJC, 6AGKFLDW: 1 Z 3 .6 GALLONS MODEL WUMBER: l0 L H CAPACITIES: A= ZO l 2. O �LIZCLJR. IUCHCS OR CALLO I � US WITCH TYPE: - $ = Z I►JCHES'OR ��' Z GO U S G(�LLOUS PUMP MAIJUFACTUR><R: C=-- (, — IULHESOR IZ3.6 GALLOI,JS MODEL NUMBER: ��OS D= 10 INCHES OR � 0 GALLOMS SWITCH TVPE: — r''1LrnCURy UDTF: PUMP AMD ALARM ARE TO 5E MINIMUM DISCHARGE 'RATE l •S p Nv TALLEO ON 5EPKRATE CIR —�.— Z G M I C I R U TS VERTICAL DIFFEILENC!< DETWEE►J PUMP OFF AUO,.015TRIBUTIOW PIPE.. a`67 FEET + MIMIMUM NETWORK SUPPLY PRESSURE , , . 6•S� FLE.T c' (3.A-L + Z Q FEET OF FORCE MAIN X =S F � O FLFRICTIOU FACTOR Z FEET 1 W % 3•!; TOTAL oyNAMIL HEAD = �S $q FEET As per manufacturer 1 0. 6 p gal /in. Liquid depth 3 8 I 7 Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. tic cover with integral handle Available for automatic and •Farms Motor: 'and float switch attachment • EPO4 Single phase: 0.4 HP, manual operation. Automatic • Heavy duty sump 115 or 230 Vp 60 Hz, 1550 models include Mechanical points. • Water transfer RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty • Dewatering automatic reset. preset at the factory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4" maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. • Total heads: up to 24 feet. with three prong grounding Co. Canadian Standards Association _ • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in 7" or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: _ thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 I ! components. ! Pump: EP05 a ! — - - -- i -- � — ?'7S FT ; • Solids handling capability: c 25 - --l— 3 /4" maximum. a ' I I i W - -' • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. • Discharge size: 1 NPT. Z 5- • Mechanical seal: carbon- 0 15 rotary/ceramic- stationary, a 4 i I BUNA -N elastomers. — EP 5', • Temperature: ° 3 10 ! ! 104 °F (40 °C) continuous I j 140 °F (60 °C) intermittent. 2 I I I 5 0 00 10 20 30 40 50 GPM L 0 2 4 6 S 10 12 m/h CAPACITY ®1995 Goulds Pumps, Inc. Effective May, 1995 83871 wa;consin Department of Commerce SOIL EVALUATION REPORT Page __I__ of Division of Safety and Buildings in accordance with Comm 85, Wis Adm. Code C!► Attach complete sibs plan on paper not less than 81/2 x 11 inches in size. Plan must • Caro�� include, but not limited to: vertical and horizontal reference paint (BM), direction and Parcel I.D. percent slope, scale or dimensions, north anew, and location and distance to nearest road. Please print aB info, Date � �� t Personal kdonnation You p may be used for [pies > X.04 (1) (m)). Z _ fl\ Property Owner �' Location -, G*k t 1/4 1/4 S Ta N R �' E(or)MD Property Owner's Mailing address F 4' r � l_at ._-_._' Block # Subd. Nana or CSW K -�• re Pi,rx. city Sias zip Code lt- U N' Y Village F3 T Neared Road � . CW New Construction Use: a Residentiurll / NcRnber Y_ Code derived design lbw rate g l-ROI6 oa GPO ❑ Replacement 4 411 C1 Public or oommerrtial - Parent material Flood Plain elevation if applicable Al Ganerai comments Sy.S 1� w . e: te. of - 4 7• / C and recommendations: � efy e.V . E" # ° Boring factor in — Pit Ground surface elev. �O ft Depth to lerritirrg . Son Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munson Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 'EOM �j�� V•� r-- F Boring #❑ Boring Eg Pit Ground surface elev. YS' t/O ft Depth to limiting factor 3� in. Son Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Effu1:1 '0102 Z 1 4 7 -%. 7 -f i L 5 1 — Ste! e.�• o f, " EfB xW #1 = BOD > 30 < 220 mg& and TSS >30 150 mg& ` Ef mit #2 = BC0 < 30 mg& and TSS < 30 mg& CST Name (Please P shone CST Number - O Address Date Evaluation Conducted Telephone Number 6 ) S� Property Owner /^F .�►M S __ Parcel ID # Page of F Borings ❑ Boring Pit Ground surfaceelev. �� � ft. Depth fA limiting factor in. Soil Application Rate ddzori {3erp'th' Dorili6nt Dolor ' Redwe ftscxiption Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. *EfW1 *Eff#2 1 - Z 16W - ; V4 .5 2, rr-C' c `� • � ❑ Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struc tum Consistence Boundary Roots GPD/(E? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 F Boring # F] Boring ❑ PitGround surface elev. ft. Depth iD limiting factor in. Soil Appka#T Rate Horizon Depth Dominant Color Redox Descniftn Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 Effluent #1 BOD > 30 < 220 mglL and TSS >30 <_ 150 mglL ' Effluent #2 = BOD, < 30 M& and TSS 1 30 mg& 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 cor►tact the department at 60&266 -3151 or TTY 60 &2648777. SBD -8330 (807/00) f PAGE_3_OF__-) NAME LOT# -S LEGAL DESCRIPTION w ' /4 vw' /4,S3 (vT3o,N,R J%E (or)(0 SCALE: F'= �U �BM1/ELEVATION / U BM I DESCRIPTION ha ( n Co " vtA W! Fic« J �BLEVATION 9X1.3 S � 3� BM 2 DESCRIPTION %Z H) SYSTEM ELEVATION !R Z ALTERNATE ELEVATION iV (A CONTOUR ELEVATION dy I 1 I a r b� 2 SIGNATURE DATE 81 ' CHOIX COUNTY S!?PTIC 'PANIC MA AGIUMM13N'1' AND 0"llitsfUP CERTIFICATION DORM Mailing Address Property Address I / (Verlficatoa rcyutre;cl rang 1'la11ni11g I)Cpanrloc11t fur 11ew l rrsln,cfiun) z City /Stale lrttrccl l Nund,cr D o2 /� ©�— s LEG ll1' Chit "!'holy ~ Property Localiou - y,, JA y , - ��_!t '!'own of _ Subdivision Cerfli9ed Survey M 11 � . WRITaaly Dead ll , Vctlntuc Spec liotlrlc O yea no I,itl lines idwilifitiltle yes < 110 MAIN•11iPKI A w( r. !. Itltprapernso slid inalnicllalleco(yuri saplic syraciui cinim Ics1111 in Its is, C11(O111te l4tlrie b) llalldla wi propernlatoie11a11ce coitalsrs of pumping out file septle teiik ave,y three yeals iir thui11cr, if ,cellod by a licensed 111ri>tter. What you tall into the system can affect Ilia funcoon of ilia septic tack as if ttcalntcili stage In 111c (11611026) s yslc11t. 771e pcaperly fyWUCr agrees i l subriti l Si. Ciofx 7011 AdtaUuicul a eGlllitath »i 1111111, tlgn t ed illy ilia owner rod by a utasltsrpluntlrcr Jwftncyrftilit pitunbm, Iesif hated Idwiuber or a licensed pu11gicr vchlfyitlg that (1) the on - tile wastewsierzileaal sy stem is In proper operalhhs condition offal /ur(2) 011er luspecliu11 lied p1111q►lrg (if rece6ssry), Ilia septic lailk Is less dial) 113. full of sludge. /we, lire undenleued hero call Ilia above tcquifellicats and &RICO tit 111811114111 Ilse private sewage dlepassl system Willi lho tiandar49 set forth, heref 1, as act by ilia Depau11tc111 of Cnr,frewc slid Ibe hepatl11,elit of Natural Itesonrces, Slate of WiaaOaala. Cedlficallon sooting fiat your teptle syslain has Well ufaintairfed nnrst lie couydciail stilt renifrrcd to ilia St. Croix Cotinly Zonlag Of a wllhin 30 flaye if 011ie three year otlpin dale. SIGNAIURti Or. A 1'pUCAN't' a Z DATA �'4'N1�1� Cg'R�rrli�ar�A�rr . 1 (we) ce a b o ve, b y y vii Icnla Ott ibis li the properly dea till ;u lt11t ale Moo its Ilia liew ar illy (mil) knowledge. i (we) 1111 (M) ilia ovnics of.. to of a wallurty iced reeoohlell it Itegisict of llccds Oilicc. sloNA7I�nt1 Or• Arr1.ICAtJ•e � q 0 Z- . DA7b °O "' • Atly bttOtllhllotl lbal Is tttls - fe >t•cscntrd Isl y Icsok In the itrlfely pct,uif balks revoked by life Zontu` Department. 0 Include Milt lids apihllesdals: a ,,au,t,ed wallalkly decd fiaau ilia liagisicr or t)aclls office a copy of Olio certified survey mall if tcfcrcllce Is 11 lu'llte warranty deed T ' d 9Z T 0— b66— T S9 Jautaad R44ed d9S : jb0 20 40 Idu 0= .1x120 F 419 PA�- X5655$ STATE BAR OF WISCONSIN FORM 2 - 1999 s,'3', I -EN H. WAL5H WARRANTY DEED OF DEEDS Document Number j.. CROIX CO. T WI This Deed, made between Ames Investment Corporation, LLC a RECEIVED FOR RECORD Minnesota Limited Liability Company v3-18-2001 10:50 Ail wWOTY DEED :Y,?IPT k Grantor, and Brian J. Buechler and Patricia L. Fenner, CfRT COPY FEE: ;,DFi FEE: WNSFER FEE: 77.70 RE- ORDING FEE: 11.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County. State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lot Plat o Torey Pin es in the Town of Richmond, St. Croix County, iscousin. 026 -1101- 80,026. 1101 -90 Parcel Identification Number (PIN) This is not homestead property. o6) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of September 2001 P Amt nt Corpor ion, LLJ,C�' AUTHENTICATION IIM1 ACKNOWLEDGMENT ,y Pt' Signatures) O STATE OF WISCONSIN ) ss. County ) authenticated this day of Personally came before me this 1 71 1, day of September 2001 the above named Ames Investment Corporation LLC, a Minnesota Limited • t'i:,;a :. Liability Company b it's TITLE: MEMBER STATE BAR OF W[S to me known bet on(s) who executed the foregoing (If not, instrumen ac dgcd the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • ` Attorney Kr[stina Ogland Notary Public, a of Wisconsin Hudson, W i sio pe anent. If not, state expir ti (Signatures may be authenticated or acknowledged. Both are not necessary.) • Names of coons signing in an capacity must be typed or printed below their si ure. UYO mat on pmMsalonab cmnpMtl. Fond du Lwq w: pe g 8 Y �P tY tYP P 8004157.2021 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 -1999 1.62 ACRES 70487 So. FT. E E, • I I _ STATE "� ..••� COUN1 � I � I, 89°43'29'E 297.W MAF N I TREA! G WITH A ASSE: c i PLAT � I ?R 1.66 ACRES Town 72382 SO. FT. I I ORGA I I OF M 907W HERE S89°4727 W 330.0 THE 0' ABO` I 66 IN V ICI I THI: iq IN O ; $ VIt STi Cap ! �I i F FC 3 I BENCH MARK __