HomeMy WebLinkAbout026-1149-18-000 I T
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
' (ATTACH TO PERMIT) 430256 0
GENERAL 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:
Crombie, Mara I Richmond Township 026- 1149 -18 -000
CST BM Elev: Insp. BM Elev: BM Description: S ton/Town /Range/Map No:
�c r/k..,�Y 36.30.18.1118A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � r Benchmark j L4 I'D f
Dosing Alt. BM
Aeration Bldg. Sewer
�.z 95.2
St/Ht Inlet ��• S�
'
TANK SETBACK INFORMATION St/Ht Outlet "7. 1 ` 4 4 3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic �. / t!a r ,� a'� / / Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
-Z f 9 3.1 �
Holdin Bot. System 5 Z. to
i
PUMP /SIPHON INFORMATION Final Grade S 9S
Manufacturer Demand St Cover 9
GPM Z
i Model Number,,
TDH LiftF ' oss System Head TDH Ft
Forcemain L ngth Dia. to well t
SOIL ABSOR N SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS U1,7
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION
CHAMBER OR Cvvse r+
Type Of System: UNIT
f i� Model Number. f f� t
G t. n t1 y�'� ' ° 1<'1 � v
DISTRIBUTION SYSTEM r c �G- ' —4. 2 ` run-. L++
mngthQ Id Distribution x Hole Size x Hole Spacing Vent to Air Intake
L / Pipe(s) – `� " — i"� �t=i I
1 Length Dia Spacing
S R 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 Bed/Trench Edges Topsoil [ ' Yes r] No [ Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: to / 3 1 / L--- Inspection #2:
Location: 1423 126th Avenue New Richmond, WI 54017 (SW 1/4 NW 1/4 36 T30N R18W) Torey / Pines Lot 18 Parcel No: 36.30.18.1118A
1.) Alt BM Description= To U'Z o �i v� c�.ti. N L't-% C ee r Otte .5 e ' 0 U , ec�
2.) Bldg sewer length= (" 4)\ tJa'
- amount of cover = `� ~ > (� n� S u �G �, } G �5 i n 14
- - - - -, -
Plan revision Required? i ,Yes No
ation.
Use other side for addition form
SBD -6710 (R.3/97) Date Insepctors Signature Cert. No.
Safety and Buildings Division County '►
Vi sconsin On 201 W. Washington Ave., P.O. Box 7082 1 r v j
Madison, WI - Sani (608) Permit Number (to be filled in by Co.)
, ��R EIVE
De artment of Commerce &(ts ob �' D 255_(
Sanitary Permit Apphcatio� 3 20 fate P I.D. Number
,./
In accord with Comm 83.2 1, Wis. Adm. Code, personal information u pro
may be used for secondary purposes Privacy Law, s 15.114(1 ) sect ddress (if different than mailing dress)
ST. CROIX COU E E L f
I. Application Information — Please Print All Information
Property Owner's Name J p , Parcel B oc
/ /
Property er's Mailing Address Property Location ,
l n
Wes- Y A-1' c • ! �i
Ci ,State Zip Code Phone Number '� Section
�� /✓ ) 1,.1� o Lh crrcle ne)
N; /E or
II. ype of Building (check all that apply) Pi4� B� U
1-r 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number
❑ Public/Commercial -Describe Use
❑ State Owned - Describe Use i� b I ST • C� ^ �S W y �yyh ri Q/I/J Q� ❑City_❑Villagownship of 2//YZ
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B • ❑Permit Renewal it Revision ❑Change of 11 Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration �— Plumber Owner / 3 ?Z2 5_/ - 3
IV. Type of POWTS System: C heck all that appl
�
on - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Leachin Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVTreatment Area Ififormation: S /0
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
�6
1__2 it I gJ_e � - 7,0:g o `2
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site St 1 Fiber Plastic
Gallons Gallons of Units , //��- /o o Concrete Constructed Glass
New Existing W/
Tanks Tanks �✓
Septic or Holding Tank x ,
-
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, me responsibility for installation of the POWTS shown on the attached plans.
Plumber' Name (P Plumber's S� re MP/MPRSS Nummber Business Phone Nu e
6att Plumber's Address (Street, City, State, Zi
VII Coun /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date A ssuing Age t Signature tamps)
Surcharge Fee)
❑Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
sv i OVA t,U> a rJ a tJc -1 ^)(—A � !
y S7�� ! �1 T7r 1_' 477 a'✓ (! Ol 31/0 3)
/ /nJ>= iL�ZA�'03
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 laches in size
SBD -6398 (R. 08/02)
Soil Test and System PLOT PLAN
PROJECT Mara Crombv ' ADDRESS 3050 Lisbon Ave N. Lake Elmo Mn 55042
SW 1/4 NON 1/4s 36 )UND R 18 W TOWN Richmond COUNTY ST. CROIX 10/31 /03
MPRS Shaun Bird 226900 DATE
BEDROOM 4
CONVENTIONAL )00( IN -G PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28
BENCHMARK V.R.P. Top of Foundation Nee Wall ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 92.0/91.9 4' below grade
jL Standard Biodiffuser Plans Designed Using
Leaching Chamber Conventional Powts
with 31.1 ft2 of Area Manual Version 2.0
34 Grade at System Elevation
a
a
Pr operty Line 70'
as
a
0
50' °
-1 0 ,
IF 20' ST
5'
2% 5
toe M
90' Pro 4
Bedroom
2-3'X 88' Cells with House
>3' Spacing
_ B -3
30' B.M. #2
6% 50' 20'
Slope _
0 '
-1 B.M.
10' 10'
475' Property Line 100'
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
' County � /1 � J r
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 1
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �l
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 Z yG� / —
Please print all information. awed b / /,,, D
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). `2�v �� 03
Property Owner Property Lo , tio�n
eglz� ( �� {,i Govt. Lot ./ 1/4 /4 S .bT N E r) W
Property er's Mailing JAddress t Lot Block # I Subd. Name PrM#
City � State Zip Code Phone Number ❑City ❑�Villa6ieT Nearest Road
New Construction Use. esidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public o mmercial - Describe: _______. __—
Parent matedal Flood Plain elevation if applicable �Cd� f ft.
General menda�
an recom ons_5c� _ (�! �✓ J I �(L �CGL O� SD �S
L // G`a'b
s ys• ', ate+ � 2 "� � Zy 3 _ c� l � l h S � "1
l
r Boring # Boring �'1 aP (�i�'► as il1QG'
Pit Ground surface elev.q_ Depth to limiting factor �19 ft. L�'in.
Soil P
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Ef
ro C -
2 ✓ r s "_'� i 1?l
3 - C w F
if
Boring # Boring
Ground surface elev �2 / V ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fffr
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
is Z ~ � 5
Z
qY
Effluent #1 = BOD > 30 < 220 "KA and TSS >30 < 150 ` Effluent #2 = BOD < 30 mg/_ and TSS < 30 mg1L
CST Name (Please Print) S' re CST Number
Bird Plumbing, Inc. Shaun Bird , 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �� ' 715- 246 -4516
Fpp"
i
Property Owner _ Parcel ID # Page of
1 3 Boring # Boring
Pit Ground surface elev. , �?ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
2.3 '
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
F-1 Boring # ❑ pit Boring
❑ Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPWff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Etf#2
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.
SOD4330 (8.6/00)
l
~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County �1 '
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must c.�- 1 e-0 /
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. q jJ
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 2(0��� y/ �O �� 6
Please print all information. awed b Da / t /��
Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). / 03
Property Owner Property Lo �tio�n)
Q�v C o rn {/ Go . lot t/v 114 J4 S T :56N E ) W
Property is Mailing Address _ of Block # Subd. Name or r
City State Zip Code Phone Number City ❑Village Nearest Road
New Construction Use. esiden6al /Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public oommercial - Describe:
Parent material C:6� -�''�J Flood Plain elevation if applicable
amid re mmendaationsSy� 61CILICA 0 lS
V2 J iG a� SO s
/ 9 _'6
S
�/ , Y S r
ys -ir'h q2-0 - 2, 3 _ 1 ,►' _ /
l LL.J Ong �?m
/� a/YLdr �l�/ # Bodng pit Ground surface elev. r ft. Depth to limiting factor G
Soil ication 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
Ir
r l ® � # Q,Boring � /
S) pit Ground surface ale (� �) ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
I ' s
Z ; s t---- -.._
51 le z222
.Z
• Effluent #1 = BOO > 30 < 220 nVL and TSS >30 1 150 ' Effluent #2 = BOD 1 30 nV& and TSS 1 30 nVL
CST Name (Please PnM S' re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 v �� 715 - 246 -4516
• Soil Test and System PLOT PLAN
PROJECT Mara Crombv ADDRESS 30 0 Lisbon Ave N. Lake Elmo Mn 55042
SW 1/4 NW 1/4s 36 /T R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/31/03 BEDROOM 4
CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28
IL BENCHMARK V.R.P. Top of Foundation Nee Wall ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL •H. R. P. Same as Benchmark
Vent SYSTEM ELEVATION 92.0/91.9 4' below grade
>6 „ Standard Biodiffuser Plans Designed Using
Leaching Chamber Conventional Powts
of Cover with 31.1 ft2 of Area Manual Version 2.0
6' Long
11"
34" Fade at System Elevation rr
D� a
Property Line I l 70'
50' o
-1 0'
20' ST
5 '
2% $ 5 9
toe
M
90' Pro 4
Bedroom
2 -3' X 88' Cells with House
>3' Spacing
-2 B -3
30' B.M. #2
6% 50' 20'
Slope
-2
0'
10' - 1 B.M. * 10'
475' Property Line 100'
F Safety and Buildings Division
201 W. Washington Ave., P.O. Box 7162
VISCOilsi Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
j Department of Commerce (608) 266 -3151
State Plan I.D. Number
Sanitary Permit Application
In accord with Comm 83.21, Wis. Adm. Code, personal information ou rov
may be used for secondary purposes Privacy L w, s I WE D Project Address (if different than mailing address)
F � I
1. Application Information - Please Print All Information 1
H' 4
1 23
Property Owner's N me Parc N Lot # Block X
i
S ( �, �.1 �;OEI ': I i
j Property Owner's M ailing Address Property Location
I
Zi od
e Phone Number
U ` /jam ,
/ ��� ' (/V ` (cir a one)
� mo� . T N; E rW
check all that apply)
II. a of Buildin
i yp g ( Subdivin ham; CSM Number
or 2 Family Dwelling - Number of Bedrooms , t /,?/ /
u Public /Commercial - Describe Use
1 ❑City ❑ agenwnship of
State Owned - Describe Use — 3 X �� • ZS — /
III. Type of Permit: (Check only one box on line A. Complete line B if appli ble) OA)
A " System ❑ Replacement System ❑ Treatment/ Holding Tank Replacement Only ❑Other Modification to Existing System
i
List Previous Permit Number and Date Issued
B. ❑ Permit Rencwal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New
i
Before Expiration Plumber Owner
� I
1 IV Type of POWTS System: (Check all that apply)
Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil ❑ At- Grade ❑ Single Pass Sand Filter
7 1 7 r
'7J Constructed Wetland ❑ Pressurized In nd 11 Holding Tank ❑ Peat Filter L] Aerobic Treatment Unit Recirculating Sand Filter
r
Recirculating Synthetic Media Filter hing Chamb ❑ Drip Line ❑ Gravel -less P' e 11 other (expl n)
I V Dispersal /Treatment Area f ation: - r
,r D es' Flow (gpd) Design So" ication Rate(gpdsf) Dispersal Area uired (sf) Dispersal Ar a Proposed sf)� System levati n
1 VI. Tank 'nfo Capaci in Total Number Manufacturer Prefab Site Steel ber PI tiC
Gallons Gallons I of Units Concrete Constructed lass
New Existing
Tanks Tanks
Septic or Holding Tank I j�
Aerobic Treatment Unit C
Dosing Chamber i I
VII. Responsibility Statement- I, the undersign; sum; responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's nature MP /MPRS Number Business Phone Nu be
Plumber's Addre ss (Street, City, State, Z' n
VIII. County /De artment Use Only
.Approved ❑Disapproved Sanitary Permit Fe includes Groundwater Date Issued Is uin Agent Sign lure o Stamps)
0 Owner Fee) 2 7\
.7 V Owner Given Reason for Denial S
IX. Conditions of Approval /Reasons for Disap royal
. �- C
mot. ItL� V .
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches iu size
SBD -6398 (R. 01/03) A
PLOT PLA
PROJECT Mar Ctomgv ADORES 50 Lis n Ave N. Lake Elmo Mn 55042
SW '1/4 NW 1 /4s 36 /T 30 N/R 18 T N Ri hmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 ga s LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51
BENCHMARK V.R.P. Top of V PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL •H.R.P. Same as Benchmark
SYSTEM ELEVATION 94.4/94.0/93.6
Vent
j „ Standard Biodiffuser Plans Designed Using
Leaching Chamber Conventional Powts
ver with 31.1 ft2 of Area Manual Version 2.0
ong 11 ”
34" Grade at System Elevation
Please note: This plumber has no intentions of installing
leaching chambers in a sicl soil, but the soil tester did not dig
his borings deep enough for any other option. The home
owner has requested that a new soil test be done in future.
ese results will be submitted and new revisi will be filed.'
3 -3' X 107' Cells with >3' spacing
6%
Slope
Pro 4 B -3 Vents
Bedroom
House
Vents B.M. #2
20'
20 T 30' -
� 0'
10' B.M. * 10'
75' Property Line 100
PLOT PLA
PROJECT Mara Crombv ADDRES 50 Lis n Ave N. Lake Elmo Mn 55042
SW '1/4 NW 1/4s 36 /T 30 N/R 18 T N Ri hmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/6/03 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal ns LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1586 # of chambers 51
IL BENCHMARK V.R.P. Top of 1" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.4/94.0/93.6
Lent
>6 „ Standard Biodiffuser Plans Designed Using
of Cover Leaching Chamber Conventional Powts
with 31.1 ft2 of Area Manual Version 2.0
'Long
34" Grade at System Elevation
Please note: This plumber has no intentions of installing
leaching chambers in a sicl soil, but the soil tester did not dig
his borings deep enough for any other option. The home
owner has requested that a new soil test be done in future. 1.
>,
ese results will be submitted and new revisj will be filed.
0
N
V7
3 -3' X 107' Cells with >3' spacing
6%
Slope B -3
Pro 4 .--- Vents
Bedroom
House
Vents B.M. #2
20'
20 T 30' OF -2
B.M.
475' Property Line 100,
Wfsconsin oepartment of Commerce SOIL EVALUATION REPORT Page I of J
Division of Safety and Buildings ,
In accordance with Comm 85. Wis. Adm. Code
County C r I x
Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. a by Date,
Personal infannation you provide may be used fa secondary purposes (Privacy Law. s. M04 ( (m)).
Property Owner I Property Location
v me _ (—LC, Govt. Lot kj 1/4 w 1/4 S 34 T b N R /$ E (or 11
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM#
: •Pien t ry: a- 1�Zc� . - %n- An e
City State Zip Code Phone Number ❑ City _ Village_ ® Town Barest Road
D eltic M N iffntto i I i t6 73
[� New Construction Use: ® Residential !Number of bedrooms `� .Code tterived design slow rate
GPI
❑ Replacement ❑ Public or convnercial - Describe:
Parent material �r Flood Plain elevation If applicable ft.
General comments S S� m We °r fy Cr u p' 3 , a UO7
and recommendations:
❑ Boring # ❑ Boring
I [jj Pit Ground surface.elev. 6 n Depth to fimiting factor / / b
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. _ r •Eff#1 •EM
{ p-20 16 , 1 r31 2 -
Z 2b-(Pl 5 7 ry�r c5 /V
3 1-11% )() r Lf)(,o — rn s 04 Z
F Boring # Boring
❑ ® Pit Ground surface elev. 9 yo fL Depth to limiting factor 10 / in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff'
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0- � Zrr,s C- V 5 9
2
. 10-401 G 14 1(o — . S ) — — . _7 . 2
Z
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L
CST Name (Please Print) ignature CST Number s
�1or,r, _
Address Date Evaluation Conducted Telephone Number
N5)
Property Owner 5 1 eS ., Parcel ID # Page • 2 'of S
2� Boring # Boring
v Pit Ground surface elev. Iff fL Depth to limiting facto in. Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
In. Munsell flu. Sz. Coni Cobr Gr. Sz. Sh. •Eff#1 •Eff#2
I Q -2N ltd 4r,312 ,Sit Z, k r� c
7]
F Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth - Dominant Color . Redox Description. -- .. Texture .- Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Boring # Boring
D P'if - Ground surface elev. fL Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ft
in. Munsell flu. Sz. ConL Color Gr. Sz. Sh. •Eff#1 •Eff#2
- • Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/4 and TSS < 30 mg/L
r:
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.
SBD3330 (807/00)
PAGE 3 OF
NAME L OW LEGAL DESCRIP'T'ION Sw X /trW X ,S 34 1 N R E(or�
SCALE: I"= Yo
BM 1 ELEVATION /0 0 -0
I
BM 1 DESCRIFTION cw Q o �' ! u P' t e
BM 2 ELEVATION q, Z 0
BM 2 DESCRIPTION h),2 U
SYSTEM ELEVATION P `I.0 ° Lv r 9 3• o 0
ALTERNATE ELEVATION /(/ 1 Vk
CONTOUR ELEVATION t a � , S v
5
9S S
U
a�.S�
v 4 e
SIGNATURE ��� �`---� DATE �Z
�► r ORIGINAL
1666
Wisconsin Department of Commerce SOIL EVALUATION REPORT of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code �We �DCe g ,� il Testing
Attach comp site an on t y
ple pl paper not less than 8'h x 11 inches in size. Plan must Cou ' t. tir ,01X
include, but not limited lo: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pa - I.L� Cl; ` 2
Please print all information. NTY ate
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). OF / C�' (o r0
Property Owner Property Location
Ames Investment, LLC Govt. Lot NW 19 NW 1/4 S 36 T 30 N R 18 W
Property Owner's Mailing Addres; Lot # Block # Subd. Name or CSM#
34 Peninsula Rd 10 Tory Pines
City Dellwood State Zip Code Phone Number 2IJ City 1 Village Pj Town Nearest Road
MN 1 55110 1 715 - 386 -2007 Richmond 142Nd St.
✓i New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe
Parent material loess over till Flood plain elevation, if applicable NA
General comments
and recommendations: install 6'x 100' rock Fell mound on 96.4 contour as upslope edge of rock w/ 0.5' sand fill
Boring # Boring ih ty �-t `
Pit Ground Surface elev. 96.0 ft. Depth min. oil 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 -11 10YR 3/2 - sit 2 f sbk mvfr cs 1f /m .5 .8
2 11 -29 10YR 4/4 - sicl 2 m sbk mfr cs 1m .4 .6
3 1 29 -36 7.5YR 414 - s1 1 m sbk mfr gs 1f .4 6
I
4 36 -56 7.5YR 4/4 - Is 1 m sbk mvfr cs 1m .7 1.2
5 56 -66 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 0
a Boring # 1 Boring
0 Pit Ground Surface elev. 97.0 ft. Depth to limiting factor min• Sod 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 1 0 -7 10YR 3/2 - sil 2 f sbk mvfr cs 1f /m .5 .8
2 7 -38 7.5YR 4/4 - sl 1 m sbk mfr cs 1 m .4 .6
3 38 -62 7.5YR 4/4 f2d 7.5YR 5/8,5/3 Is 1 m sbk mfr - - 7 1.2
i
soils are suitable for an at -grade system; available length (shed proposed in future west of B -1) leads to recommendation for mound; horizon 2 ha
some inclusions Is; horizon 3 has occasional inclusions 5YR 4/4 scl
Effluent #1 = BOD 30 < 220 mg /L and TS ffI >30 < 150 mg/L e 2 = BOD < 30 mg /L and TSS < 30 mgr
CST Name (Please Print) Sin ure: CST Number
Henry F. Grote 222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 11/16/2002 715 233 - 0398
Property Owner Ames Investment, LLC Parcel ID # Page 2 of 3
3] Boring # .2j Boring
r
Pit Ground Surface elev. 94.9 ft. Depth to limiting facto 45 in.
!� Sod 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 -9 10YR 3/2 - sil 2 f sbk mvfr cs 1f /m .5 .8
2 9 - 16 10YR 4/4 _ sic] 2 m sbk mfr cs IM .4 6
3 16-45 7.5YR 4/4 _ sl 1 m sbk mfr cw 1m .4 .6
4 45 -58 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 0
F-1 Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
j
i
F-1 Boring # Boring
_j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon I Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots I
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 1 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 07/00)
Certified soil Testing
r
{ Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -51
Shaun Bird #226900
l
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 1 ' m� rp,rte�:
Mailing Address Jo s / ► t � - �C� rj lrz ry) N
Property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
i
LEGAL DESCRIPTION
- 3 6
Property r �
Property Location N - � '/., Sec. " : T3-a -R ( W, Town of ck,, WY,0-
Subdivision P ), Lot #.
Certified Survey Map # , Volume , Page #
Warranty Deed # T Z� s� , Volume 2' 30 g . Page # �g
Spec house ❑ yes o Lot lines identifiableges ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restrictedplumber 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.
I/we, 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 Zoning Office within 30
days of ee ye r expiration date.
/ �
SIGf4kFbiE &APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the pro described above, by virtue of a warranty deed recorded in Register of Deeds Office.
S69ATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** 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
J 2308P 384 l �
72'3537
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Ames Investment Corporation, a 07/10/2003 09:30AM
Minnesota Limited Liability Company
WARRANTY DEED
EXEMPT #
Grantor, and Mara K Crombie, REC FEE: 11.00
TRANS FEE: 164.70
COPY FEE:
CC FEE:
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
L ,Plat of Torey Pines II in the Town of Richmond, St. Croix County, Name and Return Address
Wisconsin.
026 - 1149 -18 -000
Parcel Identification Number (PIN)
This is not homestead property.
QK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this % of July 2003
Am7
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
) ss.
County )
authenticated this day of
Personally came before me this day of
_ July _ 2003 the above named
*
Ames Investment Corporation, a Minnesota Limited Liability
Company
TITLE: MEMBER STATE BAR OF WIS D. Bever
(If not, OtC� Pub lic to me known to be n(s) who executed the foregoing
ins d ed the same.
authorized by § 706.06, Wis. Stats.state of Wtscons1 tru
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, WI 54016 missio "s permanent If not, state ex irate n d
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
* Names of persons signing in any capacity must be typed or printed below their ature. Information Professionals Company Fond du Lao. wi
STATE BAR OF WISCONSIN 800-655 -2021
WARRANTY DEED FORM No.2 - 1999
2.613 ACRES � y f
(113,802 SO. FT.) l'.'.Q ... ...;.;.'..;.:..�
MIN FFE•= 1009.00 r-� I@ ICS
I
C�
....•. ..,...,.,.�� W I I H.W.E.
•
...... i W I o I UU ° �WW
......
1@ I MIN F.F.E.
•• /� ........ .P,.. LOT 17
y / 3.473 ACRES (151,296 SO. FT.) I I
.° 1 °� LEVATION= 1020.1
i�••••••• '�• � � MIN FFE = 1009.00 12 19
... �. . . . . . . . . . . . . . . . . . . . . . . . . .
SO' RADIUS TEMPORARY
CUL -DE -SAC EASEMENT
i - - - - TO BE AUTOMATICALLY
EXTINOU1SHED UPON
— ' --�' — ' — ROAD EXTENSION
S 89 W 527.55'
N 89°51'46" E 527.56'
. —.— — ._.�._
EUtYATKNr••1003.35 �� UA
i LOT 19 9
1 ±
......1 2.066 ACRES (89,979 SO. FT.) t
`
�. • ••••.••• • • •..•.••.••• �. NOTE: NO OWNER OR RESIDENT
2.'',IMINFFE= 1009.00 N •••• INTERFERE WITH OR CHAS
COMPREHENSIVE WATER D
O THIS PLAT, THIS INCLUDE
' ' ' j UPON, OBSTRUCTING, ALTS
c? PLANTING IN ANY POND E
0 WATER RUNWAYS, WATER
.. ' ..1 SEEDINGS.
408.78'
Al
+, Y o UTILITY EASEMENTS
�� NO POLE OR BURIED CABLES ARE TE
INSTALLATION WOULD DISTURB ANY
i ALONG ANY LOT LINE OR STREET LI
STAKE BY ANYONE IS A VIOLATION
STATUTES. UTILITY EASEMENTS AS F
Ise ca OF PUBL IC BODIES AND PRIVATE PU
3.604 ACRES ( 156 , 917 FT,) 3 ' SERVE THE AREA.
MIN FFE = 1009.00
SCALE IN F
100
474.84 THIS INSTRUMI
frw 949.!60 - - DATE: 5/13/200
SHEET 7 OF 2 REVISED: 7/,'
_ i �m� c�5tmaora
g — r ' " -- -ze•La - a — _ --------- ,ea•woas.•za000s
LLL B
— — -_ -a — —� — — — — —..
I = . ♦ 1�1 Ie 1 1
,' 11 1 1
el is:
ai 1
1 IA I i 1 •
�
G I L� : j yZ 1:: I 11 I I1 I jdj�j
I��J d � ]J I I 1 I 1 1 1
a .:
AL••L•L A0 '
FELL
Q .•� BE'L164 00 AO'
zvsw
A>i' LOf' •ZAO.00N � � O
� N
ZYE463.9bB0.0 • S ; � r ��{�
N N
Z
J', S
[n
1
i oo•ooE a . _ : . '? NMQL — -- —
El'OLA�
,-
Q J
•N i ' 4(,f4 - y� ♦' ±• ...... ............................ ....
Ir
x
i
.EL'DL9 9D ,EB'LOS �s: i �• 1 ' -,•�- -••.
EL'69LL
» Mpp ss Z x x A••99cm iXVISOADS
Z1C^JiJ11U@ m 11ilI1G11PKY.
tiN� Ln < A
A n _$ m c
a� 5g NQ
l
LR
y ° P
ZO
mo ll s
3