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HomeMy WebLinkAbout018-2021-11-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Permit Holder's Name: City OEVERING HOMES CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION s.15.04 (1)(m)] e Township TOWN OF HAMMOND TYPE MANUFACTURER CAPACITY Septic I ae r �t 2iwy 4o4 a Dosing Aeration r--: r Gt` TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic v Kin, s� Dosing Aeration lv�2 Holding 7z PUMP/SIPHON INFORMATION Manufacturer Num SOIL`ABSORPTION SYSTEM BED/TRENCH Width`-� v Length DIMENSIONS 9 SETBACK SYSTEM TO INFORMATION Type Of System: celgv , i� 6"Ad DISTRIBUTION SYSTEM Dist. to No. Of Trenches Z P.l� W BLDG WELL `� I I Zvi' I N'� ELEVATION DATA County: St, Croix Sanitary Permit No: ' d' ,� g •� SAN- 020=Q91 State Plan ID No: Parcel Tax No: 018-2021-11-000 Section/Town/Range/Map No: 08.29.17.1292 STATION InFS ELEV. Benchmark 1011 O1 �10. �oo Alt. BM Bldg. Sewer SUHt Inlet �. to SUHt Outlet p' 3 CC�� t i7?.. • �{ Dt Inlet Dt Bottom Header/Man. TL S O. loot) Dist. Pipe 7FV Tr Go Bot. System till q tie . Final Grade l t' ,� c,3 over l •'d- to 3. l /O?. 6 DIMENSIONS INo. Of Pits Inside Dia. Liquid Depth LEACH �AcM CHAMBEIROR ManufactyrErfik'� / \ UNIT Model Numbbee`r: Header/Manifold STATION InFS ELEV. Benchmark 1011 O1 �10. �oo Alt. BM Bldg. Sewer SUHt Inlet �. to SUHt Outlet p' 3 CC�� t i7?.. • �{ Dt Inlet Dt Bottom Header/Man. TL S O. loot) Dist. Pipe 7FV Tr Go Bot. System till q tie . Final Grade l t' ,� c,3 over l •'d- to 3. l /O?. 6 DIMENSIONS INo. Of Pits Inside Dia. Liquid Depth LEACH �AcM CHAMBEIROR ManufactyrErfik'� / \ UNIT Model Numbbee`r: Header/Manifold DIMENSIONS INo. Of Pits Inside Dia. Liquid Depth LEACH �AcM CHAMBEIROR ManufactyrErfik'� / \ UNIT Model Numbbee`r: Header/Manifold Distribution JUIL (:UVtK x Pressure Systems Onlv xx Mound Or At -Grade systems nr,ly Grr P_ , w L Depth Over Depth Over xx Depth of xx Seeded/Sodded � xx Mulched Bed/Trench Center �f I Bed/Trench Edges Yes •3" 7 ] No � /i5C Yes F-1 No COMMENTS: (Include code discrepencies, persons present, etc.),^_ Inspection #1r Inspection #2: Location: 1643 102ND AVE V two 1.) Alt BM Description = 6 Gov er � 0) C!� i1�� V [ `N 2.) Bldg sewer length = qV V ti- W °�' L.Pt amount of cover = yZ — !CC q(C�.— qA r/{/�QU.¢�r•tr s'D iJ .�", Plan revision Required? ❑Yes �No Use other side for additional information. Date Insepctor's Signature Cert. No, - - II INIII I rbqA It MnI `,)/o N l't 24 - .Oct �9�i imp 2r ? County Safety and Buildings Division APR 15 20 0 201 I : Washington Ave., P.O. `Box 7162 Sanitary Number (to be filled in by Co.) Madison, WI 53707-7162 St. Croix Cottn y Samtary-Permi pplication S ctinn lumber In accordance with SPS 383.21(2), Wis. Adm.Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 4� Ft purposes in accordance with the Privacy Law, s. 15.04(1) m Stats.� , 1. Application Information I- Please Print All Information Property Own`er's Name Parcel IF 0a��� _ Inv � c U --� Property Owner's Mailin Ad s Property Location /I L1,J � L e 4 4�s 4. i I Gout Lot 1 �— /,, Section City, State Zip Code Phone Number �A�. /] i �•) � . cE �'/�, T-�—f--N° R reW I r Ii. of Building that " ype (check all apply) �� Lot # S*Y,Name J r-2.I'amilyDwelling -- Number /.ofBedrooms as $V M I Block # v �� ❑ PubiiclCommercial-Describ U e El State Owned -Describe Use N M Number El Village of ISTal utpw CELLS 2 2 �— L- TOof , III. T of Permit: (Check only one box online A. Complete line B if applicable) n A, System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only e ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owne IV. e ofP9WTS System/Component/Device: Check ab that apply) Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of su' e s ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (expl, V. Dispersal/Treatment Area Information: y Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sfl System Elev 'on '. �-� on 7V 2 IG�Z% �fn i- VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units /1 to/� A 2 o 0 New Tanks Existing Tan}5 W f 1 7' Uj h nl, T n`'� c ai v o aj .o m td a U cn y vi c: 3 Septic or Holding Tank _ '-" � Dosing Chamber he undersigne x me responsibility for installation of the OWT S shown on the attached plans. VIIt, Responsibility StajState' PI tber's Name.�'yo / b s Signature MPINTRSNumber Business Phone Numer �', i-- PI b ddress (Street,p e) J A VW* Countv/De artment Use Only Permit Fee Date Issued Issuing . Approved ❑ Disapproved _ Sign ❑ Owner Given Reason for Denial S O • iU 14 '' ^^ '' ^^ 12b !D V a � r DL Conditions of Approval/Reasons for Disapproval 3. e✓eIn� ID AM4a /I. f*va- SYSTUIVIO`AVNES: pri)✓i f. Septic taalkfflue er-klst t fitter and 1 � /�_,rM� vn 1 � �w h Drtw%J yam/ °er11f a�naintatned 11�'a d4spersal t ell mu<t to rea plan 13"ided by pluMbOr. o, per nianagen•!ent 2. All 6tNt)ack requirements dinii be mainteinttdI��� A / n� rod✓ / 1 ordinances) / K.��u! t /V/► /, J[� A[Ieen to complete pram for the system and submit to the County only on paper not less than 8 t2 z 11 inches in size SBIl-6398 (R. I1/11) System PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 8 /T 29 N/R 17 SYSTEM ELEVATION 100.1 /99.7 4.5' below qrade CONVENTIONAL XXX MOUND SEPTIC TANK SIZE 1000 gallons HOLDING TANK SIZE LOAD RATE .5 kk BENCHMARK V.R.P. Top of survey iron ❑ BOREHOLE O WELL *H.R.P. same as benchmark 444' Property line W TOWN Hammond COUNTY ST. CROIX 4/14/20 BEDROOM 3 DATE _ CONVENTIONAL LIFT HOLDING TANK LIFT TANK SIZE DOSE TANK SIZE ABSORPTION AREA 933 # of chambers 46 ASSUME ELEVATION 100' 102nd Ave S c a Scale is 1" = 40' unless otherwise Pro 3 noted Bedroom House .7 1�\ l 2-3' X 94' cells B-1 3 0' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 B-2 >3' spacing 104.5' Vents >6" of Cover 445' property line property line lvjB.M. 4' Long Vent Filter Lifetime Filter Quick4 Standard Leaching Chamber with 20.0 ft2 of Area �5.6ft^2/pair of end caps 2" at System Elevation Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/14/20 Owner:Oevering Homes Location: SE1/4 SW1/4 S 8 T29 N,R17W 1643 102nd Ave Hammond Manuals Used: In -ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Mail 7. Filter 1 Signatu License PROJECT Oeverina Homes SE 1/4 SW 1/4S 8 /T 29 System PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 100.1/99.7 4.5 below grade CONVENTIONAL %aX MOUND SEPTIC TANK SIZE 1000 gallons HOLDING TANK SIZE LOAD RATE .5 IL BENCHMARK V.R.P. Top of survey iron 4/14/20 DATE CONVENTIONAL LIFT LIFT TANK SIZE BEDROOM 3 HOLDING TANK DOSE TANK SIZE ABSORPTION AREA 933 # of chambers 46 ❑ BOREHOLE O WELL *g,R,p, same as benchmark 444' Property line ST 40' 100' 95' 5°Io Slope 102nd Ave Pro 3 Bedroom House ASSUME ELEVATION 100' Filter Lifetime Filter Scale is 1" = 40' unless otherwise noted 2-3' X 94' cells with >3' spacing B-1 3 0' All piping shall be ASTM SDR 30/34, within 10,( tank, piping shall be ASTM F891 1 25' B-2 104.5' Vents >6" of Cover 445' property line Vent 77' property line B•M• 4' Long 12" 34" -PPro��m �raim � p o Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps at System Elevation Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates Typical Installation Vent Ae"'f Grade *o�'30/34 Septic Tank 5' Long Grade at System Elevation Spacing 5' 3 5' Long To be >1' above grade Finish grade elevation 104.5' Vent 1" at System Elevation 2-3' X 94' Cells Same on other end Observation tube/Vent �;� cnamaers per cell System elevations: A 100.1' B 99.7' At end of cell >u- POWTS OWNER'S MANUAL & MANAGEMENT PLAN INFORMA Permit IjESIGN PARQrwFTFRc Number of Bedrooms ❑ NA i Number of Public Facility Units A j Estimated flow (average)�� i aVda 1 Design flow (peak), (Estimated x 1.5) `��j i gal/day Soil Application Rate al/da tftZ i Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA Total Suspended Solids (i'SS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 5104 cfu/100m1 !Maximum Effluent Particle Size Ya in dia, ❑ NA lOther: NA "Values typical for domestic wastewater and septic tank effluent IAINTENANCE SCHEDULE Service Event (inspect condition of tank(s) At least once every: SYSTEM SPECIEICATrnNc Page of Septic Tank Capacity �` I CI NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model ir%, O NA Pump Tank Capacity NA al Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model NA Pretreatment Unit ❑ NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Dispersal Cell(s) ❑ NA n-Ground (gravity) 0 In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other. ElNA Other: ❑ NA Other ElNA Frequency r{sjb/ (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one4hird (X) of tank volume ❑ NA (inspect dispersal cell(s) At least once every: CI months} — year(s) (Maximum 3 years) ❑ NA I�lean effluent filter At least once every: ❑ m epenth ar(s)s) ❑ NA ! nspect pump, pump controls & alarm At least once every: ❑ me h(s) . ❑ year(s) NA I=lush laterals and pressure test At least once every: 0s) month(s) E NA ether. At least once every: ❑ month(s) l,.� .. ❑ vear(s) NA NA � MIAINTENANCE INSTRUCTIONS llnspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: a;atajr !Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspection must linclude a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the vol me of iz;ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be [visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local Regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('f3) or more of the tank volume, the entire contents of ',:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. loll other services, including but not limited to the servicing of'effluent filters, mechanical or pressurized components, pretreatment units, 13nd any servicing at intervals of 512 months, shall be performed by a certified POVVTS Maintainer. A service report shall be provided to the local regulatory autholfty within 110 days of completion of any service event. Page of , START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thot may impede the treatment process and/or damage the.dispersai cell(s). If high concentrations are detected have the contents of thi: tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are from at the infiltrative surface. During power outages pump tanks may frill above normal highwater levels. When power is restored the excess wastewater will bla discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenit. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park'over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or alilrade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT�R: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; dental floss; diapers; disinfectants* fat; foundation dr4n (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides, meat scraps; medications; oil; painting producgs; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code.. • All piping to tanks and pits shall be disconneded'and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. replacement system: 47�Itable replacement area has been evaluated and may be utilized for the locaflon of a replacement soll absorption systeim. he replacement am should be protected from dissturbance and compaction and should not be Infringed upon by requitled seltiacks from existing and proposed structure, lot lines and wells, Failure to protect the replacement area will result in the neied 11 and site evaluation to establish a suitable replacement area. Replace�ment systems must comply with the rulej ir 1 [3 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologK a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaivajon must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiitrafive surface. Reconstructions of such systems must comply with the rules In effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. LOCAL REGULA' Name I � �..,_ . ✓l� ,�,. ®Y err � I ( Name 1 �"� I' ��, . � f ; .. � . �' Phone This doarmentwas drafted in compliance with chapter 3PS 383.2x(2)(b)(1)(d}81{tj and 383..54(1), (2) & {3}, Wisconsin Administra#ive Code. ST. CROTX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT - OWNERSHW CER IFICATION FORM ""Mer/Buyer _ Mailing Address Property Address 6 / r L� ('Verification required from Planning & Zoriin I] C g partment for new construction.) City/State _ Parcel ldenti&atiou Number ©/ LEGAL .bESOUPTION �,� Froperty Location subdivision Certified Survey Map # Warranty Deed # V4, Sec. Spec house yes no T N R W. Town of -- Lot# --- Volume Page # ,Page # r '��s identifiabl yesLa u„t„uper use and maintenance of Your s maintenance consists of eptic system could result the systeln can affect tliePmrM out the septic tank ever in its preniafure failure to fiuiction of fife y Y three Years or sooner, if needed, b handle wastes. Proper responsibilities are specified et Co epfie tank as a treatment stage in the waste disposals system. What u § mm. 8152 1 pumper, What you put into ()and in Chapter 12 - St. G�oix County Sanitaryy caner mainte The roeHance Property rty owner agrees to submit to St. Croix County Ordinance. Owner and by a master plumber o tY planning wastewater disposal system is in proper inoperating condition cted 2 g & Zoning Dep�ent a certification fo p umber restricted lumber or a licensed pumper veri less than I/3 full of sludge.verifying that (1) the n s geed by the () after inspection and pumping (if•necessary), the septic tar is is 1/we, the undersigned have read the above standards set forth requirements and agree to Certification statin herein, as set by the De g maintain the Pertinent of Commerce and the De Private sewage disposal Systern with Zonin De g that your septic system -hasbeenDepartment of Natural Resources, State of Wisconsin.the g Foment within 30 da s of the three Year expiration date, be completed and re turned #o the St_ Croix County planning & I/we certify that all statements on this form are true to the best oi'my/ottr knowledge. f/we am/are the owner Property described above, by virtue of a Warr arty deed recorded in Register of Deeds Office (s) of the Number of bedrooms. - pStGNAT OF APPLTCANT(S) ��,�_7`/0� jJ ***Any information that is misrepresented may result in the sanita DATE rY Permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a reference is made in the warranty deed, copy of the certified survey map if i\N rr') 0 �� B8 W J J J Q 30 � W UZ ¢a m 88 s 6 Y F J lL N J rnz �i HWE=1041.14 LBO=1043 14 P O O -P HWE=1041.14 O LBO=1043.14 O HWE=1041.14 14 DRAINAGE LB0=1043. L-18 EASEMENT cD ! O .29.92' 150.00 -o - - 150400'`D 92990'— -- — - LOT N d 84066 S 0 1.93 Ac O Z N 89*20'53" E 392.90' S 89%20'53 W 392.90' - 175.00'-- -� - -- - --175,000-- — — -42.90 -- 82 -- -- -- - 10�'�% 40 -�- i15' O <4; 8 1 i 2 LOT o ( LOT o LOT 11 1 O 13 0 1 0 71533 S.F. cD 1.64 Ac. IC 77700 S.F. p ; 77700 S.F. p 1.78 Ac. J I I 1.78 Ac. J d � � W ,0 LOT 10 ��' a- 84152 S.F. HWE=1027.39 N O LB0=1029.39 O if) 1.93 Ac. pc O I HWE=102.7.390� y ` LBO=1029.39 <v I 15 , o HWE=1027.39 -,S L07 L80=1029.39 I �� Ov 7992( �P� � 1.83 It\ 45.36 175.00' �15 e 175900 , 75. 7' ---N 89620 53 E 425.57 --- i r 2 TOP OF 3/4" IRON PIN z V ELEV=1029.08' I O 1 8 L-17 I LOT N 60 S . 6 00 123993 S.F. 6? — - - - - 1.IM � 0 2.85 Ac. N 28,56 = S HWE=1025.0 v LBO=1029.0 W �9 , ti 7LOT i 6�; j8, CA 85362 S.F. 1.96 Ac. Document Number State Bar of Wisconsin Form 2-2003 WARRANTY DEED Doeunlent Name THIS DEED, made between Bruce J. Moll and Thomas S. Aaby ("Grantor," whether one or more), and Oevering Homes Investments LLC a Wisconsin Limited Liability Company ("Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St, Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Part of the Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4), the Southwest Quarter of the Southeast Quarter (SW 1l4 of SE 1l4). the Northeast Quarter of the Southwest Quarter (NE 114 of SW 114), and the Southeast Quarter of the Southwest Quarter (SE 114 of SW 114) of Section Eight (8), Township Twenty-nine (29) North, Range Seventeen (17) West, Town of Hammond, St, Croix County, Wisconsin, more particularly described as follows: Lots 1, 3.19, 21, 23, 25 and 28, County Plat of Hammond Hills Estates in the Town of Hammond. '018-1021-01-000,018-1021-03-000,018-1021-04.000,018-1021-OS•000,018-1021-06.000,018.1021-07-000, 018-2021.08-000,018.2021.09-000,018.2021.10.000,018.2021-11-000,018.2021-12.000,018-2021-13-000, 018-2021-14.000,018-2021.15.000,018-2021.16.000,018.2021-17.000,018-2021-18-000,018-2021-19-000, 018-2021-21-000,018-2021-23-000,018-2021-25-000,018-2021-28.000 Exceptiotls to warranties: Easements and restrictions of record. SEAL) � * (SEAL) * Signatures) au f3 AUTHENTICATION McCormack TITLE: MEMBER STATE BAR CiF WISCONSIN (lf not, authorized by Wis. Stat. § 706.06 ) THIS INSTRUMENT DRAFTED BY: * Bruce * Thomas S. II (�IIIII��IIII�IIII�I�I��II III 8 Tx,4294534 5 1025296 BETH PABST REGISTER OF DEEDS T. CROIX CO., WI 02/24/2016 3:41 PM EXEMPT#: N/A REC FEE: 30.00 TRANS FEE: 1155.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin WI 54002 Parcel Identification Nutnber (PIN) This is not (Is) its 110L) homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss- 5T. CROIX COUNTY) (SEAL) (SEAL) Personally came before me on the above -named Bruce J. Moll ,,;%r;i;•=' to me knownA be the person(s) w�tior rGette he forri; instrument a knowled d the same. r J r., a r.,.. ti. �� n Thomas A. McCormack Notary Public, State of Wisconsin . i Baldwin WI 54002 My commission (is permanent) (expires:;'•, j - °I~' ) (Signatures may be authenticated or acknowledged. Both are not necessary.) "1 NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION 'O TIIIS FORM SHOULD BE CLEARLY IDENTIFIED—sue""t WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 "Type name below signatures. INFO-PROTMvnvw, infoproforms.corn St. Croix County 1025296 Page 1 of 1 Exceptiotls to warranties: Easements and restrictions of record. SEAL) � * (SEAL) * Signatures) au f3 AUTHENTICATION McCormack TITLE: MEMBER STATE BAR CiF WISCONSIN (lf not, authorized by Wis. Stat. § 706.06 ) THIS INSTRUMENT DRAFTED BY: * Bruce * Thomas S. II (�IIIII��IIII�IIII�I�I��II III 8 Tx,4294534 5 1025296 BETH PABST REGISTER OF DEEDS T. CROIX CO., WI 02/24/2016 3:41 PM EXEMPT#: N/A REC FEE: 30.00 TRANS FEE: 1155.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin WI 54002 Parcel Identification Nutnber (PIN) This is not (Is) its 110L) homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss- 5T. CROIX COUNTY) (SEAL) (SEAL) Personally came before me on the above -named Bruce J. Moll ,,;%r;i;•=' to me knownA be the person(s) w�tior rGette he forri; instrument a knowled d the same. r J r., a r.,.. ti. �� n Thomas A. McCormack Notary Public, State of Wisconsin . i Baldwin WI 54002 My commission (is permanent) (expires:;'•, j - °I~' ) (Signatures may be authenticated or acknowledged. Both are not necessary.) "1 NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION 'O TIIIS FORM SHOULD BE CLEARLY IDENTIFIED—sue""t WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 "Type name below signatures. INFO-PROTMvnvw, infoproforms.corn St. Croix County 1025296 Page 1 of 1 JUG Wisconsin Department of Commerce rlivicinn of .4'afAty and Ruildintls SOIL EVALUATION REPORT Page of - in accordance with Comm 85, wis. Atlm. c.;ooe County 54, C '� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. direction Plan must and r0 Parcel I.D. include, but not limited to: vertical and horizontal reference point (BM), , /� p V 10 l /n percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Review by Date Please print all information. Personal infom:afion you provide may be used for secondary pumoses P ' s. 15.04(1) (m)). (iP �r /2 1� 7 Pro�pyyerty owner / Prope Location ? Govt. of j 1 /4 �(t1 /d S 7 % N R 1 �E (o W C /6 t) io /) ,'i riJ zi�0 y4 l - . P rty OwnersMa'iiing AAddresss% Lot # Block # Sqhd. Name or CSNV Y State WE p Code Phone urnisG1111 ❑ C' ❑village Town Nearest Roa New Construction Use)Q Residential / Number of bedrooms Code derived design flow rate J`� GPD ❑ Replacement ❑ Pu lc or commercial - D scribe: _--_—__-----r---____--- — Parent material � Flood Plain elevation imp 'cable -�iZ ft. General ommmints It, P' e C e and recommendations: 07 �ie n / ( cez /A System Elevation / 0 0 i 1 �j' �j / ` ' System Type cyVri:� t� � o f 4� i v Boring pit Ground surface elev. �`l �' eft• Depth to limiting factor (-(� in. Soil F.00liration Rate i dorizon Depth Dominant Color Rsdox Description Texture Structure Consistence Boundary Roots GPD/ft in. Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff//#1 'Elff#2 /Munsell r.4 , oI_ �N � goring # Boring pia Ground surface elev. C't ft. Depth to limiting factor So l Annlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell au. Sz. Cont. Color 'Eff#1 'Eff#2 i �c NA Pt • Effluent #1 = BOD > 30 < 220 rr►g/L and TSS >30 :E 150 mgA.i/,/ - tmuent wz = rsvu : .w mcy� anu 1 aQ Z ,w litiy" CST Nam (Pleas Print) Si9na ` fe. CST Number Bird Plumbing, Inc. Shaun Bird ± ,� 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 i' = _ o 715-246-4516 Property Owner _ MBoring # �( Boring 12SI Pit Ground surface elev. Parcel ID # ` GAL J ft. Depth to limiting factor' Z l� in. Page of 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 LjBoring # BOring ' pit Ground surface elev. ft. Depth 40 limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fP "Eff#1 `Eff#2 Boring # Boring ❑ Pit Ground surface elev ft. Depth to limiting factor in. Soi! Application Rate Horizon '),p4h in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence. Boundary Roots GPD/rf? "Eff#1 "Eff#2 `Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mg/L s Effluent #2 = BODS < 30 mglL 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. seo-saao (R.6/00) Soil T Project Name Oevering Homes LLC Address P.O. Box 179 est Plot Plan New Richmond Wi 54017 e M 4 , Lot 11 Subdivision SE 1/4 S W 1/4S 8 T 29 226900 Hammond Hills Estates Date 6/2/07 N/R17 W L.JBoring Q Well PL Property Line BM or VRp Assume Elevation 100 ft, Township Hammond County ST. CROIX Top of Survey Iron System Elevation 100.1/99.7 *HRpSameasBenchmark 445' property line � �' property