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HomeMy WebLinkAbout038-1198-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix • Gafey and building Division INSPECTION REPORT Sanitary Permit No: 399617 0 GENERAL INFORMATION (ATTACH TO PERMIT)t) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. n Z b Q Permit Holder's Name: City Village X Township Parcel Tax No: Lakes and Hills Inc. I Star Prairie Township 038- 1198 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 14 19 9 Do in Alt. BM a Aeration Bldg. Sewer 9 S t Inlet �3 3 S t Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD t Septic CA Header /Man. Aeration Dist. Pipe A D 7 Hold' Bot. System -1 9 5 PUMP /SIPHON INFORMATION Final Grade V� rer Demand St Cover S - 0 9S 9 Model Number TDH Lift Friction Loss System Head TDH Ft For emain Length Dia. D Well SOIL ABSORPTION SYSTEM CrS BED/TRENCH Width Length No. 011. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING an act INFORMATION A B OR Type Of System: IT de Num r: DISTRIBUTION SYSTEM Header /Manifold Distribution I x Hole Size x Hole Spacing Vent to Air Intake Lengt Dia // LL ngth jB , Dia / Spacing S Q SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [] No El "�' No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:_L�L1_iIft Inspection #2: 1 1 Location: 1337 216th Ave. New Richmond, WI 54017 (error 13 T31 RI 8W) Pine Acres Lot 57 Parcel No: 13.31.18.1047 y 1.) Alt BM Description = t r ) uw W C /( L V f �, 2.) Bldg sewer length = Lp �� � "r Wa6 o-p (( // etk al Ik6loeW,/ , 14 T ^OOr - amount of cover = l be e � 4 It" e- 2Gii' � Jr I,fJGtS Wd �/ Gd Q / I' k40 �.� 0 6S e k jia._ ���o� s f �tJ / l w ill Y lv -, LQSe✓ $"1_4 4 ere rbUlQr4 d0 f fr Plan revision Required? Yes No Use other side for additional information. Z Date Insepctor's Qnature / �j Cert. o. SBD -6710 (R.3/97) /, 1�9 -- "'A l'r � k QV P_ 5 V 4e ti t I �7� ��,��� � O G \ �, � d _. o O Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Buildigg Division INSPECTION REPORT Sanitary Permit No: 399617 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: Lakes and Hills Inc. I Star Prairie Township 038 - 1198 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -G rade Systems Only Depth Over Depth Over xx Depth of eded /Sodded xx Mulched xx Se Bed/Trench Center Bed/Trench Edges Topsoil Fn] [W No ® Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1337 216th Ave. New Richmond, WI 54017 (error 13 T31 N RI SW) Pine Acres Lot 52 Parcel No: 13.31.18.1047 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes no No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. Safe nd Buildings Division County � l T ' 1. �( f �y-- 201 W. Washington Ave., P.O. Box 7162 7 I *Isconsin Madison, WI 53707 - 7162 Site Address Department of Commerce -#-- 33 ?- Z — mb Sanitary Permit Application Sanitary hecY p`� ``r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Cq i Re /on may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number lr property Owner's ame Parce Number t3 - - ' ' Prope Location Property Owner Mailing Address V - l c-; R / i ; S T3( N. E City, State Zip Code i N ber ST � LotZI r Block Number C.OupTY ubdi ision Name CSM Number zON1NGUT�1t Js�i II. Type of Building (check all that apply) 1 ❑City ❑ 1 or 2 Family Dwelling - Number of Bedrooms � S []Village ❑ Public/Commercial - Describe Use ❑ State Owned Nearest n N M. Type of Permit: Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) ( Y A. For County use 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to stem Tank Onl Eris ' stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) on - Pressunzed In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland [] p In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: L Z Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft) (Min./Inch) Elevation �Jo 37s S77 1 4 �7 VI. Tank Info Capacity in Total Numbe r Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - 1, the tmd responsibility for installation of the POWTS shown on the attached plans. Busine s Phone Number Plumber's Name (Print) Plumber's S' aNTN / U Plumber's Address (Street, Ci State L / 2 s . Cotmt /De artment Use Onl S o Stamps) Sanitary Permit Fee (includes Groundwater Date Issued Issuing Ag gna (N Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse } Z Z s7 O o L Determination 1X. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. Maintain well and waterline setbacks per COMM 83.43 (8)(c). 3. The septic system is sized for a 3 bdrm residence. A violation of the state administrative codes would be created if any modifications are made to the structure that increase the # of bdrms/design wastewater flow. Attach complete plain (to the Coonry per oalY) for the sntem on Pa 2 less than 81a x 11 inches in s in SBD -6398 (R. 05101) Safe ty and Buildings Division Cowes � 201 W. Washington Ave., P.O. Box 7162 co nsin �Vws Madison, WI 53707 — 7162 Site Address 1 3 z(L Department of Commerce t7e Sanitary Permit Applicati rani Permit Number ,. In accord with Comm 83.21, Wis. Adm. Code, personal info � ybu � ° Check if Revision may be used for secondary Privac Law %6% : m I. Application Information - Please Print All Information �� � , State Plan I.D. Number Property Owner's Name " i Parcel Number 1 • �('��• l0� 7C�`I .. _ 0 3 - 30 - 000 Property Owner's Mailing Address Property Location zommo l`ICE Xi T�� N. E City, Stan Zip Code / ,hd )!1ulmbeL Lot Number Block Number tY, , Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Pub _/Commercial - Describe Use hip ❑ State Owned Nearest Road �< III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) For County use A /j--0 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to stem I I Tank Onl Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number T E Issued IV. Type of permit: (Check all that apply)(numbering scheme is for internal use) 44�n- pressurized In- Ground 2111 Mound 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 4911 30 ❑ Other V. Dispne rsaUTreatment Area Information: o r Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elev 'on Final Grade Required Proposed Rate(Gals./Days/SgXt.) 04in.1Inch) 4/ 1 f Elevation J 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 t Dosing Chamber VII. Responsibility Statement- I, the tmdersiped e responsibility for installation of the POWTS shown on the attached plans. Plumber's N (Print) Plumbe ' S' tune MP/MPRS N b e Business Phone Number / -- 21,� L zr Plumber's Address (Street, City, State, Code) i d > 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 � �I r Determination v t0 w� IX. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. This revision was submitted to reflect a slight change in system location (after- the - fact). Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches In size SBD -6398 (R. 05101) 30 �1 � 3 i j 9 fir. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County r� L� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must - -' o1i 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 Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2-1Z (--1607 Property Owner / n�, Property Location 2.4 t d Govt. Lot 1/41/4 S 3 T N R r E 6br� Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# `� — City State Zip Code Phone Number City ❑ Village Town Nearest Road c ) Sys off r� eT-New Construction Use-Z Residential / Number of bedroom Code derived design flow rate •� r7 GPD ❑ Replacement u Public or commercial - Describe: Parent material �t. LtJC�6 Flood Plain elevation if applicable - Aj General comments CCP_ ©/ and recommendations: —'-� l 1 r " 71 2 1 l [ l M ;ff-ft Boring # ❑ Boring 2 Ground surface elev. J 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 I *Eff#2 a - C 5 ® Boring # Boring r 9pit Ground surface elevy 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 I *Eff#2 Lo� OF / 1. ✓ * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CSTNarjLe lease Print) g t 5T Number Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) Property Owner �a I D # Page of Boring # Boring � Pit Ground surface elev. ft Depth to limiting factor n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 —� — j ✓ ❑ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F Boring # ❑ Boring El 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 1ft in. Munsell Qu. Sz. Cont. 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 /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) C> SOL PLOT PLAN PROJECT, ��� ADD SS 1/4 1/4S /T, W TOWN ��PQ COUNTY A4 MPRS Shaun Bird 226900 DATE �2— —0 BEDROOM CONVENTIONAW IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE b LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE/ Z, ABSORPTION AREA '# of chambers Z Z IL BENCHMARK V.R.P. - (/� ASSUME ELEVATION loo Filter Zabel A -100 ❑ BOREHOLE O WELL H.R.P. Same as Benchmark SYSTEM ELEVATION 2L— Sidewinder High Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 3 4 Grade at System Elevation w zkz'� 4 �t � Pd z_j Cue � Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 - Site Address Madison WI 53707 7162 S 11 *&consin Department of Commerce 33 2-4 c Sanitary Permit Application Sanitary Permit Number 3 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Checf if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information r State Plan I.D. Number Property OwnerZsame / 1 Number (3 - o `r 30 Property Owner's Mailing A s '" Pro@e Location �j �.Jk• S T / N, J E City, State Zip Code N kr ST �gplX r Block Number i� Z � G � s4bbdt pion Name CSM Number 4Z b ti H. Type of Building (check all t apply) ( / ❑City ❑ 1 or 2 Family Dwelling - Number of %boxon 3 1 s []Village El Public /Commercial - Describe Use 11 State Owned Nearest R III. Type of Permit: (Check only A (numbe ring scheme for internal use). COmPI ine B if applicable) A For Coup e 2 11 Replacement System 3 ❑ cement of 6 11 Addition to sum Tank Onl Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit ber Date Issued IV. Type of Permit: (Check all that apply)(numbering scheNs for internal use) zt-lPressurized n - Pressurized In- Ground 21❑ Mound \710 and Filter 50 ❑ Constructed Wetland In- Ground 41 ❑ Holding Tank ingle Pas 51 ❑ Drip Line 45 11 At-Grade 46 ❑ Aerobic Treatment Unit ec ting 30 ❑Other � r V. D' rsal/Treatment Area Information: Z Z Design Flow (gpd) Dispersal Area Dispersal Area Soil Applicad Percolation Rate System Elevation Final Grade R equ i re d Proposed Rate(Gals. ys/S t.) (Min./Inch) Elevation S 7 j Z ee , 4 , 17 , o✓ / �� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Cons Gallons Gallons of Tanks Constructed Glass New Existing Tanks Talcs Septic or Holding Tank M, Dosing Chamber VII. Responsibility Statement - I, the undersign a responsibility for installation of the POWTS wn on the attached plans. Plumber's Name (Print) Plumber's MP Numbe / Busine � �N be I � n Z ( (//' �J Plumber's Address (Street, Ci State ip �� S . Count /Department O Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signature (No Stamps) Approved Disapproved Surcharge Fee) '�11 Owner Given Initial Adverse termination 1X. Conditions of ApprovaMeasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. Maintain well and waterline setbacks per COMM 83.43 (8)(c). 3. The septic system is sized for a 3 bdrm residence. A violation of the state administrative codes would be created if any modifications are made to the structure that increase the # of bdrms/design wastewater flow. Attach complete platy (to the County only) for the "em on paper nor less than 31/Z x 11 inches in she SBD -6398 (R. 05/01) 43 1R T PLAN PROJECT /a i /�� DDRESS 1/ 4 NW 1/4S 13 /T , W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/17/01 BEDROOM 3 CONVENTIONAL X04C IN- GROUND 4RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 2" PVC Pipe ASSUME ELEVATION loo Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 97.0 B.M. 216th Ave 140' Plans Desi ed Using Conventi a1 Powts Manu ersion 2.0 60' S 5 30' 10' nts Property Line 5' B -4 30' 60' Vents T 10' 03 B edroom H ouse L We Vent >12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 3 4" Grade at System Elevation Wisransin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less ttmoi $'h x it t irActies in Plan must County include, but not limited to: vertical and horizontal reference point (S.M1, direction and percent slope, scale or dimemsions, north atrow, and loaation and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION • P /ease p int.aH information. Pendm W8 By Date Personal information you provide may be 4sod for secondary purposes (Privacy Law, a. 15.04 (1) (m)). - Property Owner perry ter*' Pro Location Lakes & Hills Develo met I Go vt. Lot U4 NW im,s 13 T 31 N,R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 52 __L Pine Acres City >> Ste Zi Code, PhoneNum�er ❑City ❑ ge 'fown Nearest Road 216 TH. Ave. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 ❑Addition to existing building - ----------- Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ft .8 trench, gpd/ft Absorption area required 643 bed, ft' 562 trench, ft Maximum design loading rate •7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 97.0 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - -- Flood plain elevation, if applicable ---- ---- ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system NS D u E S u ❑ S U ® S❑ U ❑ S N U ❑ S N U SOIL DESCRIPTION REPORT Boring# Horizon in. Munsell Qu. Sz. Cont. Color Depth Dominant Color Mottles Structure GPD/ft ��,) Texture Gr. Sz. Sh. Consistence Roots Bed Trench fec(L 1 1 0 -9 10YR3/3 ------------------ I lmsbk mvfr as if 4 .5 2 9 -15 10Y R4 /4 ------------ 1 lmsbk mvfr gw lvf 4 .5 - - -- -- - - - - -- - -- - Ground 3 15 -32 10YR4/4 -------- - - - - -- cl l msbk mfr as .2 •3 Z - - -- eiev - - _ -- 100.3 ft 4 32 -53 7.5Y ------- - - - - -- cs osg ml cw - - -- .7 8 5 53 -80 10YR5/6 ------------ - - - - -- cs o ml - - -- - - -- 7 8 Depth to -- - - - -- — -- -- -- -- limiting a factor >80" Remarks: 1 . 0 -11 10YR3 /3 ---- -------- - - - - -- 1 lmsbk mvfr as if 4 .5 2 11 -19 l 0YR4/4 ------------ - - - - -- 1 1 msbk mvfr gw l of 4 5 Ground 3 1 -32 10YR4 -- ---------- - - - - -- Cl lm sbk mfr as - - -- 2 3 Z elev - -- - - -- - -- - 100 8 ft 4 3 -60 7.SYR4/4 ------------ - - - - -- cs osg ml cw - - -- .7 .8 5 60 -89 10YR5 /6 ---------- - - - - -- es os m - - -- - - -- .7 •8 Depth to -- -- — - -- - - - -- limiting d factor Remarks: -- - - - - -- _— — - CST Name (Please Print) Signature: Telephone No. Jacque Hawkins _ �` 7 z 9- y �& Address 2 ly V Date CST NN mber Ref # U v e 4/12/00 �, 8 425 kq PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# Pending Depth Dominant Colo7QU. Mottles Structure GPDIf Horizon in Munsell Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots — Kew Bed ! Trench 3 1 0 -11 10YR3 /3 ------------ - - - - -- 1 Imsbk mvfr as if .4 .5 -- 2 11 -19 10Y /4 --- ------- - - - - - -- 1 Imsbk mvfr gw lvf .4 . 5 Ground 3 19 -35 10YR4 /4 - -------- --- - - - - -- Cl Imsbk mfr as - - -- 2 .3 Z elev _ - 101.5 4 3 5l 7.5YR4/4 ------------ - - - - -- cs osg ml cw - - -- 7 8 Depth to 5 51 -95 10YR5/6 ------ - - - - -- es osg ml - - - - - - -- 7 8 r� limiting — -- -- - - -- - - - -- - -- - -- - factor - >95" SY/ Remarks: _ 1 - 0 -9 10Y /3 ------- - - - - -- I Imsbk mvfr as if 4 .5 2 9 -17 10YR4 /3 ----------- - - - - -- 1 Imsbk mvfr gw lvf .4 .5 Ground __ -- 2 elev 3 Z 3 17 -29 10YR4 /4 -- -- - - - ----- - - - - -- Cl Imsbk mfr as - IOI.O 4 29 -59 7.5 ---- - - - - -- Cs o ml gw - - -- 7 .8 • 7 Depth to 5 59 -90 10YR5 /6 ------------ - - - - -- cs osg ml - - -- - - -- 7 ! .8 limiting - factor >90" Remarks: __ -- _ -_ -- - - - - - -- 5 1 0 -9 10 YR3 /3 ---- - - - - -- 1 Imsbk mvfr as If .4 .5 1 2 9 -19 10Y --------- - - - - -- - -- Imsbk mvfr gam' lvf .4 .5 Ground 3 19 -33 10YR4 /6 ------------ - - - - -- Cl I msbk m fr as - - -- 2 3 elev -- - -- - - -- -- -- — — - — - -- 100.O 4 33 -60 7.5YR4/4 ----- - - - - -- cs osg ml cw - - -- 7 8 -- — -- - - - - -- - -- — - -- -- - - — -- Depth to 5 60 -79 10YR5 /6 ---- -------- - - - - -- cs osg ml - - -- 7 .8 limiting -- - factor Remarks: Ground elev_._. — -- -- — — - - - -- - - — ft. Depth to limiting - - -- -- -- - - - -- — - -- factor Remarks: __ e Y TNJ a 7Z- L) Tt a 4 Sv A p � v � 3 N Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Attach complete stile plan on paper not less than 81/2 x 11 inches in size. Plan must County i J �x, 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 16.04 (1) (m)). Property Qwner Property Location CCC C " (� 5 „� . ? Govt Lot t{:f14 S ✓ T N E (4 W Property Owner's Malting Address Lot # Block # I Subd. Name or CSM# "z J City fate Zip Cade Phone Number City � Village . wn Nearest Ro d ew Construction t1 esldential 1 Number of bedrooms Code derived design flow rate � V GPD Replacement ❑ Public or co mercial - Describe: Parent material 7� -� -r Flood Plain elevation if applicabl 22= ft , General comments and recommendations; r r ' C//���/1 Q Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 .C7 � ❑ 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 ” Effluent #1 = BOO > 30 < 220 mg /L and TSS >30 _< 1 0 L ' Effluent #2 = BC < 30 mg /L and TSS < 30 mg/L CS h/ ame (Please Pri /+5",y/-/) re C T �/f, u mber Address y 12 � , Z�l Xz, L/0/ Date Evaluation Conducted Telephone Number / SBD -8330 (1107 /00) 11/15/2001 11:43 6517490441 LAKES AND HILLS INC PAGE 02 FROM P C CG-LOUR RLDRS, INC PHONE NO. : ?15 549 591! Nov. 15 200a 11:34AM P3 ST t:''ROIX CO SEPTIC TANK MAlid'MANCB AGREEMENT AND OWNWHIP CERT PICATION FORM ►gar �Id� era,, S Maw Addtou �O G p � u r�•`� Gds Propeuly Add X331 - z /e. 7 'A Ava. (Vow"tioa tep wd from Pkn ft DV"tmaot kc tow aoml>w& ct�►��a N EW k lC ►+0 w = i to an x Pcnpgrfy t oc�dan YA N V1. Soo. . w. "foxvl+ ot` 5f.#x 7 sw�dt rloian J �l tt, �., ,. Lot # CutlW Surrey Msp N - Vole *. Pogo � ---- .- ��— � -,�- -• wiry l0aat! # . vow= rw it ? . * hwIm © yca x4o Lot um mmffww1&>6w a no ' 1 zpp�onprc, vas�d�l aao4�a�c: �. waaarailsi aii�rsaaaapa6i�ctnluwdsa .r�Oa . ar L fr � teals wW mace yoam or maxim` If aaodea br a Ik=" puuW. you p t hda ibo ayeiom aaaffaea 0t 9YC lack aR a Wdt is wade dI 'i>ya por�eay oaaae atlt m aahmft to mt. t�osbc y+oosvt Deparo�n+u a oocdticadw Axm, dgaod by me omm and by a muMri► Lvpb�, �s�bdltWa +bcora�veeifyingtl►*#(i� tl+r or�dda wa�Lrwaba'd sys� is iapmpot aparsttla� ooadltiaa sx:dAar (�) dkc larpac+lost wok f (ilf aacross� tba acp& trek Is Ion kaa 1l9 69 oFaledaa Ywo. do uodaGAP" iaw swi dur abaw wtz "A to w4lobla air Plivata "MV dia?aaai.lyatsAm wtlth dtt rrth. > retby mr DtarC.mueaod ILuo Tkyact vrNaivw! its StaEv of W �ya4� Y� � a7'a�> 6oadt m�inedmwt bo camptcoad end reoemed to do 6t t�rolx Gomaty Zsaatue ♦7k�e arfilhia 30 ('a) aartw *aa A wmmmaw ca ft roam at ttaa to for bast of my (au) kwwbdga. I (we) am (M) ffic c arru»•ct) of d�° iy y v�irm�a q(* wnaq► deedtasetAW in lniatt of Deeds Ot'6m 00" 00"TUM OV Al°f►>"tC,r W D ATB "��' Aay tatlosnaUoa abet b (4�elep[OeaIIteetlA�jt �aSuit 1� � aaaita[y p� �Ett[ seraimdby � �$ �� sa «aye. twdude with this ►ppReatifr IL shn pad waWnty as" koet. flu VASIAW Of V" GMW a oopy of dw oe dfi dsiemty map If "iereaoe is made In dx wamatty decd Maintenance and Contingency Plan for a Septic System Maintenance Plan n 1. Septic Tank is to be pumped once eve 3 ears. every y 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 sa ve 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 aitemate 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 Shaun Bird # 6900 Vit..1517PA 272 KAT + LEE4 H. W ALS H REGISTER OF DEEDS Document Number Document Title ST. CROIX CO., WI ^ RECEIVED FOR RECORD 06-07 -2000 4:00 PH WARRANTY DEED CERT COPY FEE: COPY FEE: TRANSFER FEE: 990.70 RECORDING FEE: 14.00 PAGES: 3 Recording Area Name and Return Address Por'Fh Uje; Tf (-C "Z9crow(of( 3 Uri4 I5 Cr nn <-- A- fyrl2a �GdNa �ciS�,� lligSSt►o b3� - 10s'4 - fir - - 000 Parcel Identification Number (PIN) O`S� ^tort[ _So ^00. (0 rd cri • This information must be completed by submitter: document titles name?% return address, and (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the Note: Use of this cover page adds one page to your document and ,$2.00 to the recording fee Wisconsin Statutes, 59.43(2m) M (2199) 8otm No. t -M— WARRANTY DEED Mim esota Uniform Con Blanks 1978 Holstad & Larsoo, P.L.C. Individual (s) to Individual (s) V0l PA�r 27 3 J No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed( ) not required Certificate of Real Estate Value No. 19_ County Auditor by Deputy STATE DEED TAX DUE HEREON: $ (reserved for recording data) Date: May 25 20 00 FOR VALUABLE CONSIDERATION, George Marvin Birkholz and Marion Violet Birkholz husband and wife , Grantor (s), (marital status) hereby convey (s) and warrant (s) to Lakes and Hills, Inc. ,Grantees, real property in St Croix County, Wisconsin, described as follows: See attahced legal description together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: KId Affix Deed Tax Stamp Here George Marvin Birkholz A Ma Violet Birkholz STATE OF Minnesota COUNTY OF Ramsey SS. The foregoing instrument was acknowledged before me this 25th day of May 20 00 b George Marvin Birkholz and Marion Violet Birkholz, husband and wife Grantor (s). NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) .. SIGNATURE OF PERSON TAKING ACKNOWLEDGMENT �..` DEBORAH L. TEICH Tax Staunwits for the real "alydesmbedin this instrmnent NOTARY PUBLIC - MINNESOTA should be sent to (Include name and address of Grantee): MY COMMISSION ; p w EXS -iRES JAN. 31, 2005 THIS DOCUMENT WAS DRAFTED BY (NAME AND ADDRESS) Lakes and Hills, Inc. PO Boa 10622 Northwest Title & Escrow Corp. White Bear LAke, MN 55110 3535 Vadnais Center Drive, Ste. #120 Vadnais Heights, MN 55110 56030 yoi.1517MGE 274 EXHIBIT "A" Lots 1,2,3,4,5,6,7, 8, 9, 10, 11, 12,13,14, 15, 16, 17,18 ,19,20,21,22,23,24,25,26,27,28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51,53, 54, 55, 56, Pine Acres, St. Croix County, Wisconsin odd M. Hendershott, RLS 2362 • .� "�\ \ Registered Wisco�r sin Land Surve or A Dated this /r'1 l �_ day of 2000 . \ Y o 37,E { s 65.402 sq. ft. 1.501 acres rn j =�.. -, ,- ------ - - - - -- MATCH LINE — SE I ' fn 1 3 3 3 \ J 3 �---- -_. - -- = C 42- — — C am _ C C 1 -- -C70- — — C73 _ �C �! 6 - - -- r =j c� C74 i ` 7 / v �' �— -- - - - - -- _ _ N Ci — — 50. / U 0 r 51 I50. 54 190. 67,097 sq.ft. 67,766 sq.ft. 1.52 acres C79A / 1.56 acres �5f s � 1 s �� � yy, Z 9092 / ? s �� � 9 50 66,326 sq.ft. 5 2 N � 5 3 1.52 acres �► rye � o 65,892 sq.ft. g a 68,507 sq.ft. 1.51 acres 1.57 acres ^ ;� � •h — 2090.08'— � 234.33' 245.77' 227.27' 2641.67 • I 1 South line of N89 • 07 ' 26 .. AT of Sec. 13, T31 10 11 12 13 A TE NOTICE TO ALL UTILITY COMPANIES: — To preserve all Lot Corner Monumentation (ALL UTILITY COMPANIES SHALL MAINTAIN A 5 FOOT DISTANCE FROM ALL LOT CORNERS AND BENDS IN THE RIGHT —OF —WAY) Any monumentation being disturbed will be subject to remonumentation fees. i t drafted by Todd M. Hendershott