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Home My WebLink About038-1092-95-120 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538771 0 GENER2Al2 INFORMATION (ATTACH TO PERMIT) State Plan 1D 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: Townsend, Justin & Rachel I Star Prairie, Town of 038 - 1092 -95 -120 CST BM Elev: Insp. SM Elev: BM Description Section/Town /Range /Map No: 100-6 (10 0 - U 22.31.18.383A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark � � bo . d 0 0 4 Dosing Alt. Aeration Bldg. Sewer - • Holding St/Ht I�r 1et, TANK SETBACK INFORMATION St/Ht Ou tlet S�J (I �v 3 D Sr 2 /Or. 36 TANK TO ;1 WglL BLDG Ve t to Air Intake ROAD Dt Inlet . ( �� — r l Dt Bott Septic ✓ Dosing Aeration Dist. Pip />� ,?/ d� 7• J y 1 7. Holding �. System r Q� Gt'y� q&_ Final Grade � l�(N PUMP /SIPHON INFORMATION Manufacturer Demand E44 GPM Z I (�riC ,, Model Number wk d4 TDH Lift Friction Los ead TD H Ft Forcemain Length ia. Dist. to Well SOIL ABSORPTION SYSTEM �!1i BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO TPI ffBLG EL 1 LAKE /STREAM ACHI G M ctuINFORMATION CHAMBER -e _ � ` I � odel Number: / • • DIS RIBUTION SYSTEM �ZG � ' Sl ��tit (,LM" t , / 6r -c,d eader anifold Distribution x ole Size x Hole Spacing Vent to Ai r Intake i f� Pipe(s) Length Dia I lLength Dia Spacing -wlY SOIL COVER 3 x Pressure Systems Only xx Mound Or At - Grade Systems Only �1�1'L SC 0L Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ^ q / Bed/Trench Edges Topsoil ❑ Yes ❑ No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / it Inspection #2 /___ /_______ Location: 2017 110th Street New Richmond, WI 54017 (SW 1/4 SW 1/4 222�T3�1N R1 8W) INA Lot 4� � �� ` - %� ,f Parcel No: 22.31.18.383A20 L 1.) Alt BM Description = W `/Q ►cIl!(/l/ G� tM/" ` �Y ph 1 I1 SK `CG7 f 2.) Bldg sewer length — 2 V / - amount of cover = 7 � � � �� t�i1 ��' `I t� l � ✓ Gbh. L..�a " "` j Z .: � /^-' Plan revision Required? ❑ Yes Yrvo I Use other side for additional information. 1 I C�� G SQ 5 Date Insepctor's Signat re Cert. No SBD -6710 (R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. C roix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538771 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 Townsend, Justin & Rachel I Star Prairie, Town of 038- 1092 -95 -120 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 22.31.18 383A20 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 -A SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. L DIMENSIONS _ I SETBACK SYSTEM TO P/L IBLDG7WELL LAKE /STREAM CHAMBER OR Manufacturer INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake �� Pipe(s) L Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil Y ❑ N Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection Location: 2017 110th Street New Richmond, WI 54017 (SW 1/4 SW 1/4 22 T31 N R1 8W) NA Lot 4 Parcel No: 22.31.18.383A20 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. —� - -- - - Date Insepctor's Signature Cert . No. SBD -6710 (R.3/97) -� Commem lll gpv Safety and Buildings Division County�� 201 W. Washington Ave., P.O. Bo7 6 /p / j tAc ig n1 in Madison, W i 53707 anituy Permit Number (to be fitted in by Co.) i 7 State Transaction Number Sanitary Permit Application A4 In a;:,:ordance , vith s. Comm. 83.21(2), Wig. Adm. Code, submission of this form to the app rumen 1 unit rn requiro i prior to obtaining a sanitary permit. Note; Application forms f S a Project Address (if different than maili submitted to tae Department of Commerce. Personal information you a for seconds �O / /O u ow in act nrdance with the Privacy Law, s. 15.04 1 m , State I. A.p lip catit +n Information -Ple eP int Informatio M1 J Prop WY _6w is Natim Prol crty Owne ? ?3 r's Mailing Address y 1\` 7 , property Location �� ;Pa JO /T �r a A-1 Govt. Lot Z City State Zip t ode P Number Section rde o ne' II. 'ICype of Building (check all that apply) Lot e / y Subdivision Name 2 Family Dwelling - Number o f Bedrooms O CA Block !/v / a 9 ❑ I obliclCom nercial - Describe Use __ � _ —. ❑City of -- - - - - - -- CSM Number ❑Village of _ - -- ❑ irate Owner l - Describe Use ___ -- - - -- s awn of -- z ��,e_ t.✓ 1 -Ito G�ua c f ' Ill.,' jrype of Permit: (Check o nly a b o x on line A. Complete line B if applicable) A. New System ❑ Replacement System El TreatmenttHolding Tank Replacement Only ❑ Other Modification to Existing System.(explain) -- — -- - - -- List Previous Permit Number and Date Issued R. ❑ Pern tit Renewal ❑ Permit: Revision ❑ Change of Plumber ❑ Permit Transfer to New �� 1 Before ! Npiration Owner a o f t'OWTS S stemlCom on ertVDevice: (Check all that app __ _ y _ ___ ✓` - — �_ P lon- Pressu -izcd In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil i liolding Tsi ik ❑ Other Dispersal Component (explain)_____.__ -- —_ ❑Pretreatment Device V. 0 1apers — al i Treat t Area Inform ation: _ 1)e. ;n Flow (p pd) Design 3oit Application Ra gpdsf) � Dispal Arco Require st) Dispersa P System Elev o a �� 8 V)I. Tank Inc Capacity in Total # of Manufacturer Gall Gallons Units e ' New Tanks Existing Tanks Sepv '_a or Ftoldinl Tank Dustin; Chamber V I I.. Respons ibility Statement- 1, the undersigned, assuro onsibility for Installation of the POW l S shown on the attached plans. Pluri Nan a (Print) Plumber's turc MPIMPRS Number Business Phone Number Pl urnlaer's Add regs (Street, City, State, Zip (; / Conn 11I)e ailment Use Ong_____ —i Permit Fee Datc 1s 77 / Issuing Age tgnanaro Own en Reason o enial -- IX. Could t I Mika for Disapproval 3 1 7: `SepEic tank, *Mulnt filter and J1 dispersal cell must all be servlces / maintained Y as per management plan provided by plumber. 3. AN sejbaak fe must.be ,maintained Atiwn to eompteto plan6 r [ fyntam and tubmtt m the GOMnts nnry on PnPer —t— than a t/Z „ 1 a mesa /n tlffi 5131) -6398 (R, 0 1107) Valid thru 01109 PLOT PLAN PROJECT Justin Townsend ADDRESS 14117 Doman Dr. New Richmond Wi 54017 SW 1/4 SW 1/4S jg� T 31 N/R 18 A W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /20/11 BEDROOM 3 CONVENTIONAL )= IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100 Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Scale is 1" = 40' SYSTEM ELEVATION 98.8/97.3' 4.5'below qrade unless otherwise noted Property Line Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6 „ Quick4 Standard -W ' of Cover Leaching Chamber Site is to be served with 20.0 ft2 of Area by municipal 5.8ft ^2 /pair of end caps water 4' Long 12„ 110th St. 3497 Grade at System Elevation Pro 3 Bedroom 2-3'X 66' cells house with >3' spacing 15% • Slope 100' 20' B -2 25 ents 35' 70' ST 75 ' B -3 Line is to be insulated B.M.* where it crosses the 30' driveway B -1 120' Property Line 107' Property Line G� Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 ' 715- 246 -4516 Date: 5/20/11 Owner: Justin Townsend Location:SW1 /4 SW1 /4 S22 T31 N,R18W Lot 4110th St Star Prairie System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Co tingency Plan 6. Filter Specifications S et � r ' Signature License num #226900 j PLOT PLAN PROJECT Justin Townsend ADDRESS 14117 Doman Dr. New Richmond Wi 54017 SW 1/4 SW 1/4S 67�T 31 N/R 18 ?; W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/20/11 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE . ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1 " pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Scale is 1" = 40' SYSTEM ELEVATION 98.8/97.3' 4.5'below qrade unless otherwise noted Property Line Plans Designed Using Conventional Powts Manual Version 2.0 Vent >6 „ Quick4 Standard -W of Cover Leaching Chamber Site is to be served with 20.0 ft2 of Area by municapal 5.8ft ^2 /pair of end caps water 4' Long 12„ 110th St. .54-- Grade at System Elevation Pro 3 Bedroom 2-3'X 66' cells house with >3' spacing 15% Slope 100' 20 B -2 25 ents 35' 70' ST 75' B -3 Line is to be insulated 5' B.M.* where it crosses the 30' driveway B -1 120' Property Line 107' Prop Line Cross Section of Quick 4 Standard -W Leaching Chamber Typical cross s6ction for 2 of 2 cells Quick 4 Standard -W Leaching Chamber with20.0 ft2 of Area per Chamber 5.8ft ^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 103.3' Vent A Grade Vent 4' 4" 4' ,A/30/34 Septic Tank 4' Long 119 5' 4' Long 119 Grade at System Elevation 34 Grade at System Elevation 34 Spacing 5' 2 -3' X 66' Cells Observation tubeNent Same on other end Located at ends of Cell A B 16 chambers per cell System elevations: A__98.8 B__97.3 I 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 installej 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 end:; of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the sy: "tem. 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 Plan CSptio7intested ystem fails, determine cause of failure, use alternate area and install new sys e replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing bioniat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 71 5- 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 -246 -5148 Shaun Bird #226900 CK v � Q cq u. ZUC7UC7 0 W O IL W o C LL o E D ti �i N M (L r� --- _- _ - - - -- N r r a ai ST. CROIX COUNTY SWnC TANK MAWMANCE AGREME NT AND Ow�r�� CATION FORM ownerrsuyler Mailing Addy Asa ao property Add us fiw� Plam�dng & zomag D eaw �-) City /shft Parcel Identifiogdon Number .O P, / • S �/. Sec. 2 Z ; T Z N R ` J w' Town o£ Propea-ty Los" �tton _ "14 � ' Lot # Subdivisial _ A , # _ Voltuae Certtffied Sn rrey' Map # Volume _ � p # Warranty D ead # __ � J / Lot lmae idendiftble (�° J aiO Spec hostse Yes ON &*n to bMn& waabtL PIRPOW bw o Per Use and maw of YM Vic ° could re or t �. by a liowsed - WW y ou Pat iaft s ,w o< s xbu of pumpns out the sepW tmk �rY d3m Y = in the waste diq"Ml "I OwM nwhonmee the grftm ran affiect the i�000: of t&O tank as a p - t tK - a t qndfied is §CMM 83.52(1) amd in Chapter 12 - St CkDtK Caumty Saaitay 7"** DesnTUDMA a � aped by the a�v agr ees to submi too SL C rone Courtly Plans atic�emeed pub � (1) the owe 'I'h�s p y neoessexY). Myfi vresarvvatpr die Pont systaca is iafs ialuoPw °g and/or m (if c tank is less Auua 113:0 t13 of sludge- Uwe. the � bxve read aw above requ s and agree to N ous+cas Ret. of V'rnoon"L sr n&wu set ! Dash. hewn, as met by do De of Ccas and th e tip ft St Craft Cou dy Planning � Ceriiiicatioa s wmg tbat yoga septic system bas been m mated must' --- comPle bed and rr�dtooaed � Dqw memo witbia 3o days of dw tbaee year aThIdOn dst' s of the me t* fiat alt statements an ties fwm are true to the best of my /ona?aaawleci I/we am/are *e owt►aat; ) pmpecty demo+ 43ed above, by vh se of a �wiaaa dy deed xncorded of Deeds Office. Number of b nos DATE .X A1't3RE O APPLICAN(S) * :•A imfo�s aatfom� that is mdarq�a�ese rated may result is the sw*KY permit being ra+►oked by the YLmoiag Bt ZaaiaB De macs i ode with t his applicatioet a recorded Y deed from the Register of Duds O ct: alai s ctipy of t3te cxadfied survey map sefe "=e is a ade in the wa rn ty deed. FILM) DEC 2 9 1993.6. 4 JAMES O'CONNELL 5�.1�.'� ♦ Register of Deeds S CO SL Croix Co., Wf CERTIFIED SURVEY MAP Located in the Southwest Quarter of the Southwest Quarter of Section 22, Township 31 Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Surveyed for and at the request of: LEGEND Erwin L. Heinecke & Avalon A. Heinecke 09 Found Section Corner Monument 2003 110th St. • Found 1" Iron Pipe New Richmond, WI 54017 Set 1" x 24^ Iron Pipe weighing 1.68 O pounds per linear foot.' N * Existing Fence SCALE 1" = 200' p0 50 O 200 W 1/4 CORNER SECTION 22 -31 -18 Bearings are referenced to the west line of the SW4 of Section 22 t ' assumed to bear NOO "47'53 "E. 1 1 COUNTY GENERAL NOTICE ' Each parcel shown on this map is subject to state and county laws, N rules and regulations (i.e., wetlands, minimum lot size, access ° to parcel, etc.). Before purchasing or developing any parcel, ^' contact the St. Croix County Zoning Office for advise. _UN_ LANDS S89`46' 36 "E 417.54' Rs N89. 46'00 "W 418.8 4' NORTH LINE OF THE SW 1/4 OF THE SW 1/4 �/. -19.5, X46.57' \ 22.5' S89.47'48 "E 678.52' ' 9 i; 8 f _F% 5 ' — _- NOO.47'S3 "E 25.89' 1 370.97 Re 900'46'02 "W 28.00' o Yt 7 '7 - N00 "E 107.00'7 RIGHT-OF-WAY 3w o LOT 4 r yy N69.58'46 "W 3 73.66' - - -'_ /"E /C C1_SeG c`�� / /"�� //• N IR :869.57'22 "E 375.00' o 627,397 sq. ft.) t I ° LOT 2 In �°, 14.403 acres ) TOTAL AREA 1 a c C. S • M. % m 622, 407 sq. ft. ) Less R/W z i N YQL . 5, N N 14.288 acres ) l i �o of - 8 PG. 1:37 81 This lot is to be deeded to the owners of Lot 2, ± R= N89•57'22 "W 375.00' ^; C.S.M. Vol. 5, Pg. 1374 as an add -on. Transfer of l - N89.59 373.90'- 326.1 ' R• 327.00' / - this lot to any other party other than an adjoin - 9t 'A ing owner Is a violation of St. Croix County 8 -4 z . TOTAL AREA Ordinance. a '- Ic a ( m 228, 566 SQ. FT. ro N Z 12 5.24 7 AC. I J N m I'D m w r 1 0 q d 1 AREA LESS R/W I � >E � ID =1 201,269 SQ.FT. Z " I 1 Z m Q .621 AC. 0 S89'57'51 "E 920.54' 1 Irn I 0 m 4 EPTIC to Ip i 1 I � t o m 1 HOUSE w W� ID m c WELL m o �' iZ m' m m LOT 5 p IN rIOO' --. �i ❑8ARAGE a 628,049 sq. ft.) TOTAL AREA rn i lr o p� ; LOT 3 ww 14.918 acres ) le a _ _ :1 to This lot is to be deeded to the owners of Lot 1, C.S.M. Vol. 5, Pg. 1270 as an add -on. Transfer of 1 0 I 1:]SNED this lot to any other party other than an adjoining i ° 1 owner is a violation of St. Croix County Ordinance., I o E 332.28' R• 332.23' N R =373.00' zo i LOT I A '^ C. S. M. Y A 1 N O L. 5, N V 0 PG. 1270 N N SW CORNER SECTION 22 -31 -18 SOUTH LINE OF THE SW1/4 999`59'17 "E 1293.23' ' UNPLATTED LANDS D {$jl�?d by Douglas Zahler -- - -- - --- - - --- 8023599 Tx: 4017271 Affidavit of Correction 934103 For Restriction Release BETH PABST REGISTER OF DEEDS I, James E. Rusch, Professional Wisconsin Surveyor, hereby depose and ST. CROIX CO., WI RECEIVED FOR RECORD say: 03/28/2011 10:53 AM There exists a Certified Survey Map (C.S.M.) recorded in Volume 10, at EXEMPT # : Page 2719, as Document number 511177, in the St. Croix County REC FEE: 30.00 PAGES: 1 Register of Deeds Office; and That said C.S.M. depicts, describes and creates Lots 3, 4, and 5; and That the P.I.N. for said Lot 4 thereon is 038 - 1092 -95 -120; and Return address: Justin & Rachel Townsend That said Lot 4 contains a restrictive statement which was required to 1417 Doman Ave. be placed on said Lot 4 by the St. Croix County Planning and New Richmond, WI 54017 Zoning Office prior to the approval of said C.S.M.; and That said statement reads: "This lot is to be deeded to the owners of Lot 2, C.S.M. Vol. 5, Pg. 1374 as an add -on. Transfer of this lot to any other party other than an adjoining owner is a violation of St. Croix County Ordinance. ": and That said Lx triction is hereby released by the St. Croix County Planning and Zoning Office as attested to by x 9/4C Utli on this s day of March, 2011, by virtue of his signature; and Alex Blackburn, Zoning Specialist Date That I make this affidavit at the direction of said Mr. Alex Blackburn; and That I make this affidavit for the two purposes of: 1) Informing the public of the intent of the said Planning a»d Zoning Office; and 2) Informing the public and municipalities having jurisdiction that said Lot 4 was created on December 29, 1993, at about 4:30 P.M., with the recordation of said C.S.M. Volume 10, Page 2719. ames . Rusch, P. . #1376 Subscribed and sworn to before me this 21 day of March, 2011, by Mr. James E. Rusch, to me known to be the person who appeared before me and acknowledged the above. i March 21 2011 Notary Pu t. 1 Croix County, Wisconsin My commission (is-he� (expires) 10 ate j I FOS This instrument drafted by James. E. Rusch, P.S. • 0"(,� • s 9 0 x 'fi � ' o • � � OFSC' VA SC r r A �•• 1 of 1 i 8023809 State Bar of Wisconsin Form 1 -2003 Tx :4017418 WARRANTY DEED 934249 BETH PABST DocumentNumber Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Jeffrey A. Heinecke and Cheryl J. Heinecke, husband 03/30/2011 11:44 AM and wife as joint tenants EXEMPT #: 8 ( "Grantor," whether one or more), REC FEE: 30.00 and Justin D Townsend and Rachel A Townsend husband and wife as joint tenants PAGES` 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address Jeffrey A. Heinecke needed, please attach addendum): 2013 110'" Street A parcel of land located in the Southwest Quarter of the Southwest Quarter (SW %4 New Richmond, WI 54017 of SW %4) of Section Twenty-two (22), Township Thirty-one (3 1) North, Range Eighteen (18) West, described as follows: Lot 4 of Certified Survey Maps, page 2719, as Document No. 511177. \/Jl vi', �(�, >�45 e 2 �1 038- 1092 -95 -120 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: ` , ` NUttu�tor> > ,. Dated March, 2011 ? _�n T A,� JU (SEAL) A. Heinecke iqr F W ISG ` � e & ` �Itttntltdy q �t�}�tl�`` �Q (SEAL) Cheryl J ein cke AUTHENTIC4IOIV�O •• f ACKNOWLEDGMENT Signature(s) E STATE OF WISCONSIN ) ss. authenticated on B `�` �/ (` �`G jai- COUNTY ) '.F ' O ' f %7 W 1 SG Personally came before me on '/ r a 1� G * the bg ove -named t TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me kno to be the person(s) who exe r �� g authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.0 •t�, . • • , `��-�1 THIS INSTRUMENT DRAFTED BY: * Jeffrey A. Heinecke Notary Public, Sta e of isai n My Commission /NSIN ermanent) (expiret, N '.• 2 (Signatures may be authenticated or acknowledged. are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIRM SHOULD BE CLEAI>! WARRANTY DEED C 2003 STATE BAR OF W ISC fi r' AOR1►tl I'2003 1 of 1 9' -0 TW10.F,f a9to 20 TY20i�91oa10.I0 I I _ I 4 LEILINv' � LEIt1NG X ? I � � I o F I I 3 j� Ll 0O - - - - -- I �o I I x Z I I I � I � I _ o O O } 8 —1— a xA �� A s.� a I I / Zb LEbZMl N r �o wpo \ j O o F ' f- J r I I I I I i I I V.. 4 k , i Wisco nsin De p artment F ce OIL EVALUATION T Page of Division of Safety and B h PR 1 N nce Comm 85, Wis. Adm. Code County Attach complete site p1lin on p?1WeC4tOIliq 112 x V inches in size. Plan must v r I include, but not limited o $, i0111110m point (BM), direction and Parcel I.D. 2 l %�� percent slope, scale or on and distance to nearest road. J 7 Dat Please print all information. ew /f Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ✓�, 7 Property Owner , Property Location 1 Govt. Lot 1/4 5CC ) l4 SOV, T 3� N R E (,0 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# / g. �✓ y — va/ /v ? (,;t fate Zip Code Phone Numb ❑ City ❑ Village own Nearest Road O-NewConstruction us sidential /Number of bedrooms Code derived design flow rate -� GPD ❑ Replacement Public or ccyrime - Describe: —-- - - -- -- Flood Plain ele vatio n - if applicable cif / Parent material General oormlents and r9oomi rrendations: System Type �(J�'1 i�J E4 System Elevation 73 Boring 1 17 � # pit Ground surface elev. �/ /� ft. Depth to limiting factor fir% in. Soil A 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 �t ►i Boring Boring # ® pit Ground surface ele . � ft. Depth to limiting factor in. Soil lication 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 o - # ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD 130 mg/L and TSS - 30 mg/L CST Nam (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 L ;LZ � 715- 246 -4516 Property Owner Parcel ID # Page of F Boring # El 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 'Eff#2 -? - 1 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 GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicati on Rate . Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence, Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. 'Eff#1 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& 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 -8730 (8.6/00) Soil Test Plot Pla Project Name Justin and Rachel Townsend S ird Address 1417 Doman Dr. s New Richmond Wi 54017 ' TM #226900 Lot 4 Subdivision Vol 10 /Pg 2719 D 4/11/11 S W 1/4 S W 1/4S 22 T 31 N /R W Township StarPrairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe System Elevation 9 8.8/97.3'4.5' below grade *HRP Same as Benchmark Scale is 1" = 40' AL unless otherwise noted Property Line X 110th St. Pro 3 101' Bedroom 103' 99' house 15% Slope 100' 20' B -2 25' 3 ' 75' B -3 5 B.M.* B-1 120' Pro e Line i L �r 107' ro p Line b