HomeMy WebLinkAbout026-1167-03-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 552311 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:
Marek, Todd R. Richmond, Town of 026-1167-03-000
CST BM Elev: Insp. BM Elev: BM Descri'on: Section/Town/Range/Map No:
lob -6 # / 27.30.18.1305
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~ Bench
~/U a Z T3 S~ sv ~'~rk 7 ,35 L loo b
Dosing Alt. BM 00 10 e 0 f tt4 5,Z1 /,02.0-7
Aeration Bldg. Sewer
C -q4( Holding St/Ht Inlet < 9 '-*6 7U 9 S S 7
C
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO „ fP/L WEB BLDG. Ver o Air Intake ROAD Dt Inlet /
Septic YK Dt Bottom /
Dosing / N 7 Header/Man. CI 3
T CEO.
Aeration Dist. Pipe lr~~ 2.3
t3. I qq..
Holding Bot. System I e4.
2~
Final Grade
PUMP/SIPHON INFORMATIO
vt
j :4~
Manufacturer Demand St Cover to-4 v4 t 0 7
Model Number J~
TDH Lift Friction s System TDH Ft
Forcemain Length TDist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length' / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS k ~L 2
SETBACK SYSTEM TO OP/L BLD WELL LAKE/STREAM LEACHING Ma rer
INFORMATION CHAMBER
Ty Of System: > I S / 1 1J a Model Number.
LPA Dap t
L 9 a 4- -9 9 19 4Z.
DIST IBUTION SYSTEM 4v b Gd-~ t~0 j -2
Header/ anifold Distribution 1 x Hole Size x Hole Spacing ent jt6 Air Intak
~J /i Pipe(s) g~l~ " I yt 2ih~ U -6 1
Length 9 Dia 7 Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only I &t5 -T
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center 72, p 1 Bed/Trench Edges Topsoil / R Yes ❑ No ❑ Yes ® No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-4/ 2 Inspection #2:
Location: 1271 140th Ave New Richmond, WI 54017 NW 1/4 NE 1/4 27 T30N R18W) Lundy's Preserve It 9 Parcel No: 27.30.18.1305
1.) Alt BM Description = I a1 eJ kn-et-"1lf 411 , kW 4 _~a* Joavrc ,4 44jA,2( S
2.) Bldg sewer length tz~
_r 5/
-
amount of cover j ASGT 4/
Plan revision Required? ❑ Yes No
Use other side for additional information. / f
SBD-6710 (R.3/97) Date Insepctoes Sig ature Cert. No.
RECEIVED PAl
jh
com erce. is Safety and Buildings Division untY / P-0 (x
S . 01X COUN 2 W. Washington Ave., P.O. Box 7162 T
% C ~t~llN(3 -FIDE Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
D5 5 2 !
Sanitary Permit Application State. Transaction Number
In accordance with s. Comm. 83.21(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 Project Address (if different thanmailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 I m Stats. 2
1. Application Information - Please Print All Inforn on G
Property Owner's Name 3 Parcel #
® A M iPC 2 -Z A o-o
Property Owner's Mailing Address Property Location / , ? 0
D X 2 O Govt. Lot 6/ ' J
City, State
01 1 Zip Code Phone Number /J o yp Af Section
E (circle one
T-, N; R E0
[I. Type of Building (check all that apply) Lot #
`I or2 Family Dwelling.- Number orBadrooms "t-') rrY'', r
O'k- ~ Block # v,/V P S PLC V t
❑ Public/Commercial -Describe Use I ❑ City of
V tip
❑ State Owned - Describe Use CSM Number ❑ Village of
Z l~ ~ Town of I G 111164J .p
ti ;5 t ;e.,lts L+J 2 ~ a- Z Z t '
!ll. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. VNew System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply) ('-5
Non-Pressurize-d-In---Groouunnd ❑ Pressurized In-Ground 11 At-Grade C1 Mound 24 in. ofsuitable soil 11 Mound <24 in of suitable soil '56 [~4 f
❑ Holding Tank Ll Other Dispersal Component (explain) ❑ Pretreatment Device (explain) O S
V. Dis ersaVrreatment Area Information:
Desi n Flow (gpd) Design Soil Application Rate pdst) Dispersal Area Required (a / Dispersal Area Proposed Is 9yT System Elevation 3~ (o
✓ ~O + 93, 0 d-2
V[. Tank Info Capacity in Total # of Manufacturer C-d Imp
Gallons Gallons Units o
New Tanks Existing Tanks
~dlz/ 525 98 rn w t7 a
Septic or Holding Tank Z 1
Dosing Chamber Lip- 129-1
VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print) ~ Plumber's Signature MP/MVRfrNumber Business Phone Number
o w`o j" A I 2Z~L q 715 Z 73 Y KK
Plumber's d~ress (Street. City, States, Zip Code) In
Vill. Count /De artment Use Only
Approved 16-0. ❑ Disapprovev Permit Fee Date Issued [ssuin gent Signa
66 r tfGiven ReasonTdrDenial 317 Z
IX. ConditbVISgW easons for Disapproval 3~
1'. $eptic tank, effluent Eiger and
dispersal cell must all be services f maintained
tas per management plan provided by;plumber I
2' Ag
MPK t><tar rick fequir"ad rtsmust.be maintained ~~il / Atr~e~o rb (~Jd f~t?~
Attach to complete plans for the system and submit to the County only on paper not I s tha a to x 11 Inches in size
SBD-6398 (R. 01/07) Valid thru 01/09
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CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Av
Owner's Name: 40 Z7~~
Owner's Address:
Legal Description: &tJ
Township: V 0
County: s'~ G
Subdivision Name:
Lot Number:
Parcel ID Number:
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Te t & House Plans
Designer/Plumber: License Number: 2 Zg
Z////
Date: „3 7 - % Z Phone Number ~XJ-" Z73 511"-
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
PL6-~ PLIUq 0
CA L&
l = ~d
ave,
A 1h,
9~ coN-4ou.dZ,
33
~ a ~zSp s-~
i
Soll Absorption System Cross Section
k4" Schedule 4o Final Grade
VC Vent Pipe
ith Vent Cap ft
R Leaching
Chamber 9
System Elevation
3 ft ~ft Soil Absorption. System Plan View
aft
ft Vent Or Observation Pipe Leaching Trench 1
Chambers ~
4u Dia.
Trench 2 Header
Leaching Chamber Specifications
FEEIISAA urer And Model P cu rc,-Npm
sq ft per chamber Soil App lication Rate gpd/sq ft
w + _ Soil pplication Rate +
EISA = Chambers
zr
2 rows of S, chambers each.
Page of
Quick4 Plus Standard Chamber Side and End Views
48"
(EFFECTIVE LENGTH)
x- at W
Fill - K, - - _ - 34"
Quick4 Plus All-in-One 12 Encap Front, Side and End Views
11.2" -
13"
8" INV+ ERT
8" IN T 5.3" INVERT
, Wf
- 18.2" 1 -33"
Quick4 Plus All-in-One Periscope
OUICK4 PLUS
ALL-IN-ONE PERISCOP
/ (360-SWIVEL
QUICK4 PLUS
12.7" INVERT
ALL-IN-0 NE 12 5n 9"~
ENDCAP
Quick4 Plus Standard Chamber Specifications
Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm)
_ Invert Height 0.6", 5.3", 8-0", 12.7"
Effective Length 48" (122 cm) (1.5 cm, 8.4 cm, 18.5 cm, 22.6 cm)
INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY
(a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured,by Infiltrator ( "Units"), when installed and
operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder")
against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units;
provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the
septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook,
Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered
by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units.
(b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT'
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR
does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages,
including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. systems inc.
Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse
or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure
to maintain the minimum ground covers set forth in the Installation Instructions; the placement of improper materials into the system containing 6 Business Park Road • P.O. Box
768
the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal,
or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the Old Saybrook, CT 06475
terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001
third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to
apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's
installation instructions. 800.221.4436
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the Www.inflitratorsystems.com
original Holder.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty
requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase,
to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units.
-
U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. 0 2009 Infiltrator Systems Inc. Printed in U.S.A. PLUS0510101SI-2
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POWTS OWNER'S MANUAL MANAGEMENT PLAN Pa of Z
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity z al ❑ NA
Permit # 5 i2 l Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer G ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ~Z ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity - - al ❑ NA
Estimated flow (average) 0-0 gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) ®y gal/day Pump Manufacturer ❑ NA
Soil Application Rate a al/da /ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ITSS) 5150 mg/L ❑ Disinfection 13 Other:
Pretreated Effluent Quality Monthly average " Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODE) 530 mg/L OWn-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Collform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ys in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
12 ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: .3 ® month(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
® ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
® ear(s)
Flush laterals and pressure test At least once every: 3 ® y a t j(s) 13 NA
Other: At least once every: ❑ month(s) ❑ NA
❑ ear(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of. combined 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 (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to tha:servicing-of effluent filters, mechanical or pressurized components,. pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Z
Pa rh
START UP AND OPERATION
micals
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a Septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent: 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 at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve .the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; 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 safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
0 All piping to tanks and pits shall be disconnected 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.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacem t system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
13 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation 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
infiltrative 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.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name N p & 2 C L S o A) Name
Phone -7 1 S- Z 7 3 T T Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name S~- C" / ~pil/IA~
Phone Phone 21Y 3 d
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code.
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
G'
Owner/Buyer
Mailing Address D f, /(J~ n~ G4 A.) dj
Property Address oZ--7 ( 0
(Verification required from Planning & Zoning Department for new construction.)
City/State *W PJC9-1 J JP Parcel Identification Number ~Q Z 7 D 3 00
LEGAL DESCRIPTION
Property Location '/t, 105 Sec. 2 , T _3Q N R~W, Town of 9(C*444, n/A
Subdivision Lot
Certified Survey Map # Volume , Page #
Warranty Deed # / ! b b ,Volume , Page
#
Spec house &0", no Lot lines identifiable no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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 Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a yarranty deed recorded in Register of Deeds Office.
Number of bedrooms J/
31-71J -2-
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warrandeed.
ty (REV. 08/05)
I I I I I I I I I I I I I I I I
II I III I (III III
8050618
Tx:4037564
State Bar of Wisconsin Form 3-2003 951766
QUIT CLAIM DEED BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
03/02/2012 2:06 PM
EXEMPT#: NA
THIS DEED, made between Citizens State Bank REC FEE: 30.00
("Grantor," whether one or more), TRANS FEE: 273.00
and Todd Marek Construction, Inc.
("Grantee," whether one or more). PAGES: 1
Grantor quit claims AS-IS AND WITHOUT REPRESENTATION OF ANY KIND
to Grantee the following described real estate, together with the rents, profits, fixtures Recording Area
and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property")
(if more space is needed, please attach addendum): Name and Return Address
KRISTINA OGtLAND
ESTREEN & OGLAND
Lots 1, 2 3 10,13, l4 and 15, Lundy's Preserve in the Town of Richmond, St. Croix 304 Locust
County, tconsin. Hudson, WI 54016
026-1167-01-000;026-1167-02-000;026-
1167-03-000; 026-1167-10-000; 026-1167-
13-000,626-1167-14-000;026-1167-15-
000
Parcel Identification Number (PIN)
Dated CitizenXS;by:
(SEAL) I~.
v (SEAL)
` "Thom s Van Pelt, President and CEO
(SEAL) (SEAL)
r s i
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF WISCONSIN )
authenticated on lsL l~ p 0 1 ~ ~L ) ss.
1 / COUNTY )
' Personally came before me on Thomas Van Pelt on Ia-
TITLE: MI±MBER STATE BAR OF WISCONSIN the above-named
(if not, to me known to be the person(s) who executed the for6gR}~n
authorized by Wis. Stat. § 706.06) instty ent and acknowledged the same. _ of^+v B. ~1 ILLER j
Notary Public
THIS INSTRUMENT DRAFTED BY: I out. ~ • Q ~ f Wisconsin
s i.
Kristina Oaland, Estreen & Oaland Notary Public, State of
)
304 Locust Street, Hudson, WI 54016 My Commission (is~e ) (expires: -4Q5 -1,5o
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
' Type name below signatures. INFO•PRO° Legal Forms 8CM55.2021 www.infopmforms.com
1 of 1
03/05/2012 20:32 FAX 0 003
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RESERVE
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NE1/4 AND PART OF THE
ON 27 T30N R1
$w, TOWN
INTY, WISCONSIN.
r
EACH PARCEL. ON INS MAP IS SUBACT TO
STAR COUNTY AND TONNSW LAWS,, MXAM
AND AECULATM ARCQ .E.
~~AOCESS TO p) 5~~ UM LOT
OR DEIIELOPM 0 4 PARCEL. .
CONTACT TFiE ST. CRpX COUNTY ZCNING OFFICE
AND THE TOMN OF RICF9ICND FOR ADNCE.
r,
UNPLATTED LANDS
Lm OF im Z/47-
-
N89031 'I IRE 2652.09'
NW IV ox-V
• - . - -~'r . - - • ; - BENCH MARK. ~
S3' 33' i TOP OF 1' p>
EMA71ON 1 H LOT 4
Ld
...................--t....
I
LOT 2 S f 4, It
2173 ACRES ` rb DRAINAGE °
04,733 SQ FT. 19 NASEMENTV p
9 557 FT.
~ LB.Q w
G, y 907.4 "
~'2s• , ~g"3b ~
24a ~'•.~1• N79~~ 114
34
Y
LOT 8 f
.
RECEIVED
OJUN 0 1 2004
Lundy's Preserve Comments: ST. CROIX COUNTY
ZONING OFFICE
tThe soils in this subdivision are quite variable and differ across the 80 acres. Some consist
of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands
have a very deep red color unlike I have seen in all of St. Croix county. The color does not
indicate high ground water because the color is so consistent. If you go through the red
sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam
Quinn from zoning, she commented that there could be a different chemical reaction with a
sands. I believe this is the case for the sands have a consistent size, and no mottles were
found above or below the sands. Sometimes bands were present, but were very slight,
and were mentioned to have the systems sized a little bigger in order to accommodate for
any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8,
and 9 have a extremely poor soil present not suitable for a mound system. The surveyor
and I discussed this condition, and the resulting tests were spaced as far away from this area
as possible. All the soils tests were done to the best of my ability and I hold no liability for
anomalies and other oddities that can be found on this site.
Shaun Bird
CSTM #226900 i`
5/28/04
i
RECEIVEn
Wisconsin Department of Commerce SOIL EVALUATION REPORT j jNge(~-__
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County ` T. CFi01X COUNT
Attach complete site plan on paper not less than 81/2 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. 2, 7 -03--g&
Please print all information. Revi ed by Date
Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)).
property Owner Property Location
W
,r,, Govt. Lot 1/4 ~/4 S.~ T -30 N R E(0
Property Owner's Mailing Address Lt # Block # . Name qr CSM#
City State Zip Code Phone Number ❑ City ❑ village wn Nearest R90
Ayv4t-/
New Construction Use: Residential / Number of bedrooms Code derived design flow rate K GPD
❑ Replacement Public lorrccommercial I- DD scr/'be:
Parent material f n l~ Flood Plain ele ation if applicable 6_- ft
an recommendaations: ,L,a ! -P/ (/a'Ur-r ~ ~ q'y ~ ! n ~ J
I -v- 7'41 /OZ,- CIO At J"""L Lab -
I
F/I # ring
Pit Ground surface elev.` ft. Depth to limiting factor in Soil lion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
10y, -1-0
2 Z-ZZ 10,4 r s' s k
2~- 7 S/ s
-T- s
t- it LIT-
t ~
'12
Boring # ❑ ring Idea
Ground surface elev. r ft. Depth to limiting factor in• Soil Application Rate
Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
Gr. Sz. Sh. 'Eff#1 'Eff#2
in. Munse`171, Clu. Sz. Cont. Color Q Q C
100 r
l~ 3
trlo-
~ l1
tt
Effluent #1 = BOD > 30 < 220 mglL and TSS >30:_` 150 mglL ' Effluent #2 = BOD < 30 mg/1- and TSS < 30 mg1L
CST Name (Please Print) Sig CST Number
226900
Bird Plumbing, Inc. Shaun Bird Telephone Number
Date Evaluation Conducted
Address 715-246-4516
1008 192nd Ave, New Richmond, WI 54017
Property Owner Parcel ID # Page of
5~ Ong # Boring
Pit Ground surface elev.. Depth to limiting factor in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
AN6k CIS 191H__
2 -F - - L_ LVA L! Al; 7
1.
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. 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
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/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfW
Effluent #1 = BOD; > 30 < 720 mglL and TSS >30:E 150 mgA_ ' Effluent #2 = BODS < 30 mDt and TSS 30 mg1L
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 OL6100)
Soil Test Plot Pla
tProject Name Environmental Holding L.L.P. Sh B'
Address 706 19th St. S.'
Hudson Wi 54016 STM #226900
Lot 3 Subdivision Lundy's Preserve ate 5/24/04
N 1/2 NE 1/4S 27 T 30 N/R 18 W
Township Richmond
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe
System Elevation 91.6/91.1/90.6 *HRpSame as Benchmark
Alternate Benchmark Top of 1/2" pipe 99.3'
B Alt. B.M. 140th Ave
90' 10'
20'
B- 40
50'
100
9% Slope
348'
Property 10 B-2
Line
100' 98'
Please note:Soil test
was done to satisfy
county zoning
requirement. Soil Scale is 1„ = 40,
test may not be unless otherwise
suitable for owners
desired building noted
location.