HomeMy WebLinkAbout026-1294-48-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556338 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)J.
Permit Holder's Name: City Village X Township Parcel Tax No:
Richmond Acres LLC, C/o Gerald J. Smith Richmond, Town of 026-1294-48-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
(7 i; 1~" u~r•, 1. r:~~ 28.30.18.1530
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
~ ~ _D o Ck a
Dosing l ~f1 Alt. BM
/ 4&
Aeration Bldg. Sewer
Holding St/ t Inlet D
-3o-3 V ~Cr yo S72 7
TANK SETBACK INFORMATION St/Ht O tlet
S~tit/t X03 ~ p ,S IT
~
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 1 I A Dt Bottom
Dosing eader an.
iX4) 7 v
Aeration - - Dist. Pipe N -e- f- aU
`
Holding - Boo/t. S stem
V1SI c~ S l c(~~Ve Vrt'r
PUMP/SIPHON INFORMATION ' a Final Grade ^ y ys c,
!5 4~
Manufacturer Demand St Cover
I" CT-
GPM rISV✓ U-Yl ),3 / U/ t
Model Number
TDH Lift Friction Lo tem Head TDH Ft r
Forcemain Lengt Dia. I. to II
SOIL ABSORPTION SYSTEM (k b1t G d
BED/TRENCH Width r Length / No. Of Tre PIT DIMENSIONS No. Of Pits Inside Dia. Liqui De t
DIMENSIONS l'
SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM LEACHING Manuf (tyrer:V~
INFORMATION CHAMBER OR
T e Of System: n ! i
fi,tl ri ® ~\1 O Model Number:
DIST BUTI,Q SYSTEM 2 35 )d.3 0 ,w
eader' ~nifold r on x Hole Size x Hole Spacing ent o it Intake 3
Pipe(s) r A~
Length r- Dia Length_ Dia Spacing W, .ow
V
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over / Depth Over -;7 Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center / _ Bed/Trench Edges Topsoil FF] Yes No Fal Yes Nd No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1306 116th S1,eet New Richmond, WI 54017 (SW 1/4 SE 1/4 28 T30N R1 8W) Richmond At~cr`es~Lo~t 48 Parcel No: 28.30.18.1530
1.) Alt BM Description = /yt,0('cVl (,t;U[
2.) Bldg sewer length= i
-amount of cover =Z~ 7~ ~r IG~f CP ~r~'~
c g 7- o n A Gt,~e~e
Plan revision Required? ❑ Yes o r
4ture Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctors SigCert. No.
PLOT PLAN
PROJECT Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330
SW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/19/12 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 .7 ABSORPTION AREA 651 # of chambe 32
BENCHMARK V.R.P. Top of nail in wood post ASSUME ELEVATION 1001 Filter BEAR Filter
❑ BOREHOLE WELL *H.R.P. Same as Benchmark
B.M.* SYSTEM ELEVATION 95.5/95.4' 4' below qrade
A 200' Property Line
k ' All piping shall be SDR 30/34, within 10'
9 of tank, piping shall be Schedule 40.
-2
Please note: system may be lowered and a additional
45 boring would be dug to maintain 36" below system
2% slope _
L
I\ SO kale is 1" = 40' Well is to meet all
B-3 1 /1 setbacks required by
70 Unless otherwise WDNR
5 Vent
To be >5' 2-3' X 66' cells with >3' spacing
from
property
Quick4 Stan dard
line ALong Vent
Leaching Chamber
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
ST 2"
o~ti ya Grade at System Elevation
25
4 w
om
house COPY
Property Line
RO
116th St.
4
commerce.Wl.gorr Safety and Buildings Division county
■ r t401 W. Washington Ave., P.O. Box 7162 ~
iscons' Madison, WI 53707-7162 w of carttrtmr+c14 Sanitary Permit Number (to be filled in by C'o.)
~ 55 3
Sanita ermit Application State Transacts n Number
In accordance with s. Comm. 83.21(2), Wis. Adm.
+`~i~$Y'nission of this form to the appropriate governmental is re
gwred prior to obtaining a sagitpjt,pett)iit. Note: Application forms for state-owne are Project Address (if different than mailing address)
submitted to the Department of Cormrieree. Personal information you provide may be use
ds' d
u oses in accordance with the Privacy Law, s. 15. 1 m , Stats,
L Application Information - Please Print All Information
Property Owner's Name P H
2 6
Property Owner's Mailing Address Property Location
40 u~ G vt. Lot /530 't
City, State Zips a Phone Number ~
Section ~J
i~ /V i l !T (2 T v N' R cle on
II. ype of Building (check all that apply) 6K C-A
Lot 4 -
or 2 Family Dwelling - Number of BedroomSubdivision Name
lo *4 P' Rloc v
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
own of
III. Type Permit: (Check only one box on line A. Complete line B if applicable)
A' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. T e of POWTS System/Component/Device: Check all that apply) L
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil jo fd~`
[I Holding Tank El Other Dispersal Component (explain) El Pretreatment Device (explain) _ cis
V. Dis ersal/Treat nt Area Information: -11
Design Flow (gpd) Design Soil Application R (gpdsf) Dispersal Area Required (:y Dis rsal Area Pro ed (st System levati
-2 v
VL Tank Info Capacity in Total # of Manu er
Gallons Gallons Units o
New Tanks Existing Tanks (~7-~ o '9 .J .a za ~q
r a U ~n rn iz 0 fi•
Septic or Holding Tank
Dosing Chamber
VIL Responsibility Statement- I, the undersigned, assum spousibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's ature NV//MPRRSS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
VIII. oun epartment Use Only
Approved a Permit Fee Daatte d Issuitt ent Signature
❑ wn tven n for Denial ' do /P7~
IX. Condi i & Rt/Reasoas for Disapproval 3 Px J A O nCa~~ OtMGO
1. Septic tank, effluent Bier and dispersal cell must all be services I maiittaRle. A) I' A,t of a''f
as per management plan provided by plumber. 2. AN stitback reclui emeM5 Must be malMairul ~J bd r~ :ti Joe_ C44-
as per applicable code / / I
Attach to complete plans for the system and submit to the County onl on paper not less than a 1 a x 11 inches in size
SBD-6398 (R 02/09)
PLOT PLAN
PROJECT Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330
SW 1/4 SE 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/19/12 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 .7 ABSORPTION AREA 651 # of chambe 32
BENCHMARK V.R.P. Top of nail in wood post ASSUME ELEVATION 1001 Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
B.M.* SYSTEM ELEVATION 95.5/95.4' 4' below qrade
200' Property Line
99 All piping shall be SDR 30/34, within 10'
B 2 of tank, piping shall be Schedule 40.
Please note: system may be lowered and a additional
45' boring would be dug to maintain 36" below system
2% slope
Scale is 1" = 40' Well is to meet all
B_3 setbacks required by
70 unless otherwise WDNR
00-0 noted
45' Vents
To be >5' 2-3' X 66' cells with >3' spacing
from
property
line B-1
Vent
>6„ Quick4 Standard
30' of Cover Leaching Chamber
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
ST 4' Long 12"
52' 34" Grade at System Elevation
40'
Pro 3
bedroom
Property Line house
116th St.
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 9/19/12
Owner: Richmond Acres LLC
Location: SW1/4 SE1/4 S28 T30 N,R18W 1306 116th St. Richmond
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
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License n er #226900
PLOT PLAN
PROJECT Richmond Acres LLC ADDRESS 11160 190th Ave NW Elk River Mn 55330
SW 1/4 SE 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 9/19/12 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 .7 ABSORPTION AREA 651 # of chambe 32
BENCHMARK V.R.P. Top of nail in wood post ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
B.M.* SYSTEM ELEVATION 95.5/95.4' 4' below qrade
200' Property Line
9, All piping shall be SDR 30/34, within 10
of tank, piping shall be Schedule 40.
B-2
Please note: system may be lowered and a additional
45' boring would be dug to maintain 36" below system
2% slope
Scale is 1" = 40' Well is to meet all
70' B-3 unless otherwise setbacks required by
WDNR
noted
45' Vents
To be >5' 2-3' X 66' cells with >3' spacing
from
property
line B-1
ent
Quick4 Standard
30' Leaching Chamber
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
j
52' 3 4" Grade at System Elevation
ST 12L - .4
40'
Pro 3
bedroom
Property Line house
116th St.
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 To be >1' above grade
10.2ft 2 pair of end plates
Finish grade elevation
Typical Installation 99.0'
Vent i Grade Vent
3' 4" 3'
~130/34 Septic Tank
5' Long 1 99 5' S' Long 1 19 Grade at System Elevation
3619 Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-95.5'
B 95.4'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
Septic Tank Capacity gal ❑ I A
Permit # Septic Tank Manufacturer ❑ f IA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ P A
Number of Bedrooms ❑ NA Effluent Filter Model ❑ PIA
Number of Public Facility Units A Pump Tank Capacity al '10 P A
Estimated flow (average) al/day Pump Tank Manufacturer P A
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer P A
Soil Application Rate al/da /ft2 Pump Model P A
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) x220 mg/L 46 ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dump real Cell(s) O N
Biochemical Oxygen Demand (BODS) s30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) s30 mg/L AA ❑ A -Grade ❑ Mound
Fecal Coliform (geometric mean) !5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size in dia. p NA Other: N 4
Other: A,A Other: N
*Values typical for domestic wastewater and septic tank effluent. Other: N
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 4 month(s) (Maximum 3 years) ❑ N,
12 ~LJ, ear s
Pump out contents of tank(s) When combined sludge and scum equals one-third (l~) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
3 {-year(s)
Clean effluent filter At least once every: / ye nth(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: El emon arth(s) 13 Ni
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NI
❑ year(s)
Other: ❑ month(s)
At least once every: ❑ year(s) 0 N/
Other:
❑ N/
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Masts
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 )f
combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall t e
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surfac:.
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 or more of the tank volume, the entire contents f
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 the servicing of effluent filters, mechanical or pressurized components, pretreatment unit:
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.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals 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 writents 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:.
• 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
replacement 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.
❑ 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.
&_~he 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.
A DDITIONAL COMMENTS
P )WTS INSTALLER POWTS MAINTAINER
Name
Name
Phone Phone / J fl
S :PTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name v-L~ Name
Phone v Phone
Th s document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
I
,.'tom FILTER CARTRIDGE INSTRUCTIONS
b~,i TM
.:30
Installation
!Taro 2 Dry fit the likes, case onto the end of the outlet pipe to ensure it is
centered under the access opening.
If not,
then either
insert more pipe into
tank through the outlet or solvent weld (glue) additional pipe onto the outlet the
pipe.
Ck While the case is still dry fitted on the outlet pipe, measure of N!-inch pipe needed to brace the filter to the tank end wall if utilizi utilizing length
optional supplemental side support. If side support method is not utUi2ed,
proceed to step four"
y''*'c`.P ^ For installations utilizing the optional supplemental side support:
solvent weld the Y -inch pipe onto the filter case. If side support method is not
utilized, proceed to step four. 1e
Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing dawn until the filter locks into the bottom of
the case.
F.?..: S~.
If a AS switch is +"F"''!"'.
utilized: insert into the filter and lock h turnin
clockwise 400. Y g
Maintenance
1. The effluent filter should be cleaned every time the septic tank Is
serviced.
2. Open the outlet access opening to inspect the tank and filter.
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up an the filter handle to dislodge the
cartridge from the case. •``l c
5. Slide the cartridge up and out of the case for- cleaning.
6. If a VRS switch connected to an alarm Is present, the switch
should be removed by turning counterclockwise 90° and cleaned
with water only. ,
7. While holding the cartridge on its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water ' , ;
only, making sure all septage material Is rinsed back into the tank. rY fi:' '
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 401,
9. Insert the filter cartridge back into the case p
pressing down until
the filter locks into the bottom of the case.
10. Replace and secure the access opening on the tank. .y
1. aYn - •;a~ : r.
www.bearonsite.com 877-MLR T8RS (653-4583)
12-
1. 89 acre
E-Y MAP 1.96 acres I o 82,228 sq.
99 - - ~4 85, 398 sq. ft.
N D:
'27"E 450.26' S8T39'S0'E
Monument of Record N89'50 z
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8" Iron Rebar O ° ' l 2.22 acre.,
lbs. per linear foot. All? g 1.85 acres 96,538 sq.
's marked with a 1 "x18" iron 80,415 sq. ft a~ a
.13 lbs. per linear foot. a .
k Line
t of way or as noted) ° ry 863.5
way Location I / 58740'52"E 303.02'
tion of N89'50'27'E 350.98'` ; SE
Opening (R=
Water Elevation O A V) 49
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Top of Iron Rebar or Pipe o 1.80 acres 3 0 °o
ro 78,214 sq. ft I N w
tment along roadways
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W L.B.O. 962.40 }x~ p1' s ( ° o 1.75 acres
xes ~.•.N' • 5 ~a3. ~ Cos
76, 130 s q. N~
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KED WITH A 1" x 18" EA~EV m °
PER LINEAR FOOT) u ° H. W.E. =960.0 l " °
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Wisconsin Department of Commerce ITS' EVALUATION REPORT Page of _ 4q
Division of Safety and Buildings
ce with Comm 85, Wis. Adm. Code
in Varda ~ County
Attach complete site plan on paper not less than 8 1/2 x 11 i C a
(fj1 ~b
include, but not limited to: vertical and horizontal reference lj~ nt arcel I.D. -1
percent slope, scale or dimensions, north arrow, and location . 0 Z /O
Please print all information evi a Date
1.9
Personal information you provide may be used for secondary purpos (PrivacN~~. 1 (IM.-
Property Owner ST. PU eC r~U ~ qn
~JPero-~ cl 'S . SM-r ,y. t k ZO 4PFIC III 14 SE1/4 S aq T30 N R E(or
Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM#
it 90 e• NU.) y at o f -'c M c t
City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road
F1K R-21"' PIN 30 ( - 8 R►~c.h M
New Construction Use: [9 Residential/ Number of bedrooms - Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe: -
Parent material -_,,rrte~f w._L\ y '5 ~N - Flood Plain eievation if applicable I
General comments g t,eJSe S -1 rG^e~~R.~ F0 r Ce'`c S , ,
and recommendations: 1.33 G/JA
~3
❑ Boring , S U / w" S
Boring #
pit Ground surface elev. _ 11.94 ft. Depth to limiting factor O$ 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
3 _ L
a fit`=~ BFI SC yt`,t }j ` y tr )
r
5 s C
3,2,
El Boring
FJalBoring #
Pit Ground surface elev. _ • ft. Depth to limiting factor XS 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
dd 'w
or,
Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 30 mg/I-
T Name (Please P Signatur CST Nu, ber q 40
~Dz> ri Or ill c90, '7
a drr C rt M S-~ Date Evaluation Conducted Telephone Number
-7 CA :3598
5YV016
y
Y
Property Owner Gera ii T 5m + +k Parcel ID # Page C=~_ of
F,3~ Boring # Boring q
Pit Ground surface elev. ft. Depth to limiting factor gs 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
/S- _ lie ~~i m cis
, CS
T
❑ Boring # ❑ Boring -
❑ Pit Ground surface elev. 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 'Eff#2
❑ Boring # ❑ Boring T
❑ 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
Effluent #1 = BODE > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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.6=)
• • 1
Property Owner Gera l& T Sm A ` Parcel ID # Page of
Boring # ❑ Boring ex f~
F,-31 Pit Ground surface elev. 9$•s M ft. Depth to limiting factor +rs 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
~LL
-7
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
4 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
Boring # Boring -
❑ Pit Ground surface elev. _ ft. Depth to limiting factor In.
Soil A iication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /if
In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD5 < 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.
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0911712012 09:59 TAX) P.001tool
IST. CROIx COUN'j'Y
SFPTZC TANK MAIN"rENANCI? ACrRLF:MENT
AND
Qe ~-~,wo ' SSkP CER11FICATION FORM
Ga c.``II h
~,lwriert~uyer Lc.
Mailing Address 111L. o _d,o4-e, N.~..L_.,.~ _ . ~ .
Property Addireas _
(Verification required from pizaning & Zoning Depsrtiumt for raw t•onstrae ion.)
Pawl Identification Number v d- 6
l ascRxr"Ywxc~r
Property Loratioa$7/ ,:.~k ~'/a Sec. Z.9 j3L N- .R_
Subdivision ` Zia
Cerfiffed Survey map !rage #
warruty, D t d VnllllYle page #
Spec hou.sd 011"e TM "Lot lines idt o ifiabl yes no 1~
SYSTEM HACNTENAl LC_E AND OWNER CMltTFFICATIUN
Imnpr par %me and roaiactk imca of your septic system could result iu its prem itwe & lure to Lwndlo wastes. proper
rfmintenance wnsisia otp%mVjQg rrut the sieptio tmik eveay i1',roe years or sooner, if needed, by a li, msod pumper. What you put into
the system can affesot the function of the septic t ink as a tmatment star in the waste disposal system Owner m 4hitma=
xasponsibilitica are speci$ed in §Comm. $3.52(1) and in Qmpter 12 - St. nix Cotuaty Sanitary ordinanw.
The psvperty owner agrees to submit to St. croix county plimaing & Zouing LNvarta nt a certification form, signed by tlu:
owner and by a xowster plow ber, joUr;jayn= phnrtbcr, restricted t lunch er or a licenaod psmupo verifying that (1) the oo..ait,e
wastewater disposal system is in propar operatlag condition ared/or (2) after inspection and pu uWin.g (if necessary), 'tho septic mnig io
less than 1/3 M ofslttdge.
I/we. the =Awsiumd ,mm; xw W d w 4bove Mquirwnuotut s and agrae, to maiutuin thb grivata iww+aga disposal systwrt wl'th glo
standards sat forth, hareix4, as set by dza Mpar estidnt of Oonunorco aid trio Depa't t of Natumt Rissowpos, Stara of Wiseousi;L
:ertification stating your saptaii; system has been maintained must lie coniploidd and retstmed to tho St. Croix County Planning &
mooning Departm m within 30 days of the three year expirat'iwi date-
VWC certify that all statements on this form are huc to the best army/Nir lmowiedp. 1/wo rimJmv. the owner(s) of Ow
i sroperty dowribed abovo, by virtue of a vmrranty deed recorded iri Rcgist r of Deeds Of co.
I lumber" A,
- ZNAT OF APPLICANT'(S)
DATE
" **Any inforrnaliion lUt is misrepresented may rcanlt in the bruutary permit being revoked by the Puuumiug & Gonin DaPa't=m.
X' eclude with this application a ree;onlnd warranty deed :from 'the. Register of Deeds Office and a. copy of the cxrtifwd survey map if
tim=i; is made in tho warranty derd-
(l V. 08/05)
U Z8 51 P 0 7 1 8IZI 1 423
State Bar of Wisconsin Form 3-2003 KATHLEEN H. WALSH
QUIT CLAIM DEED REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number Document Name RECEIVED FOR RECORD
07/26/2005 10:00AN
QUIT CLAIM DEED
THIS DEED, made between Gerald J. Smith and Jeannine B. Smith, husband and EXOPT # 10
wife REC FEE: 13.00
("Grantor," whether one or more), TRANS FEE:
and Richmond Acres, LLC, a Wisconsin limited liability company COPY FEE:
("Grantee," whether one or more). CC FEE :
PAGES: 2
Grantor quit claims to Grantee the following described real estate, together with the rents, Recording Area
profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin
("Property") (if more space is needed, please attach addendum): Name and Return Address
See attached Exhibit A Kristina Ogland
Attorney at Lw
P.O. Box 359
Hudson, WI 54016
026-1082-40-000:026-1083-10-000: 026-1082-
70-000: 026-108240-000
Parcel Identification Number (PM)
This is not homestead property.
i
ao
Dated Ud
i
(SEAL) (SEAL)
erald J. Smffh eannine B. Smith
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE OF 11U1S1c,0rr:1 n )
c1
~r l~lX COUNTY )ss.
)
*
TITLE: MEMBER STATE BAR 0 ONS Personally came before me on
(If not, e above-named Gerald J. Smith and Jeannine B. Smith,
authorized by Wis. Stat. § 6.~ usband and wife
o me known to be the person(s) who executed the foregoing
THIS INSTRUMENT DRAFTED B instrument and acknowledged the same.
ry SIATE dF
Kristina O land Estreen & 021and Al A-An W472; 1-
304 Locust Street. Hudson, WI 54016
Notary Public, State of
My Commission (is permanent) (expires: 9-&5-6:5 1
(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 ® 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
Type name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infbproforms.com
U 2851P 078
M
EXHIBIT A
Parcel 1
The East Half of the East Half of the Southwest Quarter (E1 /2./EI/2./SWI/4) of Section Twenty Eight
(28), Township Thirty(30) North, Range Eighteen (18) West, Town ofRichmond, St. Croix County,
Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 24,1990, in Vol. 8 of C.S.M.,
pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter
(SW 1/4/SE 1/4) and partof the Southeast Quarter of the Southwest Quarter (SEVVSW 1/4), both in
Section Twenty Eight (28), Township Thirty (30) North, Range Eighteeu (18) West.
Parcel
The West Half of the Southeast Quarter (W1/2/SE1/4) of Section Twenty Eight (28), Township
Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin,
EXCEPT the following described parcels:
1. Lot One (1) of Certified Survey Map filed April 24, 1990, in Vol. 8 of C.S.M., pg.
2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast
Quarter (SWI/4/S1:1/4) and part of the Southeast Quarter of the Southwest Quarter
(SEI/4/SWI/4), both in Section Twenty Eight (28), Township Thirty (30) North,
Range Eighteen (18) West;
2. Trot One (1) of Certified Survey Map filed August 13, in Vol. 4 of C.S.M., pg.
1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast
Quarter (SW 1 /4/SE 1/4) of Section Twenty Eight (28); Township Thirty (30) North,
Mange Eighteen (18) West;
3. Commencing at the Southwest comer of Lot One (1) of Certified Survey Map filed
August 13,198 1, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of
beginning; thence N89159'15" West 20.00 feet; thence NO°01'41" East 262.00 feet;
thence S89°59'15" East 224.00 feet; thence SO°01'41" West 15.00 feet; thence
N89°59'15" West 209.00 feet; thence SO°01'41" West 242.00 feet to the point of
beginning;
4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast
Quarter (NWI/4/SE1/4) of said Section '28; thence South 16 feet; thence
Northwesterly to a point 10 feet West of the point of beginning, thence East to the
point of beginning.
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