HomeMy WebLinkAbout026-1167-14-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division -
INSPECTION REPORT Sanitary Permit No:
561056 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:
Todd Marek Construction, c/o Todd R. Marek Richmond, Town of 026-1167-14-000
CST BM Elev: Insp. BM Elev: BM Description: W~ Section/Town/Range/Map No:
27.30.18.1316
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER w~ CAPACITY STATION BS (,6#HI, OF FS ELEV_
Septic r 7'n 1 Benchmark
A to F.•I Zv (f)
Alt. BM /bZ 3(P
Aeration Bldg. Sewer I,~~ 447
7.-
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet (o . Z 01
TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet `
Septic Dt Bottom
3y Sb
Dosing 7 Header/Man. /a
r 7Z
Aeration _ Dist. Pipe
,S ~rS. s oz
Holding Bot. System ,
7. 9
Final Grade 7 , ~ 9 !;pz-
PUMP/SIPHON INFORMATION
Manufacturer Demand St Cover g -
3. ~ `fi
Model Number
TDH Lift Friction Loss UsImlRead TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
uid
Liq Depth
BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside DT
DIMENSIONS 3 7 , w`~
16 3
SETBACK SYSTEM TO GJ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR Zits'/ IL-fl, +7~
TypeO~,404,: 56 / 5/~ /
/ UNIT Model Number: / /J
DISTRIBUTION SYSTEM Z5►-ZS4-Z5 = 75 ` zs
Header/Manifo J / Distribution x Hole S' e x Hole acing Vent Air Intake
Y L , / Pipe(s)_ o+~ f
Length Dia Y 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/S ded xx Mulched
Bed/Trench Center 7 If Bed/Trench Edges \ Topsoil No <Yes No
Y 2 \
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1389 126th Street New Richmond, WI 54017 (NW 1/4 NE 1/4 27 T30N R1 8W) Lundy's Preserve Lot 14 Parcel No: 27.30.18.1316
1.) Alt BM Description = Jam-- E ~ < Co cJ ~ ~ f-0'
2.) Bldg sewer length = ' j le
- amount of cover 4 A, n I
0 ,
Z 4,e.~.
Plan revision Required? fa-1 Yes No
Use other side for additional informatio
SBD-6710 (R.3/97) Date Insepctors Signa re Cert. No.
ft 6-~- ~ pj
7 cr o `
17 t-0
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2~3 Safety and Buildings Division 1~
< 1 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
a S _ ' Madison, WI 53707-7162
°~s+ots~~~ t2 *,414 Permit Application State Transaction Number
In accordance with SPS 383.l41(Wis. A submission of this form to the appropriate govemm
is required prior to obtaining a sant vp i Note: Application forms for state-owned POWTS are, submi to ct Address (if different than mailing address)
the Department of Safety and Prl sstofiaI Sernes. Personal information you provide may be used or secon
purp oses in accordance with the Privacy Law, s. 15.04 1 m Stats. f Q ow~ -06-1
I. Application Information - Please Print All Information ! fJ /0
Property Owner's Name Parcel #
Property Owner's Mailing Address Property Location f /y/ &
Govt. Lot
City, State I I , Zip Code Phone Number Nry ,(r ~ y,, Section
7 (circle one)
~i,/, 1 I I / n/1 q )!v W /
( L V ~ T ^Zj ~ N; R E or
H. Type of Building (check all that apply) Lot # "
l or 2 Family Dwelling - Number of Bedrooms Subdivision Name /
OGk• 1av~ Block ~ /v~ ~jln.V
❑ Public/Commercial - Describe Use ❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of I
25 .BiTown of I (C91Vk0 rj®
III. Type of Permit: (Check my one bog on line A. Complete line B if applicable)
A. ;kjew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal D_ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
S r
IV. Type of POWTS System/Component/Device: Check all that apply)
Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersaVrreat ent Area Information:
Desi Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed System Elevatio
TAO a f 6-a 15-OZ W a z.s
VI. Tank Info Capacity in Total # of Manufacturer y
Gallons Gallons Units Q /D L „ y _
/ ! U
New Tanks Existing Tanks 2 o 2 .o
w U v) h cn is. 3 E
Septic or Holding Tank G y~ Z S~ W
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plum is Name (Print) Plumber's Signature MP/.N 3Number Business Phone Number
~G~ Z Z 6 7~,s Z 7 V
Plumb s Address (Street, City, State, Zip Code)
L,50, f
7t7ll- .4
VIII. Coun epartment Use Only
Approved sapprove Permit Fee Date Issued Issu' Agent Sign
$ y7y. oo Zf, /3
roen Reason fo enial
IX. Condiggsfg 1qgWlReasons for Disapproval 3)l Q~; / QGaG4 pro
1. Septic tank, effluent filter and f 4/ ;
dispersal cell must all be services I maintailltsd 3 ~J t
as per management plan provided by'plumbei,
2,: AD setback requirements must be rnaintaini
`as " 4:iode, f prdiruWAS. _
Attach to complete plans for the system and submit to the County only on paper not less than 8 M z 11 inches in size
SBD-6398 (R 11/11)
A
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
Owner's Name: -~f>? IQ
Owner's Address: ZS
Legal Description: /J
Township: C Q /\J lp
County: j~1-f C R-0 /Y,,_
Subdivision Name:
Lot Number:
Parcel ID Number: Q Z b 11 b 7', ^ -00 Q
Page 1L
Index and title
Page Plot Plan
Page 3 System Sizing & Cross-Section
Page 4Filter Specs
Page 5' Maintenance Information
Page 6'' Management Plan
Page 74
St. Croix Cty Septic Tank Maintenance Form
Page 8,, Warranty Deed
Page 91 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: 6rl T-rL ) License Number: 22jl~
Date: Phone Numbers Z7,3 ~LfL~L~I
Signature
7.1r L
L
p' I
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
pj
6 C A-L-e
a c ~ PD Sk - I''
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w~te
1571A '
B3 ti~cX ~ ~
G
~x
i
Soll AbsplRffon Sv~ystq„m Cross Section
ft q
t~ S 6
j tt
4" Schedule 40 Final Grade
PVC Vent Pipe
With Vent Cap_ ft
Leaching. ~y Z gZ,s q'
Chamber
y ~ System Elevation
-3--ft ft s ft ft
Soil Absorption System Plan View
ft
ft
f
S Leaching Trench 1
Chambers
4" Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model l/U ~L f~/2 n- lC t4e us
EISA Rating sq ft per chamber Soil Application Rate pd/sq ft
gpd Design Flow + Soil Application Rate EISA = 7-Chambers
3 rows of Z,5 -chambers each.
Page of
as
Quick4 Plans standard Chamber Side and End k: ews
48"
(EFFECTIVE LENGTH)
12"
-A W
~34"~I
Quick4 Plus Ail-in-One 12 Encap Front, Side and End Views
11.2"
13" •
LMOLL
8" INVERT 8" INVE T
5.3" INVERT
--18.2" 33"
Q ick4 Plans All-in-One Periscope
OUICK4 PLUS
ALL-IN-ONE PERISCOP
(360' SWIVEL
6
ALL
12.7" INVERT QUICK4 PLUS
ALL-INANE 12
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
INFILTRATOR
®
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty
0, 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. s y , ten 1 S ! n c .
k 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
t 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.t 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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START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products r other chemicals
that may impede the treatment process and/or damage the dispersal call(s). If high concentrations are detected have the contentil
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 falls 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:
O 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.
O 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.
O 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.
13. 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 4 & 12 eL Std Name
Phone S- Z73 ' T T Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name E Name 5-,c Z-,~r//~tl
Phone Phone
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.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 40 DD Septic Tank Capacity al ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
Effluent Filter Manufacturer z ❑ NA
DESIGN PARAMETERS
Number of Bedrooms ❑ NA Effluent Filter Model Q ❑ NA
Number of Public Facility Units -W-NA Pump Tank Capacity al A
Estimated flow (average) gal/day Pump Tank Manufacturer ANA 11 Design flow (peak), (Estimated x 1.5) (S~ gal/day Pump Manufacturer etf4A
Soil Application Rate al/da /fts Pump Model 15V 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 (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average - Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD6) 530 mg/L Kin-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: O NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
-3 D ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
® ear(s)
Clean affluent filter At least once every. O month(s) ❑ NA
® ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
3 H ear(s)
Flush laterals and pressure test At least once every: 0 month(s) O NA
ry~ ~ 103. ear (s)
Other: At least once every: 13 year(s) 0 NA
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 Qn the ground surface.
The dispersal g0II(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 regulator 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 th.e,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 44/01)
I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer IJ~
Mailing Address IJ Q 2 Z A J J~ ~C J~ fl
Property Address
1 g~ 1' '
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number 0 2 6" T b J -0 0 0
LEGAL DESCRIPTION
Property Location Iy /z, ~1/4 , Sec. TN R~W, Town of ~I c~~✓~
Subdivision L Ne y f- Pl- c73--r~- y , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # Volume , Page #
Spec house es no Lot lines identifiable es 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.
Uwe, 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 thi17deed are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a wrecorded in Register of Deeds Office.
Number of bedrooms
r9 V~-/ Z I
SIGNATURE OF APPLICANTS
O 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 warranty deed.
(REV. 08/05)
}
8 Txi4037564 $ #
State Bar of Wisconsin Forma-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. PAGES: 1
("Grantee," whether one or more).
Grantor quit claims AS4S. 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 OGLAND
ESTREEN & OGLAND
Lots 12 33 10 1 14 nd 15,•Lundy's Preserve in the Town of Richmond, St. Croix 304 Locust 16
County, Wisconst Hudson, W1 540
i
026-1167-01-000. 026-1167-02-000: 026-
1167-03-000: 026-1167-10-000:026-1167-
13-000:026-1167-14-000:026-1167-15-
000
Parcel Identification Number (PIN)
Dated o7-a 0" Ia CitizensS by:
f
(SEAL) v (SEAL)
'Thom s Van Pelt, President and CEO
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
authenticated on /t o! ) ss.
v' COUNTY )
Personally came before me on Thomas Van Pelt on Ia-
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named
(If not, to me known to be the person(s) who executed the fo
authorized by Wis. Stat. § 706.06) instru ent and acknowledged the same. u`^+tl B• WILLERT .
(Votary Public
THIS INSTRUMENT DRAFTED BY: . t;lta
T-I -Of Wisconsin.
Kristina 6iland Estreen & 021and Notary Public, State of
304 Locust Street Hudson. WI 54.016 My Commission (is-pie) (expires: 1-"I 5 )
I
(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 0 2003 STATE BAR OF WISCONSIN FORM NO. 3-200.3
• Type name below signatures. INFO-PRO° Legal Forms 800-655.2021 www.infoprolorms.com
1 of 1
I
Spa ~ ~ 5171-1
Wisconsin Department ofCommerci ; l ' `y,• SOIL EVALUATION REPORT Page 1 of 2
Division of Safety and Buildings y .
,o a ance with Comm 85, Wis. Adm. Code
County ST. CROIX
Attach complete site plan on p poer not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (B) on and Parcel I.D. 026 - 1167 - 14 - 000
percent slope, scale or dimensions, north arrow, and locatjpn~n o nearest road.
1 Re ' e b `
Please print all inform n. Date
Personal information you provide maybe used for secondary purpose ( 'v~y' ~ 15.04 (1) (m)). to,7 ~3
Property Owner jul, ,Prrty Location
1:1 El
TODD MAREK CONSTRUCTION INC. t CaQtxC Govt. Lot NW 1/4 NE 1/4 S 27 T 30 N R 18 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1298 138th Street 14 Lundy's Preserve
City State Zip Code Phone Number ity [:]Vllage E Town Nearest Road
New Richmond, WI 54017 ( 715 ) 377 - 6240 126th Street
E) New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement ❑ Public or commercial - Describe:
Parent material outwash Flood Plain elevation if applicable NA fl.
General comments Conventional In-ground trenches 0.4 loading rate
and recomuldatitk'ff"~ coil vtvQ r 1 p f~S ' I G( (/u~CS~
A 1 o!J -W 'PRZi/1 ou5
a Boring # Boring
Q Pit Ground surface elev. 10 . ft. Depth to limiting factor 102 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
1 0-14 10YR3/3 sil 2f-msbk mvfr cs 3vf-m 0.6 0.8
2 14-22 10YR5/4 - SO 2fsbk mfr aw 2vf-m 0.4 0.6
3 22-36 7.5YR3/4 Is Ifsbk mvfr aw lvf-m 0.7 1.6
7.5YR4/6 s Os ml 0.7 1.6
4 36-102
a Boring # Q Boring 104.99 ft 110
Pit Ground surface elev. . 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 0-16 10YR3/3 - sil 2fgr&sbk mvfr cs 3vf-m 0.6 0.8
2 16-26 7.5YR3/3 sl 2fsbk mfr aw 2vf-m 0.6 1.0
3 26-58 7.5YR4/6 sl 2fsbk mvfr cw 2vf-f 0.6 1.0
4 58-110 5YR4/6 - s Osg ml 0.7 1.6
Horizon 2 has 5-15% gr; horizon 4 has some pockets of l OYR3/4 sl.
* Effluent #1 = BOD > 30:E 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = BOD 30 mg/L and TSS _5 30 mg/L
CST Name (Please Print) S ture CST Number
Mary Jo Ruppert Hollister's Soil Testing & Design) 224832
Address _ Date Eva ion Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 05 - 22 - 13 (715) 426 - 1775
is
Plot Plan for Site and Soil Evaluation Page 3 of 3
Property Owner Tom #Wmr, COA S MuMIM -'L-, c-- I - . i
1"=40ft
Legal Description u ,-r 1y~ ,voy's PRES t (except where noted~'
o F Vit- AM 1/qs a7, 3&~, RJGJ- '7'Dw4 ] = Dackhoe pit
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04/23/2013 20:45 FAX _ 001/006
:gym, IN VOL' 12 PG. 3421
-i- - - - LOT 3 I U1
140th Avenue QR1H UW OF 711E WIA
osot
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33' i . 33' 33'
# LOT Z
A 2.173 ACRES
K733 SQ. FT.
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04/23/2013 20:45 FAX 10001/006 _
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _,L of -3
Division of Safety and Buildings
in accordance with Co m. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inc s in s,.tRlSot~ r
include, but not limited to: vertical and horizontal reference i (BM), direction and p I.D.
percent slope, scale or dimensions, north arrow, and I ion a d distance to nearest road. Z
Please print all inform (~J~ 20~~ `^e`" d by Date
Personal information you provide may be used for secondary pu es . a,q . f.R,0
Property Owner ~WAVgation
Govt. Lot 1/4 Alj~` 14 S~ T N R E (o W
Property Owner's Mailing Address Lot # Block # TUN. Name or CSM#
City State Zip Code Phone Number City 0 village wn Nearest R
New Construction Use: Residential/ Number of bedrooms Code derived design flow rate - 4~< 1Ji~ GPD
❑ Replacement ,~1 ] Public or commercial - 0 cube:
Parent material ~~~LG f ~ Flood lain elevation if applicable✓~ Vf ' ft.
General coriN,er>is lU,J 31, and recommendations: S><P~,~-e -C~/z/
Boring # ❑ ring
171 Pit Ground surface elev. (I 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. ~p 'Eff#1 'Eff#2
I-j-/ 2. 0 ,-0
2- 12- 2~
JA ~~JW L,
Iva 17l`, "L.J
j q5
a Boring # ° ring
Pit Ground surface elev. ~ ft. Depth to limiting factor ~~u~• 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
2_ 0- Z /V A1 1-1-11 '3
09
Effluent #1 = BOD > 30 < 720 mg1L and TSS >30:E 150 m9A- 1h Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signa CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Date Evaluation Conducted Telephone Number
Address
-246-4516
715
1008 192nd Ave, New Richmond, WI 54017 ~7 ,9
r~ t
Property Owner Parcel ID # Page of
531 Boring # Boring Q-
Ground surface elev. _~I 1, ro ft. Depth to limiting factor in. Soil ication Rate
Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPDO
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh.
3 Y .Q
s t
C
❑ Boring
Bori #
elev. ft. Depth to limiting factor in. ❑ ❑ Pit Ground surface Soil ApplicationRate
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 # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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 < 220 mg1L and TSS >30 < 150 mg1L ' Effluent #2 = BODS 130 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 Ot.6M)
Soil Test Plot Plan
Project Name Environmental Holding L.L.P. Sha ' d
Address 706 19th St. S. rf
Hudson Wi 54016 C M #226900
Lot 14 Subdivision Lundy's Preserve Date 5/24/04
N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 93.4/92.8/92.2 *HRpSame as Benchmark
Alternate Benchmark Top of Survey Iron @ 96.0'
B.M.
It. B.M.
120' 246' Property Line
320' Property Line
50'
B-1
60'
90'
B-3
7%
Slope 10'
B-2 Please note:Soil test
was done to satisfy
97' county zoning
requirement. Soil
test may not be
suitable for owners
512' Property Line desired building
location.
Pro Town Road Scale is 1" = 40'
unless otherwise
noted
RECEIVED
o JUN 01 2004
Lundy's Preserve Comments: sT. CROIX COUNTY
ZONING OFFICE
The 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