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HomeMy WebLinkAbout030-2141-00-004 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561071 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 Oeverin Homes LLC, aka Oeverin Pro ertie St. Joseph, Town of 030-2141-00-004 / CST BM Elev: Insp. BM Elev: BM Description: 5~ Section/Town/Range/Map No ~,ryr~ ) J 36.30.19.2054 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic s dd Benchmark P', • /d3• /aa Dosing Alt. BM (I AM -77 Aeration Bldg. Sewer S •.y• Holding St/Ht Inlet to • Z T. TANK SETBACK INFORMATION St/Ht Outlet 4?7•2 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` Dt Bottom Septic Dosing Header/Man. q7 Z- Aeration Dist. Pipe .(P Z Holding Bot. System 7• t. 9 99 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cov r ~tw GPM 11 1 3 • Ad •-7 um Model N TDH Friction Loss System TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a 'D Z (/P'- 4 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR : C n Type Of System: UNIT Model Nu2L Jel DISTRIBUTION SYSTEM 010 lds Header/MaNI~ Distribution Tole Size x Hole Spacing Vent fp Air In ake Pipe(s) d Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center 'yr 3 • Bed/Trench Edges Topsoil Yes ❑ No Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / Location: 814 126th Ave Hudson, WI 54 16 (SW 1/4 NW 1/4 36 T30N R19W) Natalie's Ridge Lot 4 /I Q Parcel hNo: 36.30.19.2054 1.) Alt BM Description = C 4-' hOG/C. 2.) Bldg sewer length 4 - amount of cover = 1~ Z • S Lo J e~ - - - - r-G83`f Plan revision Required? ❑ Yes No 5 76~ Use other side for additional information. Date Insep is Sig ure Cert No. SBD-6710 (R.3/97) 8~1a~•~ ~ Caulky Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 r~ + Sanitary Permit Number (to be filled in by Co.) za Madison, Wl 53707-7162 ~ 3 213 lS 7 ~7 / S Itaaarp(C~X1X~iit Application State Transaction Number In accordance with SPS 383.21(2), 51 ~is~`Atlttf.`tode, submission of this form to the appropriate governmental unit A )A required prior to obtaining a sanitary pennit. Note: Application forms for -vred POWTS are submitted to the Departnimt of Safety and Professional Servies. Personal information ov ra project Address {if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. y be used for secondary ~~77 I, lO n Information -Please ]Print All Infor n I ~t7~ 6 , Property Owner's Name ' Parcel # Property Owner's Mailing VIlress ~~c.~✓CX.~ Property Location /Y3 ~2054 City, State Govt. Lot Zip Code Phone Number , l'r . '/nYL~L~! Section )P, gA. •ircle o II. Type of $uilding (check all that apply) Lot 1 . 3 0 - 1q; It pO r W I or 2 Family Dwelling - Number of Bedrooms _ Subdivision Name f ~D V6L. Block /!-~C~~7 %n _ ❑ Public/Commereial - Describe Use 1CJ_ (t,~, ❑ City of_ © State Owned - Describe Use 7 CSM Number ❑ Village of /J A,~~ S ~~Zz G~a.M~oer3 ownof~`~cNfllf~ M. Type of Permit: (Check on one box on line A. Complete line B if applicable) ystem ❑ Replacement System ❑ Treutment/Holding Tank, Replacement Only ❑ Other Modification to Existing System (explain) Il• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Tran- sfer to New 1 ist Previous Permit Number and Date Issued Before Expiration Owner ! YV. T e ofPOWTS S stem/Com onent/Device: Check all that apply) A-r-, 111, 11 r on-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable sod ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) - ❑ Pretreatment Device (explain) V. Dis ersaUTreat ent Area Information: Dust Flow (gpd) Design Soil Application Rate dsf} Dispersal Area Required (s Dispersal Area Proposer s System leion Ill. Tank Info Ca aci / ' / t7 • L P tY m Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tunics n v 9 6 Saptic or Holding Tank Q U i;5 w C7 A, Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume re, s' ility for installation of the PO'W'T•S shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MFRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code fl ..S VIII Coun /De artmeot Use Onl Approved ❑ PermitFee Date ued Issurtt Signature 7 or Denial $ / J • ✓ ~y ~3 IX. Cond ~ easons for Disapproval QQ n 1 Sf*i6tank, efk*ntfilter and 3,,Odrl / D✓~` ~'1ovv.~pwrt~~ dispersal cell must all be services / maintatto te / r as.per management plan provided by"plumber. Ott S /N2t ii or~• , 2. -All setack requirements must be maintained. as per 'cattle code / ordinances, Attach to complete plans for the system and ubmit to the County only on paper not less than 8 In x 11 inches in size -13 b e /A SBD-5398 (R 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX i MPRS Shaun Bird 226900 DATE 5/9/13 BEDROOM 4 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Base of stake ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 126th Ave SYSTEM ELEVATION 96.5/96.4' 4' below qrade All piping shall be SDR 30/34, within 10' Vent of tank, piping shall be Schedule 40. >6" Quick4 Standard Well is to meet all of Cover Leaching Chamber setbacks required by with 20.0 ft2 of Area WDNR 5.6ft^2/pair of end caps 4' Long 12 100' Grade at System Elevation B.M. 34" 70' Scale is F = 40' unless otherwise noted Pro 4 Bedroom 10' House 0, 90' ST 20' B-1 45140' 2-3' X 90' Cells with >3' spacing Not enough slope to establish B-3 contours 85' 0% Slope 0' 55' B-2 Vents Property Line 5 t Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/8/13 Owner:Oevering Homes LLC Location: SW1/4 NW1/4 S36 T30N,R19W 814 126th Ave St. Joseph 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 8-10. Soil test ~f Signature License num er #226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/9/13 BEDROOM 4 CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Base of stake ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 126th Ave SYSTEM ELEVATION 96.5/96.4' 4' below qrade All piping shall be SDR 30/34, within 10' Vent of tank, piping shall be Schedule 40. >6" Quick4 Standard Well is to meet all of Cover Leaching Chamber setbacks required by with 20.0 ft2 of Area WDNR 5.6ft^2/pair of end caps 4' Long 12 100' Grade at System Elevation B.M. * 34" 70' Scale is 1" = 40' unless otherwise noted Pro 4 Bedroom 10' House 0, 90' ST 20' B-1 45' 2-3' X 90' Cells with >3' spacing 40' Not enough slope to establish B-3 contours 85' 0% Slope 0' 55' B-2 Vents Property Line 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 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 100.4' Vent Grade Vent 3' 4„ 3, X30/34 Septic Tank 5' Long 5' S' Long 1 Grade at System Elevation 3671 Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-96.5' B 96.4' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner q Septic Tank Capacity gal ❑ NA Permit# Septic Tank Manufacturer -~~El NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.15) L7 C/ gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ft 2 Pump Mode! NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetiand Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODr,) _<30 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L /116 NA ❑ At-Grade D Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 16 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: ❑ monthts) (Maximum 3 years) ❑ NA _ j4ear(s Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ monthis) ear(s,~ (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ~i ❑ month', i s) El NA Inspect pump, pump controls & alarm At least once every: ❑ monthis) ❑ NA _ ❑ year(s Flush laterals and pressure test At least once every: ❑ monthis) ❑ NA ❑ year(s) Other: At least once every: ❑ monthis) ❑ 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 Servn:ing 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 ('f3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc 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 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 ans, service event. Page of r~ START UP AND OPERATION 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 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 scrape; 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 replace vent system: 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. ❑ 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/OF? INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DI°_ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone _ f~lj Phone - - SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AUTHORITY Name a ,LJ _ Name Phone = o~ C Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. hLTER LARTRIDGE INSTRUCTIONS ~rWal>t~on S rLrp .Y bly fit the {t kV. rdntw, ad under ti, arc o w '"hta Ua m rind tIt t:#tat autlu t funk Nrratgth tittr eruC ar Vail' sat Waif ttet r t#rqr{ lrltiusY Ihsrwrt Mwrd d rr►.{b Pips• 4i tlylob) uddlUahaf plftet lNeCu Cf►e trutWt the _~'~tw~ a bllhihr then esrasr ig vtNi~ ,try ~tI'aaid t►M of +Ni~lnch p{lte vararlaeM tm brr Cr, the ~lte,t t,~ ►u ter ai#Chu ttuC#ut u1 i, rrra2rSxrre fire lvnyHr el►Na►ee►l supPke 1110tal !dide suwm mL Lr vide au to x114 welt 0 utllieing the prar.~a{td ht a* (am pAart Ire"Wild . (if 'lot utgixad, illo.V .1 aPut id Halfatlrrh upfl`airry t#W ~plufaul wplYlteht>tnkatl side support- ufNlad ut ed, g pre►otderedit,a ' +r to d- om ued:o t{tre filter r u. If 5fdee subpurr MakhAd ir, not o slra ep SolVdht WWd the ({Real' t:Ugp ahtu the uldlkt pure. urt the lifter ' catt'rtdger into ttre Cabe', pjgSSittr tiro rase. f r#9ttifl Uhk{l t 1r'rb ° the 616r luC#re IgCu the brrttr,r„ of It u V#'9 SWltOl iy titflk&A.' itrusit loto th%, lifl>etr ahd ice; rlnckaruk a Wp, 6aelr by ttlrnln(j ;4 J 1. Thar r/flllorrt lifter etirrauld be ur44tined every urns , serviced fife ampCls Wilk 15 2. t?peh that auklat mr easm ap*Aklu to lnsfaeaa:t the tw* Old KW. 9, Pump tl tr snptic tank cwrapieately, mmkitIq Sorg to furnilVe Che rdudvar 4 lbaye,r bet the batta►t► of the took and "at,tumt then bpeltrt +ihd offluurrt, A. D*Jc& tirm efrlaernt lave! I,na t+stan farwered huloW the invert ref tiro outlet pipes, ffrrtrf m cubit due f+mn thlr case. on thlr, if{tar handier to dislodge that rs 51 spde the ra•bld a dw u4 crud ever: ut tl,e atace tY►r c{eiltiittlf u ri, rr u Vf{S 5Mtt;b Whirriectod to shiruld hr► ra►rroved by t,ur►Nrall re ettrrttarr~ ~fhetfL, C1te svwitr:l► with Wa%r ardv. oakwlsat 5Ct Wild deantld 7. While haldhttl the L%V*# down) over the ~4'u'eras i{ ft GIB faidd (large tlLt surfctera frurbrta •r•''`s pe"mV, rill"O WOW Witrid wijcie ,4 rr~iaq,,, only, rYrmkirry more all amptagm. turaatW%j IS r1fosed buaCk lbto With to k_ y a H fl'' VRS switch is utilised +I ' , raplaal:tr ley iirgartltram foie l#l ~ •"~Ir"/tita+r t+ turuU•rg cinCkwt,;e tarp. ter and 9 s, ltts,ert tht, filter ctrrtridyia back flair the time the filter Iaoks li to the ISCADur, 1{rttlililak( dathnr utrtil 1 a, at ittrr carsrsr. ~ib,•1, . ' lq.Rugloce mid secure the +tl:rar;li i{pen{lyd or, t#te taitsit. •1•1« • „ :J d~•N 4 rvr; "a r;.7 4 11'Qt' Jl . . • .ail • • 'fi~+~►'rN:~i►l~~l't'~lltlue~Y'~.~cl~rrit. ~'"~a ~'4~.t~`~+Z"~ ~'1~►'~"l~w+J~5'i~~.~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer e'5~evP✓ C Mailing Address Property Address ed (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number, .s~ f G ~LT~ _ v LEGAL DESCRIPTION Property Location ' Sec. T 0 NR W, Town of Subdivision Lot # Certified Survey Map _ - Volume Page # - - - Warranty Deed Volume - ~ , Pale Spec 11011S (5 reo Lot lines identifiable yc. 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 :t2 - 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, asset 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 T_.'oning Department within 30 days of the three year expiration date. Uwe certify that all statements on th" f in are true to the best of my/our knowledge. I/wo am/are the owner(s) of the property described above, by virtue of a wa anty deed recorded in Register of Deeds Office. Number of bedrooms----~ - AdN' I' 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 warranty deed. (REV. 08/OS) Om ►~1 500'19,9rE 36k98~ RO ZIT N Igg CA N ~n ( 3 I : O °m w JMi~J _ g C c"~ a j §j d I I m ' MS3 J S00'19'19'E 564.98' I I •o N ( 75'-y _ I m ~ C t M eQi I ` ~ C a ^ `x--75 2000 h 500'00 W a 8 82ND STREET- n to S0019'1VE 564.98' n NOOWOOIE a aa~ N ~ s# $ I O §Rm W ~ << ? 7 SOOIVIO'E 564.98' $G7 ~ YS I 'N,q~ ~ ~ I I t 1a9.~ 3iN\ ~ f I I II I III Ill I l l l l l l l l l l l l l l l l l I DOCUMENT NO. STATE BAR F WISCONSIN FORM 1-2003 8 1 5 2 9 3 3 WARRANTY DEED Tx:4124584 978046 THIS DEED, made between Shaun Bird, single individual ("Grantor" whether BETH PABST OF DEEDS one or more) conveys and warrants to Oevering Homes LLC, a Wisconsin REGISTER STER CO., WI limited liability company("Grantee", whether one or more), the following ST. CROIX de 'bed real estate in ST. CROIX County, State of Wisconsin: 05/07/2013 09:30 AM EXEMPT#: NA Lot 4, at of Natalie's Ridge in the Town of St. Joseph, St. Croix County, REC FEE: 30.00 Wisco sin. TRANS FEE: 90.00 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 030-2141-00-004 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2013 real estate taxes. Dated this 3rd day of May, 2013. lzaGn Bird AUTHENTICATION ACKNOWLEDCMENT Signatures authenticated this day of STATE OF WISCONSIN 20- 1 ss. COUNTY OF TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Personally came before me this 3rd day of May, 2013, the above named Shaun Bird, single individual to me known to be the authorized by § 706.06, Wis. Stats.) person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert L. Loberg / Loberg Law Office * h • t~lf hJ .~~~••'•"'>A,.. Notary Public fX County, W. ,•is..~;~`~~ Q EN ,ti 1314292 / asc My Commission is permanent. (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: not necessary.) l ~t t ,O ,d d e Names of persons signing in any capacity should be typed or printed below their sibnatures. WARRANTY DEED Form No. 1-2003 1 of 1 FiRTNI~ 6 cn M IF l lr " = o i g ~i U11 WW w 00 I` 01 I~ I F ~'Y s, 0, EL R ~m 4 I I s ~ ~ I ~ I 7t I 4 99 tC$ t14 Qr C'O < v Mc al.ol A•.a - I ~ .V I do u .r I ~ ~ I I Z £ ~ I A I 2 Wi of i Y~IIAW,~1vM0 ~.~e'L rierx. A!8 x6 o o.e.,tlse~rJr~. 8 - - IR I ~I~l~ g~ ~ a Yloe . pot tt 8 u " ~w~ry.war, - ~ tl,iuva or~n.atlnJaltlxrtl - aawwAUamuvurxee { o+i wtnrnaAODUe y A£ I lad b I uteri Vn i I Va x~,3nn„V,.oJ~,tltl I I < Y,YIL A'.v a 1 I I I tr I I J I I r~wn anniiuMa3.'+niorr ~ I ( e I I lit I I A•A .tl Y I~ ! F77 _ J X 'G W him all" LU o z~ u1 A.a o'a <.a i .0 30 N~ m] a ro w h= ~ I +J 140 Q s I 2 I I + _p N I O ..x I r e 3 ~ ~ p R ..moo.. R " i : O A I e ~ FB ! I 4 sx~ ~ uxoan mna xex I ____1___~ rn vunirx,e 1 I + nhle r I I I I I I 1 I I I I I ~ I I IL- - - L_-__.lJ I I I 1 I I I I I I 1 + d ~ ~ j ~ I s I ' i d I I I j I I I 1 I ~ I r I r + I f I ~ I + I I r x I I , ~ i I I I h~~ I f j I 8 o k l ~ lay A.r. I ~ AAe I AAi JJ j~ ^y I ~ u ~ I I I'• I I_ I I;,I I I 1 I oo.ev,vuvrvl. uemv+i 11 I I j I rnr II I'•I I ---+IJ I LllJ I'~ I I I~ II I I I I I 11 II I,. I I I ~ I II ..nv~v y, I ~ I 1 "I _-_L-______ y t L~ i ~x I I IIfI I I 1 'I ~ I I r 9 I` ! q I lL , b a I I - _ _ • I 1 I I m I, I Ilg ~ i' ~ j j I i 1"T~-~~q I L' I C I f 1 a i t I, I I 4 r Ir ill I I I IS L.1 I I I' a I ~ O I I t6 ~I III I i j I I I~ ~~IaQJ---~ l__ b 5 1 I I I I I I I I I I I I I I ~y°y I I I d I I rl I aga I I I a I.,~ 1 Y~ I r~l ~ I I P I,~ I I I',I I ` I 1 I ~ ~ I I = I I I I II I I I II 17L---------- gig ~$Sg 8 ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety andBuildings ~ED in accordance with Cc 5, is. Adm. Code 1.. i Attach complete site plan on ~1of less than 8 1/2 x 11 inc m t County 4 I include, but not li } tot J~rt bad horizontal reference point (BM), I Parcel I.D. percent slope, sb Or dimensions, north arrow, and location and dis ton ~i. ST CUi9Y/ht all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location / Govt. Lot 5C C~ 1/411,1 /4 S T N R Z E (o W e f~ Property Owner's Mailing A press Lot # Block # Subd. NarAb or CSM# l City State Zip Code Phone Number ❑ C./ ❑ Village To Nearest Ro - vl7( ) New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describ ,r- Parent material ©4 .v O~!>°~f'/ JiG ,~7s.CEio',odnnPlain elevation if applicable AZZA ft. General comments a A. we.44' and recommendations: ld l01- 3 Ja r`l~ aQ. y i3~ ln~ System Type L`1`~Sys Z Elevation F T] Boring # Epl~ Boring Ip- Pit Ground surface elev. ✓ ft. Depth to limiting factor (119 in. Sal Application 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 1 3/ • 0 -17 2 - zdl- S v Boring # C] Boring FA-1 Ej pit Ground surface elegy/. Ok9- 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 &Lw 'Al /r A Effluent #1 = BOD > 30 < 220 mg& and TSS >30 1994 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Ignature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008192nd Ave, New Richmond, 017 715-246-4516 Property Owner _ Parcel ID # Page of M Boring # ❑ . K~( ~Boring , pit Ground surface elev./ o -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 4 r Os'~ ,-7-7 12 D Vr's- -rn - Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate E:] 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 I I F-1 Boring # ❑ pit Boring ❑ 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 I Effluent #1 = BODs > 30 < 220 ng/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS < 30 mg/_ and TSS < 30 mg/L - The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB68330 (RAM) ~I Property Owner Parcel JD # Paga of ❑ Boring Boring # pit Ground surface elev./ 0, f ft: Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 `Eff#2 (I Z 4-1 r2-7 -7 ❑ 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 GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate . Horizon 'lepth 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 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 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. 5848330 (86/00) Soil Test Plot Pla Project Name Oevering Homes LLC Sh Bird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 TM #226900 Lot 4 Subdivision Natalies Ridge Date 5/9/13 S W 1/4 N W 1/4S 36 T 30 N/R19 W Township St. Joseph ST. CROIX County Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. Bottom of Stake on lot line System Elevation 96.5/96.4' *HRpSameasBenchmark 126th Ave Scale is 1" = 40' unless otherwise noted 100' B.M.* 70' Pro 4 Bedroom House 90' B-1 45' 40' Not enough slope to establish B-3 contours 0-4 85' 0% Slope 0' 55' B-2 Property Line D 1317 Wisconsin Department of t J S EPORT Page I of 3 Division of Safety and Buildings in actor nee m 8]5, >Wis.. Adm. C Tom Schmitt Attach complete site plan on paper not less than 8'% 11 inches in sae Plan fis t County St. Crobc include, but not limited to: vertical and horizontal rence 0'0 erection and percent slope, scale or dimemsions, north arrow, a Iocatiorr~ tg~lq?rys~t road. Parcel I.D. Please print all information. G UFF1UE V Revi ~ Date Personal information you provide may be used for secondary purposes (Privacy Lair, s. 15.04 (1) (m ,c : a 6S" " Property Owner Property Location Grand Properties, LP Govt. Lot SW 1/4 NW 1/4 S 36 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 4 Natalie's Ridge City State Zip Code Phone Number _j City J Village 0 Town Nearest Road Somerset Wt 54025 715-247-5900 St.Joseph 80Th St. i✓ New Construction Use: 1,~I Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement I Public or commercial - Describe: Parent material outwash over sandstone r✓ Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mounds tem. System elevation is 99.33' based off of contour line established at 9 lope i00% (flat). Depth to limiting factor is 28". Boring # Baring ri/f Pit Ground Surface elev. 98.53 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 "Eff#2 1 0-11 1Oyr3/3 none sl 2msbk mfr as 2vf .6 1.0 2 11-28 1Oyr3/4 none sl 2msbk mfr 9W 1vf .6 1.0 yrr6/2 sil 2msbk mfr cW .6 .8 3 28-36 1 Oyr4/6 c2d 7.5y /2 4 36-79 10yr5/6 none ms Osg ml as .7 1.6 5 79-96 10yr8/1 none vfs 0 cemented - 0.0 0.0 2!] F Boring # Boring Pit Ground Surface elev. 98.41 ft. Depth to limiting factor 47 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz I *Eff#1 *Eff#2 1 0-15 1Oyt3/2 none sl 2fsbk mfr as 2vf .6 1.0 2 15-30 1Oyr3/3 none vfsl 2csbk mfr gvv 1vf .4 .8 3 30-47 1Oyr4/4 none vfsl 2msbk mfr cW .4 .8 4 47+ Oyr82 none vfs Om cemented 0.0 0.0 " Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS <130 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 12116/04 715-247-2941 V Qroperty Owner Grand Properties, LP Parcel ID # Page 2 of 3 3 ] Boring # Boring Pit Ground Surface elev. 98.53 ft. Depth to limiting factor 34 in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-12 10yr3/2 none sl 2msbk mfr as 2vf .6 1.0 2 12-19 10yr3/4 none vfsl 2csbk mfr 9w 1vf .4 .8 3 19-34 7.5yr4/6 none scl 2msbk mfr gw - .4 .6 4 34-47 10 6 m2d 7.5yr6/8 sic[ 2fsbk mfr cw - 4 6 7.5 /1 5 47-60 10yr8/2 none vfs 0 cemented 0.0 0.0 Resistance to penetration at SlY'. Boring # J 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 *Eff#1 *Eff#2 ~I i I~ ❑ Boring # I 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 *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S_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. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street 1595 72nd St. City, State, Zip: Somerset, Wl. 54025 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Name: Natalies Ridge 16 -p Y Lot No.: --4/_ Legal Description: ,5Z,) 1/4 MV 1/4 S36 T30N RI 9W Township of St. Joseph, St Coix County Bench Mark El. 100.00' Top of 1/2" rebar Alternate Bench Mark El. X 0 i Top of 1/2" rebar Slope= Contour Line EL Scale 1" = 40' 63 ~9, S'.3l din Q~ yy~ 43 Pdt 7 1y33 Qrqosed This soil report was done to fulfill a zoning requirement. A preliminary plot map was used, no drainage easements or driveway locations were established at the time this soil and site evaluation was conducted.