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HomeMy WebLinkAbout026-1082-70-000 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Cornmerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 563809 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: Durbin, Lance & Cath n Richmond, Town of 026-1082-70-000 CST BM Elev: Insp. BM Elev: BM Des tion: Section/Town/Range/Map No: AnD .0 ~v U 6 / '0 A-yh 28.30.18.435A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ul,~~ndvJN /o ~0 Benchmark 25- 0/. 2- l O D - O ing Alt. BM Aeration T ~1~fL~ Bldg. Sewer ~~5~ v 9 -0 Holding St/Ht Inlet ( / Outle Q 6 3 TANK SETBACK INFORMATION SUHt ' -75 TANK TO `A j P/~ + WELL BLDG. Vent o it Intake ROAD ~ t ` -75 (c Septic CV b f V ` D UI Q ! V. V<- Header/Man. Poo > g l~ O I ~ 4V hs OW /T ~ Aeration Dist. Pipe? 7- 9 3 Holding Bot. ysterry Ir - pS Final Grade PUMP/SIPHON INFORMATION '_)1W VI ' Manufacturer Demand er GP Z 9,V -7 Model Number ty~ TDH Lift Friction s Syste ad TDH Ft Forcemain Lengt Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING M c urQ` INFORMATION CHAMBER 'fy Typ f System: lob t-17~ /0 r / Model Number: D BUTION SYSTEM V (J /T ader nifold ribution [ x Hole Size x Hole Spacing Vent t Air Intake i I U Pipe(s) cn~/!_C/^✓ Length Dia Length Dia Spacing SOIL 0-VER x Pressure Systems Only xx Mound Or At-Grade Systems Only pth Over Depth Over xx Depth of jxx Seeded/Sodded xx Mulched Bed/Trenc enter A Bed/Trench Edges Topsoil ®Yes No Q Yes F:M*_]No s COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 ~ 67 i Inspection #2: Location: 1150 130th Ave. New Ri nd, WI 54017 SE 1/4 SW 1/4 28 T30N R1 8W) NA Lot 1 Parcel No: 28.30.18.435A 1.) Alt BM Description = 'T-0 of Man kol a4,~ 2.) Bldg sewer length = w V , - amount of cover = ~ r - - Plan revision Required? Fffl Yes No S Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) County - Industry Services Division r l U $ p '1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P.O. Box 7162 Madison, WI 53707-7162 »•'r~ -3 490~1 State Transacti umber Sanitary Permit ication e m to the appro overnm7~ - in accordance with SPS 383.21(2), Wis. Adm. Code, su Wn V 41- is required prior to obtaining a sanitary permit. N r state-owned I e submitted Project Address (if different than mat it address) the Department of Safety and Professional Se s. you provide may be uslr, syondary ~Q ~UL purposes in accordance with the Privacy Law (IST I. Application Information -Please Pr Il ormat' Oil-, O Property O ner's Name ~ >l~ pOH~ Parcel Property Owner's Mailing Addr::ss Property Location 5-D / Sod l~~, - Govt. Lot City, State Zip Code _ Phone Number S r,A Section Z 2 Ec cle one L T3vN: R_E J [I, Type of Building (check all that aply Lot H Subdivision Name X4-Z, 2 Family Dwelling -Number of Be" s 40 jGe_ rH Block it ❑ Public/Commercial -Describe Use L4 ❑ City of CSM Number ❑ village of _ ❑ State Owned -Describe Use own nf_1 _ I Z Q; III. Type of Permit: (Check on4e J- l Cis _ - box on line A. Complete line B if applicable) A' ❑ New System ,cement System ❑ Treatment/Flolding Tank Replacement Only ❑ Other Modification to Existing System (explain) - List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision ❑ Change of Plumber 11 Permit Transfer to New Before Expiration Owners t,~-11 QA.21~ =10 f POWTS IV. Type o S stem/Component(Device: (Check all that apply) n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain) ❑ Pretreatment Device (ex-p-la-in)g V. Dis ersal/Ti ea ent Area Information: ? - - 7D sign Flow (gpd) Desigr Soil Application Rate(g st) Dispersal Area Required (s Dispc sa! Area Pr>posed (sf)~ System Elev on 1 VI. Tank Info Capacity in Total U of Mallufacturer v ^ Gallons Gallons Units u New yanks Existing Tanks W e y n d w Uo cif yr ii: C7 a. Septic or Holding Tank la! V1I. Responsibility Statentent- 1, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans, Plumber's Name (Print) Plwnb ignatilre MP/MPRS Number Business Phone Number Plumber's Address (Street, City, tate, Zip Cod Vill. Count /De )artmene Use Only pproved El Disapprc Permit Fee Date I sued ISSLkng nt Signature A l wn Reason for Denial J ~~Z~/_ I - IX. Condit asons for, Disapproval nt~ g ~z,~y cL 1 Septic tank, effluent filter and t.~ tdispersal cell must all be servlces I maintained ss per management plan provided by plunAw. A* "44ck fegWerttents must: be maattaigdd as per wficiitiw oode f orftwicei. - Attadi to complete plans for the system amt su mit to the County only on paper not less than 8 02 X I I inches in sin. SBD-6398 (R0313) PLOT PLAN PROJECT Lance Durbin ADDRESS 1150 130th Ave New Richmond Wi 54017 SW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX 6/19/13 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.7/92.5 5' below qrade All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent >6„ Quick4 Standard Well of Cover Leaching Chamber 20' with 20.0 ft2 of Area 5.6ft^2/pair of end caps Scale is 1" = 4~ 40' 4' Long 12' Grade at System Elevation 34" unless otherwise noted 130th Ave xisting 3 Well is to meet all 40, edroom setbacks required by House WDNR B M * 0' 40' 3%Slope B-2 70, -1 15' 97.5' ~ D W Vents 5 0' Old drywell is to be 2-3' X 66' cells with >3'spacing 5' pumped and buried ED] 4, 40' 98' 100' Huffcutt Filter Tank (1) Property Line 125' Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/19/13 Owner:Lance Durbin Location: SW1 /4 SE1 /4 S28 T30 N,R18W 1150 130th Ave 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 Specifipiization 8. St.Croix Coxisting Septic Tank Fork 9-11. Soil TesSignature License nu r #226900 PLOT PLAN PROJECT Lance Durbin ADDRESS 1150 130th Ave New Richmond Wi 54017 SW 1/4 SE 1/4s 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/19/13 BEDROOM 3 CONVENTIONAL XXXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.7/92.5 5' below qrade All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent >6„ Quick4 Standard Well 20' of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps Scale is 1 = 4~ ~ 40' 4' Long 12 Grade at System Elevation unless otherwise 34" noted 130th Ave Well is to meet all xisting 3 40, fisting setbacks required by WDNR House ~~B.M.* 10' 40' 3%Slope B-2 70, B-1 15 97.5' ST Vents 5 D W ' 2-3' X 66' cells with >3'spacing 5' 10 Old drywell is to be pumped and buried 98' 40' Huffcutt 100' Filter Tank Property Line 125' 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 97.5' Vent Grade Vent 3' 4" 3' ./30/34 Septic Tank 5' Long 1 5 5' Long 1 3697 Grade at System Elevation 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-92.7' B 92.5' POWTS OWNER'S MANUAL & MAN,AGEMENI PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ur Septic Ts nk Capacity al D NA Permit # Septic Tz.nk Manufactu►er CC ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer .C-,- O NA Number of Bedrooms ❑ NA Effluent filter Model e❑ NA Number of Public Facility Units ~-NA Tank Gafineityr- ❑ TNA Estimated flow (average) ! al/da Pump Ta'ik Manufacturs3r Design flow (peak), (Estimated x 1.5) gal/da Pump Manufacturer - - - ^ Soil Application Rate 7_ al/da /ft2 Pump Model Standard Influent/Effluent Quality Monthly average` Pretreatment Unit- u i Fats, 011 1, Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter © Peat Filter Biochemical Oxygen 7emand (BOD5) 5220 mg/L. ❑ NA ❑ Mechanical Aeration O Wetland Total Suspeneed Solids (TSS) 5150 mg/L ❑ Disinfe.,,tion ❑ Other: Pretreated Effluent Quality _ Monthly average R~n-GrMind rsal Cell(s) ❑ NA Biochemical Oxygen I'3emand (BOD5) :<30 mg/L (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <30 mg/L )tA ❑ At-Grade © Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line D Other: Maximum Effluent Particle Size X 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 eve ❑ nonth(s) - (ry' ar s ~ (Maximum 3 years) ❑ NA Pump out contents of tanks) When combined sludge and scum equals one-third (16) of tank volume O NA Inspect dispersal cell(s) - At least once every: ? LQ m antis s) (Maximum 3 years) Cl NA --1 U meonthr s) Clean effluent filter At least once every: i >CLyear(s,~ NA Inspect pump, pump controls & alarm At least once every: D month(s) A ❑ year(s). Flush laterals and pressure, test At least once every: ❑ monthi s) year(s) Other: At least once every: D monthls) Other: ❑ year(s) 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; 8eptage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (f) or more of ti re tank volume, the entire contents of the tank shall be removod by a Septage Servicing Operator and disposed of in accordanc4:: with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechani ;al or pressurized components, pretreatment units, and any servicing at intervs is 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 cor ipletion of an!, service event. Page _ _ of $TART 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 o,.-cur when soil conditions are frozen at the infiltrative surface. During power outages purnp 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 rkump 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 cf the following from the wastewater stream may improve tl a performance and prolong the life of the POWTS: antibiotics; baby wipes; c garette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap::; medications; oil; painting products; pesticides; sanitary napkirs; 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 ccimpliance 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 ail 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 i:overs remov=ed 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 ent system: suitable replacement area has been evaluated and may be utilized for th ; location of :1 replacement soil absorption system. The replacement area should be protected from disturbance and compaction and shotld not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure tc 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. Barr ng advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not I:ieen 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. Dt'ATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLIE ADDITIONAL COMMENTS POWTS INSTALLER _ POWTS MAINTAINER ~J Name Name ~ Phone Phone I SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name _~i1-~ - Name ~Q Phone J s Phone ~J J" This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), 12) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 62 __LCL11 I Mailing Address 1-5-22 , Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number ~~=~a_ 7D Uzrv LEGAL DESCRIPTION Property Location, 1/a %a , Sec. Z , T _~D N R/ ` W, Town of Subdivision Lot # Certified Survey Map Volume Page # 02~ Warranty Deed # Volume - Page # Spec house ye no Lot lines identifiable <DO 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 owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri, signed by the wastewater disposal system is in proper operating condition and/or (2) after inspection anpumping O(ifng that necessary), the onssite less than 1/3 full of sludge. pumping the septic tank is 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. I/we certify that all statements on this form are true to a best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recor din Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) '`-~~~-L-~ 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) A 1"'ILTER CARTRIDGE INSTRUCTIONS :crap x Dry Ift the P"' afar, .*44 the Wttl at ths allug tripe to effsure it ix tehturud urerbrrr' dw irecwf% awaning. If nulr dw teptir Instil'i rrrs»e WI)wt silts, tile tank Horrrugh Oft ou"A "But -WW Wlba) additlahai plpe twit thee ouflat pipe. i`, 1E P a WhO tim omm dtifj dfy fltttafi 0'tl tuft cutm piprt, rrrw miewif thre 6agm ut 44-I0eh pip rer+i>ird i►raca tfrgr 'W W to Use t-* old me it tiqu1no t hr. septimow suplo egrneolir+i sotrwe rt. If acids auppart tnathui IN hvt utgutd, ptotmed to 40 *K* a• it Fw y' "Mel"19 tha uptiv od half side sirppori S0P~ l mmm 41W %-Ohch µe ante dye kite, cmm- If awe sapputt triathslfi is twt utgised. protrptd to sixeu r. Sahlt ht wild tiysi'iikei crite ttMo the autiet taitrre. im;Ort tire, 00te+ caeiaidge aria he raga, Ple"510.9 fi~ IWO the tiNleer k ekr, iertu the butt,,,, the ~:Am- rioekWiself 41 kS ~rd► far utlir.~c d_ rtve"* arts t!w w anti lock by turning •r Y l'r , ~ t .r . i~dY'M'~i~IftCli 7'he mttltisrdf tikryr pihosiid k,r tterut„ed ay'nty tltrre Ei1C a:aptlC Ct1nk is 3errvic~tr4. 1. Upran the airkleet as}cesa epei,brpr to 1n*P1ct the hthk attll ff#tot; 15Uire¢ t1.er 6etrYlC tewrlc GtWr1 -..L ,,ever tr+t the battr,tr r i tYr+u RlQt1 ae makft sUr« to rgtrolve the sludµtr 4- Dh,;6 tl,n .6At hivari 1 rW not Joist the nmgtrr Wed +etlfuilfrt, u rrutiet rr't' buan towrcred brtfaW tht invert uP tttrr Al pipe, llrrtrfy peth up err tiger !titer htlnrlte tg, µ ctrrttwu" fret, fire ,free. dlalrtd~si the 5. SIlda the rat tr'fdya 1►p and of rt: ,rt'ri ro f f;, YY a "~t1e te►Y nfuastl►ig. VHS stclt J be ro rerrauvftJ by by atd ttBtl to my alortrf + Prosent, t}re w switflr With h wztter urrl:y rtrwinei caurtt"nj ftWliW 46. tt attested • WNW ituyditty the rsrY iYrf tYidgfy 66 its tddsy •i. wow,) over hit! Ciarttta fla 7cr nsrr vw'tirrgr rlhslb on t ha p cuff! Le trrc Grg only, +rrdk}nti were elf, i1ti t:ettY L, r rt tl' VFtS ymrRch Is utilized Yrtatgg,. ruvaetiaf is ritrsgrt M19 Witt' Whtue 'f' rmrttW+, r . ' hack 11rtn tie(, tank. turoving ri'erckiaistr 8r7~¢lio,!Y by IirstlrtlYtp igtl? Hftsat' ' t ,Y tli dl• i Y►rsart the totter i;a tlre, lifter t4C6- itarid" bank l L" . 'dta ttre hatt+orn Qfr tth7 tag*,' kr'liiyg a dnWrl atrNt , ta.kerplate bnd xaellra tbb pct;ess a+ra. . kr19"Wfl Litt the tithfi. rg v,• ° ' i.L::.y:riMf.1.M• ~~t11p~1+1~'r~lJ~'~'1~')176'S~i~+ir".ICt►7m. .a~ r GTjT (653-456.3) - 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. my Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), directio~ Pa I.D. percent slope, scale or dimensions, north arrow, and on and distance to near estea - 70 " Please print all . f n. S2- o 2 1,9evie d by Date R /Personal information you provide may be u r ary p as (Privacy Law, s. 15.04 Property Ow7q, Property Locatio t ~s~-- Govt. Lot L~ 1/4 1/4 S T3(.~ N R 1Y E (or W r, Property Owner's Mailing Address Lot # Block # Subd. me or CSM# / a-- wl g 1 19 City to Zip Code Phone Number ❑ City ❑ VIlag 150own, 407 Nearest Road ❑ New Construction Us esidential / Number of bedrooms Code derived design flow rate 41J7j GPD eplacement ❑ Public o~Jcom, mercial - Describe: Parent material 0 4Z-X. ~~C.✓' Flood Plain elevation if applicable ft. General comments o3~l~w . and reoarwnendations: System Type /_D lJ~r System Elevation' [ Boring F-/ I # Boring J l ' 7 . 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. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2 7-0 n Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal 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 .7 I • Effluent #1 = BOD > 30 <220 mg1L and TSS 30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (please prirtt) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address D to Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Boring # Q \ 121 Boring it Ground surface elev. tJ ' ft. Depth to limiting factor s in. Soil -Apprication 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 y3 U S J r 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 H Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth 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 = BODS > 30 < 220 mg1L and TSS >30 < 150 mgA_ ' Effluent #2 = BOD5 < 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330 (8.6/00) Property Owner _ Parcel ID # Page of 121 Boring # Boring q6, 0 ,dam it Ground surface elev. ft. Depth to limiting factor- in. Soil Applicati on 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 L o- 3 U, Boring # Boring F-1 ❑ 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 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ' )epth 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' 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. SBD-9330 (8.6/00) Soil Test Plot Plan Project Name Lance Durbin Shaun Address 1150 130th Ave . New Richmond Wi 54017 M #226900 Lot 1 Subdivision Date i6/1 9/13 S W 1/4 SE 1/4S 28 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 92.7/92.5 *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted Well 20' 40' 130th Ave Existing 3 40' Bedroom House B.M.* CFA L 40' 3%Slope B-2 70' B-1 15' 97.5' ST DW 5' 98' 40' 100' _,,,Property Line la- 125' ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEM:3NT FOR UTILIZATION OF AN EXISTING SEPTIC TANK i'?z:i.s is to certify that I have inspected t.Ze septic tank presently <:~(:~rving the t residence located at:: Section T _ N, R------W, T o n i > f - - Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. 1st time serviced: J~-d flow :rack occur from absorption system? Yes No (If no, skip next line) Approxima':.e volume or length of time: gallons mi-nlat:e~ . +-opacity. /Crz. - Construct-,.on: Prefab Concrete Steel Other -nufacturer: (If known) Acje Of Tar: If known).: IS-* ature (Name) Please pri~zz- t Number) Date ~'ozm to be- completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: Iri accepting the above statement regardi g existing septic tank condition, I certify that the tank to the of my knowledge will conform to the requirements of ILHR 83, s Adm. i Code (except for nspection opening ver outlet baffle). NamJ Signatu MP/MPR, .v l l l l l i {III 111 f l l l l{ I! I l f 1111111 State Bar of Wisconsin Form 1-2003 8 Tx34 9 2473 6 WARRANTY DEED 974893 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 03/13/2013 2:38 PM THIS DEED, made between Kevin W. Killin and Michelle E. Killin, husband and EXEMPT#: NA wife REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 544.50 and Lance Durbin and Cathryn Durbin husband and wife PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Retff AdaV1' IrC]Jaddendum): . Estreert That part of the SWIA SE1/4 and the SEI/4 SWIM of Sec. 28-T30N-R18W 304 Locust Street described as follows: Lot I of Certified Survey Map recorded in Vol. 8 of Certified, Hudson, WI 54016 Survey Maps, Page 2199 as Doc. No. 457843. 10'4Grantee herein is prohibited from conveying the subject property for any sales U price for a period of 30 days from the date of this Deed. After said 30 day period, 026-1082-70-000 Grantee is further prohibited from conveying the property for a sales price greater Parcel Identification Number (PIN) than $217,800.00 for a period of 90 days from the date of this Deed. These 'ntis is homestead property. restrictions shall run with the land and are not personal to the Grantee. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and reservations, if any, of record. vt Dated _175 ~1 3 (SEAL) (SEAL) * ;Kevin W. Killin (SEAL)L LL~,A (SEAL) * *Michelle E. Killin AUTHENTICATION ACKNOWLEDGMENT Signature(s) Kevin W. Killin, Michelle E. Killin STATE OF ) authe ~icated.gyl p$ ?,O'-r 3 ) ss, l/ COUNTY ) *Kristina O gland Personally came before me on , TITLE: MEMBERS ATE BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Kristina Ogland, Estreen & Ogland Notary Public, State of 304 Locust Street, Hudson. WI 54016 My Commission (is permanent) (expires: ) (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. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. INFO-PROT' Legal Forms 800-655-2021 www.infoproforms.com 1 of 1 45'7843 CERTIFIED SURVEY MAP LOCATED IN THE SW 1/4 OF THE SE 1/4 AND THE SE 1/4 OF THE OF THE SWI/4 OF SECTION 28, T30N, R18W, TOWN OF RICHMOND, ST. CROIX CO., W1. OWNED 8Y: FARM CREDIT SERVICES NW. T,_"._ HWY. 35 NORTH 1/4 CORNEROF SECTION RIVER FALLS, WI 54022. n 2aJ COUNTY MONUMENT N FOUND) . A V - I NOTE: BEARINGS ARE REFERENCED " TO 7NE SOUTH LINE OF THE SW I/t. G1 FILED (ASSUMED WEST). J ♦ s NORTH-SOUTH QUARTER LINE ° £ 4'1990 o° APR2 = CONNELL e .1AME8 01 Deeds roixCD•'`1d► O uNPLAT ED LANDS r i EA S T 600.00' 247. 46' 33Y. 34 W E S y. stied p• M N Z' q CIZ' .Q ' LOT I o:+ fD - corn crle~ ° a ei p. snea stied eorn Oslies w o 4J. 1 Q'• e.. p. o~ ; I$ ~ n W• sai ti F-' 1- ° x F-' w o W= stied( N shed Q• OI► ° = Z• LJ ~ tern er/a y,. d • W i z • a M; ~ heop ~ gore o• q.. . IL a uFrlc o m i O i iI ; > U~ F •yd"V.MeY O I Q ,~1 O~ " • V O A 'A w 545 800.00' "1 EAST _ 2369.1324r. 00' ! 333.00'- A+ WEST 2_203.I3- 130 TH q wE 600.0o, 1/4 CORNER OF SECTION SOUTH LINE OF THE SW 1/4 Y8. cco mrY NONU/d ENT SOUTH LINE OF THE SE 1/4 FOUND). ~/G~ A"RQYD APR 2 4 1990 O * SET 1'.X 24" IRON PIPE WE IGHING 1.13 ST. CROV COUNTY L8S. PER LINEAR FOOT. C0AA0l1+Jffi4dh& PARKS PLANNr4G AND ZOn.NC con,«urrrR-~ ~`yG ONS~ww_ AREAS "Y 8.26 ACRES JAM= UL (360 , 000 SO. FT.) S-1804 7. 81 AC. EXCLUDING RIGHT-OF- WAY SMFN(3 VALLEY 1 340, 200 SO. FT.) w1$• SCALE 1" 1 50 #still JAMES M. WEBER 5-1804 0' 75 150 300' WEBER LAND SURVEYING O ATE0 -5 tom SHEET 1 OF 2 90-23 TNIS IN57RUMENT DRAFTED BY •.-~~bt..- YOLUM 8 PAGE 2199