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HomeMy WebLinkAbout026-1294-06-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563813 0 GENERAL INFORMATION 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: Smith, Gerald J. & Jeannine B. Richmond, Town of 026-1294-06-000 CST BM Elev: Insp. BM Elev: SM Description: Section/Town/Range/Map No: lob rVI ( G-" I 28.30.18.1488 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV. r Septic ~r► i /aaO Benchmark 3 Des+ng ~ Alt. BM F ~ ~ ~ FF CJ/~.J i I o O u ti ~ Aeration Bldg. ewer S -rF . C7 Holding St/Ht Inlet Q 6. z clg, TANK SETBACK INFORMATION St/Ht Outlet 5 77.8 TANK TO ~P/L WELL BLDG. Ventto 3irIntal]e ROAD Dt Inlet ~ A~_ \ Septic J ~,7 Dt Bottom ~ G(J Dosing Header/Man. -7. '7 Aeration Dist. Pipe '7. •7 'T . Cp S.c '7 . 3 Holding Bot. System dr.0 5. 3 PUMP/SIPHON INFORMATION Final Grade J.'5 16 d • g Manufacturer Demand St Cover GPM r-; 1 J~ ~p z Z 1,11-Z Model Num TDH Lift Friction Loss System Head JTFt Forcemain Length S. to well SOIL ABSORPTION YSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside DiZ~ Liquid epth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TJ'4A&-l- Type Qo ASyste k/m: O /Q Z ` I UNIT Model Number: G .U DISTRIBUTION SYSTEM & 4-1& = a- q)S Header/Manifold Distribution Tole Size x Hole Spacing Vent to Air Intake ~ Pipe(s) Length Dia__~_ Length Dia \ Spacing ` ' d U 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 Bed/Trench Center S Bed/Trench Edges Topsoil Yes rm-] No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Richmond, WI 54017 (SW 1/4 SE 1/4 28 T30N 18W) Richmond Acres Lot 6 Parcel No: 28.30.18.1488 Location: 1315 116th Stre New( , - 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = Plan revision Required? ❑ Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctoes Sig lure Cert. No. L PLOT PLAN PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River MN 55330 SW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/20/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of power box ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL IH.R.P. Same as Benchmark SYSTEM ELEVATION95.4/95.2 5.5' below grade B.M. 116th St. Well is to meet all setbacks required by WDNR All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Scale is 1" = 40' 20' Pro 3 unless otherwise 100' ST Bedroom noted 15' House B-1 301 Vents Vent 3% slope Quick4 Standard 60' >6 Leaching Chamber 2-3' X 66' cells of Cover with 20.0 ft2 of Area with >3 spacing 5.6ft^2/pair of end caps 4' Long 12" B-2 3 4 Grade at System Elevation -3 60 101' 50' Property Line sandstone found at 96" County - - i> Industry Services Division /x ' '1400 E Washin ton Ave 0 j ` 9 Sanitary Permit Number (to be idled in by Co.) Sps., i=l P.O. Box 7162 Madison, WI 53707-7162 ni y Permit Application State Transaction Number In accordance ' iga6.21 is. Adm. Code, submission of this form to the appropriate governmental unit is required pri btaini sanitary permit. Note: Application forms for state-owned POWTS are submitted to j et&r 4ss (ifditTerent than mailing address) the Department at' and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15,04(l )(m), Slats. _ 1. Application Inforrnatioa Please Print All Informatio - U # - Property Owner's Narne l'ar~N/ ~Of 13 n JrC/ - - S 6 9 - 04- Property Owner's Mailing Addr::ss Pro t ation .Vbul 1116o ~ _Aje Govt. Lot _ City, State Zip Code Phone Number /q 'A, Section Z / / / / S 330 ~ y - ale ooerN 11. Type of Building (check all that apply) Lot T N; R E r W or 2 Family Dwelling - Number of Bedroom Subdivision Nar ae p1G. C1~~ cy.tSrL Block # ❑ Public/Commercial - Describe Use ❑ State Owned- Describe Use j f CSNI Number ❑ Village oi' ~ tK L J /loNa own of-- Ill. Type oi' Permit: (Check only one bo5c on line A. Complete line B if applicable) A' S stem ❑ Replacement System ❑ Treatment/Holdin , 1 ank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal I-~ Permit Revision Change of Plumber ❑ PermitTransfer to Piew List Previous Permit Number and Date Issued Before Expiration Owner ~e l Y IV. Type of POWTS System/Component/Device: (Check all that apply) s - C,,,f- n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in of suitable soil l' ❑ Holding Tank ❑ Other Dispersal Component (explain)___-____ _ ❑ Pretream,ent Device (explain)- V. Dispersal/Treat entAr_•ea information: - S/ Design Flow (gpd) Desigr Soil Application Rate( dsf) Dispersal Area Required (sf Dispe • al Area P ~oposed System Elevation Z- - If 1 9 J-- Vi. Tank Ilafo Capacity in Tota # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks W ~I rl. U n C7 a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assu re onsibility for installation of the POWTS shown on the attached planes. Plu er's Name (Print) Plumber' i at'ure MP/MFRS Number Business Phone Nw ber Plumber's Address (Street, City, State, 'Lip Code VIII. unt /De arttfient_ 1Jse Only ITIS-surg _ pproved Iapp Permiit Fee /Date J5)3 Signature iven Reaso D' / 7~ 66 b IX, Condit ;E11A.~VVN0Weasous for Disapproval , ~ Septic tank, effluent, filter and 3 dispersal cell must all be servltias PinaWried kovyPA~+~~ t-Jf 4-L, ° S as per management plan provided by plumber, t 2. AN seq ck requirements must bat tnaintak4d r t~9 c. f" ~'o~ , p 11 1111 per- ble code / wdm riesiis em D 1 f~1'4 Attach to complete plans for the system anti submit to the County only on paper not less than 8 i/2 x inches in size SBD-6398 (R0313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/19/13 Owner:Gerald Smith Location: SW1/4 SE1/4 S28 T30 N,R18W Lot 6 Richmond Acres 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 C 'ngency Plan 7. Filter Specifications et 8-10.Soil Test Signature License numb 226900 PLOT PLAN PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River MN 55330 SW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/20/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of power box ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION95.4/95.2 5.5' below grade B.M.* 116th St. Well is to meet all setbacks required by WDNR All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 20' Scale is 1" = 40' 100' Pro 3 unless otherwise ST Bedroom noted 15' House B-1 30' Vents 3% slope 60' >6 vent Standard r Leaching Chamber with >3' spacing with 20.0 ft2 of Area 2-3' X 66' cells ?4'Long 12" 5.6ft^2/pair of end caps B-2 Grade at System Elevation B-3 60, 3 4„ 101' 50' Property Line sandstone found at 96" 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 100.5' Le Grade Vent :Septic Tank 3' 5' L5' S' Long 3 6 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 16 chambers per cell B System elevations: A_95.4' B_95.2' POWTS OWNER'S MANUAL & MANAGEMENT' PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity ai ❑ NA Permit Septic Tank Manufactui er-J~'nCt~-' ❑ NA DESIGN PARAMETERS Effluent Filter Manufactia_er-- ❑'NA Number of Bedrooms Y ❑ NA Effluent Filter Model NA Number of Public Facility Units -*;4~A Pump Tank Capacity - gal NA Estimated flow (average) al/da Pump Tank Manufacturw NA Design flow (peak), (Estimated x 1.5) allda Pump Manufacturer NA Soil Application Rate - • gal/da /ftz Pump Mode! - NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) !530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetiand Total Suspenced Solids (TSS) 5150 mg/L ❑ Disinfe,;tion ❑ Other: Pretreated Effluent Quality A Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 115LVA ❑ At- racfe ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100mI ❑ Drip-Line_ ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA other: tN Other---- NA Other *Values typical for domestic wastewater and septic tank effluent. Other: v _ MAIN TENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ months) every: _ ear s (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (rf,) of tank volume ❑ NA El onth Inspect dispersal cell(s) At least once every: years; (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ onthf s) - NA Years;------ Inspect pump, pump controls & alarm At least once every: © nthis) 11 NA Flush laterals and pressure test At least once every: ❑ monthis} 11 NA l year(s) - - Other: ❑ monthl s - At least once every: - - ry' ❑ year(s) 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 scam and to check for any back up or ponding of effluent or the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to checF: for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires th= immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (:J) 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 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 POWT:3 Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an,, service event. Page of 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 ocseur 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 Ooerator 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 vehiclas 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 scrap;; 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 opsnings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, ali 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 ent system: %A.suitable replacement area has been evaluated and may be utilized for thc; 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 anc 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/OF1 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 IMPOSSIBIL ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER _ Name - ~~i~ - - Name Phone 7JJ `d- b - _ yJ / Phone Y ~ SEPTAGE SERVICING OP~EER~ATOR UMPER LOCAL REGULATORY AU-"HORITY _ Name A~~__..1~' - - Name ~L Phone - J Phone 7j L~ 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. LTER uARTRIDGE INSTRUCTIONS ri w x Ury fit aye 0Yt . earl. lj"w Om " at tim alme Oope to ensure it, ix c+ant'ditd unl4i". d" im=wfp O"rVing. It 009, thm Wttmr 1nbw,t trrw'a pipet limo tku tank ttrrutigh 0- -46-tor wheat -WW (ykso) additiurrai i* trbtc the uutlot pipe- ;z ~N a Whirr we sowtirtAt dry fi'Gtdd on the outlet pipe, .,*mks. tiru i."" of 76-im* Wo caw ed v o wa" "'a 1Yg7 W 1* the t~ 1"d V" if MIZI sg thr, uptiorW swim nter~ril surrtatat. If tide safport rru"w its rwt utoked, RYtlt7Ytid to stjltl fbui yvFrr~ .3 For ytrtlFtiiy{y ttlq 3~~ rMrirl t ~-il{Ctl OtPOWINOW SItIY supptlf+t: Ltft cad, pro food to ~u . urltu the f cabs, ii We suppurt twath4d is root 5 WOO UVOIttet case ithts tint auilkrt r ua. cartr a into he ra«a, ENavslriq "W" urrtN the 6Ef fi.adrt♦ fire rifte tha Cisw. Wm rntb tho buttutz, Ur ?t;r ~g tl 1 tr'tlf hti 4t'iEL11 ri.: Ilrsw't atta I rEackuWse ypb, fire ritur- aaq lock by turmn~ ~~r ~al~i►tetrilaiM~tcta t8`dCrnt+t+. , t. The nrtlWsrril tF1Eat shotljd tfr tlaartod ovary tirrkt saptlC tethk iy ~ervFced. • 11p" the "inlet "I': s a Purrrp thtt 1511ptir twat pafaUrp to lnspuct the tOhk and f ltej,, eWnplWtrl2tyr nrmk#1V asurri to rt3trurUe the swdNu :4 layer urr lthe bokharrf Of this bark 411W yqt 4- rhrae, the efttpw t leva,E h •luet tare r;r:tlYrr and outlet prp ao iuvarr (dW11 d brtfoW t ettiuu►rt, e, rlrrr fY p44 up utr tiler HYtvr huadte to ht: fnbtrrt of tiro c~ ctrrtYWyo frgrrr ON eur~e, dfislud 5. Slider the Uu the terirMW UO alel 01 0~Of th r;• rr a rms swkt lr a race ~+r+' talearN►ty. ' sh6o6i culr►rbrWsr! to am elarh► is fahi8dnt, ire switth with Wstta r",J nry y, by irurwi , r ur ardt► g[1w dtrd ~aaed r. Wliifi! Utddf y 1:,ke rrtrY quwa ddb rbii its tl! acr.-rrsy (large frttl• ~ e wrriy, erryki/l oPanh-101 rl W utFSLe f4citay ! ~ Jr' VHS N aura rrll agr. rraattrrl:gl i7: t1h11~~~ldfyit lift'tit wmke,Y e swlir h Is utfllxard bad lYrtn tittq 't ; teak. LOW. t'urrrirrg ~iucktnrls+3 sr Wui by infer whWill Niter W id xrf Vit rite fatrr , tars Yrite,r• lrea cerrtrirEygr bauc•k inrt-u '"i~k6 ks l! itu ttrtr beytkrfen tit t'har tn, fivplata urrd xnclird tbl7 ire IYrmrsiir~ duWrrtlnYlP . .''",'I r; stcirsrti uiuehHrf~ Oh tl7r! ~ VII . r~.. ,lfe. "yS;VY1 :'k.frSrd '11 • X711 'y~l~ .J.••I 4. y . . 'v • 2 toot I.r:..v-• it-Mf.7.y'' I w . AA (653,41 ~ 12 . 7 '9 6 6 e► IL U 2 8 1 4 P 5 3~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIR CO., WI DOCUMENT NO. WARRANTY DEED RECEIVED FOR RECORD 06/03/:2005 12:06PH WARRANTY DEED EXEMPT it This Deed, made between David A. Ball and Kimberly A. Ball, husband REC FEE: 13.00 and wife and Dennis F. Ball and Nancy A. Ball, husband and wife, TRANS FEE: 3185.40 Grantors, and Gerald J. Smith, a married person, Grantee, COPY FEE: WITNESSETH, That the said Grantors, for a valuable consideration CC FEE: PAGES: 2 convey to Grantee the following described real estate in St. Croix County, State of Wisconsin:: RETURN TO: Parcel 1: The East Half of the East Half of the Southwest Quarter Loberg Law Office (El/. 359 West Main Street /E'/2 Ellsworth, WI 54011 /SW%) of Section Twenty Eight (28), Township Thirty (30) North, PID #026-1082-40-000 Range Eighteen (18) West, Town of Richmond, St. Croix County, 026-1082-70-100 Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 026-1082-95-000 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being 026-1083-10-000 part of the Southwest Quarter of the Southeast Quarter (SW'/,/SE'/,) and part of the Southeast Quarter of the Southwest Quarter (SE'/./SW'/.), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West. Parcel 2: The West Half of the Southeast Quarter (W'/2 /SE%) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: 1. Lot One (1) of Certified Survey Map filed April 24, 1990, in Vol. 8 of C.S.M., pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW'/,/SE'/,) and part of the Southeast Quarter of the Southwest Quarter (SE'/✓SW%), both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 2. Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, being part of the Southwest Quarter of the Southeast Quarter (SW'/JSE%) of Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (18) West; 3. Commencing at the Southwest comer of Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No. 372738, for the point of beginning; thence N89'59'1 5" West 20.00 feet; thence NO'01'41" East 262.00 feet; thence S89'59'15" East 224.00 feet; thence SO'01'41" West 15.00 feet; thence N89'59'15" West 209.00 feet; thence SO'01'41" West 242.00 feet to the point of beginning; 4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter (NW'/./SE%) of said Section 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginning. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants and conditions and will warrant and defend the same. LA L 17 acres 94,407 sq. ft. $ rv ^ " ' . S •Y 46 as N89'50'27"E 468.85' 1.96 acres_ 85,178 sq. ft. ` ! 1.94 ccres A 4 84,691 sq, ft. oo I C co ~ I I rn u I N89'50'27"E 283.65' I o o N89-50-27"E 435.60' I w ~w ( _ to 47 m 96 acres 1.89 acres I 28 sq, ft. N o , 228q. ft. 450.26' ~~j rr S87'39'S0"E 436.68' C3 24 C~ riZ'r'Zo^.^-y^ ~.1AL.dC3L. 212 ST, CROIX COUNTY SLPTICTANK MAINTENANCE AGRE)~MF.NT ' AND OWNERSHIP CERTIFICATION FORIvI Owner/Buyer Mailing Address Property Address _ ~'j 4A -C ~ (Verification required from Planning i & Zoning Department for new canswction.J 3~ City/State - ~ Parcel Identification Number LEGAL D_ ESCRII'TION Property Locatiola~jv' tom.. 'A Sec.2 Y t 'T ~W,Town of Sttbdivfsion Plat:_ , Lot # k l:)'. Certified Survey rVIap # Volume Page # Warranty Deed #,,y"~j (before 2007)Vo)ume/ Page # 1 Spec hoes yes no Lot lines identiGeb! ' yes no SYSTLtyI i14AINTI:;t . ~IAI<,CE ANn QLWNC CERTIFIATXOII' Improper usr. r: d t ai rte:;ante ofyeur sspac system could result in its pre failure to limidle wastes, pror maintenance consists of ptur ping out the septic tank everythree years or sooner, if ded,by r licensed pumper. What yon put into the system sat affect thv function of flit: septic tank as a treatment stage in the waste disposal stistetn. Owner maintenance responsibilities are specie;cd in SComm. 83.52(1) and in Chapter 12 - St. Croix County Sanittzij Ordinance. The property aivner agrees to submit to St. Croix County Planning & Zoning Depar"mint a certification form. signed by the owner and by a master plumber, jounwyimn plumber. restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) nticr inspection and pumAng (if necessary). the septic tank is less than 113 full ofsludtle. 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 Natured Resources, Sttte of Wisconsin. Certlflcation stating that your septic system has been maintained trust be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year ,aspiration date. Uwe certify that all statements on this form are true to best of my/our knowledge. Vwe am/are the owner(s) of the property described above:, by virtue of a warranty deed record in Register of Deeds Office. Number of bedroor.:ls ~S Sic n OF A~P~,ICANT(s~ ~ ~ DATE ***Any information that its misrepresented may result in the sanitary permit being revoked by ttte 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) f S T' 'V ` „ty , a~P coy m cQ \10/ , 1 0°•o T I? o / a yo` v < / / O F (0g...... i /C~00 \ \ O (1, \'b o ry \ o \ ° G oy; I' yam. o / Iv Av\~ wog Jr. t 0• °4 } /f 1~' _ 7S 1`lr'J \ v Q \ r' \ 'u :so o `mom awo l' <v ab} / • S9 X11` ' ~ eyr' ' 2 \ i` '1 \ D4 o a m / G~ oy ~S J Vj~ I \<vll~ 1, c- RG <Q~ / Q~~ o ? JP° °~~3~y~ y oho l I } O r V 0y (,,Q/ y Qd=3 <2° 0-8 y ^'y~ Ya J qb i Y V og o ? ` o y o r° Q 11 pct' a~~=$ R' / Q 3 J~ 24<3< ,a1Q €r. '0j- s~f `dam+F / E? \ y6 for,3 do ?k3 cA --ors aoa• a rl i +1.11 t Vt }ry i o~~~f ~ \ od•FaT JjE'ci'~~ och 0 c7 1 } ^o"• ~_i~ ` 2 ~S.,c' ~r..3•M°' ,~rd3~ga~r0"°..;•y~'1" • if ` i I ry ' a V i' 3 rev i=o° S9~vya~~,oc23a0~ ~c / 4 1Q, A* \ Pr ~~m< a 2~3?= $~4 a o~~ Q \RS& o l n O i' ,Oi l abm Q/p//. r".'~'•c~?,"° 'ego Ceu2 `d~'C" < Q~,\~ } P/\ myd'~° cry}QN¢ V~ G V aq . ti o c~\~// Q• o` 2° "cO v° °Q '~~<<=°^`5'9=ti o Q REPORT Page of { } : = F is u c 9 co y 3t<0~~ d1 to o ° c * o ~os~o °ti< r ~d S\ a° Q'~J <C/v°yoo o of ° o t '~j J\ f m ° ok 6' a 21°d < 2°~ 0~ ode 4 p9o o` . oro °i, o ~o m N ~~~~V v ° c ° ° ° o v ~~'J=~o=°o m ? Jec ho County _y J e° 4°~ `°co °Q <c s0 g ° ?e 5 P ? Ast q0 ."z 't arest road. m° Ste ' ed b "IyV fDate ° . 0 6 0 os "'r s~*'e Property Location _~~``°?y spa h Govt. Lot 0 1/4 1/4 Z FT 3i`J N R E (o W Property LI, m o~< o r Lot _q Block # Subd. Na or CSM# o SC CRY y~R/2 ,o El City El Village Town Nearest Road Ef-INOW Construction Usesidentiai , . oms Code derived design flow rate GPD ❑ Replacement ❑ Public or comme -Abe: Parent material /24.e _ ce-4 Flood Plain elevation if applicable General comments and recommendations: System Type f'I✓ System Elevation / r~ Jam. 01 M 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 GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 X- JL-~ 161110 -2, 2S k~. ~s 1 ~.v U ,y S M ~bl~ - c7 y o -5 s Boring # ❑ Boring ® & Pit Ground surface elev. ft. Depth to limiting factor Z l) 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 Z -Z S C ' rn 4> t3- rn t~ l - A Or- 'IT • Effluent #1 = BOO > 30 < 220 mg& and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Da Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 -3 715-246-4516 1 Property Owner _ Parcel ID # Page of ❑ Boring Boring # p~ F,5-,] Spit Ground surface elev. Q 1- 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 Q'1 L 0Vr 3h- .L 7 Z- 3 y IDS DJ ~ ~ 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit 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 = BOD3 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seD433,0 (e.6=) Property Owner Parcel ID # Page of ® Boring # ❑ Boring S,Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sal II ion Rate in. Munsell Qu. Sz. Cont. Color GPD/fF Gr. Sz. Sh. 'Eff#1 -'fEff#2 Z, OJ ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil D/fF in. Munsell GPD/fF Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 D Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots Sal Application GPD Rate . 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 = BOD. < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R-6/00) Soil Test Plot Plan Project Name Gerald Smith Sha ird Address 11160 190th Ave NW Elk River Mn 55330 C M #226900 Lot 6 Subdivision Richmond Acres Date 6/19/13 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. Top of power box System Elevation 95.4/95.2 *HRpSame as Benchmark B.M.* 116th St. Scale is 1" = 40' unless otherwise noted 100' 30' -1 100' 3% slope 60' B-2 B-3 60' 101' 50' Property Line sandstone found at 96" r r ILI h C v d r {~a66 - i fi r fJ- 1 - ~ CAS f~ Wisconsin Department of Commerce EVALUATION REPORT Page of Division of Safety and Buildings accordance with Comm 85, Wis. Adm. Code S-~' ~ C O 17~ Attach complete site plan on paper not less than 8 1/2 x 11 nches County A.M. include, but not limited to: vertical and horizontal reference int (iT~iteA Parcel I.D. percent slope. scale or dimensions, north arrow, and locati and distance to nearest rojad jet-2 e4o 1.2 Please print all informati A U G f; 200eV18`Ne Date ley Personal information you provide maybe used for secondary purp as (Privacy Law, s. 15.04 (1) (m Property Owner ZONI OFF I E 1/ Gem) 4 rj F.~1/4 S dq T30 N R E (or Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# ,1 90-~` e• N LO co at o f -rc m c rc City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Roahd F1K R-VCR IAN 30 (welly/4,88 61 PNi6%M T New Construction Use: [2~ Residential / Number of bedrooms Code derived desig rate S O GPD ❑ Replacement } ❑ Public or commercial - Describe: Parent material __.QV_14!J T; I ! . _ Flood Plain elevation if applicable ft. General comments 5 u 5 Std t 3 --T,- to %f F0 C- e C.- e- and recommendations:37 T. ) ( 97. 7') T,4 (9t..~t') Ulv~.wpwN ~'Q G ` : T,a (97.35' $ ~e of : T,S (U-30 I , 4~"r S VV tR. T.3 ! 9 7.03' .a7' S i r-7 wl s i 441~~✓ Boring y Boring # El F71 54 pit Ground surface elev. ~~•v r 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 0 -10 i s/;z L- nn %IaL m rv- uu 4 C= , • 1 10- y t_ r wl Fv- C- w I T-- • q ' T s YV-N L G w 14 to o -S w, L Lw - • r Boring # Boring ® pit Ground surface elev. ! D ft. pth 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 10 V R 3/.7 1 F, 1. L. iM yr- to , )lo a f( YK L It="bI to Iv , 7 I . to -4.7 r e G+ cQ. o v Effluent #1 S >3 11 < 150 mg/L ent #2 = E~a 30 mg/L d TSS 5 3 T Name (Please T P lgna u umber a.r X cqk'A I "7q 10 a ~V Date Evaluation Conducted Telephone Number a3-bs 76 aya3.sss Property Owner Gera lek Sm +I, Parcel ID # Page _i;p_ of _ Boring # ❑ Boring + 3 pit Ground surface elev. f vC, b ft. Depth to limiting factor 5 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 J - I v~R31 L. s 5k t . - ~ \0 C*~ '$J S 7,SYRY L- ► FsbK W%F, - w I r , 4 .7 r45-NOW "iz ; c w 1,j F . y .7 0 -7 1 YY47 2:5104, 11 - L:, 5 -S s Y 4-1, zi ac.k R'1 1, ~o-wt S 1, - 6C,&J_tL Boring # ❑ Boring dUQ vI o -'Y ❑ ❑ Pit Ground surface elev. _ ft. Depth to limiting factor - in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. =Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODE > 30 5 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. M-9330(RAM) i Property Owner Ge.ro,1i~ Parcel ID # Page CQ_ of _ F-31 Boring # ❑ Boring F P5 Pit Ground surface elev. Y ft. Depth to limiting fader _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 u a t t ri ei. Boring # ❑ Boring a ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in Soil App ication 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 a 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 GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-833D (8.6/00) _ F Spa, _ 'R 7- 1-9Z 4. _ J o ~ r y. 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