HomeMy WebLinkAbout026-1294-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 567292 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:
Richmond Acres LLC, C/o Gerald J. Smith I Richmond, Town of 026-1294-10-000
CST BMElElev: Ins�j.BM Elev: BM Description: Section/Town/Range/Map No:
6� & 7 � �2 Q�J, — Q (� 28.30.18.1492
TANK INFORMATION ELEVATION DATA ?�
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 5Zi 3•
Dosing / �( new Alt. BM 'Os
_ Sid i Ow��✓ 2• f�j• 3
Aeration (/V (� W/„� / Bldg. Sewer
Holding St/Ht Inlet 3a,44-e a
St/Ht Outlet!� t�
TANK SETBACK INFORMATION �11 17. 2 _
TANK TO P/L WELD.. BLDG. Vent to Air Intake ROAD Dt Inlet
Septic .L 1 DO Dt Bottom
D K
Dosing 114/ t(�y� eade an. t ;J„ •
Aeration ' Dist. Pipe 5 Gam! -
� D Or'
Holding Bot.System S1 C
0. 7 211
PUMP/SIPHON I FORMATION Final Grade
�3Z .ter 7.
Manufacturer (� Demand St Cover Jr
GPM f Z a
Model Number
3f Yj 41 W Sw ch
TDH Lift Friction Loss ystem Head TDH Ft ( �/ CAA
Forcemain Length to Well �(
SOIL ABSORPTION SYSTEM 43 c,,k4nPt,,o
BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS -3 ,ti
SETBACK SYSTEM TO T P/L BLDG WEL LAKE/STREAM EACHING Mac r
INFORMATION Type Of System: HAMBER -�/
Model Number:
D RIBUTION SYSTEM
eader anifold Distributio f x Hole Size x Hole Spacing Vent to Air Intake
I? Pies f7
P ( )� N r/l d i�
gth Dia Length Dia Spacing Y'
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched
Bed/Trench Center P7 Bed/Trench Edges Topsoil
Yes No 0 Yes � No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /�/ Inspection#2:
Location: 1174 133rd Ave
New�Richmond,WI 54017(NW 1/4 SE 1/4 8 T3ON R1 8W) Richmond Acres Lot 1`0 Parcel No: 28.30.18.1492
1.)Alt BM Description= f J�'•"► 0� slum' S O 1st 1.�
2.)Bldg sewer length= f C� jt
-amount of cover= ' �/� ih�� •
ENE No �� — --- —T
Plan revision Required?
Use other side for additional information.
SBD-6710(R.3/97) Date Insepctor's Sign ture Cert.No.
PLOT PLAN
PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River Mn 55330
NW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 12/11/13 BEDROOM 3
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
1000 gallons LIFT TANK SIZE DOSE TANK SIZE
�i
HOLDING TANK SIZE LOAD TE 5 ABSORPTION AREA 931 # of chambers 46
BENCHMARK V.R.P. Top of stee fence post ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE 0 WELL -H.R. Same Benchmark
1
Scale is 1" = 40' SYSTEM ELEVATION 89.5/89.6 6' below qrade
Unless otherwise All piping shall be SDR 30/34,within 10'
noted of tank,piping shall be Schedule 40.
417 Property e Line
P
Vent
>6
„ Quick4 Standard
of Cover
Leaching Chamber
with 20.0 ft2 of Are a
5.6ft 2/pair of end caps Cj
12" 2
4 Long f�
Grade at System Elevation e U
34"
2-3' X 94' Cells wit
>3' spacing .
>
0% S e B-3
1� no ntours
100'
50'
Pro 3
Bedro m zz B.M * "
Hous �jj
I30' 0'
3'
B-1
100'
133rd Ave
,^,,.� County l_
t `4 Industry Services Division LW,('I vA�. . ' 1400E Washington Ave Sanitary Permit Number(to be filled in by Co.)
'! a6. h
P.O. Box 7162 q
v e Madison,WI 53707-7162 , 5(07 2 ! Z•
77 Sanitary Permit Application 4$ateTran Nuu�mber
I" .rdan ith SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 7/" , 4+.
is ire prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submittehor Projedt 03,tress(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary"' j.
purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stets. ____ 7 r
I. A• •lication information-Please Print All Information a /A�`i' `N� ///
Property Owner's Name Parcel#
fe -e <1 ' , 1 2 ?a ifti3O...(IC &,,'.-/ate—/— v
Property Owner's Mailing Address Property Location
•
///a //it/Z.df-e- ,itJ (,.2 �`/9
Govt.Lot Z�
City,State Zip Code Phone Number &a y.'j /, Section 2 8
t7C 1&, in-k) SS 330 � O N; Rl�°nw
[I. ype of Building(check all that apply Lo
r 2 Family Dwelling-Number cif Bedroo s //2 Subdivision Name
2 �4•.(`L Mock# /F1d X )9//Lk?
❑Public/Commercial-Describe Use 1t
A?....dyes_ �— ❑City of
v� d° CSM Number ❑Village of
❑State Owned-Describe Use lc+ �wn of l
p
III.Type of Permit: (Check only ne box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain)
B. ❑ Permit Renewal ❑Permit Revision ' '•'❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration _ Owner /� h�y'`( tcs Q J.J_ 9
IV.Type of POWTS System/Component/Device: (Check all that apply) !/�( $ •a ka.(' p
ArNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ^"8� /
/ ❑ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) /�
V.Dispersal/Treatm t Area Information: nor` .1'J LLJ7- t1�C'/
Design Flow(gpd) sign Soil Application Rate(g Dispersal Area Required(sf) Dispersal Area Proposed( System Elevati
<� ✓✓✓ /,. 7� f 3/f z 8Y 6 g'/,',3' /
VI.Tank Info Capacity in Total #of Manufacturer
Gallons ' Gallons Units , °3 c-0 _ •;
New Tanks Existing Tanks / ' (�/. c 2 ''
Septic or Holding Tank • t i1 cal CirvSi , r.l U .1 n rn w t7 a.
Dosing Chamber •
VII.Responsibility Statement-I,the undersigned,assume"-p•nsibility for installation of the POWTS shown on the attached plans.
Plum r' Name(Print) Plumber's : •-'re MP/MPRS Number Business Phone Number
A----e--.t-J 5/v 'V - ----.Yor 2-7?-6, 65 7/.)-- -7---7_1(
Plumber's Address(Street,City,State,Zip Cod 2 L / ' �Dl
'VII County/Department Use Only
! .. Permit Fee Date ssued Issuing nt Signature
i ` ./er G' 'eason for Denial
$75 0° /2- 12- 1.3
IX.CondiiB Wb Reasons for Disapproval 2(� n n 4 . np, _
T Septic'tank,of lUertt filter and 3 1,-..),),\4.)..a.1/4., („1 .J
dispersal gen must all be services/mainta l t a..,,,k , , ca..„ ,`,n.t�f.v.-•..i`hr+ti.
as per management plan provided bypIUI r
P � ,e r� ai-a /ea.a . La o
2.:N l setback requirements must berbeiMtd d
as per applicable cods! ,. ' &a _
Attach to complete plans for the system and submit to the County only on paper not les than 8 tlz x 1 inches in size I
F,)f t`Al e. Jz. 1/cdr; 5D,' `5 ?
P �
SBD-6398(R0313) •
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 12/11/13
Owner:Gerald Smith
Location: NW1/4 SE1/4 S28 T30 N,R18W 1174 133rd 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 Specifications S =
8-10. Soil Test
Signature
License numb:1 226900
PLOT PLAN
PROJECT Gerald Smith ADDRESS 11160 190th Ave NW Elk River Mn 55330
NW 1/4 SE 1/4S 28 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 12/11/13 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 .5 ABSORPTION AREA 931 # of chambers 46
BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H,R,p, Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATION 89.5/89.6 6' below grade
unless otherwise All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
noted 417' Property Line
ow Vent
>6„ Quick4 Standard
Leaching Chamber
of Cover with 20.0 ft2 of Area
5.6ft^2/pair of end caps Vents
4' Long B-2
3 4" Grade at System Elevation C�
2-3' X 94' Cells with •
>3' spacing
0% Slope B-3
no contours
100'
50'
Pro 3
Bedroom B.M.*
House
30' ST ■ 30'
'—' 40' 3'A
B-1
100'
133rd Ave V
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
Yp
T icalInstallation /� 95.5'
Went Grade ► Vent
■
3'1 4" 3'
• ...* -30/34 Septic Tank
5' Long 5' S' Long 1
Grade at System Elevation
3 6" Grade at System Elevation
Spacing 5'
2-3' X 94' Cells
Same on other end Observation tubeNent
At end of cell
23 chambers per cell
System elevations:
A 89.5'
B 89.6'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of--_
FILE INFORMATION
- — SYSTEM SPECIFICATIONS
Owner
� g al
n
NA
0wpt/t/ z/��� Septic Tank Capacity
— �
Permit# - T a n k 0 NA
Effluent Filter Manufacturer ° -^O NA_
DESIGN PARAMETERS --- - DNA
Number of Bedrooms 3 — ❑ NA Effluent Filter Model - __ - --_--xi NA Pump Tank Capacity •al it NA
Number of Public Facility Units -___ ump —
_ -- — ift NA
q
_" Pump Tank Manufacturer
Estimated flow(average) al/dam+ _--.
`'��
Design flow(peak),(Estimated x 1.5) i Pump Manufacturer --- iii l NA
7, • gaUday
- u NA
Soil Application Rare _lr�'*-" `S gajday/ft2 Pump Moclel --- _ _-
Month) average* Pretreatment Unit NA
Standard Influent/Effluent Quality Monthly 8
Fats,Oil&Grease (FOG) mg/L m /L
❑Sand/G-avel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220..mg/L
❑NA ❑ Mecharical Aeration C]
Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑Other:Y average
Monthl avera a Dispersal 1:;e11(s) 0 NA
Pretreated Effluent Quality
Biochemical Oxygen Demand (BODs) mg/L Ground(gravity) ❑ In-Ground(pressurized)
Total Suspended Solids (TSS) 5530 mg/L A 0 At-Gracie ----- ❑Mound
Fecal Coliform(geometric mean) 5104 cfu/100m ❑Drip-Line ❑Other: __—
Other: O NA
Maximum Effluent Particle Size 3s in dia, ❑NA _____,_______—T._
Other NA Other. ❑ NA
`Values typical for domestic wastewater and septic tank effluent.
Other: --- — --- ❑NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
's) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: yearmonth(s�� _--
Pump out contents of tank(s) When combined sludge and scum equals one-third(16)of tank volume - '- 0 NA
--`- ❑ month,s)
At least once every: (Maximum 3 years) 0 NA
Inspect dispersal cell(s) rY 1_> Year(s _ 5555_ —_
cent _ - - — // onth�s� ❑ NA
Clean effluent filter At least once every: year(s, --
O month)s) ❑ NA
Inspect pump, pump controls&alarm At least once every: . ❑years;
__ �_—_. __- - 0 months s) DNA
Flush laterals and pressure test At least once every: p year(s)
-- 5555
Other: --5555_ _ - — —_—--- ❑month)s) n NA
At least once every: El year(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 Servii: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 or the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to chect: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(i)or more of tl le 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.
AU other services, including but not limited to the servicing of effluent filters, mechar ical or pressurzed 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 cc'mpletion of arr,service event.
Page _of
START UP AND OPERATION
For new construction, prior to use of the POWYS'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 thu 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 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 openings sealed.
a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
lif-..
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/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS—_ — - ------ —_- -- --
POWTS INSTALLLER POWTS MAINTAINER
•
Names% %?/ - ---� Name cia �J/17
Phone �JJ l� -1- -/C Phone 7/5-......c,21//- z,3-7-
/J; 2/ " z,37/
SEPTAGE SERVICING OPERATO (PUMPER) LOCAL REGULATORY
Y AUTHORITY
Name 7 in, m���� ,4 5 Name( Tom /C7�f✓i
Phone J------ �- s T oi Phone �� ? •
i 4.
This document was drafted in compliance with chapter BPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code.
(?,A' (.,''' '°--.. i:,•
„-. FILTER CARTRIDGE INSTRIJCTION
tt leti1fn ,
ergs. 2 Dry lathe altar c ee 414tH the clod Of the Wtfatt bipe Iv ensure it in
teeter ed eeredrrr tier eeeeeee ape/lips. If May then either hart teem pips into um
took Heruurb the outlet or a uivent wale(glee)uddldwiai pipe onto the outlet
pipe.
ate 3 Whiter the Giese is eta dry fitted oti the outlet igloo,mere ore tlar hived,
of 416-inch pipe notelleet to brans the filter to the tank end will if Wetting the
optional supphmt Betel side support.IT oleio support method.is nut utilized,
proceed to ate flour.
4...r EP.3 For leesteeetiarrs tetahatng the optional suppleithertel side support:
solvent avid the%-ine:h pipe ante die alter rase. Jf side support irittho ai is not v.-
utlliied,proemial to dap four. ;�y a',?I4i;,,,,, ,.t.. Air
a!w4,, '
Solvent wahl the filter case ohto the unliet pipe. insert the filter 'r .,•'
c'arnidgee into the rate, lfreesing down until the filter feeler into the bottom or ..;- ..
the ceeilll- •• ,ir
If a VHS switch is utl reed: irncert into the ` �' k� s': 'w+a
clods*.906, end loe�c by turrrin �. ) ,
Maintenance
1. •rite effluent filter eieuUld be thinned every time the septic tank is
servic tel. • 1
1. Open the nutlet erexose upaut uu to inspect the tank end otter, 4 f
S. Pump the septic tank rueretdetety,rrsaktltg sure to retrieve the sludge st —
lever ea the hekPoen or the Gunk end net, the mom end eefiluent. • y
4. Maus the u ati ert levet has keen lowered below the invert of the "'t r "� Ai
oettlet pipe.firmly pull up on tke inter incite to dislodge tape r",
cartridge hen,the creee.
S. Slide the wiriest up aced Wit of the Cass for chewing.teer r
G. lt`a Ylt&switch cmftttected to are charter is present,the svelter. } s
should be rerneved by turning.*ureterdodewiw rJU"end deanud $ y ., :, w r,
with water only. ,r
7. While holding the cartridge a it its aide(lame fiat serfsco Nate .; r y° 141".'
.
dowry)over the awes*opening,these off the ceitridge with wane "' 4►• '. `
only,making Barre alt seeptege ftretetiel is dieted bed len the tarok. i., "` ;,, :I.•'t•
a. if Vftb switch Is utilised,repel by ineertl Late llltni and t " :.._... '�
turning f:iadcwiss leer". , { o. Y1 11106.:4:,, ,,4
h�i,
9. insert the Niter cartridge back runty the take,Orsszi a dawn.open T °° '•• r w e.. ,
the filter locks into the batten%of the nese. Pik .. ••
IQ-Replace itn+i secure the noeltu opening on the tank.
v,er••ac`.,•';..ore'4 i4W°R:5Xtti ,e,,'•"51:,7I WIC t.C.4.Iaeet'! 1
•
wygew.,bearago cent 8? •- LrTeit (653-45ti0: )
•
/2ii• '.
■
\ \ s p I CO
�' 212 acres
� 92,514 sq. ft. 0.
aN ‘1,,.
.
70 \ ac+. N89'56'03"E 477.99'
4.
�'cP 320.40' 157.59'lit
(I)
ocr-es-'' �\ c
12 sq. ft. \ �s �a °
0
0 N W\ _s ` W rn
292.15' .. of'
11.39'
I\ \ 0\
2.05 acres 10 °'
.. 0. i \ �t 89,268 sq. ft �'
9s /' \ \ 7. 75 acres
ft. \ 4 \ .74. 76,369 sq. it.
: \ ti
y I 80` +
519.87' U i CUL-
, L (7a
Q5.0 1 E-,1'7E
p N81 ---.� 5.7p //
,'' 22'58 W 210.72' O. °s89'30 rp
•
s ._ 27, ,*s
,,Q �� �38.20 9
p S 8122'58. E '�, s,�o
ft. :�.� �'. ---_. 210.72' 1 138.20' 4S
h --- C6 p N 89'50'27` E�- O
ti
14.68' f p/ •.- -.,,,/ /
314.48' , ' / f
eV
cis
∎_ '0-2CiC C3 2L P" St Crc;x Cou-:y P12riZo ^g 715-38E-4E86 2/2
ST,CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
A OWNERSHIP CER IFICATION FORM
Owner/Buyer t1%g- S
Mailing Address ///‘0 k // J�J 5 3 v
Property Address 171/ /33 rk /C e-At)e _
(Verification required from Planning&Zoning Department for new construction.
City/State Parcel Identification Number God 6 '-lo?7 —/d--67)71
LEGAL DESCRIPTION
Property /
p Locationi�iC /, y /4.Sec �.-,T N R / ,Town of /d .
Subdivision Plat; / ,.,. ,�j�4��� ,Lot#/
Certified Survey Map# ,Volume ,Page#
Warranty Deed# (before 2007)Volume ,Page#
Spec hous dap no Lot lines identi()ebl es no
SYSTEM i_____VIAINTENAISUANILTNEMLERIIEICAngti
Improper use and maintenance of ycur septic system could result in its premature failure to handle,wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in*Comm.83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(I)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 I'3 full of sludge.
Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,heroin,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.
1/we certify that all statements on this form are trite to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
r 44/Zz3
SIG i T OP 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.08/05)
824696 •
•
State Bar of Wisconsin Form 3-2003 REGISTER O. DEEDS
REGISTER OF DEEDS
QUIT CLAIM DEED ST. CROIX CO., WI
Document Number Document Name RECEIVED FOR RECORD
05/08/2006 10:40AN
QUIT CLAIM DEED
THIS DEED,made between Dennis F.Ball and Nancy A.Ball,husband and wife EXi 1)( i 13
and David A.Ball and Kimberly A.Ball,husband and wife REC FEE: 13.00
TRANS FEE:
("Grantor,"whether one or more), COPY FEE:
and Richmond Acres,LLC CC FEE:
PAGES: 2
("Grantee,"whether one or more).
Recording Area
Grantor quit claims to Grantee the following described real estate,together with the rents, Name and Return Address
profits,fixtures and other appurtenant interests,in St.Croix County,State of Wisconsin
("Property")(if more space is needed,please attach addendum): �, r =A-- •y .>
See Attached Exhibit"A". - A d L.V•
This deed is being given by and between all parties relinquishing all right,title and ;, %l %'
interest they have in that certain Agreement dated May 16,2005,recorded June 3,
2005 as Document Number 796642.
026-1082-40-000;026-1082-70-000;
026-1082-95-000;026-1083-10-000
Parcel Identification Number(PIN)
This is not homestead property.
Dated
Okwima l o e f (SEAL)^ .�'!�. _
*Dennis F.Ball *Di1 j.Ball
L
',-14 /� _ (SEAL) L `;`` _ (SEAL)
* ancy A. I *Kimberly
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)Dennis F.Ball and Nancy A.Ball,husband
and wife STATE OF IA„;t&,OY151'1 )
authenticated o ,� . C COUNTY rOt)( )ss.
ll '�rSJ � - )
* J.,pr■ ADDS' Personally came before me on • .
TITLE:MEMBER STATE BAR OF WISCONSIN the above-named David A.Ball and Kimberly A.Ball.husband
(If not, and wife
authorized by Wis.Stat. §706.06�� Nett to me known to be the person(s) who executed the foregoing
..'•"~ strument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY: •
Attorney Kristina OE_land a iP 1P� Ion r�
Hudson.WI 54016i. �� Mary Public,State of a„„
•
0. .0 ���gr y Commission(is permanent)(expires: •—/k-b•
• )
(Signatures ma •I;• ed or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. AN{ ODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED D 2003 STATE BAR OF WISCONSIN FORM NO.3-2003
*Type name below signatures. INFO-PRO""Legal Forms 800-655-2021 www.infoproforms.com
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r
EXHIBIT "A"
Parcel 1: The East Half of the East Half of the Southwest Quarter(E%/EYW/SW%)of Section Twenty Eight(28),
Township Thirty(30)North;Range Eighteen(18)West,Town of Richmond,St.Croix County,Wisconsin,
EXCEPT Lot One(1)of Certified Survey Map filed April 24,1990,in Vol.8 of C.S.M.,pg.2199,as Doc.No.
457843,being part of the Southwest Quarter of the Southeast Quarter(SW'/JSE'/.)and part of the Southeast
Quarter of the Southwest Quarter(SEY.ISW%),both in Section Twenty Eight(28),Township Thirty(30)North,
Range Eighteen(18)West.
•
Parcel 2: The West Half of the Southeast Quarter(WY,/SEY.)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 WdSEY.)end part of the Southeast Quarter of
the Southwest Quarter(SE'/.ISWV.),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'/./SE'/.)of Section Twenty Eight(28),Township
Thirty(30)North,Range Eighteen(18)West;
•
3. Commencing at the Southwest corner of Lot One(1)of Certified Survey Map filed August 13, 1981,In Voi..4 of
C.S.M.,pg. 1093,as•Doc.No.372738,for the point of beginning;thence N89'59'15"West 20.00 feet;thence
N0'01'41"East 282.00 feet;thence S89'59'15"East 224.00 feet;thence S0'01'41"West 15.00 feet;thence
N89'59'15"West 209.00 feet;thence S0'01'41"West 242.00 feet to the point of beginning;
4. Commencing at the Northeast corner of the Northwest Quarter of the Southeast Quarter(NWVJSE%)of said
Section 28;thence South 18 feet;thence Northwesterly to a point 10 feet West of the point of beginning,thence
East to the point of beginning.
2 of 2
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safe and Buildings
A n in accordance with Comm 85,Wis. Adm. Code
County C ./)✓0��,
tta co a si plan on paper not less than 8 1/2 x 11 inches in size.Plan must U l _
i not ' Ited to:vertical and horizontal reference point(BM),direction and Parcel I.D. )
e slop ,scale or dimensions,north arrow,and location and distance to nearest road. p 1(p 4 f47!f�-, /D
■ . Please print all information. Reviv ed by,,,, / it Date
■Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 0, `Li /2, /L /3
Property Owner Property Location / •f''t1. ,
(.9e/ � Si-n, �L Govt.Lot/,J 1/4 ,E 1/4 S 13 T 30 N R) ' E( )W
Property Owner's Mailing Addr Lot# Block# Subd. Na or `
City State Zip C Y I Phone Number 0 City Village Town Nearest Road
a7( Eit,PA/ I/? ij S533z1)( ) �,(Y.wt I /3 3d/ e-
New Construction Use: Residential/Number of bedrooms � Code derived design flow rate .___ GPD
❑Replacement ❑ Pub!' or commercial-Describe:
Parent material I Flood Plain elevation if applicable /Z//4f ft.
and recommendations:
comments SD?�►,o41404 , / 4i2 '' ' !v-c..)
System Type i � ..,. 4 - System Elevation b?•J/ g 91 cO
I Boring# ❑ Boring
pit Ground surface elev..9 I J• -I—ft. Depth to limiting factor 62 V 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
I D-(p 10v,- 312. a �'.) - - 6 . B
z 1I-g7io rc/ e( Jo ik 7 )4
yy-1z q lorry/6 — 5 c s ,� / Alin ' . -7 / 6
1Z
Boring# ❑ Boring �J
Pit Ground surface elev./ v t - ft. Depth to limiting factor/o2y in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
1 O—(1, J
�1 7/31 Z .---- ��� /l?�✓' C?,— ac,- ' 6 F
L ft;-60 /0y,5/(7 C- hp,r//' �, �� ig
3 go-/2 / ,V/.6 S (s /72/ 44 ,{/2 - -7
l
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'1k i
•Effluent#1 =BOD5>30<220 mg/L and TSS> ' r mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L
CST Name(Please Print) ' Sig a CST Number
Bird Plumbing, Inc. Shaun Bird .i 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmon• 54017 :=2— ---/ 715-246-4516
Property Owner_ Parcel ID# Page of
? Boring# ❑ Boring s� �{
v Pit Ground surface elev.` '� ' Y ft. Depth to limiting factor /;11 in. l 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
p- 0 r 3 -z. ain� rn-cr C� _ 6 ' 1
2 ''-/i 4,ily ----- C l 111.71,4A-. / ;- '-3
;err y/ ---.. S 0 s g lilt ,✓l4- 01/7- /--) ) (,
11) (° , it
.7 -"--..--/-1") 1 to . .. _
❑ Boring 1414 .
Boring#
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
I 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. *EMI •Eff#2
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<30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(8.6100)
Property Owner Parcel ID# Page of
2 Boring# El Boring �
L-3 )Pit Ground surface elev.PS" Y ft. Depth to limiting factor r I 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
l d/D IdrW7-- �
A- in CJ - 6 , 1
-2_ oil /4„,--‘77/ - c_ / ifil-f-4A1 ,tylf /49 )4 ' ;-- '---3
g/, /1 - , 3 o 41, i la 14- 0)14
11' 1° - Li It
Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor )n 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
Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
I 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<30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(8.600)
Soil Test Plot Plan
Project Name Gerald Smith Sha ,0 ird
Address 11160 190th Ave NW
Elk River Mn 55330 :GSM #226900
Lot 10 Subdivision Richmond Acres Da 4r 12/11/13
N W 1/4 SE 1/4S 28 T 30 N/R18 W Township Richmond
El Boring Q Well PL Property Line County STCroix
BM or VRP Assume Elevation 100 ft. Top of Stee Fence Post
System Elevation 89.589.6 *HRpSame as Benchmark
Scale is 1" = 40' A
unless otherwise 417' Property Line
noted
1
B-2
B-3 0% Slope
no contours
100'
50'
B.M.*
40' 3 .R\
B-1
100'
133rd Ave V
.
- Wisconsin Department of Commerce _ (� \\ EVALUATION REPORT Page__.1 of__L
Division of Safety and Buildings i. ,
rd omm 85,Wis. Adm. Code
County •St C Ro■ X
Attach complete site plan on paper not less than 8 1/2 x 111 ches iI 1 pealp n
include,but not limited to:vertical and horizontal reference int(B 'fftr 'alit Parcel I.D. O�
percent slope,scale or dimensions,north arrow,and locatio and distance to nearest road. /a-"/p
,_
Please print all Informatio . AUG 3 0 2005 Revi. ed by Date Personal information you provide may be used for secondary purpo s(Privacy Law,s.15.04(1)(m)). f l°/1/6
Property Owner ( 51•UlAlti s L`b tion
Gera-la '�'. St' .'tl,
ZONING vvt.Lot w 1/45 . 1/4 S a4 T30 N R 1 8 E(orel
Property Owner's Mailing Addreis Lot# Block# Subd. Name or CSM#
Ili to 190 Ave. Nu) I0 Plat of Richmowcg. Acres
City State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road
ED( RIVER 1 PIN 5533D1 (743)yq/-$g8e kic..hav, olNa 1 I33 ~' floe ►
3 New Construction Use:L .Residential/Number of bedrooms 3 Code derived design flow rate__ �S o _,GPD
❑Replacement ❑ Public or commercial-Describe: - —
Parent material__p Vl .?A. ii 11f1 -% y- __ Flood Plain elevation If applicable _ --e-e-ft. ,
General comments ?5 e. -* . 4/ -?r a r c-t~'S C. 1 ro r v s P 1 a rt-e-'t.- .
and recommendations: SS�S'r 'f r�r4hS ��Y1 Fur P r: "'ar y T.V(910.!S') j t� )i or
S',-}e, I . 71 (99.'3.) 5:+e- . rt. C 95.1:v.) be Nce-c"'r•
1.•3 C94 la') ?.7 (9s.aV')
0 1 Boring# Q 1-47--7/VS Pit Boring Ground surface elev.!a V 7,ft. Depth�miting factor g in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
1 • Ir C 3 . L.- a 6/ ✓- al.° o?F -
Q 10-04 ,,sYk yho 'A'n /Msbk MI c,t, I F • y IMI
4/ S1_ 4 IF
cw IvF •
Li S 1-',r 7.s'2 /y ._ S � � —
• 7 I. /'
Boring# ❑ Boring v`v1yt2 ad- L-61-7/
R Pit Ground surface elev._9 9.;` ft. Depth to limiting factor l 0 D in.
LSoil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
I • -0 10 a a 'car . r Ftr Lt,t.v o?F ,to
• a to- s ioyR314 Mill Iv\
IrEfn
)4.-"A) IF � `l • b
IS-a 7,SY' qlla i i 61 IMsble. cii) IJF
- 10Mihl MOO� . _ 7
Miiii -7• SYf%&$ 1a s* 4 4 I
'Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L
T Name(Please P Signature `�L Number
e
r�r/14 Zt 5+a.r1G �l t�o�
a 7 a la� "r M 34, Date Evaluation Conducted Telephone Number
Q 7- 3-o5 1Is aya 35s8
S1'0.� `r0�.1���� I. V
.5'YD 4.
Property Owner Gera ligi (1 Sm►4 h Parcel ID# Page a_of _4_/_
/�
Boring
3 Boring#
A pit Ground surface elev. .f i3.ft. Depth to limiting factor g 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
► 6-1d IV& 3h L. 02P s bk km Fr aw c V , (p , zz
10-a1 -7,sYR4/o 'lst_l 1Mcbk rnTi Lw I F .Y . '7
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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
Boring# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor _in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
•
•Effluent#1 =BODE>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(R.6/00)
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