HomeMy WebLinkAbout018-2009-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
515236 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:
Oevering Homes LLC, C/o Kenneth J. Oeverin Hammond, Town of 018 - 2009 -21 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
/3 GA 04.29.17.1005
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER t� CAPACITY STATION BS HI FS ELEV.
Septic J r U 14Z Benchmark Z
Dosing 0 ` j Alt. �M 5•
I x Bldg. Sewer / /. - �
Holding c j SUHt Inlet 7
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic 132, A )� ZS z6 Dt Bottom & .Z , 7g. 61
Dosing 1 32, 1 ,�/ Z5 Header /Man. &S !i/ /
Aeration Dist. Pipe
3.oS 9/•/9
Holding Bot. System . 72) - .3
Final Grade `r
PUMP /SIPHON INFORMATION 2 7Z
Manufacturer 'Demand St Cover
i GPM ili 24 C a%� (Ja 7
Model Number /�.
TDH Li Friction Loss System Head TDH Ft
3.IS a, 1 0
Forcemain Lent Dia. I �r Dist. to Well
!�
SOIL ABSORPTION SYSTEM Z. t, 4 Y.
BEDITRENCH Width r Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 I---
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION Ty p O Syst CHAMBER OR
�Z / I /� 1 /�
NA UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Ve to Air Intake
Pipe(s) �✓
Length ` Dia Length a C7 Dia Z Spacing �,3 ac"I
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over G Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bedrrrench Center / g5 Bed/Trench Edges �� Topsoil 1 g4.,
/ es [E No Yes 0 No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: CO / / �� Inspection #2:
Location: 1797 117th Ave Hammond WI 54015 SE 1/4 NE 1/4 4 T29N R17 Hillside Heights Lot 21 Parcel No: 04.29.17.1005
1.) Alt BM Description P/,0"_,
2.) Bldg sewer length = � 6� AC.La
- amount of cover = � �•� -�C...
p r.
Plan revision Required? Fv� Yes '�No [ LO Tt ' b Use other side for additional information.
SBD -6710 (R.3197) Date Insepctor's ignatur Cert. No.
co rvnwwe.YY i Safety and Buildings Division Coun ] tyS
201 W. Washington Ave., P.O. Box 7162 °� 1
'o i ■ Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
■� 2- Co of
Sanitary Permit Application state transaction Number $ �
In accordance with s. Comm. 8311(2), Wis. Adm. Code, submission of this fo Address (if ditlerent mss)
unit is required prior to obtaining a sanitary permit. Note: Application f for 1
submitted to the Department of Commerce. Personal information you prov may be used for secondary '
es in accordance with the Law S. I1041"M Stets.
L lication information - Please Print All Information IN
Property Owner's Natrie
t 5 � . GROIX CQUNTY Q � � � UU ` a I - ►7Vf>
e, e won
property owner's Mailing Address
eta 11 le, Govt. Lot
JJ
City, State Zip Code Phone Number JF— y., r /a, section L l _
J ctrcic
�y C,A ) 0 1 / T _1 - N; R ce W
>a Type of Building (cheek all that apply)
Subdivision Name
2 F Dwelling - Number ofBedrooms l r
❑ Public/Commercial - Describe Use D City of
CSM Number D Village of
D State Owned - Describe Use Town of /Y!
Z K /
90
III. Type of Permit: (Check only one box on line A. Complete Hue B if applicable)
A. New System D Replacement system D Treatment/Holding Tank Replacement Only D Other Modification to Existing System (explain)
B. ❑ Permit Renewal D Permit Revision D Change of Plumber ❑Permit Transfer to New
List Previous Permit Number and-Date Issued
Before Expiration ref
IV. of POWTS Sys tem/Com nent/DevIce Check all that a
❑ Non - Pressurized In- Ground D Pressurized In- (lround�� -Grade D Mound 2:24 in. of suitable soil D Mound < 24 is of suitable soil
D Holding Tank ❑ Other Dispersal Component (explain) --- ❑ Pretreatment Device (explain)
` IS
V, Drs Treatment Area Information: D Area System Elevation L
Design Soil Application
Design Flow (gpd) / Dutpenta! RW(s v '
' Capacity m Total # / Manufacturer
V1. Tank Info Pa ty
Gallons Gallons Unite
New Tanks Existing Tanks
Septic or Holding Tank IIZ�D
Hoeing chamber
VII. Res onsibility Statement -1, the undersigned, assn nsibility for installation of the POWTS shown on the attached plans)
Plumber's Name (Print) Plum MPlA�RS Number Btubpss Phone Number
Plumber's Address (Street, City, State,
a� 0 1 � ✓eu� i Z
VIII, un /De ent Use Onl
Permit Fee Date ued Issuing Signature
proved isapproved $ ( l�
ven Reason for Den
IX.Conditi ef& t so for Disapproval 3) ✓r 1ac� , � /p s7tA ►'��
1. Septic tank, efflutnt filter and
dispersal cell must all be services / maintained
as per management plan provided by plumber. � t' r
2. AV setback ret tdterhertts must be maintained O J
lWQie
system and submit to the county only on paper not !ea n 8113 :11 ehae hr fn alas
�`• - sue-
SBD -6398 (R. 01/07) Valid tbm 01/09 Q
k� C
PLOT PLAN
PROJECT Oeverino Homes LLC ADDRESS 1433 ernohous Ave Suite A New Richmond Wi 54017
SE 1/4 NE I /4S 4 /T 29 N/R 17 W T 'N Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 91.6' / I
�6 � D BEDROOM 3
CONVENTIONAL AT -GRADE X)OC ENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons IFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
BENCHMARK V.R.P. Top of telephone box ASSUME ELEVATION 140' Filter BEST GF10 -8
❑ BOREHOLE O WELL "H.R.P. SameasBenchmark
Pro Town Road ca = 1/4" = 10' '-ty Road T
3.3 Acre Parcel
area 15' below system is
'Hell is to to remain undisturbed
meet al I DNR
Setbacks
Pro 3
Bed roo m
House
91'
91.6'
a -3 ,
3% Slope 21 1
Huffcutt Combo Tank
Tank is to be properly bedded
W provided with Iockdown
:oyers with approved warning
labels 5 _
Drainage
Lot Line ( not to scale) Easement O.M. *Z
Illo-
grading is to be done to
Divert run -off away
Fro m system
l,'d eb0 :90 ti0 6Z unf
' Safety and Buildings
CO mmerce.wi. OV 141 NW BARSTOW ST FL 4TH
g WAUKESHA WI 53188 -3789
Contact Through Relay
sco s i n , .�ommerce ov
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Richard J. Leinenkugel, Secretary
April 01, 2010
CUST ID No. 226900 ATTAI: POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1008 192ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/01/2012 Identification Numbers
Transaction ID No. 1781387
SITE: Site ID No. 755529
Oevering Homes LLC Please refer to both identification nests,
Hillside Heights Lot 21 above, in all correspondence watlth the
Town of Hammond
St Croix County
SEI /4, NEI /4, S4, T29N, R17W
Lot: 21,
FOR:
Description: At- grade, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1261127
Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade;
System(s): At -grade Component Manual, Version 2.0, SBD -10854 (N.03/07), Pressure Distribution Component
Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the At-
grade Component Manual, Version 2.0, SBD -10854 (N.03/07), and the Pressure Distribution CoeWr>j6t Manual
- Version 2.0, SBD - 10706 -P (N.01 /01)
19
Q .
In the event this soil absorption system or any of its component parts malfunctio s so as th hazard,
the property owner must follow the contingency plan as described in the approve s. 7VnVI the owner
must comply with the operation, maintenance and monitoring duties as described i>e f the at -grade
component manual. A copy of this information must be given to the owner upon com he project.
Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is
required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions.
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
SHAUN R BIRD Page 2 4/1/2010
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation
and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan
under s. Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Si ly, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Julia Lewis - Osborne
POWTS Reviewer 2, Integrated Services W. Oo sxtde_. 63
(262) 397 -6005, Fax: (608) 283 -7481
julia.lewis @wisconsin.gov
Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in
Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings
Division of the Wisconsin Department of Commerce.
"Construction business" means a trade that installs, alters or repairs any building element, component,
material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the
uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs.
Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does
not include the delivery of building supplies or materials, or the manufacture of a building product not on
the building site.
For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProgram.html
Note: Effective March 29, 2010, we are consolidating our Shawano full- service office with our Green Bay office.
Please address all plans, correspondence, mail, etc. related to previous Shawano services, for delivery after that
date, to: Division of Safety & Buildings, 2331 San Luis Place, Green Bay, WI 54304. If calling moved Shawano
staff after that date, call (920)492 -5601.
Cover Page
RECEIVED
Shaun Bird MAR 2 9 2010
Bird Plumbing Inc. SAFETY eC BUILDINGS
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 3/25/10
Owner: Oevering Homes LLC
Location:SE1 /4 NE1 /4 S 4 T29 N,R17W Lot 21 Hillside Heights Hammond
System type: At -Grade
Manuals Used: At -Grade Component Manual version 2.0 SBD 10854 (N. 03/07)
Pressure Distribution Manual version 2.0 SBD 10706 -P(N. 01 /01)
Page#
1. Cover Page
2. At -Grade Plot Plan
3. At -Grade Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -8. Maintance and C gency plan
9 -11. Soil test
Flo �'S
Shaun Bird
Signature ''`FT�
License number 6900
'S' eGi`p
�1rp��ccc
PLOT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
SE 1/4 NE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX
SYSTEM ELEVATION 91.6'
BEDROOM 3
CONVENTIONAL AT -GRADE XX)< CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
IL BENCHMARK V.R.P. Top of telephone box ASSUME ELEVATION 100' Filter BEST GF10 -8
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Pro Town Road Scale = 1/4" = 10' Cty Road T
3.3 Acre Parcel
V
U
Pro 3 W II is to
Bedroom meet all DNR
House Setbacks
Area 15' below system is
to remain undisturbed
90
8% Slope
Huffcutt Combo Tank B-3 91.6'
92'
B -1
Tank is to be properly bedded
and provided with lockdown
covers with approved warning Grading is to be done to
labels B-2 divert run -off away
from system
Lot Line (not to scale)
B. M.
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Pressure Lateral Layout
One Lateral -..End Manifold
f--- Threaded
Cleanout
Force Main Lateral Turn-up --R Plug
X --
L Long .
Sweep
90
Be=d
Pessm�e Syabe�s Can
Distribution Network S catioms
Lateral Diameter In. Laterals are constructed of Schedule 40 PVC
Orifice Diameter LL pipe. Orifices are drilled Perpendicular to
x S CR In. the pipe with a sharp drill bit and face down.: .
L Ft Lateral turn-ups terminate with a treaded
Force Main Dsameta 2 LL cleanout plug and are enclosed in a b-8 hwli
Force Main Length 1,5-6 Ft: diameter lawn sprinkler valve box accessible
from finished grade
• • • • Grade • • • • • • -:�:
b-8 Iwh Lawn
Sprinl Valve
• Dose " •:<Mi. l ":'rAS' •:.. I •;�
03 /OSIg Page of
• d Pump Performance S ificati0
- oss Section An P
e tic Dose ank C P
S p '�
Teak Ma , P UMP Manufa�a+er
Tank Model Number Pump Model Number'
Total Tank Capacity i� Alarn2 Maau
Max. Bury Depth �. Alarm Model Number
ot
-1:
Switch Type
Filter Mangy Total Dynamic Head (TDH•- Feet
Filter Model Number Elevation Head
Distal Pressene S
Network Loss
Nfmimum pump Required Force M ss
ain Lo
Gp Ft TDH Total
m.
i
Oudet Manhole N 4" Grade With Manhole Min. 4" Above Grade'
Locking Dv� ice'. Inlet le Mounted With Locking�i�
< 6" Below.c+ w W es. .
junction Bax
`I. Fit hed ;+
vest Mm: la»
i Above Grade
t • With vent Cap
> i < ► s • a ► ► e • a a srsi s a • ,r�s�a;a s • s ►
Inlet -- 'r�► ,r
A '»
"•
Tank Volum — S _ ON titi ,; Weep
<, •.•. •f "Hole
,,.• Dom{ Volume Gal.
(�) A.! 3 S ti ,
Off Elevation
O s 2 3. t � A i y
(close.) C Ft
► ►� Bottom
.•. , . Elevation
,,, •.;. Ft
>,•. .....Total' •
• a • aaaaaarsaasa . s.ra rssa . . :<sssas :ss rte r <• a• isssars . . •sss
'Pe'a`l a ►s ► e ► ?e h•1 s ► � s•.► ►s► L 4•i s sai•s a•s4 i•aTi aaaaa,a , , , , , tia • aa • i ► s • s ► i s ► i s ► i s'<L•s • a ► s s ss ► s • a• ►a•s ►s►s S•► •s ►lla �'
s • a
with the
` ..bedd
ae ic/dose teak • is
GENERAL INS ad and tack .f ffed, m a000rdance
TA[.LATI N:
The
'$ approval h • Maximum depth of busy as vwified iy t1 t n� may not
Mo. coves emoted tD leave as � 8 &vim )
. F at ink outlet is of appc+ovect material, to.the teak wi#it
on stable soil to pse or sagging. The force main is sleeved with 4" Sch. 40 PVC too :bridge the teak
excavation and the sleeve is watertight. Electrical service complies with NEC 300 and Comm 16.a8.
0/85 W Pale of .
• i lib tssfe gal ; fifty -
lent By: Hp L"wist 3100;
DL
•aramMF�+r� "�!�
R ES SUMP /EF'''FLUENT PUM
i
s �
..
4t. 09
too Wu 48" 9Ct fc3 IUD 70 Et '� v v m atDt=
INN
am 4m !!9
Biwa
• 4 . � 8000
ftd
83 ism � .....- .- .r. lam
a. +e
rur4- cm
Oq� '@Nam _
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Wbowsh uepartrnert of Comnserea SOIL EVALUATION REPORT of
o AMM, of sd* and Bt S
in occoodanoo wigs Comm 95. Wis. Adm. Code
CMW
Attach compiele site plan on paper not less than 8112 x I 1 Wws M ate. Plan must
kwucio, but not limibed to: vertical and horixorrtat rafwwm point (Uq, &Scdon and Parcel lA.
parcentslape, scam ordimoubm north arrow, and location and distance to newest road.
Pisses print eii lnfonnatian. Reviewed by Deb
Psrsoed o*nmdon you . pmwft msY be rased forsowndwy i>vm ( Y i ew. $.15.04 (')(MD.
low /
Oe e ( GovL Lot g lg S T N R E (
Pwpeel)rpwnw's Aftess Ld I or
zip Gam
Codm M%XW M.JMbW O city O jjg Town / Ftoed
Hew Corsstre or: / Hurnearof bedrooms Code derived designs ibw.ralo .Jy GM
Paest nsabsriat Flood Piste elevm5on if aPp R
Gerwo
SYSISM Typ® ! &MGM Elevati
Soft
M Pf GoomwSureeealo,►. . tt oa>fnto +gfactor b �,
s� Awkaft tZeMle
Holm n Depth; Dm*wt6d= Redact Description Tao*= stru *". C ftxK aey Roots
K Munsd ML sz Conk color Gr. ss: sh. �rct •Eire
t b .3t z. -- S' , �- L'.
F a proursd etw. ! b * ft lc faction in.
Pit surface _L� ��__ �► __ soil
ilad2w Dq*t owkgft Color Raft Description Teukae sauckre C l sislence Bowxlrry It 02D
h tA ussell ML sa cat color Cx sz w -M
_____''' L' �.�' 'dC
el zos&e - .
E!l uw #i E!b0 > 30 :S W not and TW !'-3Q < 150 wqL • Eft 02 - BOD „30 mglt and TSS _ 30 mglL
t"$'C 1�ent0 d'leeae ! ! CST NLvdw
Bird Plumbing, Inc. Shaun Bird 226900
Address gate Evaluation Conducted. r Telephone Number
1008 182nd Ave, New Richmond, WI X4017 — 715- 246 -4516
ProporlyOwnei. Pagel 00 Pe®e at
Bwlno � �
p� Ground .. alev. + Ott 1380 b trt " factor � h Sot ` Rga
Morizon . Dpi Oomkmt Color PAd= Description TeAn Sbuckwo 8omwety fools G PDR
h Mtutset ilu. Sz Cont. Cola Gr, Sz Sh. I BM * am
AOL
An
- CM
soft a
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i .
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in. lttaIaet ML ft Cart Color Gr. Sa Sh.
• E*mtt #1: eOD > 30 _s 2W'm&A and TSS >90 <_ 150 t<t t *EA 92 = ,.BW, ;S 30 not and 1W :s 30 not
336e otCce: roc is ffi et�ai oQpot y sa tax pea�dee d boyar ;_I€ o a aee Ito s:
'mar J ' ;
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,
• Soil Test Plot Play
Project Name O evedng Homes LLC Sha
A 1433. Cemohous Ave Suite A
New Richmond WI 54017 C #226900
Lot 21 Subdivislon Hillside Heights pate 3/2 5/i 0
SE #14 NE 1/4S 4 T 29 X17 W Township Hammond
[] Boring Well PL Property Line County S T. CRO IX
k BM or VRP Assume Elevation 100 ft. Top of Telephone Box
.System Elevation 91 •g MRpSame as Benchmark .
PraTown Road Scale = 1/4" = 10' Qy Road T
3.3 Acre Parcel
90`
8% Slope
B -3 92`
B -1
B -2
B.M.
Lot Line (not to scale)
f
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code c
County .�
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must f
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. b Z
Please print all information. Revi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 14 ) o
Property Owner // 7ro- Location L 44 1
Oe _ Q ( o G1 of Jf 1/4 )VF1/4 S T O N R/ 7E (or W
Property Owner's Maili Address Block # Subd Na or M#
City tate Zip Code Phone Number y [I Village XTown Ne st Road
New Construction Us . Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement M Public or commc rcial -RME4 A
Parent material Flood P in elevation if applicable h ft.
General and recornmendations: APR 0 5 2010
System Type i ST. CROI,X COUNTY Syste Elevation � r
t NING OFFICE
M Boring # `, Boring /� ✓
Pit Ground surface elev. ft. Depth to limiting factor
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
A 31 '5 ,n 1 &7 C Y
2 s- o �/ C s /< �r
3 �! c
rl
Fa-1 Boring # C] Boring
0 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtrf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I o -/N D 31 <
3 8- 76 S S� s
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L,, 'Effluent #2 = BOD <, 30 mg/L and TSS < 30 mg/L
CST Name (Please Prirlt) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 -��' -` a7 715 - 246 -4516
Property Owner Boring _ Parcel ID # Page of
FN Boring# ❑
Pit Ground surface elev. v ft. Depth to limiting factor in. g*Eff Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #2
F-1 Bo ring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
- To — ilApplication 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
E Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
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 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 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.
SB0.8330 (RAM)
w
Property Owner _ Parcel ID # Page of
1- 31 Boris # ❑Boring n
Pit Ground surface elev. l o ft. Depth to limiting factor _ _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf#2
F-1 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 GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Ong # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ADMication Rate .
Horizon - )epth Dominant Color Redox Description- Texture Structure Consistence. Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:< 150 mg/L ' Effluent #2 = BOD < 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 (RAW)
Soil Test Plot Plan
Project Name Oevering Homes LLC Shaun 'rd
Address
1433 Cernohous Ave Suite A
New Richmond Wi 54017 C #226900
Lot 21 Subdivision Hillside Heights Date 3/25/10
SE 1/4 NE 1/4S 4 T 29 N /R W Township Hammond
C1 Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Telephone Box ---
System Elevation 91.6' *HRPSameasBenchmark
Pro Town Road Scale = 1/4" = 10 Cty Road T
3.3 Acre Parcel
90'
8% Slope
B -3 92'
B -1
B -2
Lot Line (not to scale) a. M.
{
N O
� vi
Cd I
L 0000/
c *,
« t [:]N ]H1 -10 :1N1
M" 'Z_Zo00S oar M«
— — ,60' b9 l— — — l�'S9 L �� ,00 99 i ='— — — ,b8'-t702
,50'059
00 00
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0 01 r 1
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6$436 S .F. NA 4 23 S.F.\
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74
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f 14 ,1 N 89' 0'59" W
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/ 3.45 Ac. I I
N.B. 113556 S.Fl I I
H - 1093.5' N.B. 2.61 -Ac. I
I I IJ
L BO = 1095.51
I
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H 1093.51 ( /
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\ 0 a f 0�6` .5
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Ell 170 1S. F.
U.B. 811701 S.F. 11.86 IAC.
B. 1.861 Ac.
BENCH
18/ // ,! �� / O P OF RAIL
1714176 S.F. nN.e. 7147 �i N� I II LEVATION
I 1.64 C. / N.B: 1. A� f `� /
h V4 cnRNFR
ST. CROIX COUNTY
SEPTIC TANK MAMENANCE AGREEMM
AND
OWNERSHIP CERTEZCATION FORM
0%mer/Buyer Cie L 2 e �1 C,
Meiling Address 3 e k
Property Address iii & zoning for near �.)
Citylstata Parcel Ideutfcstu
Number 6 �
I FG�IyTrs[''RiPTIOI�I L
T 2 I N RL, Town of u m
property Location � V" l� . /. ,Sod.
Subdivision �5 Ct� /
� , Volume � Page #
CertiMed Survey Map L # } / )
Deed # _ ! ! `7 � � � , Volume _~ � Page #
Warranty Lo ftb
Spec house no
SYSTEM M ' : _I M•M sum nwNFi� CERTIFIC�iTiON
is to boodle wastes. Prow
could result in its p
Im inm
�vb
�oper use and o sy stem Ho�ssd Pte• 3"m P�
Maintenalm =11M of pomp took every three soomer, ifnneeded, by a
&I system can erect ft fimaton of the septic tank as a in the waste ' Owner
respc= are spedSied in §Co=J= 83.52(1) and in Chapter 12 - St Croix County 3antar3► Os -
aubn�if to St C c Cauuty Plamning 8 zoning DepuUmnst a carton the scgaed by the
jU property o wna agr ees to tlmt (1)
p er,
restricted oar a Beemed patnpar g
estricted p teak is
owner dispo is in g and/or (2) attar (ifz>,e s$sY).
less d=1/3 fuIl of sludge- with U,� the �siped have road the above requirements and agrco'to maintain atfic Reaoia�e, S� of Wisconsin.
of Com>neroc and tlta D P g
C s sac foatb, besain. as sot by D feted and. ramaned ID the St. Crobc County
Coo stating that Ym c System has bees► maiataitted must be �
Zoning DegartmOnt wifth 30 days of the three year Mien daft.
Uwe certify that all smuts on this form are true to the best of M/0= baowledge. Lwe atafsre the ownes{s) of tine
property desmibed above, by virtme of a weaantY daed recorded in Ro8nter of Deeds Office.
Number of bedroom$
C/ � DATE
SIGNATURE �APPL�ICAN�T(S)
** *A infrmatiOn that is mi" rated may result in the sanitary permit being
mvolaea b Ilse Plantdng 4, zoning Dew ••"
iwkde with this moat a iecordsd. a►s my
decd from flee Rester of Deeds Of be and a copy of the oaffod survey maP if
reference is made in the watran ty deed -
atrv. 08/05)
STATE BAR OF WISCONSIN FORM 1 — 1998
WARRANTY DEED I9I�� �i��� 4 Ilit I��II 4 8 II�I1� ���� �•�
914
Document Number BETH PABST
REGISTER OF DEEDS
This Deed, made between Cutting Edae Four LLC A Wisconsin ST. CROIX CO., WI
Limited Liabilty Company Grantor, and Oeveriina Homes. LLC, RECEIVED FOR RECORD
Grantee. 04/02/2010 11:30AM
Grantor, for a valuable consideration conveys to Grantee the following WARRANTY DEED
described real estate in SAINT CROIX County State of EXEMPT I
Wisconsin (the "Property "):
REC FEE: 11.00
TRANS FEE: 66.00
PAGES: 1
Recording Area
Name and Return Address
}-. Croix Co" The
2iq S . Kno I4 Lis -A-tIG
WIN RI ch wt arid, I
018- 2009 -21 -000
Parcel Identification Number (PIN)
This is no homestead property.
(is) (is not)
Lot 21, Hillside Heights, Town of Hammond, St. Croix County, Wisconsin
I
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 2 nd day of Aril 201
(SEAL) (SEAL)
Gutting Edge Four LLC A Wisconsin Limited Liabilty Company
By David A Dalton, Organizer
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
} as.
authenticated this N O T AQ bt PU St Croix County
STATE 0F W ! S',, I- N3, N Personally came before me this 2nd day of
62n1 , 2010 the above named
David A Dalton. Organizer of Cutting Edna Four. A
Wisconsin Limited Liability Company to me known to be
TITLE: MEMBER STATE BAR OF WISCONSIN the person le who executed the foregoing instrument
(If not, and acknow a the same.
authorized by §706.06, Wis. Slats)
THIS INSTRUMENT WAS DRAFTED BY
Coldweli Banker Burnet/Robert Nicholson Notary Public, State of'Witonsin
1301 Coulee Road
Hudson, WI 54016 My commission is permanent. (if not, state expiration date:
10 -05227
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis.
1 of 1
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1567
Wisconsin Department bf Commerce SOIL EVALUATION REPORT P age 1 of 3
Division of Safety and tldtngs Steel's Soil Service, Inc.
(> if1 accordance with Comm 85, Wis. Adm. Code
complete site plan on paper not less than 8'% x ,�_ County
Attach con
p p p pe 1 finches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
Please print all information. Reviewed T, Date.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , + 161
Property Owner Property Location
Cuffing Edge Four, LLC Govt. Lot na SE 1/4 NE 1/4 S 4 T 29 N R 17 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
E976 170 TH Street 21 na Hillside Heights
City State Zip Code Phone Number I City _j Village 16 Town Nearest Road
Hammond WI 1 54015 1 715 - 796 -2793 Hammond I Cty Rd T
New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
r f Replacement I Public or commercial - Describe:
Parent material Ground and end moraines pitted glaical drift Flood plain elevation, if applicable na
General comments
and recommendations: Mound design. System elevation 99.77ft based on contour line elevation 98.60ft.
Boring # Lj Boring
16 Pit Ground Surface elev. 98.80 ft. Depth to limiting factor 22 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 10yr3/1 none sit 2msbk mfr cs 1vf .6 .8
2 12 -22 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 22 -75 5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0
Boring # j Boring
sm Pit Ground Surface elev. 98.80 ft. Depth to limiting factor 30 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-11 10yr3/1 none sit 2msbk mfr cs lvf .6 .8
2 11 -19 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6
3 19 -30 10yr4/4 none scl 2msbk mfr cs na .4 .6
4 30 -60 7.5yr4/4 c2d 7.5yr5/6 sl om mfr na na .2 .6
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < mg /L
CST Name (Please Print) ignature: CST Number
David J. Steel 248956
Address Steel's Soil Service, Date Evaluation Conducted Telephone Number
994 200th St., Baldwin, WI 54002 9/13/2004 715- 684 -5680
Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3
3] Boring # _j Boring
iii Pit Ground Surface elev. 98.10 ft. Depth to limiting factor 74 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -13 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 13 -27 10yr4/4 none scl 2msbk mfr cs na .4 .6
3 27 -74 7.5yr4/4 none gis osg mvfr cs na .7 1.6
4 74 -96 7.5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0
I I - T - 1
F Boring Jj # _j Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
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 P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
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STEEL'S SOIL SERVICE INC.
David J. Steel Cutting Edge Four, LLC 994200 th St.
CST - POWTSM SE1 /4,NE1/4,S4,T29N,R17W Baldwin, WI 54002
Lic. #248956 Town of Hammond St. Croix Co. Bus.(715) 684 -5680
Hillside Heights, Loi 21 Fax.(715) 684 -3449
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1" = 40'
♦ = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B 1 = 98.80 ft
B2 = 98.80 ft
B3 = 98.10 ft
}ry�Gwl� B4 = 0.00 ft
/�l• 3�/� �0 6� 33` 1
n
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