HomeMy WebLinkAbout026-1133-05-000 r
Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
' Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT)
399638 0
GENERAL INFORMATION �tod _ G -i`-,v - r� State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. S _ 3/ T ./ � 31
Permit Holder's Name: City Village X Township Parcel Tax No:
Neumann, Ted L. I Richmond Township 026- 4680*13-690
CST BM Elev: Insp. BM Elev: BM Description: I OC?
TANK INFORMATION ELEVATION DATA �a�[ . A1/e,
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic p� J � Benchmark I ! 00 .
Dosing
p �tsGLi.
Aeration Bldg. Sewer
5 7 3,0
Holding - St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO WELL JBLDG.vent to Air qIntake ROAD Dt Inlet
Septic / 33 / 2 Dt B ottom
Dosing Header /Man. ,� )
Aeration Dist. Pipe L
n1
Holding Bot. Sys
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Beqiand St Cover g
GPI� L/
Model N ber
TDH Lift Frictio oss System Head TDH j Ft
Forcemain ngth ia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 n 'E 3
SETBACK INFORMATION SYSTEM TO ` P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufactu :+ 1 -
Typ f Syst v� DI �. ^�- -5 � � / UNIT Model Numbe
DISTRIBUTIO S e�uQ� n d 6 t '�•
Header/Manifold i ribution x Hole Size x Hole Spacing Vent Air Intake
0 ti Pipe(s) '1 1 rt'�h U4 1 / a
Length_ Di, Length Dia Spacing _�
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only li(a. n
Depth Over -- ro — epth Center � / Bed/Tre Edges Topsoil of xx Seeded /Sodded xx Mulched
Bed/Trench
3 Yes [p] No ®Yes ® No
COMMENTS: "^� (I clude code discrepencies, persons present, etc.) Ins tion #1: / Z / D Inspection #2:
Location: 924'1 2nd Avenue New Richmond, WI 54017 (S 1/2 SW 1/4 6 T30N R1 W) Pine Valley Lo Parcel No: 06.30.16.• 1
1.) Alt BM Descri on
S y S'�(i►"r` &eC V , r r` `Sa4,j (� 4 Ckgink
2.) Bldg sewer length
- amount of cover a ' QA- fi S / z ' - S - U �-G Y1 a�4� 4n �
1 � �
Plan revision Required? V Yes ;o y ,,_ n�o �� Q
Use other side for additional information. ��ti """"'
Date Insepctors S nature Cart. No.
SBD -6710 (R.3197)
' Sanitary Permit Application Safety & Buildings Division
`
In accord with Comm 83.21, Wis. Adm. Code �' 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number Check if revision to previous application State Plan I. D. Number
1 5'r-co ty� 3y
I. Application Information - Please Print all Information RECEIVED Location: Cq& 3 3 -p S'_ 66)6)
Property Owner Nam / Property Location 1�
�'R'K :7 1/4��M/4, S T� (
Property Owner's Mailing Address Lot Number Block Number
/ [yI J ST. CROIX COUNTY
City, State Zip Code Subdivision Name or CSM
B /ti C t�G7/? r r :S 'a $ 2 (/S >s -� -,5 / e. (/GC Ile
I. Type of Building: (check one) ❑ city
1 or 2 Family Dwelling - No. of Bedrooms : ❑Village
tl Public /Commercial (describe use):_ mown of �/
❑ State -Owned X " " '
Nearest Road 7
1 Parcel Tax Number(s L- 4 �r
kq 4 0!p
III. Type of Permit: (Check only one box on line A. Chec box on line B if applicable)
A) 1. ew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tan Only Existing System
B) Permit Number p Date Issued
t7 ,
A Sanitary Permit was previou issued (p 3 1 ( Wo 1
IV. Type of POWT System: (Check all that apply)
tPressurized on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade t ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
3 x (O- 4'
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal ea \ 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed 33 J Rate (Gals. /day /sq. ft.) (Min. /inch) T ` ,4 — Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site eel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plum" Signature (no ps): MP/MPRS No. Business Phone Number
VAI
Plumber' Address (Street, City, State, Zip Co
Ae
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
%Approved ❑ Owner Given Initial Adverse Surch Fee)
Determination 0 , OD 3 Zw Z
X. Conditions of Approval /Reasons for Disapproval:
15 t ea to c&T-• S y JU.- . Se.� sa 41 .,13��
SBD -6398 (R. 07/00)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. OZO 1133
US
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Z ' wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 114�4A/4 S T ® N R j ?E ( W
Property Owner's Mailing Address /,1 Lot # Block # Subd�. ame or CS /M/#� //
c e ¢ J5 lJ I /t C.- v �( //e c
City / State Zip Code Phone Number ❑ City ❑ Village T wn NRdrest Road
New Construction Use ' Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material L �� G icc /�Gc TcrJG 5 l( Flood Plain elevation if applicable ft.
General comments 7
and recommendations:
12 Boring # ❑ Boring
Me Ground surface elev. / . V ft. Depth to limiting factor �jry in.
T � 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 I *Eff#2
/ a -rte 3/ g s
C.9 g
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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
o� S'
b .� Ia
* 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 Print) Signatu . CST Number
Address Date Evaluation Conducte Telephone Number
SBD -8330 (R07 /00)
Property Owner !-r' Parcel ID # Page of
5 Boring # E] 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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
7 1 0Fe
< i
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 /ft
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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
* 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 (R.07 /00)
Soil Test Plot Plan
Project Name Ted L. Neumann Byron Bird Jr.
Address 327 145th ave
H { ton W i. 54082 CSTM #220527
Lot Subdivision pine valley Date 5/3t 2 002 County CROIX
SE 1 /4 SW 1 /4S 6 T 30 N /F W Townshi Richmond
Boring 0 Well PL Property Lme # Alt. BM
,BM or VRP
Assume Elevation 100 f top of foundatlo
System Elv. T -1= 95AT -2 =94.9 H.R.P. T-3 =94.7 Same as BM
Driveway
30'
garage
172nd ave 20'
32'
2 '
20 30' BM 32' 1 ' lw/�-
B 1 10'
well
48
B
>200' to L
PLOT PLAN
PROJECT Ted L Neumann ADDRESS 327 145th ave Houlton Wi. 54082
SE 1/4 SW 1/4s 6 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
5 -30 -02 4
MPRS Byron Bird Jr . 2205 DATE BEDROOM
CONVENTIONAL XXX rade ON ENT O V I NAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE a LOAD RATE .7 ABSORPTION AREA 900 # of chambers 30
IL BENCHMARK V.R.P. top of foundation ASSUME ELEVATION 100'
❑ BOREHOLE O WELL "H.R.P. Same as BM
A Vent SYSTEM ELEVATION T- 1 =95. 1 T-2=94.9T-3=94.7
T' Sidewinder High
Capacity Leaching
Chamber with 17.2
Long 4" Elevation
Driveway
30'
garage
172nd ave E 20'
�s
/ C S � 32'
2'
Ob pipe 30 BM 32 �1 /f
62 20' 10 r Pte
\48' 4 4 A 20
Itwell
1 VW 2 0'
BI q 9
PLOT PLAN
PROJECT Ted L Neumann ADDRESS 327 145th ave Houlton Wi. 54082
SE 1/4 SW 1 /4s 6 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
5 -30 -02 BEDROOM 4
MPRS Byron Bird Jr. 2205 DATE
CONVENTIONAL XXX rade ONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE ❑ LOAD RATE .7 ABSORPTION AREA 900 # of chambers 30
BENCHMARK V.R.P. top of foundation ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL *H.R.P. same as BM
Vent SYSTEM ELEVATION T -1 =95.1 T- 2= 94.9T -3 =94.7
f Sidewinder High
CC Capacity Leaching
Cov Chamber with 17.2
6r L-1 Pcr ctmmluer
Long 4" Elevation
Driveway
30'
garage
172nd ave B2 20'
/2( , 32'
Ob pipe 30 BM 32 0'17e-'
62 Bl 10 20'
4 "' st 20' well
48
30'
B
Av&
Sanitary Permit Application G � Q Safety & Buildings Division
s , In accord with Comm 83.21, Wis. Adm. Code
'R D 201 W. Washington Ave.
See reverse side for instructions for completing this application 15 Box 7302
iscvnsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce _ (Submit completed form to coup if not
u [Privacy Law, s. 15.04(1 i
)(m) .. ( p �'
state owned.)
L Attach complete plans (to the county copy only) for the s fq par nQt 8 -1/2 x 11 inches in size.
Coun State Sani Perini umber ❑ Chec f on to pervious apc io State Plan I. D. Number
_Jft . Application Information - Please Print all Information v- _NLocation:
Property Owner Name roperty Location
1/4 , S � T
roperty Owner's Mailing Address N f`( z of Numbe Block Number
!� FiCf \�
City, State Zip Code Phon ,Nurpber _ _ \ �. S vision Name or CSM Number
ti l e u� a
I. Type of Builds (check one) "s pe. S .,�, � ❑ City
1 or 2 Family Dw 'ng - No. of Bedrooms : ❑ Village
Public /Commercial (de be use):
State- wned _ B'�
Town of
❑ - \ C
Nearest Road
Ne /� <(! i < d G l� LffC L_!`�c
P arcel Tax Number(s) v� — /0 �O-
II. Type rmit: (Check only one x on line A. Chec box on line 70. .3 0 .
A) 1. New 2. ❑ Replaceme 3. ❑ Replacement of 5. 6. ❑ Addition to
System System Tank Only Existing System
$) Permit Num Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
,[ion- pressurized In- ground ound ❑ Sand ter ❑ Constructed Wetlan
0 Pressurized In- ground ❑ d' Tank ❑ Single s ❑ Drip Line �l,6 - �o✓
❑ At -grade D Ae is Treatment Unit ❑ Recircu ing ❑ Other:
V. Dispersal/Treatment A rea Info ,er+— b
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal a 4. Application 5. Percolation RatP 6. System Elev ion 7. Final Grade
Required Proposed to ( s. /day /sq. ) (Min . /i l Elevation
�� ��`� � / • 92.0 -� q 2. �8 � S'�
r II. Tank Capacity in Aotal # of turelb b ite Steel Fiber-
PI
nformation Gallons OFGallons Tanks ` C Con- s
New Existin ete structed
Tanks Tan
.Q / ❑
VIII. Responsibility State nt
I, the undersigned, assu esponsibility for installatio6of PO W sh on tifiatod plans.
Plum er's Name (print) / Plu is Signature (n ps): MP/MP Business Phone Number
bees Address (Street, City, State, Zi e)
T
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater, Date Issued su' g Agent Sign (No stamps)
Approved 11 Owner Given Initial Adverse Surc arge Fee)Z� i 1� 12/ ��'
Determination 0
X. Conditions of Approval asons for D isappro al: I) o i �s� 9J �
(( -�j-'4 "" 6e- M ¢ s 36
So / 5 S �� �S w�' l O• z ' — a
�gaCA_►5Q dC Ct P' Si t l 5 `1Q a s Y S +1AA- .PIA -. n
�i (S �b t 1` S *c odL �N LaS�t0�5� S
SBD -6398 .07/00) w j $ 3 L.w.. CZ) ,�
I
I
e s.
}NW
Wisconsin Department of Commerce SOIL EVALUATION PORT Page of
Division of Safety and Buildings
in accordance with Cqf� ,3 Wi . A Code ` 1
Attach complete site plan on paper not less than 8 1/2 x 11 irf" in size �� ,`� , Aunty ST C fo )
include, but not limited to: vertical and horizontal reference ' 1Rt - (BM), direction and p� el I.D.
percent slope, scale or dimensions, north arrow, and locatlo an dist ,�o est
., v. O� Iq
Please print all informatiofi ";.`'� ST CR�OIX Re iewed by Date
Personal information ou provide may be used for seconds ur ose 17 c 1- 2ba i
Y P Y GYP P �c� ). \
Property Owner )) \ ' Property Lo . p �
t� , 1/4 SW 1/4 S 6 T 30 N R �t� E (o(
P�5 rty Owner's Mailing Address on >`a c f- Lo Block # Subd. Name or CSM#
sox IU�aa, ( ' R ' iC6--j M-1so») 1 Akl vQ e /�evelo mew
City State Zip Code Phone Number ❑ City ❑ Village UKTown Nearest Road
al a leor LaVe I ow 65 1 10 ( b5I ) -aL(yW R ic tM OV18 1 1 ?a " V'C
V New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate y 50 GPD
❑ Replacement ❑ Public or comm - Describe:
Parent material Q k o G s c ..^ � � °� Flood Plain elevation if applicable ft.
General comments ;
and recommendations:ai.`� a - (R�„�'r ` T#�>� �•.� c.+Sr v+c� h �` Y'�1lvY'�
9 a.
Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor � in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure R on sist en ce Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
/ d -9 )0 k 3 a S � a F& R a s a F . S . 9
a g a(O 1,5 4K 4 SL aFSiS c w e r .
3 a6- �,s� s a -s — -- , I, a
an ° o
Boring # ❑ Boring q c
a
F-1 10 Pit Ground surface elev. 7 9. s ft. Depth to limiting factor 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 I *Eff#2
1 0 - 10 104 3'a SL aF&R rn 0S A F • S` 19
a -a3 -1 . 54Rg Iq �t- j amQk M IC ) IC
3 a3 - 46 - 7 ,5V y q SL aFSB K M rA CW ► v 1= .9
yo ...Jas - 7.5 N q S (0 ML, . IA
3 Z 3 015 e.o
* Effluent A = 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 Print) Signatu CST Number
nY1q -3� as n y b
Address Date Evaluation Conducted Telephone Number
a`1- � ►. 15 -3 q%- 3588
SBD -8330 (R07 /00)
I
Property Owner Lakes i- W �ol (.. Parcel ID# Page c�Z of 3
F 3 - 1 Boring # ❑ Boring
IS Pit Ground surface elev. 9 419 y ft. Depth to limiting factor 0 0 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
L o -F JO R 3 1a SL QF6rR MPA, CAS F
R 9 -y - 154 R qliq S L a Fs cw 19"
3 y _ Dp - 7,5 L S o-s murp — ,
�Z.
2.-z g q _n
Boring #
❑ Boring
r N Pit Ground surface elev. 9 4. 4. y ft. Depth to limiting factor n 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
O -c i 1U 5 L- F&A M F a1 F ► S 9
3 Z X S 1,SVR 4ly ._ - _._ SL R E 56K 0 7rK 6"W N • 5
- 7.SkR 4 14 .._.. S - -- ,'7
a5
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
El Pit
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
* 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 (R.07 /00)
• A
x
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VALLEY ADDITION DEVELOPER FUTURE Of,NER: 0 RECORD: C.S.M. VOL 11 P
HILLVALE DEVE EARL RL & k M ANDERSEN
CONTACT: RICHARD NELSON 347 W. RIVER DR. r
ted h part of the MV4 of the SW4 and the SW4 of the 804 1 O WHITE BEAR LAKE, MN 55110 NEW RICHMOND. VA 54017
iecttoll 8, T 1, RM Town of RldY11011f1. $L Crok COt/1ty, wwconsh, M PHONE: (651) 748 -0448 r r
E.1 FAX: (651) 748 -0441
1. VOL 12 PAGE 3299
' � r
m r NORTP
_ f
CENTRAL� 1314/001
r 00
l�'ISC- �NSjjV r UNPLATTED LAND
m �
NORTH LINE OF THE S 1/2 OF THE SW 1/4 --
r
S 20' .60'
.00 1 1 1] T
A 1/
a T GE EASEMEN e
tY� H9.3 �'} p � ..;. �- _ _ _ __ �YB.H. -_ 2 00_
^, + s ° 511'2` - - -- - ' --- -- -- - ---� -- DR AINAGE
00 NL - e8 966.1
y, `+ /' -/ _ _ - - - �. - �? - °. .7z, C - � •w 267.72
.• N rb. ` p,� t .L c15
w 99q,{' 96,648 -�� - y BUILDING SE"
•w± a� •� 6 " JnJ �`\ 2.22 Acres± 4
•\ ♦;.
o p �•/ 87,289 SgFI± �1 / _ - _ s r� �, -'\ 0) 88.184 SgFt±
u £ �• 2.00 A.,-± ` �' / C18 \ � 20E �� •\ r 2.02 Acres±
`�w _ _ - a s2i - 8 -
1gP JNf 81 / 1S, ' ' �✓ N g£It•E N \ Z � 202 SgFt
*LO 5£ N '���°" �dbrJ� F y� \ ° �N \- 8a
ZIP
w +�4� -
' / yy71 ' tl & g o ' •' BG \ \ \
%y �� ?p \. 47• �\
0"! Trio. ssy •+ \\ SS W k\ C
16 =�� 17 �N �� G23 12• ,54_
is
i 99305 5 l± 95,097 SgFt± i 4 a'S'� 117,431 SgFt±
i 228 Acres* 2.18 Acea± kt? 2�a'IL• 2.70 Aces± --\ ) �i
�p17L i ?: N 1 TOP OF 2• IR
,i o /PIPE- 992.76
S •- 14 - i ,37.20' 175.56' 765.22'
'' u: N89'21'40 "E 1699.12'
87.879 SgFI± 4
2.02 Aces± rn
� II
Nee41'�0'E
a 8 UNPLATTED LAND
v
a' .o
der• u•16 ���
�. 7 �11 SSe g 1212/609 CURVE TABLE -
c ►�
2 1Z e 4) Curve Lot Tangent In Chord "-d Arc Tangent Out Curve
J✓ Number Number Radius gearing Bearing _,h I_ Delta Bearina Number N,
116,330 SgFt± ?, ! h 4 8 -9 667.00' S89 N7454'33.5 - E ;56.67' 361.06' 31'00'55" N59'24 18
I p• -- 2.67 Acea3 b 19 ✓
Vy 5 9 667.00' 58994'59 "E N82'06'3fE 19276' 193.44' 16'3700• N73Y8'Ol'E
i $\a i 6 8 667.00' N73 N66'36'03.5'E !67.18' 167.62' 14'23'55" N5924'O6'E 20
f 7 10,14 733.00' S89'34'59'E N7454'33.5'E :591.96' 396.79' 31'00'55" N5924'06'E 21
�45P W 8 10 733.00' S89'34'59'E N80'10'02.5'E 760.85' 262.25' 20'29'57' N69'55'04•E 2
q 9 R/W 733.00' N6956 "E N67 20 - E 56.00' 66.02' 5'09'38• N64 45 - E 2 -
� 11/g � ?6 10 14 733.00' N64'45 N62'04'46'E 68.49' 68.52' 5'21'20 N5924'06'E 24
11 7 533.00' N5924'06'E N6559'22'E 122.30' 122.57 13'10'32 N72'34 25
12 14 467.00' N59'24'06'E N65'59 107.15' 107.39' 13'10'32 N7234'38'E 2
�i •\ i ,^ 13 7 467.00' N72'34'38'E N6896'39'E 64.61' 64.66' 755'58' N64'38'40 27
14 15 533.00' N72 34'38 N68 36'39 - E 73.74' 73.80' 755'58 N64 38 - E 28 4 15 5 -6 523.00' N6498'40'E N86'08'40'E 563.36' 392.51' 43'00'00' S7221'20'E
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14 S rZ ^ Ilk LOT 1 LOT 2 LOT 3 Todd M. Hendersholt. RLS 2362
O O Registered Wisconsin Land Surveyor
m C. S. M. VOL 2 PAGE 597 Dated this _da of
b b - --
h - - - - - - - - - - - - - - - - - ----- SOUTH LINE OF THE
i ll ATED ro - - - - - - - - - - - - - - 17 Y1'�o` E -- -- -- -- -- -- -- -- -- --
NOTES:
JNPLATTED LAND Access to Lot 12 is limited to 91st Street n l The followin note is to be placed on deeds for future lot buyers:
Access to Lot 1170th Avenue is strictl y 2 via 170y Subject to notes, restict'wns and any easements, covenant. and
'TICE STATEMENT. prohibited. ri -of -wa of record including but not limited to those fair drainage.
No owner c resident shall do anything which would interfere with c water retention, parading, and or utilities as shown on the plot of PINE SURVEYOR
1n this plot are wbject to State. County and Township an the er ident o1 the a VALLEY ADDITION recorded in Volume _ Page _ St.Croix County,
Lotions (Le. wetlands, minimum lot size, access to 9 op pproved comprehensive wo er drainage and Wisconsin, Todd M. Handers
soil erosion plan for this Plat. This includes but is not limited to building Metro Land Sure
purchasing or developing any parcel, contact the upon. obstructing, altering, filling, excvoting w planting in any pond 412 County Roac
'rig Office and the appropriate Town Board for advice. easements. water drainage ditches. wa runways, water wWerts. berms c Lot owner. should be advised that there are Forms
in the surrounding area Little Cmoda, Mi
an this plat of the direction of the St.Croix County gross seedings. and that this subdivision may be wbject to possible Farm Animal sounds
1 Parka Committee. and smells.
This instrument drafted by Todd M. Hendershott
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POWTS OWNER'S MANUAL at MANAGEMEN4 PLAN rage of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner e ec u � Septic Tank Capacity -Z& P g al ❑ NA
Permit # Septic Tank Manufacturer We t ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
❑ NA
Number of Bedrooms 0 NA. Effluent Filter Model
Number of Commercial Units ❑ NA
Pump Tank Capacity gal ❑ NA
Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated X 1.5) ap gal /day Pump Manufacturer ❑ NA
Soil Application Rate , 7— gal /day /ft Pump Model ❑ NA
Influent/Effluent Quality
Monthly average* Pretreatment Unit ❑ NA
:_30 mg/L ❑ Sand /Gravel Filter ❑ Peat Filter
Fats, Oil 8t Grease (FOG) ❑Mechanical Aeration ❑Wetland
Biochemical Oxygen Demand (BODs) :5220 mg /L ❑Disinfection ❑Other:
Total Suspended Solids ( TSS) <1 SO mg /L Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) :530 mg/L fX- (n- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L ❑ At -grade ❑ Mound
Fecal Col(form (geometric mean) :510 cfu /100m( 1 ❑ Drip -line ❑ Other:
Maximum Effluent Particle Size -A inch diameter Values ty pical for domestic (non-commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every ❑ months j'year(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume
Inspect dispersal cell(s) At least once every ❑ months Xyear(s) (Maximum 3 yrs.)
Clean effluent filter At least once every ❑ months ❑ year(s)
Inspect pump, pump controls ax-alarm At least once every ❑months ❑ year(s) NA
Flush laterals and pressure test At least once every ❑months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mast
Plumber, Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspection
must Include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tf
volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal
cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on
the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (A) 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 ch. NR 113, Wiscons
Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other
maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting produce or other chemic
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the conter
^r aka tanwsi removed by z sentage servicing operator prior to use.
System start up shall not occur when soil condltloiu are frown at the Inllltradve surface.
During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(;) In one large dose, overloading the cell(s)and may result In the backup or surface discharge of
Muent. To avoid r ower to the effluent pump or contact a s or POWTS Ma gtalncr to mov
ssist In mane llyy Operating acing the pump con ob to
p ying
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 dlswrb or compact the area
within 15 feet down slope of any mound or at-grids soli absorption area.
Reduction or elimination of the following from the wutewater stream may improve the performance and prolong the life of the
POWTSs antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; (cult and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
palridnrz croducts: oesticides: sanitary naokins: tamponsi and water softener brine.
ARANDONEMENT
When the POWTS fails and /or Is permanently taken out or service the following steps shall be taken to insure that the system is
property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Code%
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and property 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, grave( 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:
M A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by
required setbacks from existing and proposed stmcwre, 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.
17 A suitable replacement area Is not available due to setback- and /.or soil limitations. Barring advances in POWTS technology
a holding tank may be instilled as a last resort to replace the failed POWTS.
j2l� The site has not been evaluated to identify a suitable replacement area. Upon rallure 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.
D Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the
Infiltrative surface. Reconstrualoru of such systems mwst.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 TRII'sATMENT TANK UNDER ANY CIRCUMSTANCES.
DEATH MAY RESULT. RESCUE OF A PERSON FROM TK-9 INTERIOR OF A TANK MAY BE DIFFICULT OR
1~1 F.
ADDITIONAL COMMENTS
POWTS INSTALLER 'POWTS MAINTAINER
Name yl ` f— Name c vn
Phone �6 �61� Phone
SEPTAGE SERVICING OPERATOR PUMPER LOCAL, REGULATORY AUTHORITY
Name
Phnne n / "� 6
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
i
Owner/Buyer ml/
Mailing Address
r
Property Address � D��
(Verification required from Planning Department for new construction)
City /State - 11y pit f ] 62 Parcel Identification Number. /-) ,
LEGAL DESCRIPTION
Property Locatio %a, ' / a, Sec. �, T 36� -RZ-f W, Town of
Subdivision / h c U // Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # Y�g� , Volume / 2.; Page #
Spec house ❑ yes o no Lot lines identifiable g yes ❑ no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainteuance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the sirs ni
can affect the function of the septic tank as a treatment stage in the waste disposal system. r z�
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the
master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater
i r
s in proper operating condition and/or ( 2) fter in and pumping if necessary), septic tank is less than l/3 full s
) �P P P g ( rY), P 11 .
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. ication
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office 30
days of the three year iration date.
w..
SIGNATURE OF APPLICANT DATES,'
r
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I ( ., tam targthe owner(s) of
the prope described above, by virtue of a warranty deed recorded in Register of Deeds Office.
ev
SIGNATURE OF APPLICANT DA
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office - }
a copy of the certified survey map if reference is made in the warranty deed X 0
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VOL 1720PA 5'1 8
- t65rE�884
STATE BAR OF WISCONSIN FORM 2 - 1999 ;:; ' ('; w,= cN H. WALSH
Document Number WARRANTY DEED R_G s STER OF DEEDS
u 01:{ 00.1 WI
This Deed, made between Hillv Developm Lim a _ k�CEIV D FOR RECORD
Minnesota Lim Liability Partner -Oili 3:30 AN
_ WARRANTY DEED
Grantor, and wed L. Neuman a nd Nanc . Ne uman, husband and EXEMPT A
Y CELT COPY FEE:
w ife, O "`Y FEE:
- - TRANSFER FEE: 73.50
FEE. 11.00
- - -- VAOES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. C _ County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lot 5, Pine Valley Addition, Town of Richmond, St. Croix County, Name and Retti Addre s
Wisconsin. KRIS�TINA OGLAND
ATTORNEY AT LAW
P.O. BOX 359
HUDSON, WI 54016
Ptof026- 1060. 80,026 - 1063 - 95 & 026 - 1064 -10
Parcel Identification Number (PIN)
This is not _ homestead property.
pi;) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this _ D day of Se ptember 2001
Hillvale Development Limited
• By: Richard S. Nelson
• —
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Hillval Development L imited, a Min STATE OF WISCONSIN )
Limited Liabilit Partner by Richard S. N elson _ ) ss.
tp St. C roix — County )
authenticated this 0 da of Sept 2001
Personally came before me this day of
August 2001 the above named
• Kr istina O gland —
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, _ -- instrument and acknowledged the same.
authorized by 0 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY • ^ _..
Attorne Kristin Ogland_ _ Notary Public, State of Wisconsin
Hud W l 54016 My Commission is permanent. (If not, state expiration date:
(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. inrorma+fon Proresslonala company, Fans as Lac, sw
600- 65S2o21
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1999
F
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