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026-1296-02-000 (2)
PIV CROIX COUNTY AA PLANNING &. ZONING June 24, 2010 Oeverin 9 Homes LLC 1433 Cernohous Ave., Suite A Code Administra New Richmond, WI 54017 715- 386 -4680 RE: POWTS Installation Inspection, Sanitary Permit #515248 Land Information Planning Location of Property: St. Croix County, Wisconsin 715 - 386 -4674 Municipality: Richmond Township Real Prop e Subdivision or Plat: Country View Ridge 715 -3 677 SE 1/4 of NE /4 of Section 7, T30N, R18W Lot Number: 4 Re o g Address: 988 165 Ave. - 386 -4675 Dear Mr. Oevering: An inspection by county staff of the POWTS servicing the above referenced property was conducted on May 14, 2010. At the time of the installation inspection, this Private On -site Wastewater Treatment System ( POWTS) was found to be code compliant for a three (3) bedroom home with a design wastewater flow of 450 gallons /day. Included is a copy of the inspection report. If u h a question regarding re tment s st lease contact yo have any q st on gar ng this m t a y e, p ur c o office at 715.386.4680. Si am Quinn, P WTS Inspector #665054 ST. CRO1X COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, WI 54016 715386 -4686 FAX PZ @CO.SA /NT -CRO/X W1. US WWW.CO.SAINT CROIX.WI.US Wisconslrl Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515248 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 Richmond, Town of 026 - 1296 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 07.30.18.1535 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r.f CAPACITY STATION BS HI FS ELEV. Septic / � O Benchmark � 1 �• Dosing Alt. M / 2 4, Aeration Bldg. Sewer Holding St/Ht Inlet ' y � TANK SETBACK INFORMATION St/Ht Outlet (v . ' 3 C? • Z TANK TO k P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` �\ 6 ( S d+ r-._ Septic to Dt Bottom Dosing Header /Man. 4.s5 �7.ss Aeration Dist. Pipe �• 97.'K Holding Bot. System q( . ;I 7 L �` • � S PUMP /SIPHON INFORMATION Final Grade y. 3 Manufacturer Demand St Cover GPM Z 5 Model Number TDH Lift Friction Loss Syste ead Ft Forcemain la. Dist. to well SOIL ABSORPTION SYkTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. _ Liquid Depth DIMENSIONS _72 SETBACK SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: I L Z5 �— Model Number: 3 (, � A'" o� R•�: tom. DISTRIBUTION SYSTEM A r4 s Header /Manifold �1 Distribution x Hole Size x Hole S acing ent Air Ntake Pipe(s) \ �_ G� % .... Lengt Dia_ Length Dia >. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only �`~ S Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3. 5 Bed[Trench Edges �� Topsoil \ Yes Fa No �jLs 0 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 988 165th Ave New Richmond WI 54017 (SE 1/4 NE 1/4 7 T R1 8W) Country View Ridge iddge Lot 4 Parcel No: 07.30.18.1535 A0 1.) Alt BM Description = t r �'k�` C�` `�` �S �^a �K.S o •1 1/ � 2.) Bldg sewer length = f� rj �,h. r a JJCJ ju L, VL. o ,� ( - amount of cover Z• S 6 v, o 5 Plan revision Required? q FQ Yes No Use other side for additional information. Date Insepctors i ature Cert. No. SBD -6710 (R.3/97) r d k -- e2 q - Y 7- 6 0 eommereeml.gov Safety and Buildings Division County :C 201 W. Washington Ave., P.O. Box 7162 5 t/- � ' ��O c' Madison, WI 07/1�62,� Sanitary Permit Numbeer ((to be filled in o.) Department of Commerce ► 52 T cg Sanitary Permit Application °®`°° State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /)+ unit is req uired prior to obtaini a san i t ary unit. Note: Application forms for state -owned POWTS are o'ect Address if different than mailing address 9 P 8 �Y Pe PP l ( B ) submitted to the Department of Commerce. Personal information you provide may be used for q p Q purpo in accordance with the Privacy Law s. 15.04(l m Slats. !! U U I. Application Informatio — Please Print AJI InfornXQ Property Owner's Name - Parcel # w bZ( -j29j Oy -DOd Property Owner �Mailing Address Property Location 1 r R 0\y-C Q .kr - nfF1 0 Ej Govt. Lot City, tate Zip ode - '7 tY. pp P Pho PlA * S£ / +, N E ' /., Section �/t:w !C,' �/>'+� o j�. k• r j Y O) 7 T 3 G N R (circle o II. Type of Building (check all that apply) �� Lot # 8-1 or 2 Family Dwelling — Number of Bedrooms 3 Subdivision Name ❑ Public /Commercial — Describe Use / Block # O ❑ City of ❑ State Owned — Describe Use CSM Number ❑ Village of AL Town of 4 t y+ , f III. Type of Permit: Check onl one box on line A. Complete line B if applicable) YP ( P PP ) A* ew System ❑ Replacement System g p y 8 Y (explain) ❑ Treatment/Holdin Tank Replacement Onl ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issue Before Expiration Owner :5/1 7 8��jill 6% IV. Type of POWTS S stem/Com onent/Device: Check all that appl JX - N on-Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVTreatm Area Information: I SAS' To ✓� Design Flow (gpd) Design Soil Application Ra e(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation �sv . ,s .� go , 9o0 7 9L. VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 81 g New Tanks Existing Tanks ,q nn d c �d B £� F-10 V rn , Cn epdc r Holding Tank X DOD .� k �✓ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PO show on the attached plans. umber's Name (Prim ) Plumber's Signature Number Business Phone Number a c kt �-) t L y Pl ber's Address (Street, City, State, Zip Code) Z L 9 / P - '7 , A-u e LA, FY5 3 VIII. County/Department Use Onl pp roved D Permit F`eee Date Iss ed x Issuing A Signature ZnReason for $ ! 5' `� / IX. Conditions of Approval/Reasons for Disapproval SYSTEM NER: 1 Septic tank, effluen iher and 2 , p 3 7 8 0 --/ , 67 0 , j -- l dispersal cell must all be services ! maintained V Fti5 i D N P(ti as per management plan provided by pkmi!ber. / 2. AN setback requitements must be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 W x 11 inches in size b" /. spa rbX A AV-J �� d-a�._ w kt" 5 hu"" SBD -6398 (R. 02/09) Valid thru 02/11 Al) A. P � C � M u r Z 3 o� � 3 0 0 3 LL N C � H ti fj , o � lu ti 3 w IV � w � ° o 0 C3 VA c- a � 0 x w �J 1 W In k, r I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: N�"/t .., i/, Cw 1't ,g �� Owner's Name: Owner's Address: 1 l c. • , � h a S �� Legal Description: Se- — A-6 �E -] Township: �� C_ /Yh U,n-c1 I County: Subdivision Name: A-; Lot Number: 7 Parcel ID Number: 02 `) Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross - Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenanc Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer /Plumber: License Number: Z Z Z 8 Z_ Date: S- 3 d Phone Number 47 L - L L-7 1 Signature Designed pursuant the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SRD- 10705 -P (N.01 /01). Page 1 I i I I Soil Absorption System Cross Section oa o ft 99• Z. ft 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ♦_ 9�- 7 ft Leaching Chamber ;f. System Elevation 3 ft_ ft S ft Soil Absorption_ System Plan View ft 3 ft ft Leaching Trench 1 Chambers 4' Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leachina Chamber Specifications Manufacturer And Model _ 14 %C k 4 s EISA Rating Zv . c sq ft per chamber Soil Application Rate gpd /sq ft Y O gpd Design Flow s • S Soil Application Rate + Z O • EISA = YS Chambers 3 rows of /-3 chambers each. Page of ' N G! W m. F �e O LL £ y u o � J b Y� c C Qj L C Q M1~7 RS 4- c t 46 f cz w IM Eq 0! O b Lu m , a ~ o m a C O v aJ .O m ms's: 3��a =dcc O Q11 9 E! " GJ W s N o !A u N Fi 'c d -C 4-J C N 4F f a Gj "'S a� O and a My ti E. E £ Z Q a`��` Im Q Q aTj H A 06= I W if Q N a _m sm s3 a m S d Y LLo •�o�uNE�V 1 1 ed $3os „LILY Y= 1 a w o 4.j € 1 N= 1 0•? 1 Aga 30 va Vim' 1 .,s 95 a d'-_� 1 • r1 o j m u m c ail © E 1 � a E 1 1 d 0 �w 1 �y P f ' V 2K O � sv — � •� a >« wz��o , i � m 1 by 1 r N on s Y M IA N U N INGROUND SOIL ABSORPTION MANAGEMENT PLAN PURSUANT TO COMM. 83.54, WIS. ADM. CODE General This system shall be operated in accordance with Comm.82 -84 Wis Adm. Code and shall be maintained in accordance with its component manual [In- ground Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (n.01/01) and SSWMP publication 9.6 (01/81) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic tank or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm. 83.33, Wis Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed and watertight upon the completion of service. Any opening deemed unsound ,defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis Adm Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of the triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxium scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Dept. of Commerce. Pump Tank The pump tank shall be inspected at once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption System No trees or shrubs should be planted on the absorption area. Plantings may be made away from the cell's perimeter, and the area shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than foot or for vegetative maintenance) on the area is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired of replaced with a component of the same or equal performance. If the dispersal area fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Replacement in a suitable area nearby is also an option at which point a diversion valve will be installed between the old and new systems to allow dispersal cell rotation at a schedule to be determined at the time of cell replacement. I i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Ownere'o u Art Septic Tank Capacity 10 06 gal ❑ NA Permit # I Septic Tank Manufacturer w ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer � ❑ NA Number of Bedrooms 13 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units G-I-KA Pump Tank Capacity gal O_Nl� Estimated flow (average) ��'7� gal /day Pump Tank Manufacturer El Design flow (peak), (Estimated x 1.5) 37 gal /day Pump Manufacturer 91-MA Soil Application Rate gal/day/ft' Pump Model CWA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 4a-MA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L E14A ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ILIA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. g-qA Other: ❑ NA Other: "A Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ®. m onth(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cells) At least once ever ❑ month(s) p y' °� • year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: // • mo nth 1 ❑ year(s ) ❑ NA �e ) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s Flush laterals and pressure test At least once every: p mont ►(s) ❑ NA Other: At least once every: ❑ month(s) ❑ NA ❑ 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 Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not 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 the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the 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 scraps; 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. • 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. 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. r n fa' f h so' site ❑ he site has not been evaluated to identify a suitable replacement area. Upon failure o the POWTS a d and T s Y p p 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 INSTALLER POWTS MAINTAINER Name cc w �7 1 /L • - �F 'ti C Name 0 c Lc E Phone 4t7 Z Phone Y2Z — L Y Z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I START UP AND Page of N OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not 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 the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the 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 scraps; 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. • 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. 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 INSTALLER POWTS MAINTAINER Name , �� ti �F 'f',' Name p e tc Phone Y7 Z Z `f 2-1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name -:5y. (fA- a:1< Z Phone Phone ? 66— e ft; b This document was drafted in compliance with chapter Comm 83.22(2)(b)(1►(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer �ok `>A J r 1-4. Mailing Address /V33 Property Address (Verification required from Planning & Zoning Department for new construction.) City /StatA [A - ,.. ' Parcel Identification Number GZ 4 - /Z 9 b - o V - o v o LEGAL DESCRIPTION Property Location Sf 'A ,/ ''A , Sec. - , T 30 N R /$ W, Town of IC�'cG»,, oA , J Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yespo Lot lines identifiablekes no SYSTEM MAINTENANCE A OWNER NER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 1/3 frill of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we 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 -3 SI P CANT(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. 081051 ' 110.91, 1 10 8 � � � 43 ,587 s . f fib LO 1 .001 acre LBO - 975.00 43,568 seft. 1 .000 ocre { LBO - 975 � .qgp. n R .4. ' �11� 2 Wqp. Wht iAp�� a` K Re0 �~ s a1w11wWwaw• an1E1a111uoe11eww� .M' •r Drainage 5 .0 E d s e m o t 31,611 sq.ft. � As- 1.874 Does N `. "1 6 � 3 = 975.00 .. 7 08, 0 l6 ° \ 4S 0000o Apr - 30.2010 01:50 PM St. Croix County PtanrZoninq 715 - 386 -4686 4f4 0 U N T R Y I E ithwest Quarter of the Northeast Quarter, part of the Sat ' '.a-t Quarter o )f the Southeast Quarter and part of the Northwest Quarter of the South p 30 North, Range 18 West, Town of Richmond, County of St. Croix, State Bench Mark Top of 2" 0. D. iron Pi Elevation 974.12 ft - NA% r�- - -� N88 "E 507.00' - - -- f� 1i0.�1 _ LANDS �'. 30� Bench Meek +� 8t_t r i9b "{ if2 " 0. 0. Iron � YJ" r 977.14 ft — NAVO as �'`� .,�" 43, ft. , � 4 41, eq.ft. 4 LBO = 6-00 1.062 78 sqfL acres LBO = s 50 �, LBO = 970M 99.0v 43.3m sq.tL 1.000 Gore LBO - 975.00 � -4 `�7 Ngs 3'7Lr 4. ?6' Co o r� K► 4. �Ia,�il�r{^ t1 !' f r.• — "�(�� \J iE�iS LL ' dV ' t iT E -7�- f �s ` �rl- �,..+.. --�' err r 81,811 sq.ft r M 1d'' ._ 1. 4 acres /' `0, ' N CA`s r " N897Y500E ik - 78;f —167. er CM CP r r s N O s f I � • ��� f � 2 5 � • .r •�- ' f 4,- Cif ( ft. r rr •� 1 43,62 ft• V` S/1 ac res 1A02 acres �. V IL - � N26"! 2'26 ° W $2 ! ` 115.62' .0W Ile ~' � 55.87' 2 �' N8T"t1 vo"E 310. 87,540 owl't. 2.11117 acres ! rA I 1.0110 ag7e I N89'15'45" 6 cn ! SOWN ! N87'Dt'14"E 368.16 1 t ( 96 , 111111 IIIII ill! ill! !!N! !I 111 !l111l1l11 f flf l�If 9 0 0 5� 7 1 2 • 990571 STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Country View Ridge, LLC, a 07/22/2009 08:OOAM Wisconsin limited liability company, Grantor, and Kenneth Oevering WARRANTY DEED and Amparo K. Oevering, husband and wife, Grantee. EXEMPT t Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 13.00 described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 541.80 PAGES: 2 Lots 3, 4, 1, 15, 17, 18, 22, 25, and 26, Country View Ridge in the Town o Richmond, St. Croix County, Wisconsin. Recording Area 13� Name and F. Address: Orartzo O ering PO Bo 79 New ichmond, WI 54016 See attached addendum Par el Identification Number (PIN) This is not homestead property. Dated this ( ( r day of �Cb , 2009. Country View Ridge, LLC, a Wisconsin limited liability company } C! . * BZQgMJ7,n DE hlit- * * B AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY OF ST. CROIX ,) �ss. r authenticated this Personally came before me this ` - day of the above named Country * View Ridge, LLC, a Wisconsin limited liability company to me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN in nt acknowledged the same. 1'•c�I authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, Stake of Wisconsin Robert L. Loberg My commission is permanent. (if not, state pi�dtion r' .� Loberg Law Office sw/ SFA7235 �] /L� r Q (Signatures may be authenticated or acknowledged. Both are not necessary.) ° 6 1 • ti. *Names of persons signing in any capacity must be typed or printed below their signature sr�YE WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 1 of 2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85 !jd* ounty C2 0 �, X Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pt' include, but not limited to: vertical and horizontal reference point (BM), direction an Parcel IT) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 024 —! z- 9 — o d O n Please print all information. Revi d by Date 4 1 Personal information you provide may be used for secondary purposes (Privacy La .04 (1) (m)). Prope Owner _ � Pro erty Location (� okf ' �- Lw /cf . �e � Go Lot SE 1 14/Vf 1/4 7 T 30 N R . E (oi Property Owner's Mailing Ad Lot / # Block # Subd. Name or CSNV City / / State Zip Code P one N GR �R i ❑ Village To n Nearest Road f� lv i Alm""4 w �Y l - 7 ( ) �S ON1Na G > 0 A. ! lv Cc v E l New Construction Use: CB- Residential / Numb edrooms 3 Code derived design flow rate S�iSO GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain,elevation 'If applicable ft. General comments and recommendations: ❑ Boring # [] Boring p C x - [Z Pit Ground surface elev. / - 1 ft. Depth to limiting factor > 7Y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 (5- 31 / Qy A- -- o� �, a S / Z 1 - 2 - is ou VW �tlo�7 F21- Boring # Boring ? Pit Ground surface elev. 9 q. x- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ! o. - /0 !04 4 313 _` S f Q S a ` 04X-1/ -- s © Sea u * 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 N e Please Print) Signature CST Number G k r ' f Address Date Evaluation Conducted Telephone Number 7-t- / Pik 8J Y -Zf- 4/ 72 --Z 7- c 3 Property Owner Parcel ID # Page 2– of 3 Boring #Boring Q 3 oil pit Ground surface elev. % 9 ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / 6 -0 , %oy./- X/ ,s , -,& Qs ,,,,., `/ �o Z 8- 31 Dyc'�I a r Q� �' • 7 I. z 3 31– o- </ N FY-1 Boring # ❑ Boring Q pit Ground surface elev. ` �• 3 ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 D 1014 L 4 S I . 1n 3 3 j loo j 07 � sl y '--- , s o f ...., l c �. �� �' - S • 9 .4 Le ,r G Boring F-1 Boring # El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDBF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I I K * 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) . pr r 2 Property Owner Parcel ID # Page Z of J Boring # �ra� Boring 2 n –Pit Ground surface elev. 7 . ft. Depth to limiting factor > lip 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 6 - b' / o y.4 3 12 - -- ! x a .57 , •� j to Z_ 8 - 31 V/ G - >' 7 1. ' f1 Boring # ❑ Boring Q ® pit Ground surface elev. l �• 3 ft. Depth to limiting factor. 7 in. Soil Application 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 1 '9 o 14 3 i S / Mn b K_ 6? 1 ';Z . q . (P 16- le)1/ - v l S RS I -7 47— .3 3 3 (ov /O'1,c /V — S 0 I C / v t - S • 9 • ? LP V F-1 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 GPDhT 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 (R07 /00) k Q Q4 CA 1 1 1 1 -o � r - u` n X .N N N � w-1 v v 1. W l .. � Cana lw9v Gib �it� 1014 ITIv mLw o 11G(1011 M,04d.W Y.N.Q aRY�7Vi1A�gM /�},� B A�/� 4° /ru G7715i a. R+•k.a wa wM ��r„Mwo � W 4/I 1 1 5NIbm/ A7 V "'�M1 •u wu ' AW r raMi WU40 aau b voM► 4rti ° mnnm J6�u8 dtl n VIOL .� a Two Mau: „ac ' 8 ;;• ii u :i .s ul 0 00 P �� ' CN E3 E3 wx 001 ul l i : q- ,q- q 4- Q , d��n 1 i, Lu 4.4 &4 &4 a4 is s ,r v -- . ao..w�snwawvw W6111.'�. vnn owmlernM mat pyltl 1f ad1UC wn nwe �.ox �„a �,�,�� 93WDH �NI��l3D T . +ao,r�,r a „ �, i Bu n mau r w �m oaw .o _. .. .. ... . .. .......... .1— .__M_........� i ----------- I i . 9 i i I f # . �b4 I i 11 - - -- ! i _ lid IF . I a � I i . b i r � ,fE .O•.4 i� Ln a ffi" A,ar a,u AA swoo u doom _ o V + a � I a ad .fF 77- - 4 011 4 � * aoa � dvea � �° • } I s o D • ' s�urrs�i ( d AA ,P,L . ♦,I .tF .6.f A.* � p A.. AF7t A.x A,x � il Y° E� 9 J-x - --------------------------- — ------------------ ------------------- ------------- ------ - ---------------------- --------- * --- --------------------------- — -- -- ---------- ------------------- -- smeonbu awow I 11 179 ml a ___ EK --------------- - - I --- y - - ----- o LL 070gW POOL .N Igo *-,m All �� 1•e n�sCC e� �FCF Wisconsin Oepartment of Commerce . PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514957 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: Country View Ridge LL C, c/o Oevering Homes I Richmond, Town of 026- 96 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/ p No: 07.30.18.1535 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SE TBACK INFORMATION St/Ht Outl TANK TO P/L WELL BLDG. ent to Air Intake ROAD Dt Inl Septic Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer emand St over GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of its Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO /L JBLDG IWELL LAKE /STREAM LEACHIIV Manufacturer: INFORMATION CHAMBER Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM HeaderlManifold Distrib x Hole Size x Hole Spacing Vent to Air Intake Pipe(s Len Dia L Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only F pth Over Depth Over xx Depth of xx SeededlSodded xx Mulched d /Trench Center Bed/Trench Edges Topsoil Yes 0 No E] Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection \ / / Location: 988 165th Ave New Richmond, WI 54017 (SE 114 NE 1/4 7 T30N R18W) Country View Ridge Lot 4 Parcel 07.30.18.1535 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes [] No — Use other side for additional information. Date Insepctor s Signature Cert. No. SBD -6710 (R.3/97) I 44 /ZZ/83 � 09:10 FdZ 716 336 4666 comes opal � COI �rd�P�mB�a�T162 �yfMw� ' f�� . Wl S3T0T -T� 5 � c Siu�titary' Per" wa Inaeo.a•� llA � as hr'� .ii6: COMM co.ml 'L ow" ttwe AtMM+y' M e Y O�pw a Sir �` T iilhsai.a 7ra ° w 0 Popov wow �L-C,- PMPWW ` il lo II a [�aiir<<elrel�a�tl sR aA �oix GUUNT 2t�ib1 _twAsoEftb G ZO OSUOCorwsd-D�R�us° f 9 t-1 g }'� W ' �y l�•Mdt�► Me�M � � brc 13 a U , lb Qftpsomm"AWA d ���wsssitliss�bss�Drts6swe Zy�tHtaw Dcr..rr El 13 "waftrwo- 13 plume sillydn+d 0 tea"~ t7 �s 1. arwiW■ ► © wsssr�<Kw.dwis i.Clw� ❑�,�sslosp D ssowwari� °�" ,�s.rswwist < � aa�t•A � ` . sbwhv41 ( UWN r.+ ysift Ai�s�'"'tir sflrs>tO�M�� •asllydrsi lld�clir�isr M YtL tls nsseo ',J' = slWar rrs.�'s 4l..eR. lBE� 3 b✓, eye % -- P�° 44_ j.' swk tank; tNter Wd d•.persal c must aN bo ! j• �j•,�o J� as per ma ent plan provided by plumber• 2. AN "Vie. be maintained wM.�wtrssnts.r>+r• rilirtN �a sytM/Ns a � t�oi+onf A Vaa _ atr.ouo� 4� 0 3 PLOT PLAN PROJECT Countrvview Ridae Ilc ADDRESS P.O.Box 176 New Richmond Wi 54017 SE 1/4 NE 1 14S 7 /T 0 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/11/08 BEDROOM 3 CONVENTIONAL )00( IN -G U D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TA SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 157 # of chambers 57 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL *H.R.P. SameasBenchmark Well is to meet all SYSTEM ELEVATION 99.3/98.6/98.2 2.5' Blow qrade setbacks required by B.M.* WDNR Plans Designed Using ' Property Line 99 , 0 ' Conventional Powts B -1 Manual Version 2.0 20' 9% Slope 80' Vents Scale is 1" = 40' unless otherwise noted -3' X 76' ce with >3'spacing B -2 B -3 4 ' S 25' 317' Property Line Vent Pro 3 bedroom >6„ Quick4 Standard -W house of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.8ft ^2 /pair of end caps 34" Grade at System Elevation Town road Co py • PLOT PLAN PROJECT Countrvview Ridae Il TN ADDRESS P.O.Box 176 New Richmond Wi 54017 SE 1/4 NE 1 /4S 7 /R 18 W TOW Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 8/11 /O8 3 DATE BEDROOM CONVENTIONAL )OCX IN -URE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC T A allons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 157 # of chambers 57 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 99.3/98.6/98.2 2.5' below q r a d e setbacks required by B M * WDNR Plans Designed Using 171' Property Line 99 , 0' Conventional Powts Manual Version 2.0 B2 9% Slope Vents Scale is 1" = 40' unless otherwise noted 3 -3' X 76' cells with >3'spacing B -2 B -3 40' S 25' 317' Property Line Vent Pro 3 bedroom >6 Quick4 Standard -W house of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12" 5.8ft ^2 /pair of end caps 34" Grade at System Elevation Town road Wisconsin Department of Commerce C' CC _REPORT Page of Division of Safety and Buildings Fanddistance F in accordance wi r Attach complete site plan on paper not less than 8 1/2 x 1Plan must County C roix include, but not limited to: vertical and horizontal referenc aQ� Parcel I.D. /, G� r percent slope, scale or dimensions, north arrow, and locat�nea7e Nad. D' "� Please pr int all informati n. ST. CRO) COUNTY Re vie ed by Date Personal information you provide may be used for secondary pu t7 QI: � r 4 (ml). Property Owner Property Location �f �A e 4t.) E!) Govt. Lot 5 15 1/4 � /4 / T 36 N R/9 E (o W Property rs Mailing Add A of # Block # Subd. Name or CSM# City State Zip Code Ph mbar ❑ C ❑ illage To Nearest Road /71 / New Crxistruction Use: esidential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or meraal - D scribe: Parent material ..i � Flood Plain elevation if applicable /%// ft. General nts 'q?, .3 9 S- and recommen dations: 1 M B �ng # Pit Ground surface elev. ft. Depth to limiting factor � in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft In. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 12 -3 /0 In/ "7 I 3 I C j VI —— �►/� rid (� ® Bori ng # Boring 1 Pit Ground surface elev. � ft. Depth to limiting factor I ZL� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 �1 L 3) S I a / n•, _S �, V rI u • Effluent #1 = BOD > 30 220 mglL and SS >30 < 150 ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Marne (Please Print) _ Sig CST Nurnber Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number t 1008 192nd Ave, New Richmond, WI 5401 S - -- 0 X—"' 715 - 246 -4516 Q'a Property Owner — Parcel ID # Page of a Boring # Boring I Pit LU Ground surface elev. � Depth to limiting factor ` � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs GP ' Eff#1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#2 If,- 3 J )Z Y Z 6 D El Boring # ❑ Boring E] pi Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Eff#1 GPD/f' Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Boring # Bori ❑ n9 F) pit Ground surface elev. ft. Depth to limiting factor in. Soil ADd ilcation 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 • Effluent #1 BOD > 30 = _ nxJ�- and TSS >30 < 150 mg/L • Effluent #2 = BOD, a 30 rrrg/L and TSS < 30 mglL c _ 220 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. ssu a3w (X66) r Soil Test Plot P1a Project Name Country View Ridge LLC S n Bir Address P.O. Box 176 New Richmond Wi 54017 M #226900 Lot 213 Subdivision Country View Ridge Date 5/20/05 SE 1/4 NE 1/4S 7 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron /Nail System Elevation 99.3/98.6 *HRpSame as Benchmark B.M. Scale is 1" = 40' unless otherwise noted 171' Property Line 99, 30' B -1 20' 9% Slope 80' 40' B -2 B -3 101 317' Property Line 0 NARY VIES rt I ithwest Quarter of the Northeast Quarter, part of the S4 Quarter o )f the Southeast Quarter and part of the Northwest Quarter of the SouthE p 30 North, Range 18 West, Town of Richmond, County of St. Croix, State Bench Mark Top of 2" 0. D. Iron Pi Elevation 974.12 ft - NA\ - - - -- N88 "E 507.00' -- -- 110.91' 186.24 139.10 -- 176.85' ' ! 24.28 � 8$ _ LANDS h��� i Drainage k2' 33.0 N53 01'30 "E V _ N ' 1 .98' r� 0 S2931'12 E " Bench Mark W 81.17' N )f 2" 0. D. Iron Pipe ( � a JP.. 2 C 977.14 ft - NAVD 88 '� � W 43, s .ft. P 46,2 0 sq.ft. '� �� a c!? 46,278 sq.ft. _ es 9 LBO �� a 5.00 I_; 1.062 acres g LBO == 970.50 LBO = 970.50 43,568 sq.ft. 196.08' — N 1.000 acre W / J LBO = 975.00 0 _ o p N8534 W _ y -4.76' o_ � 1 _ — — —N 89'22' 50 "1 Drainage t� cap 'o � -- . v; ° � Easement r'� s ly er a, = O ;� 167.35 81,611 sq.ft. — �s 1.874 acres � �� NO2'-';6'16 �0 %Q ® M N89 LBO = 975.00 / — — 4216; - _167.35— , °c * 66.32'x Se\b N ° o N u 0\1\ 1+ 1 o•/ �y 0 i LU 6� 43 5 s . ft. N �r i �0 43,62 sq.ft. 1 t' 1.001 acres ,�'� i .k� Tt'• 1.002 acres n v 6 .� 22.95 =:Z�. / °`, 0 i i S 1 115.62' 195.00 — ---- N26'12'26 "W /22 N87'11'00"E 310.62' 14 �� \ /�� 55.87 , � 6 Y � 87,548 sq.ft. 6 \ 2.010 acres i LO 15 ®t cV 26 "W` -_ - � Y . \ M 43,56 q.ft. { I 1.000 acre N89'1 5'45 "E I 308.00 ' ► `, N8TO1'14 "E 368.16' � 7 — I� M (0 Z)l All Bather lot corners on this plot, will be evidenced by a 1.05 inch (O.Q.) x 18 inch iron pipe (1_ f3 lbs -11in. ft), set cY� Note: D OZ The following lots must be developed as pairs (One dwelling �V per two lots) until such time that municipal sewer and water becomes available. At that time these tots must be connected to the municipal sewer and water service. When they are connected the lots may be developed and built on individually. The following lots are subject to the City of New Richmond i building setback ordinance, Q) i ' Lots 1 & 2 Lots 3 & 4 Lots 23 & 24 Lots 25 & 26 W- ' - -East Line of the Southeast Quarter of Section T OWNER Country View Ridge, LLC uoi It/ uo iur ua: LL VAA '115 355 MU lih001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address r Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location '/, ` 4 ,Sec. , T �21N RAW, Town of Subdivision Plat: � f aj��/ 2 ,Lot #� Certified Survey Map # , Volume ,Page # Warranty Deed # (before 2007)Volume Page # 0 6 J Spec ho yes f no Lot lines identifiabl�s Co no SYSTEM MAINTENANCE AND OWNER CERTIFICATION / Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 1/3 frill of sludge. 1 /we, 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 Conunerce 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we 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 SIGNA OF 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) , Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 P on ncy Plan . If system fails, determine cause of failure, use aitemate area and install new tested replacement area. . Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other faili ng components as needed. Plumber: Shaun Bird 71 5- 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 U 2656P 061 774312 STATE BAR OF WISCONSIN FORM I - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., NI This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD J. Kieckhoefer Grantor, and Country View 09/14/2004 10:29AK Ridim. LLC Grantee. NARRAHTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMF+T # the following described real estate in St. Croix County, State of Wisconsin (the "Property ") (if more space is needed, please attach addendum): REC FEE: 13.90 See attached Exhibit A TRANS FEE: 1410.60 COPY FEE: CC FEE: PAGES: 2 Recording Area Name , and Return Address a o-', c ( 0, V � 26- 1025 - 40-000 \ Together with all appurtenant rights, title and interests. 026 - 102430 -000; 026 - 102440 -000; 026- 1025 -30-0 Parcel Identification Number (PIN) This is not homestead property (is) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and reservations, if any, of record. Dated this 2rNO day of 2004 * Gerald A. Kieckhoefer, Jr. * David J. Ki ckhoefer * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Gerald A. Kieckhoefer, Jr. and David J. STATE OF ) Kieckhoefer ) ss. County ) authenticated this da of 2004 Personally came before me this day of the above named * Kristina Og)and TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland, Estreen At Ogland 304 Locust Street, Hudson, WI 54016 Notary Public, State of 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. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 1 - 1999 U 2656 P 062 Exhibit A Located in part of the SE'1. of the NE %, the NE % of the SE %, the NW % of the SE'/ and the SW Y- of the NE V. of Section 7, Township 30 North Ran a 18 W Of St. Croix, State of Wisconsin described as follvv� s:l g e s: Town of Richmond, County Commencing at the East quarter comer of said Sect! n 7, this also being the Point of Beginning; Thence S00 °37'1 0 "E along the East line of the SE �/ of said Section 7 a distance of 880.89 feet; Thence S89 ° 18'55"W on the northerly line of a Certl ad Survey Map recorded In Volume 13, Page 3752 a distance of 610.00 feet; Thence 3 00 ° 37'10 "1= on the westerly line of said Certified Survey Map 428.42 feet (Record 428.50 feet); Thence S ° �I8'5 2 along the south line of the N %= of the SE '/ of said Section 7 a distance of 1146,36 feet Thence N00 ° 33'53"W 1384,45 feet; Thence N88 0 57'22 "E 1048.00 feet; Thence N51 °0 .0 feet; Thence NSS ° 22'35 "E 507.00 feet to 0'00 "E 25 a point on the East line of the NE % of said Section E 'along Said EasYllne of terminating_ ;Thence S00 °40'35 " the NE % of said Section 7 a distance of 248. 0 feet to fhe Point of Begfining and there f I f FROM :OEVERING HOPES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12 r - 1 9 72 y E 1 I I ' t FROM :OEVERI.NG HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11 AN a� O %-- slow foal O w �I i Wiscobsin Department of Commerce S EVALUATION RPORT Page of 3 Division of Safety and Buildings J� in accordance wkh mm! Coun ty Attach complete site plan on paper not less than 8 1/2 x 11 nches in siz include, but not limited to: vertical and horizontal reference int ( paw I.D_ percent slope, scale or dimensions, north arrow, and locati n and diSt'ah ed by Dat Please print all informa n. ST. CR Personal information you provide may be used for secondary pu PfZ4W tp / Property Owner r � ,�, Govt. Lot �� 1/4 l e:' S T � N R f 9 E (o W Property is Mailing Add Lot # Block # Subd. Name or CSM# City State Zip Code P Number ❑ C ❑ illage To Nearest Roa I 6 J New Construction Use: esidenbal /Number of bedrooms 3 Code derived design flow rate fa GPD ❑ Replacement ❑ Public or mercial - Describe: Parent X Flood Plain levation if applicable /y ft. General comments - p and recommendations: $ 51 P�1/ C �/�( 93, / 3, Boring # Boring Pit Ground surface el '-7' ft. Depth to limiting factor l z d in. Soil Application Rate Floriaon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. °Eff#1 °Eff#2 r/p 31 e N ,t a Boring # Boring z Pit Ground surface elev. �ft. Depth to limiting factor --oil A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ° Eff# 1 °Eff#2 s ,, , . (o /'.0 2 C- t s hk 4!�"� (--, 14:� l\/FS – rn' mom, a rt I '&I ,t Effluent #1 = BOD > 30 < 220 mglL and TSS >30 150 ° Effluent #2 = B013 30 mgA and TSS < 30 mg/L CST Name (Please Pratt) CST Number Bird Plumbing, Inc. S haun Bird ZI P 'leo " 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 7 J !"� — �� 715 - 246 -4516 I � – , Property Owner _ Parcel ID # Page of GI Boring # Boring , T pit Ground surface elev. ft. Depth to limiting factor Ltn. Soil Application Rate sistence Horizon Depth Dominant Color Redox Description Texture SWcture Con Boundary Roots GPDO in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 'Eff#2 l') 0 r ? 2 o F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Doninant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 'Eff#2 C] Boring � # Ground surface elev. ft. Depth to limiting factor in. F ❑ Pit Soil AWIcation Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff; in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'E11#1 'Etf#2 Effluent #1 = BOD > 30 220 rng1L and TSS >30 < 150 mglL ' Effluent #2 = BOD 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. saD -8330 tx.60)) ,yea Soil Test Plot Plan Project Name Country View Ridge LLC Shaun Bird Address P.O. Box 176 Z�4 New Richmond Wi 54017 CSTM #2206 Lot 2 A Subdivision Country View Ridge Date 5/20/05 SE 1/4 NE 1/4S 7 T 30 N /R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron/Nail System Elevation 93.9/93.2 *HRpSame as Benchmark 10 property line 83' Property Line 30' 0' * 98 B -2 10% Slope 30' B -3 Scale is 1" = 40' 0' 94' unless otherwise noted B -1 301' property line I J