HomeMy WebLinkAbout026-1296-20-000 Wisconsin I Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
506373 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 LLC Richmond, Town of 026- 1296 -20 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
B M I C,5 1 1 07.30.18.1551
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER j CAPACITY STATION BS HI I FS ELEV.
Septic � Benchmark
g Al B
Aeration Bldg. Sewer 951
Holding St/Ht Inlet 9` 3 93 q
TANK SETBACK INFORMATION St/Ht Outlet �5 93.7
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man. BIZ g`
Aeration .- Dist. Pipe !G q2
I C,
Holding _._ Bot. System N. , 11 7 VP
6
Final Grade
PUMP /SIPHON INFORMATION C
Manufacturer Demand St Cover
P
Model Number
7T Fric i $ _ Head T Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer .��
INFORMATION CHAMBER OR W a
Type Of System: Ar UNIT lk
IV A— 1 Model Number:
DISTRIBUTION SYSTEM /6.0(o =32 da
Headei /Manifol d -I Fstribution x Hole Size x Hole Spacing Vent to Aiyllnt
�( oe(s) �� --
Length IL Dia ngth_ Dia Spacing ell
SOIL COVER x Pressure Systems On ly xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center q renc
Bed/Th Edges Topsoil
� Yes [:] No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / I Inspection #2:
Location: 1635 98th Street ew Richmond, WI 54017 (NE 1/4 SE 1/4 7 T30N R18W) Country View Ridge Lot 20 Parcel No: 07.30.18.1551
1.) Alt BM Description = /
2.) Bldg sewer length = 1 57
- amount of cover
Plan revision Required? J Yes >No J/ 07 <_ 3 75
Use other side for additional information.
Date Inse or' Si ture Cart. No.
SBD -6710 (R.3/97)
commeree.Wl.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 54 , 0 (,g ` yL
Misconsin Madison, WI 53707-7162 Sanitary
it Number (to be (to be in by Co.)
Deparbnot of Sanitary Permit Application State Transaction tuber
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a ropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Application forms for s weed POWTS are Project Address (if different than t ing address)
submitted to the Department of Commerce. Personal information provide r secondary
ses in accordance with the Privacy Law, s. 15.04 1 m , Stats. 1 7.
L A tication Information — Please Print All Informatio
Property Owner's Name Parcel #
(�, CRECEIV - oz(,- )ZI(o i zo, a,a.e
4Bw n 1 /CC
Property Owner's Mai Address �0� Loc ♦
P D I OCT 1 7 20 Govt Lot
City, State Zip Code Phone Number /�� - /.,� Y. Section 2
/__ ST. CROfX COUNTY /� / ircl eo
t T Z/! N; R ` E W
U. of Building (check all that apply)
OK drD Subdivision Name
r 2 Family Dwelling - Number of Bedrooms CJ
Bloc t
❑Public /Commercial - Describe Use hoop f) a,ti.
❑City of
CSM Number [I Village of
❑ State Owned - Describe Use
own of
Ae4 " ,�z
III. Type of Permit: (Cheekonlyonebo3fonfineA. Complete line B if applicable)
A. w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
IV. of POWTS S stem/Com oneut/Device: Check ail that apply)
ti w
Pressurized In Ground ❑Pressurized In- Ground ❑ At -Grade [I Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑Other Dispersal Component (explain) ❑Pretreatment Device (explain)
V. Dis rgal/Treatment Area Information: '� l
Design Flow (gpd) Design Soillication R;ie(gpdsf) Dispersal Required (s Dispersal Area posed (sf) System levatio
lel - l - s - V � , 1 5
Tan o Capaci ✓ ty / in 6 Total # of Manufacturer ✓ y `
Gallons Gallons Units L'
New Tanks Existing Tanks 6�i
o ('f CA vJ
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Stateme - I, the undersigned, assume s risibility for installation of the POWTS shown on the attached plans.
Pl liar's Name (Prints Plumber's re MP/MPRS Number I Business Phone Number
r�
Plumber's Address (S�tyet, City, Zip Code) -
.c
VIII. Conn /De artment Use Only i
Approved = Permit FeeFee Date I sued Issuing A t Signature
n Reason or Denial - 7,/� ' 0O / �� ,$ / D 7
IX. Conditig��easons for Disapproval 3' (� �� / p p� �a �ra ✓� �. "`J A..
t. Septic W*,'0muent filler and J ( wJ f 0,4 n�o..',�� Aee..
dispersal cal must all be services / maintained
as per management plan provided by plumber.
3. AN sftack rx{uWements must be maintained
7 par system and submit to the County only on paper not less than 8 112 x 11Inches in size
SBD -6398 (R_ 01/07) Valid thru 01/09
r
1
PL N
PROJECT Country View Ridae LLC P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1/4S 7 /T 30 N/ W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/17/07 BEDROOM 3
CONVENTIONAL )00( IN- GROUND P URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 10 0 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
hL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filte
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 94.2/94.0 4.5' below qrade
WDNR
398' Property Line B.M.
B -2
30'
Plans Designed Using
Conventional Powts 15' 90' B 1 30'
Manual Version 2.0 ST
30' ❑ 3� 0' �
Pro 3 Vents 30' by
Bedroom
House
B -3 45'
2% Slope
2 -3' X 66' Cells with >3' spacing
Vent
>6 " Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.8ft ^2 /pair of end caps
4' Long
12"
Grade at System Elevation
34"
Scale is P = 40'
unless otherwise
noted
PLO LAN
PROJECT Country View Ridae LLC RESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/17/07 BEDROOM 3
CONVENTIONAL XXX IN- GROUND P-d#U CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 10 YO gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑BOREHOLE O WELL *H. R. P Same as Benchmark
Well is to meet all
setbacks required by SYSTEM ELEVATION 94.2/94.0 4.5' below qrade
WDNR
398' Property Line * B.M.
B -2
30'
Plans Designed Using 15' B -1
Conventional Powts 90' 30'
Manual Version 2.0 ST
30 ❑ 3� 0'
Pro 3 Vents 30'
Bedroom
House
B-3
45'
2% Slope
2 -3' X 66' Cells with >3' spacing
jC Quick4 Standard -W
Leaching Chamber
with 20.0 ft2 of Area
5.8ft ^2 /pair of end caps
3 4 Grade at System Elevation
Scale is 1" = 40'
unless otherwise
noted
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Divisice.of Safety and Buildings
in accordance oV e
Attach complete site plan on paper not less than 8 112 x 1 inches in size -an must County 5-11; C r oi x
include, but not limited to: vertical and horizontal referen point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and loca n an�ipt" w oad.
Please print all informal n. 1� 7 Review by Date
Personal information you provide may be used for secondary pu ses (f�iSa�y.ys.�YS oa INI } n)).
Property Owner �
�o n f r 2� Z� Govt. Lot 1/45 1/4 / T N R/ E (o W
Property l's Mailing Add _ of # lock # Subd. Name or CSM#
v t3t�JL / 7 �o N.k.F�. It 20 e!' Le
city State Zip Code ❑ C ❑ illage To Nearest oad
New Construction Use: ji / Number of bedrooms ..> Code derived design flow rate 1D GPD
❑ Replacement ❑ Public or mmercial - D scribe:
Parent material i �� Flood Plain elevation if applicable ft.
General comments
and recommendations: �� / �!
S y 5'i� x
S&7( H � �olvy,, 4Ga
Q Boring ' f
M �#
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/tf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
2
1
A 5
Boring # Boring f�
NN" pit Ground surface elev. �' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh. `Eff#1 •Eff#2
6- a �3
I
,i
L "
Effluent #1 = BOD > 30 220 mglL and TSS >30 150 mg1L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL
CST Name (Please Print) _ Signature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 J !-"' C;o t:7 ��" 715- 246 -4516
U /
Property Owner _ Parcel ID # Page of
a#
Boring , �� �� ✓
pit Ground surface elev. �, ` Depth to limiting factor in•
GPDlft? Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
nn c S Z
1 3"7 fl C1 Z m s 1�
0 L4
r/
F Bori # ° ring
°pi Ground surface elev. ft. Depth to limiting factor in. Soil — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ' Eff#2
Boring ❑Boring
F
# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit - Soil ADVIl ication Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consi stetj Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2
• Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mgA_ • Effluent #2 = BOD < 30 mg& 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.
SOU4330(RAW)
I
Soil Test Plot Plan
Project Name Country View Ridge LLC Shaun
Address P.O. Box 176
New Richmond Wi 54017
CST 226900
Lot 18A
Subdivision Country View Ridge Date 5/20105
NE 1/4 SE 1/4S 7 T 30 N /R18 W
Township Richmond
F� Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron/Nail
System Elevation 94.2/94.0 *HRPSame as Benchmark
398' Property Line
B M.
98.5' B -2
30'
15' 90 B -1 30
97.5'
30
2% Slope
Eld B -3 45'
Scale is 1" = 40'
unless otherwise
noted
';
F 5
J � *
tL
acres
o K 0
S
115.62 195.00 I-
`� - N26'12'26 "W "
55.87 .�2 2 ,' N87'11 00 E 310.62' 0 1 1 rn
Y O
i 87,548 sq.ft. 1 o0 -0 I Co 00 LO 1 100
®1 �` 2.010 acres C14 2 5 c6 I
M 43,561 sq.ft. I I
I M
r 1.000 acre 0 1
N8915'45 "E - toa
VA 308.00 I
N87'01'14 "E 368.16 M , _
I I • w
26 1 a, 33' 33' 1 r
1 2 '� N 43, 578 sq. ft. .+ Q 1 O
1.000 acre
I 1 75,935 sq.ft. I I M
1.743 acres
Q; 3 N SW I to
o o `� `�` S "E 1 I W
o - (D 307, 95'
h 0 rn 1 I
Pj z
N + S8724'23 'E 398.77' Y I I
N
0
in v I
~' 2 7 m 1
20 N 8 U) rn
O y
/ v 0,672 sq.ft. I ^ v I
m 83,879 sq. ft. M 1.852 acres o C-4
'� 1
1.926 acres O I12 100
I o I
i m 03 1
`� , - - -- - -- I 33.00' -, -�- I I
9 - N89'18'55 414.05 - -�\,
137.81' 276.24' 300.76' �` I
S89'1 8'55 "W 610.00'
(N89 7'31 '"E) I `
i
Bench Mark I I
Top of 1" 0. D. Iron Pipe I
Elevation 974.67 ft – NAVD 88 1 F–
I
o i W1 Co
LOT I ^I
=I I I
19 CER TIFIED SUR VEY MAP I of W
ft I
85,690 sq.. `
1.967 acres d, — — — — — — — — I Ol 1 0 1
LBO = 959.00 VOL UME 13 ,
- A PGE 37 I i
------
0 I
o O Z ( I cn I
I I
I I I
�S I I
COUNTRY VIEW RIDGE
Located in part of the Southwest Quarter of the Northeast Quarter, part of the Southeast Quarter of the Northeast Quarter, part of
the Northeast Quarter of the Southeast Quarter and port of the Northwest Quarter of the Southeast Quarter, all in Section 7,
Township 30 North, Range 18 West, Town of Richmond, County of St. Croix, State of Wisconsin /-
Thmsmnoobjecuomto this plsleiHumpaun / V I C I N I T Y M A P 1
Sas.236.15, 276.16, 22620 and 276.21(I)ord(2), - -rw°e wnaeut can+ 1
;Nem 7 ->G -IS kcfion 7, F30'7, RIBw
19is 9hk. as provided by a.?r'6.L, IVIsStiI:
L'mihed oCTeP.Eil 26 . 20 AS eeNSa° 97112 n - xdw as p "m ; tan �„ °, me 1
"n uvueai aim nma a,e. °e
,-- - —
N86'22'35 "E 5072' ' a 7
�
86.24; - 7 l0 17685'
110.91' I Np I/e 2 N( Ip '
O a ' ' n'°"'ye x M1 I 1100 %2a w
DepsrtnentofAdmini9oadon UNPLATTED LANDS
ti W Z - l o;'wx9VYJOt
0:29'71'711 ----- oN u
8na 9°A a Q y U BI.17' N ,J' A' m
nalr p 0 a 3 ! 2 0 w
Oewlia 97.11 n - NAw p0 10 43 S87 It m, 16279 It m 16,280 con. in a yi ,
4 P ool °era q £ 1.062 am n sw 1/4 (lp
L6a = 97500 f I®J 7 97030 IBO = MID 046.00'
1 0569 ban. N o - o
220.00' 220.00' 7fi8.59 196,D8' taco bore £ u j m N m a I thou dwwe
ti L90 = 9,100 0 "n o I;
$ eB�s :w- _' -
- - - - - - - - - - - - - - �.,', °., 16 -o�� �b� tl89'22�50'E;'
P,
-a the - - - m I n< a,�ia °7 - - - - - o ,os o � r'I ,ad sa=e
a ° c
It t ROB Nor 6ns1 waled m m Ue Se°Ihasf 0°Me m m, 8•: Fll yIL
s 2 ".�'
tae a,lesat 00, b +0 ,
1 9s.W / s� �e• '0:*slse � .,;'�� �S p N89't2aD
'� J � 6J 1 q +a •,ED �� $ _ - 67.J5-- ' '. EENC
W 97.911 yIL pp 7 ; 6
m 2245 °ra ; U ; a752 :9N 5e " Q Found St Croix County Station Coma
n 0 91,918 "T a 87.918 1931. m U >D' 9
n 2.0`89aes 2018 a,a " t J 0
"o o No m/ 6 9 '�' 5� ' +1 N s, s W I e Food f ( O.D.) Iron Pape (Unless Noted)
N ,u7 f 19 .' - W
Z Z Z / i3ti �3 y13 � 4o' 23 I P 6 24
d 6
n 17,; "�� 1 0 Set 2andJ8 00)s 30'tron Pipe 365 Es n N.`
ta roam l _ 6 >a / ' ( ( A x
rho a r, '4�yA ta w ) i[379nvelf, a
tae To 1001 nl
1)06.04') Record Dole
rn u e 99n ' ����1 9 T' 1 I 1 (N897J'IO "W
E -- --- 22Q00 2296-;�Y +�106 115.62 19��, G ------ 12'UtiilyEasement
. i>N2612'26'W 3 N8111'W'E 1 b Im � N8857'22'E 799.12' )65� o 59 \ /' 6587 X22 1 1 tit -Bu96mg Beldame line
J- - - - -` m 5 qll. 0 m Q I . ^ N885T2YE 306.98' a = �,.,, ^\ 6 1 2oro,aa n n ' � too. 22 E 426.698 1 4
'----„ J7 �' -- 259.18' ?'- 11.80- \ ' ',, \1 �l n 43 N .A. I a- o i lo
Z Lo lest P est 9u9dng d Do by
m 1
m N2612'26'W' Y n Loosest Door a WYldoe Elevation 56. 11 tJ I r N
1 I N8915'45'E - 700.00' ^f a
in j F 1 1 N `, 306.00 All 9a lot o ners m fh s dal, well Ge esiMnceO Dv c
d Fn I W I; N8711
finrdoq ku °a - - 36816' ;, , I
'14'E
n1 I A 26 I 3 I �.�51 rh j00J x 18 �m nm proe ILIJ 16x/1r,. Rj, set
2 ' s7ze�ll. MI IV I" .c°' 6t121�r, �� j o7 1 21 N av9 4 n. I. o n 33' o
I b 0 I coo c;::
0 0 2000000 h 87t70p.n. I ! I 7s,9JS:au. �' 4: m �N nm Note:
Leo =sa9ao z1 Iz „, tow9aa b t om m
Ip m - Th e IoHawhg lots must be developed as po9s (One dealing
�I -` S86'4T12'E 426.59' i n io I p ', S83'S1'3rE 8 Iw N per two lots) untl such tine that municga weer and enter
° J o° m n
Di H JOZ95' becomes owllable. Al that We these tots must be connected
QI " t i I lo m n m I ei 'n W w to the municipal sewer and eater rate When they are
N 1 1 71 1 I 6
by in Z a IL d carmected the lots may be developed and built an isidudly.
1 1 n� I + W W I, { 6 The IolowMg lots are s.Apc1 to the City of Nee Rearmed
21 • a I l ry l ' S8724'T3'E,
g al ez7H1 pan. ! axo'x9'4d' 1 I i p ry I 1�. 396.7) ° n n buiding setback ordinance,
I 1900 arcs A` 6535' Oh 7 i I I n ry o� 'a '° 0
N o
0
taa = 90100 e' 27 mryy i 7 271.5 y n n y "m Y I In h Lots 1 e 2
y e , / 2 • S8618'46'E 245.75' 482%.23 t y " + ° 20 m ', n ° I Lots 3 a 4
in 2 j N 90,672 a„P- r a
` e 93,879 sIsR. h 1852 ° ^es Lots 23 d: 24
o ( �. 1926 aaa ° I ' tar n Lots 25 At 26
Z N32 - 571 o ' ( m I ^( ,�,mnn ° omnercr
583111'pp•E 7 10 - :> 4956 / ®is_ 1\ 1 li sallml
I 0 I a 1 _ - - I �B918'55E <I4 05 1'
3 . 137.61' 27624 ]0070
e,. , 1 90 1 7
I
C<7 9ua
a 12 I0a L n 7 � e 1 aax
m , I �3\ R 1 s al i� I9 ll ,.o Pip
60.315 soft
N IBIS aia ^ o'�' 557W12t 1 / 0en'im 971.67 H - NAw 88
: 2. azof eob71 sae //,� W l m
i66 �1 LBC =9.9.00 \ M1Osb � / mo N,�
U) 9� 29 81, 6 o
).66 287.01'1 x 1y� N m + IDD O 100 200
a n I ss1a1'n :,
u ��; ?n 19 CER1 FlE0 SURVEY SAP It
0, is.* m m .1 A, °I
N89'52'41 'E 301.71' 1 NIN 7x65 79' JE 98690 so� 3 Ba+wv
b. G 'o 1 SCALE W FE-1 oe sov18ea1 waU a 5e9ia 7.
I I° 584 31 9 1967 arzs
o ' 'fi �G, Lao�959ro n VOLUME 13�PACE 3752 � I 1 p 97e��eme�
1 4
Ed ,aawa s<r9�d 1 yl as' ,c m n
I.f0,fi9J son. a�. S1
d I a °liege ! 1) w
to be aBnquheed ". Faamal 0 0 0
,ad ala 9 n fit ry - 919.00 m TI p9� ' �9 o i m I
q1 I e s a ov m ,
IJ 5 1 �. o •0
i n
11 161 61 N;' /ISP :tab
N 76,222 eyJt. 'r I `a Z Z m r /0 n Z
1.750 aaa i9 1 N i3 I '6 1", i 6 1 bJ ss yf
�I h 'd I� /�tlAao2 �p5
1Im \1 n1 'w8376'511 '•N26600'' L __
o� uw somo I a I WII '(' 211.99' - t I/
m Bzs --------- - - - - -J
1 ' MELCHERT WALIQ{Y
66.39 " -- SJ352' `t o, 7/8' 4m 7p e " landscape architecture H1`beey 12
58978'52 'W 1148.36 - (� rands.auw7a civil en ' eerin A749 ad. In 54016
Sabm 7-70-16 �° 8 Phone (715) 366 -7730
UNPLATTED LANDS waa°9d:pde land surveying Felt (715) 386 -7889
H.,, 4. atele, 19.2x5 Sheet 2 of 2 Sheets 1�7 W4LIX1
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
Conn Plan
Option #1. ystem fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. 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 failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
ST. CROIX COUNTY
SEPTIC TANK MARMNANCE AGREEMENT
AND
ow- N- ERSHIP CERTIFICATION FORM
IBu GBcc /t t � �
Owner er , y
Mailing Address
p rop erty ddress a t�
D for new construction.
(V erification required fro m )
p Planning & Zonm P
g
Parcel Identification Number
a d �aa-s� , J_
City /State
LEGAL DESCRIP'T'ION • `
property Location �_
' ✓ i/a , Sec. r N R W, Town of
Lot # Zp
Subdivision C � n
,Volume c� page:#
Certified Survey Map # /
(/ G page # � 6
Volume
Warranty Deed # _
Spec house o no Lot lines identifiableo no
SYSTEM MAIl�i'TENANCE AND OWNER CERTIFICATION Pro
Improper use and maintenance of your septic system could result in its premature failure to handle w tes� pm i nto you
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed p per dispos s ystem Owns' maintenance
the system can affect the function of the s . c tank as a treacmen 1 to St County Sanitary Ordinance.
responsibilities are specified in §Comm 8352(1) and in Chap
s to submit to St Croix County Planning & Zoning Department a certification form, signed by the
The pro owner lumber, restricted plumber or a licensed pumper verifying that (1) the on -site
is
owner and by a master plumber, journeyman
?lumber, and/or (2) after inspection and pumping (if necessary). the septic tank
wastewater disposal system is in proper operating
less
than 113 full of sludge.
sewage system with the
agre to maintain the private ge ��
requ irements and agr resin.
have read the above req Natural g Stan of Wilco
Uwe, the undersigned Department of .
and the De
standards set forth, herein. as set by the system his bee of Commerce P &
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. Uwe am/are the owner(s f h �`'
prop described above, by virtue of a warranty dud recorded in Register of Deeds Office. / 0 -/7
DATE
SIGNATURE pppLYCANT(S)
n that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning DeparaMni. * **
Any inf
0
ormati eP
I 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 deers.
(REV. 08105)
U 2656F 061 774312
STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:26AK
Ridge, LLC Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXW #
the following described real estate in St. Croix County, State of Wisconsin
(the "Property ") (if more space is needed, please attach addendum): REC FEE: 13.80
See attached Exhibit A TRANS FEE: 1410.60
COPY FEE:
CC FEE:
PAGES: 2
Recording Area
G� mom) Return Address -a
AL (4 No, V\. -VT-
26- 102540-000
Together with all appurtenant rights, title and interests. 026- 102430 -000; 026 - 1024 -40 -000; 026- 1025 -30 0 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 2r�OL day of 2004
* Gerald A. Kieckhoefer, Jr. 4David J. Ki ckhoefer
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gerald A. Kieckhoefer, Jr, an_ d David J. STATE OF )
Kieckhoefer ) ss.
County )
authenticated thisU da of 4 56yA& 1 kry -&1 2004
Personally came before me this _ day of
the above named
* Kristin Ogland
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. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland, Estreen & 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 sighing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, W1
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 Y, of the NE %, the NE , of the SE -/, the NW % of the SE'/ and
SW % of the NE "K of Section 7, Township 0 the
No I
p North
of St Range Croix, State of Wisconsin described as follbws:I n
9 est. Town of Richmond, County
Commencing at the East quarter comer f
os id S
o said S00 " ti 7, this also being 3710 E along the East line o , -
n9 the Point of Beginnin -
f
Thence S89 ° 18'S5"V1/ on the northerly line the SE / of said Section 7 a distance of 880.99 feet
Y eofaCe d
375 a Surve
2 a distance of Y Map recorded
610.00 feet• The ° " In Volume 13 Pag
The nce
Ma 4 S00 3710 E on the westerly S
Map 28.42 feet Re y Itne of said C ertified
( cord 428.50 feet); Thence S89 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 °57'22 "E 1048.00 feet; Thence N51 ° 00'00 "E 25 .00 feet; Thence N88 022'35 "E 507.00 feet to
a point on the East line of the NE'/ of said Section ;Thence S00 °40'35 along Skid East line of
the NE % of said Section 7 a distance of 246. feet to the Point of Beglnning and there
terminating.
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