HomeMy WebLinkAbout026-1296-21-000 County.
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No.
506184 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 I Richmond, Town of 026- 1296 -21 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
8M L -5-r 07.30.18.1552
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ;�� � �� � Benchmark
� L m Alt. BM /, a q7 q
� '� A44- I / I
Aeration Bldg. Sewer 4. 2-7. Z
Holding St/Ht Inlet
( G
TANK SETBACK INFORMATION St/Ht Outlet � Z_ � I J
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet IA
Septic J/L 9 - 7 7 � Dt Bottom . �^
Dosing 1 C Header /Man.
Aeration Dist. Pipe
Holding Bot. System F3 TS
Final Grade , r . 0 C? 7,
PUMP /SIPHON INFORMATION ']
Manufacturer GP St Cover �, C"
Model Number
TDH Lift Friction Los System He TDH Ft
Forcemain Length Dia. st. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width / Length i No. Of Trenches \\ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS �T 2 e v�ci/, �� �`� •� \
SETBACK SYSTEM TO T P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: ( UNIT Model Number:
DISTRIBUTION SYSTEM Aire' /L; r fps = 3Z r r
Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to it Ir�t�ke
�. 0 Pi \ \ "S. Z k-(a -�
Length 1 Dia A 4 Length Dia Spacing e�
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded /Sodded rMulched
Bed /Trench Center `.�, 3, $ Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 1639 98th Street Ne�w�R, ichmon WI 54017 (NE 1/4 SE 1/4 7 T30N R18W) Country View Ridge Lot 21 Parcel No: 07.30.18.1552
1.) Alt BM Description = e 1 ; �" 61#-1 � CL �'
2.) Bldg sewer length = '3G
- amount of cover =
f
Plan revision Required? Yes XNo r 6
f J3
Use other side for additional Information. _. L_ _ - -___ - —�
Date Insepctor's ignature Cert. No.
SBD -6710 (R.3/97)
1
stem and Soil Test PLOT PLAN
PROJECT Country View Ridae LLC A DRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T 30 N/ 18 W TOWN Richmond COUNTY ST. CROIX
7/23/07 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 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
Vent
SYSTEM ELEVATION 93.1/93.7' 4' below qrade
>6 " Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area Well is to meet all
5.8ft ^2 /pair of end caps setbacks required by
Long 4 Lon Grade at System Elevation 60 WDNR 90, B. M. dd 34
367' Property Line Plans Designed Using 5'
Conventional Po 30, KAAI
IU
7% Slope B -2
Manual Version 2.0 Vents z'�
B -1 -F�
30' ��
ST 10'
10'
Pro 3 B -3
Bedroom
House
2 -3' X 66' cells with 125'
>3' spacing Property
Line f ��
Scale is 1" = 40'
unless otherwise
noted
96'
Property
Line
398' Prop Line
coinmerce.W1.90V Safety and Buildings Division County 1 t
201 W. Washington Ave., P.O. Box 7162 'f
s co n s n Madison, WI 53707 -7162 Sanilmy Permit N _ er Cttoo ISefifil_led in by Co.)
Departrrtem of Comtaeroe ',�V (�
State Transaction Number
Sanitary Permit Application J_V(
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the ap nate g men
unit is required prior to obtaining a sanitary permit, Note: Application forms for state -o PO ect Address if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used econda
p urposes in accordance with the Privacy Law, s. 15.04 1 (m), Stats. / t
1. A 6 „Y
Application Information - Please Print All Information
Property Owner's Name % Pa r ce l
Cnw
Property Owner's Mailing Addres K FC t! VEU Property Location
1 1 (Q Govt of S
City, State I Zip Code Phot�imb2r 4 2007 n / y, �_ /. Section
J 4 ` (circle o
( I T N; R E W
11. Type of Building (check all that apply) LotW. gX OUNTY
Subdivision Name
.ar..2 Family Dwelling - Number of Bedrooms
Block # D LL. rl 1
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
❑ State Owned - Describe Use
�1 -wn of
111. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ' System ❑ Replacement System ❑ Treatment/Ho)ding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previou Permit Number and Date Issued
B. ❑ Permit Renewal . Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner �� /� O 7
IV. iype of POWTS S stem /Com onent/Device: Check all that a 1 )
n- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil Mound ra of sui ble oil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (expl in)
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area e�red (st) Dispe al Area Proposed (st) System El ation
_ S ! ? 3, 1 3 ,
Vl. Tank Info Capacity in Total # of Manufacturer
z
Gallons Gallons Units 4 e _
New Tanks Existing Tanks —
a U rn H 6 iz C7 a
Septic or Holding Tank �
Dosing Chamber Ijo
VII. Responsibility Statement- 1, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans.
Plumb's Name (Print) „ Plumbe ignature MP /MPRS Number Business Phone Number c,_ z I - Z 26 - L_ - Z �
Plumber's Address (Street, City, State, Zip Code)
V111. unty /De artment Use Onl
Permit F e�..,, r .,, Date slued t mg Agent atur
Approved ❑ Disapproved $ �� G�'�
❑ Owner Given Reason for Denial V ✓ ��
IX. Cond' 'ons of Approval/Reasons for Disapproval
Cr 7- 7/_2 0
Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x I1 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
stem and Soil Test PLOT PLAN
PROJECT Country View Ridae LLC A DRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1/4S 7 /T 30 N/ 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/23/07 BEDROOM 3
CONVENTIONAL )00( IN•GRO PRESSURE ..CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 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 s It. g,P. Same as Benchmark
Vent
SYSTEM ELEVATION 93.1/93.7' 4' below qrade
setbacks required by
ALong Quick4 Standard -W
Leaching Chamber
with 20.0 M of Area
5.8ft ^2/ air of end caps Well is to meet all
2" P P
34" Grade a t System Elevation 60' WDNR 90' B. M.
367' Property Line Plans Designed Using 5' B -2
7% Slope
Conventional Powts 30 p
Manual Version 2.0 Vents
B -1
30'
ST 10'
10'
Pro 3 B -3
Bedroom
House
2 -3' X 66' cells with 125' J
>3' spacing Property
Line
Scale is 1" 40
unless otherwise
noted
96'
Property
Line
398' Property Line
r
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. ��j
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 006 1 2 ? (. , ., — L - )Oj
Please print all information. Review d DYI Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a� a
Property Own / Property Location
Pa w IX 4-.(` U 2 � Govt. Lot 1/4 1/4 S T b N � $ E ( W
P Owner's Mailing Addre # Block # Subd. Name or CSM#
D) 13 l -� (c / , v /�r�
o, ✓! 1<r
City State Zip Code Phone Numbe ❑ CitT ❑ T Nearest Road
p ew (�-;G ) I � 01'7 1 ( ) " 2 -
New Construction U Residential / Number of bedrooms Code derived design flow rate -� GPD
❑ Replacement ❑ Public r commer ' __—
Parent material R ECE IV W. Plai i elevation if applicable
General comments
and recommendations: JUL 2 4 2007
SS��
System Type �. X COUNTYstem Elevation 3 /
Boring / �\
I
Boring # /
Pit Ground surface elev. I ft. Depth to limiting factor � U
_ 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
2 !o
Boring # C3 Boring
O- Pit Ground surface elev. -1-- 2 `-L ft. Depth to limiting factor / u 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 I - Eff#2
Z - S
Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mgA-,,OV Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST )Name (Please Pnnt) Si CST Number
Bird Plumbing, Inc. Shaun Bird �'% 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 ��� �� 715 - 246 -4516
l
Property Owner Parcel ID # Page of
Boring
❑ Boring
t Ground surface elev. �� ft. Depth to limiting factor /I in. Soil lication 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
0 / ,3l S C
3 �� !� S Os ti� `✓l / t
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 GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
E] Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
F 0 Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgA. ' Effluent #2 = BOD 130 mgA. and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8.6/00)
r - -
�
— N00'33'53_ 196.83' i
- .�
N01 '02'38 "W
STREET
N00'3353 "W 197.38 �? I
OD
0) 8 I I I o w
...s = iTl\ I z N I 0D co r \ OD O c w
V I O .c
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N07 9 c $� --� � goo' ao m {
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I I 38 "W 3'
694, 3 N { � I
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377,3 I x �
co
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1 N NOD s 6'� t�N
0=1 0
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fl I A mp
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OD
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00, ' 00' 4 5�'0 ' 3. 98
S-[`G� 0. 16. y' \\ \\ m
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8 -------------------- - - - - -- \ \ ti \ '� \ n
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etbo Z
OD — 00 m v N O \ UP
N O
N p) 0 G• to \ \ .1
V o
w
O �N c) -P- Jo
\ \ °s. `
w N \ ��
U OD (A O �14 0.
Nj OD
w
- -- NOt'38'05 "W 543.37' -- W
Gi o o)
-- 220.09' - N N
\� 188.03' 96.46' 3.63' 135.25' \� i ,
eorr =7opjin Safety and Buildings Division County 1
201 W. Washington Ave., P.O. Box 7162 7 ✓b 1
i ;c Madison, WI 5370 7 -7162 Sanitary Pemtit N llod is by Co•)
e e s lication erve
A Santary Permi t pp A1 1A
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to th riate en Address (If different than / �1 address)
unit is required prior to obtaining a sanitary permit. Note: Application forms for std J y�vt
submitted to the Departmem of Commerce. Personal information you provide may be used dary {_
es in accordance with the Privacy Law, s. 15. / & 1 m , Stats. / O 2
L A lication Information — Please
it All Information Parcel #
property Owner's Name RECEI
T Property Location
own in Address MAY 0 9 2Q • �'
Govt.
City, fate Zip Code S l8g�j(tOW `/a.Z� y Section
�.. G
I4J `� J
( , 11 / cucle
Qt,t� L(J ` �(. T,L --N; R orW
II. Type of Building (check all that- aPpiy) Lot #
r/ �'
P — Subdivision Name
or 2 Family Dwelling -i - N � s umber of Bedrooms_ J ,
5 cz L1� L � Block # A a 17 T7 i J
❑Public/Commercial - Describe Use �� 11 City of
CSM Number El village of
C1 state Owned - Describe Use Town of /s. / f •�P
� ac
III. Type of Permit: (Check y one b o e A. Complete lion B if applicable)
A. ❑ Replacemen yst o eplacement only ❑ Other Modification to Existing System (explain)
System
B. ❑ Permit Renewal ❑ Permit Revi hange of Plumber ❑ Permit Transfer to New
List Previous Permit Number and Date Issue
Before Expiration owner 1 69 C411,4��
IV. a of POWTS S tem/Com onen evice: Check all that appl
f N 0 on-Pressurized In -Ground [] Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Moun < 24 in. of suitable soil
lding Tank [I Other Dispersal Component (expl rsal/Treatment Area Information: Dispersal Area Proposed (sf) System E
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf)
J'Z7 `� Z �+S 2, ,
VI. Tank Info Capacity in Total # of Manufacturer B
Gallons Gallons Units 1! U
New Tanks Existing Tanks a V rn on py
Septic or Holding Tank ir 1 1 11
I
Dosing Chamber
VII. Responsibility Statement - I, the undersigned, ass esponsibility for Installation of the POWTS ssh�RS Number Business Phone Number
Plumber's Name (Print) Plumber' store L6 /� /�✓� l J am/
Plumber's Address (Street, City, State, Zip Code)(
VII oun /De ailment Use nl
Permit Fee UU Da ued I mg Ag ` S ignature
Approved ❑Disapproved $
/U 0
Q,Qwn Given Reason for Denial /
for Disapproval��t
dispersal cell must all be serviced / maintained pale-iz" , > - 1 4 J
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach to complete plans for the system and submit to the County only on piper not less than 8 in x 11 inches in size
SBD -6398 (R. 01/07) Valid thru 01109
� � 1
..:
��
�.
},_�� �,
�.�
�...-
I
PLOT PLAN
PROJECT Country View Ridae LLC jA DRESS 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 DATE5 BEDROOM 3
CONVENTIONAL )00( IN- GROUND PRESS RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 100 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
Vent
SYSTEM ELEVATION 97.4/97.2' 3.5' below qrade
>691 Quick4 Standard -W
of Cover Leaching Chamber
with 20.0 ft2 of Area Well is to meet all
12"
5.8ft ^2 /pair of end caps setbacks required by
4 Lon g WDNR
Grade at System Elevation
34" 367' Property Line
Plans Designed Using
Conventional Powts
Manual Version 2.0
125'
Property
Scale is 1" = 40' Line
unless otherwise
Pro 3 noted ' S�
Bedroom
House 25'
O
ST
30'
B -2
90'
0 '
2% Slope 96'
Property
Line
-1
2 -3' X 66' cells with
>3' spacing Vents
30'
5 B -3 B.M.
398' Prop Line 30'
45'
r
PLOT PLAN
PROJECT Country View Ridae LLC A DRESS 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 5/9/07 BEDROOM 3
CONVENTIONAL M IN- GROUND PRESS RE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 100 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
ASSUME ELEVAT ION 100' Filter BEST F ilter
BENCHMARK V.R.P. Top of survey iron r
e
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Vent
SYSTEM ELEVATION 97.4/97.2' 3.5' below qrad
>6 „ Quick4 Standard -W
of Cover Leaching Chamber
W
ith 20.0 ft2 of Area Well is to meet all
12" 5.8ft ^2 /pair of end caps setbacks required by
4' Long WDNR
Grade at System Elevation
34" 367' Property Line
Plans Designed Using
Conventional Powts
Manual Version 2.0
125'
Property
Scale is 1" = 40' Line
unless otherwise
Pro 3 noted
Bedroom
House 25'
O
ST
30'
B -2 90'
0 '
2% Slope 96'
Property
Line
-1
2 -3' X 66' cells with
>3' spacing Vents
30'
B -3 B.M.
398' Property Line 5 30'
45'
I
" t
Wisconsin Department of �rce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in a m� "fie / Cou
Attach complete site plan on paper not les /2 x 1 inccee �z�. 1 must my
include, but not limited to: vertical and horizontal re rence point (BM), direction and Parcel I.D. Q / / / /la
percent slope, scale or dimensions, north arrow, a jgp
locat,and (stapce to-nearest cad. o� L� 6 U
Please print all ink mation. T J U h Reviewed by Date
Personal information you provide maybe used for secon ry (1) m)). I�
Property Owner cation
f/J �/ r 7
e r�� Zh e Govt. Lot f ! 1/4J�1/4 T / N R f E (o W
Property es Mailing Addr L # Block # Subd. Name or CSM#
r1V "K.A- lam# z l -- 6'1" 4'/' 1Lo 2�
City State Zip Code PfZFe ITU m r C ❑ lage To dearest ad L
New Construction Use: fg4esidential /Number of bedrooms J Code derived design flow rate '-M GPD
❑ Replacement ❑ Public or meraal - D scribe: __ -_ —__. -- - - - - -- - - - - -- --
Parent material a ,� Flood Plain elevation if applicable ft.
General m e rits � ��
and recommendations: 51 S� � / 1 - 2 Z. 1 9
Boring # Boring l'
Pit Ground surface elev. / A ft. Depth to limiting factor /l o in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten
Roots GPD/fft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
ril �� �7 . — 7
,t
it
® Boring # Boring F- Pit Ground surface elev. - `=='-� Depth to limiting factor i^ Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2
-� 1 3/z St 2!2 c s AV _ D
S/ c
I I
It
Effluent #1 = BOD > 30 220 fng/L and TSS >30 < 150 ° Effluent #2 = BOD < 30 mg/L and TSS < 30 mgt
CST Name (Please Print) _ Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �!� -- 715- 246 -4516
r j `
i
Property Owner _ Parcel ID # Page of
Bafng # Boring /
Apit Ground surface elev. O �J ) ft. Depth to limiting factor in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff`
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 A 'Eff #2
D c S 0 3/Z n. 2 ,� o
3 '/ OS
Boring
II
F-1 # C] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in• Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2
Boring # ❑ Boring
F
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Amoication Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Ef1#1 I 'Eff#2
Effluent #1 = BOD_ > 3o :E 220 mg/L and TSS >30 < 150 mgft. ` Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg1L
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.
SOD4330 QL60)
Soil Test Plot Pla
Project,Name Country View Ridge LLC S ird
Address P.O. Box 176
New Richmond Wi 54017 7 STM #226900
Lot 19A Subdivision Country View Ridge Date 5/20/05
NE 1/4 SE 1/4S 7 T 30 N /R W Township Richmond
❑ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron/Nail
System Elevation 97.4/97.2 *HRPSame as Benchmark
Ad 367' Property Line
125'
Property
Scale is 1" = 40' line
unless otherwise
noted
101'
100' B -2
90'
0'
2% Slope 96'
Property
Line
-1
30'
B -3
5 '
' operty Line 30' .M.
45'
i
3 � 8"
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
O'WNERSHTP CERTIFICATION FORM
owner/Buyer `c. �/� P
Mailing Address
Address
Props' mification required from Planning & Zoning Dep�mncnt for new consuu -)
Id
�. arcel entification Number
City /State
LEGAL DESCRIPTION f
1 /4 i",T--of
0 I�1
Locau .i-- oII 1 /4 , �+� , Sec. ���
=.L
Lot # .
n
subdivision .�—.
`�-- Volume page#
Certified Survey Map # I
Volume 2 3- & Page # y
w�� Deed #
yes Lot lines identifiab yes no
Spec house no
SYSTEM MA]�iTENAN AND OWNER CERTIFICATION
emature failure to handle wastes. Proper
Improper use and maintenance of your septic system could result in its pr a licensed pumper. What you put into
consists of pumping out the septic tank every three years or sooner, if needed. by
owner wintanance
the system can affect the function of the septic tank as a treatment stage in the waste disposal system-
maintenance cons
ter I2 - St. Croix County Sanitary Ordinance-
responsibilities are specified in §Comm. 8352(1) and in Chapter
Department a =tificanon.fomo' stated by the
The property owner agrees to submit to St. Croix County Planning & that (1) the On-site
man
owner and by a master plumber, journey , plumber, restricted plumber or a licensed pumper venf}' necessar th se ptic tank is
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping
less than 15 full of sludge- private sewage disposal sys with the
I/we, the undersigned have read the above requirements and agr to maintain the r of l.Tatural Resources. State of Wisconsin
standards set forth, herein. as set by the Department of Commerce and the Depm .&
Certification stating that your septic system has b een mairstauied must be completed and returned to the St. Croix County Plstmtng
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. It= am/are the owner's) of the
above, b deed recorded in Register of Deeds Office.
v
X: ribed y
virtue of a warran ty
DATE
GNATURE APPLICANT'S)
* * Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning DVa MML * **
a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
Include with this a pplica tion
refrarence is made in the wanwty deed
(REV. 08105)
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
V y Plan re use alternate area and install new
system fails, determine cause of failu , ted 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
U 2656P 061 774312
STATE BAR OF WISCONSIN FORM I - 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 10:20AK
RidEe. LLC Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXBIPT #
the following described real estate in St. Croix County, State of Wisconsin
(the "Property ") (if more space is needed, please attach addendum): REC FEE: 13.00
See attached Exhibit A TRANS FEE: 1410.60
COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Name and Return Address��� „!� , •tQ
a v\. kc.9i
26 -1025- 40-000
Together with all appurtenant rights, title and interests. 026 - 102430 -000; 026 - 1024 40 -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
'7 - , v' day of 2004
1''` ^_ /1
* Gerald A. Kieckhoefer, Jr. * David J. K
* *
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
* 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. Slats.) 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 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. I - 1999
U 2656P 062
Exhibit A
Located in part of the SE Y, of the NE Ys, the NE , of the SE' /, the NW % of the SE'/ and the
SW Y, of the NE '/ of Section 7, Township 30 North] Ran a 18 VIN
of St. Croix, State of Wisconsin described as follows :l g est, Town of Richmond, County
Commencing at the East quarter comer of said Sect! n 7, this also being the Point of Beginning;
Thence S00 °37'10 "E along the East Line of the SE'/ of said Section 7 a distance of 880.99 feet;
Thence S89 on the northerly line of a Certi ie ec
d Survey Map rorded in Volume 13, Page
3752 a distance of 610.00 feet; Thence 300 ° 37'10'E on the westerly
Map 428.42 feet (Record 428,50 feet); Thence S89°J' 52W tine of said Certified Survey
18" along the south line of the N %Z of the
SE '/ of said Section 7 a distance of 1146,36 feet Thence N00 0 33'53"W 1384.45 feet; Thence
N88 0 57'22 "E 1048.00 feet; Thence N51 0 00 1 00 "E 25 .00 feet; Thence N88 0 22'35 "E 507.00 feet to
a point on the East line of the NE'/ of said Section ; Thence S00 "40'35'E along $'aid East'line of
the NE % of said Section 7 a distance of 248. 0 feet to (he Point of Beginning avid there
terminating.
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