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f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ,; 420612 0 GENERAL 111FORMATION (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: X Parcel Tax No: Cit Village Township Y 9 p Derrick, Steve I Richmond Township 026- 1149 -00 -008 CST BM Elev: Insp. BM Elev: BM Description: co f C%>•o TANK INFORMATION ELEVATION DATA /S- Illy TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV. Septic Benchmark t J E-t 5 t lYt7p { o$. �z I CA - c7 Dosing Alt. BM Aeration Bldg. Sewer !o. 33 99 - 39 f Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. EVentto r In take ROAD Dt Inlet Septic S ► > Sb r 3O / Dt Bottom Dosing Header /Man. ,z %, Aeration Dist. Pipe 96 • (0 2' Holding 7 Bot. System jD. 22,Z_ r `f S . S PUMP /SIPHON INFORMATION Final Grade 0 Manufacturer Demand St over GPM `• 3`Z l03 • � Model Numb TDH Lift fiction Loss System Head H Ft Forcemai Length Dist. to well i SOIL ABSORPTION SYSTEM (2Z RENC Width Length No. f T enches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 r � I � - czZ SETBACK SYST TO P/L BLDG WELL LAKE /STREAM LEACHING Mal3fa¢tur INFORMATION Type Of System: CHAMBER OR � ��- - vv � �� Z� r r , I Lx:) UNIT Model Number: 1 DISTRIBUTION SYSTEM L-4 Lo Header /Manifold tl acing Distribution x Hole Size x Hole Sp Vent to Air Intake Pip Length Di a Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center lBedfrrench Edges Topsoil I FS-1 Yes [] No [ Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #11:&A 1. 3 Inspection #2: Location: 1258 152nd Ave New Richmond, WI 54017 (SW 1/4 SE 1/4 15 T30N R18W) Cherry Knolls Lot 8 �arcel No: 15.30.18.1113 1.) Alt BM Description = u� C7 T• w�o. ,w2 � 1) 8*1C� A - jcD &C. - 2.) Bldg sewer length = t, 3s f Q�iSUVa fig+, �ue-t HL- �"` � Z� - amount of cover = � Cl M d.� ' f -r� Q S 3 � � �w�,aa. H uP�"` s Ste. 'l�i�•� -- `sc"�'°"'► _ Plan revision Required? Yes X No t �2S Use other side for additional information. SBD -6710 (R.3/97) Date L Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 J T t Visconsin Madison, WI 53707 - 7162 Site Address De ar iment of bommerce a'� 7 '� ` bam y pe n it Number Sanitary permit Application �a0 �-- In accord with Comm 8911, Wis. Adm. Code, personal information you provide ❑Check if it may be used for aeeo see Privacy Law, 0.04(11(m) State Plan I.D. Number I. Application Information — Please Print All Information Parcel Nttmbet 07- - Mfr - 00 -6 V Property Owner's Name j � G Q 5 30. /,P • W '� t " U e . 'Pe ^� k y' t Property Location / Property owner's Mailing Address , ` -, °. City, tate Zip Code ¢ N , r c Lot Number Block Nu r ty. -, Subdivision Name CSM Number II: Type of Building (check all that apply) ❑City >'°— or 2 Family Dwelling - Number of Bedrooms ' ❑Village ❑Public/Commercial - Describe Use -- -- // �ownship C / 7�C 3 X Nearest Road S� ❑ State owned Z 2 O 6r III. Type of Permit: (Check only one box on For County use. line A (numbering scheme for internal use). Complete line B to applicable) A. 1 IXNew 2 ❑ Replacement System 3 ❑ Replacement of 6 C3 'Addition to S sum Tank Oil Exis • S Date Issued stem Permit Number B. ❑ Check if Sanitary Permit Previously Issued l IV. Type of Permit: (Check all t apply) (numbering scheme is for internal use) - .. • f�.}� �'�' �yYC%� 44 ' Non - Pressurized Ii- Groun 210 Mound 47 ❑ Sand Filter 50 C1 Constructed Wetland 3� `� 41 ❑Holding Tark 48 ❑ Single Pass 51 El Drip Line �� e OW0 22 ❑ Pressurized In- Ground 45 ❑ At•Gradc 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other V. Dis ersaUTreatmcut Area Informati On percolation Rate System Etevati Final Grade Design Flow (Bpd) Dispersal Area Dispersal Area Soi�Applicadon llncb) Elevation Req uired Proposed Rat(M G � d ef 7 ac, g� , �4 l• a i. S �.� I 'l l' O �`� , Prefab Steel Fiber Plastic V1, Tang Ido Capacity in Total Number anufacturer Concrete Constructed Glass Gallons Gallons of Tanks New Fatiatiag Tanks 'ranks Septic or Holding Tank Dosing Chamber VII. Res onsibili Statement I, the undersigned, Assume resPomtb for alls►tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signs PRS Number Business Phone Number Plumber's Address (Street, City, State, zip Code) / unty IDe PmMG4 Use Only Date Issued gent Signature (No Stamps) Approved ❑Disapproved S��y Permit Fee (includes Groundwater Surcharge Fee) S Sv a�3 ❑ Owner Given Initial Adverse • ad ✓ l-� r Determination . Conditions of Approval/Reasons for Disc proval �, ��5� ° �,y d �,,� p•r. Gn�- u- t�`��� a- G�'`Q-i Bl �g3 2 P ✓ sirs u mots In V �l M-63 kp xl� L w C o w A c f �.�, . t \ Q Q N v� c� v .�1 � cn � 4 c� a b � A D v q \ I i S WisctinsinD4artmentofCommerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D , Ziq ^ �j (6� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. T f Please print all Information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location I T Steve Derrick Govt. Lot SW 1/4 SE 1/4 S 15 T 30 N R 18 E() W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1438 County Road G 8 - Cherry Knolls City State Zip Code Phone Number ity ®Village ■ own Nearest Road New Richmond WI 1 54017 1 ( 7J5-246-3120 County Road G Q New Construction Uses Residential/ Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement ® Public or commercial - Describe: _ Parent material i .oeSS ever till Flood Plain elevation If applicable ft General comments Site suitable for a conventional below grade sy stem and recommendations: * w / eating bands of s, 7.5yr5/6, Osg, n il 8 2002 Ong # ©Boring - - Pit Ground surface elev. 102.00 ft. Depth to limiting factor >110 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 1 0-9 10yr3 /2 sil 2msbk mfr cs 2f .5 .8 2 9 -24 7.5 4/4 sicl Imsbk, mfi cs if ,2 .3 3 24-62 7.5yr4/4 *sl 0m mfi cs - .3 .5 4 62- 10 7.5yr5/4 s Osg ml _ _ .7 1.2 a 2 Boring # Boring 100.00 >1 10 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef1#2 1 0 -9 10yr3 /2 sil 2msbk mfr cs 2f .5 .8 2 9 -24 1 4/4 sicl lmsbk mfi cs if .2 .3 3 - 5 414 *sl Om mfi cs - .3 .5 4 65 -110 7.5yr5/4 s Osg ml - - .7 1.2 / e rtS L 6 ' * Effluent #1 = SOD > 30 220 mg/L and TSS >30 150 mg/L 'Effluent = BOD < 30 mg/L and TSS < 30 mg& CST Name (Please Print) Signet ur CST Number Thomas C Nelson 227387 Address Date Evaluation.Cend Telephone Number 1432 120th Street, New Richmond, WI 9 -25 -02 715 -246 -2454 r , k Steve Derri 2 3 Properly Owner Parcel ID # Page Of M 0 Boring # Boring 101.70 >110 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. *Efr#1 *Eff#2 1 0 -10 10yr3/2 - sil 2msbk mfr cs 2f .5 .8 2 10 -25 7.5w4/4 - sicl lmsbk mfi cs if .2 .3 3 25-45 7.5yr4/4 - *sl Om mfi cs - •3 .5 4 45 -110 7.5yr5/4 - s Osg ml - - 7 1.2 � S, F Boring # spit Boring Ground surface elev. _ ft. Depth to limiting factor in. — 8;5A - 90cation 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 'Efr#2 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Pit p boil Ap0ioation 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 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 m9& 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- 8330Tat (8.07/00) I Pam Quinn From: Kevin Grabau Sent: Friday, November 22, 2002 11:13 AM To: Tom Nelson (E- mail); Jon Sonnentag; Rod Eslinger; Pam Quinn Subject: Cherry Knolls Tom Nelson, This is Kevin Grabau - -St. Croix Zoning. I tried calling, but I got cut -off and got the dial tone again, so I thought I would reach you through email. The reasonfor my contact: we will have to set up some on -sites for the Cherry Knolls. It's been office policy that if we have soils tests that are first mounds, then receive some soil reports for conventionals in the same area, to do some on- sites to check things out and cover everyone's interests. I need to map out your soil tests together with the previous ones to determine where they are in relation to each other. Basically, if I was to receive two soil tests that are in same proximity, then an on -site required. If the conventional site was uphill, or on another part of the site, an on -site may not be required. It depends on the circumstances. Just letting you know. We have some permit applications in for this development, and we will need to set something up fairly soon. We could just go from one lot to another and nail them all down at one time. Let me know what would work out for you. Please call me with any questions. Thanks. n- S r�-�- d��- I I �� L Kevin Grabau -- St. Croix County Zoning Department - 1101 Carmichael Rd Hudson, WI 54016 715.386.4680 keving @co.saint - croix.wi.us M .s Aw J� 1 WWW.t h yi ?phMth �A�dydtfi�h.COM PAO ?15 246 -2454 CHERRY XWOLLN p!� LOT 8 v�� i D ' Fop ow-vitfL 1o �2 ►'" r� 2 � 3 o f tIIA I 1 10 �b � b� o0 62 130,60 ; 63 \ / a 4 or 3 Thomas Nelson Scale I � 227387 r - wiscnnsin t )n,,:,rlmen . ul c:mn,mn,r, " SOIL AND SITE EVALUATION Division of Saloty and Buildimcf,c Page of ltureau of Integrated Service: in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction aril �� G '- percent slope, scale or dimensions. north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed b -- Personat rnlormarron you provide may he used for secondary purposes (Pnvacy Law, s. 15.04 ( (m))- Property Owner Property Location e� Govt. Lot ,) L-- 114 d� 1/4,S `!� .N,R `$ E (or) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City Ola�cZ Code Phone Number ❑ City ❑ Village [A-T -c NeareN Road New Construction Use: 19 residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: _��^ Code derived daily flow 9 Recommended design loading rate �' / bed, gpdM trench, gpde Absorption area required ed, ft trench, ft Maximum design loading rate >< bed, gpd/tt trench, gpd/ft Recommended infiltration surface elevation(s) 0 A4�� sLe �im� - w/ ft (as referred to site plan benchmark) Additional design/site considerations keom 6-,'60' Z. '. -CS T Parent material 0 -t K14-e 6_- k^ " — 1 I U CGT Flood plain elevation, if applicable � � Q h S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U ❑ S ❑ U SOIL DESCRIPTION REPORT 2 - OW1 r Boris # Horizon Depth Dominant Color Mottles Stricture GPD/ft 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Bed—. Tferteh 3 12 - 2w� s b k, ,rt r c. s Z. nl s �3 k. M4 C5 ? -F q Ground 7.5.1{ts s IZ y g�� /GS /�tTr' G�✓ - fo elev S 6a" $YIC. q1l, M DS C1 Al Depth to limiting factor in. Remarks: - w Ie jW C' a �SY4 `1 J � we (, 4 1 - zr - . �1.�a � z1.0 (k s-� wA4 �ar S� I I IS I-G)�i jV'r1.• k4'A CV tt�_4 d� Z ' '10 �+ vyv� ft V :Ca�xs �3 �6a mi d 2 3M� t� kl (fvVf A V&A I "'a vtis�� v Wiscons Department ofCommerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size_ Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. Reviewed by Date Personal Wormadon you provide may be used for secondary pumo■8e (Privacy taw, e. 15.04 (1) (m)). Property Owner Property Location a Steve Derrick GovL Lot SW 1/4 SE 1/4 S 15 T 30 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Su bd. Name or CSW 1438 County Road G 8 - Cherry Knolls City State Zip Code Phone Number +tY Vllage ■ own Nearest Road New Richmond WI 54017 ( 7 }5 246 - 3120 County Road G E] New Constr useE) Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement ❑ Public or commercial - Describe: _._.__ _..__________i . Parent material i nrcc nvPr rill Flood Plain elevation if applicable General oomrrlerMs Site suitable for a conventional below grade sy6tem ' and recommendations: • w/ alternating bands of s, 7.5yr5/6, Osg, 61 r f ❑ Boring E Boring # >110 in. I@ Pit G rou nd surface ales. 102.00 ft. Depth to limiting factcr Son i � t , Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell (1u. Sz- Cont. Color Gr. Sz. Sh. •Efi#1 •E02 1 0-9 10yr3/2 - sil 2msbk mfr cs 2f .5 .8 2 9 -24 7.5 4/4 - sicl lmsbk mfi cs If .2 .3 3 24-62 7.Syr4/4 •sl 0m mfi cs .3 .5 - 4 62 -110 7.5yr5/4 s Osg ml _ - .7 1.2 100.00 goring >110 ❑ Boring # a Pit Ground surface elev. R Depth to Nmifing factor b. Soil Apolcafim Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz- Cont. Color Gr. Sz Sh. •Eft#1 02 1 0-9 10yr3/2 - sil 2msbk mfr i cs 2f .5 .8 2 9 -24 1 4/4 - sicl lmsbk mfi cs ; if .2 .3 3 24-65 7.5yr4/4 •A Om mfi cs - 3 ' .5 4 65 -110 7.5yr5/4 - s Osg ml - - 7 :1.2 1 • Effluent #1 = SOD > 30 1 220 nV& and TSS >30 150 mg/L 'Effluent = BOD < 30 rngiL and TSS <_ 30 rrlg/L CST Name (Please Print) S ce CST Number 227387 Thomas C Nelson Address Date Evaluation Conducted Telephone Number , 1432 120th Street, New Richmond, WI 9 -25-02 715- 246 -2454 f.t1n 11''I. TMY.I.. l 2 3 Perry Owner Steve Derrick Parcel ID # Page of P] Boring #� 101.70 >110 Pit Ground surface elev. ft Depth to limiting factor 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 0-10 1Oyr3 /2 - sit 2msbk mfr cs 2f .5 .8 2 10 -25 7.5w4/4 - sic] lmsbk mfi cs if .2 .3 3 25-45 7.5yr4/4 - •sl Om mfi cs - .3 .5 4 45 -110 7.5yr5/4 - s Osg ml - - .7 1.2 Bor ing # g Bor ing Pit Ground surface elev. fl. Depth to limiting factor in. — SW — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflf in. Munsell Qu. Sz- Cont Color Gr. Sz- Sh. •Etf#1 •Etf#2 ❑ Boring # Borg Ground surface elev. fL Depth to limiting factor in. Pit 6ofl Rate Horizon Depth Dominant Color Redox Description Te�dure Structure Consistence Boundary Roots GPDIIf In. Munsell Qu. Sz Cont. Color Gr. Sz Sh •Etf#1 •Etf#2 • Effluent #1 = BOD > 30:5 220 mgll. end TSS >30 < 150 nglL • Effluent #2 = BOD, < 30 nVL and TSS < 30 nV& 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. SOD- IM-0t.07ooi I WWW.t hV� lOhMt h tA��I�t fiS h.�OM 7K -246-24T4 CHERRY KNOLLS ? LOT 8 0 � i b �z io a� ��,1,� Q�� 1 P �' bi 16a„o 97- roo,aa 63 - �qo r a or 3 Thamac Nelson Scale 1"= 22738' Private 4nsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment thin System (POWTS) shall include information and procedures for r i l b inin the department, agent, t the parameters of Comm 83 and 84, and the conditions of app a Y or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Desii n Specifications Sanitary Permit Number oZ 0 Number of Bedrooms .Sb Design Flow - Peak ( pd Estimated Flow - Avera e ( pd) bU Septic Tank Capacity (gal) D � Soil Absorption Component Size ( ) Domestic T pe of Wastewater Table 2: Soil Absorption p Tank Component ReSobillAbsoertoln Component Sep Design Flow - Peak pd 1/8 Maximum Influent Particle Size (in) 220 Maximum 1301), (m /L) 150 Maximum TSS (m L) Table 3: Maintenan SGh9dui Septic Tank Inspect and r service once every 3 ea v once eve 3 ears e ast Outlet Filter Inspect once Soil Absorption Component inspect once every 3 ears Sepilc 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 I Management Pian for a Septic Ta arc S al: gasorpticn Compor�snl filter is equipped I with an alarm, the filter shell be serviced if the alarm is activatsd c nth usly. Intermittent filter alums may indicate surge Mows or a and s In the lank septic tank shoat helve it$ cements nsrnoved when the k are not removed at the exceeds 113 the liquk! volume of the tank. If the oor,tents of the tan own e r of when the next service time of an asomment, n% tsnance personnel " i t SCUM red � a ccumulation in the needs to be performed to ma intai n less t trek. Manhole risers, aooss risers and oovers should be Inspected for water tightnss and soundness. A+acaeas ope n � s u sed for Service and assesament Shall be sealed waieftht upon the completion of aervlos. Any opening deemed unsound, defectidv� S sh " cured t be replaced. ,Exposed &*Gets opertirigS greeter than 8 -Inohe Into"ank. an eflecelve lockins device to prevent aooldentei or uraeuthorisced entry No one ah0UW enbr a septic or o ther ft f Or d "k M r any newton w hoot bekV to full comrplJence tit' outer ~ng a cOndned opm. The 10010" wain the other a "~t of hWR# tonic may 46MOR WS1 pm person from the lntwlor of the tank May in alt or lntpoalclW Tank abandonment aril be In aoaardana with Conan 33,33, Wts Adm. Code when the tank is no longer used as a poWyS component, sell emian r The Soil absorpton component serving this afro R thbgoampor<ears ovmcn wastewater from a residential fac1iity The tlmtts of *pan Table 3, The longevity of a toll absorption oornponent depends greedy on proper and timely maintenar�oe, and system use within or below the limits of re liable Operation, Good water �nservi p umbin se water conrvatl+c� practices by $11 aocupgtriife of InStI Of fixtures are key factors In extending the use absorption oompo Want`s operation must be assessed by In=pectlon at least The soli i ny a in once every three years. The Inspection Shad Intsl s evide u i s o discharge the observation pipes, and a vi inspe Alon for any ed and from the oomportent On steeply sloping site$, areas of erosion wa sewage reported to the owner for repair. The Surface dlsoharge domestic from the system Is prohibited and considered a human health hazard. Traffic around or over the loll absorption component should be avoided pattIcularty nt may load during winter months, The compactlon or removal Of snow covet ovsr budieuit or to hydraulic failure by freezing. This type of failure li usually temPomcY is ImposslWs to repair until weather conditions Improve. in g t�Nimw �ICh "y aped t� component will reduce diffusion of Mgsn Into the sot f an A more Intense, and sander, organic clogging of the sell. Z r Management Plan for a septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the componsnt may obstruct wastewater flow. Contingency Plan In the event of system a ava, the existing system cou d also be t reused AW period of three to installation of a divsrter four years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc. Inca case fail of tad onrig� alte rnate they will have to be need rom�OVed at any trees, shrubs, etc. ha Di property owners expense. if aiternate area is d there are other sk9rnso systems that can be used, in which, oouid result in added expense to the property owner, Any tank abandonment code lease con you 10=1 Zoning office ce orcontaott instaN�p pl regarding this , p 2—o w44 % tAA %T, ( ) 3 $ t. 1 4 (o8 0 Sc�R�►.�Cr, O.�t,.{L 't �, �.M � 1 N 01 r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - --s� 6 ee- i ZE: - /J c' z. c/L Mailing Address Property Address 12. S$ /S d f rom Planning Department for new construction} Verification re sue m ( q �S � :T�;cvn/ of City/State N ���- ^AI Parcel Identification Number OZ-k - /QV 1 6? - o - • -r A , EQ,& L DFSQ jPnQN Property Location -&LIL t /4, S E A, Sec. L'S -- , T y^ , ,N -RAW, Town of Subdivision �� /</&., a /I , Lot # Dnc-,0 (, 8 c�9s - Certified Survey Map # __ . Volume Page # • 7 q Volume ►$ Pa Se # 3_ 9 Wa rr anty D - � S ..- Spec ho Z -yes no Lot . lines identifiable S-yes ❑ no Improper use and maintenance of your septic system could result in its premature failure to handle waste+, 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 traaameat stage in the waste disposal system. Tho property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a msstcrplumber, journeyman.pluntber, rest riatedplumber or a licemedpumper verifying that (1) &a ou -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is leas than 1/3 full of sludge. Itwe, the undersigned have read the ab quircments sad agree to maintain the private sewage disposal system with the standards set forth, herein, as se the De eat of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating fir c tom has n ma' twined must be completed and returned to the St. Croix County Zoning Office within 30 days of a ar p to. Si GNA OFLICANT DATE OMER CEMIFIC 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. SIGNATURE OF APPLICANT DATE w # + * *+ Any information that is mis-represented may :exult in the sanitary permit being revoked by the Z=4 Department. www * ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i U 1858P 387 6 7 4 2 1 9 Document Number WARRANTY DEED KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROIX CO., VI This'Deed, made between CRAIG R WARREN and LUCILLE R RECEIVED FOR RECORD WARREN 03 -21 -2002 1:15 Pd husband and wife Grantor, EXEWT # DEED )<EXPT t AND STEVEN ] DERRICK REC FEE: 15.00 TRANS FEE: 60.00 G COPY FEE: Grantee, CERT COPY FEE: Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 3 Recordin Area dollar and other valuable consideration, conveys to Grantee the following Name and Return Address described real estate in St. Croix County, State of Wisconsin: This is not homestead property. ROBERT F WALL Together with all and singular the hereditaments and appurtenances 522 SECOND STREET thereunto belonging; And Grantor warrants that the title is good, HUDSON WI 54016 indefeasible in fee simple and free and clear of all encumbrances except Casements, covenants, and restrictions of record, and will warrant and defend the same. (Parcel Identification Number) 0 26 - 1046 -20 -000 — /a - 7y (��y • ICCI- SEE ATTACHED DESCRIPTION Q L G707 & -,/ -CQD V ated this 21 day of CRAE IR WA EN ILLE R WARREN AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF COUNTY OF ST. CROIX aurr ur,... Personally came before me this t;L� authenticated this _ day of the above named CRAIG R R WARREN to me known to be the persons) w}W e t t+4 foregoing signature lost ant and noyvledge the Wqie. U r type or print name si nature W/Msry Pub type or print nam e•�' er e .ec _f B. 2004 TITLE: MEMBER STATE BAR OF WISCONSIN — tissitm1 (If not, Notary Public ST. CROIX County,_ authorized by §706.06, Wis. Stets.) My commission is permanent. (It not, state expirat date: THIS INSTRUMENT WAS DRAFTED BY Robert F. Wall 'Names of persons signing in any capacity should be typed or printed below their signatures. U 1858P 388 Description: Part of the Southeast Quarter of the Southeast Quarter and part of the Southwest Quarter of the Southeast Quarter of Section 15, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin, described as follows: Commencing at the South Quarter corner of said Section 15; thence, on an assumed bearing along the south line of the Southeast Quarter of said Section 15, South 89 degrees 58 minutes 05 seconds East a distance of 1016.75 feet to the west line of Parcel IC of a Certified Survey Map recorded in Volume I Page 93 in the Register of Deeds Office for said County; thence, along last said west line, North 00 degrees 23 minutes 22 seconds West a distance of 683.12 feet to the north line of said Parcel IC; thence, along last said north line, South 85 degrees 42 minutes 15 seconds East a distance of 284.92 feet to the point of beginning of the parcel to be described; thence, continuing along last said north line, South 85 degrees 42 minutes 15 seconds East a distance of 66.22 feet to the east line of said Parcel IC; thence, along last said east line, South 00 degrees 23 minutes 06 seconds East a distance of 657.01 feet to the south line of said southeast Quarter; thence, along last said south line, North 89 degrees 58 minutes 05 seconds West a distance of 66.00 feet; thence North 00 degrees 23 minutes 06 seconds West a distance of 155.95 feet; thence, along the arc of a curve concave to the west, a distance of 29.15 feet, said curve has a radius of 167.00 feet and a chord that bears North 05 degrees 23 minutes 06 seconds West a distance of 29.11 feet; thence North 10 degrees 23 minutes 06 seconds West a distance of 101.95 feet; thence, along arc of a curve, concave to the east, a distance of 40.67 feet, said curve has a radius of 233.00 feet and a chord that bears North 05 degrees 23 minutes 06 seconds West a distance of 40.61 feet; thence North 00 degrees 23 minutes 06 seconds West a distance of 65.00 feet; thence along the arc of a curve, concave to the east, a distance of 40.67 feet, said curve has a radius of 233.00 feet and a chord that bears North 04 degrees 36 minutes 54 seconds East a distance of 40.61 feet; thence North 09 degrees 36 minutes 54 seconds East a distance of 101.95 feet; thence, along the arc of a curve, concave to the west, a distance of 29.15 feet, said curve has a radius of 167.00 feet and a chord that bears North 04 degrees 36 minutes 54 seconds East a distance of 29.11 feet; thence North 00 degrees 23 minutes 06 seconds West a distance of 101.27 feet to the point of beginning. Containing 49,235 Square Feet (1.13 acres . Subject to County Trunk Highway °G along the most southerl line of the above described parcel. Also subject to all easements, restrict and covenants of recor . The above described parcel is being added to the adjoining parcel already owned by Steven J. Derrick described in Volume 'a e 29> Document : um r sorx ount ter �7 rc s OfceHis existin arcel, the one to which the above el is being added, described to volume and page in the previous sentence is escribed as: I U 1858P 389 A parcel of land located in the NW'/e SE'h, NE'/. SE'/e, SE'/. SE' /,, and the SW' /. SE' /a of Section l 5, , r30N, RI 8W, Town of Richmond, St. Croix County, Wisconsin, described as follows: Commencing at the S % corner of said Section 15; thence NO'] 4'36"W (assumed bearings referenced to the monumented East line of said SE' /. of Section 15, bearing N0 0 37'40 "W) 707.67' along the monumented N -S ''A Section line (previously recorded as NO' 14'30"W) to the point of beginning; thence continuing NO °14'36 "W along said line 1922.33' to the monumented center of said Section 15; thence N89 °56'20 "E 1872.44' along the monumented E -W' /. Section line to the West line of that Certified Survey Map recorded in Volume 4, page 927; thence SO °37'E 430.00; thence N89 °56'20 "E 60.00'; thence SOa37'E 1378.45'; thence S89a47'W 372.25'; thence SO °37'40 "E 175.00': thence N85 °59'40 "W 900.39'; thence S89 °47'06 "W 675.57' (previously recorded as S 89'47'W 675.71') to the point of beginning, subject to all easements and restrictions of record. The parcel conveyed is added to Derrick's existing parcel to create a single parcel. Warren DerrickDeedDesc -02 Q 3113 2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page �of 3 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. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information iewe by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location eve Govt. Lot S 1/45 1/4 S 5 T 3�j N R ( E (or) (9 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /y C bi 6-- 8 1 1 C I( City State Zip Code Phone Number ❑ City ❑ Village Y Town Nearest Road liJ S o / - 7 1 ( >/r ) Zy6 - 3 Zn I e .c l ia vvt rjyL cQ C [� New Construction Use:1� Residential / Number of bedrooms thy_' Code derived design flow rate 'Vrcl GPD ❑ Replacement // ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments 5 )( W\, el - v- / 9 7v and recommendations: C WS r elm V • Fe- J� -- RRECEIVED MAR 1 3 l❑ Boring ❑ Boring p � ST. CROIX COUNTY ` g [ pit Ground surface elev. / G a ft. Depth to limiting factor _ ZONING OFF I tion 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 n - c 1 �.�' 5 • Z to-z(4 l '-4 _' sid Zmsb r c 3 IO 31 �. /to s .I 2 m5 bk ❑ Boring # ❑ Boring Pit Ground surface elev. 9.8• � ft. Depth to limiting factor 2'4 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ( 6 -1 0 It3 312 -- S i 1 2rr.QbV .5 .9 2 !0-2 16 (y Sic) Zrnsbk TWr c 3 2q -3t P - 1 .5 Ur 4 Ito Sc-1 2rr5b WVP' i * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) signature CST Number kkehl Sc� P- c 25 3cv Address Date Evaluation Conducted Telephone Number 083 SBD -8330 (R07 /00) Property Owner ecc k. Parcel ID # Page Z of 3 ❑ Boring # ❑ Boring / 3 ® Pit Ground surface elev. 9�Q ft. Depth to limiting factor .2? 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 3 sit 2nnabk r c3 I y� .5 . $ Z V r -- Si c,l Z rr r CS 3 29,38 I F!F 7.5 -Scl Zmahk m-Pi 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I E] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) PAGE 3 OF NAME Of r I L TOT# Ff LEG AL DESCRIPTIONSIV 1 4-S 1 4 ,S / 13 C ,N,R.1 E(or Ij SCALE: I"= 10 BM 1 ELEVATION /00.0 BM 1 DESCRIPTION I op o TJc P c BM 2 ELEVATION 'T9 yG BM 2 DESCRIPTION �o r SYSTEM ELEVATION `-6 1 ALTERNATE ELEVATION IV , 4 — CONTOUR ELEVATION :Z- q �S ° S \ SIGNA E DATE N SEE SURwYOIR'S UNPLA TIED =LANDS REPORT ON THIS AREA Z 0) N00'12'S4*W 5288.14' �, w N00'12'54 "W 696.15' NORTH— Ln to 1V 00V0',3 4"E 6 95.82' �/ LANE �� N00'12'54 "W 31 l _ 430.81' - - 63.02 " "- wF sT UNE OF LAND CONTRACT, o NOO�O'34 "W VOLUME 699, PAGE 295 o � 12 ' • 25.07 • Z M.�i,ZZ•01'N c� � � � O C z ,6QO3OS STAIR CY W rob 0 / / 0 / I �' / t , z . w i __•_ 370.98 `r aT� T r' � K _ T '� vl �' �� �`2 �� �� .� `� 1.� �� 7. A. T RE\�` IMINARY PLAT OF CHERRY KNOLLS • • LOCATED N PART THE BE 1/ 15� 1B / TOWN OF `COUNTY A� Pre d fo and of h quest of: d A 2 Ste // ., Sl A T ws ssal 8 .T. 'G' x i WA 6a7 YD 65 1 ° 65 Ne Rf on M 0L7� fast QN1 N w K. 54017 fa.7 s Rd y x x OF 04IO 4 ■ L' ! 6a3 M7J ssaa x 7G � No" wr lo "Mi EX * " N00IS'717'W 6301.00' LAC SEMM /S seY4o+0 1e72.at' MA 4t'1 w 6E os SFCnm 15 '• x 1612 452 J 33 33 • s6u y x x x W. ssaf t1a3 , IODu x x so" x x x low 0 1 T T 4 1.S L O T 15 O 3 I L x xtE 86509 FT. 1.81 ACRES x 11 1 CHES ?. 1 AdP S x I �+ : 78930 SQ �► L T 1 "ix x X. 1 Md= ooar 7 1aa6A 96 2 S4 x 202 x s1 yo x "Li x 111fA \ x 111.0 /RA a x ?.02 ES 0 T tsa3 I 87830 f7. L 0 T 21 2 x ss7.i x x 1fu L B FT. tsls 2 J A E .oa 1 A S "a' or 1NA ' z' * na, LTY 1 saa x x 1w T � L O T ri slfA ,{,• 4 `� W. x ssfA x 89 A T 9 L 4614 I'm FT. mi x 1. clay 1 2 A x x 3. 79 52 899 1610 AIO x x Y H.W.E. 972.0 t4 °"X DDas x x 1ra1 frao 177.7 � x 1.91 s7s3 x T L ?6 A 1,MN.. T 9 x x aas ?6 S0. !t)t ?. fd�A o O OF • x 11101113•7 p 177 .7 1 B A '\ O T It x x . L T i' WAIER V. / 964. ON 2 1 1 Smx AAR 'i x 1 x 2.1 A. yIi °r x x r 1494 , G 9 Lot 4J FT. 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W 1' I'm 1" '� M Nsod 1 7707 1.76 73 to � O 0 • 7 Shan Md. (.461 U-0k.U. M 6219 1.M 146,• LW b IOLDf * Aembe for Ow. • 77077 1A/ 27 •7101 1.32 lO7Al AREA OF LAND TO 6E PUTTED: &46L 43 m R. 1 lam 1A1 71 48m 1.04 71.71 AOK1 y 6.wy 1114,11'" Lb. (11x1 Fran A-0-011 w sass t.i s 01711 LIPS - " -D-w Ewmq c tw n a ]0 DOP00 10 1 i14 .n mmm U f SM R710 fo FT. IAf AOO D.10. 66TH O.Ir Oa.w 12 67316 Im 31 97. agamm LOT Wft "a MET ® O.M. Pally Al- 13 671]0 = 32 fain 1.31 101 AODI110M 7AL OMAN 46 WA ¢ �� Alfrac OM+•Y L..~ 11 11601 1.0 I 37 11320 1.46 P1NIpo= TOTAL 1E710M Of TOWN ROAD¢ 00+ LF Z D 6 1 RaN, aDNYA® 10 M[ IM�1Q 30146 6a R. M2 AMU " 4602 to 36 11703 2.13 pE CONTOURS ARE 210046 AT 2 FOOT fllurvALS 17 Han 1.76 v 46z,o 1.a 3HT Of lRy C T.H. " ""° 1412 NTY TRUNK H/MMAY V ; - - - SWWOGt ML4* SWIM LM OF )W SE 1/4 SEMOV 15 �17.°1°•Fa° (mN11P AW sysD eMEN. Alw NoIE m de ill P.o ehoen en tl111 g 0o. n*J. l to t d. County and par d. P lee% rz all reyurtl.lr (Le. eetlarldl. mrYnun lot etoe, ao.w to party. "s Baare pi"ho1r6 or hWaPti6 •nY PNa•L "teat Mo SL Crok County NO OMNER OR RESIDENT SMALL DO AN1'MNO WHICH WOUID N7EIEElE MiH OR CHANGE ME ?Dory OMm .M On alpraprbh Two Lord far a*A- OPERAVON OF THE APPROVED OQLVW MVE WATER DRAINAGE AND SOIL EROSION PLAN FOR MS PLAT. MS 1W3LDES 6UT IS NOT UNTED 70 OIADNG UPON. OMMCN110, ALWWNQ- � be. r . e. iElAN6. E16:AVATNG OR PlAN1NG N ANY POND EASENEN7S, WATER DRAINAGE DRCFES. Yea1 ep.w" a1si"a w r' my WATER RUNWAYS. WATER CULVER78, BERMS OR aws lFEOINOS 1w.a.ep..Ad 46.1 1 em • a.y N•Mr1.•+ 1010 S. +IV Mall w rw a as 111. a w.aanr. k a rr 4 r ey.roAar�a e1u ew t