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HomeMy WebLinkAbout026-1153-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479201 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: Gibson, Travis I Richmond, Town of 026- 1153 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: QL5 i ie 6p d �,,)Q,�, &,, 19.30.18.1142 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic e Benchmark Dosing Alt. BM / vw 6 tea . (.o Z S i n / Bldg. Sewer Holding SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �/' /^ , I 1 / g Dt Bottom P a /l/'/FJ / I • � 3 3` � Dosing 2- A) 4 / I � P ? / Header /Man. -7 Aeration Dist. Pipe 7 • L$ q - 3 . qT Holding Bot. System ` q� 1 PUMP /SIPHON INFORMATION Final Grade �✓ bb 7�1 Manufacturer ����� Demand St Cover GPM Model Number , I es �� `A /�' TDH Li Friction Loss JSystem Head TDH Ft Forcemain Length i Dia. 1,11 Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No, Of Trenches PIT DIM F No.O Pits Inside Dia. Liq Depth DIMENSIONS +4 � SETBACK SYSTE TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of 1 System: / r „ i UNIT Model Number. DISTRIBUTION SYSTEM ' ✓ - 7+ - 7 w 7 = Z l ►`ate -,.�, Header/Manifold j j Distribution x Hole ize x Hole S acing Vent to Air Int e Pipes) z Length J', Dia Length \ Dia Spacing_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over ✓ Depth Over xx Depth of eded /Sodded xx Mulched Bed/Trench Center b7 Bed/Trench Edges Topsoil N11. xx Se Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1486 94th Street New Richmond, WI 54017 NE 1/4 NW /4 19 T30N R1 8W) Glen View L t 4 Parcel No: 19.30.18.1142 1.) Alt BM Description = j CO ��" ��� ✓vim �' 2.) Bldg sewer length = g - amount of cover = ��s�re �� e� S c l �• 3a Zinse '- V jSnat. d1 t Plan revision Required? E] Yes Q Use other side for additional information. SBD -6710 (R.3/97) Date No tor Cart. No. Safety and Buildings Division County ` V AN 201 W. Washington Ave., P.O. Box 7162 / (ra i;,1 �consin Madison, WI 53707 – 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 "Zb Sanitary Permit App 'on State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal ' yo providpC/'►C� may be used for secondary purposes Privacy La 5. ( m [[t\ C 1 e. !_W than mailing address) I. Application Information – Please Print All Information Property Owner's Name , t Rl� f Property O wner's Mailing Address Property Location � Cit ® z Y4,O � /+, Section tY, P _ Zip Code Phone Number (� 1 5 `[ D a _ J� J� all rcl (J N; o II 7r,22 f Building (check all that apply) `� OL G�5 Q�(� JSQ� mily Dwelling - Number of Bedroo 1\ Subdivision Name CSM Number El Pubic /Commercial - Describe Use p ❑ State Owned - Describe Use (,.) ElatXjIvina o I III. Type of Permit: (Check only one box on line A. Complete line B if applicable) _ A. bw, < L- System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System U. ❑ Permit Renewal Permit Revision ❑ Change of W e it Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized XachingChaWber ound 11 Holding Tank 11 Peat Filter 11 Aerobic Treatment Unit El Recirculating Sand Filter El Recirculating Synthetic Medi Filt ❑ Dri Line El Gravel-less Pie L1 Other (exp in) V. Dispersal/Treatment : r 1, Z Design Flow (gpd) Rate(gpdsf) Disp sal A Required (sf) ispersal Area Proposed (sf) System evati n J --Z7 � < 7 / 3 7 re �< • J , VI. Tank Info otal Number Manufacturer Prefab Site Steel Fib Plastic aons Gallons of Units Concrete Constructed G! s New Existing Tanks Tanks Sept ic or Holding Tank Aerobic Treatment Unit f Dosing Chamber 3a ✓ VII. Responsibility St _z_ atemen - I, the undersign m ume responsibility for installation of the POWTS shown on the attached plans. PI r' ae (Print) Plumber' r ature MP/MPRS Number Business Phone Number d q�� 71 � , �6 Plumber's Address (Street, City, State, r ode) n VIII. Coun /De artment Use Onl Approved ❑ Di ov Sanitary Permit Fee (includes Groundwater Date Iss Issuin gent Signature o S Surcharge Fee) ,rL ❑ Own Reason rj�nial IX. Conditions of Approval/Reasons for Disapproval STEM OWNER: G Vt t 1 Septic tank, effluent filter and a dispersal cell must all be services / maillfsrtid as per management plan prodded by pklmbar. f OGa� o ✓� r o� V� o .�-�– ,Q a �— s t 2. AN setback M** mat must be malpttaUtyd as Per x11 ble code / ordinav". Attach complete plans (to the County only) for the system on paper not less than s1J2 x 11 inches in size SBD -6398 (R. 01/03) - �9ditli r - � PL T PLAN PROJECT Travis Gibson DDRE S P.O. box 154 Star Prairie Wi 54026 NE 1/4 NW 1/4S 19 /T 30 R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/25/05 BEDROOM 3 O CONVENTIONAL IN- GROUND P SSURE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 653 # of chambers 21 IL BENCHMARK V.R.P. To of Power Box Top ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Plans Designed Usin g Conventio Powts SYSTEM ELEVATION 93.5/93.4/93.3 2.5' below qrade Manual Version 2.0 Scale is 1" = 40' vent unless otherwise >6" Standard Biodiffuser of Cover Leaching Chamber noted with 3 1. 1 ft2 of Area Well is to meet all setbacks required by 6' Long 11 " WDNR 3 4 „ Grade at System Elevation Combo Tank Property Line 10' Pro 3 bedroom House 0' B -2 10' 3 -3' X 45' cells with >3' spacing operty Line 50' -3 25' 0% Slope, site was cut! 5 ' Vent 30' B -1 20' B.M. Couldesac Property Owner _ Parcel ID # Page of ❑ Boring # Boring 3 � Q 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. I J *Eff#1 - Eff#2 IF F F-1 Boring # [] Boring C] pit Ground surface elev. ft. Depth to limiting factor 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 I •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Co Color Gr. Sz. Sh. - Eff#1 I - Eff#2 - Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' 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.6=) Property Owner _ Parcel ID # Page of 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 GPDO in. Munsell Qu. Sz. Cont. Color -, -Gr. Sz. Sh. `Eff#1 I `Eff#2 D - I �!L T o 6 2- D 5 O� it ® Boring # El Boring �� L pit Ground surface elev. ft. Depth to limiting factor n. 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 F-1 Boring # ❑ 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. `Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 130 mg/L and TSS 1 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.6(00) . i Soil Test Plot Plan Project Name Travis Gibson ShaJnd Address P.O. Box 154 Star Prairie Wi 54026 CS #226900 Lot 4 Subdivision Glen View Acres Date / /05 NE 1/4 NW 1/4S 1 9 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 Power Box System Elevation 93.5/93.4/93.3 *HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted Property Line Pro 3 bedroom House B -2 0 ' -� operty Line 50' -3 5 0% Slope, site was cut! 5 20 30' B -1 k B.M. Couldesac ry Naae Ut .SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ►►" Cl VENT PIPE 12 MIN. ABOVE GRADE & WEATHERPROOF 2:25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK 6 FINISHED GRADE - WARNING LABEL u MIN. fr 04 2y" IN. 4� C.Z, a�bs�aw►�ba X.n. rite: ' , %` �e M� , INLET - GAS ifqq , ` WATER TIGHT SEALS GAS- I A � SEAL �J F1L ._.L_. ALM APPROVED PIPE APPROVED B ON 3' ONTO PIPE 3' `"F SOLID SOIL ONTO SOLID C SOIL PUMP OFF ELEV .FT O D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS �� f SEPTIC / DOSE G�i NUMBER DOSES PER DAY: TANK MANUFACTURER TANK SIZES SEPTIC / � GAL. DOSE VOLUME INCLUDING / DOSE GAL. FLOWBA � GAL. ALARM MANUFACTiURER:I� CAPACITIES: A = Z / INCHES = 67-4-; MODEL NUMBER: g = 2 INCHES = GAL. SWITCH TYPE: C GAL. PUMP MANUFACTURER: � MODEL NUMBER: D = INCHES = GAL. SWITCH TYPE: ^ ��C REQUIRED DISCHARGE RATE �� GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC J / � FEET VERTICAL DIFFERENCE BETWEEN P UK? OFF AND DISTRIBUTION PIPE `_ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . • . • • • • . ' . - — + FEET FORCEMAIN X ,-','S F TOTAL I DYNAMIC A HEAD FEET Ip DIAMETER INTERNAL DIMENSIONS OF P TANK: L off. D ✓-- _ ---- -- �/_.__�� --- T SIGNED: - LICENSE NUMBER' DA +E - -- 1/88 FROM BRIAN VA"T-PREFERRED PUMP FAX NO. 7154258035 Mar. 30 2005 09:57AM PI 1 W'Al f )YNAVC Iii Al),; P iji CURVE UF1 UEN1 AND MODEL 153 i Feet Meters Col. 1,;IF(s God. i Wei-, 5 1.5 45 ZI 10 42 231 2 30- 15 4.6 36 261 53 20: 16 20 1 61 28 167 44 2 2 �2; - 7T' 20 129 t J4 129 ji Rc, 167 -- 87 . 1 3 30 j 172 4 -1 35 10.7 L 40 12.2 30.0 it c�y I --.— — ... I , , A " - 1 -1 I-off Heod 1 0 6 0 8 0 100 ('AHONS, 8 160 �40 320 , 'LOW PER MINUTE 01.$SMTCMP Model 151 Models 152 CONSULT FACTORY FOR 6 rAsZ I 1/4 718 3 27/32— SPECIAL APPLICATIONS 3 .1 '.7 3 • Timed dWng panels available. 77 • Ei"'cal 31tefflatin fOr duplex systems, are available and supplied with an alarm. 7/8 variahie level control switches are a4lable for controlling single phase systems. • Dwble *gyba6 variable level float switches are available for variable level long and short cycle controls• • Seated (Wk-Box available for outdoor installations See W420. • over 130 (5A•c.) special quotation required. T I I f/16 15111SW153 Series J51HWIS3 MODS S dKt" 4 J/8 Model Amps S odel N151 115 i I n &0 2or3 ..RN�151115 — &D i—rdudOd 2or3 Lkrs—f zx s Non .2 A 200 iiiTEW SK20PA LM.t L 2 X Aift 12 kchided 200 NI52 115 1 &S I _ 2or gNiS? IIS I Auto a.5 Included. 200 230 I RW Q I 2or3 J ; Auto 4.3 Inducted 2or3 No io.5 1 2or3 1_pi�t 15 �i, Auto 10.5 Indi" 200 9ELECTION GUIDE 1 E153 1 23D I NW 1 5.3 1 2o,3 1 1, $ mach aordmiblepWybackvanablel&elfbaI jjLAF 1 23D I I Avlo 11 5.3 Wukd I 2or3 wg switch. Rotor to FWAIT7, IA CKU-'h0t:4:j 2. See FM712 for correct nwW of Electrical Alternator E-Pak Ave nv, ci tontrots. protitcoo devicto am witing should be doft by a quslifled I variable Iml cDntrS sWech 10-0225 used as a control activator. duplex (3) It licensed electrician. Ali ele AcZkl and so* rods$ should be followed InCluding the MCA recent, Nations Electric Code (NEC) SO the OCCUPSKIN &ft 00 ke&M Act (OM (O� or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve Safety fi cWT is engineered into the design of every Zoeller pump. mila 7V. P a Box 16my W (wa for. corn r— All AA%ift n.0►^IPH • � (1.94 ACRES) L.B.O. EL. = 930.00 U 351.81' 88.83' [946.79'] 440.64 k9 5 � 33 11 .5s \� ♦ \ +� \ © 88,027 S.F. (2.02 ACRES) z y 9 \\ O • \ 8 546.58' \ N83' "E °• o i 8 44- Os m • �7 91,513 S.F. ! (2.10 ACRES) j cn • S y L.B.O. EL. = 927.00 I N r ` I w 4 S86'34'47 "E I 406.08' I �' O 58.49' / 167.19' �'' Ln N 91,764 S.F. i 1so.41' NN w (2.11 ACRES) [946.5' L.B.O. EL. 927.00 5 �� DRAINAGE I ` w // E I 668 S.F. / O H.W.L. = 924.80 12 ACRES) j " j '• =L. = 923.00 / N89'59 51 E 43.43' so.a2' 80.79 33' 3. 71.82 `�� 390.82' I I 66' 1. o L7 19 sib ? '9•�� I I 00 16 i' I 71,264 S.F. - 7 (1,664 ACRES) 1 L.B.O. EL. = 927.00 I 1 h / g 81,015 S.F. I i l 3 (1.86 ACRES) ��` /� ,:� 18 c I 6 L.B.O. EL. = 927.00 o`'i ,�' i I o ,�a/ , 88,801 S.F. ' i c 7 S.F. ,.10 �►��/ ,�� (2.04 ACRES) / is ACRES) c �� /� L.B.O. EL. = 927.00 1 � = 923.00 $� V / / ( P / O 2 i� / • / / 2 1- /��• / , 30.32 / \ ,6 i , 1 loo, / 18 86,087 S.F. cV �' °' - - - (1.98 ACRES) / ' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer / Mailing Address Property Address ��� ( CM 4 (Verification required from Planning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location / " '/4 , /X '/4 , Sec. / /, T I !W,Townof Subdivision 14- � J % ,Lot # _X. Certified Survey Map # Volume , Page # Warranty Deed # 7 � , Volume �T Page # �v Spec house ❑ ye 74— Lot lines identifiabi 4es ] no SYSTEM MAINTENANCE � � 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. The property owner agrees to submit to St. Croix County 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 full 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 statiqg that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Depart ment wi n 30 d ys of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 descri above, virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Maintenance and Contingency Plan for a Septic System Maintenance Plan 3 years. 1. Septic Tank is to be pump ed once every 2. Effluent fitter 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. he ends of 3. Once every 3 years, cells are to be inspected via the inspections pipes at t the cells. s garbage, and w ater conditioner discharge into the system. 4. Owner agrees to limit greases, g 9 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 Contingency Plan option #1. If system fails, determine cause of failure, use alternate area and install new Sv:n# replacement area. OptiII system at a lower elevation, by removing chambers, removing biomat, ystem. Opti on #3. No adequate area, is suitable for replacement area, and system elevation cannons 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 2745P 060 766E1ES3 WALSH EGIST DEEDS ER OF DEEDS State Bar of Wisconsin Form 2 -2003 R ER N. REGIST WARRANTY DEED ST. CROIX CO., NI Document Number Document Name RECEIVED FOR RECORD 02/07/2005 10:00AK WARRANTY DEED THIS DEED, made between Advanced Home Design and Construction EXE1P1 # Corporation ( "Grantor," whether one or more), REC FEE: 11.00 and Travis Gibson and Jodi Kay Swanson, both single persons TRAITS FEE: 119.70 "Grantee," whether one or more). (` " COPY FEE: ) CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Name and Return Address Lot 4, Plat of Glenview in the Town of Richmond, St. Croix County, Wisconsin. (� O BoX 1 O /.,-& 026 - 1153 -04 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights- of-way of record, if any. Dated Advanced Home Design and Construe 'on Corporation (SEAL) (SEAL) * *By rew Lethert President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF F L ) )SS. LE E COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on l o Q (� 1 } � 1 W , (If not, the above -named Advanced Homes Desilzn and Construction authorized by Wis. Stat. § 706.06) Corporation. B . Drew Lethert. President to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. �� "'My, My c e My nladon Do1 Attorney Kristina OQland Na, Expire July 11, 2006 Hudson, WI 54016 Notary Public, State of FL My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROT" Legal Forms 800- 655 -2021 www.infoproforms.com Parcel #: 026- 1153 -04 -000 05/26/2005 08:40 AM PAGE 1OF1 Alt. Parcel #: 19.30.18.1142 026 - TOWN OF RICHMOND Current X 1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner * GIBSON, TRAVIS TRAVIS GIBSON SWANSON, JODI KAY JODI KAY SWANSON 1486 94TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1486 94TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2.110 Plat: 1984 - GLENVIEW LOTS 1 -43 026/03 SEC 19 T30N R1 8W PT NE NW GLENVIEW LOT 4 Block/Condo Bldg: LOT 004 2.110AC Tract(s): (Sec- Twn -Rng 401/4 1601/4) 19- 30N -18W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 02/07/2005 786883 2745/060 WD 05/10/2004 762128 2568/395 WD 10/21/2003 744287 9/88 PLAT 09/03/2003 738635 2398/458 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/01/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.110 24,200 0 24,200 NO Totals for 2005: General Property 2.110 24,200 0 24,200 Woodland 0.000 0 0 Totals for 2004: General Property 2.110 24,200 0 24,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 453294 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: Advanced Home Desi n Richmond Township 026 - 1153 -04 -000 CST BM Elev: Insp. BM Elev: 7 Description: Section n /Range /Map No: 19.30.18.1142 TANK I FbWATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt tlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD D let Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Mode[ Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to ell SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS o. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM L CHING Manufacturer: INFORMATION CHA ER OR Type Of System: U Model Number: DISTRIBUTION SYSTEM Header /Manifold I D istr tion x Hole Size x Hole S ing Vent to Air Intake Pip ) Length Dia Le th Dia Spacing SOIL COVER x Pre ssure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 - i] Yes A-1 � � Yes � ] No COMMENTS: (Include code discrepancies persons present, etc.) Inspection #1: / / Inspecti\N19.30.18.1142 Location: 1486 94th Street New Richmond, WI 54017 (NE 1/4 NW 1/4 19 T30N R1 8W) Glen View Lot 4 Parc 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? na Yes [] No Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Signature Cart. No. PLOT PLAN PROJECT Advanced Home Desion Coro A ADDRESS 11340 Ivvwood St. Coon Raids Mn 55433 NE 1/4 NW 1 /4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/2/04 BEDROOM 5 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK IZE LOAD RATE .7 ABSORPTION AREA 1119 # of chambe Cs kk BENCHMARK ?P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O ELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 9 . 91.6/91.2 6' below qrade Alt. BM Top of Sury Iron @ 96.6 Scale is 1" = 40' ell is to meet all unless otherwise s acks required by noted - W R Vent Plans Designed Using Stand d Bio user Conventional Powts >6" Manual Version 2.0 of Cover Leachin tuber with 31.1 of Area 6' Long 1119 3 4" Gr e at Syste Elevation Please note: a great deal of grading wa s =ein some of these lots in this subdivision, further testing Pro 5 may need to done to make sure Bedroom system will still work in original House area. Combo ST J` ` 233' Propert Line 5 ' B -3 � 4% Slope 'At sIv 3 -3' X 75' cells with >3' Spacing L;V ) B -2 -1 40' Vents g2 B. M. 543' Property Line 72' ' • B.M. i Safety and Buildings Division County 201 W /, �� \' W. Washington Ave., P.O. Box 7162 �` ■ 1` ■ Scons n Madison, WI 53707 - 7162 Sanitary Perndt Number (to be filled in by Co.) De Brtment of Commerce ( 266 -3151 Z Sanitary ermit A tic ti 4/ ate Plan I.D. Number In accord with Com Y PP ��C���l � m 83.21, Wis. Adm. Code, personal i n ation you provide maybe acct for secondary purposes Privacy Law, 15.04( 2( oject (if different t /mait;»g address) 6 7 I. Application Information - Print All Infor on � `7 L � l ;� ;�iU> <Uu //S3 -O Owner's Name r - I , E Parcel # # Brock # I �Urz 1 rty Owner's Mailing Address Property Location s City, State Code Phone Number 56 , -'k, Section 7 �U N: of Bui ing (check all that apply) I r 2 Family Dwelling - Number of Bedrooms - ��� &___ - Subdivision CSM Nu Public/Comrnerciat - Describe Use 3 Z d4ZV � - , 4e State Owned - Describe Use Sfi c'i (A/ City_ Villageowaship of III. 't: (Check only one box online A. Complete fineN if app ' ble) A - New Syste Replacement System Treatment /Holding eplacement Only Other Modification to Existing System B • Permit Renewal Permit Revision grange of t Transfer to New last Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. (Check all that a 1 ) Non - Pn�In- Mound Z 24 in. of suitable soil Mound < 24 is of sui le soil At -Grade Single Pass Sand [titter Constructed Weiland Pressurized In -Ground Holding T Peat Filter Aerobe Treatment Unit Recirwla Q. i Recirculating Synthetic Media Filter g Chamber Dri Line Graveldess Pine Other (explain) ,� V. D' tment Area Ing rmation: TD X Design Plow (gpd) Design Soil Application Rabe(gpdst) Dispersal Area Required (sl) Dis Proposed (sf) S Bev on w gle VL Tank Info Capacity in Total umber Manufacturer fab Site Steel Fiber Plastic Gallons Gallons of Units Co Constructed Glass New Existing Tanks Tanks Septic or Holding Tack � . Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, th assume respotuibility for installation of the POWTS drown on the attAbed Plumheeea lyame (Print) / 1;, 6 Plumber' ignanire MP/MPRS Number = Plumbers Address (Shea, City, s V11L Cozen /De partment Use Onl Approved.. Disapproved Sanitary Permit Fee (includes Groundwater Date Issued t Si atu tamps) Surcharge Fee) Owner Given Reason for Denial tf' 25Z 0 L IIC. Conditions of ApprovA jcaeval - fy SYSTEM OWNER: c, a uen filter and 0 dispersal cell must all be serviced /maintained as per management plan provided by plumber. e,6wt* - 3' ' 2. All setback requirements must be maintaine - r f� as per app ' able code /ordinances. Attach complete Flans (to the County only) fyr the m on paper n4 Joss 1 1/2 x It tn= size PLOT PLAN PROJECT Advanced Home Desian Corn A ADDRESS 11340 Ivvwood St. Coon Rapids Mn 55433 NE 114 NW 1 /4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/2/04 BEDROOM 5 CONVENTIONAL XXX IN-GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1119 # of chambe s 36 IL BENCHMARK V.R.P. TN.-of Steel Fence Post ASSUME ELEVATION 0' Filter Zabel A -100 ❑ BOREHOLE O WELL , R, P, Same as Benchmark SYSTEM ELEVATION .091.6/91.2 6' below qrade Alt. BM Top of Survey Iron 96.6' Scale is 1" = 40' Well is meet all unless otherwise setbacks r is by noted WDNR Vent Plans Designed Using Standard iodi ser Conventional Powts >6" Manual Version 2.0 of Cover Leachin Chambe with 3 .1 ft2 of Area 6' Long 11 " rade at System Elevatio Please note: a great deal of grading 3 4 19 wa — mein some of these lots in this subdivision, further testing Pro 5 may need to done to make sure Bedroom system will still work in original House ea. Combo ST va 233 Propert Line 50' B -3 � 4% {; Slope �� 3 -3' X 75' cells with >3' Spacing B -2 -1 40' Vents gZ B.M. 543' Property Line 72' rVIL. No B.M. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page —L of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code n County I 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. 12 A D Please print all information. R ewed b Date Personal information you provide may be used or 8'800nd2ry purposes (Privacy Law, s. 15.04 (f) (m)). d Property Owner t --Property Location !! g bovt. Lot !Pt �lt /4 S I / T N R E (o ( W Pro ps Owner's Mailing Address e Lot # Block # Sub Name or C M# / n in City fate Zip Cote P ow umber City ❑Village To Nearest Road New Construction User Residential / Number of bedrooms - Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: - - -- Parentmaterial Flood Plain elevation ifapplicable /fit ft. General com v� /4,4✓ 7/ . and recommendations: t J�r 92, V endations: i � V s rig Boring M # pit Ground surface elev. r ft. Depth to limiting factor 3 U in. J 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 'E V2 I 7 31z s Ink z ? -i o s/ ---- -- c m All ® Boring # BO "" pit Ground surface elev. v' �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 - /Z)"/- 3 _ �iiry fn 6` 1tv C t_ s f yy f . y t.'o Z , 1 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 Nam (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ����� 0 715- 246 -4516 Property Owne r P rcel ID # Page of 13-1 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Lundary Roots GPDJ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � G L c ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n• 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 Boring # ❑ Boring F 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/ff � in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD 130 mg/L 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. SBD -8330 (8.6/00) Soil Test Plot Plan Project Name Lakes and Hill Development Shaun B' Address P.O. Box 10598 White Bear Lake Mn 55110 CST #226900 Lot 4 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 19 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 Steel Fence Post System Elevation 92 .0/91.5 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 96.6' Scale is 1" = 40' unless otherwise noted Please note: survey was not completed at time of testing, Please Note: Tested area setbacks from lot lines may may not be suitable for change. Installer must verify all lot lines and setbacks desired building area. before installation. Check system location before excavating. A a� 0 M B -3 N 4% Slope r4oV 40' B -2 35 B -1 40' 9' B.M. 5 43' Property Line 72' .M. ST CROIX COUN'T'Y PENANCE AGREEMENT SEPTIC AND yINggSHIP CERTIFICATION FORM �SS 33 Owner/Buyer / Address !�'�w . Mailing _ _ .�.p _ Address 1 De for new construction) Property (Verification required from Planntng eP b parcel Identification Number City /State LEGAL DESCRIPTION T Town of 4y Lot 1 / *, S.C./ —�— Property Loeatior►��^- Lot # Subdivision Volume .._ _ - -- Page # Certified Survey Map # Volume Page # 3 - 7& 1 Deed # 2 Warranty es ❑ no Spec ho p no use Lot lines identifiable premature failure to handle wastes. Proper maintenance SYS �NAN tic tanof your septic system could result in its P a licensed pumper. What you Put into the system Proper use and maintenance every three l years or sooner, if needed by stem out the sepk a in the waste disposal syst consists of Pumping trea tmen t stag can affect the function of the septic tank as a tree nt a certification form, signed by the owner l system and by a Dep artment that (1) the on -site wasteR'aterdisposa The property owner agrees to submit to St. Croix Zoe Den pu mper verifying ter full sa sludge. o yman plum restrictedplumber or a licensed (i the septic tank is less than mas plumber. j after i in if necessary), condition and/or (2) ection and pump g is in proper operating private sewage disposal system with the standards ed have read the above requ and agree to ma the P Resources, State of Wisconsin- Certification Uwe, the undersign tof Commerce and the Departme Zoning O nt of Natural ff within 30 set forth, herein. as set by the Departmen feted and returned to the St. Croix County tic system has been maintained must be comp stating that your septic iration date- DATE e. the three P / iGN� - njRE CF L ANT O WNER CE � ICATION ) knowledge. I (we) am (are) the owner(s) of true to the RT' I (we) certify that all sta on this form dee corded in Re of Deeds Office. the ro erty descri d above, by virtue of a warranty /1 -d DATE SIGNATU OF APPLICANT D e p artment. * :s «« A information that is mis- represented may result in the sanitary p being revoked by the Zoning p stamped warranty deed from the Register of Deeds office deed ' • Include with this application a if reference is made in the warranty a copy of the certified survey map U. 2568P 395 7621 ZEE: E3 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS bocument Number ST. CROIK CO.. WI This Deed, made between Hillvale Development Limited Liability RECEIVED FOR RECORD Partnership Grantor, 415/10/2@N 11: 45AK and Advanced Home Design & Construction Corp. WARRANTY DEED Grantee. EXDPT i Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00 the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 134.70 (if more space is needed, please attach addendum): C OPY FEE Lot 4, Plat of Glenview in the Town of Richmond, St. Croix County, PAGES: 1 Wisconsin. Recording Area Name and Return Address ktAt �'� ) I ULI 026 - 1153 - 04-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of May 2004 J L * * Hillvale Development Limited Liability Partnership AUTHENTICATION CKNOWLEDGMENT Signature(s) _ _ STATE OF Z7 _ ) racy L. Turner Count ) authenticated this __ day o NIotaary Public _ State of Wisco nsin Personally came before me this �the y of May 2 ve named Hillvale Development Limited Liability Partnership * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ _ to known to be the pers ) who executed the foregoing authorized by § 706.06, Wis. Stats.) ins nt and kno 1 the sa e. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina O * Hud son, W 54016 Notary Ame of My Comm ssion is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) , k L -- \` ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wl STATE BAR OF WISCONSIN 800- 655 -2021 WARRANTY DEED FORM No. 2 - 1999 L - -