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Home My WebLink About026-1153-08-000 0 fir ' 1 3 d .� CD g c •^ I 3 .-•: i �• C / ) ;u d< �° 0 o o - (D N `r CD M 7 (D y N f0 3 O C A O c m w m A O 1 N N 0. j �• 6 N CD n' �_ p O O� n (O 0 m S A O O 0 C O (D 0O m c O p l 3 O o �7r N O 7 O O 0 0 CD cn v y F .. a m to A va n N ' W _ Z 3 C) L CD N N o m !T CL 0 0 0 3 �• cn A 00 Oro N 3 cncnwo; O N A 0 v N Duo O CD CD �• 0QCD c N Or o CD l oo y A CL CD O. = C td -•I fA CA O N D. A Z O �m G y li 7 CD n fQ Z °_ N W T m 00 t0 ,3 a m Z H O 9 A OD 0 3 Z o' f A � A CD m 0 a yam a CD 0 - I 3 m _. 0 CD N f0 7 T .�•. O O W C o a, o CL m 0o 3 m m a� c o y 3 3 TZ ca y d `m m N 6 CL N A O 7 C N ~ O -• M W m CD m N C O O A CD A M tA O o ti C i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488214 0 . GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information yoy 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: Xion , Bee I Richmond, Town of 026- 1153 -08 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 4}¢, Q rA *- 2-- 19.30.18.1146 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic z• / Z�8 Benchmark 161 9 Alt. BM Ft �fe wlk 5:11 2•b /a`/•� Aeration Bldg. Sewer 3 W,5 Ak Holding St/Ht Inlet # $.rj qg. 3$' TANK SETBACK INFORMATION St/Ht outlet q. t,5 y4• zS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z I / S -Y t 7 5b/ Dt Bottom �.. Dosing Header /Man. 775 9-Y, a5 Aeratio Dist. Pipe $ Holding Bot. System ' y•e q2.8 PUMP /SIPHON INFORMATION Final Grade �• (i5 Manufacturer Demand St Cover GPM +5 162 • b Model Number ` P � 'I' D ��f • ra -- j TS - 1. TDH Lift Friction Loss System TDH t Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / a • y LL 3 — r SETBACK SYSTEM TO tlOO ( P /L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: / ,L INFORMATION —8�R Typ Of System• i UNIT Mode umber: �o A.�o z+ > �s>5 4 :ra,(,,- vj N� c0; dk.. DISTRIBUTION SYSTEM � ' '/ Header /Manifold Distribution Size acing Vent to Ax Intake // Pipe(s) \ Zr, Length 5 Dia Length Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over 1 XX Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 4- Bed/Trench Edges \ Topsoil es ] No y Yes [: ; No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 1 Inspection #2: Location: 1499 92nd St New Richmond, WI 54017 (NE 1/4 NW 1/4 19 T30N R18W) Glen View Lot 8 . Parcel No: 19.30.18.1146 1.) Alt BM Description = "tic ) f 2.) Bldg sewer length - amount of cover = v � Plan revision Required? Yes `No — Use other side for additional information. Date Insepctor' Signa a Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County �+ �r Q ' Nvi rsconsin 201 W. Washington Ave., P.O. Box 7162 7 / Madison, W1 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Dep artment of Commerce (608) 26 1 Sanitary Permit Application E M D Nun« In accord with Comm 83.21, Wis. Adm. Code, personal information �^ may be used for secondary purposes Privacy Law, &15.04(1)(m Project (if different than mailing address) 1. Application Information - Please Print All Information 06 of 9 1 9 2- ,) Property Owner's Name 0 t I VR Cul 1 # Lot Block # Property Owner's Mailing s Property location L r City, State Zip Code Phone Number i -- -,�, A Section 1 5 ( AWL " J 3 10� "'- H. Type of Building (check all that apply) CvJ 1 or 2 Family Dwelling - Number of Bedrooms ivision Name CSM Number -� ❑ Public/Commercial &cube Use $, ❑ State Owned - Describe Use ❑City ❑Village ownship of & A&* 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) 02(v - 1[5 - 0 • l f A rNew System ❑ Replacement ys Rep System ' ❑ lbeatmmt/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. Tylm of POWTS stem: Check all that ap S ° Non - Pressurized tan - Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized b4round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic T=tment Unit ❑ Recirculating Sand Filter ❑ Recirculat S thetic Media Filter UlzachingChamber ❑ Dri Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Informs on: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (d) Dispersal Area Proposed (sfJ System Elevation ao rYY 890. oo, b VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Now Existing Talcs Talcs Scoicos3iaidi ank ^ Acrobic Treatment Unit f+ Dosing Chamber VII. Responsibility Statement - 1, the un&. for installation of the POWTS shown on the attached Pl (Print) P MP/MPRS Number Business Phone Number P 3g Z 7t1"- 26 Plumber's Address (Street, City, State, Zip Code d ' Wit; A'0AWW/f, 1, z fy ?,-/ 1V Conn /De at Use Only Approved ❑ D. Sanitary Permit Fee (mciR 7 Groundwater Date Issued Issuing Si gnattm m (No ) Surcharge Fee) ❑ Giver Reason for j IX. Conditions ppr 3 > Al, SYSTEM OWNER: / A 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 1 p 2. All setback requirements must be maintained ��' I 1 W t ( 4 � (_ as per applicable code /ordinances. Atteeh complete platy (te the County only)flerlhe system on paper not ka time 81/2 z 11 Woes In size s LI 7SB .01/03) S 0 p U� f � Y s - N � y ' � � � ' fw � f � v w �� • � " � ,��) `� � � •. ••� . . ,- s . � •'� i ' � !, �v < _ � <., • '� , + t, + i ► "' • _ R t T.L. Sinz Plumbing Inc. E5'609 708th Ave. Phone: (715) 235 -2644 , J . Menomonie, WI 547510�� Fax: (715) 235 -2592 www.tlsinzplumbing.com T Z . C6 A n 9 � -:I, N 2 II a �a tj Z� C; 09 *4. T.L. Sinz Plumbing Inc. L o . E5609 708th Ave. Phone: (715) 235 -2644 Menomonie, WI 54751 ` Fax: (715) 235 -2592 S www.tlsinzplumbing.com 7 \ ° ` 3 H 9 � M -� 3- d y— cr- M w A 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 ° C P i 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 information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner -m operty Location p 9 Govt. Lot iR /4 S /9 T N R E (o W Props Owner's Mailing Address Ltl Block # Subd. Name or M# 10 s - . r✓ie�/ City torte Zip Code P one,Number] City C] Village XTo Nearest Road New Construction Use:A Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: __ -- Parent material ') Flood Plain ele v ation if applicable ft. General comments and recom mendations: LJ Boring C'99 l� 00t f=69, 2 D a eon # [] pit Ground surface elev. v' Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 of 100 60 ® Boli ng # Boring / Pit Ground surface elev. ! D ft. Depth to limiting factor /3 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 ( e YA L M CS I ,(P Z 10y /'� 100 •b b g� ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 �_�_ - �� 715 - 246 -4516 Property Owner _ Parcel ID # Page of [37 Boring # ❑ Boring l surface elev. / 6t � ft. Depth to limiting factor 14 pit Ground 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 L _ A r s I r n.�r 'v GOJ✓ a f ❑ ^ /� a Boring Boring vv E] pi Ground surface elev. r ° ' � ft. Depth to limiting factor 7 Z 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 'Etf#2 6 —IZ /Q j►2 3 L S,' 1 Z f -7z ,o ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ADplicationfate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPQM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff #1 'Eff#2 Effluent #1 = BOD > 30 < 220 mi and TSS >30 1150 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. sea8330(R.6too) 2`� r Soil Test Plot Pla Project Name Lakes and Hill Development Sh Address P.O. Box 10598 White Bear Lake Mn 55110 ffi TM #226900 Lot 8 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 1 9 T 30 N /13 W Township Richmond Boring Count Well PL Property Line Y ST. CROIX Assume To ssu a Elevation 100 ft. EM or VIRr » of Steel Fence Post System Elev 'on 100.6/99.0 *HRPSame as Benchmark Alt. BM Top of ey Iron @ 97.0' Scale is 1" = 40' � Please note: survey was not unless otherwise completed at time of testing, PI a Note: Tested1l2led setbacks from lot lines may may n be suitable for change. Installer must verify desired b ' ding area. all lot lines and setbacks Check systerocation ,� before installation. before excavating,. VB.M. 250' \ 500' Property Line Alt. .M. 102' 30' 104' � 100' _ 0 a � a� U a 12% Slo 45' o ( � C ° r ° B -3 0 5 , � r yPl� d� a 20 -2 Existing Town Road ° Soil Test Plot Plan Project Name Lakes and Hill Development Shaun Address P.O. Box 10598 ✓' R White Bear Lake Mn 55110 C #226900 D Lot 8 Subdivision Glen View Date 7 /03 ` 00 2003 1/4 N W 1 /4S 19 T 30 N /R18 W Township Richmond s z��h� co�,�� . Gt=FCE F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 100.6/99.0 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 97.0' Scale is P = 40' unless otherwise Please note: survey was not completed at time of testing, Please Note: Testedl3@led setbacks from lot lines may may not be suitable for change. Installer must verify desired building area. all lot lines and setbacks Check system location ,� before installation. before excavating. B.M. 325' 00' operty Line V Alt .M. 102' 30' 104' 100' -1 0 o 12% Slope 45 } V N °° B -3 PIC 0 5' H 20 -2 Existing Town Road u I m UNPLATTED LANDS !- - - - - -- ff" ---- -- ----- ---- -------------- - - - - -- ___ ------------------------------------- S00'00'10'E 605.11' 0 SOOdDI•'C_ ia.7•a� :_] 256.16• o -_ �� Y - -� :--- °� r--_- NOOWIO 604.43* 120.53' �. 1 1 10 C �... ! 1 14• 1 in N 7 MM ( � 1 '� 1 � •m •Z1 �� 1XlP ]41X g N V • m �.. 1 N N M m ` s r 1� i m• i, :� x {ki° >o �• — 1 o I i ` eJ S00'00'26"E 256.20' '� M j • b6. .t, 219.56 `�� .4. M � �` � ' 7,., N g A' I �M.96.YStoS 1 I n�n� .1 � •� 24'E I ✓ -- tn Z I 11135' o - -- -- - N 'ig 71 M m Q6 • m N`1Sy Z „� I «IWI r ^ M i� j . aA r p I S k I m 1 j m I I 1 WI� m m• m •m m m • NOO 696.24'• • •SfE s� ` W� • 4 1 I _ I 1 1 350.04' air W" - 54420' IMO2' 166.02 4 160.01' _..'.:fin ♦ I J 5,1, m N M X 1,11 1 ��j � � � � I • N � = N ,` M N WOO I a s �� • I b '. 'if.pl�- 1 N 8i m i • w m 1 zl 1? I 1 •� v a 4 ri m • . 4P' M r N I / / iW ! * �__�yr m Q 1 ^ � N • m / co R . QD 101 ! • g! 1 v � *e � N \ � ��'' // I Y I " ♦ t w e l I / 1 ' i I 13 1 3T 16400' 16 '= 61.7Y - - i 1 I � 111 SEE SHEI VtvrL/"11 150TH AVENUE a mm -w 33 �-_. -__ �- --__I -___ -- __ --__. F. 9ASOXWT 43 j L. B. �.oa I EA EN Kw.L in 232.00 4p I �► ��ir K80 &F. 4rA BUM &F. it, r , 42 LO .O. ACRES) LO.O. EL A 934.00 •4T 224 .4 rt �} .. POWTS OWNER'S MANUAL a MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner oN Septic Tank Capacity f fjp gal 11 NA Permit # 2� Septic Tank Manufacturer �ff� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer c , Q)&dCp ❑ NA Number of Bedrooms ❑ NA. Effluent Filter Model A NA Number of Commercial Units Zg � Pump Tank Capacity gal I NA. Estimated flow (average) D gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) b gal /day Pump Manufacturer NA Soil Application Rate 7 gal /day /ft' Pump Model NA Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil 8T Grease (FOG) _ <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) x150 mg /L ❑Disinfection ❑Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg /L en- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) !00 mg /L ❑ At -grade ❑ Mound Fecal C ollform (geometric mean) s10' cfu /100ml ❑ Drip -line ❑ Other: Maximum Effluent Particle Size % Inch diameter * Values typical for domestic (non - commercial) wastewater and sepuc tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every /7j,3 ❑ months years) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months ,'year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every ❑ months Wear(s) 0 tf Inspect pump, pump controls at:alarm At least once every ❑ months ❑ year(s) NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum .and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (fi) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of complgtion of any service event. START UP AND OPERATION For new construction, prior to use, of the POWTS check treatment tank(s) for the presence of painting products or other chemica s that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the contents .-t .L- ,...,,..,:.,a ;, t c' -Arina nncrntnr nrinr to nca. Page of System start up shall not occur when soli conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may'result In "the backup or surface` discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. F Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may. improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and: vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produce; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pie shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pie shall,be removed and properly disposed of by Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant repl e nA suitable replacement area has been evaluated and may be utilized for the location of a replacement t soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will. result In the need for a new soil and site evaluation to establish a suitable replacement area.. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. O The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN.' DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMAA.CCIRI.F.. ., ADDITIONAL COMMENTS . POWTS INSTALLER POWTS MAINTAINER Name / N a me Phone (,�• -?y3 Phone SEPTAGE SERVICING OP 216 (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency Phnno Phone / tb 05/25/2006 10:43 7152352592 T L SINZ PLUMBING PAGE 03/03 ST. CROtK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ov;ner/Buyer l��e � / D 1 7 Mailing Address Property ,Address � (Verification tequired — ft m, Phmming & Zoning Department for new construction.) City /State Parcel Identification Number ®o76 -Dk t'e 0 �• ��/° LEGAL DESCRIPTION Property Location NE Y4 , /!) '/4 , Sec. T jU N R W, Town of A Subdivision j , - .7 . 1 110t # . Certified Survey Map # Volume , Page It Warranty Deed # �eS`3 Volume , Page # Spec house yes no Lot lines identifiable yes no EX MAINTENANCE AND OWNER CERTIFICATION Imiproper use and maintenance of your septic system could result in its premature failure to handle wastes. ,Proper Maintenance consists of puropmS out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Com n 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plarming & Zoning Departfent 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 dis system is in P r OW Y P oper operaturg 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. Certafration staling that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we anr/aare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms C SIGNATURE OF ICANT(S) DATE * "Any kforwation that is rraisrepresented may result in the sanitary permit being revoked by the Planning & ,Zoning DeparWmt, * *+ Include with this application a recorded warratriy deed from the Register of Deeds Office and a copy of the certified survey map if mfere= is made in the warranty deed. (REV. 03/05) mod, 824538 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. YALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI Document Number Document Name RECEIVED FOR RECORD 05/05/2006 10:25AK WARRANTY DEED THIS DEED, made between Hillvale Development Limited Liability Partnership, a EXOPT # Minnesota Limited Liability Partnership REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 137.70 and Bee Xione and Ong Van¢, husband and wife COPY FEE: r--- -- CC FEE: ("Grantee," whether one or more). PAGES: 1 Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is n Lot ded, please attach addendum): 8, GlenView Addition in the Town of Richmond, St. Croix County, Wisconsin. a� f 026- 1153 -08 -M 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 (SEAL) ,�Of V (SEAL) * *Hillvale Development Limited Liability Partnership (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ) ss. COUN ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Hillvale Deve opment Limi Liability authorized by Wis. Stat. § 7706.06) Partnership, a Minnesota Limited Liability Partnership THIS INSTRUMENT DRAFTED FRaCy L Turner to 6own to be the person(s) who executed the foregoing ins t kMlee same. Attorney Nota PUblIC Hudson, WI 54016 St a t e O ICrnnc,: Notary Pu is State of My Commission (is permanent) (expires: 1 1 1 — (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 ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -1 Legal Forms 800. 855.2021 www.infoprofonns.com 1 of 1 i ...L - - - - - ------------------------- ------------ � - -.. sao.�� 150TH AVENU V u , r __—__ _—_____.__— ____.w.__ ----� s it I V _yam SASEMENT S IASEIJEWr Isw 7 s~ • o3s.00 �r 3zs rit�r �.M7 S.F., (1.97 ACRES) ) LDAL K Li �e.o. E.. $34.00 `�. ',10's 144 1 N � 4r ., IM'E 7.54' Pr'1 1 ��l n � o o s� b4 Od s • �$ y Co C. 5 '4 fl ; o 0 cr - � Y ^ V 6 v S O � c C S I t.0 rF'ti'✓FwZ na v' 4M"+ IYM4grF1M�. .MSN+.v's.MNacw••..w...- . +..w- .w. aw......... .. .:.+._.- ...__.w Visconsin #2490 TION REPORT •• Department of Commerce a w omm 85, Wis. Adm. Code Page 1 of 2 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site p lan on p aper not less than 8% x 11 inches in size. Plan must County St. Croix P P p P include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 026 - 1153 -08 -000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Xiong, Bee Govt. Lot NE1 /4, NW1 /4, S19, T30N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 942 Sixth St., E. 8 1 Glen V iew Add'n City State Zip Code Phone Number E: Village Y ❑ 9 Z Town Nearest Road St. Paul MN 1 55106 1 651 - 287 - 8273 Richmond 1499 92Nd St. New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe Parent material loess over outwash sands Flood plain elevation, if applicable NA ft. General comments install "conventional" in- ground trench system w/ system elevations 4 -5' below surface contours @ 0.7 and recommendations: gpd /sq ft loading; supplement to Bird report, 7/14/03 17 Boring # u Boring Z Pit Ground surface elev. 97.7 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color RedoX Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munseli' Qu. SZ. Cont. Color Gr. Sz. Sh, 'Eff#1 'Eff#2 1 0 -8 7.5YR 3/2 - A 1 f -m sbk mvfr cs 1m .4 .6 2 8 -21 7.5YR 3/1 - A 1 m sbk mvfr gs 1m .4 .6 3 21 -29 10YR 3/4 - sil 1 m sbk mvfr cs lm .4 .6 4 29 -36 7.5YR 3/4 - sl 1 m sbk mvfr gs if .4 .7 5 36 -45 7.5YR 3/4 - Is 0 sg ml gs if .7 1.6 " 6 45 -120 10YR 4/4 1 s 0 sg ml - - .7 1.6 top of iron @ SE lot corner taken as 97.0 (Bird alt. BM) 1 I Boring # _'' Boring �J ] Pit Ground surface elev. ft. Depth to limiting factor in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. 'Eff #1 •Eff#2 i I I I Soils confirmed at Bird pit locations by horizontal reference; vertical elevations and plot plan distance to house do not agree ' Effluent #1 = BOD 30.< 220 mg /L and TSf >30 < ti L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Si a re: CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 10/4/2006 715- 233 -0398 SBD -8330 (R 07/00) j