HomeMy WebLinkAbout026-1153-38-000 Wisconsin Departmentof Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Saft.ty and BG'ilding Division
r_ ,
+' INSPECTION REPORT Sanitary Permit No: 499209
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:
Sinn, David I Richmond, Town of 026- 1153 -38 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
c 1 1 00 .0 , c 84 4MBk 19.30.18.1176
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer v� V i
Holding St/Ht Inlet oz • O�
I �
SUHt Outlet
TANK S ACK INFORMATIO �• J f I��
TANK P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ' i Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
O D O�
Holding Bot. System �0.3u O
O tJ� • O
Final Grade I O2 , j
PUMP/ PHON INFORMATION 511
Manufacturer Ge 7v
P mand St Cover o �'� � - 1 D G�. '
3•
Model Nu
TDH Lift Fr' to ss System Head TD Ft
Forcemain I Lle ngth Dia.
SOIL ABSORPTION SYSTE
9ESCRENCH] Width i Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM C t�C.
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact D
INFORMATION CHAMBER OR
Type Of System: r f UNIT Model Nu e
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole S Vent to Air Intake
Pipe(s
Length Dia 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 Bed /Trench Edges Topsoil Yes No Yes No
CO EFTS de c di crepenci r ons present, etc.) Inspection #1: / z w o Inspection / G �/� S 90@ 14 Inclu:de
tunkno (NYV 1 4 1/4 19 T30N R1 8W) Glen View Lot 38 Parcel No: 19.30.18.1176
1.} Alt BM Description = 5•T +wG�w C&Jtf
2.) Bldg sewer length
amount of cover = / _p.. A
(A 3>
Plan revision Required? Yes `�f._YR�! No
( \
X
Use other side for additional informal on. /Z_ uuu
bate Inse ctor's Signature Cert. No.
p 9
SBD -6710 (R.3/97)
' Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 S � . C ,� s-
Madison, W1 53707 62 S Permit Number (to be filled in by Co.)
/SCOnsin (608) 266 -315 99
Department of Commerce
]an T.D. Nt�mmber
Sanitary Permit Application N �..
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Priva L V C n Project Address (if different / than mailing address)
GL✓
I. Application Information - Please Print All I !nf0rM ati n
Ircel # Block #
Property Owner's Name
JJ cc, �7 S 1 (� V� i NtY
Property Owner's Mailing Address Property Location
3 o— �' /., Se ction City, State de Pho Number 2 IS N; E le
11 Type of Building (check all that apply) Z/ p� Su�o M �r Subdivision Name CSM Number
or 2 Family Dwelling — Number of Bedrooms — /
Public/Commercial — Describe Use /
❑ Pu 1
w..,IrshJ ❑City_ ❑Village,�ownship of
❑ State Owned — Describe Use Z t � � w J11 g L
M. Type of Permit: (Check only one box on line A. Complete line B if applicable) + D
^ ❑ Existing System
A. ew System ❑Replacement System ❑ Treatment/Holding Tank Rep lacement Only Other Modification to Ext
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal �R.,isio- ❑ C hange of El Permit Transfer to New
Before Expiration Plumber Owner % t) S
IV. a of POWTS System: Check all that a
rte,
n - Pressurized In- Ground ❑ Mound? 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- ound ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Reci_>_ g Sand Filter ❑
Recirculating Synthetic Media Filter bing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) /
V. Dis ersaYrreatmcut Area Information:
Dis orsal Area R u }red (sf) Dis ersal Area Proposed (sf) S /
Design Flow (gpd) Design So� Application Rate(gpdsfJ p � � e9 ystem Elevation
/
c
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site ! Filar Plastic
Gallons Gallons of Units Q� I- Concrete Constructed Glass
New Existing W UC''/
Tanks Tanks
Septic or Holding Tank X S S
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement - L the unde ed, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Pl s Signature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, stge, Zip ode)
VmXcoun /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date su Issuin gent Sign o Stamp
;4pproved ❑ ' approv Surcharge Fee) �f5 Qb /D 3 D(
[I caner ' en Reason enial /
IX. Conditions of Approval/Reasons for Disapproval
t
PP
SYSTWoA:
1. Septic tank, effluent filter and
dispersal cell must all be servilces I mainUdOW 5rJ ` �6�' cL J`
as per management plan provided by plumber.
2 All setback requirements must be maintained � �� v el
a$ per applcable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 91/2 x 11 inches in size
SBD -6398 (R. 01/03)
Soil st and System PLOT PLAN
pROJLCT Dave Sinn DRESS 163 Anderson Scout Camo Rd. Houlton Wi 54082
1/4 NW 1 /4S 19 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/28/06 BEDROOM 4
CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36
BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100° Filter BEST Filter
❑ BOREHOLE O WELL H.R.P. Same as Benchmark
SYSTEM ELEVATION 100.0/98.5 4' below grade
Plans Designed Using
Conventional Powts
Manual Version 2.0
CD r i'n j
Well is to meet all
setbacks required by
WDNR
Pro 4
Bedroom B -1
House • ; Pa-s
20' B -3
434' Property Line 90'
20% Slope
45'
Ak 30'
B -2
Scale is 1" = 40 ' Ven 2 -3 990'Cells with
unless otherwise
>3' Spacing
0
noted
Vent
>6" ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long 1 1 " COPY 80'
3619 Grade at System Elevation Road
Soil st and System PLOT PLAN
PROJECT Dave Sinn DRESS 163 Anderson Scout Camo Rd. Houlton Wi 54082
1/4 NW 1 /4S 19 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX
i
�
MPRS Shaun Bird 226900 DATE 10/28/06 BEDROOM 4
CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36
IL BENCHMARK V.R.P. Top of Power Box ASSUME ELEVATION 100° Filter BEST Filter
❑ BOREHOLE O WELL H. R. P Same as Benchmark
SYSTEM ELEVATION 100.0/98.5 4' below qrade
Plans Designed Using
Conventional Powts
Manual Version 2.0
6ri��n
Well is to meet all
setbacks required by
WDNR
Pro 4
Bedroom B -1
House
20' B -3
434' Property Line 90'
20% Slope
45'
30'
B -2
Scale is 1" = 40' Vents 2 -3' X 90' Cells with
unless otherwise o' 1 Spacing
noted
Vent
>6 „ ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long 11 " 80'
Grade at System Elevation Road
36"
r
,1
Wisconsin Department of Commerce �ECE�V & E LUATION REPORT Page of
Division of Safety and Buildings Its.
in accordance with Comm 85, 's. Adm. Code
2hhQ County
Attach complete site plan on paper t less%48 U2 Q 1 4.J s in si . Plan must
include, but not limited to: vertical an horizontal reference point (BM), redion and Parcel I.D.
percent slope, scale or dimensions, rth al�gw, gp6j c�gBWWdista to nearest road.
Please p 'nt all informatio Revi ed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /ls 3d a
Property Property Location
�6 Govt. Lot 1 /4 AiIJ /4 S T 3 b N R U E (or)Q
Property Owner's Mail' Address Lot # Block # Subd me or CSM#
City State Zip Code Phone Number ❑ City ❑Village own Nearest Road
New Construction Use: `Residential / Number of bedrooms 1 Code derived design flow rate U7',L GPD
❑ Replacement ❑ Public or commercial - Describe: __—
Parent material ou h A J c.t , Flood Plain elevation if applicable /✓) ft.
General comments
and recommendations:
System Type 6W L) ? ,,\.. ,' 1 System Elevation �D
Boring # Boring pit Ground surface elev. a a ft. Depth to limiting factor l So 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
Ong # ❑ Boring
pit Ground surface elev. 1 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. I 'Eff#1 I 'Eff#2
-1 L3 lo v , 5 1 -4 - �-' S �` T 0 -6 _ 1 4 o
0- - ,�o S Y ij{
3b -9 b. s 1V1 ILI) 1
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150
mm
Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
CST Name (Please Print) Si 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
1 r
Property Owner _ Parcel ID # Page of
F Bodng ❑ Boring
# ® pit Ground surface elev. y D 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
1 0- (0 0,,- 31 � - i^ s mo
F-1 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. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef##2
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑
❑ pit Soil lication Rate
Horizon Iepth 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 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.
SOD -9330 (8.6/00)
Property Owner _ Parcel ID # Page of
ng # ❑ Boring
1 ® Pit Ground surface elev. 0 D ft. Depth to limiting factor in.
r*Eff Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 •Ef f#2
Mo
z.. - o
i
/f
E 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
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth 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, < 30 ffKA and TSS < 30 nxyL
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 (RAM)
Safety and Buildings Division County
r
201 W. Washington Ave., P.O. Box 7162 G O
scvnslin Madison, WI 53707 — 7162 Sanitary Permit Number (to be i in by Co.)
Department of Commerce (608) 266 -3151 yl 99 Z09
Sanitary Permit Applica state P.D. Number
In accord with Comm 83.21, Wis. Adm. C ovide L'
may be used for secondary purpos Priva A 5 rqject Address IlTertrill than mailing address)
I. Application Informa ' n - Please Print All atioon�� 6 2006
1 S Property Owner's Owner's Name C P # Block #
4--�t - W \5 J ST. CROIX CO !: U
Property Owner's Mailing Address Proop�eyrt�y Lo
Ci Zip Code Number Section
1 P � /„ I1. T e of Buildin check all that a I T N; /fE
r W ( • / / �!J
P g( apply) e k a5 a M: �-e
2 Family Dwelling — Number of Bedrooms p Subdivi Name t CSM Number
❑ Public/Commercial — Describe Use
❑ State Owned — Describe Use 4 t J i / ❑City ❑villag ownship of /
III. Type 2f-Permit: (Check only one box on line A. Comps sin if applicable) , 0Q0
A ' ew System ❑Replacement System ❑ Treatmen ding Tatilc Replacement Only 11 Other Modification to Existing System
B• ❑Permit Renewal El Permit Revision Cher f \Pe it Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber
IV. lype of POWTS System: Check all that apply) /J
on — Pressurized In- Ground ❑ Mound 124 in. of suita soil El Mound < 2NPip ❑ At -Grade El Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In and ❑ Hol ng Tank ❑ Peat Filter tment Unit El Recirculating Sand Filter El
Recirculating Synthetic Media Filter Leaching Cha er ❑ Drip Line ❑ GrOther (explain)
V. Dispersal/Treatment Ar ea forma
Dew ig� Flow (gpd)� Design Soil Application at dsfJ Dispersal Area Required (s� Dis e Area Proposed (sf) System Elevation
9
. 6 07D
VI. 'Tank Info Capacity to T I Number Manufacturer Xrefib Site 4Steel Fiber ' Plastic
Gallons G ons of Units C rete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
V II. Responsibility Statement ifbe undersigned, 994 responsibility for installation of the POWTS shown on the a hed plans.
Plumber' Name (Print) I s LF lumber's Si MPIMPRS Num er Busl s Phone Number
Plumber's Address (Street, City Wate, Zip
VIII. Coun /De artment Use Onl
A roved ❑ D' v Sanitary Permit Fee includes Groundwater Date ssu issui
(p
n ent Sign to o S p
PP { f�
Surcharge Fee) s�(� /6� ZJ0
101 n Reason for sal / f ' `�
IX. Conditions of A ' rovaUReasons for Disapproval t
S1�T61�OMINEt�:
I. septic tank, smuelt few and
d I 0 �
cell must all ery in � — 1 '
fspersal be s lies / mainta ed
as per management plan provided by plumber.
2. All setback requirements must be maintained re-o- .
as per applicable code / ordinances. I"
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
I
i
%314WO M3TZY2
7 ,.h
v
OT PLAN
'PROD CT Dave Sinn ADDRESS 163 Anderson Scout Camn Rd. Houlton Wi 54082
Py�l /4 NW 1 /4S 19 4NDSSURE /R 18
W TOWN Richmond ST
COUNTY CROIX
MPRS Shaun Bird 226900 10/15/06 4
DATE BEDROOM
CONVENTIONAL )= IN -G CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TA gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TAN IZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36
IL BENCHMARK P. Top of Steel Fence Post
ASSUME ELEV ION 100' Filter BEST Filter
F BOREHOLE • LL * H. R. P. Same as Benchmark
SYSTEM ELEV 1 95.2/95.1
41 BM Top of Survey @
M. 509' Pro ert Line
Alt. 175'
.M. 0' Tested area lies on top of a
3 B ridge, has 0% Slope, but
ents surround areas are increasing
3 -3' X 60' cells slope up to >25%
35' with >3' Spacing
B -3 Plans Designed Using
Well is to meet all Conventional Powts
setbacks required by Manual Version 2.0
WDNR
Please Note: Tested area
may not be suitable for 20' T 20'
desired building din area.
Check system location B -2
before excavating.
Pro 4
434' Pr erty Line Bedroom
House
Please note: su ey was not
completed at a of testing,
setbacks from lot lines may
change. Installer must verify
all lot lines and setbacks
before installation.
Scale is F = 40'
unless otherwise COPY
noted
Vent
> 6" ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long
11"
3 6" Grade at System Elevation
OT PLAN
PROJECT Dave Sinn ADDRESS 163 Anderson Scout Camp Rd. Houlton Wi 54082
;T114 NW 1 /4S 19 /T 3 N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/15/06 BEDROOM 4
CONVENTIONAL XXX IN -GR ND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANKS 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 900 # of chambers 36
BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION Filter BEST Filter
❑ BOREHOLE WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 9 , /95.1
BM Top of Surve on @
•M• 509' io ert Line
Alt. 175' 0 IP7 Tested area lies on top of a
Illo-
.M. ridge, has 0% Slope, but
3 B -1 surround areas are increasing
Vents i slope up to >25%
3 -3' 60' cells
35' w' ' >3' Spacing
Plans Designed Using
B -3 Conventional Powts
Well is to meet all Manual Version 2.0
setbacks required by
WDNR
Please Note: Tested area ST 20'
may not be suitable for 20' Wd desired building area.
Check system location B -2
before excavating. Pro 4
434' Property Li Bedroom
House
Please note: survey was t
completed at time of tes g,
setbacks from lot line ay
change. Installer mu verify
all lot lines and setb ks
before installation.
Scale is 1" = 40'
unless otherwise
noted
Vent
>6 „ ARC 36 Biodiffuser
of Cover Leaching Chamber
with 25.0 ft2 of Area
5' Long 11 "
3611 Grade at System Elevation
UNPLATTED LANDS
P.O.B —.1,
-
— -- - - -------------------------------------------------- --- ---------------------- ------------------------- -----
-------------------
- - - - - - - - - - - - - - - - -
-----------------------------
I UNPLATTED LANDS
LQT 43
— PARCEL IN
VOL 1 1091 it.,
PAGE 15 s1 f!AGE 29-,k, 4 i rt R N T .BD 4
alr49j
42 9
mg
if 38 z
39
41
4 1 10
M. Acom n.F. m
rn
37
c
z 40
ol
> (A. A—)
z `148TH-- -- --- - -
AVENUE
i- --- 12
36 34
can AaOJ
35 1
33
Np
D 4,4
LOCATION SKETCH 32
BOTH J.— Al.
l"`- ------- --- - - ---- --
:NEm T -- -- - T z; - T, --------- -
LEGEND 1 ,
31 22
'1 -
AMENU TO DIA. w> i I 23
—M— amour ,R—
SECTION 19, T30N. RIBW
TOWN OF RICHMOND
30
ST, CROIX COUNTY, WISCONSIN
J.—
24
29
07 25
BEARINGS BASED ON THE NORTH LINE
UNPLATTED LANDS 05
OF THE NW 1/4
" JEC. 19,T30N. R19W
ASSUMED SEA 6 N88 WWI!
(ST CROIX COUNTY COORDINATE SYSTEM)
SCALE: 1" = 100' 26
4
28
GlenView 27
PART OF THE NW Y4 OF THE NW Y4, PART OF THE NE Y4 A
OF THE NW X, PART OF THE SW X OF THE NW Y4 AND
PART OF THE SE Y4 OF THE NW Y4, ALL LOCATED IN Na322'53-W 539.31
SECTION 19, T30N, R18W, TOWN OF RICHMOND,
ST. CROIX COUNTY, WISCONSIN UNPLATTED LANDS
SURVEYOR RONALD D. J SPERSDII SHEET 2 OF 3
DRAFTED BY: RONALD D. JASPERSOH
------ -------
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 8 112 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, a ewed by Date P D
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). XA A �iv • S
Property Owner Property Location
e- /0,0 0 t°/1_� Govt. Lot I W MR �IA S T30 N R Id E (o W
Props Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City tate Zip Code P one Number ❑ City ❑ village To Nearest Road
MJ4 s1<1/0
New Construction User Residential / Number of bedrooms Code derived design flow rate GPD
C3 Replacement El Public or commercial - Describe: _- -_ —_ -. __ -- - --- - - - - -- - --
Parent material a J x✓ Flood Plain elevation if applicable ft.
General corruner>Ts ,! - � r �✓ '� 1 tJc�Ln.'�tT''"`J �t.� , � G/ S� l � -
( f ��
and recommendations:
V � % /10 .
_� ) C3 r -A&I wax
f' 7 a I&C e /
Boring
M Bori
pit Ground surface elev al� � ft. Depth to limiting factor in.
Soil plication 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
o -1 , Z- S e _ ,s .7
s. 7- o
2_7_F�_
® # �7( Boring �t %� �Q
JL 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
3 /zr -5 L��
A y a ort
�- _ �' S a 2
s s IVl A 1 4 , M 7 l
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �_��- C� 715- 246 -4516
Property Owner _ Parcel ID # Page of
FT Boring # 11 Boring //'�n
Pit Ground surface elev. L l/ Ul � ft. Depth to limiting factor �_""�n• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
IOU
2 S - C L q I z
r
a/ G �
�,{— q�• 20
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
a Boring Boring # Cl Pit
Ground surface elev. ft. Depth to limiting factor in.
Soil Appfication 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
I
' Effluent #1 = BOD > 30 < 220 mg/L 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.
SB o- 8330 (R.6100)
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun '
Address P.O. Box 10598
White Bear Lake Mn 55110 CSTJW #226900
Lot 38 Subdivision Glen View Date 7/1 8/03
Nd 1/4 N W 1/4S 1 9 T 30 N /R W Township Richmond
R Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 95.2/95.1 *HRpSame as Benchmark
�.
B Top of Survey Iron @ L9 `t
.M. 509' Property Line
Alt 175'
.M. 0,
35'
-1
35'
Tested area lies on top of a
ridge, has 0% Slope, but
B_ surround areas are increasing
0' slope up to >25%
Please Note: Tested area
may not be suitable for
desired building area.
Check system location B -2
before excavating.
434' Property Line
Please note: survey was not
completed at time of testing,
setbacks from lot lines may
change. Installer must verify
all lot lines and setbacks
before installation.
Scale is 1" = 40'
unless otherwise
noted
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RECEIVED
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun ' d OCT 0 3 2006
Address P.O. Box 10598 ST. CROIX COUNTY
White Bear Lake Mn 55110 CS #2269
Lot 38 Subdivision Glen View Date 7/18/03 -
1/4 N W 1/4S 1 9 T 3 0 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
Sys Elevation 95.2195.1 * H R PSame as Benchmark
)J. BM Top of Survey iron CQ?
•M 509' Property Line
Alt. 175'
` iVL 0'
B -1
35'
5'
0'
B -3
Please Note: Tested area
may not be suitable for
desired building area.
Check system location B -2
before excavating.
Tested area lies on top of a
434' Property Line ridge, has 0% Slope, but
surround areas are increasing
Please note: survey was not slope up to >25%
completed at time.of testing,
setbacks from lot lines may
change. Installer must verify
all lot lines and setbacks
hPf - installat
is P= 40'
s otherwise
� l
r-
BWOL 00 ZZ oecl
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Co lan
Option #1. If,.system fails, determine cause of failure, use alternate area and install new
ystemfrf tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 -246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROIX COUN'T'Y
• SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
Mailing ddress
g
property Address qD `
(verification required from Planning Department for new construction)
City /State
Parcel Identification Number
T,EGAL DESCRIPTI l ON
W r r /4 Sec. 1 7 T 0 N -R w, Town of
Property
Lo /4, �J ,
#
Subdivision /��� J i Lot L'
Certified Survey Map #
Volume �-_� .Page #
Warranty
need # `� �a9 q , Volume Page #
Spec house ❑yes no Lot lines identifiabl yes D no
SYSTEM P ENANCE tic could result in its premature failure to handle wastes. Proper maintenance
Improper use and maintenanceof y our Sep syst em a licensed Pulp,. What you put into the system
consists of pumping out the septic tank every three years or sooner, if needed by
can affect the function of the septic tank as a treatment stage in the waste disposal system
t a certification form, signed by the owner and by a
The property owner agrees to submit to St Croix Zoning DePa �g th (1) the on -site wastea��o� s
mastorplumbM jo�eY� plumber, restrictedplumber or a licensedpumper the septic tank is less than I/3 fall of sludge.
tin condition and/or (2) after inspection and pumping (if necessary),
is in groper Operating with the standards
ed have read the above requirements and agree to maintain the private sewage disposal system Certification
' undersigned eat of Commerce and the Department of Natural Resources, Sffite of Wisconsin -
set forth, herein, as set by the
Department must be completed and retarned to the St. Croix County Zoning Office within 30
s tatmg that your septic system has been maintained
.... .. of the three year expiration date. O
- .�D
DATE
TURF O APPLICANT
OW11T�i R CERTIFICATION our knowledge. I (we) am (arc) the owner(s) of
I (we) certify that all statements on this form d the o f Deeds Office in
property described above, by virtue of a warranty
_____- . ---- -- DATE
SIGNATURE OF LICANT « « * * ««
Any information that is mis- represented may result in the sanitary Perm'
t being revoked by the Zoning �paztment
of Deeds office
«« Include with this application: a stamped warranty deed from Register
a copy of the certified survey P if reference is made in the warranty deed
' 8329 1 9 1 /
KATHLEEN H. WALSH
REGISTER OF DEEDS
State Bar of Wisconsin Form 1 -2003 ST. CROIX CO., WI
WARRANTY DEED RECEIVED FOR RECORD
Document Number Document Name 08/24/2006 10:38AK
WARRANTY DEED
EXEMPT #
THIS DEED, made between Hillvale Development Limited Liability Partnership, a REC FEE: 11.00
Minnesota Limited Liability Partnership TRANS FEE: 138.00
( "Grantor," whether one or more), COPY FEE:
and David R Sinn and Elaine M. Sinn, husband and wife, as marital survivorship CC FEE:
property PAGES: 1
( "Grantee," whether one or more).
Grantor or a valuable consideratio conve to Grantee the followi describe real
r f lbl i s eY g d Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ( "Property") (if more space is me and Return Addre
needed, please attach addendum):
X00on alley Abstract & Tr e, Inc.
Hosford Street, Suite 201
WI 54016 -/-v Z)VO
Lot 38, Plat of G1enView in the Town of Richmond, St. Croix County Wisconsin. File #: 2690646 k 4 j L0c
026- 1153- 38-000
Parcel Identification Number(PIN)
This i s no t homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, restrictions and rights -of -way of record, if any.
Dated August 24, 2006
HillvaI DD elopment Limited Liability Partnership
(SEAL) - 7 ✓L�"� (SEAL)
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
)
authenticated on I racy urner St. Croix ) ss.
• )
Notary Public COUNTY
* St aM of W isconsin Personally came fore me on Au st 24 2006 ,
TITLE: MEMBER STATE BAR OF WISCONSIN the above - name Qa'1
(If not, to a known to bSAiik person(s) who executed the foregoing
authorized b Wis. Stat 706.06
Y § )
in L e same.
THIS INSTRUMENT DRAFTED BY:
Attorney Doug Berg No Pu li , State of Wisconsin
1200 Hosford Street, Suite 201 Hudson, WI 54016 My COMM ion (is permanent) (expires: Z �Z )
(Sigpstpree m a y bee n or aclmowledged. Both are pot 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. 1-2003
* Type name below signatures.
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UNPLATTED LANDS