Loading...
HomeMy WebLinkAbout026-1144-10-000 0 ■ o 7- -0 0 � 2 § . § n ] ° "Ilk ® ■ m 2 z ° & $ \ B = , ; , o n P . Z E « m « » # % - % i E c g $ §\{ 7 § CL ; - m ] x / 0) N ■ a E E ai ; E ƒ o � g § CL g /§ ° 3 \ @ 2 J 4 k / \ i Q3 I k k A rt \ �. T "a T % i } 000 a 2 \ A 2 § § 0 / k e i V Q g a f 7�gd� k k § ƒ © 2 \ \ C I -4 i & f \ § 2 / o \ \ $ ° CD \ ƒ § @ N [ 3 E E 3 a E CD w c § 0 z 9 0 : z ¥ ■ T E § z ; o » CA) CD Ki § %§k7k =° ° ° E; § [ =r CD 0. ; -n ® ] D (a Cn § ¥(D qai;3 / R EE2§g2EE § Q 0 cL Imo = s E §\kO] f oam@— E a �Ei ® ) , j§ \§i ] E _ N< , ; a 0 CL ¥ ; x\27 0 ? Eon —J k-4 = @§3= ] . j § / \\ { D e ' 0 $ � § \ eo �$ C) � 2 ?t 64)16 7/ c' 0,-�l r Gi.ti,c owi -Hie1..� ... 1 - - - -- _ ,�_ 151 _ Wow tint - �5-- - -- tu �� -- �- r _..... _ __ . I �- -__- ._ __._..... ._..__._____._ _.____ ___________. .. -. -'_' -__ __._._r. - _.____.. _ -_. i... __.._ ____.._v_ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: , � 45308 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: Horeish, Richard I Richmond Township 026- 1144 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: `fi 11 W (pI �m 20.30.18.1052 TANK INFORMATION 9LEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark B�'1 / b �� /0,0.,D Dosing Alt. BM � &4V)' E C CrA. 3,30 C /4.7 b Aeration Bldg. Sewer s: 94. 90 Holding St/Ht Inlet (Q•o %L. 6 Z) 1 TANK SETBACK INFORMATION 4: 5" 00 67`x' St/Ht Ht Outlet 2 I I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic >1 b1- 014 ?q f ow Dt Bottom O Dosing Header /Man. Aeration Dist. Pipe Fj �. 7. o Holding Bot. System I I L/ ru e f 8' 2 a Final Grade p PUMP /SIPHON INFORMATION S '? 11 O Manufacturer Demand St Cover o, GPM .3 YKa a•Z� / O • O Model Number �/ , TDH Lift Fr cti n Los Sy m H ad TDH Ft Forcemain Lengt Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches 1 I ii,,,, p PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / a G t' SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR G� Type Of System: i / M / UNIT Model Number: 123 to o DISTRIBUTION SYSTEM 5 S S Header /Manifold Distribution Vent �Ar ke / X Pipe s Length Dia Len th 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 J Bed/Trench Center 2 1 Bed/Trench Edges 2 !, Topsoi Y �r j� 1 COMMENTS: (Include code disc a ci s, P son p nt, etc.) Inspection #1:f, / / In speF�ien \ i YTT Location: 1065 144th Avenue New Richmond, WI 54017 (NW 1/4 SE 1/4 20 T30N RI 8W Waldroff Meadows Lot 11 Parc No: 20.30.18.1052 afOT do Gaah.a_a — 4r , 1011A 1. Alt BM Description 2.) Bldg sewer length= Zy - amount of cover - �''P w � , F> 1 � Plan revision Required? Yes N0 Use other side for additional information. Date Insepctor's Signature Cert. No, SBD -6710 (R.3/97) t s t.�n, 5... F • 2 F� , - r� c.t kX K -(u1 y r p 1, v►w ru ct h d oc �* p r. 1 " Safety and Buildings Division County S- , C f 0 201 W. Wasbington Ave., P.O. Box 701 Sanitary Fgn t N�� (to be Und in yC Madison. WI 53707 — 7D82 5-3 l� � (608) 263.b546 Sure Plan Li,. Number Department of Commerce , ieation �Jf Sanitary Permit App P info �- Project Address if different thaw mailing address) 83.21, Wis. Adm. Code, vac w, s);S.Od(1 C F 6 f FT In accord with Cotton may be used for secondary P s Inforfnation - Please Print All In r �, R ) � / Block i1 I. Applisatlon Parcel # Lot Property Owners Name /�✓ J Propert? Location o ailing Address����� /., Section Property ( � Zi C e Phone Number . one P T5� N f -t< - 1 City, State � r � L� � of lid' b or Svbdiviaon d r � jy a Otis uudiag LcbK atl w :t apply) /A /� ar 2 Family D'"rrllina- N=,ber of 844rooms v!/ wnsbip of ❑ PublirJCaratnacisl- Describe Use G2�� ❑City - %villa D state owned - Describe v (�•(/t,-� B if app - Com lete line licable) IIL Type et nit; (Check only oat box on line A• 1? Tank Replao�t Only Orbs Modifuatioa to Existing System ❑ TrestrnentlHoldiag A. System ❑ PAPlaeeateat System bast Previous Pumit Number and Data Lsuad ❑ Change of ❑Permit to New O � �e o�� Owner C] B, perm ew it Renal Plumber Before Expiration S stem: Check all that a 1 Mound <24 in. ofsuitable soil At` V Single Pats Sand Fiber IV. a of PC C Ravi t ter > Z4 in. of Suitable soil ❑ Aerobic Trearmwr Unit urizul ia,Grormd ❑ Mound _ [J oa -Press ❑ Fiold3ag Tank C] Peat Filter Constructed Worland 13 Pressurised inlrzotmd I3 (}ravel -less Pipe ❑Other (axPlsi Chamber ED D Line E1eYati tiaeireulstia S ace Media Filter Dispersal Ares Pr Po (at) Sys' vestment Aces ormanon: d.0 DiaP�l ]required (st) V. Des ip 1 r (a Design Soul Application - � Site Glass �J � ) i Number Manufacturer Constructed VL Tan k Info Ca�try in Gallons G�loas of Units ✓ l New tsistiag Tanks Tanks septic or Holding Teak Aaebie TrastMat Unit DosingCUmber for insta3hstfon of the POWYS shown on sae attached lent sumo reapana {bfIIty > uainrss PlzineNum I the unde � ✓' /�� onsibility Statement , ntan V II. Reap Plumber, re Plumber Name (print) )� ) r;z -� Zi G e) 1 t. (/ 1 Plumber's Addreu (Street, Ciry, S / �) /-�/ suing Date issued I Cogs /D sermon Use Onl Sanitary permit Foe (include O� d,vster /2l0 Disapproved Surcharge Fee) Approved ❑ [] Owner Craven Reason far Denial IX. Conditions of ApprovWReasons for DisapP revel U 71 sal for the system Sa paper sot less the , &0 �e 3 / Ansel ,eamplote PIS" (to t`e county y) T Won -AIN (R. 08102) Soil Testa System PLOT PLAN PROJECT Richard and Colleen Horeish ADD 404N. 5th St. New Richmond Wi 54017 NW 1/4 SE 1 /4S 20 /T 30 N/R 1 W T WN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/17/04 BEDROOM 3 CONVENTIONAL )00( IN- GROUND PRE e �(/RE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 L / BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 99.37' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.0/90 below grade 350' `fu Z operty Line Assumed lot stake vl, ►rll _„ � 70' B- 15' 2 -3' X 69' Cells with >3' Spacing Line Pro perty H.W.L. -� 15% 90 B.M. A (,S/ Slope pp � 10' 1 -3 A1t.B.M. is top of 1.5" 60' Pipe @ 101.2' B -1 2j0' Vent >6 " Standard Biodiffuser of Cover Leaching Chamber with 3 1. 1 ft2 of Area Pro 3 6' Long 11 Bedroom 34" Grade at System Elevation House Plans Designed Using Conventional Powts Manual Version 2.0 Well is to meet all setbacks required by WDNR Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code C County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ` include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locatio�r mod. Please print all informati Re ' wed by Date Personal information you provide may be used for secondary pu es (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot ok) 1 /451i 1/4 S t-Of -�� N R E ( r) Property Owner's Mailing Address of # Block # Subd. Name or M# S .� 7` ' t ✓ �Ch L %tA City State Zip Code Phone Number ❑ City ❑ Village ITown Nearest Road a sY�r 7 New Construction Use).:KResiclential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or com eraal - Describe: __— Parent material Flood Plain elevation if applicable �?' ft. and recommendations: N� FI-1 Boring Boring # it 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 1141 Jb i �. 0°20 Boring # Boring a Pit Ground surface elev� ft. 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 2— /V / • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 15VW Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) – lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation ucted Telephone Number 1008 192nd Ave, New Richmond, WI 540 40 - -/' --0 715- 246 -4516 Property Owner _ Parcel ID # Page of F21 Boring # ❑ Boring ) 96 it Ground surface elev. s ft. Depth to limiting factor q-0— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z, v Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. – go — flApplication 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 F-1 ❑ Boring Boring # Ground surface elev, ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fg 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/_ ' Effluent #2 = BOD < 30 mg/_ 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. seD -9330 (rt.6100) 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 81/2 x 11 inches in size. Plan must , include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all Information. R laws Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Properly Owner Property Location U I a d d ra Govt• t C ,/ 1/4 SG 114 S ZO T 3 N R E (or� ti Property Owner's Mailing Address of # lock # Sttbd. Nance or CSM# city Zip Code Phone Number City ❑ Village [DTown Nearest Road W l 1 /O/& ( 7/S) 5 — to i; ,�rLo't C New Construction Use: Residential / Number of bedrooms 3 y Code derived design flow rate O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material (J(f e / t 1�i� q S • �!G Flood Plain elevation if applicable ° ?t 7 7` • ft• General comments y .5 l � e- � V , 9 3• f and recommendations: G e' It V , c/ 3 . S Go w• r �. • a o E 12 e -e ❑ Boring (^ l11M 1 Boring # ' Pit Ground surface elev. Depth to limiting factor r'v \:. rn, Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun , qoots,. ' GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ! o - /a r3�Z - S,' Z•nas /c �r G 1 • s Boring # (❑ Boring Z I� pit Ground surface elev. q9 G U ft. Depth to limiting factor /� 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 `Eff#2 o - l/ 10 , 1(312- Z ebi M-Cv- S 8 717 Zinnslpt Yyk-Cr 6,5 Effluent #1 = BOP > 30 < 220 mglt_ and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mglL and TSS < 30 mg/- CST Name (Please Print / nature CST Number "Gt s K I + 1 G! -- Z.5 3 3G Address Date Evaluation Conducted Telephone Number � I Property Owner �J'A �U L� t't Parcel ID # l/ m Page Z of E] Boring 9 F - 31 Boring # ® Pit Ground surface elev. 7 7, 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 ❑ 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 # ❑ pit Boring ❑ 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 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate (format, please contact the department at 608 -266 -3151 or TTY 608- 2648777. SBD -8330 (R 070)) PAGE 3 OF NAME W14A Ya TOT# LEGAL DESCRIPTION ,Uw SEY ,S 2U T 30 ,N,R, /Sf E(or�/ SCALE: i ll �U BM I ELEVATION / 6)0 . 0 BM I DESCRIPTI BM 2 ELEVATION '76 40 BM 2 DESCRIPTION -n v 2" 1 2 _- - -- - .... ..........._ _ -- _._.._..------- -- SYSTEM ELEVATION GIs• Y6 I ALTERNATE ELEVATION CONTOUR ELEVATION 9 -fo a �u v 6�3 SIGNATURE /'��saE1Zl DATE . n s Division County r � Safety �7l1$� 201 W. Was ngton� as Madi j&08) n, WI L� °r Sari Pantit umber (to be filled in by Co.) js O�sf 261 -6546 o artment of Commerce State Plan ID. Number Sanitary Permit Ap li tion nal in tmatL�lmyPLLPrande In accord with Comm 83.21, Wis. Adm. Code, perso 5 Project Address (if different that ' ling address) be used for secondary purposes Privacy law s15.04Q)�' -ra� 4 L (4 I. Application Information – Please Print All Information Parce�l4# Lot # property Owner�tn Property Locati Property Owner's M fling Address yob City, State Zip Code, Phone Number r � > r ) � ) 1 J(circl 0 WO.- I ( / ` L �✓� , l/ / ✓ .�.T N; lv ff// E o IL a of Building (check all that app j ao S "UL ubdivision Norneo ,/ �Q N 1 or 2 Family Dwelling -Number of Hedroo S' W 4L 6" r F ❑ Public/Commercial Describe Use t ' G S ❑City CiVilla ownship of ; . / ✓.(3 ❑ State Owned - Describe Use 2 rIL Type of permit: (Cheek only one box on Hine A Complete line B if applicable) A, � tment/Holdiag Tattle Rep ent Only C) Other Modification to Existing System ew System ❑ Replacement System ❑ u B. ❑Permit Renewal C1 Permit Revision [3 Change Cg° [I P ransfer to New List vious ermit N b Before Expiration Plumber Own stem: Check all that SVP 1 0 Sin Pass Sand Filter on _pressurised la Ground ❑ Mound > 24 in. of suitable soil ❑ Mo 4 in. of suitable soil 13 At de Single ❑ ❑ Aerobic Treatrrtcot Unit ❑ Recircul ling San Filter Constructed Wetland C] pressurized In round C3 Holding Tank ❑ P Filter C Other (explain) Recirculating Synthetic Media Filter hing Chamber [C]Drip Li ❑Grave s Pipe V. Din ersWrrreatment Area I ormati on: 1 Area Required (sf) Dispersal roposed (sf) System El don Design Flow (915d) Design Soil Application Rate(gpdsf) Disp _ / Gr t Capacity in Tot Numb M� Constructed Glass VL Tank Info !: Gallons Gallons of U � L ,/:E Jo k A – f op New Existing Tanks Tanks Septic or Holding Tank +' Aerobic Treatment Unit Dosing chamber i of t POVi'TS sbo on the attached plans VII. Responsibility Statement- 1, the unde gne a responsibility for he M P Number Business Phone Nur mbe P lum s Name (Prins) PI u er's ! re ,�X Plumber's Address (Street, city S Zi e) VIII. Coua /D artment Use Onl Sanitary Permit Fee (includes 0.3-1.1 Date Issued lssui g Agent Signature o Stamps) PProved Disapproved Surch u ge Fee) S Q Owner Given Reason for Denial 2 SD IX. Conditions of pprov 3) Oc�3 (S S SYSTEM OWNER 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained w^ as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach eontpkte pleas to the County only) for the system On paper sot less than $1/2 ill inches [a sire 0 SBD -6398 (R. 08102) P OT PLAN PROJECT Richard and Colleen Horeish ADDRESS 404N. 5th St. New Richmond Wi 54017 NW 1/4 SE 1 /4S 20 ANDPRESSURE 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3 /31 /04 BEDROOM 3 CONVENTIONAL )0()( IN -G CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of 1/4" rebar ASSUME ELEVATION 99.37 Filter ZabelA -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 95.0/94.9 4.5' below qrade 70' iLC&100.0' r B.M. #1 2 20' Vents 0% Slope B -2 0' 20 B-1 Vent > 6„ Standard Biodiffuser 35' Leaching Chamber of Cover with 31.1 ft2 of Area 70' B -3 _ 6' Long 3411 Grade at System - Elevation Plans Designed Using Conventional Powts B -5 40' 20' Manual Version 2 2 -3' T X 69' Cells with >3' Spacing 0' IF 659' Pro 3 01r, Property Well is to meet all Bedroom Line setbacks required b House 9 Y WDNR POT PLAN PROJECT Richard and C olleen Horeish ADDRESS 404N. 5th St. New Richmond Wi 54017 NW 1/4 SE 1 /4S 20 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3 /31 /04 BEDROOM 3 CONVENTIONAL XXXX IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE � SEPTIC TANK I 9 MOUND SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Top of 1/4" rebar ASSUME ELEVATION 99.37° Filter ZabelA -100 ❑ BOREHOLE O WELL * H. R. P Same as Benchmark SYSTEM ELEVATION 95.0/94.9 4.5' below qrade 70' is top of 1/4" rebar C 100.0' B.M. #2 B.M. #1 2 20' 2 20' , Vents 0% Slope B -2 0' 20 B-1 I I _ j ent Standard Biodiffuser 35' Leaching Chamber with 3 1. 1 ft2 of Area 70' B -3 - 3 4 Grade at System - Elevation Plans Designed Using Conventional Powts B -5 40' 20° B -4 Manual Version 2 ' 2 -3' T X 69' Cells with >3' Spacing 30' 659' Pro 3 Property Well is to meet all Bedroom Line setbacks required by House WDNR 1 11 I - wtscoirt Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, t/Ifis. Adm. Code cou Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must I reference point BM , direction and Parcel I.D. include. but not limited to: vertical and horizontal pa ( ) percent slope, scale ordimensions, north arrow, and location and distance to nearest road. Please pdnt all inforMation. a by Q Personal information you provide may be used for secondary puny (Privacy Low, s. 15.04 (1) (m)). o Property Owner Property Location D v -2 wal 6 (- Govt Lot �j jW 1 /4 S(� 4 S ZQ T 3 (3 N R l E (or)( Property Owner's Mailing Address Lot Block It Subd. Name or CS W City State Zip Code Phone Number ❑ City ❑ Village [gTown Nearest Road 11 ® New Construction Use: Residential / Number of bedrooms Code derived design flow rate y = (J GPD Replacement ❑ Public or commercial - Desatw. Parent material Flood Plain elevation if applicable MS HU General comments Sys ern 21� U 1 9S Sn h and recommendations: e%e U, `T S•Sb D EL F� ?Rl41� ST CRO;x. CS COUNTl �s F I eori # E] Boring �; � ,• ,� _ Ground surface elev. ft Depth to limiting factor / Z/ in. ! i �it � _ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f _ in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 *01102 - S T Boring # ❑ Boring p Ej-pit- Ground surface elev. / Z(� ft Depth to limiting factor 12 - / in. Applica Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •EW1 - 011#2 1, WLS -7 * Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 a 150 mg/L • Effluent #2 = BOD < 30 mg& and TSS < 30 mg& CST Name (Please Print) Signatu CST Number An M 25 9 Address Date Evaluation Conducted Telephone Number 2 ' a 5402f - z° - ocj 15)247 - U(� n Page � of ID # CQ CQ I"O P arc el Property owner 1-<J � gj ftnn g # Q Boring O © Ground surface elev. / 9 ft Depth to limiting factor in. son Rate orion Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPDI(f in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 '111102 QS.a T%L ° t( Boring E] Boring p �� Ground surface elev. i i• R Depth to limiting factor 2 (D in. Soft Appipation Rate H n Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'EW - 11110L a Boring # ❑ Boring o �it Ground surface elev. q9 / ft Depth b uniting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef11t1 'E11#2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg1L ' 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 60 &266 -3151 or TTY 608- 264 -8777. SB"30OL07l00) PAGE OF_ NAME W-AId rQ ��' LOT# (( LEGAL DESCRIPTIONAV '' %4.S 114,S 2c)T -; b N,R ($ E (or SCALE: F'= qQ BM 1 ELEVATION Z BM 1 DESCRIPTION -6V 0,� j4 e BM 2 ELEVATION 16 6 0 - O BM 2 DESCRIPTION �y_( 1 y l Q (rja c SYSTEM ELEVATION I S ALTERNATE ELEVATION CONTOUR ELEVATION d \ r �O „ (zo ll SIGNATURE DATE 0� 8H B i t 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 Contin ency Plan L tion#1 ' ) fails, determine cause of failure, use alternate area and install new system in 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 COUNTY PENANCE AGREEMENT' ''SEPTIC .Tf►NK AND . OWNERSHIP CERTIFICATION FORM owner/Buyer J l� Mailing Address 0 I T- V Property Address from Pl Department for new construction) — (Vc:rificationrequire 'pSZ) parcel Identification Number City /State LEGAL DESCRIPT _ N , Town of I,ocatios>, /•, •� Sec. _, T W — > Property Lot # /�• Subdivision ,r Page # Certified Survey Map # Volume Page # 0 Warranty Deed # _ Z- gS Volume , Lot lines identifiable�-yes D no Spec house El ye j SYSTEM 7 N � tics stem could result in its premature failure to handle ba Y s• p maintenance improper use an d maintenance of your sep Y a licensed pumper• ou p into the system out the septic tank every three years or sooner, if needed by consists of pumping a in the waste disposal system can affect the function c the septic tank as a treatment stag Department a certification form, signed by the owner and by a .fi pro perty Owner agrees to submit to St. Croix Zoning De p er verifying that (1) the on -site wastewaterdisposal system or s masterplumber, journey.nanplumber, reS�ctedplumber licensed the septic tank is less than 1/3 full of sludge. is in proper operating ca ndition and/or (2) after inspection and pumping (if necessary), d InVe read the above requirements and agree to maintain the private sewage disposal system with the standards Uwe, the undersigned ut of Commerce and the Department of Natural Resources, State of Zoi�g offiC ertificati on 30 set forth, herein, as set t y the Departure completed and returned to the St. Croix County s tating that your septic system has been maintained must be days of th ee year a K iration date. 3/ / DATE SiGNA: [JRE OF APPLICANT OWNER CERTIF our' knowledge. I (we) am (are) the owners) of I (we) certify that all statements on this form co recorded in Register of Deeds Office. are the pro erty described iLbove, by virtue of a warranty 3 DATE SIGNATURE OF APP::,ICANT • ormati that is mis- represented may result in the sanitary Permit being revoked by the Zoning Department. * * * * ** Any lnf lication: a stamped warranty deed from the Register of Deeds office deed ** Include with this app ' if reference is made in the warranty a copy of the certified survey map U 2425 P 610 - 7d+E>_185 t k STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER T. CROIX GO., WI RECEIVED FOR RECORD This Deed, made between David J. Waldroff and Julie A. Waldroff, 10/02/ 2003 09: 45A1I husband and wife Grantor, and Rick Horeish and Colleen Horeish, husband and wife WARRANTY DEED Grantee. EXEMPT # 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: 186.00 ace is needed, please attach addendum): COPY FEE: Lot 11, >Valdroff Meadows. St. Croix County, Wisconsin. CC FEE: PAGES: 1 Recording Area Name and Return �ess OGLAND ATl - C '• .r-Y AT LAW P.C. COX 359 HUDS01J, WI 54016 026 - 1062 -70 -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 September 2003 A L V * * J. Waldr —'— * ;Ji A. Wald — AUTHENTICATION ACKNOWLEDGMENT Signature(s) Da J. Waldroff and Julie A. Waldroff, STATE OF ) husband and wife ) ss. _ County ) authenticated thi d day of _ September _ _ , 2003 Personally came before me this _ day of the above named * Kristina O gland TITLE: MEMBER STATE BAR OF WISCONSIN (if not, _ _ _ _ _ _ _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland, Attorney at 304 Locust Street, Hudson, WI 54 Notary Public, State of — My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) * Names of persons signing in any capacity must be typed or printed below their signature. INFO -PRO (800)655 -2021 www.infoprofonc .com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 C2 N 8W5W27" W 487.83' 7 TOWN ROAD CENTER OF ' C �g 3� C11 — — — — 1-10 S89°59'27 'E 487.83 — — — — — - / 33.21 STORMWATER / Li5 i PONDING AREA a � — H.W.L. = 940.0 6 J _.._.._.._.._.._ L�L13 — i \ 4 1 MIN FFE = S MIN FFE = 941.4 ' / '' F, LOT 10 $ LOT 12 3.142 ACRES 3.145 ACRES (136,849 SO. FT.) '� (137,016 SO. FT.) ca LOT 11 TOTAL ^ ACRES dl+�" ' cm� 3.115 ACRES 2.904 A (12 CRS S `b (135,705 SO. FT.) (180, W TO MEANDER LINE y TOTAL �) a'p MEANDER LINE 3.976 ACRES (173,173 SO. FT.) TO MEANDER LINE O.H.W.M. Z ell g V *•% MIN FFE = 941.4 / ;. 441.84' j :tg1' . F 65' 209.3 1 82, i / . 48.02' 7. ± f 8 1312.0 4' +] LINE OF THE NW1 /4 OF THE SE1 /4 OF SECTION 20 ,.N A -- rpL WA{. ON � /2000.831.3 MHpaA441E oD dLQmFP)@ @mH191D o w OO 4GJ EM SHEET 2 OF 2 SHEETS