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HomeMy WebLinkAbout026-1137-06-000 ant of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix DiVision ` INSPECTION REPORT Sanitary Permit No: 399500 FORMATION (ATTACH TO PERMIT) State Plan ID No: �n you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. -------r ne: City Village X Township Parcel Tax No: /a Builders, Inc. Richmond Township 026 - 1137 -06 -000 Insp. BM Elev: BM Description: lot,�l QVL t TAB._ J ELEVATION DATA TYPE ,ANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` Benchmark Dosing Holdin Alt. BM Aeration Bldg. Sewer 6 -90 am 9b•?s St/Ht Inlet SUHt Outlet TANK SETBACK INFORMATION �$ 4S�•�� r TANK TO P/L WELL BLDG. VeEto ir Inta ke ROAD Dt Inlet Septic Z 3 t �____ Dt Bottom Dosing eader /Man. g g ' 9S IS Aeration Dist'Pip •or Is" (0 S Holding Bot. Sy m 9 �- 75 " Final Grade PUMP /SIPHON INFORMATI 3-45 R9 • Sfl Man facturer mand St Cover G Model umb TD Lift Friction Loss System Head j1111 Ft Forcemain Length SOIL ABSORPTION SYSTEM MMU RENCW Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME IONS SETBACK SYSTEM TO P/L IBLOG IWELL LAKE/STREAM LEACHING M INFORMATION CHAMBER OR Type Of System: UNIT r: 30 i 5 1 1 ci•- DISTRIBUTION SYSTEM Header/Mani N! I Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe( L 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 Fill] Yes ❑ No Yes i N COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 d b / C7 / Inspection #2: ' 7 — ' 1= — Location: 1491 111th Street Now 54017 (NW 1/4 NW 1/4 21 T3c0LN)R18W`_)_Go_lfv�iew A Parcel No: 21.30.18.93$, / � 1.) Alt BM Description = T�+�^� � r / Owe /J– �� `M 2 • f.�D4M 2.) Bldg sewer length - amount of cover = 4 ' 3� &t a Ar -Iwob 6P, l.•4e� Plan revision Required? No 1 Use other side for additionato do n� Y 2� rc � (t l �riKalt Date Ins epctors Signature Cert. No. SBD 6710 (R.3/97) 1 /Z /'O I ve a i 3 0 Sanitary Permit Application I Safety & Buildings Division �� In accord with Comm 83.21, Wis. Adm. Code 201 W Was g x 7302 �sco�rstin See reverse side for instructions f or completing this application Madison, WI 53707 -7302 Personal information you provide may be used for secondary purposes (Submit completed form [0 county if not Department of Commerce [Privacy LBW, S. 15,04(lxm )] state owned.) Attac complete plans (to the county copy only) for the system, on paper not less than 8 -U2 x 11 inches in size. Coun ` y State Sanitary Perm� umber ❑ Check if rcv4s' 1 1 s application State Plan 1. D. Number , v `� I. A lication Information - Please Print all Information Locatio Pro" Owner Name .� ,,, \ Property Location / R �N�� ` �' � ! rrGJ cc✓ 1��G` e ; 114 4A14, 1�% T ,N, R/ / (or) rW Property Ownees Mailing Address i Lot Num er Block Number City, State Cip Code ti � ne Num r f Subd v s ott a me or M Number a 4 II. ype of Building: (check one) ac. plrl ❑ City l or 2 Family Dwelling - No. of Bedrooms: 13 Village ❑ ublic/Commercial (describe use):_ lnw t J wn of ❑ State -Owned A�l j Nearest Road 2 'X68 • -� QS ur Farce ax Num s l III. Type of !Zmit: (Che o nly one box on lin A. Check box on line B if applicable) b 2( - bb -oto A) I. w 2. U Replacement 3. C Replacement of 4. 5. 6. Q Addition to Syste System Tank Only Existing System B) ermrtNumber Date Issue ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 14-- IW *kM &.pressurized In- ground LI Mound ❑ Sand Filter ❑ Constructed Wetland ssurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: _ I- Design Flow pd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals]daylsq. P..) (Min. /inch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- P asuc Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for instafation of V40 shown on the attached plans. amt s Name (print) Plumber re (no MP P S No. Business ne Number Plumber's Address (Street, City, hate, Zrp / d; 92� 1 �.s Q2 IX. County/Department Use Only Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signatu (No stamps) Approved 0 Owner Given Initial Adverse Surch Fee) a0 Determination 22S • ��z 1�v ) X. Conditions of Approval /Reasons for Disapproval: - ) tat U#" P, LbAg- vMD-639R (R 07/00) PL 4AE �Ss PROJECT P.C. Collova Builders Inc. 705 Co untv Rd E Hudson Wi 54016 NW 1 / 4 NW 1 /4 S 21 /T 30 / W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 I CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 1 1/2" PVC Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P Same as Benchmark SYSTEM ELEVATION 96.3 Property Line Vent >12" Sidewinder High Capacity Leaching Plans Designed Using of Cover Ca p y g g g 100 Chamber Conventional Powts Manual Version 2.0 16" Long Grade at System Elevation B.M. #2 34 „ 25 30' .M. or l Vents 1 30' S0' - -=�30' 30' 50' 1 T o3 I B edroom ° I ,-, ouse 80' / 40' 2 -3' X 69' Cells with >3' Spacing Vents30' 0 PLOT AN PROJECT -P.C. Collova Builders Inc. AD Ess 705 Countv Rd E Hudson Wi 54016 NW 1/4 NW 1/4s 21 /T 30 % W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/01 BEDROOM 3 CONVENTIONAL )00( IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 BENCHMARK V.R.P. Top of 1 1/2" PVC Pipe ASSUME ELEVATION 100' Filter Abel A -100 ❑ BOREHOLE O WELL *H Same as Benchmark SYSTEM ELEVATION 96.3 Property Line Vent > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using 100' Chamber Conventional Powts 16" Manual Version 2.0 6' Lon C Long 34" Grade at System Elevation =M#2 25 30' .M. ents 1 30' 50' B -2 30' T 03 C#0 2L 80 Ouse B -3 / 40' "_0A 2-3'X 69' Cells with >3' Spacing Vents30' 0 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 1 - 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. Z (3 �_ 66— VD Please print all information. v' wedby Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). alll 2 f Z Property Owner //// Property e Location IF - �n f �U Govt. Lot L,_) 1lWi J14 S ?- T 3 R E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# J City State LAX ��� City ❑ Village own Nearest R ad L 46, 1, L � D I I 90ri�, A �;- I /', a, PL jV I New Construction Use' r Code derived design flow rate GPD ❑ Replacement ❑ d Parent material 1.{� ]� _ Flood Plain elevation if applicable ft. General comments and recommendations: Fq-1 Boring # E] Boring Pit Ground surface elev l e& ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 0 - /Z CJ i3 /z d S 6Z •(0 d Z.� Boring # F E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 1 0 m /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST N me (Please Print) AM& (/ , T Number f/ eL�t // a e Address Dat luation Conducted Telephone Number 9.2 C �yal ;7 �r SBD -8330 (R07 /00) Property Owner Parcel ID # Page of 1-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soii Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 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 /ft 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 - 264 -8777. SBD -8330 (R.07 100) v&consin :department of commerce SOIL EVALUATION REPORT Page l of 3 R Pisa fety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must S4 . C rol include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and tocatiSm &%ance to nearest road. ^ i , ` , i ' Reviewed by Date Please pdnt all e rn an f Q Personal information you provide may be used for ldary pu rivacy L&V4 1¢.04 (1) (m)). �' ` ( �' Property Owner t„ y `Pro rty Location t f U4�/W 1/4 S Z( T p N R 1 E (or� i Lots Block # S1rbd. Name or CM# S Property Owner's Mailing Address I_ y 7 ST .'Pax '.�, �p(���t?vJ Acres 1 uUX d jD State Tip ❑ village [,Town Nearest Road City \ pFFfCE ® New Construction Use: ® Residential / Number of - Code derived design flow rate 4150 / (cnn GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Oy+wCi 5 I Flood Plain elevation if applicable .C/ [/4- ft General comments S �.5fe r''' c(-e L) • 9(0. 3 d and recommendations: t�4, el2 v• 176-3 F Boring # ❑ Boring ® Pit Ground surface elev. 99 6 ° ft. Depth to limiting factor < < h_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 o- 2 Z �z -3 �0 s s ) 2 — 3 .-7 F11 Boring # Bow ® Pit Ground surface elev. D ft Depth to limiting factor i �� n. Soil Appiication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz Cont Color Gr- Sz. Sh. *Efr#1 *Eff42 0-1( Itl 5. i 2mrbL (5 l vIC -s 2 / / -3b 1b S11, Z k- * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Adorn Schu ketr - - 253 Address Date Evaluation Conducted Telephone Number 2 l- A-l60S Property Owner N C 150n Parcel ID # Page 2 of 3 F3] Boring # E] Boring �o © pit Ground surface elev. 7 " 5 ft Depth to limbV factor 116 _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stare Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 6- 3 tb 2- 5; I Zmabk mrr- C • S • 8 2 /3 -32 S/ 5 I 2 aacbK mk C -- y 3 M - 1/0 18 yc 4 L F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 - T - F-1 Boring # F] Boring Ground surface elev. ft. Depth to Igniting factor in. El 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 mg& 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. seD -W30 (t.mioo) r - PAGE 3 OF�_ NAME LOT# & LEGAL DESCRIPTION NW 1 �4NW l /4, SZ( T,36 N,R19E(o00 +, SCALE: I"= 4 — 6;l LEVATION /OU •U x — BM I DESCRIPTION -c J 2 Aj c P " e- BM LEVATION 99.8f' BM 2 DESCRIPTION 4,0 o - s 1 Qt1c (>r'QP SYSTEM ELEVATION U ALTERNATE ELEVATION '76 3 G CONTOUR ELEVATION o -5/ o P C � y o � ■ V DATE SIGNATURE ■ IC I -- FROM,: P C COLLOUR BURS, INC PHONE NO. ; 715 549 5911 Feb. 01 2001 e7: MW P1 ST CROix COUN SEPTIC TANK MAINTENANCE AGREEMENT AND O WN13RSHIP CERTIFICATION FORM Owner/Buyer 06 o v e, g I c{ n S j <_ Mailing Address `70 0v • Property Address 1 q I l� , ,Verification required from Planning Department for new eonstrvction) City/State 16) k,1 m l L_<� Parcel Identification Number LEGAL DFSCRIPTIQN -Ir' Property Location _k(Aj__ %/4, iY� :, Scc. Q T N -R_L7 W, Town of \ Subdivision 1 Lot ff Cer#Itied Survey Map i>' Valtunc Pag # Warranty Deed # 65-3/ Volume U I g Spec houssP�yes ❑ no Lot lie_ identifiable es ❑ no SYSTEM MAINTENANCE Improper uise and mainteaancc of your septic system could result in its premature failure to i:sndic wastes. Proper nmintcaancc consists of pumping out the septic ta.ak every th= years or scaaer, if needed by a licecsed pumper. What you put into the system can affect the function of the teptic tank as a treatment stage in tha waste disposal system. The property owner agrees to submit to SL Croix Zoning Department a certification form, signed by the owns and by a M=WP + JQ=eY=&nph= b restrictedplumbcroral icensedpurgerve rifyingtlut(l)th - wastcwaterdisposalsystem is in proper operating condition and/or (2) after inspection and pumping (if ae:essa: j), the septic tank is less than 113 full of sludge. Vwe, the uadcnigand have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by d= Department of Commerce and the Department of Natural Resources, State of Wisconaia- Certification stating tbat�vr o septic system has been maintained must be completed and returned to rive SL Croix County Zoning Office within 30 days of the tlu;- year exp tion ta. / X01 i�c1 Off APPLICANT DATE OWNER CERTIFICATION . I (wo) y drat all statcrneau an this form are true to the best of ny (cur) knowledge. I (we) ant (are) the ownet(s) of the ptarrty desar ed abo q, by virtue of a my decd recorded in Register of Deeds OtTice. 10. 11 ._._ _ 1 I ` A �Td NATURE 0# APPLICANT DATE a 'e a t A information that is mis -re resented may result in rite P ' Y sanitary Pet:ttit being revoked by the Zoning Department. ` " "•' •' Include with this applicaliatu a scan: ed warrant decd from the R.e ister of Deeds o 4 Y g t'ltce a eery of the cartified survey map if reference is made in the warranty decd ,081'08/01 WED 08;01 FAX 715 386 4087 REGISTER OF DEEDS f�j001 I STATE BAR OG ct00+ Q , 2 -1999 KATHLEEN H. WALSH Do cument Number '�VAitRTY l['ED REGISTER OF DEEDS 5T. CROIX CO., WT RECEIVED FOR RECORD This Deed, made between Mllv Developvi T.l d, s Min nesota Limited Liability Part 08 -07 -2001 9:30 AM _ UARRANTY DEED EXEMPT II Grantor, and P. C CDIlov>t Buil TRC., a M Corpora CRT COPY FEE: CORY FEES — ... - - TRANSFER FEE: 780.60 RECORDING FEE: 10.00 PAGESI Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate In St. C County, State of Wisconsin (if more space c, needed, please attach addendum): Rcccrding Ann None and Retum Address Lots 1, 2, 3, 66 7, 29, 30, 31, 32 and 33, DA J. E STREEN Golf Acres, 'Down of Richmond, St. Croix County, Wisconsin. 304 LOCUST ST. HUDSON, W� 5 - 016 q5 Pt 026- 10 12 -50 _ Parcel Identification Number ([V) This is not homestead property. of) (is not) Exceptions to warranties:- Easements, restrictions and rights -of -way of record, If any. Dated this _ q 0 $�" day of Jane 2001 lalllvale Development Limited By: 'R ichard Nelson AUTHENTICATION ACKNOWLEDGMENT Signature(s) — STATE Of WISCONSIN ) St. Croi County ) authenticated this day of , ,. ',� ! da of Personally came before me this y Junt 2001 the above named iilllvale veto me at Limited, a M innesota Li it_e Liability s Kri stian 0 fare 1; _.. Partne a b Richard Ne lso n, TITI..Ii: ,%IEMBLIt STATE BAR OF WISCONSIN to i !(Srson(s) who cxt;cuted the foregoing (If not., in gad the same• authori ed by $ 706.06, 1Vis..SI ts,) THIS tNSTRUMrN'1' WAS DRAFTED BY • 21� _ _ Attorney Kristina 01 1and Nat t isconsin kludto - 5U11i _. My"q' anent• (If not, state expiration data; (Signatures mar be authandcated or n4nowledgcd, Both are not necessary.) "tirNnN _ •) "Nflmts of persons signing in any capo4lty must br lyped or printed below theft signature. Woanatm P+erefai"wa c«npr-ny, Fend du Lao al STATE aAti OF WISCONSIN eCOa3s•zoa' WARRANTY DEED FORM No, 3 .1999 - 1 11L 1 i1 X71. S00 °4 f'43 "E -- "- S00 °41'43 "E "Dedicated to the -- - - ----— - - -- — 66 00' - - -- 217.00' 2 17 .00' -- 216.84' - -� 1 - - - - -- - 867.34'— I I I 1 j -------- - - - - -- ----------- - - - - -- -- - - - - -- I � to I I co �— 100 -- N N I N U w o 1 00 ( ao 2 0 3 4 i of .* 87,234 sq.ft. �. No 87,234 sq.ft. No 87,171 1 sq.ft. ` 2.00 acres 2.00 acres � 2.00 acres ( E z z ! I CO I lb t ^ ^ Lu to i N N00 °41'43 "W I 00 — 8 68.06'— 1 I - rn 217.00' 217.00' 216. 4' I N 1 00 w 427.34' I 33' 33' I 1 C ! I I 173' 00 co d' N 1 y 00 rj 00 1 5 Itn sq. ft. 00 87,137 sq. ft. I I c es 2.00 acres i 11 1 1 ill 1 I � /1 1 0 4 jlp CIV CO CV N a� C7-- 6 CO / o � / 34 89,782 sq. ft. 87,178 s 2.06 acres CO / ;� 2.00 acr ?/ � / 1 1 ^ o llv _ I I ao —C 3 123.79' ( 00 op — — — 259.00' — / N00 041'43 "WW) 00 ; N00 0 41'43 "W T C ' 9\ — Cjp'C11��__ C12, — — � N z 'n — — - c�3 S00 0 41'43 "E ") rn S00 °41'4. 614 — 123.79' 33' 33' ---- - - - - -- 373.91 c� I 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 titter 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 Contingency Plan 1. if system fails, determine cause of failure, use aftemate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 c54 , 6L� Z 7/ - S9W - - 4 t 07 0 Shaun Bird #2/6900