HomeMy WebLinkAbout026-1137-37-000 :
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Division
x INSPECTION REPORT Sanitary Permit No:
399647 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:
New Horizon Homes Inc. I Richmond Township 026- 1137 -37 -000
CST BM Elev: w linsp. BM Elev: BM Description: / 11
('1 � / /[ ti l C ► ; ? Y , i t S k� ." 6 yf7 , e
TANK INFO ATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
I
Septic Bench rk /
Dosing Alt. BM 5 j h C
d
,f� fJ S I,cr �'Ja
Aeration Bldg. Sewer
Holding Ht Inlet Flo( Oft- 20
TANK SETBACK INFORMATION F ; -, .,�; ,,r 3 f0. 3� (✓� S
TANK TO P/L WELL BLDG. Vent to A' Intake ROAD Dt�plet��
Septic
Dosing Header /Man. 7 C, 2
Aeration Dist. Pie :3
Holding Bot. System G)Gf . ZC �•
PUMP /SIPHON INFORMATION Final Grad C HI
Manufact rer emand �
St ver
G . y6
Model Numbe
r
TDH Lift 1 1icti on Loss System Head TD Ft
Forcemai Length ia. Dist. to W
SOIL ABSORPTION SYSTEM SC'EcC� r2.
BED ENCH Width `� C Len t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENS � J � –1 1 � /. - -.
SETBACK SYSTEM TO P/L LDG WELL LAKE/STREAM RING Menu ct r.
INFORMATION CHAMBE T Cli
Ty p Of System: ( r / Model Number.
I
DISTRIBUTION SYSTEM tr
Header /Manifold Distn lion Ci — FHole iz e x Hole Spacing Vent to Air Intake
q l� Pipe(s) / I/ f
Length I0 Dia Length Dia a� 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 > 1 Z / BedlTrench Edges Topsoil [0 Yes [] No ® Yes No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspectio 1rr : 1 , 3 0 / •� Inspection #2:
Location: 1478112th Street New Richmond, WI 54017 (SW 1/4 NW 1/4 21 T30N RI 8W) Golf View Acres of 37 Parcel No: 21.30.18.993
1.) Alt BM Description = 166,46m or S�l��k l'-
2.) Bldg sewer length
- amount of cover
Plan revision Required? jai Yes l No
31 23
Use other side for additional information. _
Date Insep oi's Signature Cart. No.
SBD -6710 (R.3/97)
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Safety and Buildings Division County
Lsy _ 201 W. Washington Ave., P.O. Box 7162 �x i 'aL
N onsin `+p Madison, WI 53707 - 7162 Site Address �-
Department of Commerce Oa70 8 22 1 y7 $ (� �"�~ S
Sanitary Permit Application Sanitary Permit Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State Plan I.D. N r
AV
Property Owner' Name Parcel Number 2!b 113 3
Prope s ailing Address Property Location
r
�7X 14 v k; S G T ON,
City, State Zip Code Phone Number Lot Number s3 Block Number
< 7 tsion h1a m.T
II. Type of Builtlmg (check all that apply) ❑City
K i or 2 Family Dwelling - Number of Bedrooms ID/A []village
❑ Public /Commercial - Describe Use Township
❑ State Owned Nearest Road
Z
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A For County use
ew 2 ❑ Replacement System 3 ❑ Replacemem of 6 ❑ Addition to
System Tank Onl Exis ' System
B. ❑Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that Ppply)(numbering scheme is for internal use)
4,0< Non -Pressurized In-Ground 72 10 Mound 47 ❑ Sand Filter 50 ❑ Constricted Wetland
❑ Single Pass 51 ❑ Drip Line
41 ❑ Holding Tank 48 mg �
22 ❑Pressurized In- Ground �g
45 ❑ At -Grade 46 ❑ Aerobic Treagnent Unit 49 ❑ Recirculating 30 ❑ Other �� 3
V. Dispee rsaUTreatment Area Information:, t a-- A- kli
Design Flow (gpd) Dispersal Area DispersaY Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate( Gals ./Days /Sq.Ft. (Min./Inch) Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks �
Septic or Holding Tank _
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's i cure MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip e)
VIII. County /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ftsum Agent Signature (No Stamps)
Surcharge Fee) d fit)
v Adverse `i
El Owner Giv Initial l ��-S 'o
Determination
IX. Conditions of Approval/Reasons for Disapproval +�
r 001- L- Ad
.vt� -w fivLE�I.J -�'c � Zot�6Y�
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. 05101)
r
1 ��/i -PLOT PLAN
PROJECT ADDRESS P . Box 10622 White Bear Lake
SW 114 NW 1/4S 21 /T 30 N/R 18 OWN Richmond COUNTY ST. CROIX
MFRS Shaun Bird 226900 DATE 12/20/01 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESS CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE WELL s m B hm
O H.R.P.
Sa a as enc rk a
Vent SYSTEM ELEVATION 95.3
> 12" Sidewinder High
of Cover Capacity Leaching
Plans Designed Using
g
C
6' Long —Grade Conventional Powts
Manual Version 2.0
16"
Grade at System Elevation
M Prope Line
35'
35'
B -1
80'
220' 40;
30' 30'
T .� 40' �) Pro 4 .
-3 Bedroom
House
Q 2-3' X 94' Ce s ith >3' Spacing
1rjj,) N
Alt. B. 09 J
Property Line
PLAN A
PROJECT ADDRESS P Box 10622 White Bear Lake
SW 1/4 NW 1 /4S 21 /T 30 N/R 18 OWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 - DATE 12/20/01 BEDROOM 4
CONVENTIONAL XXX IN- GROUND PRESS WE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL - H. R. P. Same as Benchmark
Vent SYSTEM ELEVATION 95.3
> 12" Sidewinder High
of Cover Capacity Leaching Plans Designed Using
Chamber Conventional Powts
Manual Version 2.0
6' Long
16"
Grade at System Elevation
S� ICO.00 J Prope Line
AC 35'
35'
B -1
B -2 80'
220' 40;
30' 30'
T
40' Pro 4
B -3 Bedroom
House
2 -3' X 94' Cells
with >3' Spacing
N
Alt. B.
Property Line
Wk0orsiftepartment of commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
SA C rol
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 referenceLWint (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, ap* location anc distance to nearest road.
Please pri►rt al � bjtntation-
R iewed y Da
r ., /, of
Personal infortnafion you provide may be used r` dndary (Pri vacy Laic, x: (1) (m)). Z vT
Property Owner -" u L Property Location
—J a
'
. Goat. Lot 5, W 114,,(--U/ 1/4 S( T a N R/ E (or)&f tcJ�ard e �n�`
Property Owner's Mailing Address �' - Lot# Block # Subd. Name or CSM#
sT crux -1 C -rol�� ►eve Acres
60y, I O '' � � cc.jr�TY
City Std Zip r, , F,f�o FF10E City ❑ Village (,Town Nearest Road
�� � --
It
/2 s
® New Construction use: [59 Residential / Number of bOMms 3 `� Code derived design flow rate 4 5 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material +CAJ S t' Flood Plain elevation if applicable - 29/ ft
General comments 5 7 °' L? f
and recommendations: �Gf Pfw,� S , 3 D
I F1 Boring
❑ Boring #
® Pit Ground surface elev. ��/e ft Depth to limiting factor 1 2 t) in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnx:ture Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Effp2
l o 10 Z 5� 2-DLAb k es i V4 -
Z Sf 1 2 nY
3 14,6 -120 ID y Ilo rn s rr, t — . l. Z
oc
F -21 Boring # Boring ® pit Ground surface elev. � d' ft Depth to limiting factor 5 in. Soil Ap lication 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
1
041 Z S; I .3
Z /y - LI I rLF `I S "1 bl — s -
.4 6jy, Z ' .0
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL
CST Name (Please Print) Signature CST Number
Ardo►m Schu ker �-
Z533CA
Address Date Evaluation Conducted Telephone Number
21t3 86T S4 . Somer w I 24022) Z11 -I-AI608
Property Owner N e ISon Parcel ID # Page 2 of 3'
F 3] Boring # ❑ Boring Pit Ground surface elev. Q9 -/d ft Depth to limiting factor / /I� in.
M Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnx*ure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Effi'/2
I 0 -10 10 Vr 3/2— Si I ry - -s v-C 5 - (
nrTS17 5 8
3 Rio y �h m
A
F—I Boring # E] Boring
[I 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
F —I Boring # [:] Boring F1 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. *Efr#1 *Eff#2
• Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 42 = 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.
san -ztw Q 07=)
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PAGE 3 OF
NAME iU e l Sc> n LOW 37 LEGAL DESCRIPTION <w '/4 Alw /4 S Z 1 T 3o,N,R 19 E (orYW
SCALE: I "= yO
1
BM 1 ELEVATION
BM 1 DESCRIPTION
x
BM 2 ELEVATION �{ • O q S ec. Z
BM 2 DESCRIPTION &� T� "D e
SYSTEM ELEVATION 95', 3 o
ALTERNATE ELEVATION --- 3d
CONTOUR ELEVATION n o
1
n 51oQ�-
■ a L-+- ■
mur -1
■
d- 3
SM P'
i
SIGN
,- DATES
�!7
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
Contingency Plan
1. If system fails, determine cause of failure, use alternate 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
e(
r
Shaun Bird #226900 )/
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Ownerffluyer Z� 1- / � / - f; -v AltaO
Mailing Address P d J
Property Address 4 /7 5 l�
(Verification required from Planning Department for new construction) / l
City/State Parcel Identification Number
LEGAL DESCRIPTION
Pro Location 4 , /t�� /., Sec. �� T�1 -P- Town of
Property t�
Subdivision T>1f-,✓i f � Act . Lot #
Certified Survey Map # . Volume . .Page #
Warranty Deed #
3 Volume Page # z 1
Spec ho'7 ❑ no Lot lines identifiable no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
of Commerce and the
set forth, herein, as set by the Department Departm ent of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
2 ysthe three y ex iration date.
.w-
SIGMA O LICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1 '�o /
SIONA *FAP�PLICANT
DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
VOL 1G68PA14 3 649430
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Hillvale Development Limite a__- 06 -26 - 2001 9:30 AM
Minnes Limited Liability Partne -- - - --
- - -- WARRANTY DEED
EXEMPT M
Grantor, and New Horizon Homes, I nc., a Wi sconsin Corporatio CERT COPY FEE:
COPY FEE:
_ �_ - -- TRANSFER FEE: 156.00
- -- _ - -- f RECORDING FEE: 10.00
— - ---------- - - - - -- - -- -- PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix - -__ County,
State of Wisconsin (if more space is needed, please attach addendum):
Recording Area
Lots 36 and 37, Golfview Acres, St. Croix County, Wisconsin. Name an Return Address GLAND
T LAW
p
AT ! A
':X 359
HU��. -�v, WI 54016
Pt 026- 1012 -5 _ - ---
Parcel Identification Number (PIN)
This is not -- homestead property.
QI) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
��•
Dated this day of Z001 June —
Hilivale Develo ment Limited
—_. - - -- -.— • By - -- 0- A, —
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) _ Hillval Development Limited ss.
- -_ -- County )
44-.
authenticated this 2 of 3nne 2001 Personally carne before me this _ -- day of
-- - -- the above named
" Kristina Opland -
L "1 1
: iwENfB��ATE BAR OF WISCONSIN to mt known to be the person(s) who
T jTt executed the foregoing
instrument and acknowledged the same.
=e =uthlUiz# ty§ 7 6.06, Wis. Stats.) _ -- it '• t -- TAS *ST, WAS DRAFTED BY " - - - --
Irnby ris Ogfand - --_ Notary Public, State Wisconsin
— 01 _— -- - - - - -- My Commission is p (If not, state expiration date:
(Signatutes•may be authenticated or acknowledged. Both are not necessary. _ - -. - -- -- - --
INormal�on ProfeaalOnals Company, Fora du Lac, WI
" Names of persons signing in any capacity must be typed or printed below their signature. soo.655s021
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2-1999
NW. 114, and part of the SW 114 of the NW 1/4, o f Sect
114, and Pa?`t o f the SE 1/4 o f the NE 1 4 o
ha Raill road, all in ion
Chicago,' St. Paul, Minneapolis and Onw : Section n
roix County, Wisconsin,
TH S UNPLA TTED LANDS
2018.96'
"Dedicated to the Public" 1966.38'
)0'-------- - - - - -- _ _
403.40' - - - - -- - -- 209.00' -- 1 - - - - --
209.00'
• I - 1033.04'- o
10 1- ( � o
I6 � 87 134q. s - t.
f - - - - -- �
-----------------
^ -- - - -- - - --
N IN b
i 2.00 acres O
ao
N00 041'43 "W 3 / 0 38
- o O
403.40' W 87,153 sq.ft. 87,153 sq.ft.
- 100' ---1 u 2.00 acres Z 2.00 acres
L 35
W I v
n 86, 981 sq. ft. 2.00 acres 00 N00 °41'43 "W
Z I NO ° I TO - 625.22'-
. 3 8300' W 209.00' 209.00'
i N 173100' 210.00' 302.95
i(
31
/ V 3 68,536 sq.ft.
`� 1.57 acres =`
3 32
/ 33 3
°
o�
87,091 sq.ft. M r
ao w j 87,150 sq.ft. 00 2.00 acres
J 2.00 acres U N
ao ao
34 N
87,178 sq.ft.
2.00 acres /