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Home My WebLink About026-1165-04-000 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety'dnd Building Division INSPECTION REPORT sanitary Permit No: 506241 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: II Dalstock LLC Richmond, Town of 026 - 1165 047000 `I CST BM Elev ,rn Insp BM Elev: BM Description: Section /Town /Range /Map No: h -p l01� c� "14 S 22.30.18.1270 TANK INFORMATION ELEVATION DATA f. TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. l Septic B cc�tf l CI1J ��•- � • p ) - L-3 /ao: o Dosing V V � r , Alt. BM Aeration Bluer o �l 6 (o 3 � ,S o s Holding t /Ht Inlet 6Z 4 7s 9 Y s S t Outlet TANK SETBACK INFORMATION S' Z • t' TANK TO P/L WELL j BLDG. Vent to Air Intake ROAD Dt Inlet Septic f- Dt Bottom �- � I Dosing � �� Header /Man. g Aeration Dist. Pipe 3 g 2. � Holding Bot Sys tem 2 n i l J• � /- a l � Final Gr ade PUMP /SIPHON INFORMATION rni Gil Manufacturer Demand St Cover i k(�PM y I Model Number TDH Lift Fn oss System Head TDH Ft Forcem_aitr, I Length Dia. Dis . SOIL ABSORPTION SYSTEM .Pack — S 7 X ZV f BED /TRENCH Width Length r No. Of Trenches PIT DI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I SETBACK SYSTEM TO P/L B� WELL LAKE /STREA LEACHING Man INFORMATION CHAMBER O Typ f System: / Jrn / / U Model Numb : / C) (J `.L DISTRIBUTION SYSTEM 4O YUQ Header /Manifipl / I Di , ibution I x Hole Si /e I x Hole Spacing Ven t o Air I ntake Vl Imo, e(s) I l!J ( j Lengt Dia ii 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 L/ Bed /Trench Edges Topsoil Yes No f ;, Yes l A COMMENTS: (I nclude code discrepencies, persons present, etc.) Inspection #1://Inspection #2: Location: 1468 129th Street New ich ond, WI 54017 (N 1/2 SE 1/4 22 T30N R18W) Lundy Meadows Lo Parcel No: 22.30.18.1270 1.) Alt BM Description = 2.) Bldg sewer length = 7S %�Z�ni� y " - amount of cover = / - r U s - -T ----r- Plan revision Required? Yes YNo �f Use other side for additional information. / !L0 J t __ - — Date Insepeter's Sig ature Cert. No. SBD -6710 (R.3/97) , LDRESS LAN PROJECT Dalstock LLC 1748 112th ST. New Richmond Wi 54017 N 1/2 SE 1 /4S 22 /T 30 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE6 /28/07 BEDROOM 3 CONVENTIONAL XXX IN-GROUND /P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 00 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 157 # of chambers 57 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 94.2/93.8/93.4 4.5' below qrade setbacks required by WDNR Alt. BM Top of 2" Pipe @ 100.2' Alt. B.M. 229' Property Line 25, Plans Designed Using Conventional Powts 5 ' B -1 Manual Version 2.0 Please note: Installer must Vents verify all lot lines and setbacks before installation. B-3 6% Pro 3 Slope Bedroom 4 40' House 40' 3(1 W S ST 30' B -2 2 Please note: r/ A 41 Prope y Llnlie soils area 2mg and have a error, would be a.6 0� lar 3 -3' X 78' C s pacing loading rate, but show a.4 loading rate, V system is to be designed fora .4, but if soils at the time of installation indicate better soils, a ,5 loading rate is to be installed.' Zoe Vent >6„ Quick4 Standard -W Leaching Chamber Pro Town Road of Cover with 20.0 ft2 of Area 4' Long 1211 5.8ft ^2 /pair of end caps 34" Grade at System Elevation Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. commerce.wli.gov Safety and Buildings Division County t 7 62 201 W. Washington Ave., .O. Sox 1 . C,/- g s CU n s Madison, WI 53 162 Sanitary Permit Number (to be filled in by Co.) Department of commerce Sanitary Permit Application State Transac to / Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appro i gove 't/ unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne OWTS Project Address if different thanmailing address) submitted to the Department of Commerce. Personal information you provide may be used for ondary � s► p urposes in accordance with the Privacy Law, s. 15.04 1 m), Stats. � Q 1 1. Application Information - Please Print All Information Property 0 Name arcel # Property Owner's Mailing Address JUN 2 7 -perry Location 1 �7 ovt. Lot City, State Zip Code hone $trim ROIX COUNTY � '14, Section 2-2 N r V ! N; R W II. ype of Building (check all that apply) 2 Subdivision Na Lot # �1i11 or 2 Family Dwelling- Number of Bedroo s Block # Lt y k- yn &.I- IvA ❑ Public /Commercial - Describe Use ❑City of CSM Number ❑ Village of _ El Stare caned - Describe Use � to � Town of / d 111. Type of Permit: (Check only one box on line A. Compl a line B if applicable) A ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Change of Plumber List Previous Pe beF andDat�lssued i Revision ❑ ❑ Permit Transfer to New B. Permit Renewal C1 Permit s Before Expiration Owner ,SAP IV. Type of POWTS System/Component/Devic Check all that appl Non - Pressurized In- Ground ❑ Pressurized 11 round j ❑ A -Grade ❑ Mound >_24 in. ofsuitable soil C1 Mound 24 in. r ❑ Holding Tank ❑ Other Dispersal Component ii l , � ❑ Pretreatment Device (explain) I V. Dis ersalfrreatment Area Information: Design Flow (gpd) Design cation Z ate(gpdsfj Dispersal Area Re uired (st) Dispersal Area Proposed (st) System Elev tion VI. Tank Info Capacity in Total # of Manufacturer `2 c � Gallons Gallons Units U y New Tanks Existing Tanks a 0 N in iz 0. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assn s risibility for installation of the POWTS shown on the attached plans. Plumber's N me (Print) Plumber' Lure MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 8 ��a 1 J Y D VIII. un /De artment Use Onl Permit Fee Date Issued uing Age n ignatu � Approved ❑ Disapproved av ❑Owner Given Reason for Denial $ ✓ P/_2 IX. Conditions of Approval/Reasons for Disapprova SQA SYSTEM OWNER: s'j �d 6=(�z� C41Li4:24lLe AA1 .. 1 Septic tank, effluent filter and lam dispersal cell must all be serviced /maintained �`S ! �f as per management plan PrOvided by PIUMbPr A; I Mil bUtua requlremoeolttp lltNftb��4f�i4ft and submit to the County only on paper not less than g M2 x 1I inch size as per applicable code /ordinances. SBD -6398 (R. 01/07) Valid thru 01/09 P PLAN PROJECT Dalstock LLC DRESS 1748 112th ST. New Richmond Wi 54017 N 1/2 SE 1 /4S 22 /T 30 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/28/07 BEDROOM 3 CONVENTIONAL )00( IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 00 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1 157 # of chambers 57 IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark Well is to meet all SYSTEM ELEVATION 94.2/93.8/93.4 4.5' below qrade setbacks required by WDNR Alt. BM Top of 2" Pipe @ 100.2' Alt. B.M. 229' Property Line 25, Plans Designed Using Conventional Powts 5 B -1 Manual Version 2.0 Please note: Installer must Vents verify all lot lines and setbacks before installation. B -3 85' 6% Pro 3 Slope Bedroom 40' House 40' 30' ST 30' B -2 Please note: soil test may have a error, in B- Prope y Iln#1e soils area 2mgr, and would be a.6 3 -3' X 78' Cells with >3' spacing loading rate, but show a.4 loading rate, system is to be designed for a .4, but if soils at the time of installation indicate better soils, a,5 loading rate is to be installed. Vent >6„ Quick4 Standard -W of Cover Leaching Chamber Pro Town Road with 20.0 ft2 of Area r4'Lo 12" 5.8ft ^2 /pair of end caps 3 4" Grade at System Elevation Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page - of-3— Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. L Please print all information. 'ewed Date ? O Personal information you provide mily'bt u9¢djprg8 ndarypurposeaj macy Law, s. 15.04 (1) (m)). Property Owner F Property Location Govt. Lot 1/ 1/4 S T N R E (o W Property Owner's Mai Address y3 , / !' i Lot Block # Subd. Name or City late 4p Code Phone Number City ❑ Village ,�K[Tqo Nearest Road New Construction UsA Residential I Number of bedroom Code derived design flow rate GPD ❑ Replacement Public or mercial - Describe: — Parent material Flood Plain elevation if applicable _ �/� ft• General comments and recommendations: 4-'�� L Cdv�i��f�tl�"`✓ � " �� / Bofing 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 Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Etf #2 S- /t/ y 6? -6d 2 A& a� az ®� # Q Boring -y/ / pit Ground surface ele . - / �� f /— ft. Depth to limiting factor .I 11Z2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. /h M � unse el� lll � Clu. Sz. Cont. Color / Gr. Sz. Sh. 'Eff#1 'Eff#2 o • Effluent #1 = BOD > 30 220 mg/L and TSS >30 1150 ' Effluent #2 = BOD 130 mg/L 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 5401 — f�__ v 715 - 246 -4516 Property Owner _ Parcel ID # Page of ❑ Boring ❑ Jl� g Boring pit Ground surface elev�u " ft. Depth to limiting factor L �^ 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 'EffQ 4 X e ; - 77 Z I z 3 C� 14 , a Boring —19'7 ° R�.2 1 n Boring # l ft Depth to li L r in. Lam' J/ l I Pit Ground surface elev. P ^9 Soil licati e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f . in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ff#2 i f yf F Boring Boring # Ground surface elev. ft. Depth to limiting 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 mg1L 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 (8.6/00) i A w f ► 4 Soil Test Plot Pla Project Name William Stock/Steve Dalton S i Bird Address 1748 112th St. New Richmond Wi 54017 TM #226900 Lot 4 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N/13 W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 94.2/93.7 *HRpSame as Benchmark Alt. BM Top of 2" Pipe @ 100.2 Scale is 1" = 40' * alt. B.M. unless otherwise 229' Property Line 25' 5' -1 Please note: Installer must verify all lot lines and setbacks before installation. -3 85' 6% Please Note: Tested area 0' may not be suitable for desired building area. Check system location before excavating. 0 , -2 a� 97' 0 99' � go 98 , 00 Pro Town Road ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Oixmer/1Buyer7d s LL Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) I City /State A Ad Parcel Identification Number 0 11� S -0 CJUU LEGAL DESCRIPTION Property Location 1 , 'SE'/4 , Sec. , T 3y N R W, Town of It ceo�')"'J Subdivision Lot #. rl I Certified Survey Map # —i--- , Volume �� , Page # r , �� Pa Deed # Volume ge # 63L Warranty Spec house yes no Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of yout septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septicitank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic dank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm 83.520) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit t� St. Croix County Planning & 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 operati�g condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the ab Dve requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Pla nning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this Corm are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warran:7 deed recorded in Register of Deeds Office. Nu er of bedrooms 7 SIGNATURE OF APPLICANT(S) DATE * * *An y ' misrepresented y sanitary permit being revoked by the Planning & Zoning Department. * ** information that is mist resented ma result in the sari i Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) i r - 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 ncy Plan Option #1. if ystem fails, determine cause of failure, use alternate area and install new s in to ed 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 FROM :OEVERING HOMES LAC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11 AM 1w. 1�14 .......... ... , • � -• oq e h O all S�tl 51C gyp a td !•trig SIR AV W-Awd .99 a� t -- --- - --- ---- ------- -- -- -- - -- r w e 3 - 61 M � t r "r r P. r w I� m o rl m ----- 2' ow 11 ' Awwr ZTd Wdt?T:OT b00Z bT •oaa ZBZTT£SSTZ: *ON XUA 0 S3WOH ON183ABO: W08J U 293°P 639 7 -+4302 11 STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO WI RECEIVED FOR RECORD This Deed, made between L. Lawrence Williams and Viraina R. 10/21/2003 09:45AK Williams husband and wife and each in their own right Grantor, and Dalstock LLC, a Wisconsin limited liability company Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT # described real estate in St. Croix County, State of Wisconsin (the "Property") REC FEE • 11.00 (if more space is needed, please attach addendum): TRANS FEE: 3015.00 The South One -half of the Northwest Quarter (S 'V2 of NW '/. of Section COPY FEE: Twenty -three (23), Township Thirty (30) North, Range Eighteen (18) West, CC FEE: EXCEPT Lot One (1) of Certified Survey Map recorded in Vol. 8 of PAGES: 1 Certified Survey Maps, Page 2305 as document number 465057; AND The North One -half of the Southeast Quarter (N '/2 of SE '/4) of Section Twenty -two (22), Township Thirty (30) North, Range Eighteen (18) West. Virginia R. Williams joins in this deed for the sole purpose of conveying any Recording Area interest she may have in the subject property under the Marital Property Laws Name and Return Address of the State of Wisconsin. Robert J. Richardson Bakke Norman, SC Parcel Id numbers: 5233 McKay Ave., P.O. Box 399 026- 1068 -80- 000: 026 - 1068 -90 -000: 026- 1066-80- 000;026- 1066 -90 -000 L Spring Valley, WI 54767 Together with all appurtenant rights, title and interests. See above Parcel Identification Number (PIN) This is not 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 Dated this 15th day of October 2003 * L. Lawrence Williams * Vir gqia R. Williams * AUTHENTICATION ACKNOWLEDGMENT Signature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Vireina R. Williams ) ss. County ) authenticated this 15th da f October 2003 Personally came before me this day of 2003 the above named * ob rt J. Richardson TI LE: MEMBER STATE BAR OF WISCONSIN (If no to me known to be the verson(s) who executed the foregoing authorized by 5706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY ROBERT J. RICHARDSON. Bakke Norman, SC SPRING VALLEY, WI 54767 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. MFO -PRO ( 800) 655 -2021 w%% , w.in1`oprofonns.con6TATE BAR OF WISCO WARRANTY DEED FORM No. 1 - 2000 ' I _ 1407HIAVENUE Id 33'1 33' 4 55 - 65 - 3820--2003 144th Avenue SEC. 22, T. 30 N., R.18 W. r TOWN OF RICHMOND, ST. CROIX COUNTY, WI POND V I E W ' NOT TO SCALE MEADOWS LOT 17 LOT 18 1 7T' 145.83' 268.30' 422.70' 1 H LOS' 1 68, 036 sq. ft: LOT2 1.56 acres S. 74, 877 sq. ft. oo• 1.72 acres LOT 7 F •5 91, 368 sq. ft. . ' 5 2.10 acres �p st� - ' 6 73 4 N 69 .5 rn LOT 3 66,985 sq. ft. 1.54 acres LOT 6 / \ - l - 69,618 sq. ft. D. O. T. - _1.60 acres / / from N 89 372 / 0" E 229.05' / 0� • . 2A S 5 ao S 87;31'0. 68, sq, - - - _ ` ` •\ 0 1.58 acre LOTS / �aans 4¢'W _ V _ 13.57 • • w 70, 000 sq. ft. 1.61 acres - - • / 4) \ -".� LOT 29 - - \ c3 IN /. \ � \