HomeMy WebLinkAbout026-1290-10-000 Wisconsin Department of Commerce County:
Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No:
479240 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, Town of 0 Zke - l 9� - 45 6 �M
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
IB M k cl -ST 22.30.18. / � 3
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 17 L Benchmark / 16 1.4
2,,_ Pm X: A 1 . f 6 Alt. B M C) �j �/ fT . �0 5
Aeration Bldg. Sewer q9. 3
Holding SUHt Inlet
9• VS q �S
St/Ht Outlet 9 ty 5 q l ,
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic l / 33 ' 33 / Dt Bottom
Dosing Header /Man. '10 740 v
Aeration I Dist. Pipe
/6 O
Holding Bot. System f-
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
4TDH
Model Numbe
/Z 5 4 FT ZS
TDH Li Friction Loss jSystej ad Ft
Forcemain 4 ia. I Dist. to Well I) t Q� 1113
SOIL ABSORPTION SYSTEM �
BEDITRENCH Width Length "\ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS X J
SETBACK SYSTEM TO O P/L JBLDG IWELL LEACHING Manufacturer. t
INFORMATION HAMBER OR ( t
Type Of System: � ' � � _ 1� �� � � UNIT
Model Number. 1
mac
DISTRIBUTION SYSTEM VO / Ba 3 T�-
Header/Manifold % Distribution x Hole Size x Hole Spacing Vent to Air take
Pipe(s) �\ Z
Length Dia Z/ 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 /�odded xx Mulc ed
Bed/Trench Center �f� Bed/Trench Edges ` Topsoil
^ Yes :_ No Yes I .:] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: J ! Inspection #2:
Location: 1420 129th Street New Richmond, WI 5 S 112 SE 114 222T/T3 N R18W) Lundy's North of 10 Parcel No: 22.30.18.
1.) Alt BM Description = �J `o ��- V a • `� 4— �IS a v�
2.) Bldg sewer length = A , ' n p 1
- amount of cover = L ii �+ c• v�r C-- 1 p }a �� Ax
Plan revision Required? [ Yes o
Use other side for additional information.'
Date Insepctor's nature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County t 'S:�
201 W. Washington Ave., P.O. Box 7162' �� `�
.r W1 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
M (6 y I Z U
Department of Commerce State Plan 1.D.Number
Sanitary Permit AP lication 4 WA
in accord with Comm 83.21, Wis. Adm. Code, pers al info Y u t O Project Addy (if different than mailing address)
may be used for secondary Purposes Privac La-.s 5 1))
I co ()
1. Application Information - Please Print AI! Iaforttta n ZONIN
NT>
parcel # Lot # Block
�+ }�
PropertyOwller's -Name � r 3 !�
0 property Location
Property Owner's Mailing Address <"
N
6 J '�., Section n G.
litJ Phone umber
l
Zip ode l rcl one
City, State '
r 1+ I ' ' J7 (` 7 1 N, R E r W
rI r/ CS Number
j1. pe of Building (check all that apply) � ,� Subdivision N /�
1 or 2 Family Dwelling - Number of Bedrooms — 1��2 /' � u
❑ public /Commercial - Describe Use ❑City_ (villa o ip of
0 State owned - Describe Use
111. Type of Permit: (Check only one box on line A. Complete line B if applicable) Other Modification to Existing System
A. System ❑ Replacement System ❑ Treatment/! Toldmg Tank Replacement Only
❑ ❑
List Previous Permit Number and Date Issued
Change of [] permit Transfer to New
I3. 0 permit Renewal permit Revision plumber Owner
Before Expiration �
) 1
1V, a of POVVTS S stem: (Check all that a 1 ST
'��� ❑Mound ? ?4 in. of suitable soil ❑Mound < 24 in. of suitable soil [I At - Grade ❑ Single pass Sand Filter ❑ El
❑ Recirculating San�d
Constructed Welland [] pressunzed Tn- and Iloldmg fink [I peat Filter ❑Aerobic Treatment Unit SF�ilir
er (explain)
Recirculating Synthetic Media Filter ching Chamber 0 Drip Line 0 Gravel-less vel -less 1pe
(' Dis a Area l�ropo� (sfl SYS ' ;1 vation
V. Dis ersaVl reatment Ar nfortnation: Dis sal Area Required (sf) II <0 6 �`l
Design Soil A ation Rate(gp fl P !) r r
Design Flow (gpd)
/5 " prefab steel F Plastic
iJ �• Site
Total Number Manufacturer Glass
VI. Tank Info Capacity in Concrete Constructed
Gallons Gallons of Units
New Existing
Tanks Tanks
Septic or Holding Tank ' 2i
Aerobic Treaw=t Unix
Dosing Chamber
MP RS Number one Number r ✓A
VII. Responsibility Statement- I, the unders' assume respons Business ph
ibility for installation of the PDX' TS shown on the attached r ani
plumber's ame (print)
plum lgnature� 6
C �,✓ ,r. (� j
plumber's Address (Str eet, City, State, ode
Vin. C n Me artment Ilse Onl Sanitary permit Fee (includes Groundwater / Date Issued sluing A t Si S ps}
gnature
PProved 0 Disapproved Surcharge Fee)
❑ Owner Given Reason for Denial ✓ lJ v
DL Conditions of ApprovaltReasons for Disapproval
SYST 1 OWN f ��
1 eptic tank, effluent filter and l ' "vim C� �. O/X !.d
dispersal cell must all be serviced /maintained � 1 4t'
as per management plan provided by plumber.
All setback requirements must be maintained Vk7
as per applicable code /ordinances. Y ee
J
for the sy tem on pa r not n j� 8 !E X It inches s D+ _� `C
Attach complete plans (t oun on ty ly) ��A cc'�i J 'I
SBD -6398 (R. 01/03)
V3N/ OT PLAN
PROJECT New Ho rizon Homes Inc. ADDRESS 1476 Hwv 65 New Richmond Wi 54017
S 1/2 SE 1 /4S 22 IT R 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 - DATE 6/7/05 BEDROOM 4
CONVENTIONAL XXX IN -GROUN P ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 55 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 89.6/89.2/88.8 4.5' below qrade
Alternate Be cbmar � op of 1/2" Pipe C 100.3' Plans Designed Using
Conventional Powts
J
Alt.B.M. Manual Version 2.0
B.M. 274' Property Line
Area of soils Well is to meet all
not suitable setbacks required by Scale is 1 " = 40'
for WDNR
conventional unless otherwise
system b� noted
Pro 4
Bedroom
House
150'
30'
1'6 8% Slope
60'
30'
CY
40' 4 B -1
B -3
3 -3' X 83' Cel with >3' Spacing
278'
Pro rty
Line
ent
>6„ S andard Biodiffuser
of Cover Le ching Chamber
wi 31.1 ft2 of Area
6' Long
11"
Grade at System Elevation
13N OT PLAN
PROJECT New H orizo n Homes InADDRESS 147 Hwv 65 New Richmond Wi 54017
S 112 SE 1 /4S 22 //R 8 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 - DATE 6/7/05 BEDROOM 4
CONVENTIONAL XXX IN -GROUN P ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE
55 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 1212 # of chambers 39
,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 89.6/89.2/88.8 4.5' belo q r a de
Alternate Benchmark Top of 1/2" Pipe @ 100.3' Plans Designed Using
J Conventional Powts
* Alt.B.M. N � Manual Version 2.0
B M 274' Property Line
Area of soils Well is to meet all
not suitable setbacks required by Scale is 1" = 40'
for WDNR
conventional unless otherwise
� system 5 Vents noted
B -2 Pro 4
Bedroom
House
150'
30'
8% Slope
ST
60'
30'
40' B-3 45' B -1
3 -3' X 83' Cells with >3' Spacing
278'
Property
Line
Vent
>655 Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
3 4" Grade at System Elevation
Dj)
Wlsconsin Department ofCorn Cn&4 ;.; , SOILIEV RT Page of
Division of Safety and Building or _' , wdh Corfim 85, Wis. Adm, Code <, County
Attach complete site plan on x 11 in in size. Plan must
include, but not limited to: vertical and horizonta ce poi(�t (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and locafiM and distance to nearest road.
Please print all information. R ewe Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
r
Property Owner Property Location
Govt. Lot 1/ S 1/4 S �t�T _20 N R J E
Property Owner's Mailing Addr ss Lot Block # 1 01,16d, Name ow CSkf#
ZM
City State Zip Code Phone Number ❑ City ❑ villa a To Nearest Road�
New Construction Us r Residential / Number of bedrooms Code derived design flow rate �� GPD
❑ Replacement ��� Public mera Describe:
Parent material — Flood Plain elevation if applicable `i`� '� ft•
General comments
and recommendations: syl v 0 0
F-/1 Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor D in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Fz — l Bo6ng# ❑Boring
Pit Ground surface elev. r ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure *C onsstenceEloundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
IL 16
ry / F , ' /.o
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 ' Efliuent #2 = BOD 130 mg/L and TSS <_ 30 mgiL
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conduc ed Telephone Number
1008 192nd Ave, New Richmond, 454017 --1 715 - 246 -4516
Property Owner _ Parcel ID # Page of
3 �� # C] Bo ring //
Pit Ground surface elev. ft. Depth to limiting factor !r� in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
d� l., U 3z- r , m a rY1 o
2.. 1(3 Icy rs/ C-
3 �6-It 1
F -1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicatim Rate
Horizon Depth Dominant Colof Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '5#2
F Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate.
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 1220 mg/L and TSS >30 1150 mgli- ' Effluent #2 = BOD, 130 mglL and TSS _< 30 mglL
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.
SBD8330 (8.6/00)
Soil Test Plot Plan
Project Name Environmental Holdings LLP Shau ' d
Address 706 19th St.
Hudson Wi 54016 CS #226900
Lot 10 Subdivision Lundy's North Date 12/1/04
S 1/2 SE 1/4S 22 T 30 N /R 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 89.6/89.2 *HRpSame as Benchmark
Alternate Benchmark Top of 1 /2" Pipe @ 100.3'
AIt.B.M.
B.M. 274' Property Line
Scale is 1 „ = 40 ,
Area of soils unless otherwise
not suitable
for noted
conventional
system
B -2
150'
60' g% Slope
40' 45' B -1
B -3 94'
Please note: soil test
2'
may not be suitable for
278' owners desired
Property building location, Soil
Line test was done to
7exca vating.
e
ion
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years. r filter is being installed in
2. Effluent filter is to be cleaned once a year. Please note: a large
order to extend the maintenance interval of the filter. at the ends of
3. Once every 3 years, cells are to be inspected via the i n spections pipes
the cells.
age, and water conditioner discharge into the system.
4. Owner agrees to limit greases, garb
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 d as per Comm. 83
8. Discharge into system is not exceed those required p
CIO ency Plan
ion #1.> If system fails, determine cause of failure, useernate and 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.
ble for replacement area, and system elevation
O P tian#3. No adequate area is suita
cannont be lowered. install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715-246 -45
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715- 246 -51
Shaun Bird #226900
ST. CRO.IX COUNTY
SEP'T`IC TANK MAINTENANCE AGREP.�'�M'NT
AND
(,)WNP..PSHIP CERTIFICATIQN FORM
h' ;.i�liig < ► :: •13
(Veri lacation;requiCeti from Planning Depart itent for new construction) — _
. Parcel Identification. Numbor
l! ►jaet'ly .. ,axon _ s 'is, .r re, Sec_ 2-_,. 1' 3 o N -R f 3 W. 'T owfi �t _L? ►�L- Lr�.ea.,aJ.D
LL v��� Q.`3.... ►1a oR T 1-( L ot 4, _..t 0 .�
t; .:; to t*(': " r 0 - Vey Mal ;, # _. � _ _ ._, Voiurnp Page #
ai✓ran s aid # _. Page # ��_,
yes ao Lot lines dentifiable A yes E.) no
iar use and v.igdntenarxceof your septic system could result in its premature faiiure to handle waste s5 P ype�; �.r.ai�t?3sanCC
.tsdsts of 't wing out th , septic, tan.. every three years or sooner, if needed by a licensed pumper. What.ya ptkt ini ; the syste:rn
(; affect z.
a 7 � � .,rtrtiott of t ae septic tattle: as a treattzaerat stage in the wants disposal systetxt.
T ,e operty own , agrei s to submit to St. Croix Zoning Department a certif cancan form, sued by the= oa* nt r and by a
r�. ;sterpl►t: iu jour'neyrtra i plu,'mt'+rr, restricted pl !i)ber or a licensed putaaper verifying that (1) this on -site wgstevratr;rd► , s. sat syster
is tt z iG "acting 4011d ,aridVor ( 2) after ire % io a and pumping (if sae cssary), 'the scptio tactic is less. tb.an 113 ' :'af sludge.
1 •. ;re, the u rn :a ;;gigtied have react thi'v above requircments -and agree to maintain the private sewage disposal systaITI Vvith• fi u:: standards
sr f>rth, as set b t:iG l)c:n ►rrmcnt of t:omunerce and the Department of Natural Resourctos, State of Wis4 ott;sjr ' t;: ; 4fication
),4„ t septic systi.mm has :been maintained must be completed and returned to the St. Croix C ounty Z t"J witlu.n 30
dl:: "s of thi year expi ation date.
API)u'r- . N� .... DATE
N
1 N Isertify that -all statenterits on this form are true to the best of my (our) knowledge. I (we,) ana •,,are;) tla "'Wno►(s) of
ti proper' ' s!.aribed abo :c, by t -irtue of a warranty deed recorded in Register of Deeds Office,
:i ,1t3A I'I !.t G*F F1PF'I DA`I`f
r
fbrmation t Tat is niis- represcnted may result its the sanitary permit being revoked by the Zorting 0epall'. at. "' •
!' ltteluri < !!` ; WR eppi eation a stamped warranty deed from the Registet of Deeds office
a copy of the certified survey map if rcfcrcncc is made in the warranty deed
60 39Vd
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UNPLATTED LANDS
----------------- - - - - -- - --- ; o
---------------� y
EAST LINE OF THE VEST 82V i Oo
)0'19'57 "E) OF THE SWt /4 OF THE SE1 /4 DRAI
)6'W 1324.07 W OW
T20-OT M10- _ T--
. _ _ 24 6.67'
2 266 3'
K 101ST 1293.
OW - - Npip'37'O6" 47.E 30' T
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State Bar of Wisconsin Form I - 2003 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number Document Name
ST. CROIX CO., MI
THIS DEED, made between Environmental Holding Company, RECEIVED FOR RECORD
LLC, a Wisconsin Limited Liability Company , 05/18/2005 12:45PU
( "Grantor," whether one or more), WARRANTY and New Horizon Homes, Inc. ANTY ANTY DEED
( "Grantee," whether one or more). REC FE EEB: 11. 08
COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE;
described real estate, together with the rents, profits, fixtures and other PAGES: 1
appurtenant interests, in St. Croix County, State of
Wisconsin ( "Property") (if more space is needed, please attach addendum):
Lots 2, 6, 8, 10, and 21 Lundy's North, Town of
r Yr
Richmond St. oix Count Wisconsin. RecordingArca
Name and Return Address
Tr��� C7t2.L
L.i i Sqo /4
Part of 026 - 1066 -95 -00
and 026 - 1067 -30 -000
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:
Roadways, Easements and Restrictions of Record.
Dated May, 11, 2005
Enxi o 1 ding Company, LLC
(SEAL) `__ _ _ (SEAL)
* * by e f Warren, President
(SEAL) (SEAL)
* *
AUTHENTIC e ACKNOWLEDGMENT
� G
Signature(s) ti STATE OF WISCONSIN )
ss.
authenticated on �' '�' St. Croix COUNTY)
PUBLIC Personally came before me on May, 1'�, 2005 ,
N � Z the above -named Jeff Warren
* 1.
TITLE: MEMBER STATE BAR to me known to be the person(s) who executed the
O S
(If not, f egoing instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
*Meri a J. Bune
Michael H. Forecki, Attorney At Law Notary blic, State of Wisconsin
Eau Claire, WI 54701 My Commission (is permanent) (expires: 11/20/2005
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORAM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2003
*Type name below signatures.
Attorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire Wl 54701 -7928 Phone. (715) 835-3029 Fax: (715) 8354112 T6063626.ZFX
Merilee 1. Bune Produced with ZipFortnT° by RE FormsNet, LLC 18025 Fifteen Mile Road, C"on Township, Michigan 48035, (1)00) 38"805 wwwziotorm.wr
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THIS PLAN IS THE PROPERTY OF;
w_ (;FNFRAL NOTATIONS: Tll me
PLAT
1
•. I
LOT 20 HOF
LOT 19
LOT 18 , -------- I!-
L Val
33' 33'
a t j j LOT 1
I I 1.87 ACF
(8030 SO
I I L.B.O.
w� LOT 11: j j 589.3
1.51 ACRES 55226'Of "W 52.06
(65.578 SO. Ft) i `� I �`.� N89'S7'29 413.85'
ovi BENCH MARK: TOP
•
~
OF 970 4: LOT 13 dl
588'04'36 23.78' `� \ `.� ••• 2.10 ACRES �ti
(919677 SO. FT-).
L. B.O.
DRA
EA 5
LOT i 0 .. ................
Q �I 1.51 ACRES �' \ .$h `�� HWE
I (65.738 SO. FT.) •'•�
r•a I +� I
LB-0- 960.5 `
LOT 9 ••••' �'--`
1.93 ACRES
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