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HomeMy WebLinkAbout026-1160-20-000 • Count Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453020 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: Dalstock LLC Richmond Township 821 - 11410 - Zd -a�b CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /chi 1 d - ) 6 1 L \ 23.30.18. /ZL TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1 / 14d f + 7S $ /06 Dseirtg —s Alt. BM eA, S` E . v Cn� + /0 Aeration Bldg. S wer 13 c ` Holding SUHt Inlet (41 . 3 � ,S St/Ht Outlet TANK SETBACK INFORMATION 6 . 45 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � / �� � i Dt Bottom � Dosing Header /Man. — 7 ,- 7 9 Aeration Dist. Pipe I C Holding - Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover / P PM /+ Model Number TDH Lift Friction Loss Sys t ea TDH Ft Q 1 TZ O TT Forcemain Len ia. Dist. to Well �.. SOIL ABSORPTION SYSTEM 9, - L - BED/TRENCH Width f Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liqui `(� Depth DIMENSIONS �j� 10 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION (• f /� CR CHAMBER OR + Type O + � / ` V 01 UNIT Model Number: j v P� DISTRIBUTION SYSTEM O �t� - 17 Header /Manifold / Distribution x ole Size x Hole Spacing Vent to Air Int Pipe(s) �rl L Dia Length Dia \ Spacing \ I \-.11 \ 3 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil \ Yes No \es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1323 146th Avenue New Richmond, WI 54017 (S 1/2 N 1/4 23 T30N R1 8W) Whitetail Meadows Lot 20 Parcel No: 23.30.18. x� � aJP. � - C�OLUr � 1.) Alt BM Description = � a.•^S �-- --s S h 2.) Bldg sewer length = Z 6 Le< �S titrx amount of cover = `l Z 7 V) Plan y� Q AJ��InCs Plan revision Required? K es No Use other side for additiormatio . / / I n Date Inse ✓ tor's ature Cert. No. SBD -6710 (R.3/97) 1 / I ll �I�YI W� p U\J rvQ I.f Safety and Buildings Division Cataty �, /�� l t 201 W. Washington Ave., P.O. Box 7082 J it Number (to be Stied in by Co.) Madison, WI 537Q7 — 7082 nary P ��� �Z D i sconsin (608) 261 -6546 De artment of Commerce Sta a Plan LD. Number Sanitary Permit Applicati G in accord with Comm 83.21, Wis. Adm. Code, Persons] infottnati you provide a s es Privacy Law, s15.6d( {m) Q D ��� Proje A reu (if different than ttrailingsj may be used for secondary purpo # ) 3 Z ) v6 i. Application Iaformstioa - Please Print All Information ��O�X G ' F VU Zn pa Lot # Block # Pcopecty en's ame D �,-- Property a n Pro Owner's yalling Address ^L/ 6-2 C �� �� y /4, Section ZAI? City, State i Zip Code / Phone Number / II, Type of Bt1i1 ng (check al that apply) P¢l 5 Subdivi 'on�Nr a CSM Number 1 or 2 Family Dwelling - Number of Bedrooms - /J ❑ IiaCommercial - Describe Usc C ❑ State Owned - Describe Use ❑city ❑villa wnship of IM Type of Permit: (Check only out box on line A. mplete line B if applicable) (� r A. System 0 Replacement System 0 Trratment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV ,T of POWTS System: Check all that a 1 Non - Pressurized In- Ground ❑Mound ? Z4 in. of suitable soil ❑Mound < 24 in. of suitable soil 13 At-Grade ❑single Pass Sand Filter C1 Constructed Wetland 13 Press inGround 0 Holding Tank ❑ Pn' Filter ❑Aerobic Treatment Unit ; q ❑Gravel -less Pi Other (e lai - 7 1 rin thetic Media Filter his Chamber ❑Drip Li `/� Pe reat t Area Information: 1 Area p ropos system El tion ) Design Soil pplieation Pate(gpdsf) Dispersal Am Required (st) Dispe j p , 5 �i Capacity is Total Number Manufacnucr Prefab Seel r P tic Concrete Construct 1 Gallons Gallons of Uni ts New Existing Tanks Tanks Septic or Holdia5 Taint Aerobic Treatment Unit Dosing Cbambcr VII. Responsibility Statement- 1, the unders a assume responsibiliry for installation of the POWTS shown on the attached plans Z ama (Pr in Plum M _ ' MP/MPRS Number Business Phoz bet %L �J Plu mber's Address (Street, C; , 'ate ' ode) I J VIII. Coun !D leartmeat Use Onl Approved ❑Disapproved Sanitary Permit Fee pnOudcs Groundwater Date Issued I sui Agent Signatur (No Stamps) Surcharge Fee) 91; Z 5-O Qr 0 Owner Given Reason for Denial "iitt" II Q IX. Conditions of Approval/ReMons for Disapproval SYSTEM OWNER: �� �o t� 1 Septic tank, effluent filter and .1� 1t dispersal cell must all be serviced / maintained S �� � — [Z' as per management plan provided by plumber. �� l 2. All setback requirements must be maintained �,� v� as per applicable code /ordinances. Attach Complete plans (to the County only) for the system an paper not Ices than 51/2 s 11 lncbes In size SBD -6398 (R. 08/027 r LOT PLAN PROJECT Dalstock ADDRESS 1748 112th st. New Richmond Wi 54017 S 1/2 NW 1 14s 23 /T 30 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/6/04 BEDROOM 4 CONVENTIONAL )00( IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •4 ABSORPTION AREA 1617 # of chambers 52 BENCHMARK V.R.P. Topof Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL • H. R. P. Same as Benchmark SYSTEM ELEVATION 96.7/96.6196.5/96.4 4' below qrad Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Scale is 1 " = 40' Conventional Powts � unless otherwise Manual Version 2.0 noted Well is to meet all Pro 4 setbacks required by Bedroom WDNR House Vent Standard Biodiffuser 30' of Cover Leaching Chamber 30' ` P *y with 3 1. 1 ft2 of Area ST o 6' Long 1 1 " gesso 3 4" Grade at System Elevation Distribution Box 5' 0 B ' 4 -3' X 83' cells erty Line With >3' Spacing B -3 Not enough sloe 1% Slope to establish contours Vents 172' Property Line B- t. 15' #i 150' Property Line `�- . ,�:�' I I - 4301, OT PLAN PROJECT Dalstock ADDRESS 1748 112th st. New Richmond Wi 54017 S 1/2 NW 1 14S 23 / 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE3/6/04 BEDROOM 4 CONVENTIONAL XXX IN -GROU ` / PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1617 # of chambers 52 kk BENCHMARK V.R.P. Topof Survey Iron ASSUME ELEVATION 100° Filter ZabelA -100 ❑ BOREHOLE 0 WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 96.7/96.6/96.5/96.4 4' below qrad Alt. BM Top of 2" Pipe C 100.2' Plans Designed Using Scale is 1 = 40' Conventional Powts � unless otherwise Manual Version 2.0 noted Well is to meet all Pro 4 setbacks required by Bedroom WDNR House nt Standard Biodiffuser 30' ji Leaching Chamber 30' with 3 1. 1 ft2 of Area ST Pro ccessory Building 0 34 Grade at System Elevation p Distribution Box 5' 30' 20' 4 -3' X 83' cells erty Line with >3' Spacing B -3 Not enough slope 1% Slope to establish contours Vents 172' Property Line B- Alt. 5 150' Property Line * M. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Gomm 85, Wis. Adm. Gale 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 refet'ence point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nelrest road. ' ' Please print all information. e wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (rd)). k�� A �' Property Owner Property Location y Govt. Lot vG 1 /4 S �3T N R E( W l Gr✓ , f J # me or CSM# Property Owner's Mailing �7ddress Lot Subd. # Block Na state Zip Code Phone Number ❑City ❑ illage ' own ' Nearest Road city N Use Residential / Number of bedrooms Code derived design flow rate �� GPD ❑ P or commercial - Describe: -- - - - - -- - -- - -- - - -- - -- Parent material �(Jr�lX Flood Plain elevation if applicable General comments; <7 / � 7 A ,� , and recommendations. -- !a'��C�,.� i? L� � � � -S 2Z� ' U Tao Ong # ❑ Bonng / ` w Ground surface Soil eiey! �` ft. Depth to limiting factor _ in. Ul .,- , rte /1 Zda Pit Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2 _ 0 All s — JAI z lJ r Boring # Boring Pit Ground surface Depth to limiting factor -7�-' In. - go - TiApplicabon 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 '1 Z of Effluent #1 = SOD > 30 < 220 n4L and TSS >30 < mgrL • Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -0 t 715- 246 -4516 R a Property Owner ID # Page of Boring# ❑ Boring /s.� !C � it Ground surface elev ZV ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •04 Z "2 '� C L l ; blz 9* , 40 F—I 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/fP 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 ication 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 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mg/L • Effluent #2 = BOD _< 30 mgA. 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. SOD4330 (RO Soil Test Plot Pla Project Name William Stock/Steve Dalton Sh Bird Address 1748 112th St. New Richmond Wi 54017 STM #226900 Lot 20 Subdivision Whitetail Meadows Date 8/15/03 S 1 /2 N W 1 /4S 2 3 T 30 N /R W Township Richmond n Boring () Well PL Property Line County S T. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron 96.6/96. Benchmark System Elevation 5 HRPSame as Be rk c a Alt. BM Top of 2" Pipe @ 100.2' Scale is 1" 40' Please note: Installer must unless otherwise verify all lot lines and setbacks before installation noted Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. i a� a 45' B -2 20' B -3 1% Slope Not enough slope r to establish 45' contours 172' Property Line B -1 It. 150' Property Line 15' 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 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 If system fails, determine cause of failure, use alternate area and install new O� . system in tested replacement area. ption #2. nstall system at a lower elevation, by removing chambers, removing biomat, an stall new system. O ��rf#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 71 5- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY 'SEPTIC E NANCE AGREEMENT MAINT :AND O CERTIFICATION FORM /�6 C� OwnerBuyer Mailing Address Property Addres s (Verification required from Planning Department for new construction) \ City /State Parcel Identification N er ON (� i t�o(,,�rtX LEGAL DESCRIPTI , r' W, Town o Properly Location — � i Sec. . TN < Lot # a o Subdivision G�/�/ Volume Page # Certified Survey Map # Lj 1 Pa e # Warranty Deed # _ . Vole g Sp ec hour � ❑ no Lot lines identifiabl ❑ no � p .�� SYSTEM MNA.NCE maintenance Improper use and maintenance of your septic system could result in its premature failure to handle Wwast a ou Pro the ystem consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumpe can affect the function of the septic tank as a treatment stage in the waste disposal system owner agrees to submit to St. Croix Zoning D a certification form, signed by the owner and by a 1U pfopertY pumper that (1) the on -site wastewater disposal system masterplumber, journeymanplumber, restrictedplumber or alicensed pumpe g the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and pumping . (if necessary), have read the above requirements and agree to maintain the private sewage disposal system with the standards I/wc, the undersigned artment of Natural Resources, State of Wisconsin. Certification set forth, herein, as set by the Department of Commerce and the ep d to the St. Croix County Zoning office within 30 sta ' ' that your septic system has been maintained must be compl and returne y f year expiration date. 6 Pn , Z yJ' DATE SiGNA : [JRE OF APPLICANT O WNER CE ) RTIFICATION we am are the owner(s) of I (we) cer APPLICAN that all statements on this form are true to the best of my (our) knowledge. I ( ) ( the p ' col ed above, by virtue of a wash' deed recorded in Register of Deeds Office. �d� escri DATE ATURE OF T . 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 U 293 63 1 � 744312 STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H WALSH REGISTER O Document Number WARRANTY DEED ST. CRO I XCO.. D EEDS I RECEIVED FOR RECORD This Deed, made between L. Lawrence Williams and Vireina R. 10/21/2003 09 :45AN _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 t 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 '/2 of NW '/. of Section COPY FEE: Twenty -three (23), Township Thirty (30) North, Range Eighteen (18) West, CC FEE: EXCEPT Lot One (l) 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 '/.) 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 number S233 McKay Ave., P.O. Box 399 026- 1068 -80 -000 026 - 1068 -90 -000 026- 1066 -80 -000 26- 1066 -90 -000 Spring Valley, WI 54767 x-3 , vc % ° t �-tTS —''fo o ee L — .,o f . — �"^Q • �o art • — ro .s 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 is R. Williams AUTHENTICATION ACKNOWLEDGMENT Sianature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Vireina R. Williams ) ss. County 1 authenticated this 1 2003 Personally came before me this day of c 2003 the above named * (LE: rt J. Richardson TI MEMBER STATE BAR OF WISCONSIN f not, to me known to be the mrson(s) who executed the foreP_oine authorized by 4706.06, 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 Dermanent. (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.infoproforrns.comSTATE BAR OF w1SCO WARRANTY DEED FORM No. 1 - 2000 v' O v N h II H O• `' '7 �'� o z ^N O m v ^ J M O ��• �M N o LO O O F 'Ztt M 6 O nl, m ( m °i ,sr to o 3 v QO `O w � tt a cV l .'; IS � � � � , rzgla -_ � o w� ,LZ9Fd s a6l - xvw n •sb•� 1A w ' , N co ca Z Z p o n _� W cQ .' , CN Ile a • . \ �3 \\ - C11 3 „9Z,6Z.00S .-� �� G '1, ” M 9Z,6Z.00N • • / • ` f \ " Cr CA . o .00'0 v ° -4 h i r7 0 • �O V.Z j I0 Ul) N � I'i M S00'29'28 "E ' 571,39' W J 307.18' I 264.21' O m N F- CN ° ' W ° �yv Wv= M z o -4 V V "I W • I cO v � W \` pe, O LL loll u to I 80fS I , h N 10 -40.18'17.46'-0" 0 o s� s t s` o� F , 57.64 F. `M Z6 MOON `�' „9 Z 0 •w o I All III , 0 $ ? c 0 7 , 2 2. a ■ 0) k @ � _ ■ m E z ° & 2 § - g E - ° C E & & _ § \ } § 0 2 2 o NCL � � CL IC1 0 o § ( E E » gr / C ° R = . -0 i77 ] 0 f w m C ® I 2 / k § ƒ n r @ i %. &\ . ( [ $ r z 0 0 0 2 Or o 2 , � % o J R § ■ CA ■ - ° ƒ } §�/ � e ¥ '-4 i § z E § z St, g 0 7 % \ \ [ z } 72 -q CA � ° § § - 0 # § 9 0 .. , ) U ■ 0 o 0 } \ 7 7 £ / % i §m §§EP > gk%(nCD k § _ <_0) 00) §� ) 0-@ . a ) § c = E - , \/( E ECOD §EE�mC, ; §/ \§/ q� � = » /S( §0 2 K) = = m =. ° \ §\� �§ a f �E/\ /@ d ° }kf} ® m }_ ƒ[§ \\ / S CR k-4 \ { /_ % / 2 0 N � CD § § ECL �2 - - - - - - PL O P PROJECT Daistock T LAN C-� /U DRESS 1748 112th st. New Richmond Wi 54017 �V�® S 1/2 NW 1 /4S 23 /T 30 18 W TOWN Richmond COUNTY ST CROIX 0 200 z0,�/ % MPRS Shaun Bird 226900 12/3/04 DATE BEDROO rCo NG CONVENTIONAL )00( IN.GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK F MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 2000 # of chambers 65 ,BENCHMARK V.R.P. Topof Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 96.7/96.6/96.5/96.4 4' be low qr Alt. BM Top of 2" Pipe @ 100.2' Plans Designed Using Scale is 1" = 40' Conventional Powts � unless otherwise Manual Version 2.0 noted Well is to meet all setbacks required by WDNR Vent >6 " Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area Pro 4 6' Long 11 " Bedroom Grade at System Elevat House 3 3 -3' X 101' cells with >3' Spacing and 13' X 107' 30' Cell B -2 erty Line ST 20' B -3 1% Slope Not enough slope 50' to establish contours Vents 172' Property Line B -1 15' * Al M. 150' Property Line M.