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
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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.