HomeMy WebLinkAbout026-1127-41-000 Wisconsin Department of commerce Coun
PRIVATE SEWAGE SYSTEM
Safety and Buildings Division ' 9t. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) sanit3�b2� ftNo.:
Personal information you provice may be used for secondary purposes [Privacy La s.15.04 (1)(m)]. 3 ��``�J II��ZtSS
Perrrlit Holdgr :; lyame: ❑ City ❑y� IJa�ge� o f: State Plan ID No.:
Gra Ows l Peter 1 1 71 ncY
CST BM Elev Insp. BM Elev.: BM Description: ParcebrgNp127 -41 -000
(J O // Up ' 11
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1 I C Z � Benchmark 7
osl / d d
Aerati Bldg. Sewer ,S 3 a
olding
t t Inlet , q __ �
TANK SETBACK INFORMATION Ht Outlet G Z/
Ve
TANK TO P / L WELL BLDG. Air i to ntake ROAD
Air I
Septic -� Z >� LQ �'` ?`, NA
NA Header / Man. 7 9 1
Aeration Dist. Pipe L ?. 95 9
H 1 ng Bot. System /,&
PUMP/ SIPHON INFORMATION Final Grade
Manufacturer Demand - !5 - 0 16 2- 06
Model Number GP
TDH I Lift riction S stem TDH
Forcem In Length Dia. oist.
SOIL ABSORPTION SYSTEM ea cL
BED NCH Width Len th No. Of Trenches ffD T No. Of Pits Inside Dia. Liquid Depth
Dim 3 Z IM E 1 N
SETBACK SYSTEM TO P / L BLDG WELL I LAKE / STREAM
LEAC Manu durer.
INFORMATION TypeO ) / AM R M o a Num
System: 64 3 23 S-
DISTRIBUTION SYSTEM
Header / Manifold Distribution Pipe(s) D x Hole Size x Hole Spacing Vent To Air Intake
Length �/ Dia. / Lengthq�� 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 Bed /Trench Edges Topsoil ❑Yes No Yes No
nsl3ent I 11M W I
/ CO MMENTS: (Include code discrepancies, persons present, etc.) (� Z��d(
Location: 1446 133rd Avenue, New Richmond, WI 54017 (NE 1/4 SW 11 25`T30N R18W) - 253018851
Richmond Hills -Lot 41 n C kek,�,yect /
1.) Alt BM Description = 4 r of tom. 0-kat.
2.) Bldg sewer length= Z Q 1
(( - amount of cover = >/e it
3 �bbseru�e.._ V�'S ,ice solaa.L /rte �h 3`� e,. Plan sIi on req fired? ❑ Yes l No
Use other side for additional informStion. Y 2 6 6
SBD -6710 (R.3/97) Da Inspector' ignature Cert No.
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Sanitary Permit Application Safety 7W153707-p2 Division to accord with CuUm 83.21. Wis. Adm. Code 20 t Wton Ave. verse side ftx;ASr y i0p};gtion ox
7302
inforaniioa pm ► Mwliw73
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t. A icaUott.Inf rmation - Please Pant ail InfarmsUon r.
tdtm�e Uon•
i ? c i ,p`U - Location a w� .1?FF >= t^S 3 R (K w
p Cede tae Mama ar CSM *lumber
II. Tybe of Bu l ding: (check one) D City
E Public/Commetd Ncr.ofBcdeooms �-/ ✓ QS Per �,[ar5 S {{ tC 0�
O State -Owned (describe �t(Tovvq
� 1leaee9I Read
Tax i _
M. of ermh: Check one box on tine A. Check bast on tine B if a licable S
A) 1. Iter �
m
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B) Tank Only Exists
i it
IV. Type of POWT System: ( alt that apply)
g Pr to-giotndta -tea O Mound O sand F7ter O Constructed Wetttnd
O Atlpdc O Wiling Tank 0 Shoo Pass D Drip Line
El Amebic Tmatment Unit o O Other.
V. D talent Area Information: SM
Ra>m tt) (MiAJlnek) w '` Elevation 3
rOP 9( ' 1 4
> 7 2 _ 9�� 3 ✓ /0a , ✓
Vll; ' aak C'apaeity in ToW d of : Pmefab She Stud Fiber- restie J;; L.
Worm :lion Gas= rant on- con- tL
Taks T Crete struated
sC7 �` rs
1i. a o 0 0
VIII. Responsibility Statement
1. the undersimmbdLa fm otthe POW TS skawa on the attacw
FAWRAM N&
rQuo" Aft= Cade) iture
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IX. ConatYmepsrtmeut Use only suo o-
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05/02/01 WED 10:27 FAX 715 386 4686 ST CRX CO ZONING 0 001
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567 -P (8.6199).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) Do
Estimated Flow - Average ( pd) ° 'G
Septic Tank Ca I
Soil Absorption Component Size (ft
Type of Wastewater Domestic C ha
Table 2: Soil Absorption Component - L imits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak ( pd) a S/Y ca
Maximum influent Particle Size (in) 1/
Maximum BOD L) 220
Maximum TSS (mg/L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and/or service once every 3 years
Outlet Filter Inspect once a y
rlt r Ins year and clean at least once every 3 Mrs
Soil Absorption Component Inspect once every 3 years
Saatic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the sep ' and outlet filter shall be assessed at least
once every 3 years by inspection. Th utlet filte hall be cleaned as necessary to ensure
proper operat' The filter cartridge shou not be removed unless provisions are made to
r solids in the tank that may slough off the filter when removed from its enclosure. If the
05/02/01 WED 10:27 FAX 715 386 4686 ST CRX CO ZONING 0002
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tarn
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are riot removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than &inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being In full compliance with OSHA standards for
entering a Wined space. The atnosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the Interior of the tank may be dh0bulf or impossible.
Tank abandonment shall be in acxcrdance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Comoonent
The soil absorption component serving this stricture is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspettion shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing, This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
�Wiscons;n Department of Commerce SOIL EVALUATION REPORT Page 1_ 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 St. C r oix
include, but not limited to: vertical and horizontal reference ^ paint ARM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and.leca)igp ano cpiUnce to nearest road. endin '
Please print all ipffdrnntati66. Reviewed by Date
Personal information you provide may be used forsecondary pur�ose9 viva Law, s. 15.Q4 (1) (m)). Z
1 11 r'
Property Owner '- =- + 1j ? Properly Location
R J C De Inc.. Govt: Lqt I SE 1/4 SW 114 S 25 T 30 N R 18 (or) W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM#
1868 Cty. Rd. C s` ''"` "'� :4 na Richmond Hills
City State Zip Code hone hl (N4 ICE ❑ Village ® Town Nearest Road
New Richmond WI 154017 1 (71'5 } 247 -5721 , Richmond
® New Construction Use: ❑ Residential /Number otbredret@m's • Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material rrl an; �d}r-€t Flood Plain elevation if applicable ft.
na
General comments
and recommendations:
trenches 4.00' below grade, spaced to code
a Boring # ❑ Boring 101.30 +96
® Pit Ground surface elev. ft. Depth to limiting factor in.
Soil licetion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
1 0 -18. 10 r 2/2 none L 2msbk mfr 9W if .5 .8
2 -2 •1
3 26- 41'7.5 r4 4 none ob. is osq mvfr I aw .5 .9
4 41 - 9 '7.5 r 4 none ms o
T`. 3
6a"
2] Boring # F] Boring
® Pit Ground surface elev. 10 0 . 3 0 ft Depth to limiting factor +96 - in.
Soil licetion 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 0 -17• 10 r 2/2 none L 2msbk mfr aw if
2 17 -3 •10 r 4/4 none sil 2msbk mfr qw if .5 .8
3 30- 41'7.5 r4 4 none cob.l os
Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Gary L. Steel 02298
Address Date E luabon Conducted Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 10 -18 -2000 715- 246 -6200
Propertyowner J C Development Inc Parcel ID# p ending Page 2 of 3
3] Boring # ❑ Boring
® Pit Ground surface elev. 1 00.30 ft. Depth to limiting factor +96 - in,
– § - o - 7 il — 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
1 0-12' 10 r 2/2 none L 2 msbk mfr if
2 12 -28 10 si
3 28-41
AZA none cos os
4 41 -96 7.5 r 4/6 non ml na na 7 1.2
Y �«
F1 Boring # F] 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 /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2
Boring
F Boring # Ground surface elev. ft. Depth to limiting factor in.
E] 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 mg/L 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 (R.6/00)
STEEL'S SOIL SERVICE
Gary L. Steel RJC Development, Inc,. 1554 200th Ave.
CSTM2298 ME' SW4 S25- T30N -R18W New Richmond, WI 54017
MPRSW -3254 town of Richmond (715) 246 -6200
lot #41- Richmond Hills
N
1 " =40'
._- top of 1" pvc pipe @ el. 100.00'
Alt. BM.= top of 1" pvc pipe @ el. 100.75'
50`
00.3
0(.3
�.2
4qO
Gary L. Steel
10 -18 -2000
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM +L� ` ?`. U ROM
S
Owner/Buyer P e i r co 00— k C) W-S-k
Mailing Address Woo ve VO V o d n C A ;S `
Property Address r
(Verification required fr Planning Department for new construction) }
amity /State rG, ( Parcel Identification Number V ` 1 7" 3�P
LEGAL DESCRIPTION
? roperty Location A / - E '' /4, c� '/, Sec. o�.5 T, N -R I�W, Town of
c c
)ubdivision _ U� V\-No nC� l! , , Lot #
- ertified Survey Map # , Volume , Page #
Narranty Deed # Volume _ �o , Page #
)pec house ❑ yes l� no Lot lines identifiable yes ❑ no
;YSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
onsists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
an 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
raster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
s in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
'we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
et forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
tating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
ays of the three year expiration date.
x
Z t, 4- �z
r IGNATURE OF APPLICANT DATE
) WNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owner(s) of
le pro described above, by virtue of a warranty deed recorded in Register of Deeds Office.
X _- 01-II
IGNATURE OF APPLICANT 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 decd
vol- 1624PACE 481
STATE BAR OF WISCONSIN FORM 2 - 1999 CHAS :3 21
KATHLEEN H. WALSH
Document Number WARRANTY DEED RECrSTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between RJC Development, Inc., a Wisconsin UEM FOR RECORD
Corporation, 04 -25 -2001 9:15 AN
il>Af1ROU DEED
Grantor, and Peter M. Grabowski and Lora J. Grabowski, husband EXEMPT D
CERTr O Y FEE:
and wife, COPY FEE:
IRANGEER FEE: 97.50
RECORDING FEE: 10.00
PAGES:, 1
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
Lot 41, Plat of Richmond Hills in the Town of Richmond, St. Croix County, NV Re it Addrecc
Wisconsin. C
/7 74 '7�J/
026 - 1127 -36
Parcel Identification Number (PIN)
This is not homestead property.
QK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this do y4A day of April 2001
RJ *John
: * Barlson, President
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
County )
authenticated this day of Personally came before me this Q27� day of
April 2001 the above named
RJC Development, Inc., a Wisconsin Corporation, by John H.
* Carlson, President
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowled ed the same.
authorized by § 706.06, Wis. Stats.) — x;,
THIS INSTRUMENT WAS DRAFTED BY * GERA RVIEUX
Attorney Kristina Ogland Notary Public, State of Wisconst � o ff ry u C
Hudson, WI 54016 My Commission is permagent. ( I1OT 198t8'e10i date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) Al .4 y I )
* Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company, Fob du Lac, 21
WARRANTY DEED STATE BAR OF WISCONSIN
FORM No. 2 - 1999
PRELIMINARY PLAT OF RICHMOND HILLS
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The Real Estate Leaders
RICHMOND HILLS
th 130. Avenue and 140 Street
New Richmond, WI
Hwy 65 South of New Richmond to 13& Ave.
North.to Richmond HiUs- Subdivision.
Rolling topography affords views and walk -out sites.
Cul-de-sac and corner lots are still available.
Easy access to the freeway.
Open Builder- Covenants apply
PRESENTED BY: RE /MAX TODAY AND JERRY HARVIEUX
715- 246 - 7074 - ofice
86 -
toll tree
715- 246 -2105 ext. 40 -voice mail
715- 246 - 6700 -home
RE/MAX Today
704 Somerset Road • New Richmond, Wisconsin 54017
Office: (715) 246 -7125 • Fax: (715) 246 -7079
Each RE /MAX® office is independently owned and operated.
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