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Home My WebLink About026-1149-15-000 - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430098 0 GENERAL INFO'AMATION 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: Freiermuth, Daniel I Richmond Township 6Q • CST BM Elev: Insp. BM Elev: BM Description: f Section/Town /Range/ ap No: 36.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �f] �/• I i TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �( N� Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM 5 QS del Number T Lift Fr' ss System Head DH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of P s Inside Liquid D DIMENSIONS SETBACK S EM TO P/L LDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR - 1 & _r )y = M I UNIT Model Number: DISTRIBUTION SYSTEM ` Header /Manifold Distribution x Hole Size x Hole Spacing "t�Air e / 1 1 Pipe(s) Length Dia Len is 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 I Bed/Trench Edges f Topsoil F,q Yes L No Yes [ i,i No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: // Inspection #2: Location: 1267 142nd St Hudson, WI 54016 (SW 1/4 NW 1/4 36 T30N R18W) Torey Pines Lot 15 Parcel No: 36.30.18. 1.) Alt BM Description =� t'"JL/ 3 )TWIL W& r+o cz:%" oh low; �i � e� �p(,t�' t4 be C1C)W� 4l� (�t Z' 2.) Bldg sewer length = �'� J i► otrt lylSh(1 �Q Q - amount of cover = yµ ['", "" 4w� �yctla ( �(,�✓ 11 — I 1 1+ C-cAV?.✓ Plan revision Required? I Yes Use other side for additional informati No 1— TA J J J Date Ins ctor's Signature ert. o. SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 (/� I N vsconsin Madison, !W on, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 9 3 0 State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privacy Law, s ` Project Address (if different than mailing address) I. Application Information - Please Print All Information 4 � 2 6 I`� - 5-E- . Property Owner's Na me Parcel f/ / Lot k Block # Property Owner's M ailing Address ZCr N UFFiCE Property Location c5le.) t /a,_Aaj' /a,Section 3 City, State Zip Code Phone Number G., /� CL X.� �5r% G N T 1� (cE cl W ) T� N; `SL --S1— II. Type of Building (check all that apply) X or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use 7 r y a. ❑ State Owned - Describe Use ❑City_❑ t lage0ownship of ,' III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. I New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ❑ B. ❑Permit Renewal ❑Permit Revision Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit recirculating Sand Filter i ❑ Recirculating Synthetic Media Filter aching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) B e gt� V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal rea Required (sf) Dispersal Area Proposed (sf) System Elevat' n 4 VI. Tan k Info Capacity in Total Number Manufacturer Prefab Site Seel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit 124 o Dosing Chamber VII. Responsibility Statement- I, the undersigned responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's S' re MP /MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip e _ VIII. County /De artment Use Onl Approved El Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agen ignature (No mps) X Surcharge Fee) !% 22s �_ Z3 ` 11 Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval 15� V �e_ 07 v . a ch complete plans (to the County n1 f the system on paper of I t n R x 1 inche i�e SBD -6398 (R. 01/03) �- 4`t PLOT PLAN PROJECT Daniel Freiermuth A DRESS 1271 Gresham ave N. Oakdale Mn 55128 II SW 1'/4 NW 1/4 S 36 /T L3 N 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/29/03 BEDROOM 4 CONVENTIONAL XXX IN -GR_ D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION loo' Filter Zabel A -100 I ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark II I SYSTEM ELEVATION 94.5/95.0 2.5' below qrade 300' Property Line 140.;- 25' 2 -3' X 94' Cells with >3' spacing B.M. #1 10' B.M. Vents #2 10' 5 1 30' 30' T Pro 4 Bedroom e House >5' from B-3 lot line Plans Designed Using Vent Conventional Powts Standard Biodiffuser Manual Version 2.0 J6'Lon Leaching Chamber with 31.1 ft2 of Area a 34" Grade at System Elevationo PLOT PLAN PROJECT Daniel Freiermuth A DRESS 1271 Gresham ave N. Oakdale Mn 55128 SW' 1/4 NW 1 /4S 36 /T 3 N 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/29/03 BEDROOM 4 CONVENTIONAL )00( IN -GR, D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambers 30 BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL H. R. P. Same as Benchmark SYSTEM ELEVATION 94.5/95.0 2.5' below qrade 300' Property Line 140.-;- 25 B.M. #1 2 -3' X 94' Cells with >3' spacing 1 0 , B.M. Vents #2 B -2 10' /- 5 , 30' T 30' B- Pro 4 30' Bedroom Vents House >5' from B lot line Plans Designed UsingVent Conventional Powts Standard Biodiffuser Manual Version 2.0 ALong Leaching Chamber with 3 1. 1 ft2 of Area 1 34" Grade at Sy stem Elevationo Wisconsin D epartment of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County - Cc x 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 reference point (BM); direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Re 'owed by Date Personal kftn, at you tie ma be ur ed for secondary purposes (privacy Low. s. 15.04 (1) ( m)). Z 3 3 I Property Owner (Property LopUon. _ ....... - r LL Govt. Lot 3(,J 1/4 N� S T N R I $ E (or& Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# 6 r State Zip Code • Phone Number ❑City _ Village (.Town Nearest Road Ql "cod M �It ( ) -?.,007 Vh mom, 1 40 k 5{ 0-kew Construction Use:O - •Residential / Number of bedrooms Code derived design flow rate a GPO i ❑ Replacement ❑ Public or commercial - Desafbe: .. _ 77,, - Parent material / Flood Plain elevation N applicable �' General comments P S S can't el-cu- 9 y!3Sa L oci -�� Q3 S`v and recommendations: y 2002 F1 Boring # ❑ Boring Pit Ground surface.elev. ' ! 6 ft. Depth to limiting factor 0 In. • - Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11t In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 f°ls•o 21- ng # ❑ Boring ® Pit Ground surface elev. 1 8 ' /0 R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI(t in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Ef(#2 J —$ Sz 2 m5 -1 10 rn1 - l V1 I.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 CST Name (Please Print) Signature CST Number �5--h 12 - 253349 Address Date Evaluation Conducted Telephone Number � I_3 �`�`' �-. S�- >•', -�-. wi ��l-OZ5 __ 7- � / C�rS)z�- 7 -YodB' Property Owner y_ _ PareN ID # Page �� of 3 a r Boring # ❑ Boring Pit Ground surface elev. �' /Q fL Depth to limiting factor / 2� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Shuc Lure Consistence Boundary Roots GPD/flz In. Munseli Qu. Si. Cont. Odor = "; Ge Sm Sh. •Eff#1 , Eff#2 7] Boring Boring # ❑ ❑ Pit Ground surface elev. R Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color . Redox Description.,_ .. Texture .- Structure Consistence Boundary Roots GPD/ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Boring # ❑ Boring " ❑ Plf • Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD/ft in. Munsen Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef1#1 •01#2 • Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 _< 150 mg/L • Effluent #2 = BOD, < 30 mgi14 and TSS < 30 mg/L x ; The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to acceis services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (801/00) I Parcel ID # Page . 2. - of 3 Property Owner �p�v e S�� - . : 3' Boring # a pit Ground surface elev. A ' /Q Q ft. Depth to limiting factor ZD in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Du. Sz Cont Color Gr Sz Sh. 'Eff #1 -Eff#2 a Boring # Boring Ground surface elev. R Depth to limiting factor in. Pit Sdt Application Rate Horizon Depth • Dominant Color . Redox Description _- Texture - Struchue Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Bodfg # ° Boring - piC • Ground surface elev. R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture . Struchue Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eif#2 - Effluent #1 = BODS > 30 < 220 nv& and TSS >30 < 150 mg& • Effluent #2 = BOD < 30 mg& and TSS < 30 mg& r Ile Department of Commerce an equal opportunity service provider and employer. If you need assistance to acceis services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SSM30 (RO7" 1 i PAGE 5 OF NAME A R 5 -- LOT# I S LEGAL DESCRIPTION j Nw YA . 3G T Z 0 N.R, l$ E(or)&f SCALE: 1 "= O BM 1 ELEVATION lDU � 0 BM i DESCRIPTION 4T->0 a �-{- BM 2 ELEVATION 9 �� Sy BM 2 DESCRIPTION 0 � L t+ O JC, SYSTEM ELEVATION e I j S y 3, 90 ALTERNATE ELEVATION /U CONTOUR ELEVATION 00 * ,Vu a U m 8� 2 2 a $ q , ql ,UU S q � SIGNATURE ��" DATE 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 1. If system fails, determine cause of failure, use alternate area and install new system or j install system at a lower elevation. 2. 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 ST CROIX COUNTY SEPTIC TANK mAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i owner/Buyer � [�, i t r r - L f�►d. `� Mailin g Address - 2- r Q y a Yr � fJ ��- Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number I LEGAL DESCRIPTION 1,.) � 6 `� r/ _ U� Property Locatio _ _ /,, /" /4, Sec. . T �/ N R� W, own of T Subdivision G' ` Lot # Certified Survey Map # �-- , Volume , Page # Warranty Deed # , Volume Z2-1 , Page # S 6 Spec house ❑ yesX no Lot lines identifiable Z4es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of um p every Y e septic tank eve three ears or sooner, if needed by a licensed pumper. What you put into the system pumping P g th but can 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above 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 Zoning Office within 30 da of the three year expiration date. 11__*� / SIGNA`T'URE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 5 3 IGNATURE 0 t 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 deed L C I U f" b KATHLEEN H. WALSH REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2 - 1999 ST CROIX CO., WI Document Number WARRANTY DEED RECEIVED FOR RECORD This Deed, made between Ames Investment Corporation, LLC a 06/11/2003 09:15AN Minnesota Limited Liability Company WARRANTY DEED EXERT # REC FEE: 11.00 Grantor, and Daniel W. Freiermuth, TRANS FEE: 140.70 COPY FEE: CC FEE: 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 Name and Return Address of 1 lat of Torey Pines I I in the Town of Richmond, St. Croix County, Wisconsin. 026 - 1149 -15 -000 Parcel Identification Number (PIN) This is not homestead property. (K) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. c Dated this \��_ day of June , 2003 Ames 2 1X Corporation, LI,C� * * * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County ) authenticated this day o racy L. Turn ®r � Personally came before me this J t/ - \day of Notar PO IC June 2003 the above named S tate o Aes Investment Corporation, LLC, a Minnesota Limited * Liability Company TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to Wwn to be person(s) who executed the foregoing in m aIn le th ame. authorized by § 706.06, Wis. Stats.) i THIS INSTRUMENT WAS DRAFTED BY * G L - Z ! � W ROA At torney Kristina Ogland Notary Publ , State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) yZ :� I •) * Names of persons signing in any capacity must be typed or printed below their signature. Information Proressionais company, Fond du Lac, wi STATE BAR OF WISCONSIN 900 - 655 -2021 WARRANTY DEED FORM No. 2 -1999 m tft �M I ; Z 0 �l W o !� s " MGJP�44t�D � �7 OO 1 � S00°08's2 "E 2386.86' +� - - - - -- - - -- 1769.73' )Or -- - _ _ _ _ - �' 200.00' / : 507.83 A I- SOI 14'4VE 224!� - - -,1 4°1 N46"E o — — 213 t T \ 10 v LO 9 O N N O th • N o � o � r OD II b w u 7- - % w T �. • : 6 1Y L w O J Iz O 'COD CM c U Z O z NZ a z g z IB " c uo 8 Y� F • ~a(Ol \ Q �. Q 0vs T \� ' ch II • �� W J m C'4 LLI LL LL MOM Z '08'52" W 878.76' �8 �\ — — TOWN RO ' w 8 78. 7 ' 1 71 F N T Q � U e3• N F- uJ i n El ]EI =E9 O 0 O 0 o Q V� tT � G �