HomeMy WebLinkAbout030-2141-00-016
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 552315 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:
McCabe Homes Inc., c/o Tom McCabe St. Joseph, Town of 030-2141-00-016
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
519-651 13 - I GS 36.30.19.2066
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 11 J r ~ t L /ZC0 Benchmark t vST 3• 75 q$ 16:5
Dosing r! cY Tl Alt. BM
er c o^lft r o O~ Q4.I l l ~ b /oo • 75
Aeration Bldg. ewer 9 5 , Y5
Holding St/Ht Inlet
9 y- 95
TANK SETBACK INFORMATION St/Ht Outlet 7.6 V, 7S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 39 / /a., Dt Bottom
.l n.
Dosing Header/Man. -7• I ~3 5
Aeration Dist. Pipe 7. Q 93 7
75
Holding Bot. System 97 85
were .4.. q z , 75
PUMP/SIPHON INFORMATION Final Grade 3.1 9 8. <°5
Manufacturer Demand St Cover
GPM C~
Ike Je.~ / y~ 95
Model N er
r
TDH ift Friction Loss Syste d TDH Ft
Forcemain Le ia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 QI Z 1 r~ \
SETBACK SYSTEM TO Dec P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System:
~Z, p} ~4 CHAMBER OR Model Number:
54,
37
Co n J .I~h. ht P{
DISTRIBUTION SYSTEM Z I t 1 ,!L
Header/Manifold t Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) 1 ilE o~-a- v~
Length Dia j Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ,3 J E...1 6e yS
Depth Over / Depth Over xx Depth of xx Seeded/Sodded T Mulched
Bed/Trench Center Bed /Trench Edges Topsoil ~~Yes ® No `'Yes Q No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2:
Location: 1253 84th Street New Richmond, WI 54017 (NE 1/4 SW 1/4 36 T30N R19W) Natalie's Ridge Lot 16 Parcel No: 36.30.19.2066
1.) Alt BM Description = C Lam.?, . Lc J,
2.) Bldg sewer length
~.~-~_~,6
C-,o -amount of cover= ~f~~j `~~e /I L_. X
d/ 7 A.:~ b:Plan revision Required? FE-1 Yes X'No 3 f ~ i L ~-+D
se other side for additional information.
U
Date Insepcto Sign a Cert. No.
SBD-6710 (R.3/97)
.Wi.gOV Safety and Buildings Divis - -
TV- 01 W. Washington Ave., P.O. ~o 7I f ~v I
IS Q 1• Madison, WI 53707-7162 Santa Permit Number (to be filledin by Co.)
Dope errt of miner ~VCa1w AGE - { /
Sa mit Application State Transaction Number
In accordance with s. Co is. Adm. Code, submission of this form to the appropriate governmental M
unit is required prior to g a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
purposes in accordance with the Privac Law, s. 15.04 ! (m , Stats. / 5
1. Application Information - Please Print All Information
Property Owner's Name Parcel # '
030
Property Owner's Mailing Address Property Location
u Govt. Lot (w r Z t7 (O (O
City, St t Zip Code Phone Number
Section
1 1....._LJ 3 v- --N: R_/-/-- e W
II
. T pe o uildiug (check all that apply) T
i Lot.
or 2 Family Dwelling -Number of Bedroo _G K l Subdivision Name ,
//v "i'\ Black # -
❑ Public/Commercial - Describe Use.-
- ❑ City of
❑ State Owned - Describe Use CSM Number El Village of
Town of
III. Type o ermit: (Check only one box online A. Complete line B if applicable) - -
A. ew System y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
I e of POWTS S stem/Component/Device: Check all that apply) -
n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil -
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pre tment Devi
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area roposed (at) System Elevario
VI. Tank Info Capacity in Total # or - Manufacturer -
Gallons Gallons Units c v
New Tanks Existing Tanks VV a
y o U~
(T-Flo cNd
_ cG U in y rn w (7 Gy,
Septic or Holding ,rank _ -
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assum s nAbility for installation of the POWTS shown on the attached plans. ]/~j_-Z(
Plu is Name (Print) Plumber' urc MP/MFRS Number Business Phone Number
~~t~ ✓
Plumber's Address (Street, City, State, Zip Code)
O'ZIS z 5X / ej
VIII oun /De artment Uie Only
Permit Fee Date Issued A ssuing A en ignat
Approved El Disapproved
❑ Owner Given Reason for Denial $ 3I~~~~~~ Lv' rvL~~-
IX. Conditions of Approval/Reasons for Disapproval , -
SYSTEM OWNER: ~llyC/~ ~;yt >~~~CL -~Cw+
1 Septic tank, effluent filter and a 9
dispersal cell must all be serviced / maintained
as per management plan provided by plumber. _ V 7✓ / c~
2. All setback requirements must be maintained
as per applicabiqtt~blldPt9fRt "Sjje" r the system and sub to the C9unty only on paper tt less than s 112 x 1 Inches in s1
SBD-6398 (R. 0 I/07) Valid thtu 0 1/09 r ^ 5vi_"
PLOT PLAN
PROJECT McCabe Homes ADDRESS 948 Labarae Road Hudson Wi 54016
NE 1/4 SW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
3/7/12 BEDROOM 3
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 93.5/93.4' 5' below qrade
setbacks required by
WDNR
130'
Plans Designed Using
Conventional Powts
Manual Version 2.0
B.M.*
39' Pro 3
Bedroom
House
56' B-1
55' 25' ST 0'
Vent
21' B-3 >6„ Quick4 Standard
7' of Cover Leaching Chamber
with 20.0 ft2 of Area
A1t.B.M. 10.2ft^2/pair of end caps
39' Long 12" Grade at System Elevation
34"
2-3' X 86' Cells with >3' spacing
Property Line 71, Vents
B-2
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715-246-4516
Date: 3/6/12
Owner: McCabe Homes
Location: NE1/4 SW1/4 S36 T30 N,R19W Lot 16 Natalies Ridge St.Joseph
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbton system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-5. Maintanance and Contingency Plan
6. Filter Specifications S e
Signature
License number" 2 6900
PLOT PLAN
PROJECT McCabe Homes ADDRESS 948 Labarae Road Hudson Wi 54016
NE 1/4 SW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
DATE 3/7/12 BEDROOM 3
MPRS Shaun Bird 226900
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 93.5/93.4' 5' below qrade
setbacks required by
WDNR
130'
Plans Designed Using
Conventional Powts
Manual Version 2.0
B.M.*
39' Pro 3
Bedroom
56' B-1 House
55' 25' 0'
ST
Vent
21' B-3 >6" Quick4 Standard
71 of Cover Leaching Chamber
with 20.0 ft2 of Area
Alt.B.M. 10.2ft^2/pair of end caps
39' 4' Long 12„ Grade at System Elevation
34'
2-3' X 86' Cells with >3' spacing
Property Line 71 f Vents
B-2
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft^2 pair of end plates Finish grade elevation
Typical Installation 98.5
Vent Grade Vent
3' 4" 3,
./30/34 Septic Tank
5' Long 1 5) 5' Long 1 Grade at System Elevation
3699 Grade at System Elevation
Spacing 5'
2-3' X 86' Cells
Same on other end Observation tubeNent
At end of cell
A
B
21 chambers per cell
System elevations:
A-93.5
B 93.4
I-A 1333
Wisconsin Department 01 G SOtLE AEWION REPORT Page 1 of 3
Division of Safety and Bui! 1 in accord ce w' h fqm~i g~,V{ dm. a Tom Schmitt
°3 ✓_Ut~ County
Attach complete site plan on paper not less than 8'% 11 inches in size. Plan must St. Crok
include, but not limited to: vertical and horizontal refe nce pp@@~l SIN directi
percent slope, scale or dimensions, north arrow, and ocatioi~ (1~ r 074 l road. Parcel I.D.
Please print all informer""`"°' Revi red By Date
Personal inforrnabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (,4t 1.765
Property Owner Property Location
Grand Properties, LP Govt. Lot NE 1/4 S 19 S 36 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
712 Rivard Streeet, Suite 300 16 Natalie's Ridge
City State Zip Code Phone Number City Village ✓ Town Nearest Road
Somerset WI 54025 715-247-5900 St.Joseph Cty. Rd. A
✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Outwash (stream terrace) Flood plain elevation, if applicable na
General comments
and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is
94.75'. Area is flat.
4n'- WL r~
Boring # Boring
✓ Pit Ground Surface elev. 98.65 ft. Depth to fimiting factor 101+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
-Eff#1 •Eff#2
1 0-14 1Oyr3/2 none sl 2fsbk mfr as 2vf .6 1.0
2 14-23 7.5yr4/6 none sl 2msbk mfr gW 1vf .6 1.0
3 23-31 7.5yr5/6 none ms Osg ml 9W .7 1.6
4 31-48 7.5yr5/4 none grcos Osg ml cs .7 1.6
5 48-101 10yr5/6 none grms Osg ml .7 1.6
r rI G~ I,
a Boring # Boring
✓ Pit Ground Surface elev. 98.25 ft. Depth to limiting factor 99+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
-Eff#1 *Eff#2
1 0-20 1Oyr3/1 none I 2%bk mfr as 2vf .6 .8
2 20-31 1Oyr4/4 none sicl 3msbk mfr 9W 1vf .4 .7
3 31-38 1Oyr4/4 none Is 1csbk mvfr cs .7 1.6
4 38-47 1Oyr3/4 none grls Osg ml cs .7 1.6
5 47-60 1Oyr5/6 none vgrs Osg ml cs .7 1.6
6 60-84 1Oyr6/4 none grs Osg ml cs .7 1.6
7 84-99 1Oyr6/4 none IS Osg ml .7 1.6
" Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS -._30 mg/L . I~
CST Name (Please Print) Signature: CST Number
Thomas J. Schmitt ,J 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
1595 72nd St., New Richmond, WI 54017 4/18/05 715-247-2941
Property Owner Grand Properties, LP Parcel ID # Page 2 of 3
3 ] Boring # Boring
Pit Ground Surface elev. 98.25 ft. Depth to limiting factor 98+ in. Soil Application Rate
F
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots '
*Eff#1 "Eff#2
1 0-14 1Oyr3/2 none sl 2fsbk mfr as 2vf .6 1.0
2 14-26 1Oyr3/4 none sl 2msbk mfr gw 1vf .6 1.0
3 26-35 10yr4/6 none grls 1 csbk mvfr cs .7 1.6
4 35-60 1Oyr5/4 none grcos Osg ml cs .7 1.6
5 60-98 1Oyr6/4 none grs Osg ml .7 1.6
11 3.
Boring # Boring
ft. Depth to limiting factor in.
F-1 Pit Ground Surface elev.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots s GPD *Eifi#1 "Eff#2
❑ 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 Gl? "Eff#1 "Eff#2
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mgA- " Effluent #2 = BOD5 <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.
Page 3 of 3
Conducted by: Conducted For:
Schmitt Soil Testing, Inc. Name: Grand Properties, LP
Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street
1595 72nd St. City, State, Zip: Somerset, WI. 54025
New Richmond, W1. 54017
Phone: 715-247-2941 Subd.Name: Natalies Ridge
Lot No.. 16,
Legal Description: /1/, I145_4-1l/4 S36 T30N R19W
Township of St. Joseph, St Coix County
® Soil Boring
® Bench Mark El. 100.00' Top of 2" pvc pipe
0 ~ernate fnch Mark EL~„2 Top of 2" vc pipe
Pe- 4
Contour Line El. //0
.
Scale 1" = 40' Wb
~pGI, U
L~ NHS
i
VV
This soil report was ~do~ irement. It may or may not be in a location suitable for your use.
11, ~i 3.0 A •
.95 AB. I
.9 ® k 920,8
L.B.O.= 923.1
A3
H,W,L.=921.1
LOT
22 AC. \
(2.94 AC.)
--~V 918.8
RAD = 8a
A
~3 A-15 1 918.8
x 918.4 /
a
by / / k
w I I/ ' \ \ ' / • iy
X' 918.2
LOT 17 f
i LCD;
.011 AC 917.7~~f ,
x~ j
( 1 A 3.:
x 916.6 L.B.O.= 16.5 w 12.
i O LB.C
IOT 6 x 918.3
3.013 AC. •
(2.63 C•)
16.5
917.8
H.W,L.-914.5 Rk
914.4
1 x
5 i 916.7
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent 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 Pis Ze.. gento system is not exceed those required as per Comm. 83
COption y Plan
#1. f system fails, determine cause of failure, use alternate area and install new
tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#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 715-246-5148
Shaun Bird #226900
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...PpPpPp... ~CACACA
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerA3uyer A101 Cu zll~
Mailing Address
Property Address
(Verification required om Planning & Zoning Department for new construction.) c/
City/State Parcel Identification Number e~~5c/2 °2~l
LEGAL DESCRIPTION
1
Property Locationv~~ Sec. -7, Te~Z7ZN R1// W, Town of
Subdivision Lot
Certified Survey Map # , Volume , Page #
I.~- ' ~IAn ~ rye
Deed # 2 d Volume Page #
Spec house no Lot lines identifiabl ye no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping, out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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.
Uwe, 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 Planning &
Zoning Department within 30 days of the three year expiration date.
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 o a warranty deed recorded in Register of Deeds Office.
Number of 00111S
SIG O PLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
LOT I
3.022 ACRES
131,648 SQ. FT:
' i
9 j .
LOT 23
w ~gp`t8'22OE 4'74'a .
r
r r
33 33 J
LOT 17
r
3.011 ACRES
r
131.141 SQ. FT.
LB.O.- 916.5 r r s
r
LOT 2
LOT 16
r 3.012 ACRES
r 131,216 SQ. FT
LB.O.m 918.5 .
r
H.YV.E.m 914.5
DRA11VAGE
EASEMENT K r ~ s~• ~
LOT 25
r~
IRON PIPE,
VA'n0N 914.4
8 0 x54037973
STATE BAR OF WISCONSIN FORM 3 - 2000 952094
Document Number QUIT CLAIM DEED BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, Grantor, ST. CROIX CO., WI
and McCabe Homes, Inc., Grantee. 03/07/2012 3:52 PM
EXEMPT#: NA
Grantor quit claims to Grantee the following described real estate in St. REC FEE: 30.00
Croix County, State of Wisconsin (the "Property"): TRANS FEE: 90.00
PAGES: 1
Lot 16 Natalie's Ridge, St. Croix County, Wisconsin.
Sold as is with all faults.
Recording Area
Name and Return Address:
Title One Premier Group
Together with all appurtenant rights, title and interests. 030-2141-00-016
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 7th day of March, 2012.
Citizens ank
* Thomas Van Pelt, President
* *
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ST. CROIX COUNTY. ) ss.
i
authenticated this 7th day of March, 2012 Personally came before me this 7th day of March, 2012
the above named Citizens State Bank, Thomas Van Pelt, it's
* President to known to be the person(s) who executed the
TITLE: MEMBER STATE BAR OF WISCONSIN for oing ins u ent and a nowledged the same.
(If not, ,`,,,,,U,rrnh►nry,'~~.
authorized by § 706.06, Wis. Stats.) a tta
THIS INSTRUMENT WAS DRAFTED BY s
H Forecki Notary Pb c, State of Wconsin
Michael r
My commission is perma® (I not,~sta rpiratwn date:
10/27/2013 cA ; )
(Signatures may be authenticated or acknowledged. Both are not necessary.) f C
*Names of persons signing in any capacity must be typed or printed below their signature SC.O14,
~'OM If kir60000
1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
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