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Home My WebLink About026-1114-30-000St. Croix County Planning and Zoning Friday, September 08, 2006 at 11:27.,23 AM Detail Sanitary Information Page I of Computer #: 026-1114-30-000 Sub/Plat: Willow River Meadows Section: 1 Parcel #: 01.30.18.656 Lot: 4 TN/RNG: T30N R18W Municipality: Rich d, Town o� CSM 1/4 1/4: SE 1/4 NW 1/4 Owner: Heinz. Gary 754 144th Street New Ri mond, 4 17 State Permit 224685 Issued: 09/13/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Perm . Installed: 11/16/1994 POWTS Detail: Bed- Seepage Bedrooms: 4 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Jenkins/Thompson Yes Powers, Calvin 1200 gal. Tank to 12' x 78' bed Jim Thompson Signed Off Yes to permit file Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 9/13/1997 6/19/2000 04/01/2005 6/19/2003 5/5/2004 04/01/2005 5/5/2007 WILLOW RIVER JOINT. NE%, NEki, Sec. 1 VENTURE T30N R18W, Town of 1505 Highway 65 Richmond, Lot 4, New Richmond, WI 54017 Willow River Meadows Address Site: 1754 144th Street New Richmond, WI 54017 Permit No: 22468S 9/13/94 Calvin Powers New System - Bed Money Owed attach notecard $0.00 St. Croix County Planning and Zonin I � Wednesday, October 19, 2005 at 5:04.16 PM Detail Sanitary Information Page I oft Computer 4: 026-1114-30-000 Sub/Plat: Willow River Meadows Section: 1 Parcel N: 01.30.18.858 Lot: 4 TN/RNG: T30N R18W Municipality: Richmond, Town of CSM: 114 1/4: SE 1/4 NW 1/4 Owner. Willow River Joint Venture 1754 144th Street New Richmond, WI 54017 State Permit: 224685 Issued: 09/13/1994 POWTS Dispersal: Non -Pressurized In -ground Permit: New County rmlt: 0 Installed: POWTS Detail: Bed- Seepage Bedra WI Fund: I I f POWTS Pretnatrnent: NA Notes InsDSCIQr As Buill Plumber Other Requirements Additional Notes Money Owed nnined yes Powers. Cahn check archives, attach notecard to permit file $0.00 Signed Off: y PS 12- I^ (, / � Maintenance / Scheduled Pump Date Pumped 1 st Notification 2nd Notification 3rd Notification 9/13/1997 6/192000 04/01/2005 6/192003 5/512004 04/01r"5 5/5/2007 Parcel #: 026-1114-30-000 10/19/2005 05:05 PM PAGE 1 OF 1 Alt. Parcel M 01,30.18.656 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner STEVEN C & LISA A SKOYEN 0 - SKOYEN, STEVEN C & LISA A 1754 144TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description • 1754 144TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 2,000 Plat: 2630-WILLOW RIVER MEADOWS SEC 1 T30N R18W SE NW & NE SW LOT 4 OF Block/Condo Bldg: LOT 04 WILLOW RIVER MEADOWS 2 ACRES Tract(s): (Sec-Twn-Rng 40114 1601/4) 01-30N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/06/2001 650444 1675/467 WD 08/19/1999 608799 1450/039 QC 07/23/1997 1106/111 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/20/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 47,300 168,100 215,400 NO Totals for 2005: General Property 2.000 47,300 168,100 215,400 Woodland 0.000 0 0 Totals for 2004: General Property 2.000 47,300 168,100 215.400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 218 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 000 u / STC - 104 - ��JS�N AS BUILT SANITARY SYSTEM REPORT OWNER �S ADDRESS /%!,/ /C./S/l� ST2 SUBDIVISION / CSMI /4 �, ✓ ena��V6J5 LOT SECTION /' T N-R i � � zD W, Town of ST. CROIX (BOUNTY, WISCONSIN Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE B SEPTIC TANK / PUMP CHAMBER HOLDING TANK INFORMATION Manufacturer: /LJiquid Capacity: /2oD �/ft Setback from: Wel�d�44001_ House_ Other Pump: Manufacturer Model# Size Float seperation-i Gallons/cycle: ' Alarm Location SOIL ABSORPTION SYSTEM. Width:_ /2 Length 7Sr �tumber of t,*QRC405 2 — Distance & Direction to nearest prop. line: Setback from: well: pjq— House Other i ELEVATIONS Building Sewer _ ST Inlets /D%. ST outlet L 9 PC inlet PC bottom_______ Pump Off Header/Manifold 2•Z / Bottom of system 7 4 ,. I' 1;` Existing Grade's Final grade .'1 DATE OF INSTALLATION: /� ��Iho PLUMBER ON JOB: IL 7 171, LICENSE NUMBER: `% �!n [1�,� • S INSPECTOR: rTi M 3/93: )t Wisconsin Department of Industry, Lador ar(dMuman Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ST. CROIX Permit Holder's Name: DCity Vi age ❑ Town of: WILLOW RIVER JOINT VENTURE }( CST BM Elev.: Insp. BM Elev..- , BM Description: ItGv, cv I lad. a Ifffd1 211►t111111T,r_rdr@TT TYPE MANUFACTURER CAPACITY Septic Dosin Aeration H g IP►IVK �011: I ISAC-K INFORMATION TANKTO P/L WELL BLDG. Ventto Air Intake ROAD Septic U d% NA Dosi n NA Aeration NA Holdi VUMP / SIPHON INFORMATION Manufacturer Demand 'M e r PM TDH Lift Fri temVS Forc Length Dia. Dist rower SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark 8 160 7 moo..? Bldg. Sewer /0/ S- 7 St / FK Inlet St/Hi Outlet 77 Dt Inlet Dt Bottom Header#�r Dist. Pipe 99 9 Qy, Bot. System 9 / i 07 Final Grade er& as spas' Q3, yj' BED /TRENCH DIMENSIONS_ Width/ length g i No. Of � enches PIT No Of Pits Liquid DepthDIME LEACH 411nsido er: SETBACKSYSTEM TO P/ L BLDG WELL LAKE / STREAM INFORMATION ype 4 r &fcd -2Zy r 7-D/f•% , 2 CHAMBSystem: r: r.r •...vv..Vr• P■ Jr&M Header Manifold Oisvi uUon Pipe s � x e z Hole Spacing Vent To An Inta e Length � Dia. Length L Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Gra ystem I Depth Over ii / „ Depth Over xx Depth Of xx Seeded / Sodded uiched Bed I I�icbCenter 17 7 Bed /Trfpth Edges / % Topsoil P ❑ Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) +-As i✓1 �( LOCAT�ION: ReAichmond.1.30.18W, NE, , Lot 4, 144th Street �G CJ* Ii�C1 .c x. /1/ ' / , <• „mac /� o'ri cii S. Al , (��% .Cd/ G► r �Q�Oe� mil{ i+�V . (Lc�/ /r%tor'�.`+'�[* �l1�GL��/ F aC/ t Plan revision required? ❑ Yes 8-No Use other side for additional information. �G-- Lr L✓J/—L�J SBD-6710 (R 05r91) Date Inspector's Signatur Cert No � DILHR PERMIT RENEWAL DATE: %/ / PRnPFRT LOCATION: '/a T 7e) N.R /A E SANITARY PEMIT TRANSFER/R WAL (PLB 67•V ILL;[ ((dw Ki 4)t-2t 444EZ __ ___-.- �....�.nv n�eeu�r un� neo ❑e ru�11U!]G nl E: S�COUNTY UNIFORM PERMIT 0aw(nr,s teTF STATE PLAN I.D. NUMBER: LAKE OR LANDMARK: SANITARY PERMIT TRANSFERRED TO: 1, the undersigned, hereby assume responsibility for installation of the private sewage system that has previously been approved for this property. w nuaaR s tinMF lit�CHANGEDI: J SIGNAT RE OF DILHR-SBD-6399 (R. 5/82) r EVIOUSPLUMIER'SADDRESS: H NE NUMBER: MP/NPRS UMBER: PHONE NUMBER: DATE APPRRROV ED. DISTRIBUTION: Original -County Copy - Bureau of Plumbing ' I J / Copy -Owner Copy - Plumber Oos kk;:id. 15a� �iaNw oi�T �ErJrv,�r/i+'J�c��ir�Z � $72�ziC7(JS RumrSL;c Box Y74 CE01 �.Ns, dl c Cq 74 f gy\f& I n) p ZA Iq IF Styr %,z W)p &AP3 c�41, es e-Y y stir �� ra 011 1200600.- s.< sir a -t A-C Ars �ILHR SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code —Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. ❑ �aik Check N rev to prwlotE ua application STATE PLAN I.D. NUMBER c�va r +< d- '/41V dC 34. S T�Q , N, R 8 PROPERTY OWNER'S MAILING k ADD LOT r r BLOCK // CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISI NAME OR CSM NUMBER II. TYPE OF BUILDING: (Check one) ❑ State Owned CITY NEAREST ROAD` O VILLAGE �A ❑ Public g1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NII Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ 3 ❑ Campground 7 ❑ Medical Facility/Nursing Home 4 ❑ Church/School 8 ❑ Merchandise: Sales/Repairs 5 ❑ Hotel/Motel 9 ❑ Mobile Home Park Office/Factory IV. TYj'PPErOF PERMIT: (Check only one in line A. Check line B if applicable) E 10 ❑ Outdoor Recreational Facility 11 ❑ RestauranVBar/Dining 12 ❑ Service Station/Car Wash 13 ❑ Other: Specify A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of System System Tank Only 1_ Existing System B) A Sanitary Permit was previously issued Permit # �a 10 gS Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 11 Seepage Bed 12 Seepage Trench 13 ❑ Seepage Pit 14 ❑ System -In -Fill Pressurized Distribution 21 ❑ Mound 22 ❑ In -Ground Pressure Experimental 30 ❑ SpecityType 5. ❑ Repair of an Exist' System q-►3.9� Other 41 ❑ Holding Tank 42 ❑ Pit Privy 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12.ABSORP. AREA REQUIRED (sq. ft.) 13. ABSORP. AREA PROPOSE (sq. ft.) 4. LOADING RATE (Gals/d /sq. ft.) 5. PERC. RATE SYSTEM ELEV. (Min./inch) 7. FINAL GRADE 6 Goo 16. O ELEVATION • 99, Feet VII. TANK CAPACITY 403. Feet INFORMATION in allons New iati Toltal Galona of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. Tanks Tanks oncret strutted glaze APP Se tic Tank or Holdin Tank .70U - .2o v Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system Plumber's Name (Print): Plumber's Sigpoture: (No Stamps) L_I Disapproved Approved 10 Owner Given Initial X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: on the attached plans. '/PRSW No.: Business Phone Number: CP i q - I G//ce'1ZL1, > SBD-6398(R.08/93) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Farm (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than B% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. S130-6M (R.11188) SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code —Attach complete plans (to the county copy only) for the system, on paper not less than 8'% x 11 inches in size. —See reverse side for instructions for completing this application. I. APPLICANT INFORMATION — PLEASEIPRINT ALL INFORMATION. U-'r / d L-) 'C /tJcSc J0AWJ7- FeXA11& AALC� PROPERTY OWNI§R15 MAILIr ADDR Ess L07 g /SOS5.� 80x ,4 C it�K STAgp ZIP CODE MM NUMBER SUBDI ci y.►e.�o (0� SS�0�7 %/S yLti732o 11. TYPE OF BUILDING: (Check one) ❑ State Owned VII ❑ Public n 1 or 2 Fam. Dwelling—# of bedrooms 7 MITI wnn i� t. C l STATE SANITARY PERMIT( 0 �4(0�5 ❑ Check If revision 10 Previous application STATE PLAN I.D. NUMBER '/a,S T>Je_,N,R1B E BLOCK ll NAME R CSM NUMBER � �ve, t /> ,7 NEARE )Tires=f� Ill. BUILDING USE: (If building type is public, check all that apply) 1 ❑ APVCondo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify. IV. TYPPEEj OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. > I New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an �¢ System System Tank Only Existing System 13 Existing System B) LJ A Sanitary Permit was previously issued. Permit # f l A S Date Issued Q V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution 21 11 Seepage Bed 12 ❑ Seepage Trench 13 ❑ Seepage Pit 14 ❑ System -In -Fill Pressurized Distribution 21 ❑ Mound 22 ❑ In -Ground Pressure Experimental 30 ❑ Specify Type Other 41 ❑ Holding Tank 42 ❑ Pit Privy 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 12. ABSORP. AREA RE UIRED (eq. ft.) 61 sP 13. ABSORP. AREA PROPOSE (sq. n•) 4. LOADING RATE (Galsy/.) 16,0077n 5. PERC. RATE 6. SYSTEM ELEV. (Min./inch) 0 7. FINAL GRADE ELEVATION t � VII. TANK TANK CAPACITY A Z Feet 103o Feet INFORMATION in gallons New Total Gallons N of Tanks Manufacturer's Name Prefab. Site Con- Steel Fiber - Plastic Exper. Tanks Tanks oncret strutted glass APP• — 1/.700 1 v,vcr a„tia, nvn unamoer I I I VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shoW on the attached plans. Plumber's Name (Print): Plum a Si lure: ( Stamps MP PRS1N No.: jBussft� Pitons Number. Plum {'a Address (Street. [r. tie 2 r s -.77S/ 7 ;fN Approved LJ surcharge Fee) - „""" ,oaanry n m arp nnayyg t o O van initial Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: f SBD4398(R.DSM) DISTRIBUTION: Original to County, one Copy To: Safety d Bukdinps DIVblon, OwnerPlumber , r INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date,'and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety S Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'f2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form, and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11188) ITE%LHR2 SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. -See reverse side for instructions for completing this application. I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. w MAILING ADDRESS NL 1/4 LOT# CITY, STAR cr ZIP CODE PHONE NUMBER SUBDII �� L_ _1 S O/ 7 ME- W II. TYPE OF BUILDING' (Check one) ❑ State Owned CIT VIL ❑ Public X1 or 2 Fam. Dwelling-# of bedrooms III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo S*C he 1 I STATE SANK Y MIT N da�(o�5 ❑ CAecx M revision to previous applicalion STATE PLAN I.D. NUMBER rLOCATION %4,S / T ,N,R /8 or)W BLOCK # N/A- JN NAM% CSM NUMBER IE ; Rif NEAREST ROAD L / AN 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 4 ❑ Church/School 8 ❑ Mobile Home Park 5 ❑ Hotel/Motel 9 ❑ Office/Factory IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.rU� New 2. ❑ Replacement 3. ❑ Replacement of System System Tank Only B) ❑ A Sanitary Permit was previously issued. Permit # V. TYPE OF SYSTEM: (Check only one) Non -Pressurized D' t a, 10 ❑ Outdoor Recreational Facility 11 ElRestaurant/Bar/Dining 12 ❑ Service Station/Car Wash 13 ❑ Other: Specify 4. ❑ Reconnection of Existing System Date Issued Is rl utlon Pressurized Distribution Experimental 11 )!4 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 12 ❑ Seepage Trench 22 ❑ In -Ground 13 ❑ Seepage Pit Pressure 14 ❑ System -In -Fill 5. ❑ Repair of an Existing System Other 41 ❑ Holding Tank 42 ❑ Pit Privy 43 ❑ Vault Privy VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 14.LOADINGRATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. 11) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 858 S� 7 Allh ELEVATION VII. TANK CAPACITY 6�eet — Feet INFORMATION in allons Total #of Prefab. Site Fiber - New isti Gallons Tanks Manufacturer's Name Con - ...........Steel Plastic Exper. Ta Its Tanks Inc structed glass App. VII1. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name ring Plumber's Signat Stamps) MWMPRSW No.: Busineas Phone Number: Cql 01 t\ �a c..► L v S 1 sL3 �/ Il 14 Plumber's Address (St. t, City, Stale, Zip Code � T 190p �d'S'ta 11.1i.J �rc�ima��,•ae> X a.wnt rrverwnrMEtvT USE ONLY Li Disapproved Sanitary Pnermit Fee (Incluaw erotaMwahr Approved ❑ Owner Given Initial d L Surcherga Foe) e e Issued4` Issuing Agent SI A v rmin ti n o r /cam ✓ ! / X. CONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-87) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 6 Buildings Division. Owner. Plumber INSTRUCTIONS 1. -A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be subruitted4o the county prior to instailatiQn. 5. Onsite-sewage systemss must be properly'maintafned. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually ekery 2 to 3 years. 6. If you have questions concerning your orisite sewage system, contact your local code adr�iinistrator or the State of WisGonsill atety. & Buildings Division, 608-266-38151, . . To be con'ip)ete aad accurate tjlis sRnitary permit application must include: I. Property owner's name�and mpi� address. Provide the legal description and parcel tax number(s) of where the system is to be l6stt;fl It. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in #1-7. VI 1. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross segtion of the soil absorption system if required by the.cgunty; E) s6i1 test data on a 115 form; and F) all sizing information. GROUNDWATER'SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through the" surcharges are used fbr monitoring groundwater, ground Water contamination investigations and establishment of standa'�ds. r- SBD-6398 (R.11188) , , - roSS Alf Inl.t. Andd oblolvallon PIP. I, ( 1 I 1 A►pn.�. viol top ' JeWw•.. 12•N..e Wool a.e. 20. 12' Abn II►I _ 1• Cool lrq Te /led Ore.. vonl III, �. ee...A ho Or i/nIMIk C I e tell" 2• Avis. polo O..r III. Ohble.ilee rlP e e e —Teo Sys��-� r'Au.eiel. lone le III. • /ul..elee III, b.le. ,, ° �'Cnpllnl 7wwlo Hlep AI /.Il.w 01 iJ11es �Icv•.+Ian ... �� 2"oFAG6RE4A7E —� ELEV. of 99 F LT--� SOIL FILL. DISTRIBU7loI.1 piPC Y :ce •. (� k 1:"OPlA-21/Z AGGRCGAT E 0 APPROVED S`19PETIC COVCI ' 'MATERIA,1. oR v' Of STPtAw /i- OR MARSW HA.`j DISTA115LITIOU PIPE TO 6E Al LEAST- ��,�f-i-- AUU A7 LCAS7L011JCH[S 13UT 1.10 MORE THAW 4Z JUCRES BELOW ftUCHES BELOW II1.1AL GRADE AVVILIM OEpr" OF EXCAVATIoo FXom OWWAL 6itAVa WILL BE mi.Z- t""'MUM 05Pn1 OF EACA1/AT10►J F}\011 O�16WAL• (jRAPV- WILL BC INCHES I If\1CHC5 SIGUCD: LICr jSC L)UM5E11:� DATE: 110 f Wiswrmn ent UtborandHupar Relate industry. SOIL AND SITE EVALUATION REPORT Labor and Human Relations Divisio6 or safety 6 Bindings in accord with ILHR 83.05, Wis. Adm. Code Page 1 of 3 Attach complete site plan on paper not less than 8112 x 11 i izq .Plan must include, but not limited to vertical and horizontal reference point (BM) n o j Pe, scale or dimensioned, north arrow, and location and distance I oad. APPLICANT INFORMATION -PLEASE PRINT NF�ION �r COUNTY St. Croix PARCEL I.D. * 026-114-30 REVIEWED BY DATE PROPERTY OWNER: ,L 1'PROPM LOCATION Derrick Construction, Inc. ao r GOVT NE vA SW ve,S 1 T 30 N,R 18 F4or) W PROPERTY OWNERS MAII.ING ADDRESS ICA 1505 Hy. #65 T LOCKt SUED. NAME OR CSM • ?':�"' ,p na Willow River Meadows CITY, STATE ZIP CODE P New Richmond, WI. 54017 (71 ER n�' QVILLAGE ®TOWN INEARESTROAD Richmond ( ;j New Construction Use JK ] Residential / Number of (] Addition to existing building [ I Replacement I ) Public or commercial describe Code derived daily flow 450 gpd Reomended design loading rate • 7 bed, gp(W • 8 trench, gpdnt2 Absorption area required 643 bed, Ill 563 trench,112 Maximum design loading rate • 7 bed. gpolft2 -8 trench, gpdAt2 Recommended infiltration surface elevations) 99.02 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash flood plain elevation, if applicable na R S - Suitable for system CONVENTIONAL MOUND U- Unsuitable for system i ®S ❑ U I ®S ❑ U IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK &I S❑ U I[2S ❑ U ❑ S El U I❑ S fRu Boring # s tx Ground elev. 103. 224. Depth to limiting factor +86" Ground elev. 102.22 tt. Depth to limiting factor +82" SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell MOWN Qj. Sz. Cont. color Texture Texture I Structure Sz. Sh. ConsistenoelBoutdary Roots GPD/ft Bed friend- 1 0-12 10yr3/2 none 1 2msbk mfr aw 2f .5 .6 2 12-32 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 32-86 7.5yr4/6 none co s Osg ml na na .7 .8 Remarks: 1 0-8 1 2 8-25 10yr4/4 none sil lfsbk mfr gw if .2 .3 3 25-32 10yr4/4 none sl lmsbk mvfrCrw na .4 .5 4 32-82 7.5yr4/6 none co s Osg ml na na .7 .8 Remarks: Name: —Please Pnn Gary L. Steel rfe„- 1554 Oqth. ave. , New Richmond, WI. 54017 71 cstm 02 PROPEFrryOWNER. Derrick Const. SOIL DESCRIPTION REPORT PARCEL I.D. # 026-114-30 Page 2. of 3 - Boring # 3 Ground Nev. 102.02 it. Depth to limiting bw +8219 Boring # 4 Ground elev. 102.92 ft. Depth to limiting %M +841, Boring # 5 Ground elev. 101.62 It. Depth to IM" favor +821, Boring # town Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Conscie !Boun:13y Roots GPD/ftid in. M-119- I iswri Qu. Sz. Cont Color Gr. Sz. Sh. I I 3— ITS-ch 1 ()-10 �-29 iQvr1/9 none none I sil 9in-thk lfsbk mfr mfr 9w if 1.2 .3 3 29-82 _iOyr4/�4 7.5yr4./6 none Co S I Osg Ml na na .7 .8 1 0-11 1 - 10yr3 /2 none 2msbk mfr 9w 12f 1.5 �.6 1 2 11-301 11 11 -30 10yr4/4 none sil lfsbk mfr 9w if .2 .3 3 30_84 30-84 7.5yr4/6 none Co S Osg Mi na na .7 .8 1 10-12 1 10yr3/2 none 1 2msbk mfr gw 2f .5 .6 2 12-301 10yr4/4 none sil lfsbk mfr 9w if .2 .3 3 30-82 7.5yr4/6 none Cos Osg Mi na -na .7 .8 Remarks: M-8330(R.05M) STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NEkSWk Sl-T30N-R18W New Richmond, WI 54017 MPRSW-3254 town of Richmond (715) 246�200 1 lot #4-Willow River Meadows N 1"=40' estop of SW lot survey stake at el. 100' 5. ��nEr2 Gary L. Steel 8-29-94 I 603.61 60 °� 'WSJ 425.10 Ou tlot 1 �/ 1.07 Aar ■ �'"O Jy 2.03 ACM N J�6 b1 M1 0 1 6 '$ 2.0: Aar '� N River m ' o ^i• ZOt AaM ?� 969 aA 2.02� p`W Aa66 1p� � n Meadows ^ A 15 � 2.0 w2.15 AaM 'r 14 305 2.02 AaM �. Y 206 ,,, 2J 13 '�a I 1 216 Aar Z033 ACM ) ??� .04 v / J 361.13 9 n 10 161.13 200 2 263.16 2.01 ACM , i 200 AnM a _ e w zoo"`"` 12 N 22 ZOt ACM 2.00 Acm a 206 216 135.29 e Public ii6 4M.7A m m 23 po R 2.00 Hems 2.22 � y5 2.p0 AGM `6 r'ra ►t � 0 269 206.30 24 SM.30 O4 d. .� 2.00 ACM 6 28 r► 2.02 ACM ry 2.27 Aar ` 51 mj 425.25 ,yOs s 1"33 25 0 Z01 Aar gam, 2.04 Aar "0.49 mm « 27 • rn m 2.33 ACM Zu ACM • 4 n o, T7.60 2.0 AaM 476.33 250.57 a 1 �.d? � 77.60 3 N N A o - 26 rm 2M Aa it, Aar w o N 507.06 30 4z6 211.03 u Zoe Aar 220 200 o 323.20 V N e 32 33 a ar 2 N n 2.20 ACM N 1.94 A O O 1.61, ACM �^„ 2.03 ACM Y 200.50 326.37 226 Highway GG "DERRICK CONSTRUCTION (715) 246-2320 Route 1 �o New Richmond Wisconsin STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St Croix County OWNER/BUYER _ \RltL,,_ow P�kvd'+ \�►,T VENTM✓ �M�u►c.t—t Q. St�vc—t-�S MAILING ADDRESS 1SoS 1}tl�NwpX cow lJ�-w �( 1{MONO All 540 �'1 PROPERTY ADDRESS 1 -1 c, 4 lz} qC , ST (location of septic system) CITY/STATE %w btu+ MONK, VH 1 54o i 1 obtain from the Planning Dept. PROPERTY LOCATION 9 E 1/4, N t 1/4, Section I , T 30 N-R M W TOWN OF VA CAA MoN D ST. CROIX COUNTY, WI SUBDIVISION WI LA o w V-tv %y- M 6Ap o w 5 LOT NUMBER 4 CERTl1FIEDSURVEY MAP , VOLUME , PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Me, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three yearApiration date.,, SIGNED: DATE: q — Z — 9 y St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 STC-100 This application form is to be completed in full and signed by 'the owner(s) of the property being develo ed will only result An delays of the permit developed. e- '. Shny ould this development be intended for resale by owner/contrachtord this house), thenla second form should be retained and completed when the ►(spec property' is sold and submitted to this office with the appropriate deed recording. ----------------- - STEv��» property Wiu-ow v�L ,o--------- Owner of pro VFN Ilt MIUiAEL Location of'propert r S Y �_i/4 �t 1/4 f Section � Township�► T � N-R �'� W Mailing address ISO S N� w R-1 cam-+ M o "o fin! i Address of site t Subdivision name V/ i i..t_ow P, ox 0 o v.. S S 4-0► -1 Other homes on property? _yes X No Previous owner of property • M Total size of parcel Date parcel -wag created 10 - iA - nL up \Ni 54o rl no. 4. Are all corners and lot lines identifiable? X _yes Is this ro ert No P property being developed for (spec house)? X Yes No Volume �_Gand page Number 4� b Of Deeds. as recorded with the Register INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEhD which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. fln addition, a certified survey, if available, would be helpful so as to avoid to a delays of the reviewing process. If the deed description references Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify .that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owners) of the property deescribed in this information form b warranty deed recorded in the office of the Count Re Deeds as Document No. 455 z0 Qn Y virtue of. a and that I Y Register' 'of own the proposed site for the sewage disposal system) or I e(Wel othe btained an easement, to run the above described property, for id system, and recorded tin cthenoffficeaOf County Registers of ame hadeeds been Document No. 4�S2o(o g atur of appl cant Co -applicant Date of signature Date of Signature �- Ion$�ro■i - .�..� December 9, 1994 Derrick Construction P.O. Box A New Richmond, Wisconsin 54017 ATTN: Mike ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 RE: Septic Inspection for Willow River Joint Venture Address: 1754 144th Street, New Richmond, Wisconsin Dear Mike: An inspection of the septic system for the above address was conducted on November 16, 1994. This property is located in the NE$ of the NE; of Section 1, T30N-R18W, Lot 4, Willow River Meadows, Town of Richmond, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a four (4) bedroom home. Should you have any questions, please feel free to contact this office. ly, es K. Thompso �— istant Zoning Administrator mz CQ �' 00 P13