The URL can be used to link to this page

Home My WebLink About026-1173-28-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556391 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: Letourneau, Ne & Barbara Richmond, Town of 026-1173-28-000 CST SM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 100 0 J" 20.30.18.1382 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t' CAPACITY STATION BS HI FS ELEV. r Septic t~ 1 Benchmark Dosing Alt. BM r~ L JA=S • L: /V (f 2-Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION 7.17 `i 7,,Y:; TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic 1fi Dt Bottom ~ Dosing J Header/Man. L., Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head Ft Forcemain Lengt Dist. to Well ` SOIL ABSORPTION SYSTEM BED/TRENCH Width Length/ No. Of Trenches PIT DI ENSIGNS N0. Of Pits Inside Dia. Liquid Depth DIMENSIONS L! ad- /,-e 1_... _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~st~r l Type Of System: UNIT "►t~.X_ S~ Z /wA- Model fyLp]L7e >t r/ " 't_ I DISTRIBUTION SYSTEM kj 2-1 ; J,,• Header/Manifol Distribution x Hole Size x Hole Spacing Vent o Air Intake y Pipe(s) \ ~ Cos C-^~. LLength Dia Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only E' l', Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bedrrrench Center Bed/Trench Edges Topsoil Yes No W, ~ El es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1446 109th Street ew Richmond, WI 54017 (NE 1/4 SE 1/4 20 T30N R18W) Waldroff Meadows IV Lot 28 Parcel No: 20.30.18.1382 .t / 1.) Alt BM Description 2.) Bldg sewer length = 3 - amount of cover = + e Plan revision Required? ❑ Yes No ( 17 4Z Use other side for additional informatidn. SBD-6710 (R.3/97) Date Insepctor Signature Cert. No. i County t f t. r Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 91 `nary Permit Application f,,, State Transaction Number In accordance with SPS 38 1 Wis. Adm. Code, submission of this form to the approprih,gov a un l is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS UT4 subr~i itted to jest Add s different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used o ondary purposes in accordance with the Privacy Law, s. 15.04 1 m Slats. Q L Application Information - ase Print All Information Property Owner's Name 1.3-qrb"r,0__ Parcel # Property Owner's Mailing Address Property Location Govt. Lot C • City, State Zip Code Phone Number Section (circle one) S T ?4n N; REor~ ,II,,. Type of Building (check all that apply) 0 ~ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name / D ` ~ Bl # ❑ Public/Commercial -Describe Use /L ❑ City of ❑ State Owned - Describe Use 7 _ CSM Number ❑ Village of Z b- 4-- at, Z/ 4-zz / l~t/1C~~tDi ,ownofoe III. Type of Permit: (Check ly one box on line A. Complete line B if applicable) A' New System ❑ Replacement System Treatment/Holding Tank Replacement Only El 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 Z:Z ti . IV. Type of POWTS System/Component/Device: Check all that apply) ['IY n-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil i p ❑ Holding Tank ❑ r Dispersal Component (expl n) ❑ Pretreatment Device (explai _ V. Dis ersaUTre went Area Information: Design Flow (gpdYJ Design Soil Application Rat sf) Dispersal Area Required (sf) Dispersal Area Propo d (s System Elevation r7 I VI. Tank Info Capacity in Total # of Manufacturer / Gallons Gallons Units 4`~ um ob U h Y New Tanks Existing Taroks 2 0 B y c~ P. U & m A 2z a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum Si MP/MPRS Number Business Phone Number 3 /moo /7 10 dl~3o~l zli Plumber's Address (Street, City, State, Zip Code) VI d. Coun /Department Use On improved Permit Fee Date T d Issuing t Signature p tvenReasonfor nial q7✓' 1 Z'" IX. ConditBllL>IWN100 tld!tWeasons for Disapproval 1. Septic tank, effluent fiker end 100 dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AO tlDOWk requifemenfa must. be maintained 'as Im bie Oodq. Attach to complete plans for the system and submit to the County only on paper not less than 8 to a 11 inches in size SBD-6398 (R. 11/11) d f ron VJ / DO r 3 J15 7 ~e ~G Y P .Co f of 3 J:flo ✓rfc I* Im 111-5 Its v o~ s - KNUDTSON PLUMBING & v f CONTRACTING, LLC S 927150TH ST. 648447MPRS 'p ROBERTS, W 154023-8525 /051-470-1737 '00pO-71;ell et") CELL I E / 7L4 rte(.- /I 2R CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Letourneau System Owner's Name: Neil Letourneal Owner's Address:d CA 42U,,, rj2E:z Z=J6 Legal Description: NE 1/4 SE1/4 Sec 20 T30 NR 18 W Township: Richmond County: St Croix Subdivision Name: Waldroff Meadows IV Lot Number. 28 Parcel ID Number: 026-1173-28-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson License Number. 648443 Date: Phone Number (651) 470-1737 Signature ` Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Y VV d jdAl Ofr roon p`/° #DO ` ICJ -/olyo f2- IL p- o ~r~ von n! ®ST Clpn4ei5 " v s ~i(JGt v -;FF /7I-G q 4~o c,<,S j/ KNUDTSO CTING PLUMBING & L v LLC CONTRACTING, G o Z-_p .S 927150TH ST. 648447MPRS p ROBERTS WI 54023-8525 ,,APO CELL 1-470-1737 /v,/ Z /-c- 7LD u•-17 2q~ Sop Ab*R tlra on System CMN Section 101.90 ft 4. Schedule 40 Final Grade PVC Vent P With Vent C p . t Leaching 98 Chamber .50 ft ~ System Elevation Sou Absowdon System Plan A _ft -yff--f t Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Die. Trench 2 Header Leachtna Chamber Seectflcafons Manufacturer And Model Infiltrator Quick 4 EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpolsq ft 600.00 gpd Design Flow + 0'70 Soil Application Rate + 20 EISA = 43.00 Chambers 2 rows of chambers each. ~Zt? i Page of 1. l 0 r Filte r PL-52 ' 5 EFFLUENT FILTER The PL-525 Filter is rated for 4 r over 10,000 GPD (gallons per day) 1116" Filtration Slots AWm making it one of the largest filters in its class. It has 525 linear feet E of 1/16" filtration slots. Like the E Polylok PL-122, the Polylok WC PL-525 has an automatic shut` off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. i 95 Unm Y No other filter on the market can Ffl aWm F make that claim. 1aaoo coo PL-525 Maintenance: SM 40 F" The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. j AuMmaticSM-Off 1. Locate the outlet of the U.S. Patent No# s,o15,48a WWWnFiWis 5,871,640 septic tank. 2. Remove tank cover and pump tank if necessary. -525 Ii' staff ton: 3. Glue the filter housing to . 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and com- the filter is not centered Pull PL-525 out of the housing. merciat waste flows up to under the access opening 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD), use a Polylok Extend & Lok. or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. and completely inserted. 5. Replace and secure the septic 7. Replace septic tank cover. tank cover. 3'civafe o.Bite W axes` Treauumt Sysftm In-Groat Mamagemmt Pa IDSE'S 38:1.54Vibe. AdnL CodecuklAV81a OnsdaWastclookx Ticsimcut syskM(POWM).9" kthKIC audpmwkM t ft systcM of SPS 383 aid 3K amd fbe of appmvg by *c or Unit MW moved pbos and peas far the system -w1 be filed w t*5 cOMoty g or hem pbnASPS 383.5+1,,Vrl& A im. Cctdikand a Sw'i. pdm Cc Muster Prime Onshe Wes'Treatment Systems (Veasim 2 ) SBD-10705-P (N-01101) Table 1: System Design Specfficatims + NU= ber ~Bedmc~s - fiber son Stu A-3 PUMP Tauic - CAL _ _ chamber Cap&Cft GaL - f L/ U _ T ofd ° ~ Table 2Z Sal ANMptim Comp rt -Limns ofReliable Operaivn se is-T Des FLT Marx. hdipant Partidie size NA ;f8-inch A Bw:5 NA 1220 hfudiuMTSS(MA NA. ISO Msxigm FOCT NA 30 Table 3: A&fiatenance SchedLle Septic Taal mdkw wrViae on= evay 3 t)otiet Fitter" Sborld ' anoe Ayeff and clean= needed on= fxcg 3 yamw- if appEcable, Sail Service Prov ` 71 5-186-468M- POWTS Re lator it Croix Zaning ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Opt net %Buyer ke A, I l,P~vyr Mailing Address -o /O h ~~lpr•~ / u, Property Address Z A16 C-9 (Verification required from Planning & Zoning Department for new construction.) City/StateAw A0 Parcel Identification Number Qom( _1177a?F-460 LEGAL DESCRIPTION Property Location /05 'i , Sec. p7 0 , T 3N R_I:F W, Town of A:G4-lnewid Subdivision Plat: QQC p~ V , Lot #D~a . Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house yes no Lot lines identifiable yes 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 waste\vater 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 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 of a wa qty deed recorded in Register of Deeds Office. L Number of bedro _ SI A OF APPLICANTS /l?lLa 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) 965761 BETH PABST F REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2 - 2000 Sr. cROIx co., WI RECEIVED FOR RECORD i Document Number WARRANTY DEED 10/22/2012 08:00 AM THIS DEED, made between North American Banking EXEMPT # NA Company, a Minnesota banking corporation, Grantor, and REC FEE: 30.00 Neal Letourneau and Barbara Kay Letourneau, husband and TRANS FEE: 51.00 Wife, Survivorsip Manta rop i€e. PAGES: 3 Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, **The above recording information a verifies that this document has Wisconsin: been electronically recorded & returned to the submitter SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF ' Recording Area Name and Return Address: Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 1007139 O Exceptions to warranties: 026-1173-28-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) This is not homestead property. Dated this North American Banki g Company, a Minnesota banking corporation BY: i Bradley . H kle, President WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 3 i Exhibit A Legal Description Lot 28, Waldroff Meadows IV, St. Croix County, Wisconsin. f WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 3 of 3 81 YwO gpmpp' R NbM11 p•pppY • Msww ~pp~y► ~ .wwwAn ,~wa•s NM9"360E 101&950 -145th Avenue Wwwwa WIIIIW~ IIMw w iM1lAr r N~ _ 1wMYn 0. p•YMlpe www•s N w R wwwww M awMK V9Me• J ~y A 6p 4 ww N 33 w . gt IP~EtRWRWWRdt1PR4~iteb 4tdc~q~IF~adsti►~!l~~1Ra9IE~W~IBNewkW9t96 a6 i s k as a s ~ a s w.w~ aaarx o . _ T. 12 8 p 1 . 999 q Cd WW 87,073 SO. 04 Q 46 qt X39' L M R 6 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 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. Pending percent slope, scale or dimensions, north arrow, and 22lkgo anddistaw* to nearest road. 26. - _QF ~t76v L Re ' wed Date Please PTint all o Personal information you provide may be used for frdary purposes (Privacy Law, s. 15.04 (1) (m)). GL' / U Property Owner s : ;?:tPropertyLocation /ZO 1!1 David Waldrof Govt. Lot NE 1/4 SE 1/4 S 30 N R 18 E (or))WW Property Owners Mailing Address Lot # Block # Subd. Name CSM# 398 River Road ZONlhly:Ir`y 28.,'` _ Waldroff Meadows IV City State Zip Code Phone Number ily Village ■ Town Nearest Road Hudson WI 54016 ( 715-549-6601 144th Avenue New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement Public or commercial - Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable lk4A ft. General comments and recommendations: ❑ Boring # D Boring 0 Pit Ground surface elev. 101.90 ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f ? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0-8 10yr3/2 - sil 2msbk dsh as 2f .6 .8 2 8-19 1 4/4 - sil lmsbk dsh cw if .4 .6 3 19-24 7.5yr4/6 is Osg dl cw _ .7 1.6 4 24-90 7.5yr4/6 s Os dl - - .7 1.6 5 l) 2 Boring # Boring 101 0 >90 Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eif#2 1 0-11 10yr3/2 sil 2msbk dsh as 2f .6 .8 2 11-17 1 4/4 sil 2msbk dsh cw if .6 .8 3 17-24 7.5yr4/6 - is Osg dl cw _ .7 1.6 4 24-90 7.5yr4/6 - s Osg dl - - .7 1.6 5 ~I 1 " Effluent #1 = BOD > 30:5 220 mg/L and TSS >30'< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/- CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, W1 September 8, 2004 715-246-2454 Waldroff Meadows N Pending Property Owner Parcel ID # Page of ❑ Boring #U Boring 3 Q Pit Ground surface elev. 99.12 ft. Depth to limiting factor in. in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr3/2 - sil 2msbk dsh cw 2f .6 .8 2 10-20 1 4/4 - sil 2msbk dsh cw if 6 .8 3 20-25 7.5yr4/6 - 1s Osg dl cw _ .7 1.6 4 25-90 7.5yr4/6 - s Osg dl - - .7 1.6 ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring # Boring F-1 spit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 " Effluent #1 = BODS > 30:5 220 mg1L and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mglL and TSS < 30 mg1L i 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. SBI3-933MA (8.07/00) it it Waldroff Meadows IV Lot 28 .c. t `°l100 N a~ NOq 5~ a 5 3 %0 Scale 1 = 30' BM1 Top of iron pipe 100.00 BM2 Top of iron pipe 10a.10 B1 101.90' B2 101.40' B3 99.12' Thomas Nelson 227387 aM Z