HomeMy WebLinkAbout026-1296-26-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No 561083 0
GENERAL INFORMATION (ATTACH TO PERMIT State Plan ID N4/&-y/5/ O 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
Oeverin , Kenneth J. & Am aro Richmond, Town of 7i 026-1296-20000
CST BM Elev: Insp. BM Elev: BM Description: Sect n/Town/Range/Map No
G5 _f 07.30.18.155
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
i
Septic J ~~l Z 1660 Benchmark
' g Alt. BM 5V ~ /fir
Aeration Bldg. Sewer q ~7
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
~J . ?L• C,o
TANK TO P/L WELL BLDG. CUeRtii?Air Intake ROAD Dt Inlet
Septic 5Z Z7 Dt Bottom
Dosing ✓ Header/Man.
Aeration Dist. Pipe 14. Z
I t. .t
Holding Bot. System 11.3 'fs • L
l~
PUMP/SIPHON INFORMATION Final Grade S. z 161,3
Manufacturer Demand St Cover
/f J-
GPM YY'• ~•b I'
Model umber
TDH Lift Friction Loss System TDH Ft
Forcemain Leng Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Leng h No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D th
DIMENSIONS "3' ^ Z, re, _
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: r
INFORMATION CHAMBER OR ~-r (T7 ac
Type Of System 4Z UNIT Model Number: T J
DISTRIBUTION SYSTEM /L4-/l, = 3 F
rHeagdter/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
/ Pipe(s) L' nh _ Dia / Length **1_1 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 M ched
Bed/Trench Center / Bed/Trench Edges \ Topsoil
/ nI Yes No Yes [ No
COMMENTS' -(IInclude code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Locatlon~WOth Street Ne Richmond, 154017 (NE 1/4 SE 1/4 7 T30N R18W) Country View Ridge Lo 25 Parcel No: 07.30.18.155(
1.) Alt BM Description = ri ~ - _ J C'..- LOX 6 I,,
2.) Bldg sewer length = /
AA n n
- amount of cover = Z ~ * AJ d~ Z a
6 +C 5 6
~d?
Plan revision Required? ❑ Yes ❑ No U Z,/ 3]
Use other side for additional information. L L L J
SBD-6710 (R.3/97) Date Insepctor' ignature Cerl No.
r County
Industry Services [division J
1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
Box 7162
Madison. WI 53707-7162 CO ~
S !tar Permit Application 2p1 ~tateTranyattionN1,M, t
Y
rn accordance P .183 (2), Wis. Adm. Code, submission of this forth to the appropriate govH1,,1 ntal unit _
is required pri r t tair a sanitary permit. Note: Application forms for state-owned POWTS areStt t6~0, Project flddr~Ss (If iflerent than
the mailing address)
Depart Saf and Professional Servies. Personal information you provide may be used fo secondaN /(p
Ur oses in a ance with the Privacy Law, s. 15.04(I)(m) Slats.
1. A lication Information -Please Print All Information
Property Owner's Name
Parceltl 1
Z_ C, 6 Z
Property Owner's Maili dress -
1 _z Property Location C
City, Slaty ) 't'-, 0~ Govt. Lot. - - - 1557
~
Zip Code Phone Number
/22 5e Section
t I S7 role o
II. Type of Building (check all that apply) o f 3 I). N; R _ O_ h u( W1
or 2 Family Dwelling- Number of Bedrooms _ Subdivision Name `,-J- - -
6k L Bloc - C~u n
❑ Public/Colrnnercial - Describe Use X91 C..V-Nl_ } -
J! i,~~d ❑ City of
C State Owned - Describe Use _ CSM Nmn C1 ) Village, of'
n rr rr ~ ( D
Z IJ S 1r ll w 1/ua ~lD 5 -_-Qt` ~,~t two own o l, I15
lll. "Type of Permit: (Check only u e box on line A. Complete line B if '41,120 - - --t1l
A, -
New System ❑ Replacement System ❑ Treaurlent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal Permit Revision List Previous Permit Number and Date Issued
❑ Change of Plumber ❑ Permit Transfer o New
Before Expiration Owner n
fV. a of POWTS S ,!tern/Component/Device (Check all that apply)
on-Pressurized In-Grou•id D Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. o1'suitlble soil Q Mound < 24 in. of suitable soil
❑ Holding Tank C Othe" Dispersal Component (explain}_-- [J Pretr ;abnent Device (explain)-- n
V. Dis ersal/7'reat 11t Area Information:
De ign Flow (gpd) Desin Soil A lication Ra - -
fpp (gpdsf) Dispersal Area Required (sf) Disi ersal Area Proposed f) System Glevatio I
VI. Tank Info • Capacity in Total ~4 of
Manufacturer -
Gallons Gallons Units
a' O b V
New Ttmks Existing Tanks
C 1 a V %J n w 0 a
Septic or Holding T:aik - - - - - } _
Dosing Chamber
T~'~ _ V11. Responsibility Statement- 1, the undersigned, assu r ponsibility for installation of the PO WTS shuwn on the attached plans.
Plum r- Name (Print) Plumber' ature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip ode)
Vill, ount /De artment•l)se Olily -
Approved o,ed $ermitit Fee Date Isssued~ Issui,g A t Signature
lven Reason or 1 V J ' C>C> $1) / 1 3
IX. ConditftVWj,,9WNjjj~asons for Disapproval - _1 1 - - -
f. Septic tank, effluent filter and ~Q►~x2.~ ✓YIUtSd- a l.d 2-(o ar'oa
4spersal cell.must all be s f 'nt W ~ S as per management plan provided by plumber. W a dL eQ c J7O • AN setIck requirements mutt be mafntahaillrt
f U
- as wr ao~I. eels r~ti.,>.,~.~
A:Cach to complete plane for the system and submit to the County only on paper not less than 8 I/2 x 11 inches a. seize
SBD-6398 (110313)
PLOT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 11/4 SE 1/4S 7 /T N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/6/13 BEDROOM 3
CONVENTIONAL XXX IN-G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter BEARFilter
❑BOREHOLE O WELL IH.R.P. Same as Benchmark
SYSTEM ELEVATION 96.7/96.6 4.5' below qrade
Well is to meet all
setbacks required by
WDNR
Plans Designed Using
Conventional Powts
Manual Version 2.0
Scale is 1" = 40'
unless otherwise
noted
308' Property Line
125' Property
Line
2-3' X 66' Cells with >3' Spacing
B-3
0% Slope B-2 ST Pro 3
0' 30' Bedroom
House
Vents
70'
50'
B-1
* 10
B.M.
20' 70' 307' Property Line
. 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
5.6ft^2 pair of end plates Finish grade elevation
Typical Installation 101'
Vent Grade Vent
3' 4„ 3'
~~30/34 :Se:ptank
Long 1 5~ 5' Long 1 91
Grade at System Elevation
36" Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A-96.7'
B 96.6'
POWTS OWNER'S MANUAL & MANAGEMENI PLAN Page of-.__.
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ~i , - C~~ Septic Tank Capacity saI ❑ NA
- r _ L~ &
Permit # Septic Tank Manufactur er lu ru - ~ ❑ NA
DESIGN PARAMETERS - Effluent Filter Manufacbarer j- Q NA
Number of Bedrooms ~w I] NA Effluent Filter Model ❑ NA
Number of Public Facility Units 'ANA Pump Tank Capacity al 3 NA
Estimated flow (average) 2 Pump Tank Manufacturer NA
- - - - ; '~--dal/day
Design flow (peak), (Estimated x 1.5) Pump Manufacturer ❑ NA
Soil Application Rate z Pump Model NA
Standard Influent/Effluent Quality Monthly averagefi. Pretreatment Unit - Y NA
Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/I_. ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (-SS) _1f,(a mg/L ❑ Disinfection ❑ Other:
- - - - - -----Y -
Pretreated Effluent (duality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODs) 53C mg/L -Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <3C mg/L >~NA ❑ At-Grade Ll Mound
Fecal Coliform (geometric mean) 510' cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size it dia. L1 NA Other NA
clther: A Other: NA
*Values typical for domestic wastewater and septic tanl; effluent Other. - - - NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
11 month's) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every;
'R Os
year Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume _ ❑ NA
Inspect dispersal cell(s) At least once every: ` ❑ months s)
- (Maximum 3 years) ❑ NA
ear s.
❑ months s)
Glean effluent filter At least once every: earth; C] NA
Inspect purnp, pump controls & alarm At least once every: monthls) NA
year s
- - - ❑ (
Flush laterals and pressure test At least once every: ❑ month's) NA
Cl year(s)
other ❑ month's) T -
At least once every: NA,
year(s) -T--
Okher:
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWT:S Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and to check for any back up or ponding of effluent on the ground si irface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
l-he ponding of effluent on the ground surface may indicate a failing condition and requires th,~ immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of tl le tank volume, the entire contents of
the tank shall be removed by a Septage Serficing Operator and disposed of in accordanc,3 with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressur zed components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of an, service event.
Page, of
START UP AND OPERATION
For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of panting products or other chemicals that
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage, Servicing O:erator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the Bump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
t5 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater strearn may irnprovo the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap; ; medications-, oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings seale.i.
The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
+ After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacer rent system:
77suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the i~iplacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in PowTs technology a
holding tank may be installed as a last resort to replace the failed POWTdr.
❑ The site has not been evaluated to identify a suitable replacement area. Jpon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following nrmoval of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WARNING»
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlON, INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER _
N Name y
Name
Phone 7i~--may( /Jo Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name L Name
Phone / / J ' of T l ~7 Phone/.J = i
Y
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wiscoi )sin Administrative Code.
CARTRIDGE INSTRUCTIONS
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SON4'9 0311 BTdNt~
Wisconsin Department of commerce SOIR PORT Page of
Division of Safety and Buildings
in accordance 'h Comm 85, Wis. Adm. Code minty X
Attach complete site plan on paper not less than 8 1 /2 x 11 inclNt h si.. Rlaq 09$ L
include, but not limited to: vertical and horizontal refere point (BM), direction and' Parcel I.D.
percent slope, scale or dimensions, north arrow, and to tion st road
ZONING OFFICE Review by Date
Please print all inform ~p /J~ d5
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.040) (m)).
properly Owner Property Location
n {r ; / ~ y~ Z Govt. Lot 1/4 •SF_ 1/4 s7 T.36 N R/d E (o W
Property ees Mailing AddrgK; t# Block # Subd. Name or CSM#
~j 3,-) X ~7 IJ.~.R. lo%~ 210 01 110u~ ~ /6' 2i-
city / State Zip Code umber ❑(;lty ❑yllage To Nearest Ro /
ec~e ,'toll i ~J / t ) Cry~v/r, M?
el 'W New Construction Use: esidential ! Number of bedrooms Code derived design flow rate fZ> GPD
❑ Replacement ❑ Public or mmeraal - D scribe: f~ - - ft
Parent material Flood Plain elevation if applicable
General comments and recommendations: 5`
C4,9 "V
Se_
Boring
Bori Mng# /
Pit Ground surface elev. W/, 2ft• Depth to limiting factor l( y in. Soil Application Rate
Roots •EGPD Eff#2
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary
in. Munselll Clu. Sz. Cont. Color Gr. Sz. Sh.
I L Al- I r, 2Z_ E_
nA-
a Boring # Boring f~
Pit Ground surface elev. ~ft. Depth to limiting factor &Ori- Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots °E GPD/fF
in. Munsell Clu. Sz. Cont Color Gr. Sz. Sh.
C--r-- 2aq -to 2
2-
o
~ y-
Il
II
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:5 15*mgA,,/, Effluent #2 BOD < 30 mg/L and TSS < 30 mg1L
CST Narns (pl~ Print) _ SCST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5401 Jam-"' C ,o 715-246-4516
i
Parcel ID # Page of
property owner -
a Boring # Pit D ft, Depth to limiting factor in Soil ication Rate
3 Boring Ground surface elev
Horizon Depth Dominant Color Redo- Description Texture Structure Consistence Boundary Roots GPDR
`Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
i ~..177- p 3/ 5i Zr7' r cs 2 D
2 I Z-'1 ID . si C r Z s !c f"J'y- LA .
/I
❑ Boring
F-1 Boring # ft. pit Ground surface elev. Depth to limiting factor in. Soil lication Rate
❑
Roots GPD/ff'
Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary •Eff#1 'Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
❑ Boring in.
pit # Ground surface elev. ft. Depth to limiting factor .
❑ Pit Soil ication Rate
Roots GPD/ff
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary •Eff#1 'Eff#2
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh.
' Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 150 mg/l_ ' Effluent #2 = BOD5 130 mg/L and TSS 30 mg1L
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.
SOD-8330 (8.6/00)
. Soil Test Plot Plan
Project Name Country View Ridge LLC Shau it
Address P.O. Box 176
New Richmond Wi 54017 M #226900
Lot 22& Subdivision Country View Ridge Date 5/20/05
NE 1/4 SE 1/4S 7 T 30 N/R18 W Township Richmond
M Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron/Nail
System Elevation 96.7/96.6 *HRpSameas Benchmark
Scale is 1" = 40'
N unless otherwise
noted
308' Property Line
10
125' Property
Line
B-3 B-2
0% Slope
70'
50'
B-1
*
B.M. 10'
20' 70' 307' Property Line
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWri'ERSHIP CERTIFICATION FORM
Owner/Buyer C'v a r-.lv- 1 ff x , C
Mailing Address
Property Address Department for new construction.),
(Verification required from Planning & Zoning
Q L F--7 r ~ l A
City/State Parcel Identification Number 26 _*~T7)
oZe - tzR6 -
LEGAL DESCRIPTION
Property Location r r c. T ~N R1_-•"-W , Town of/~I
N ~ a , Se
~ Lot # O~ Ip
Subdivision #
Volume Page#
Certified Survey Map #
Volume Page
Warranty Deed #
Spec house yes 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 w~ s.~ap ut into
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper' you p
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 es to submit to St. Croix County Planning & Zoning Department a certification form,
signed by the
The property owner agre
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that the on--site
s tank is
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping C necessary), the septic 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
prop described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE AP (S) ( DATE
Any information that is misr d 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. 08105)
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. Disch r e into system is not exceed those required as per Comm. 83
ntingen y Plan
(=0in . 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
i
Shaun Bird #226900
11911110111111111111111111111111111111111 IN
* 0 5 7 1 2
900571
STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Country View Ridge, LLC, a 07/22/2009 08:00AH
Wisconsin limited liability company, Grantor, and Kenneth Oevering WARRANTY DEED
and Amparo K. Oevering, husband and wife, Grantee. EXEMPT
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 13.00
described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 541.80
PAGES: 2
Lots 3, 4, 11, 15, 17, 18, 22, 51 nd A6, Countr View Ridge in the
Town of Richmond, St. Croix nty, "Cousin.
Recording Area
l~
Name and R Address:
Oranzo O Bring
PO Bo 79
New ichmond, WI 54016
See attached addendum
Parcel Identification Number (PIN)
This is not homestead property.
Dated this ((rday of ~:CIO , 2009.
Country View Ridge, LLC, a Wisconsin limited liability
company 1
y
* By: ()EA lj p Dfa)h )
* * By:
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
COUNTY OF ST. CROIX ) ss.
authenticated this Personally came before me this day of
_ the above named Country
* View Ridge, LLC, a Wisconsin limited liability company to
me known to be the person(s) who executed the foregoing
TITLE: MEMBER STATE BAR OF WISCONSIN in nt acknowledged the same.
([f not, (i.~" c~~
t ( 4,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFCED BY * . 6~m6nn C)
Notary Public, Stake of Wisconsin
Robert L. Loberg V
Lobe% Law Office sw/ SFA7235 MY commissionti-s}permanent. (If not, state tio~n_d
(Signatures may be authenticated or acknowledged. Both are not necessary.)1~~
"Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
1 of 2
Tax No. 026-1296-03-000 (Lot 3 Country View Ridge)
Tax No. 026-1296-04-000 (Lot 4 Country View Ridge)
Tax No. 026-1296-11-000 (Lot 11 Country View Ridge)
Tax No. 026-1296-15-000 (Lot 15 Country View Ridge)
Tax No. 026-1296-17-000 (Lot 17 Country View Ridge)
Tax No. 026-1296-18-000 (Lot 18 Country View Ridge)
Tax No. 026-1296-22-000 (Lot 22 Country View Ridge)
Tax No. 026-1296-25-000 (Lot 25 Country View Ridge)
Tax No. 026-1296-26-000 (Lot 26 Country View Ridge)
2of2
'I
N88'22'35"E 507.00' 11n 7",
110.91' 186.24',-- 139.1o' 176.85'
Q 24.28 c' g
Easement 1% f 33.00-~ j- O I A
b
6 to
66 Z tt q>>0 Z N53101 30 E ^
I 0 0
r~ O 52931'12'E N' 123.98' N N I o N
on Pipe 3 81.17` 2 - 0 1 W 33' 33' I V)
- NAVD 88
43,587 sq. ft. c0 rn 46.280 sq.ft. W
e~ 46.278 sq.ft- I
5 a, 1.001 acres 1.062 acres to
4 cP LBO = 975.00 `z 1.062 acres LBO = 970.50 O LO
LBO 970.50 I I
= o t
43.568 s ft. i t
196.08 q' - N o co O t
7.000 acre O I i
LBO = 975-00 O -4
~ cv 0
i
Lo. i'---- 169. _ _ ' tlt { N p li
gyp. _N_85U4~Z5'W - Y-4.76 3 q I k (n,
- Ads 164.27'- t • Found East Ouorter Corner
Drainage W 2~'0 -'N89'22'50"E- Section 7-3a-18
5 Railroad Spike
Easement
~N \g 0, n 167.35 r
81,611 sq.ft ? 0 ~`r" P.O.B
1.874 acres
N02~56'16"w 00 2 ® r tr
t
LBO = 975.00 / tS 1 ~i o h !
42 16, '1(18.48' N89'22'50"E
I ~~0 '366• ® -167.35---1 ~t I
~bccµ
5e i i / O
N °o { I O
03
~ 287.2~~ ~ 4""~ 6~9 ~ ~ WI ( •
23 w M
24 I I 04
i Vk ~;P• 43,629 sq.ft. 43,580 sq.ft. CnI I 0
r 1.002 acres 1.001 acres
r' Pi N S,L1 19 a K ~!y o I ~f I ~l (N83 :33'40"W 1
r I .-1 I I
/-N26'12'26"W 6 115.62' 195.00 Y _ 1 pl
14 33 \ ; 55.87' X22 N8711 00"E: 310.62 o I I o? ~I
3~ t 1
i 5 i 87,548 sq.ft. 10 Q
p0 00
6 \ 2.010 acres aJ 0
15 ` I ~0 25 I ; Leo
V.- A 43,561 sq.ftM r- I ZI
1.000 acre O I ~l
\I 11 N89'15'45"E I - 1o0.00' q I ^ I
II 308.00 , I
ti1 1 i 1 N87'01'14"E 368.16 i i
i
26
it I 21 LO N I T 3 0 33' 33' I W r
I I 43,578 sq.ft. o p O
I 1.000 acre o c
00
75,935 sq.ft. r ( > o r-
1
1.743 acres U Z o o M I I M n Note: U) Z 04 Y' 1 w o i IC) N The
o i S83' "
o o ~t 51'32 E 307.95' Per t
;rl i ; o I becoi
h 4t z i rn I a I w ~u to th
i o/ iv ( 100,
S8724'23"E 398.77' I I Then
01 no
buildi
2 7 0 1 00 00
2 O `f in 00 Z I w <n Lots
2 2 / a N 80,672 sq.ft. a, f\ °u I { Lots
17 83,879 sq.ft, to 1.852 acres I t
1.926 acres O ?c d
100' N o I , Lots
06 m I I East Line of the Lots
I , Southeast Ouarter of
t Section 7
g, - ` 19 \ N89'18'55"E 414.05' -----y, 33.00'- `c~ 1 I'
137.81' 276.24' 300.75'
/ S89'18'55"W 610.00'
(N8977J 1 E) I i I
Bench Mork ( 1
Top of 1' O. D. Iron Pipe
y Elevation 974.67 ft - NAVD 88
F
LL11 I
W / _ O
LL9 00
CO I<
0 W)
R/` m LOT 1 1u~i1~to i
to - I i
19 CERTIFIED SURVEY MAP I * i { 100
r ~N
i
a 85,690 sq.ft. Lt1 k I OI W
1.967 acres O y I UI I o I
LBO = 959.00 VOL UME 13 PAGE 37 2 I ~ I
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Wisconsir, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION,REPORT Sanitary Permit No:
488229 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:
Richmond Town of 026-1296-26-000
Country View Ridge LLC
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
07.30.18.1557
TANK INFORMATION ELEVATION DATA
TYPE MAN ACTURER CAPACITY STATION HI FS ELEV.
1k As . - ) eb-P& N
Septic enchmark OF %now
00F ;00
Dosing It. B
g. Sewer
Aeration
IN
Holding St/Ht Inlet
PD utlet
TANK SETBACK I I
TANK TO P/L OFF BLDG. Vent to Air Intake ROA Septic
Dosing Man.
Aeration Di . Pipe
Holding tot. System
final Grade~►.
PUMP/SIPHON INFORMATI N/ k
Manufacturer nd S over
Model Number GPM
TDH Lift Friction Loss S d ITt Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liqui epth
DIMENSIONS
SETBACK SYSTEM TO P/L LDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header/Manifold Distribution x Hole Size x Hole Spa g Dto tak e
Pipe(s)
Length Dia Length 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 Bed/Trench Center Bed/Trench Edges Topsoil ] Yes -II N es 17
1 No
i
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspecti 2:
Location: 1642 100th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 7 T30N R18W) Country View Ridge Lot 26 Parcel : 07.30.18.1557
1.) Alt BM Description =
2.) Bldg sewer length
- amount of cover =
I
Plan revision Required? Yes No ~ I
Use other side for additional information. -
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
f
rt.
t A j
J `•Mi.. , v'a's,,,
R J/v
1,13
4 t
.1.0 J
ty uildings Division County
. mgton Ave., P.O. Box 7162 L4, (r O
*6consin Madiso 53707-71622 Sanitary Pen nit Number (to be filled in by Co.)
Department of Commerce C: f, J= IV 1= I
N - Iq
0 0
Sanitary Permit App cation state Plan T.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal formation you ro de
maybe used for secondary purposes Privacy La , s15.N Nn)jj L0 0 6 oject Address (if different address1. Application Information -Please Print All Information ST. CROIX
COUNTY~ !
Property Owner's Name ~ P .el # T.ot # Block #
L
Property er's Mailin ddress Prope Locatio
• 1 I D r Section
City, State Zip Code Phone Number
l e)
T ~0 R E ~rcW
t,L_~ , j 5
I1.ype ofBuilding (check all that apply) 5 a _VLkA 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Num
❑ Public/Commercial - Describe Use (10 Lt r, t t (Ali rK ❑ State Owned - Describe Use ❑City ❑vina ip f
L
M. Type of Permit: (Check only one box on line A. mplete line ),I'if applicable) OZ6 - 129/0 2ro -C M . /55-?L
A stem ❑ Replacement System ❑ Trea t/Holrling Tank Repl t Only ❑ Other odificati system
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change ❑ Permit T u b u
Before Expiration Plumber 4pwner
I/ \ ~ VV 5,
IV. a of POWTS S stem Check all that apply) c 7_~ 2 0_ •t
Pressurized In-Ground ❑ Mound > 24 in. of suitable oil ❑ Mound < 24 ia. suitable soil ❑ At-Grade El Single Pass Sand Filter ❑
Constructed Wetland ❑ Press=hing nd ❑ 1H ldi Tank ❑ Peat Filter ❑ Aetiskic Treatment Unit 11 Recirculating Sand Filter ❑
Recirculating Synthetic Media Fi! Chamber ❑ Drip Line ❑ Gravel-less Pipe', Other (explain)
V. Dispersal/Treatment Area In rmation:
El
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis rsal AN Proposed (sf) PIM7
5 V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Uni 4ef- Concrete Constructed Glass
New Existing
Tanks Tanis
Septic or TloWng Tank ~
Aerobic TMIM eat Unit
Dosing Chamber
V11. Responsibility State - 1,.the undersign ume responsibility for installation of the POWTS shown on the attached plans.
Pi s Name nt) Plumber'.%Zi4idiurc MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, ' "p L-oe) 14
. Coun /De artment Use Only
Approved ❑ Di roved Sanitary Permit Fee eludes Groundwater Date Issued Issuin Agent Signal (No Stamps)
Surcharge Fee)
ven Reason nial 13 W
IX. Conditions o 1 %A
SYSTEM OWNED; 3~ OILE a,,, C v`
1 Septic tank, effluent filter and a- c / *r ~at u i C S S)
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintainer)
as per applicable code/ordinances
Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in size
S13D-6398 (R. 01103)
PL PLAN
PROJECT Countrv View Ridae LLC DDRES8 P.O. Box 176 New Richmond Wi 54017
NE J/4 SE 1/4S 7 /T 30 /R 18 W TOWN Richmond COUNTY ST. CROIX
i¢
MPRS Shaun Bird 226900 DATE 6/12/06 BEDROOM 3
CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 96.7/96.6 4.5' below qrade
Well is to meet all Vent
setbacks required by
WDNR >6" Sta d 'd Bio us °!S
`
of Cover Lea ber ~;)A
with 25.0 ft2 of Area
5' Long 11 "
3 4" Grade at System Elevation
Plans Designed Using Scale is 1" = 40'
Conventional Powts unless otherwise
Manual Version 2.0 noted
308' Property Line
125' Property
Line
2-3' X 65' Cells with >3' Spacing
B-3
0% Slope B-?_ Pro 3
0' ST 30' Bedroom
House
50' 70'
B.
20' 70 307' Property Line
p I I
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w~ a
o►~~ m
~ SONb'7 011 b'7dNn g6 -919,7, 3„*,f,9f-0
o ~'a
3.0 L,MO
66'088 3„0 l,L5~-OOS
Ob.O S~ •
M - - - - -
,ss•ZZ 1339J S ~lC YO I ----,£o•ZSL oHgnd OVA 01
,o*.oos - - ,oo s - - s L'L£Z- - - - - -,o9's~ I w -,09'09 L- - -
l0' 199 I g 1 M.0 l,L£.OON -
o (W - W I I g ( Iuawaso3
~ M to M Ca I i-I(DMaAliQ }UJO(` 130C
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U 2656 P 0 6 2
Exhibit A
Locate -
d in part of the SE of the +
NE the NE / of the SE ,
SW of the NE of Section 7, Township 30 North Range 18 IlWethe NW Y, of the SE st. Town of Richmond, aCounty
of St. Croix, State of Wisconsin described as follbws:l
Commencing at the East quarter comer of said Secb n 7, this also being the Point of Beginning;
Thence S00°37'10"E along the East line of the SE'/ of said Section 7 a distance of 880.99 feet.
Thence S89°18'55*W on the northerly line of a Ce ed Survey Map recorded in Volume 13, Page
3752 a distance of 610.00 feet; Thence S00°37'10"E on the westerly line of said Certified Survey
Map 428.42 feet (Record 428.50 feet); Thence S89'* 8'52"W along the south line of the N Y. of the
SE of said Section 7 a distance of 1146.36 feet Thence N00°3353"W 1384.45 feet; Thence
N88°57'22"E 1048.00 feet; Thence N~1 °00'00"E 25 .00 feet; Thence N88°22'35"E 507.00 feet to
a point on the East line of the NE Y4 of said Section• ; Thence S00°40'35"E along said East line of
the NE % of said Section 7 a distance of 248.0 feet to fhe Point of Beginning acrd there
terminating.
U 2 6 5 6 P 061 774Z3 12
STATE BAR OF WISCONSIN FORM 1 , 1999 KATHLEEN H. VALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIK CO., VI
RECEIVED FOR RECORD
This Deed made between Gerald A. Kieckhoefer Jr. and David
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:26AK
Ridge, LLC Grantee. VARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXW i
the following described real estate in St. Croix County, State of Wisconsin
(the "Property") (if more space is needed, please attach addendum): REC FEE: 13.00
TRANS FEE: 1410.60
See attached Exhibit A COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Name and Re
^ka J 7Q
A~cj turn Address
i
u A V\. 0-4-t - tc
26-1025-40-000
Together with all appurtenant rights, title and interests. 026-102430-000; 026-1024-40-000; 026-1025-30-00
Parcel Identification Number (PIN)
This is not homestead property
(is)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements, restrictions and reservations, if any, of record.
Dated this Zr4L day of , 2004
* Gerald A. Kieckhoefer, Jr. * David J. Ki ckhoefer
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gerald A. Kieckhoefer, Jr. and David J. STATE OF )
Kieckhoefer ) ss.
County )
authenticated this da of 45Cy*0W-&&1 2004
Personally came before me this _ day of
the above named
* Krist Ina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not, to me known to be the person(s) who executed the foregoing
• authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Kristina Ogland, Estreen & Ogland
304 Locust Street, Hudson, WI 54016 Notary Public, State of
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) )
" Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800-655-2021
WARRANTY DEED FORM No. 1-1999