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Home My WebLink About026-1017-95-000 I Wisconsin De of Commerce p PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 404934 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: Wilson, Tim I Richmond Township 026- 1017 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA o.1 0. at TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t W ►2 95.16 icro.o Dosing ILI Alt. BM Aeration Bldg. Sewer S fl v*l Lt 1 -40 I 1 * r Holding St/Ht Inlet r J .20 93. 1o " St/Ht Outlet r TANK SETBACK INFORMATION s' S 93•�of TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 Q t r Dt Bottom �tW 1 Dosing Header /Man. Aeration Dist. Pipe 7 31> Holding Bot. System .10 o $9 •�' Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover 1 GPM Model Number TDH Lift Friction L System Head DH Ft Force m Length j biT Dist. to Well SOIL ORPTION SYSTEM (I S 9684BEUCIL Width Length No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 ..J, ) CL SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manuf t er: INFORMATION CHAMBER OR !=X� 6 r Type Of System: y z —4661 UNIT Mq*l Number: CrJ DISTRIBUTION SYSTEM Header /Manifol Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s 7 40 1 Length Length Dia Spacing T SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ;i Yes No j Yes xl No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 NAAA / Of / 2°® Inspection #2: Location: 1170 105th Street New Richmond, WI 54017 (SE 1/4 NW 1/4 5 T30N R18W) NA Lot l �P�a - eiNo: - 1.) Alt BM Description = %.tbt 1 U ~ T "n .4 � S P length = at - a ' I t ed t. � • MZ E�t 20 2.) Bldg sewer l > ��l„�1S w - ` amount of cover = Sa ( toner "a " Ju,,L �) 2:eLk too � . A Lam, ,fe'^" M3 Plan revision Required? Yes X No e T Use other side for additional information. `)t — L_V4� - / Date nsepctor's Signature Cart. No. SBD -6710 (R.3/97) J J j� Safety and tuildings Division County 201 W. Washington Ave., P.O. Box 7162 visconsin Madison, WI 53707 - 7162 Site Add sz Department of Commerce j. _o -L Awl i 9llzjt RENO Sanitary Permit Application t Number F E P? 7 7 PY12 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide i evision g'{ C►Or may be used for second purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information State PlAp t�: Nurt�(,P1tX Prope Ow ner's Name Parcel Numbe Property Owner's Mailing Address Property Location dos,- s/ S ry )A; S T 3 0N,R E City, State Zip Code Phone Number Lot Number Block Number v Subdivision Name CSM Number H. Type of Building (Check all that apply.) ❑ City PW_ or 2 Family Dwelling - Number of Bedrooms O Village ❑ Public /Commercial - Describe Use ownthi ❑ State Owned Nearest jZoad ��> 2 3 93 -15 c s �?�C�n s c �.S, � III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. 113 New 3 O Replacement of 6 O Addition to System eplacement System Tank Only Existing System F For County use B ' ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) loU Non - Pressurized In- Ground 210 Mound 47 O Sand Filter 50 O Constructed Wetland 22 O Pressurized In- Ground 41 Holding Tank 48 ❑ Single Pass 51 Drip Line 45 ❑ At -Grade 46 OAerobic Treatment Uni 49 O Recirculating 30 OOther s V. Dispersal/Tr ent Area Information: L Design Flow (gpd) Dispersal Area Dispersal Area Sorl App Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) / // Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Z �� 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 lure MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Code) el-41S19vc? P./_,�j e SY01 - 7 VIII. Count /De partment Use Onl td Disapproved Date Issued Issuing Agent Signature (No Stamps) y�► Approved O Owner Given Initial Adverse Sanitary Permit Fee (includes Grordwater �) Determination I Surcharge Fee) 2�S Y�l11EfiE li j IX. Conditions of Ap$rovaUReasons for Disapproval 1G9►,st� t�. u,e tMC� `�-� o ,,�. �1" C �t.r o� t�v -}et�� rec,Bw�wt er�tS 6 Attach complete plans (to the County onlA for the #Istem on paper not less than 81/2 x 11 inches in size 136�, PLAN PROJECT Tim Wilson ADDRESS SE '1/4 NW 1/4S 5 / /R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE2 /26/02 BEDROOM 4 CONVENTIONAL )= IN -GR D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 IL BENCHMARK V.R.P. Top of nail in maple tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (D WELL sH.R.P. Same as Benchmark Vent SYSTEM ELEVATION 91.0/90.0 > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 6' Long 16 60' 3 4" Grade at System Elevation 0' RXR 90' lop 20' Vents ST existing to be 10' pumped and collapsed Vents ' 20' New ST B -1 f0' 5' 0 2 -3' x 94' Cells with >3' spacing Existing 4 Bedroom House W) 0 LOT PLAN PROJECT Tim Wilson ADDRESS SE 1/4 NW 1/4s 5 /T 30:' N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE2 /26/02 BEDROOM 4 CONVENTIONAL X)OC IN-GR47D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 514 # of chambers 30 BENCHMARK V.R.P. Top of nail in maple tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Vent SYSTEM ELEVATION 91.0/90.0 ALong Sidewinder High Capacity Leaching Plans Designed Using Chamber Conventional Powts Manual Version 2.0 6" 1 60 Grade at System Elevation 4 0 ' RXR °lo" 90' lop 20 Vents ST existing to be 10, pumped and collapsed Vents ' 20' New ST B-2 75 ' B -1 to' 5' 0 2 -3' x 94' Cells with >3' spacing Existing 4 Bedroom House 0 W i sconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code & L �d '* o Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County C r r / y include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0e ( - CO / 7 percent slope, scale or dimensions, north arrow, and to ort and distance to nearest road. el Please print all in f ion: R eviewed by Date Personal information you provide may be used for s pu a aw, s. 15:04,(1) (m)). I Property Owner / L . - Property, Location �, /✓t W��SU n E � R „� Govt. Lot 1/4 1/4 S T 2;(fjN R E(or)® Property Owner's Mailing Add Less Lot # Block # Subd. Name or CSM# City State Zip Code o Nuri>Wf —t( -, ❑ City ❑ Village [3Town Nearest Road / ,r0,ch -5 ❑ New Construction Use: [ Residential / Number of bedrooms - y Code derived design flow rate G GPD [Replacement ❑ Public or commercial - Describe: Parent material 0(4rY, S b , Flood Plain elevation if applicable General comments �� v and recommendations: /� Z&vG et' f 6- 70 r Boring # ❑ Boring Pit Ground surface elev. qlo Z� ft. Depth to limiting factor ��y in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 S A / G 3 /lD 2 — -- 0 ,f Off. do a Boring # ❑ Boring ❑ pit Ground surface elev. 9�y ft. Depth to limiting factor l_— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 I a -I l A 311 z 11 3 y 6 y C _ S ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Na a Please Print) -�. Signature / ' CST Number ..-- 3 o s Address Date Evaluation Conducted Telephone Number SBD- 833 (R07 /00) Property Owner C✓� /So Parcel ID # Page Z of a Boring # ❑ Boring [ Pit Ground surface elev. 1 1 �'3,1 ft. Depth to limiting factor _ //Z— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 M5 o� F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. moil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 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. t SBD -8330 (R.07 /00) J • PAGE_ ,3 OF 3 NAME LOT# LEGAL DESCFJPTION54F' /.M.A / Sj T3a,N,R /r4"E (or) 4 SCALE: I "= � BM I ELEVATION �11(�• O BM I DESCRIPTION ` , •/ . ' n & J r- , 1 az1� t n BM 2 ELEVATION Ste- ( BM 2 DESCRIPTION SYSTEM ELEVATION �4GOty *✓ �� d ALTERNATE ELEVATION CONTOUR ELEVATION �a U G • ��• � Fr 0 x SIGNATURE DATE - d Z Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 S� - L - - a _ 3N- Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBBM13NT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address � 8 S A/ !�- �� J-r S `f d �7 Property Address (Verification required from Planning Department for new construction) City /State ^ r'. ` Parcel Identification Number f LEGAL DESCRIPTION Location � %a, /4, Sec. . 11L Town of Property Subdivision Lot # Volume — . Page # fly Certified Survey Map # �/ Warranty Deed # `� ` ! / . Volume � d Page # 4� Spec house ❑ yessno Lot lines identifiab� yes ❑ no S MAINTENANCE 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 fimction of the septic tank as a treatment stage in the waste disposal system. The properly owner agrees to submit to St. Croix Zoning Departm ent a certification form, signed by the owner and by a mastor plumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 15 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 Zoning Office within 30 three year a lion date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the perry described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 - 1982 �O oe 571499 WARRANTY DEED DOCUMENT NO. 12891011 M IU � Harold R. Wolvert, a !:ingle person, GISTWS OFFICE ST. CROIX Co.. WI J AN 19, q AN 2 0 1998 con"andwarr2ntsto Timoth Wilson, a single Person, II 8:00 A. M I� i ii THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADORES the following described real estate it. St. Croix County. State of Wisconsin: `I ZL 3 �/� !�/�f�I�e /�"-' 026-1017-95 PARCEL IDENTIFICATION NUMBER Part of Southeast Quarter of Northwest Quarter (SE 1/4 of NW 1/4) of Section Five (5) , Township Thirty (30) North, Range Eighteen (18) West described as follows: Commencing at the SE corner of said Northwest Quarter (NW 1/4); thence North on East line of said North- 6141 west Quarter (NW 1/4) 797 feet to Place of Beginning; thence S88 820 feet to the SEly line of Minneapolis, St. Paul and Soo Ste. Marie Railway Company; thence N57 on said SEly line 974.54 feet; theric S 508 feet to Place of Beginning. County of St. Croix, State of Wisconsin. Approximately five acres. TRAN 0 , ;;FER This is homestead property. (is) (is not) Exception to warranties: Subject to easements, reservations and restrictions of record. Dated this January —dayof-- A . D ., 10 (SEAL) 06 L� (SEAL) HAROLD R. WOLVERT (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, St. Croix rounty authenticated this — day of 19— Personiall came before me this day of JanuZry 19-L — the above named Harold R. Wolvert TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by 4706.06, WIS. Stats.) R4DG to me L-bown to be the person who executed the foregoing silt ins and 1&Vwledge the same. THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP • WAX Hudson, Wisconsin r4,11 p St. Croix County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) a*41919 % 4"1".) 1 ir Narrin of persons signing in any capacity should by typed or printed below their signatures. &F i WARRANTY DEED STATE BAR OF WISCONSIN sYMcanael Low a&* Co.. Inc. Foes NO. 2 — 19" Mtwatkea. WIL .,. „ �„ 01999 Clad Ca"ogaphics. /nr. St Clad. MN 56301 -`- PAG SEE PA GE 6 K 6a 64 SEE E 67 t BDTH AV V w. PP K NEW � � y A RICHMOND •t+�'� 175TH AV 175tH AV 2 176TH AV 1 N y ? f74TH AV c N N V RD CAR LL 172ND AV GG g i « P ST CY 1170TH AV a � 166TH AV •- F N N N 8 10 � 11 e X � 65 Mound �W w Lake 160TH AV o 1607H AV � 157TH AV Long Pond 1 1 nderson s 16 15 14 13 Springs + 0 150TH AV G G y r 146TH AV C y~ t 20 21 22 23 24 Lundy � tr t C � Pond °0 140TH AV " ? 140TH AV Boardman A L. 30 N 29 28 w s R 0 130 V 130TH AV r ur 31 32 33 34 65 35 �r 36 ounds o Pond N E 1500 900 E 10 �7YCC LAICCS 1100 1200 SEE PAGE 31 1300 1400 'Over 36 Years Experience' "Known By The Homes We Build And 0 • ' Our Satisfied Customers" 10 FINANCIAL HELP AVAILABLE DERRICK RESIDENTIAL •COMMERCIAL* FARM BUILDINGS •REMODELING CONSTRUCTION FREE a "Lots Available in Southview Addition" PLANNING I SERVICE Highway 65 South •New Richmond • (715) 246 -2320 i ' w i % V V �, v / v o� 0 3 m c T 3 rr rr CC r 0 c 3 7 z UT 2 ° A G '-� C71 N • <° c 0 A y S W w C n O y w 0 3° R C 7 CD A? 7 OD O 0 N N a s1 fl1 N a 0 V (D CD � m e ? o m b co A� 0 3 o ° o C U) Z D m Z m co D CL CD r o CD a CD N 3 W W 0 CD . ° '< p O ° 0 r W 0 (n N N M c i o c ) Q 0000 » �• W ` z CD CD c 9 M = QD c - N B'',i O » 0 c 3 2 f FL y ° Z O Z W Z .0. 0 o ? O N -n D O ° o � V AI 7 m N N C N Or o N a CD C/) 6 W D c CO»D CL p z I m w m e z G 0 3 °D Z A CD A Q a � I m c o a N U) I Q ( A I I o Oo N O ti O O 0 b W m R A