HomeMy WebLinkAbout026-1133-16-000 xnsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
rety and Building Division
INSPECTION REPORT Sanitary Permit No:
399688 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:
Hilivale Development LLP I Richmond Township 026- 1133 -16 -000
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic - 6 Benchmark /0. 11a 7
Dosing A - 1 00 Alt. BM 0•. sc f tt
5WC6,r-•-6 seal -
Aeration Bldg. Sewer
re- "
Holding St/Ht Inlet �.gs
(03-
St/Ht Outlet
TANK SETBACK INFORMATION rl. to- �l
TANK TO P/L WELL N I BLDG. Ve t to Air IrAake ROAD Dt Inlet
Septic 'a Dt Bottom
Dosing He er /M n. g ' 02 2 6
Aeration Dist Pipe 8 1 w , j0
r Holding B ystem i0 7
PUMP /SIPHON INFORMATION Final Grade 7• Z d 3. 6
Manufacturer mand St Cover
GP 3.54 D'"I•
Model Nu ber
TDH Lift N zz riction ss System Head TDH Ft
Forcemain ngth Dia. ist. to well - , L
SOIL ABSORPTION SYSTEM 3 b 64,h
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 i I t
SETBACK SYSTEM TO l P/L BLDG WELL LAKE /STREAM LEACHING Ma tprer: /
INFORMATION CHAMBER O TY�
Type f System: 3' , IMod6l Number:
DISTRIBUTION SYSTEM t lL7l TfvjC.K V
Header /M ni Idr Distribution f g/ x Hole Size _ r Hole Spacing p ke
f Pipe(s)
Length D a Length L) i pacing I
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only LI�►!� `N
Dept �. Depth Over xx Depth of xx Seeded /Sodded l xx e '
B /Trench Ce er a Bed/Trench Edges Topsoil Yes No ,s Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: I'0 /L� L Inspection #2:
Location: 919 172 nd veNNew Richmond, WI 54017 (SW 11_/4� SW�1 /4 6 T30N R18W) Pine Valley Lot 16 Parcel No: 06.30.18.929
1.) Alt BM Description k50 � m d�.6 - 3 - wl CW ►"t(wi"—'
2.) Bldg sewer length = 3 Q
- amount of cover = 2 "ad-. h 9- Qt11, .
Plan revision Required? J Yes No
Use other side for additional information.
Date Insepctor's Si nature Cert. No.
SBD -6710 (R.3/97)
�� �,� sad, � •s9B ��
,9
1
County
Safety and Buildings Division
201 W. Washington Ave., P.O. Box 7162 S�
onsin Madison, WI 53707 - 7162 Site Address-
Esc
Department of Commerce AJ V a'
Sanitary Permit Application sanitar Pe rmit Number
$
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary ses Privacy Law, s15. 1 m --
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel N ber OZ — It 33 16 -aa
0 4W
Property Own a Address Property lion
Leo �v c�
-SW yAS(:: !k; S (0 T3 b N. R
City, State Zip Code Phone Numbj ' 3rt' Lot N ber Block N ber
ubdivision Name CSM Number
H. Type of Building (check all that apply) as Sw n ❑City
06 1 or 2 Family Dwelling - Number of Bedrooms ❑Village
❑ Public /Commercial - Describe Use ownship `
❑ State Nearest Road
r3ct\ rS
III. Tylkof Permit: (Check only one box on liXe A (numbering Iftmoor internal use). Complete line B if applicable)
A For County use
1 �. New 2 11 Replacement System 3 ❑Replacement of 6 ❑Addition to
Sy stem I I Tank Only Number Date Issued
Existing stem
B. ❑ Check if Sanitary Permit Previously Lssued
Permit
rm
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44 )(Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recircula ' g 30 ❑ Other
V. Disperns al/'lYeatment Area Information: t
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed Rate( Gals. /Days/Sq.Ft.) (Min./Inch) Elevation
VI. Tank Info Capacity in Total Nudiber ufacwrer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank _
_1[3 i �S il3
Dosing Chamber
VII. Responsibility Statement - 1, the undersigned assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name ) ber's SigpahlN MP/MPRS Number Business Phone Number
F(c E rs 7 " S 3 715"
Plumber's Address (Street, City, State, Zip Code)
- ND co Q A
VIII. Count /De artment Use Onl
Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
❑ Owner Given Initial Adverse 2-2,9- 3a
Determination
1X. Conditions o Approv easons for Disapproval
t S AL4W
Kttach complete plans to a County 30 or a system on x
WIQ.K� S ,
SBD -6398 (R. 05101)
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W isconsin Department of Commerce SOIL EVALUATION`R�PORT Page J of 3
bivision of Safety and Buildings ' `� ,
in accordance with Co Wis. Add Code`,
6 Punty
Attach complete site plan on paper not less than 8 1/2 x 11 i in size.
include, but not limited to: vertical and horizontal reference p (BM), direction and Pacel I.D.
percent slope, scale or dimensions, north arrow, and location and dis"de.to tteafest road. �e • 1 i Y, g
Please print all information. ?l1�1 Re d by Date
Personal information you provide maybe used for secondary purpose (Privacy �w `5� 1'+a (m)). � Z
Propert y Owner 1� ; Property oc
o ^ 1/4 SW 1/4 S �j T3() N R g E( W
P� erty Owner's Mailing Address lock # Sub ame or CS #
U cAe)A an ac
1 City State Zip Code Phone Number ❑ City Village !'Town Nearest Roag
wL,'4 r C AP 551 (&�� )�y8 -pyyK ►��M0%18 1 7e- _I
New Construction User Residential / Number of bedrooms 3 Code derived design flow rate y 5o GPD
❑ Replacement E] Public or comm rcial - Describe:
Parent material 1 1 a c is Flood Plain elevation if applicable ft.
General comments ' Si oZ - $1 a$ a — 75 TAIENLt, (VS v� , r,
and recommendations:
T t T.Y ti` i Fo.r
iai.,9 C "rY5 ---. 9 8,ba
Boring # ❑ Boring
Pit Ground surface elev. 07. Q ? ft. Depth to limiting factor a5 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 1 *Eff#2
0- 10 3 1A SL
SL
3 16 -3% -16 ID 4 L S
3S- 4 l YS y 1V S
S g 4jq SL
The soil test report for lot 3 was discovered to be
ol•/ inaccurate during the septic inspection on Nov 2,
Ili 2001. The soil horizon reported as single grain
loamy sand was actually massive loamy sand with
® Boring # ❑ Boring occasional pockets of sandy loam. Therefore the
Pit Ground surface elev. 03 , 69 ft. loading rate must be .5/.7 and not .7/1.2. If this
error is discovered on any other lot, additional
Horizon Depth Dominant Color Redox Description Textur<
in. Munsell Qu. Sz. Cont. Color borings /soil investigations will need to be performed
3 for the rest of the subdivision. The plumber should
—1 `Q SL make note of the potential for error and prepare for
S, 5� the possibility of increasing the size of the drain field.
Y
g -3 l,S R w - - - *1-
35- y`7
'41q SL
y7 -►�o s K y �,� SC.
o.
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L
CST Name (Please , Pr�t) � Signatur�
1 TGY
Address
i
Property Owner L a f Parcel ID # Page a of 3
F3-1 Boring # ❑ Boring
19 Pit Ground surface elev. 105-SID ft. Depth to limiting factor aS 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
I c,- OVe 3 1a S(- ar6rR MFK as ar ►s ►9
3 .3 , 5uqlq SL I `FS6K `MFR CW JF r e 1D
<up y SL FSN m R — L
S2. 3z g$.32
FT Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor I DD 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
i o-`7 iow - SL a F R awg gs; a F .i5
7-1 b -7, s 5L a FSQK m r R CW 1 F ,
3 1,6- 1,5 4 y OV R -56k MER (W I\j r- . S , 9
-SQ - 7,54p 41q SL AFS6K mF g .5
❑Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
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
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * 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.
SBD -8330 (R.07 /00)
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--- oa Otte► w LVNING
91001
Private Onsite Wastewat Treatment System Management Plan
Septic Tank And Gravity in -Ground Sail Absorption Component
Pursuant to Coaxn 83.54 Wis. Adrn. Code each Private Onsite W tqr Treatment
SWOM (POWYS) she!! include infornatlon and Procedures for nraints m'N the system wdhm
the Per-On' of Comm 83 wild 84. and the conditions of approval by the
Or 9 unit. T h e a p p r o v e d plans, a n d pl f o r s y s t e m we on M e e t �n t�
zon ing heantth department.
This �^�merg Plan c0mptiss with Comm 83.54, Wis. Adm. Code, and #M In Ground
Sod A Component Manual for Private Onsite Wastewater Treatmerd Systms S8D-
10567 -P (R -6M).
Table 1: nr tw n
Sa permit N
Nurnfiw Sedroons
Des Fbw -Peak ( )
Estimalaed Flow - A c
tic Tank
Soif size J no a
T of Wastewater Do}'1'tel
Table 2: Solt - Lkmb Of Refa6le
Tar* W AbwqMm
)esign Flow , N k j I InOG,
�m IMiuera Partde sire
� 1/8
MTwnt T3S } 220
154
Tabb 3: MSS Schoduk
. Tank Wwyw service once, 3 yem
SON Q~ Fbr Insped once a r and dean at bast once every 3
ftPed once every 3 yews
The SOPW tank shat be maintained by an ondiridual cefied to service septic tanks
under s. 281.48, Stats. The eonteMs of the sePBc tank shag be disposed of in accordance with
NR
esiroorns. 113, Wis. Adrrn. Code (Servicing Septic or Holding Tanks, Purr>pi Chambers, Grease R ferceplom see p age Bel �Paga �. Seepage TMnc hes. Prtvift, or Portable
The operating condition of the seDti tank and nutlet fitter shall be assessed at least
once every 3 years by inspeckIn. T ou8et s haft be cleaned as necessary to ensu
Pr�oper� flan. The fiber cartridge not be removed unless ar+e made to
re tarn a0lids rn the tank that may slough off the Nor when removed from its fie, if the
05/02/01 WED 10:27 FAX 715 396 4666 ST CRZ CO ZONING
Management Plan for a Septic Tank and Soil Absorption Component
fitter is equipped with an alarm, "filter shah be serviced if the 111110rrrn is activated c 0ntin M*'
In initial filler alarms may indicate surge flows or an flog Continuous alarm. The
septic tank shaft have Its dents rerw4ed when the volume of scruff and sludge in the tank
exceeds 1t3 the liquid volume of the tank. if the contents of the tank are not removed at the
We of an assessment, maintenaruae personnel shah advise the owner of when the next service
needs to be perforrned to maintain toss than rnaxlmum scum and sludge accumulation in the
tarn.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessmerd shall be sealed watertight upon
the completion of service. Any opening deemed unsound. defective. or subject to failure must
be replaced. Exposed access openings greater them 8. inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one shouts wobw s septic or ofhher dsrrsbnent or hole ft hnk for
any reason without befog► to lire corutpAINOW IWO OSHA soWwds for
entering a corned space. The afmoupfi►e * M►hhii<r tie septic or anther
datasbeNrut
of hoNkly tw* nW comdoin Nehaif games, and resram of a
person iFoear ate aalbarior• of tihe talc wM► be aMlt or frrupos�ble.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
,Soil A q aftn Canwar eM
The soil absorption component serving this "Lore is designed lo acxept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
meirstertance, and system use wN Wn or below the Wrdfts of reliable operation. Good water
oonam Ovation practices by all occupants and the installation of water oorsWWV plumbing
fixtures are key faclos in extending the useful We of this component.
The soil absorption component's operation must be assessed by inspedlon at least
once every three years. The inspection shell include recording the revels of pondirg, if any, in
the observaActrt pipes, and a visual inspection for any evidence of surface seepop or dWk-cje
from the czanpor mi* On steeply sloping WHes, arses of erosion should be ideMllled and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the s ;ystm is prohilrted and considered a human health hazard.
Traffic around or over the soli absorption component should be avoided particularly
during winter months. The cWq*CWn or removal of snow covet over ft component may lead
to hydmA is taitura by freezing. This type of failure is usually temporary. but is difF0A or
impassible 10 repair until weather conditions improve. in general. soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal call, which may lead to
more intense, and earlier, organic elagglng of the soil.
2
• kU Pian for a Septic Tapk and SoN AbsOrPtiO COM
ftr►ongs of deep - rooted "" WO StwubS directly over or "Min ten feet et of the
cumponerit O be avoided since root ,
intnsion "to the conVaront my o b� eater
now.
3T. chjl>, ZjNil = 586-46dO
plumber = Calvin Powers - 4
Replacement site will 5'e that soil tested area by
C3T (#
heplacement site must be left undistumbed, or
mana contingency plan must be modified
and filed with the zoning office, outlining the
steps to be taken in event of septic system failure.
3
01/24/2022 16:39 6517481441 LAKES AND HILLS INC PAGE 02
„� M i L&GA* Du i I Jers LL C FAX NO.. : 15 247 41GG an. 24 2 - 20 . 2 � Q4'. "M r'G
r �
,fan 24 tP MPRp CftVIN POWERS
ST MOM COUNTY
3L t� TAM. ,l ANUNAA+CB A(M.9"NT
AND
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Cuvscd 3urvu map _. Yo]turto F
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:30rr lauuee ycoy i J t!o Lot tin" ldantifisbat+ M yea iw
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t'.ASf7 � e� Ali► t1n ant,�ir s .rwcy C.a... y...,� ,�_ �co[xa 4f'aoeded•�ay a s:aeaao6 puooper. 4'V'G.,c you yrl i.w tlw �rswa
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Let fmb here!. m mat by t3�evezm^cgt aF4 �c �d tq M104 Mmk ofmar,. 4 ap". m ounc al'b *;Mwx l�:tprx:i[r
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01/24/2022 16:39 6517480441 LAKES AND HILLS INC PAGE 03
vla!_ 1652plu 226 f v
ST AT13 SAR GF WISCONSIN FORM 2-1999 99 KA114LEEN H. WALSH
Document Number WARRANTY DEED RE61STE�R OF DEED
This Deed, made between Earl L Ande o04 _glary RMEIVED FOR FEM
G Andersen,, bualkand aii d Vife _ - - Ct�-04 ~'�44A 111100 M
EXEPTII 9�
Grantor, and I �n /144 dted _ UST COPY FEE:
L iatbillt PartuelC �° FEfs
y - 'f?J fE1 FEE: 46&00
REM01116 FEEt i0.00
pRI1 a: I
Grantee, "�.��..
Grantor, for a valuable comitf veion, cotivvs to Grantee Oe
following described real estate in 5!. Croix _ County,
State of Wisconsin (if more space is needed, please attach addendum)
S1P. ofSW1f 4of Section 6- 10- 1 $excW Certified Survey Map in Vol. 2, ReoxdingArco
page 597 and exept Certified Survey Map in Vol. 5, page 1251, and except dame and Room Address
Certifiod Survey Map in VoL 11, page 3031 and except part to A:ark A. Northwest Title 6 Escrow Corp.
'Stephens and Lorraine C. Stephens in Vol. 1212, page 609. 4255 WMte Near PArkwaay #1300A
Vaeloe-ia Reftblts. N1 55LIO
026- 102'2-20& 02& 1022 - 10
Parccl ldtatificai wn N ombcr (PIN)
This 6 001 tWmcstcad Pivperty.
Oil (is 116!}
Exceptions to warranties: Eastmimis, restrictions and rights -of -way of ; e ,,k D DESMAH NWJkRY KWIL C Dated this day of Aptil 2661 dA
AUTHENTICATION ACKNOWLEDGMENT
5ignature(s) STATE OF Mitmsota 1
)35'
-�— gy County )
authenticated this day of�.
Personally cants before me this 3rd day of
M April 2001 _ the above named
Ea L Ander and Mary 6 Anderson,
TITLE: MEMBEIK STATE BAR OF WISCONSIN --
(tf nqt, _.__ ttr rote known to be the per who executed the foregoing
instrument and acknowledged the same.
tauthorized by ii 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAPTLD BY
Attorae -Kriutkta Oglaad. _ Notary Public, State of VA*ear►rrin
Hudson. Y _ . _ _ . M I,- permanent. (IT not, state expriraitivn dFatk:
(Signatuan may leeaulhemieated or acknowledged. Both we not necessary.)
" Names of persons signing in any capacity must be typed or printed below their signature- h mmacam rrmr a.ionw Gwowrnv, V.na au c sq 4w
WARRANTY DIFIED)
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