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HomeMy WebLinkAbout026-1025-40-060 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Satc+ty and Bu'iding Division INSPECTION REPORT Sanitary Permit No: 499289 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: P.C. Collova Builders, Inc. Richmond, Town of 026- 1025 -40 -060 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 / OCR f; ^ II, Cry 1 07.30.18.10OA06 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,SS CAPACITY STATION BS HI FS ELEV. Septic Benchmark t�esr„g Alt. B ` / + �S • Z Aeration Bldg. Sewer y Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet �.S .. 7 . 9 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic -7 50 r 7 (0 : Z i 60 Dt Bottom Dosing Header /Man. 7, L Aeration Dist. Pipe g.5 fl 7. Hooding Bot. System I I qi... 7 — , / g 9(0 - 8 Final Grade PUMP /SIPHON INFORMATION 3•� /02 -9 Manufacturer Demand St Cover GPM a�,4 ��•� Model Number TDH Lift Friction Loss System d TDH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 liZ Z \� �- i• SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR `z'\ Type Of System: 5 , 7 i ' 7 (olb UNIT Model Number: I -�] � 1`r O t G,s1uC c u -�7L. DISTRIBUTION SYSTEM M>M, Z3.-)-Z,3 d: Header /Manifold , Distribution x Hole Size x Hole Spacing Vent to A Int e Pipe(s) \ 3 f f Length Dia Length Dia Spacing Q SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Dept of xx Seeded /Sodded xx Mulched Bed /Trench Center y Gj Bed/Trench Edges \ Topsoil Yes No Yes „, No COMMENTS: (Include code discrepencies persons present, etc.) Inspe #1: / / Inspection #2: / / Location: 1643 95th Stre t Ne Richmond, WI 54017 (NW 1/4 SE 1/4 7 T30N R18W) NA Lot 1 L ParcelNo: 07.30.18.100A06 1.) Alt BM Description = � / �� { � — LoC% — .S C� 2.) Bldg sewer length = C' Q - amount of cover = nn Plan revision Required? �• -;' Yes No s C"7 3 7 Use other side for additional information. Date Insepct s Signat Cert. No. SBD -6710 (R.3/97) commeree.wi.gov Safety and Buildings Division County (1 201 W. Washington Ave., P.O. Box 7162 Madison, WI 5 3 707 -7 1 62 i soon s i n Sanitary Permit Number (to be filled in by Co.) i i , rtment of Commerce Z / 6 ( Z? / Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo pnate governmental t V unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned PO Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may b nda y purp oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. Application Information - Please Print All Info do 7 �^ Prope Owner's Name 200 P arcel �� k7ej 12 O C­ 1 Eg 1 4 Property Owner's Mailing Address uNTY operty Location lrl ' L g�. CROIX CO Vt. Lot City, State tip Code one Nu %y Section � 6(D� � ) j �/ / circle one) �r/� Cl ZBlo T l N; R Type of Building (check ail that apply) 71 1 or 2 Family Dwelling - Number of Bedroo Subdivision Name So a v� �5 1 9 y 9 9 Z. ❑ Public /Commercial - Describe Use PC NJ� kvu& � I El city of / - F✓�'J tom. � or-.� CSM Number ❑ Village of ❑State Owned - Describe Use .7- Npi w ` cl 9 z— own of 1I1. Type f Permit: (Check only one box on line A. Complete line B if applicable) Z 5 Q A System ❑Replacement System ❑ TreatmendHolding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal El Permit Revision El Change of Plumber POwncr Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration IV. a of POWTS System/Component/Device: Check all that appl Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil �Gs2�L/ ❑ Holding Tank El Other Dispersal Component (explain) ❑Pretreatment Device (explain) ,_ V. Dis ersal/Treatment Area Information: Design Flow( gpd) Design Soil Application Rate(gpdsf) Dispersal Area Re (sf) Dispersal Area Proposed (sf) System Eleva ' n VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units d ° " U New Tanks Existing Tanks Septic or Holding Tank ILICn Dosing Chamber VII. Responsibility Statement t - _ I, the undersigned, assume s onsibility for installation of the POWTS shown on the attached plans. Plumbe 's Name (Print) Plumber's re MP/MPRS Number Business Phone Number Plumber's Address (Street, City, Zip C e� I. Coun /De artment Use Onl Approved ❑❑=7ve�/ , Permit Fee Date I sue Issuing nt Signature z / #� /O 7 n Reason o vial IX. Conditions of Approval/Reasons for Disapproval \ 9J. &e,_ U&�,1l+Al— , lj ��- SYSTEM OWNER: J 1. Septic tank, effluent filter and (� e N �, d'o G•,)� o�✓^a-� d ispers a l ce8 must all be services / l a m as per m anagement plan provided by y p L 2. All setback requirements must be maintained y) t) p t Ut✓ V C' ✓�- e system and submit to the County only on paper not less than 8� inches in size er-4 SBD -6398 (R. 01/07) Valid thru 01/09 t t tT , I divk�X C�a�� nna. -�- � ✓le.clza66�� _ PNDPRESSURE T PLAN PROJECT P.C. C0110va Bldrs. DDRESS P.O. Box 489 Somerset Wi 54025 NW 1/4 SE 1 / 4S 7 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 2/10/07 3 DATE BEDROOM CONVENTIONAL XXX IN -d CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 36 ,BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 103.1/102.0 5' below q setbacks required by Vent WDN Plans Designed Using Conventional Powts A5n ARC 36 Biodiffuser Manual Version 2.0 Leaching Chamber with 25.0 ft2 of Area 1 91 Grade at System Elevation Pr --b oom Hou 25' ST 97' Pr operty L ine 90' 0� -3 50' 18 Slope B -1 5' 2 -3' X 90' Cells with >3' Spacing Scale is 1" = 40' unless otherwise noted NKP- 95th St. kPRESSURE LAN PROJECT P.C. Collova Bldrs. RESS P.O. Box 489 Somerset Wi 54025 NW 1/4 S E 1 /4 ' s 7 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/10/07 BEDROOM 3 CONVENTIONAL )00( IN -G( CONVENTIONAL LIFT HOLDING T ANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 36 BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 103.1/102.0 5' below qrade setbacks required by Vent WDNR Plans Designed Using ARC 36 Biodiffuser ALong Conventional Powts Leaching Chamber Manual Version 2.0 with 25.0 ft2 of Area 1 " 3 6" Grade at System Elevation Pro 3 Bedroom House 25' ST 97' 30' Property 45' 2 L ine 90' 0 ' LJ B -3 50' 18% Slope B -1 5' 2 -3' X 90' Cells with >3' Spacing Scale is 1" = 40' -�-- unless otherwise noted .M. 95th St. RECEIVED Wisconsin Department of Commerce SOIL EV LUATION REPORT Page of Division of Safety and Buildings APR 2 5. 2005 j � in accordance with Comm 85, is. Adm. Code County Q ` Y Attach complete site plan n paf; n .te , G41rITe� in si .Plan must v t ( /� / n include, but not limited to verltCal an z r BM rection and Parcel I. D26 �aLS - `1� — IOU percent slope, scale or dimensions, oca Ion and distance to nearest road. Re ed by Date Please print all information. 'e Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ply Owner Property Location �� ✓� ' Govt. Lot 1 /451 /4 T ,3 rs N R E (o W Property O • Owner's Mailing Address of lock # Subd. Na CSM# City State Zip Code Phone Number City El V Page To N� st Road ,1 117 1 L Nee Construction Usesidential / Number of bedrooms Code derived design flow rate GPD e : e ❑ Replacement ❑Public or commercial - Describe: - - -- -- -- Parent material G LC ✓ Float Plain elev if applicable � /t�✓ ft General and recommendations: e Yv— I ✓Zc1vtl/1a'V v �,�' �, CC d A N � �"a a �Q � _S 1 �� 7t7�` �' � ( r • • `�� �'` G' ' Boring # n Bon '_ a j/ / j$P P it Ground surface Wa G Y 1 ft. Depth to limiting factor in. Soil A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .EGPD Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 2 z_ ,t ring Boring # 1 /ft. Depth to limiting factor pit Ground surface ele . g --- t--- -= In ' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 z t Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 ' Effluent #2 = BOD < 30 mg/L and TSS <_ 30 mglL CST Nam (per per) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Date Evaluation Conducted Telephone Number Address 715- 246 -4516 1008 192nd Ave, New Richmond, WI 540 - 'Y v�! 1 Property Owner Parcel ID # Page of _ / ® Boring Boring # 1 6 - 1 I it Ground surface elev. ft. Depth to limiting factor �n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struchare Consistence Boundary Roots GPDO i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �- � �3� hrl C � ► 1, �•- � Yw ti'�1 � loa ❑ Boring El Boring # in. E] Pit Ground surface elev. ft. Depth to limiting factor Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring E] Boring # Ground surface elev. ft. Depth to limiting factor in. F ❑ Pit Soil iration Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Elf #1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 :� 150 mglL ` Effluent #2 = BOD, <_ 30 mg& and TSS 130 mglL 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.6100) Soil Test Plot Pla Project Name P.C. Collova Builders Inc. Sh Bird Address P.O. Box 489 ,�. Somerset Wi 54025 C M #226900 Lot 1 Subdivision -------- Date 4/21/05 N W 1/4 SE 1/4S 7 T 30 N /R W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 103.1/102.0 *HRpSame as Benchmark Scale is 1" = 40' unless otherwise noted 97' P roperty 45' -2 L ine 90' 70' -3 50' 1 18% Slope B -1 108' 5' 106' 104' B.M. 95th St. 7 9 OFE0 8 2 0 VOL 19 PAGE 4992 KATREM H. ALSH CERTIFIED SURVEY MAP REGISTER OF DEEDS ST. CROIK CO. MI RECEIVED FOR WORD Located in part of the Northwest Quarter of the Southeast Quarter of Section 7)06/06/2005 04:36PH Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. CERTIFIED SURVEY MAP NA47H 114 CORNER REC FEE' 13. 00 sEC. 7 -30 -16 COPY FEE 3.60 ' (FOUND 314" IRON REROD) PAGES: 2 i °l UNPLATTED LANDS OF OWNER F i t -- ao 0 r *I � EAST -WEST 1/4 LINE N89'37'47 "E 297.32' 264.50' \ m n -- I z i . i r a ° ° ° o ` 32.82' �= z N i 33' LOT 1 N C)> ° o co + w w I TOTAL AREA: (A > y m a o o 0 97,959 SQ. FT. o N z ti o m " C) °o 0 2.25 ACRES ° o o ' o m m .ri m rv_ AREA EXC. R -O- W: _ D z rn 87,285 SQ. FT. r" FA d" n o 0 o Z 2..00 ACRES c,+ I ° a J NO TH m n O 1 00 . 00' D o c Z I C.i C I Z S89'37' 4�7 ' W 296.37' o z O O i 64.50' �(n O �, m `. O o C I �! p � 31.87' 66' ,aNT DRIVEWAY o z o. m ^v Z �,,,r EASEMENT a) I ' o �-4 I �� w LOT c,+o �M mo ° o � o �o TOTAL AREA: o J� m o 1< a 0' � 0 97,648 SQ. FT. o o'D y �y ° � 2.24 ACRES °- 150 0 150 ao �• ° 'Z �� .p AREA EXC. R -O -W: o ` 3 4 I LO v' 87,285 SO. FT. GRAPHIC SCALE °a ? W 2 ACRES SCALE IN FEET: 1 inch = 150 feet Cn ° v 01 i i S89 - 37 * 47 - W 295.43' �' j ``\ .v�Mwrrrfwuf W 264.50' �o v� C^! � �r30.93 � � _ I ' LOT * A o_ p �! TOTAL AREA: W W DODGE i 95,928 SO. FT. o w w ;-•� 2.20 ACRES EAR _ °D_ t° AREA EXC.. R. -O- W; ..... . VA y % f � .ccii 133' < 87.267 S FT. � 'rye SURr� "�r �J 2.00 ACRES PROPOSED cp J r� - ,30.1 2' f DRIVEWAY N- 66' JaNT DRIVEWAY 1➢ 351 EASEMENT FAR LOTS J � LOTS 3 AND 4 FA NOO'32'03 "w_ ' S8 "W 381.80' o cc LEGEND 66.00 N89'27'S7 "E 382.00' (� Section Corner Monument Z t 35 .04' of Record ) LOT 4 ° O Set 1" x 18" O.O. Iron Pipe wt. LW ��28.96' N O 1.13 pounds per linear foot J N) DRIVEWAY TOTAL AREA: 9 Buildin Setback Line ......' ca _ 14 ) w 91,311 SQ. o (100' from Right of Way) 2.10 ACRES FT. rr ! O AREA EXC. R -O -W: fV �m CA 87,237 SO. FT. 5.08' : 2.00 ACRES iv JOB # A1057SD43 J rn « 377.64' Ga Prepared by. ttt J� z S89'17'31 "W 382.72' n ! t = j o SOUTH UNE OF THE NWf /4 -SE! /� J 1' 0 Consulting Group, Inc. r.1 U N P L A T T E D LA Phone No. (715) 246 -4319 `� a? Wo Prepared for and at the request of: Fax No. (715) 246 -3830 Dave and Pam Kieckhoefer P.O. Box 325 � � SOUTH 114 CARN£R 943 170th Avenue New Richmond, WI 54017 SEC. 7 -30-16 (FOUND ALUMINUM New Richmond, WI 54017 Sheet 1 of 2 COUNTY MONUMENT) Drafted by. Jesse B. Suzan Vol 19 Page 4992 i� U 2 8 2 y P 12 0 - 7978 State Bar of Wisconsin Form 2 -2003 KATHLEEN H. YALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., MI Document Number Document Name RECEIVED FOR RECORD 06/16/2005 10:06AN WARRANTY DEED THIS DEED, made between David J. Kieckhoefer and Pamela A. Kieckhoefer EXDPT t husband and wife REC FEE: 11.00 ( "Grantor," whether one or more), TRANS FEE: 876.00 and P. C. Collova Builders, Inc. COPY FEE: CC FEE: ( "Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space Name and Return Address is needed, please attach addendum): Part of the NW '/4 of the SE '/, of Section 7, Township 30 North, Range 18 West, Town of Richmond, described as follows: Lots 1,2 and 3 of Certified Survey Map - recorded June 6, 2005 in Vol. 19, Page 4992, Doc. No. 796820; AND Part of the NW '/+ of the SE '/4 and Part of SW '/, of the NE '/, of Section 7, Township 30 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 4 of Certified Survey Map recorded June 8, 2005 in Vol. 19, page 4993, 026 P cel 026 1024 - 3 az I and 026 - 1 0 2 5 - 40 - 0 5 0 dentification n Number Number ( PIN) Doc. No. 797062. This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated -TullL t4, ,-oy S� ~ (SEAL) (SEAL) * *David J. Kieckhoefer (SEAL) ( )"r (.t 1, ` (SEAL) * *Pamela A. Kieckhoefer AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ) ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on s.< (Q-- . 44 - (If not, the above -named David J. Kieckhoef . authorized by Wis. Stat. § 706.06) Kieckhoefer, husband and wife �``�'. to me known to be a person(s) who exe t# 'fi (egbinf, THIS INSTRUMENT DRAFTED BY: ins - d a 1 e same. _�! :��?' Attorney Kristina Oeland = O Hudson, WI 54016 * D v1 19 nLh:A % Z s Notary Public, State of Etta C11 a Q. ' My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) W. NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFI WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PROTM Legal Forms 800 - 855 -2021 www.infbproforms.com i ST. CROIX COUNTY SEPTIC TANK MA DUENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer�� Mailing Address - 0 ) Property Address (Verification required from Planning & Zoning Department for new co ction.)� City /State Parcel Identification Number LEGAL DESCRIPTION �, property Location � 1/ ` , = _ 1 /4 , Sec• , T –J N R W Town of — Lot # ' Subdivision � Volume � � Certified Survey Map # Page' # , —��` =' Warranty Deed # ,Volume � Page # LJ Spec house ye no Lot lines identifiable (yes SXSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature fail a li um r� Whatyou put into maintenance consists of pumping out the septic tank every three years or sooner, if needed, by P Pe 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 The property owner agrees to submit to St. Croix County Planning & Zoning Department a certificcat (1) form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pum verifying wastewater 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 a nd 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. Uwe am/am the owner(s) of the 7:S ve, by virtue of a warranty deed recorded in Register of Deeds Office. //D/07 DATE TURE OF APPLICANTS) ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Deparanent. * * 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) 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 (5sin ncy Plan If system fails, determine cause of failure, use alternate area and install new ested replacemen t 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 Shaun Bird #226900