HomeMy WebLinkAbout026-1296-13-000 Wisconsin Dyartment of Commerce PRIVATE SEWAGE SYSTEM g County: St. Croix
S;qety and Building Division
INSPECTION REPORT Sanitary Permit No: 488237 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:
Country View Ridge LLC Richmond, Town of 026- 1296 -13 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
1� I C•S 07.30.18.1544
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS., HI FS ELEV.
Septic y Pt-- Benchmark
Dosing 1 Alt. BM 1
f o c�
Aeration 2 1 Bldg. Sewer
clJ 4 I �,� I .Z 7b• - 1
Holding St/Ht Inlet
- 7- Z 7s, a ct
�
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet `
Septic '9Z l NA - 3( i 3(o Dt Bottom Za ,cj 7/,-31
Dosing 4 Z I � 1 n J 3 361 Header /Man. J
Fld!tn Dist. Pipe Bot. System j
. _
FirW Grade d ` —
PUMP /SIPHON INFORMATION
r
Manufacturer // , Demand St Cover y
l-•1 (� a GPM �� Goa. lZ 7 q ' 9
Model Number 7 E Z f P
n E�9, Z.. Friction Lo System lead TDH Ft
ZS, 33
Forcemain Length Dia. ,I I Dist.toWell
I I Z
SOIL ABSORP SYSTEM
BED/TRENCH Width i Length No. Of Tre hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS f O 76. �e \� --
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Ty a Of System: , UNIT
J G r $y A V Model Number.
DISTRIBUTION SYSTEM /" T J � /
Header /Manifold IDistribution r x Hole Size x Hole Spacing Vent to Air Inta g Pipes) �� P 9 \ 3Z Z
L Dia Length Dia S acin
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded /SoZ xx Mulched
Bed /trench Center Bed/Trench Edges Topsoil ,—
Yes Q No es No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:.,.& a � 1. Inspection #2:
t������ 3 t•,ic{,' — . 14-5'1
Location: 1630 97th St New Richmond, WI 5401 (NW 1/4 SE 1/4 7 T30N R18W) CoOnt`ry View Ridge Lot , p 7 / 6 lYeParcel No: 07.30.18.1544
1.) Alt BM Description
2.) Bldg sewer length = r
- amount of cover =
5
Plan revision Required? Yes No —7 3
Use other side for additional informati n. P�
Date Insepctoes gnature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County I
AW 201 W. Washington Ave., P.O. Box 7162
Visconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
(608) 266 -3151 �S �3
Department of Commerce Al
P r A State Plan I.D. Number
Sanity �
r3' pp ,D v�- ��—
In accord with Comm 83. 1, Wi ode, person I info
may be used for utposes 'vacy law, s 15.040)(m) Project if different th l address)
/3 (. s_
I. Application Information a PA I fo n G — i n
L - __ 0110
Property Owner's Name 0 U11 ST. CROIX000NTY Parcel# Block#
S ee 1
Property Owner's Mailing Ad �t s / P A ro � p � er tt y Location
, D 1 e) � ! / ) � yy J _ %,, Section
�
city, State - Zip 1 C . 00de Phone Number /-�
/ v ` �tJ C L IGS.G N: E
II. ype of Building (check all that apply) 6k Subdivision Name CSM umber
2 Family Dwelling - Number of Bedroom fTb J SC�aP a w
e a ti i l 2
❑ Public/Commercial - Describe Use p
❑ State owned - Describe Use 10 ❑City_ ❑Vi g ip of Y)
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) b 21 Z 3
A' 4.:w System ❑ Replacement System ❑ Treatment/Holdmg Tank Replacement Only ❑ Other Modification to Existing System
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check ill that sip lv) O
❑ Non - Pressurized In- Ground ❑Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil Grade ❑ Single Pass Sand Filter ❑
Constructed Weiland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peai Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravcl -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufaettuer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New
Tanks Tanks
Septic or Holding Tank CR1'J J JAI
Aerobic Treatment Unit
Dosing Chamber I 6 —+
VII. Responsibility Staten - , "the undersign4 jume responsibility for installation of the POWTS shown on the attached plans
Plum s Name (Print) Plumber' i MP/MPRS Number Business Phone Number
: z
s
Plumber's Address (Street, City, S p C
lz�� Z L' 1 V,4,�_ 40 --V, 2
VWHIIL !De irtment Use Onl stain
Approved C] ' Sanitary Permit Fee (includes Groundwater Date Issued Issu' Agent Si ture o
Surcharge Fee) y� Op O �
❑ O en Reason for nisi (�
IX. Conditions of Approval/Reasons for Disapproval n q
SYSTEM OWNER: 3 , ll7J t 1 A.1— 5 41 4. v� thcS2
1. 31*W 1s *, a(tN1sM Mier and
ns must all Mvided by Pius. a
as pN � r,� P p /
mg be nm*ftkod
2.. �� 6 �,�
n per � COC�e !
Attach complete plans (to the County only) for the system on paper not less than 819 x 11 inches lu size
SBD -6398 (R.. 01/03)
i
s
-�
tip }4.Vp �A3T�;Y8
;t2w4ft
4 � a li •, '°� �s
19 #
PLOT PLAN
PROJECT Country View Ridae LLC ADDRESS P.O. Box 176 New Richmond Wi 54017
NW 1/4 SE 1 /4s 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 89.0' 3
BEDROOM
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
B.M. h .
307 Property Line
97t St
p Y
Property Line
Well is to meet
all setbacks
found in Comm. Huffcutt Combo Tank Pro 3
83 Bedroom
House
B -2
N 13% Slope Tank is to be properly
Grading is to be bedded and provided with
done to divert lockdown covers with
run -off away ❑ B-3 approved warning labels
from system
Area 15' below
system is to remain
undisturbed
B -1
89.5'
89.0' 85.5'
328' Property Line
Safety and Buildings
4003 N KINNEY COULEE RD
Commerce.wi.gov LA CROSSE WI 54601 -1831
iscons TDD #: (608) 264 -8777
www.commerce.wi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
June 13, 2006
CUST ID No. 226900 ATTN. POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/13/2008 Identification Numbers
Transaction ID No. 1278242
SITE• Site ID No. 713962
County View Ridge, LLC Please refer to both identification numbers,
97'' Street above, in all correspondence with the agenc
Town of Richmond
St Croix County
NWIA, SE1/4, S7, T30N, R18W
Subdivision: Country View Ridge; lot 13
FOR:
Description: Proposed Three Bedroom At -grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 1079649
Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade
System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual,
SBD- 10573 -P (R.6/99)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
component manual(s) referenced above.
A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the
designated county official in accordance with. the provisions of Sec. 145.20(2)(d), Wis. Stats.
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil
compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department which may include local
inspectors.
P.O. y. 1,
SHAUN R BIRD Page 2 6/13/2006
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reportg shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any -others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, ` Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
*era Swim
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code: 7633
jerry.swim@wisconsin.gov
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 5/31/06
Owner:Country View Ridge LLC
Location:NW1 /4 SE1 /4 S 7T 30 N,R18W Lot 13 Country View Ridge Richmond
System type: At -Grade
Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99)
SSWMP Publication 9.6 Design of Pressure Distribution
Networks for ST -SAS (01/81)
Page#
1. Cover Page
2. At -Grade Plot Plan
3. At -Grade Cross Section N
4. Pipe Cross Section /Pipe Layout ` G
5. Pump Chamber Cross Section ?
6. Pump Curve
7 -8. Maintance and Co tigency plan G
o v
9 -11. Soil test Z
ca
Shaun Bird
Signature L -
License number 2 00
DiVISin 5AF - TY AND BUILDINGS
SE:E (.iA ONDLP4CE
> 5 B > 5
P t1 ..
5t 2 � upS N
_ � �-- t� �srrtt �T ;c. t.sr►- r�aae. --f r �
w EA Srsagt�tr �� t , �cactinrs WELL
ir
> J i
} tl2B
L � CEL of AC,�t�T�
ftembveb SYm THE - n(- Fabric Distribution Late
STP 1616 -D Observation _ -_., 11 t r Soil Cover
7 i ' �2 � -ra
e
2:5' -2 5
Plan Viev and Cross Section of Wi.s,,nsi n At-grade- i3ni t v rh a
Single Absorption Area on a Sloping, Site
Page Of
Distribution Pipe DetAil For Lateral I#etwork
ACce sr
PvC F orce Ma
PVC flistriEbvtion Pipe
P -
Last dole Should Be Next To
rims- up
Hole Diam eter "" r 32—Inch
X 2 Imhes Lateral Diameter Inch(es)
Y� incises Force Main Diameter
# of Holes/Pipe - �
Invert Elevation Of Laterals �, S Ft.
Signed:
License Number:
Date:
r CROSS SECTI4;� AND SpECI ICATIt?1�5
S£PI C TANK pUtir CliAtiSER
v GLADE WEATHERPWF APPROVED
4 Gi VZNT PIPE }Z" "TN. ABO jUNCTION BOX
WINDOW OR W CONDUIT MA�iROLE COVER
y ` FROM DOOR, w / PAD LOCK �
FAES 4.IR INTAKr �e�;rr � ..—WA RING LASEL
�!�'
FINS GRADE "
_ ,- 3...�„►—
18"
i
INLET
GAS -
WATER TIGHT SEALS TIGHT �
A SEAL ; a jo PPE
Ri.?t 3$ o9m
g ON SoLl f SOIL
APPROVED
PIP£ C. 2 FF
Old SOLID. FT - -+_
APPRO�EiJ $E,D;yIN UNDER TANX P CONCRETE PAD
SPECIPIC1�TZa3+{5 � -
s ! DOSE rMa
DOS£5 'PER i3AY =
{FhC�1�3RER: }3135E �tf}ME FI�Ci.UDII I _
TA A�K - &CK:
�` � fLOWS � / �L �
Gp i.. l 71 GAL -
T141 X SZ2ES SEPTIC € i L. INCAirs
5 cAFRCITI£ L.
ALA 3dAA�FACTtIRER. g = '?_ INCHES = 30
14ont:L UMBER = t.. C
SWITCH TYPE = C INCRES = .r�,r �£'
�i _ ;DIE
p47t4P S = /�-- --
14ANLTFACTUR£R = II
MODEL bvKBER ' ---+ ^ '�j`'` GP � G r P} R I LMR ;6 _ scut
A-'
SWITCH TYPE: a. pU £ AI�R?'� id2RZ13G
G_ t4 FEET
REQD ;RED DISCHt,RGE R''TE BZSTitIB TI ;>IP£ �,r -FEET
V£R'�ZCA►L DZFFEg'ENC-E $rWE:F. � PUMP o; P ` #AND ` - _ - - FEET
FACTOR
DRK S€3PPLY PR SS R� - ZOi3 E F- FggCTIQN --- FEET
+ MiNI�M IRLTW �. T> D`fAL DY IC HEAD = /.f�-- -- ETER
� T v im `�AIIi� • S.rLIi�G
IN'I£itNf�L Dii ENS 1 LIQUID
LICENSE 1 UM £g -
SIGNED= _
it88
sent b y: HP LaSerJet s iuu; i 110 Doe 0OZI ; may -o -uo t:oorm; rrayts elj
9EH SERIES SUMP /EFFLUENT PUMP
1t.65
8.95
o
Specifications
MW Ca , reirOMM err O WA M Ca O
K K r>s er rites m..k) ar&WO 9 It 1s 1~ No rs1 PEI W 012txr
micas 509339 OLIMA C 115 314 1 tow 70 64 55 41 32 tae W 24 9.11 01AAM94
9Bt1CM 5MUD MIMA 4fT 230 314 6S 1000 70 64 55 41 32 13.6 2(F 24 9.11 01.64xe94
SH -3&ws 599350 MCA 4 115 314 Mo tow n 64 55 Al 32 13.9 21Y 27 9.11 x TIM x1.94
991 -C1 ge 5mm ULCSA 4re 230 314 U 1000 70 fA 55 41 32 11a W 27 9.11 x 11.64 x 894
Gar�aous OutyRakd— "Lithe 6imtWaa�wawDU�smen�Oce�nuaesdWYU► ort0u11roY�ertmwiNinBitq�FstKdra6npsiatmseoornOS •'
FLOW- LITERS /HOUR Construction
0 1000 2000 3000 Motor Housing Byoyry Coated Cast Iron
.. Impeller Material Poly Carbonate
3o to I m eller Type Closed Vane
Volute __._... ABS -- ._._...
�- 7.5 Power Cord SJTW-A
20 W Mechanical Shaft Seal 1Vitrile with canyon and
ceramic faces
Fasteners Stainless Steel
= to = Shaft _ _ _ ! Stainless Steel
2.s Bearings Upper Sleeve and Lower
Ball Bearings
0 20 40 60 80
rLOV- GALLONS /MINUTE
PU PERFORMANCE CURVE Little Giant Primp Co
_ 115V 60HZ ro sax 12078.4 Wshom City, OK 73157
* Phosm 40594735!1 • Fu: 405.22 &1556
• F.-md: cas�osrcrserriae (Slittlaeioat.tu®
www.UttleGiant-rump.com :�� Form 995235 —Q7103
QoVVTS OWNER'S SYSTEM E T PLAN
Page of
MANUAL & MANAGE
SYSTEM SPECtFiCAT[CA[S
naH sepdc Tanis Capac" ai C3 NA
F[L.E INFOi2MA M ✓ L septic T2tnic Manufs�r E.t e�+LC+et� nw
owner
P went Etter lVlanada �l D wt
p�10ERS O NA ouent Fifr Model / DNA
DESS al O NA
number of Bet MOT- Pomp Tank CaPadtY
Units NA
Number of CommP� � atfd Pump Tank Manufacturer It
fbw (avela9e� .- atld Pump Manufacturer Esgrrajed J D
Din l ow (per+ (6stmated x 1. da Pomp Model AA
preb .,�ent Unit _ o peat Filter
Son nPPr�°r' Monthly ave4e` p Sand(Gra n
Fa p Wetland
tnfluert�� Quay � Mgn- D mechan3cat Aerabo D Other
Fats, Og & Grease (FOG) 0 mg/l
O , I Demand (OODs) S12 D Disinfek ion
B� � sonde ) sS 50 rr► 1L- Manufaetu�
Monthly avemg Geti(s) D in-ground (p
Pteti l � hrfit Quality D �i0 m91L e D graded (gravity) D Mound ressurized)
13rochemipl O Dom (t30 s} :530 mgn- - D Other_
Total
suspended Solids (T SS) 5•l W c �/t 0oMl V SstswaW and
Fecal 00905m (geometric meean) values typ i c al om
for destic
: ] Y, inchdameter atiw Effluent Particle S ize values types for p " �
NTENAMCE SCHEDULE Service Frequ loncy
S r(s} (Maximum 3 yrs.j
serv
Event D months
At least once every C3
one -third (ys) of tank volume
inspect condE of tank(s) When combined sludge and scum e4 ear(s) (Maximum 3 y
Pump out contents of tank(s) D months
At least ante every s)
Inspect dispersal ceil(s) At least once every D months, s} D NA
clean Efiluent faer At least once ever 5} p NA
inspect puWP, pump controls & alarm At least once every D months
Flush laterals and pies ro pi feast once every DNA
test D months D year(s)
�� p months L1 year(s) f1 NA
At least Once every
00"r
one of the following l or
tNAt � � dispersa e � ahadt be made by an ind c�trYtn9 r poVVTS Mamts'mer. Sept W
InspeCOWA Restricted wer; ppwTS Is C(s) w identify anY missing n
Cordfic* ns: Master Plumber: Master Plumber on of the tanks) or back up
tor. Tonic inspections must include a v(sual InSFet'b a and scum and to check for any
ure the volume of combined sludg to check the eftlueni levels
ServkMg Opera
Nudware,
Men ft any packs � - aisPO cell{s} shall be vc'u y pow Of e fuent on the
or pore[mg of emuent on the g for any ponding of effluent on th ground sur!` of the local regulatory �'
in the obsersrali n Pipe and m check tires the immediate notYficaS tank volume, the
ground aurfalce may indicate a fasng in n and rn in any tank eg or more Of the
mutation of sludge and scum t,lals dis posed of fi akxordance with � NR
When the Combined aka cued by a Septage Servicing opera
enfte contents of the tank shalt be rein t nponents; and Sn
113, Wisoortsin Administrative Code_ onentS, p retreat#'
apical or press urized POWT'S camp �Rtttd by a �� POV1tTS Maintainer
_
The servidng of effluent MtBrs. mesh IS r months or less shalt be p? Brent.
other matnienancx or monitoring at iMterva 12 of comPtet[on of any Seri= .
A serf i* ,report Shall'be PaMded to the local regulatory authority wftftin 10 days of other
START UP AND OPERATION p resence Of paaifing Produce
use of 111e PD�S treatm tank(s) far the p
For new consttucdon. prior � proci'.ss and/or se carnage the dispersal cell(s)- f Conon"ffionS ale
chemjca s tYiat may imped the treatment to a servfcin operator p '
�
detected hate the contents of the tank(s) removed by a P 9 g
i' P
soi l - con d i t i ons are frozen at the infiltMtive Surface_
System sYa� up shag not ocwr when so:� "oo n is resw ed the excess
�� t �tiiti above ' normal iiighwaier leYets_ 1�fYte pa+srer
DcttEng Poor tanks cetl(s} in one large dose, overloading the c(s} and maY result in the
wa.
wig d eof a ,t avoid th7js situation have the contents of the pcaxttg tank removed by a
bad or surer to ,estmIng 'power to the effluent pump or contact a Pluc�er- of POVYTS Maintainer m
Sepiage Se�g Pr
to restore normal levels within the pump tank. confiWs
assist in manuaw q pump
D r e timre or 5f over fall and dlspersal txfls. i}o not drive or park over] 'Dr oitltr>�rise dls>tub or =Pact ,
arm wedn 15feet down slope of any mound or at -grade soli absorption ama-
arn
ftncn the wastewater stre may improve the perfiommCe and prolong the fde
Reduce or•efrnination of the �I� bwIng busts; condoms; Cptton swabs; deur�easets dental boss; drapet%
of the POW - & anttlbio5tS; baWvAP6W .
drallt {8WV PUMP) water, fruit and vegetable pteGrngss gee. mw,` hettxades; meat
drsrtifec�rils: A uc s; pesfiude�; sanitary napkin s: tampons: - and water softener brine.
meamgon o4 " " S ;
ASAMt ONiMEHT taken out of service the following steps shall Ise 'taken to Insure that the
When th POWTS falls andfor is perm aentlY
sy � is propedY and saW abandoned in compfance with ch- Comm 83.33, Wmc onsin Admhtistt2five Code:
All pfin9 to tanks and pits sW -be di and the abandoned Pipe openings sealed -
TF,a oonfen!!s of aII tat►1LS and pits shall be removed and properly disposed of by a Septage SecViang Operator
• After Pumping, all tanks and pits shall be excavated and removed or their Covers r+emared -and tine void space
tilled with soil, grave! or another inert solid material
Ct?NMGENCY PLAN
if the POWTS fails and cannot be r�ePaii-ed tie following measures have been, or must be taKert, ib provide a Dods
compliant replacement system
fl A suitable replacemenCat�ea has �� evaluated and may be utilized f the location of a replaoemerat sorb
ai�ocpfion system_ The replacement area should be protected from disturbance an d compaa san and should not
be infringed upon by required setbacks from eztsting and proposed structure. lot lines and wells_ Failure to
protect the replacement area will result in the need for a new soil and site = evaluation to establish a suitable
replacement area Replacement systems must comptY with the rules in effect at that time.
D A suitable replacement area
not available'due to setback and/or soil fmirations- Barring advances in POWTS
technology a tiold -m talk t lkrnay be installed as a last resort to replace the fated POWTS_
e site teas not been evaluated to identify a suitable replacement area Upon Wure of the POWTS a soil.and
s ate evaluation must be performed to locate a suitable replacement area If no nit area is available a
oldrng tank may be insulted as a last resort to replace the fated POVVT"S-
Moand and atVrade soft absorption systems maY be reconstructed in place fidlowing removal of the biomat at
infiltrative surface. Reaonstruc5ons of such systems must ComplY With the rules in effect at that time -
<-- WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFI OXYGEA!
t)O NOT ENTER A SEPTIC, PUMP Op. OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES- DEATH MAY
RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK mAY 13E DIFFICULT OR illlfPOSSI
ADomoKAL COMMENTS
POWTS INSTALLER POWTS N WNTAINER
Name
Phone �S V Pllt�fte
SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULA70KY /iU - / Y
Name Agency , _ x C t�
Phone ��- Phone
This doouraeot was drated by the s1 fE of the G.teea Lske, Marquette and Waushara County Zoning and San}lalmrr egCt dm This doauneat meds
the mad-wn mgc&emerats of dr. Coarm and 83 & (3). Wisconsta Aa3rrr&j=afm Codes Use of 94s d,,=mt does rot
guarantee the peiformance of the Powrs. (,BAW (2101}
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHI P CERTIFICATION FORM
OwnerBuyer [
Mailing Address T C� 1s 6X.
Property Address l l S
(tr 'cation required from Planning & Zoning Department for new cons / on.)
City /State
Parcel Identification Number 'r 2 -67 �L o4 �
LEGAL DESCRIPTION `
Locasion/U >/a , S� 1 /4 , Sec. Town of
, TN RW,
pr operty
Subdivision Lot # ��� '`
Certified Survey Map # ll ,, _ Volume - Page #l
Warranty
Deed # - ,Volume `-�V S� Page
Spec house yes no Lot lines identifiable ( 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 P ut 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. 8352(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department ta a y ceertificanon form. signed by the
owner and by a master plumber, Journeyman plumber, restricted plumber or a license that (1) the on -site
d um v
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 an d 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.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe an/are the owner(s) of the
prop described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE APPLICANT {S) DATE
* ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning DepaiUnent. * **
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)
Safety and Buildings
j commerce.wi. ov 4003 N KINNEY COULEE RD
LACROSSE W
g R 31
1 5 4601 -1 8
TDD #: (608) 264 -8777
i co n s i n www.commerce.wi.gov /sb/
Department of Commerce www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
June 13, 2006
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/13/2008 Identification Numbers
Transaction ID No. 1278242
SITE: Site ID No. 713962
County View Ridge, LLC Please refer to both identification
97 Street numbers, above, in all
Town of Richmond correspondence with the agency.
St Croix County
NWIA, SE1 /4, S7, T30N, R18W
Subdivision: Country View Ridge; lot 13
FOR:
Description: Proposed Three Bedroom At -grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 1079649
Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from
original grade
System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component
Manual,
SBD- 10573 -P (R.6/99)
The submittal described above has been reviewed for conformance with applicable Wisconsin
Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY
APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible
for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the
Department per s.145.06, stats.
The following conditions shall be met during construction or installation and prior to occupancy
or use:
• m i constructed and located in accordance with the enclosed approved This system s to be co pp plans
p
and with the component manual(s) referenced above.
• A sanitary permit must be obtained from the county where this project is located in
accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the POWTS installation is required. Arrangements for inspection shall be made
with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),
i
SHAUN R BIRD Page 2 6/13/2006
Wis. Stats.
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular
traffic or soil compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the
owner of the tank explaining that periodic cleaning of the filter is required. Access to the
filter for cleaning must be provided per Comm 84 product approval conditions.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site
during construction and open to inspection by authorized representatives of the Department,
which may include local inspectors.
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including
instructions relating to proper use and maintenance of the system. Owners shall receive a
copy of the appropriate operation and maintenance manual and/or owner's manual for the
POWTS described in this approval.
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the
operation and maintenance of the POWTS occurs in accordance with this chapter and the
approved management plan under s. Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved
management plan or as required under s. Comm 83.54(4) shall be considered a human health
hazard. In the event this soil absorption system or any of its component parts malfunctions so
as to create a health hazard, the property owner must follow the contingency plan as
described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals
appropriate for the component(s) utilized in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes
or additions should conditions arise making them necessary for code compliance. As per state
stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for
designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed
below, or at the address on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are
responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M Swim
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633
jerry.swim@wisconsin.gov
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
r
C
Wisconsin Department of commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with C m
Attach complete site plan on paper not less than 8 112 .11 in es in si
r LVEP my �S C
include. but not limited to: vertical and horizontal reference poi t (BM), direction and P reel I.D. /
percent slope, scale or dimensions, north arrow, and location nd distatr to rrAearest road. 6 Z� '' Z 9 1F� "' 13 ^ a i�6
Please print all information. 1 'FUu eviewed by Date
Personal information you provide maybe used for secondary purpos tPriva�y71,>ty{�1.�d��11 �j
P rope rty / 1 V 1, tion
P Owner � n �� Z (�i,/ // Z / /l Govt. lot 1/4�� 1/4 7 T 3 N R/ E (o W
Property r s Mailing Addr h l t # I Block # Subd. Name or CSM#
.' 0 j Box /7 6 rtrL.q. — &u-' '/,- ie 2i
city / State Zip Code C' ❑ Hage TOW Nearest ad
New Construction Use: esidential / Number of bedrooms Code derived design flow rate fly GPD
❑ Replacement ❑ Public or meraal - Describe:--
Parent material Flood Plain elevation if applicable Ae// o* ft.
General comments
and recommendations: 4 i 3l . l7
Boring # ^� Q g n
Pit Ground surface elev. / , ff. Depth to limiting factor V in.
Soil Application Rate
HorI= Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
4-7D S
®Bonng # 4 Boring
pit Ground surface elev. ft. Depth to limiting factor m.
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
6 l ot le V� - i /-6
6
l ry r`� ! •a
Effluent #1 = BOD > 30 220 rrtglL and TSS >30:E 150 Effluent #2 = BOD 1 30 mg/- and TSS < 30 mgli-
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 j' —C;o r' 715 - 246 -4516
Property Owner _ Parcel ID # Page of
3 a Boring # Boring
Pit Ground surface elev. ZP t. Depth to limiting factor In. icabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh.
'Eff#1 `Eft#2
A 1ij
F-1 Boring # p 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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Applicatim Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
` Effluent #1 = BOD > 30 1220 mglL and TSS >30 1150 mgk ` Effluent #2 = BOD 130 mgll_ 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.
SBD4330 (R M)
• Soil Test Plot Pla
Project' Nagne Country View Ridge LLC Sh B' d
Address P.O. Box 176
New Richmond Wi 54017 TM #226900
Lot 11 Subdivision Country View Ridge Date 5/20/05
NW 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/Nail
System Elevation 89.0 *HRPSame as Benchmark
B.M. 307' Property line
Scale is 1" = 40'
unless otherwise
noted
85.5'
89.5'
B -2
13% Slope
243' property line
B -3
100'
50'
B -1 30'
30'
50'
3281 Property Line
l
FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P12
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FROM :OEVERING HOMES LLC FAX NO. :7155311282 Dec. 14 2004 10:14PM P11
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U 2656P 061 774.312
STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIK CO., WI
This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:29AK
Ridge, LLC Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEPPT if
the following described real estate in St. Croix County, State of Wisconsin
(the "Property") (if more space is needed, please attach addendum): REC. FEE: 13.80
See attached Exhibit A TRANS FEE: 1410.60
COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Name and Return Address
4 aQ
LWqa LJL5
f
26- 1025 -40-000
Together with all appurtenant rights, title and interests. 026 - 102430 -000; 026 - 1024 -40 -000: 026- 1025 -30-0
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 Z Y� day of 2004
Gerald A. Kieckhoefer, Jr. David J. Ki oefer
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Gerald A. Kieckhoefer, Jr. and David J. STATE OF )
Kieckhoefer ) ss.
�
,( County )
authenticated this �` da of 2004
Personally came before me this — _ — _ day of
the above named
* Krist_ina Ofiand
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. I -1999
U 2656 P 062
Exhibit A
Located in part of the SE'/ of the NE %, the NE , f the SE V4, ,
SW % of the NE '/ of Section 7, Township 30 North Rang 18 W the NW / of the SE d , County
and the
of St. Croix, State of Wisconsin described as folibviis ch
: 9 ems• Town of RI mond
Commencing at the East quarter comer of said Secti 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 0 18'55 4 W on the northerly line of a Ce ed Survey Map recorded in Volume 13, Page
3752 a distance of 610.00 feet; Thence 300 °37'10 "E on the westerly line of said Certified Su
Map 428.42 feet (Record 428.50 feet); Thence S89°�18'52 along the south line of the N i4 of the
SE '/ of said Section 7 a distance of 1146.36 feet Thence NOW 3'53"W 1384.45 feet; Thence
N88 °57'22 "E 1048.00 feet; Thence N51 ° 00'00 "E 25 .00 feet Thence N88 °22'35 "E
a point on the East line of the NE' /. of said Section ;Thence S00 °4 "E orlon $ 07.00 feet to
i
the NE / of said Section 7 a distance of 248. 0 feet to the Point of i East line of
terminating. Beginning g rid there
f
i
97,914 sq.ft.
0) 8
2.248 acres 2
00 87,918 sqft.
W) X
2.018 acres
N
0
z ZI
,-80' radius temporary
cul—de—sac easement
to be released in writing by
the Town of Richmond upon
road extension
0
—246.68 — — — — — 220.00 — — —
N88*57'22 799.12'
ks N88*5722 426.69" Nf
—t22.64 278.52'— — — — 100
;5� 'n (01
<q% 0
0
>
W
3r. W
0 0 00
00 f5 1!
10
n (n 100.
87,128 sq.ft. in
b
2.000 acres 0 0
LBO 989.00 V .: 0
z
zi
Ow
426-59'
1z
CL V �
C*4 82,781 sqft. S40-49 J, 465,,
1.900 acres 65.55
C-4
0 LBO 984.00
LC) C14 6�
11 1 S
z N32'30'5,
49.56'
S83Vj @
30.
'00 87,1'
0) 2.00
00 12
80,345 sq. ft. 100
1.845 acres
6 6'
(9
2,97
S57*04'22
75.65' S
N89 301.71' C*4
80* radius temporary 130,693,
cul—de—sac easement t<
to be extinguished upon 3.000 C
road extension LBO = 9
10 I in
13 -.01 0! ;D 100 10
V_
CS! 76,222 sq.ft. CD
1.750 acres N A r o �
OD
N89*18'52 It
A 60.00.
328-46' —
66.39'
S8918
Revised: October 19, 2005