HomeMy WebLinkAbout026-1296-14-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
488156 0
GENERAL INFORMATION } (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for .11condary 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 -14 -000
CST BM Elev: Insp. BM Elev: Description Section/Town /Range /Map No:
/00 BM IJ ►� cs % 07.30.18.1545
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
7, 4 /6"7 Jab
Septic q q - Benchmark
Dosing Alt. BM
Go bi (act w., I c 55 �JL . C)
Aeration � I � Bldg. Sewer � . , �$ • S
Holding St/ Ht Inlet all 5
TANK SETBACK INFORMATION S t /Ht Outlet
TAN TO P/L WELL BLDG. vent to Air Intake ROAD Dt Inlet � \
/� t Bottom
t7 qs
ep is /JA- fig/ /
Z I
I , 1A vlf' , �� `� ea er an. 1 L ` Z. joZ •Cj
era ion is P ipe / 7—
�� / 6Z
o mg
Bo t. System
oZ
PUMP /SIPHON INFORMATION ina Grad 7 3 . - L /03
m anufacturer L r � G GPM Dem St F t Cov S . Z5
o e um De r
i nc ion ss ys
7r S 0 .
lF orcemain / 015. Z N �A,
SOIL A SORPTION SYSTEM
3a
DIMENSIONS / q ti. 1
Sr
INFORMATION Y � 3 �U 1� CHAMBER OR Model NuFfItul.
�'I i — V CGS &f O� UNIT
lbutivil
Il Pipe(s) / /J I P Cc�✓
Lengt Dia •Z Length Dia Spacing Z J✓�
x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed /Trench Center / 9 Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ( -P / ] 9 / O(p Inspection #2:
-,,Q, PI o� CA-, Location: 1631 97th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 7 T R18W) Country View Ridge Lot 14 � Parcel No: 07.30.18.1545
1.) Alt BM Description 0, +
l �„ct,•,• t •S. 1_ a c �CS o,,�
2.) Bldg sewer length = ��
- amount of cover =
7`(Z
Plan revision Required? Yes _ No - �
Use other side for additional information. 19 �� �5
- -� LDate� to ature - Ce Na
SBD -6710 (R.3/97)
1
r -
• t
Safety and Buildings Division n l
201 W. Washington Av v
\* &Consin, Ma n, WI 5 07 — Sanitary Pe it Number (to be filled in by Co.)
08) 266- 151 y •� /
Department of Commerce
Sanitary Permit Ap 'ca n M tale Plan I. . N
In accord with Comm 83.21, Wis. Adm. Code, personal i ation o e CRDI C U v
may be used for secondary purposes Privacy Law, s 4(1)(m ST Project Ad s (if different than mailing address)
I. Application Information — Please Print All Information
/
C� 7 5V
Property Owner's Name Parcel # of # Block #
Property Owner's iling Address Property LOl ation
v , 3 o,4 I , ''A, Section
City, State Zip Phone Number - C
G�.c..t) ,�...t c--t�� +�Lj�V`r'� �, 1 5'C � 1 T N, �E tWJ ) • � ✓ ��
11. Type of Building (check all that apply) a r Cob Sv M�
Subdivision Name CSM Number
or 2 Family Dwelling - Number of Bedrooms . KQ 1 a s^
El Public/Commercial - Describe Use C e6`c
❑ State Owned - Describe Use 16 'F ❑City_ ❑Vill ge'�Township of r
III. Type of Permit: (Check only one box online A. Complete line B if applicable) Dz (p •l2 (p /y OOa
7 1�_� w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. — Type of POWTS System: Check all that appl
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland El Pressurized In- Ground El Holding Tank El Peat Filter ❑ Aerobic Treatment Unit E7 Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersaVrreatment Area Information:
/ Design Flow (gpd) Design So` Application Rate(gpdsf) I Dispersal Ar ea Requir d (sf) Disppl Area Proposed (s System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units ' _ n / Concrete Constructed Glass
New Existing f✓ /ZA 4QtX. A ! �
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement I, the undersign ume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe ' ature MP/MPRS Number Business Phone Number
Qu s�
Plumber's Address (Street, City, State, Zi de)
VIII. Count /De artment Use Onl
Approved isapprove Sanitary Permit Fee (includes Groundwater Date Issue Issuin ent Signa S
Surcharge Fee)
El en Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER: 3) 90 : t+�JE6� St 1 0 - YV�a� n Q
t . Septic tank, effluent fitter and �
dispersal cell must all be services / maintained
as per management plan provided by plumber. I
2. AN setback rWAM
code I arr us di ttlw ertstairttained
as par q*Jc" PC,
`
Attach complete plans (to the County only) for the system on paper n ess than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
,
PLOT PLAN
PROJECT Country View Ridae LLC ADDRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 102.0' BEDROOM 3
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE
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
97th St.
Scale = 1/4" = 10' Property
Line
Well is to meet all
setbacks found in
Comm. 83
Huffcutt B - 2 Grading is to be done
Combo Tank to divert run -off
away from system
Pro 3
Bedroom
House 10% Slope
Tank is to be properly B-3 102.5'
bedded and provided with 102
lockdown covers with Area 15' below
approved warning labels system is to 100.5' B. M.
remain
undisturbed
287' 287' Property Line
C y
PLOT PLAN
PROJECT Country View Ridae LLC ADDRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1/4S 7 ` / 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX
SYSTEM ELEVATION 102.0 BEDROOM 3
CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none
kk BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P . Same as Benchmark
97th St.
Scale = 1/4" = 10 Property
Line
Well is to meet all
setbacks found in
Comm. 83
Huffcutt B - 2 Grading is to be done
Combo Tank to divert run -off
away from system
Pro 3
Bedroom
House 10% Slope
B -1
Tank is to be properly B-3 102.5'
bedded and provided with 102
lockdown covers with Area 15' below
approved warning labels system is to 100.5' B. M.
remain
undisturbed
287' Property Line
Safety and Buildings
4003 N KINNEY COULEE RD
commerce.wi.gov LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
i scons i n www.c ommerce.mi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
April 27, 2006
CUST ID No. 226900 ATTN.• POWTS Inspector
ZONING OFFICE
SHAUN R BIRD ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 04/27/2008 Identification Numbers
Transaction ED No. 1266184
SITE: Site ED No. 712085
Country View Ridge LLC Please refer to both. identification numbers; 11
97` Street L above, in all corres ondence with the agenc
Town of Richmond,
St Croix County
NEI/4, SEIA, S7, T30N, R18W
Lot: 14,
FOR:
Description: Three Bedroom At -Grade System
Object Type: POWTS Component Manual Regulated Object ID No.: 1072875
Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade;
System: At -grade Component Manual, SBD- 10570 -P (R.6/99),
Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter
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, (,' o" d t O
stats. r" 'c,., ow "1
The following conditions shall be met during construction or installation and prior to occupancy or use:
D: rA. PTMENT OF I
Reminders J �!Q�N� sAFrt;Y
• This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESPI
component manuals listed above.
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and
dispersal are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area. chs. NR 811 & 812c
• 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. Stat
SHAUN R BIRD Page 2 4/27/2006
• 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 M include local inspectors
Owner Responsibilities:
• Comm 83.52 Responsibilities. 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.
• Comm 83.55 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.
All permits required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
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
Charles L Bratz
POWTS Reviewer II, Integrated Services WiSMART code: 7633
(608)789-7893, 7:45 am - 4:30 pm Monday - Friday
charlie.bratz@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: 4/21/06
Owner:Country View Ridge LLC
Location:NE1 /4 SE1 /4 S 7T30 N,R18W Lot 14 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 , fYp
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
� Pc
6. Pump Curve i'ihGs
7 -8. Maintance aLnugency an )NpENC
9 -11. Soil test
Shaun Bird
Signature
Licen se number '6900
RECEIVED
APR 2 4 2006
SAFETY & BUILDINGS
2 ; N
PVC F0P4ETAAIw
`-cuRw-ups
— tSTAt tT ;o p.1 LATR -AAL
w
E
STl�6t1 t�'LD os��fltTlbts V�ELL
>5
ir i
t/ 8 1/f B
If28
A
8= Ft.
L = IF{- CELL of %L - Z & MAIXE.&ArTE
eLb SXw THEMc. Fabric
D istribution Lateral
hipmo
S M161C Lb Observation - -� ,�= t �-- Soil Cover
{�jp 121i 1 ! t / �
y. Q-
f LbWF D
A 5
D �>Z SWE
plats view and Cross Section of s�osssi>z Unit With a
Single Absorption Area on a Sloping Site
�� cc 1t
S tGriA -ru �E
• I
I
Page Of
Distribution pipe Det'3il for Lateral 3jetwork
ACCe S'f
a. TuRk -UP (CLft ,40u T)
H:
- PVC Force Main
PVC Distribution Pipe
P- ---- --
* fast Hole S hould Be Next To
TURN- up
P
8 0 Ft. Hole Diameter � 3 2 - Inch
x �--� Inches Lateral Diameter � Inch(es)
Y `� inches Force Main Diameter � Inches
of Holes /Pipe 7_
Invert Elevation Of Laterals / 22• C — Ft.
Signed:
License der:
Date:
J
T W And S ICATZ{TNS
SEPTIC TANK 6, PUMF CliAMB£R CROSS SECT .
rAnWjtPRWf APPROVED
„ �Y�, ABOVE GRADS £ Ji1NCTIOt� BOX
y" G VENT P LPE I I NDow 4R W 'TK CDATDU I T tN a I.E cOv ER
> �oH DOOR, w1 FADuCK
s -.IR INTAKE Ham# ;NG LABEL r ttE ai_ T � << .
�C I HIM.
Flt =D GRADE
INLET s j
AS-
wAT£R Tlr.HT SEALS – T — TIGHT
A SEA ► ; APPROVED PIPE
a F ON SOLID SOIL
APPS '
PIPE 3: C ' FF
Own SO LID. � ,0, fFT.
SOIL pump t)FF ELEV - O
G UNDER TAY+I
3- Y ED K
pPFRO BEDD�rf j�ONCRETE PAD
SP rCIFICATIONS r.,
SEPTIC f DOSE Null ER DOSES PER DAY: �_ -----
FAC`3�3 -ER : OCS£ v c3 ME � KC LUi3 i l[6 9' �� _
TANK HAND GAL. FI.13 C1G / -- CAL
GAL - �7 J'-G AL-
TA11iC SIZES DOSE SEPTIC � tJ - =0 _�' vicars '
S CAFACgTIFrS:
D A GP L-
- : J v
MA#DFACZVIiER,= (j 8 = .2
_ INCHES
1 —
A- � MODEL �tf$ER s /° � _ � 3 INCHES
C
= ��- �=
ITCH TYPE /
--- ,//
nA3�1ETFAC'1�3R£R � � ;HCHES =
13 -5
PUMP PUMP t� I LHR 16.23 VA 8PE, �#P M I MG
M � ;TCIi � 3 Gail _ � U 8 AL:AR WIRING � _P FEET
REQ�TTRM D3:SC?"%RGE } I STgIB TIC PIPE EET
pUtiP OFF AND '
VERTICAL DIFFERENCE HETWE:E3� FT1I04 FT Ii
i + FA" -_- FEET
+ MIN JM NETS, O RK # SUPPLY PRESSUgE Tp'IFiL DYN�IC i r
FEET F4RCEl X j-�-" /
� DI
PUMP `i'ArtK:
INT£DNAI. DLI�ENSIflFiH �£
LINID
LICENSE NUM El " �.
SIGNED- _
" /as
I
TOTAL DYNAMIC HEAD /CAPACITY
• PER MINUTE
HEAD CAPACITY CURVE EFFLUENT AN D E'NA TERIN G
MODEL 1'52/153 MODEL 152 153
W
50 Feet i Meters Goi. Liters Gal. Liters
5 1 -5 E9 261 77 291
153
10
3.1 61 _ 231 70 - 265
12 4O 152 15 4.6 1 53 201 67231
i 20 6.1 1 44 167 52 197
30 25 7.6 I 34 1 129 42 159
Q 8 30 9 .1 23 11 87 33 y 125
o , 35 103 i -- - 22 i 85
Y 20 10 12.2 i -- -- 11 ( 42
o •
4 I Lock yc 38.0 Ft. (11.6m) 4 4.0 F t. (134m) i
10 014M.
l
a
20 40 60 80 1 00
GALLONS '
LiTF4S 0 80 160 940 320 - 3 27(32 a 5 /6 j
FLOW PER MINUTE �
3 27/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS E _
• Timed dosing panels available. 3 27132
• Electrical alternators, for duplex systems, are available and supplied with
an alarm.
• Variable level control switches are available for. controlling single phase
systems. E
• Double piggyback variable level float switches are available for variable�"� 'j�
level long and short cycle controls-
• Sealed Qwik43ox available for outdoor installations. See FM1420.
• Over 130 °F. (54 °C,) special quotation required. '
12 1/a I
. 1511153 Series • l ----�-
152F153 MODELS Conu i selection 1 1 I 1
Model YoNs -Ph Mode Asnpor Sim ac Ou tex ' 1/h
N152 115 1 Non 8S 1 2 or 3 f i
aN152 116 1 Auto 8.5 included 2 or 3 t , �_ SK2M
E152 230 1 Hen 4.3 1 1 2 or 3 t
BE152 230 1 Auto 4.3 Included 2 or 3
Ni 53 115 1 Non 10.5 1 2or3
SN153 115 1 Auto 10.5 included 2 or 3 SELECTION GUIDE
E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float
BE153 230 t Am m S.J Included 2 or 3 switch. Refer to FM1477.
n
A cAUoN 2. See FM0712 for correct model-of Electrical Alternator E-Pak.
Au installation of controls, Protection devices and wging should be done by a qualified 3. Variable level control switch 10-0225 used as contra! activator, specify duplex (3)
licensed elecbisian. Ali elcmicd and safety codes should be followed Including the most. or (4) float system.
recent National Electric Code (NEC) and the occupational Safety and Health Act (OSHA).
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO: P.O. L30X 16347
Louisville, KY 40256 -0347 �
L SHIP T0: 3649 Cane Run Road
w rff, Louisville, KY 40211 -1961 iry F S XT /Es"
f 502) 7732731.1(800) 928-PUMP
httpylwwwzoe1)er com FAX (502) 774 - 3624
® Copyright 2000 Zoeller Co. All rights reserved.
l aye of
e S 01tYt+iER'S �yANUAL & MANAGEMENT PLAN POINT SPEGIFtCATf
SYSTEM ,�,,,�>
Septic Tanis CaPa Y C7� at 0 NA
INf'ORMA - " taw
EuJE A Septic Tank Mangy
owner'Gr
Petmlt _ Effluent Flier Mamftc 1w - o hA
pFSi0N PARAl -3 0 NA �quent f= rtter'Model llT r7
Q NA
Tank CRPa�` al D NA Nu nbe�r of Belt wT* Pump .
4-a NA
Numb of � Prdai Units aYd Pump Tank Manufacturer.
O NA
flow av+eMe) m Manus KA
�n flow (peaK?• fEsb�marted " �� , � alld Pump Model l�
SoII Monthly average 0 rotate Filter
Peat F71ber
trrflrratstl
Qua G �i0 mg1L p Mechan Aeration fl Wetland
Fats, Oil � Grease ) 5=o mg/L ❑ Disinfection a Other
gipdemical Ou!'gen Demand {BOOS)
Total am $crids (TSS) m /L. Man ter
Monthly average" Dispersal CeliCs? j3 in -ground ( pressudzed)
t QuatttY NA p ground (gMvp
P Eft wt . S_i0 m91L O Mound
en D (90Ds) grade C3 Other
S'rocheroicai Oxyg clad Sotid5 {TSS) /L p pri ne
S30 m9
Total S m uric mean) s10` cfurl0omi
nn (geometric y inch diameter vgnresmalai
for dor+c (non•ootrr+>c,wmsta+�a�r and
�� tarsic ertiuent.
A Size Values types for rua wasi7E+ tai
l WNTEXANCE SCHEDULE Service Frequency
Service Event ❑ rnontfis r(s) (Maxirnurn 3 y*8•)
At least once every uais one -third (K) of tank volume
inspect condidon of tank(s)
When combined sludge and scorn e4 s (Maximum 3 yrs-)
Pump out contents of tanks)
� )
AL least once eve p months ry � r(s)
Inspect dispel 0I At }east once every 0 Q months
s) 0 NA
Cfeanefltuentfiitier controls S alarm At least once every months s) O NA
Inspect Pump- P ump � At least once every � II - ' 0 year( s)
d s � NA
Flush later an pressure At least once every Q coo
oC+er p months II year (s) ❑ NA
At least Once every
oa>er
lank volume veils Sha¢i be made by an individual carrying one of ilia fctitowr+in3 licenses or
r�dAtNfENANCE INSTRUCTIONS
ebor. POW TS Maintamer. Septage
lnspe of Mags and dispersal pOWTS finspe �g o r broken
Mastrl pi ;Master Plumber de 2 visual Inspection of the tank(s) Sevrer; to r any back u p
identify any
ins must: include a visu fo
Servicing mr• Tank ins ° ure the volume of combined sludge and scum and o+� ��t feveis
hard. tdetft any Cracks ro leaks. rrteas The dispersal veil {s) shall be vi$LNAY hs � ��� of etfiusnt on the
,r poI O f effluent on the ground surface_ round surface.
in observation PiPes and to Check for any ponding of effluent Ax , the g
indicate a faSittg �pnd rtion and req�rres the Imm or more of ediate notification of the local regulatory �'
ground may flats one -this (Ys) the e
ufatfon of sludge and scum in any tank eq d(4) of In accordance With
When the combined acxum owed by a Septage Servicing operator and
entitt: of the tank shall be rem
113, Wisconsin Administrative Cade. onents, P � atPment �ponenK, and anY
antral of pressurized POWT - S comp a died POWTS Maintainer.
'Ilse setvlcing of effluent filters, t�h
ofherinafntenanoe or monitoring at inwmis of 12 months or_fess shall be �rformed by Ie of any serv►ce
A .111ge repo Ftshaft be PrM� to ant
oc� the 1 Lego
latory authority within 10 days of comp
START UP AMID OPERATION rodutts or other
For
treatment tank(s) for pt�sence �� ¢
new oonstlivMUM. Prior to use of the PD YTS check ce'it if eonceni� dons are
cheml gfs tfiat may impede the treatment process - damage the dispersal t s riior to use -
d have the contents of the t removed by a septage servicing aperabor p
• power to the effluent pump �yg "conditions are frozen at the infiltrative surface_
System start up shalt not occur when rostpred tfie excess
��� P l y 0 above normal haghwate teveis_ Vrrhen p ower
Dosing r� oeti(s) n one large dose, overloading the ced(s) and may result in the
v�t be discharged to the d"� i
>>� a< ca r a of efft3 ent_ To avoid this situation have the c.Ontersts o f the pump tank removed by a
w
e S surft e .OpwaWr �� wrrg or contact a FILM tree or POWs• ' Mairtlainerto
assist in g pip �trols to restore normal tevefs witizin the pump tank.
Do not drive or park vehit .ins ° tinks an d dtspersai cis. Do not drive ar park over, or o t raise disturb or compact,
m area Woffn 15 feet down slope of any mound or at -grade =1 absorption area -
Reduction or- elimination Of the fllowing f rom the wastewater stream may improve the perionrrarM and p1OW9 the tdie
of the POIAtTS: antz'bla6cs: � bu s; condoms, cotton sways: degt�e'asers: tienta(tk�s; c cs:
Pe
diaht (sump plump) water, fruit and vegetable peelings; 9aS0Mw% gr�, herb"rddes meat
drsin ' t roducds pesticides. sanitary napkins. t and wafter softener brine.
s rnedkatWW- of 0arnting p
AaMoo4UENT taken out of service the foltoyArig steps shall t3 taken to Insure that the
When the POWrS faits Petir12t1et1t�''
system is propedty and, sa * abandoned in eomprranc� vrifh ch_ Comm 83.33, 1Arrsconsfn .4drrrinislrativ�e Code
• AN piping to tanks and pits shaft •be disconnected and the abandoned pipe Openings seal6&
Tho contents of 2a tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
After pum as tanks and pits shall be excavated and removed or their covers ren"'acr•arnd the void space
Wed srdh soli, gravel oranoftaer inert solid material.
CONMGENCY PLAN
If the POW T'S fads and cannot be repaired the following measures have been, or must be takes. to provide a code
compliant replacement system
O A suitable rieplacarment "ams has been evaluated and may be utilized f the location of a replacement sod
absorption system_ Th re placement area should be protected from disturbance and compaction and should not
be infringed upon by cequked setbacks from existing and proposed structure. rot fines and wells. Failure to
protect the replacement area will res ult in the need for a new soil and site 'evalCratYOrk W establish a suitab
replacement area. Replacement systems must Comply with the rules in effect at that time.
D A suitable replacement area is not available due to setback and/or soil limitations_ Barring advances in POYYTS
technology a hold tank may be installed as a last resort to replace the faded POWrS.
e site has not been eva[Lmted to identify a suitable replacement area. Upon failure of the POWTS a sod.and
site evaluation must be perfonved to locate a suitable replacement area If no replacement area is avaifaWe a
holding tank may be Irt s�fal[ed as a last resort to replace the failed POWrS.
Mound and atVmde sag absorpf on systems MaY be reconstructed in place fiolkwAng nNnoval of the biomat at
the infiltrative surface. Reaonsb ucd ons of such systems m ust comply with the rules in effect at that time_
<<WARMING>>
SEPTIC, PUMP AND OTHER T .EATMENT TANKS MAY CONTAIN LET14AL. GASSES ANDIOR INSUFFICIENT OXYGE&
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 13E DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWVTS INSTALLER POWTS MAINTAINER
Name
phone /J .� Phone
SEPTAGE SERVICING fJPERATOR PUMP LOCAL REGULATORYAUiHMY
a1Tlt= ' Agency FN
hone 3 ---- Phone
R is doomsent was dad by the Stall's of the green Lake, Marquette and Waushara County Z.ontaq and SaaA`afion alwdim 7bb d=OrA meets
me mk*nucn aqWmnwft of dL. Cam 83- 22(Z}ib} 1XdW* arrd 83-54(l). & (3). Wisconsin Afttriisttaffm Cc& Use of this daclmwg 6005110t
guarantee the pe&naace of the POW 'S_ G1JW (Ml)
WisoDl'an Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings .
in accordance with Comm 85, Wis. Adm. Code - �
Attach complete site plan on paper not less than 8 1/2 x 1 inc/ Coun `" S t I er x
EZ
include, but not limited to: vertical and horizontal referen poin �I�g1pp Parcel I.D.
percent slope, scale or dimensions, north arrow, and I tion and dista7i road.
Please print all inform on. Reviewed by Date
MAC' � .-
Personal information you provide may be used for secondary p rposes (Privacy w!!. 151(1) (m)). 5
Property Owner S ! . 0 " F Local n
1 /4sF 1/4 S T� N R f E (o w
Pmpe I's Mailing Add / t # # Subd. Name or CSM#
�v 1 S0 N, /J.K.4 ly 41 rA 2i
City StateZip Code ❑ C' y ❑ illage To Nearest R ad
/ r
New Construction Use: esidential /Number of bedrooms J Code derived design flow rate J GPD
❑Replacement ❑Public or mercia - D / $scribe: _ _._ —_ -- -- --- - - - - --
Parent material / / f Flood Plain elevation if applicable %1/� ft•
General comments
and recommendations: S�e 4, PTV
s� � � S
M � # Boring /
Pit Ground surface elevf _ _ ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I S m C' �' ►4/� i b a
2 1Z -y6 l J fo
W] Boring * Bpit oring /
Ground surface elev. < D �" ft. Depth to limiting factor• EI Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2
0„V 1 /D r 3 �Z 4 2 ✓'
13 L .s Ae i at „A-)
n 1, �-
Effluent #1 = BOD > 220 mg/L and TSS >30:E 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 nxyl
CST Name (Please Print) ignatu re CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 J am-" _ 715- 246 -4516
.w
Property Owner _ Parcel ID # / Page of
Boring
Boring # / ✓
`—�
pit Ground surface elev. � �ft Depth to limiting factor i ^• Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIif
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o r 3/y S( 2 4-r- c 2-en ' (0 0
� , S(
F-1 Boring # ° Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor r ^• Soii licafion Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Boring
# Ground surface elev. ft. Depth to limiting factor in.
F ng
El pit - Soil Applicaticivi Rate
Horizon Depth Dominant Color Redox Desc . Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 220 mi and TSS >30 150 mi ' Effluent #2 = BOD < 30 mgll, and TSS _< 30 mi
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.
SBD8330 (R.6A0)
Soil Test Plot Pla piud
Project Name Country View Ridge LLC Sh
Address P.O. Box 176
New Richmond Wi 54017 CS #226900
Lot 1 2 Subdivision Country View Ridge Date 5/20/05
NE 1/4 SE 1/4S 7 T 30 N /R W Township Richmond
Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron /Nail
System Elevation 102.0 *HRpSameasBenchmark
97th St.
_9" Property Line
-2 30'
100.5'
50'
o�
10% Slope
s�
40' B -1
B -3 102.5
5 '
d N B.M.
Scale is 1" = 40'
unless otherwise 287' Property Line
noted
r -
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 4
Mailing Address p
Property Address -1
(Verification required from Planning & Zoning Department for new construction.
City /State Parcel Identification Number
OZ6- /Z9'4o —/.V—GYM
LEGAL DESCRIPTION
"?
Property Location, 4 � '/4 ,A!�1a , Sec. �, T N R AV , Town of
Subdivision -1. - , Lot #
Certified Survey Map #
, Volume c , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiabl yes 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 put 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_ 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
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.
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 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
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
�SIGNATURE-O DATE
* ** Any information that is misrepresented 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. 08/05)
I
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-�s� - -- 278.52'-- - --__: 33' 33• -�- -- 259.18' - - - - 47.80 - -- \�
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E 245.75' N82 36 23 /�.
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2 r o,.\ 2.000 acres \\
sq.ft. I 100'
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acres I I i I •\ -' S57b422" 18 x
{ \��` 82.01' 80,874 sq.ft.
{
6 6 I �� ` 1.857 acres
{ p �i `� LBO = 959.00
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Ui S57 . 287 01 k ,
•1 "E 301.71' { N N ; ` 75. 5' S7 N 9 j63 , C� 1
nporary o 5 84•87i/,9y �
asement { 3 { 3 I o 13 , q. ft. w to �6�' _
'shed upon N 3.000 acres I 12 ` Drainage I
-1 \ N LBO = 959.00 m 63 09 s ,� Easemen t - I
0 I N
I J '
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:res { c { N { I) m .31 85 0 S N
0
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m { ^ /A I N8978'S2"E �;- N2839'52 1 E
\ / h 66.00'
328.46'
78. �o oo' / - '
66.39' 1 533.52' - r'
I South Line of the North Ha lf
- - - - I S89'18'52 "W 1146.36 - - - -of the Southeast Quarter
UNPLA TTEC
U 2656P 061 774312 ��
STATE BAR OF WISCONSIN FORM 1 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:28AK
Ridge, LLC Grantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT 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: 13.80
See attached Exhibit A TRANS FEE: 1410.60
COPY FEE:
CC FEE:
PAGES: 2
Recording Area
Na m om'') Return qCS Address "a a 1Q
26- 102540 -000
Together with all appurtenant rights, title and interests. 026 - 1024 -30 -000: 026 - 102440- 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 2- day of 2004
* Gerald A. Kieckhoefer, Jr. * David J. Kitckhoefer
* *
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
* Kristina 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. Slats.) 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
U 2656P 062
Exhibit A
Located in part of the SE 1 /2 of the NE %, the NE % of the SE 1 %,
SW '/. of the NE '/. of Section 7, Township 30 North] Ran e 1 g W the NW '/. of the SE '/ and the
Of St. Croix, State of Wisconsi n g est. Town of Richmond
described as follows: S ,County
Commencing at the East quarter comer of said Sects n 7, this also being the Point of Beginning;
Thence S00 °37'1 0 °E along the East line of the SE'/ of said Section 7 a distance of 880.99 feet;
Thence S89 on the northerly line of a Certi led Survey Map recorded in Volume 13, Pag
3752 a distance of 610.00 feet; Thence S00 °3T10° on the westerly line of said Certified Surv
Map 428.42 feet (Record 428.50 feet); Thence S89 °�18'S2"W along the south line of the N'
of the
SE % of said Section 7 a distance of 1148.36 feet Thence N00'33 W '53 1384,45 feet; Thence
N88 1048.00 feet; Thence N51 °00'00 "E 25 .00 feet; Thence a point on the E ast line of the NE X of said Section ; Thence S00 °40'35 E along s'ald East feet of
the NE % of said Section 7 a distance of
terminating. int 248. 0 feet to the Po of Beginning and there
i
i
r
Parcel #: 026- 1296 -14 -000 05/02/2006 09:02 AM
PAGE 1 OF 1
Alt. Parcel M 07.39.18.1545 026 - TOWN OF RICHMOND
Current ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
11/29/2005 00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
COUNTRY VIEW RIDGE LLC 0 - COUNTRY VIEW RIDGE LLC
PO BOX 179
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1631 97TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 3.000 Plat: 10/090- COUNTRY VIEW RIDGE LOTS 1 -27 026/05
SEC 7 T30N R18W PT NE SE COUNTRY VIEW Block/Condo Bldg: LOT 014
RIDGE LOT 14 (3.000AC)
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
07- 30N -18W NE SE
Notes: Parcel History:
Date Doc # Vol /Page Type
11/29/2005 813158 10/090 PLAT
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 02/15/2006
Description Class Acres Land Improve Total State Reason
Totals for 2006:
General Property 0.000 0 0 0
i
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
C4
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do