HomeMy WebLinkAbout026-1296-22-000 Wisconsi7Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
`Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 483980 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:
Oeverin , Kenneth J. I Richmond, Town of 026- 1296 -22 -000
CST BM Elev: �� Ins BM Elev: BM DD cr � Section/Town /Range /Map No:
07.30.18.1553
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 0
Benchmark /0 7
Dosing I I n I / Alt. BM wit vi - a ✓ U
Aeration Bldg. Sewer---
Holding St/H nlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO r P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /
Septic / Dt Bottom
Dosing h� Head /Man.
Aeration 2,5 rl !/�- Dist. Pipe co G �
Holding Bot.4- Sy , ,'� - G - g a � 461m kfulilf
PUMP /SIPHON INFORMATION t/t Final de
Manufacturer Demand St Cover f
GPM 2 5 KI 5 6 1• U's
Model Number
TD H Lift Friction Lo Sy m Head TDH Ft
Forcemain Length Dia. Dist. t ell
SOIL ABSORPTION SYSTEM / (� �P/!q
B DIMENSIONS Width Length / /, No. Of Trenches PIT DIM
DI ENSIONS No. Of Pits Inside Dia. Liquid Depth
MENSIONS 2 T �
SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM HING an ctur M 1-�
INFORMATION Typ f System: L Q / CHAMBER
. [ � T/ / U Model Number:
XL
DISTRIBUTION SYSTEM
Header /Manifol Distribution J�✓Q / x Hole Size x Hole Spacing Vent to rr Intake
/- A
Length f0 Dia Len (s) V Dia C Spacing_
SOIL COVER lj x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center 1 (" Bed/Trench Edges Topsoil Yes N No 7 Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�/ 2 � ! �K Inspection #2:
Location: 985 165th Ave New Richmond, W 1 54017 (NE 1/4 SE 1/4 7 T30N R1 8W) Country View Ridge Lot 22 Parcel No: 07.30.18.1553
1.) Alt BM Description p��
2. Bldg sewer length = r
- amount of cover �-
Plan revision Required? ❑ Yes H
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
PLOT PLAN
PROJECT Ken Oeverina 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
MPRS Shaun Bird 226900 9 /8/10 3
DATE BEDROOM
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 # of chambers 32
,BENCHMARK V.R.P. Top of Survey iron
ASSUME ELEVATION 100 Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark,
SYSTEM 9 4' b q rade
Well is to meet all Scale is 1" _
setbacks required by
WDNR Un1eSS O 1Se
not Vent
v > 6» Quick tandard -W
Leaching hamber
Plan D i of Cover .
g
ne Using with 20.0 ft of Area
Conv ntion P wts �o t 5.8ft ^2 /pair o end caps
Manu 1 V rsio 2.0 1"
4' Long 2
34" Grade at System levation
95 Property Line
A'0 B 2 V�--
20' 15' 2 -3' X 6 Cells with >3' spacing
Pro 3
Bedroom
House -' 133' Property
B -3 Line
r 10% Slope
' 1
Vents
45' B -1
30'
367' Property Line 120'
�hS dC-�
C.W1 -gov Safety and Buil ' s County
201 W. Washington . Box 7
n mh os! ns Madison, WI 7 -716 Sanitary Permit Number to be filled in by Co.)
Sanitary Permit Applicati State Trann Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo to the a governmental
unit is required prior to obtaining a ,sanitary permit. Note: Application for WTS a P% all Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you vide may be ,
as in accordance with the Privacy Law, s. 15. 1 m , Stats. GJ�
I. Appficadon Information - Print Informatiou
a l #
Property owner's N v e P tie /
property Owner' Mailing Address
. O l7 X o Govt.. Lot G '
Zip Code Phone Number F y., JG ys, Section
City, State t n- R 4- /f le o
C°L(.�f j [ T .202 —N; V� —_ E t
H. Type of Building (check all that apply) Subdivision Name
2 Family Dwelling - Number of Bedrooms / ,, , I /
B D u rf (// &-Z
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
❑ State Owned - Describe Use —
� own of
' : / f-/ f
III. Type f Permit: (Check only o e box on tine A. Complete line B if applicable)
A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Pemtit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Tape of POWTS S stem/Com onent/Device: Check all that appl
n- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
toldin
g Tank ❑ Ather Dispersal Component (explain} ❑ Pretreatment Device (exp T 7Nt. rea Information: EI n
gn Flow (gpn Soil Application f1 Dispersal Area Required I)iepe;sal Pro (SO Sys
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a
Tanks Existing T anks V 7t
is
Septic or Holding Tank . tX�
Dosing Chamber
VIL Responsibility Statement -1, the undersigned, assn onslbllity for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' re Business Phone Number
Plumber's Address (Street, City, State, Zi
VIII. our !De ent Use OnI
Permit Fee Date Issued Issuin eat Signs
Approved lsapp $
eial 1
IaL ondi PPININ. aso iorDisapproval 3 �` J g
i . Septic t „(�p,� �(atJt` /tGt...I
ank, eff utnt finer and rr ''
dispersal cell must all be services / maintained ka A-,4L CO5 IAA.) I Qom
as per management plan provided by plumber.
2. AN B*Wk taquiternenta must be maintained
Attach to complete p ns or t e system and submit to the County only en paper not less than s 1/2 x I I inch" In 5120
SBD -6398 (R. 01/07) Valid thra 01/09
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in actor nce �Ggrw W� dm. ode County
Attach complete site plan on paper not less than 1/2 x 11 inches in size. Plan mus
ference point (BM), direction and
include, but not limited to: vertical and horizontal r Parcel I.D.
percent slope, scale or dimensions, north arrow, d Ioc Seares 2 � nd lisf ri road.
Please print all inh rmation. Review by Date
r�R�� I COUN7
personal information you provide may be used for sewn ary p �s' , 15.04 ti (1 (m11.
Property Owner roper ly Location
n 7t r�t e Govt. Lot AJ 1/4 5L 1A S T � N R/ 0 E (o W
Proper y &ne t's Mailing AddrKs Block # Subd. Name or CSM#
City State Zip Code e u ❑ C ❑ irllage '� WTMW Nearest Ro
S I
New Construction Use: tS / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or mera_ al - D scribe: — _ -_—__- __------- ____ - -- --
Parent material Flood Plain elevation if applicable
General comend is ations: �
and recom Sit° � ejeV � - 7
merxi� � � (o
Ste' �� fe � � e
Boring # Q Boring jj /
a Pit Ground surface elev. I ft. Depth to limiting factor in.
P 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
1111W 1 6
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Conk Color Gr. Sz. Sh. 'Eff#1 I `Eff#2
S/ 2rn r 6,-t 4;- c s 2
CPO
1 - D S rn( a /•
3 Il %/b et s
o �
r
• Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD < 30 mg/L and TSS < 30 nxyL
CST Harm (Please Print) _ Signature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �" aO — 715- 246 -4516
Property Owner _ Parcel ID # Page of
Boring #
Boring
3 pit Ground surface elev. I b }t ft. Depth to limiting factor in. RnwiI Application Rate
Horizon Depth Dominant Color Redox Description Texture ;Gr.S e Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color h 'Eff #1 'Eff#2
,- C5 Z Y 1.1
Yi c.
,r
r►
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lirxtion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efi#1 'Eff#2
❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit n'Eff#1 Application Rate
Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2
• Effluent #1 = BOD > 30:s 220 mg1L and TSS >30 < 150 mglL • Effluent #2 = BOD < 30 mglL and TSS <_ 30 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.
SSD4330 (RAM)
Soil Test Plot Plan
Project Name Country View Ridge LLC Shaun Bird
Address P.O. Box 176
New Richmond Wi 54017 CSTM 4k26900
Lot 20A 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 97.1/96.3 *HRpSame as Benchmark
4* Prop e
101' 9 '
-2 150'
133' Property
Line
B -3
10% Slope
50'
Scale is 1" = 40'
unless otherwise to B -1
noted 4s
30'
K B
30' Property Line 120'
06 -____.__------ _______
III
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 9/5/10
Owner: Ken Oevering
Location:NE1 /4 SE1 /4 S7 T30 N,R18W Lot 22 Country View Ridge Richmond
System type: In- ground absorbtion system(conventional)
Manuals Used: In- ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4 -5. Maintanance and Contingency Plan
6. Filter Specifications Shee
Signature
License numb 26900
PLOT PLAN
PROJECT Ken Oeverina 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
MPRS Shaun Bird 226900 DATE 9/8/10 BEDROOM 3
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 648 # of chambers 32
kk BENCHMARK V.R.P. Top of Survey iron ASSUME ELEVATION 100 Filter BEST Filter
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 97.1/96.3 4' below grade
Well is to meet all Scale is 1" = 40'
setbacks required by
WDNR unless otherwise
noted Vent
> 6» Quick4 Standard -W
Plans Desi gned Using
of Cover
Leaching Chamber
Conventional Powts
with 20.0 ft2 of Area
Manual Version 2.0 4' Long 12" 5.8ft ^2 /pair of end caps
34" Grade at System Elevation
95' Property Line
B -2 150'
20' ST
---� T 2 -3' X 66' Cells with >3' spacing
Pro 3
Bedroom
House 133' Property
B -3 Line
10% Slope
50'
Vents
45' B -1
30'
367' Property Line 120'
Cross Section of Quick 4 Standard -W Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard -W Leaching
Chamber with 20.0 ft2 of Area per
Chamber 5.8ft ^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 101.0
Vent 0 Grade Vent
4' 4" 4,
.A�30/34 Septic Tank
4' Long 1 11 5 ' 4' Long 1 91
3 4" Grade at System Elevation 3471 Grade at System Elevation
Spacing 5'
2 - 3' X 66' Cells
Same on other end Observation tubeNent
9.5'
A
B
16 chambers per cell
System elevations:
A__97.1
B__96.3
i
ST. CROlX COUNTY
I
SEPTIC TANK MA MngANCE AGREEMENT i
AND
OWNERSHIP CERTIFICATION FORM
4wnesrBuyer t?U � ✓' i /�
Mailing Address e
Rpperty address
(vaifioaam requned from Pluming & Zoning Deparm�t for W-w oomstroctcan.)
i
City /Stave Parcel identification Number
G` N j
Property Location'/. ,'y+ , Sec. , T�N R W, Town of
Lot # Z
Subdivision '
Certified Survey Map # -
, Volume , Page # --
J ✓ -71 Warral"Deed # Volume
, , Page # _
SpOC 1 no Lot Una 0=UfIabld(;) no
. I
SYSTEM wstyt AND OWNER CERTI CAT ION
;
Impzopec nw and mamtOMM 0f7VM SV=
every tluee y�ea�s lt soo�ea, ifaeed°d' oweed' p�. � Put bft
oomsasta � tank as a 3reatmcnt stage in the waste disposat s Ownec maw
9ie can affect of tb�e septa i
reaponatbs�ities are Vied in §Conan. 83.52(1) and in Chapter 12 - St. Caoac Cozmty 3aaitgty °'
C
Cr
to S
to ag�e
ly a a mbfication farm, sig�oect by ft
.� pwaar ea snbaait t. ix oun ty M==9 � zoning *d ( .� on -site
l=ber, plambcr or a licensed p S
waswwa &Vo Mmian is in propw o g• condition' sWor (2) a = bspeWm and P (if' '), t�o ° Ink is
less than la full of studge.
I*c, tb. d have read the above x*q===M and ap - to =aftftin the pdvaft seymp diRMISI 8"
anti ties Dept of Natural RwowcM She of W
ssa &nb saa fm*, h=eia, as aft by tine D C erco 3etfld and re4uned M Ste St. Croix Coupty P & I
c=bficawm stating that your septic system lass been roainlsiaaed �t COQ
Zoning Dc m.w within 30 daps of to ft" year =0ratiten dam•
j,we cxatify that all ststemgnts.on this farm are true to the best of my /tar knowledge- ywe aw(we &e ovAer(s) oftbe
�perty 8ee=ibed above, by Artm of a wanway deed seomded of Deeds Offcx.
Number of bedrooma
I
7 T 2
GN OF CANTS) DATE
***Any infommtion t is aiiste1 aseatea may resuh in the samtaty permit
being revoked by ft Planing �g + :a
Iacliidc with this application a seconded w=ordy deed fa+om the Register of Deeds office and a copy o f ft oeatifiod swvey map if
refpraaee is made in the wwanty dead. ,
(REV. 08185)
i
I
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. a into system is not exceed those required as per Comm. 83
ontingen Plan
Option #1. f system fails, determine cause of failure, use alternate area and install new
sy in tested replacement 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
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000571
STATE BAR OF WISCONSIN FORM 2- 2000 BETH PABST
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
THIS DEED, made between Country View Ridge, LLC, a 07/22/2009 08:OOAM
Wisconsin limited liability company, Grantor, and Kenneth Oevering WARRANTY DEED
and Amparo K. Oevering, husband and wife, Grantee. EXEMPT I
Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 13.00
described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 541.80
PAGES: 2
Lots 3, 4, 11, 15, 17, 18, 22 25, and 26, Country View Ridge in the
Town of Richmond, St. Croix County, Wisconsin.
Recording Area
13�
Name and R Address:
Oranzo O Bring
PO Bo 79
New ichmond, WI 54016
See attached addendum
Parcel Identification Number (PIN)
This is not homestead property.
Dated this (( day of �b , 2009.
Country View Ridge, LLC, a Wisconsin limited liability
company r '
By: ORA- tj Dfa .h,1j�_- --
* * By:
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
COUNTY OF ST. CROIX ) ss.
authenticated this Personally came before me this f � day of
, the above named Country
* View Ridge, LLC, a Wisconsin limited liability company to
me known to be the person(s) who executed the foregoing
TITLE: f MEMBER STATE BAR OF WISCONSIN in 1 t� a the same. .,
1. Cie
authorized by § 706.06, Wis. Stats.) . '•-
,pj ( 4 THIS INSTRUMENT WAS DRAFTED BY s
Notary Public, Stake of Wisconsin Q v
Robert L. Loberg My commission is permanent. (If not, statepi�tion_cl� -
Loberg Law Office sw/ SFA7235 V
(Signatures may be authenticated or acknowledged. Both are not necessary.)�� �� 4 .��P���� • �,.
*Names of persons signing n an capac must be or printed below their signature
s
8 Y h' tYP� P gna T�1'E
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
1 of 2
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arm
23 /� W 24 M Of
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4 43,580 sq.ft.
r — 3,629 sq.ft. e} I (nl
•Dr1 - 1.001 acres
A• 1.00
6� , � � 2 acres i� I I
/ z I OI
195.00'
1 °1
-
N26
55.87 S ''115.62
55.87 /2 2 .l N87-11'00 "E 310.62' "o
6 - 87,548 sq.ft. i op
�'; \\ a N 00 L
15
25
\ r ` K) 43,561 sq.ft.
\� �- 1.000 acre _ _ _ M i N
1 y� N891 545 "E - ioo.00'
1 N87'01'1 4 "E 368.16' T-1
308.00 — —
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43 578 sq.ft. v
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(' ( 75 935 sq.ft. vrn I °'
1 1.743 acres O >` M CO
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398.77'
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3 879osq.ft. N 80,672 sq.ft. I c
7) /2
/ 1.852 acres
1.926 acres v_ 100'
o� O I' N
( o0
00 m
A
- - - - -- N89'18'55 "E 414.05' - - - - -�� 33.00' - \�� \
19 �� 137.81' 276.24' \ :`..'� 300.76' �� X\ : `•
/ S89'1 8'55 "W 610.00'
� (N89'1 731 "E) I I
Bench Mark I
/
Top of 1" 0. D. Iron Pipe I I
Elevation 974.67 ft – NAVD 88 I
N F--I w
W C
�- o I WI I a
00 I� r
o N LOT 1 Icil��
I
V-
19 CER TIFIED SUR V
85,690 sq.ft. W — — — — — — — _ EY MAP I of u
1.967 acres i 01
\o` LBO = 959.00 VOLUME I J PAGE 37
00 ------ L - - - - -- r
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