HomeMy WebLinkAbout026-1296-27-000 Wisconsin. Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
I INSPECTION REPORT Sanitary Permit No:
488148 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 I Richmond, Town of 026- 1296 -27 -000
CST BM Elev: Insp. BM Elev: BM Description: SectionTrown /Range /Map No:
/X I Q ✓ A 1 57 07.30.18.1558
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
� A lt. BM _A6 A Z -y
t
4 -cam. — 16 P a� o o
Aeration Bldg. 9ewer 4,6 97,
'Holding St/Ht In
TANK SETBACK INFORMATION S t /Ht O ut l et 51 3
TANK TO P/L WELL BLDG. V ent o Air Intake ROAD Dt In
ep is � � � l B ottom
osmg Header/Man.
5.5 C? ,9 /,
A eration Dist. Pipe
5,5 qs�9
o mg o . ys em
0�
PUMP /SIPHON INFORMATION F inal Grad Z -Le TT <1 0
anu ac urer uemancl St Cover
M ��i�.. � JBJI. dY� ��•�
m odel um er
T� l. .
F rictio n L OSS ys em r1 ea 7F 5 `74:
rcemam i .
Sol SOKPTION SYSTEM
Mr-wilmr-MIrl MUM ILLHYL11 Ul I lenclle5 PTTDTFVI MoIUNO 114U, VT ril 5 111SULI __ Uepul
DIMENSIONS 3 r � `_
Zr% INFORMATION J CHAMBER OR
UNIT 1v1UUU1 Null t~
JA I—' I'll
►�,
Pipes) Z
Length_ Dia � Length N , Dia \ Spacing � r...
Y
x Pressure Systems Only xx Mound Or At -Grade Systems Only
Bed/Trench Center �• Bed/Trench Edges Topsoil l I Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1638 100th Street New Richmond, I 4017 (NE 1/4 SE 1/4 7 T30N R1 8W) Country View Ridge Lot 27 Parcel No: 07.30.18.1558
1.) Alt BM Description = O�'a� .Ovw CL% n� La �-�°' c
2.) Bldg sewer length = Zc
- amount of cover =
3
Plan revision Required? Yes o f
Use other side for additional information. r ��
D at — — - — insep 4ignatu - C ert': No
SBD -6710 (R.3/97)
Safety j d Buildings Division County
01 W. We �sconsin ad Wl� Sanitary Permit Number (to be filled in by Co.)
8) 266 -3151
Department of Commerce
Plan .D. Num
Sanitary Permi lic tioh? tale ber
�er In accord with Comm 83.21, Wis. Adm. Code, persona ation you provide G (>
in
may be used for secondary purposes Privacy Law, sl .04(I �) CROIX oject Address (if different than mailing address)
I. Application Information - Please Print All Information 3 C6 /X
Property Owner's Name Parcel # Block #
l�C
Property Owner's M g Address Property Loca
i O � � b Y<, 5� %, Section
City, State Zip Code Phone Number /� CC �(
/V e� t J 5� DI - 7 1 71Yt 76 Z) -ooP / T Z DN, /A; c o W e)
II. ype of Building (check all that apply) O k 4b (- 5 u� n�
V Subdivision Name CSM Num
I or 2 Family Dwelling - Number of Bedrooms ,J
G
❑ Public /Commercial - Describe Use ^!
❑ State Owned - Describe Use , Ce (,� }�3 1�= t� ❑Cny_ ❑Vil Toymsi
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 2 - / 2 - 520d
New 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 \
r r \J
IV. Type of PO TS System: Check all that appl
> 4z: In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El /
Recirculatin g Synthetic nthetic Media Filter ing Chamber 11 Drip Line El Gravel-less Pipe ❑ Other (explain)
V. Dis ersaVrreatment Area ormation:
De si F w (gpd) Design Soil Applica n Rate(gpdsf) Dispersal Area Require f) Dispersal Area Proposed (sf) System Elevati
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site St I Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank_
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility the undersi n ume responsibility for installation of the POWTS shown on the attached plans.
P tY St ent- I g
Plumbqr's Name (Print Plumber's lure MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip C T
vni,,eounty /De artment Use Onl
VW
pproved isapprove �Reas,, Sanitary Permit Fee (includes Groundwater Dat Issue Issuing A Signature (NqS
Surcharge Fee) , / �,1 �� z, r D
ll s� iv en ni al ` r
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER: 3) � r a c4
1. Septic tank, aHklent fitter d �•e
dispersal cell must all be services / maintainer l ye
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
A114wo m3TPYZ
/TLOT PLAN
PROJECT Countrv.View Ridoe LL C F ADDRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T 3 :' N/R 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 4/20/06
,.c3 DATE
BEDROOM 3
CONVENTIONAL XXX IN.G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK
Y
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26
A ft BENCHMARK V.R.P. Top of survey iron ,
ASSUME ELEVATION 100 Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 96.4/96.2 3.5' below qrade
307' property line
Well is to meet all
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
Scale is 1" = 40'
unless otherwise
noted
6 '
Vents 2 -3' X 66' Cells with >3' Spacing
.M. - 90' B -2 Pro 3
20 ST 30 ' Bedroom
30 20' House
45' B -3
2% Slope
P
100th St.
Vent
188'
property > 6» Standard Biodiffuser
line of Cover ac amber
with 25.0 f f Area
5' Long
11"
34
„ Grade at System Elevation
'PLOT PLAN
PROJECT Country Vie Ridae LLC ADDRESS P.O. Box 176 New Richmond Wi 54017
NE 1/4 SE 1 /4S 7 /T 3 N 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE4 /20/06 BEDROOM 3
CONVENTIONAL )00( IN -G UND 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 650 # of chambers 26
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 96.4/96.2 3.5' below qrade
307' property line
AL Well is to meet all
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
Scale is 1" = 40'
unless otherwise
noted
96'
Vents 2 -3' X 66' Cells with >3' Spacing
* B- 90' B -2
B.M. Pro 3
20 ST 30 ' Bedroom
20' House
30 '
B
45' -3
2% Slope
100th St.
Vent
property Standard Biodiffuser
ALong
line ac amber
with 25.0 f0 of Area
"
Grade at System Elevation
34" y
Wisconsin Department of Commerce N REPORT Page of
Division of Safety and Buildings
in a dance with Comm 7Law.s. Adm. Code Coun
Attach complete site plan on paper not less tha 8 1/2 AMMAY cls an m t ` / (,-o/ x
include, but not limited to: vertical and horizonta reference poin ( ion a parcel I.D.
percent slope, scale or dimensions, north arro and locat� � V I �t1 near st road. J �Reviewed by Date
Please print a0 i forma - Personal information you provide may be used for secondary purposes (Pri. (t) (m }). � 6 5
Property Owner / /J Property Location
A j r- �+ L' r2� t� L� (� Govt. Lot AIC 114 5,114 S T 3 N R/S E ( W
Property el's Mailing AddrKs LQt #� Block # I Subd. Name or CSM#
C-) x
7%
City State Zip Code Num ❑ C' ❑ Wage To Nearest Road
o i M s�<
G'c.J C yC�1 L�J1 4 I7 ( )
New Construction Use: esidential / Number of bedrooms J Code derived design flow rate -� GPD
❑ Replacement ❑ Public or mmeraal -Describe:
scribe: — __ - -___ -- ----- - - - - -- --
Parent material i �� Flood Plain elevation if applicable i'!// j4 ft•
General comments r
and recommendations: ��Oe � 81 V ! 'r✓ ' / ! !� �i
M Boring #
Bring oGround surface elev. ft. Depth to limiting factor �` in. ✓ Soil Application Rate
horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
, VL 5 - j ,� , 6 //
u
a ng# Bo ring r
Pit Ground surface elev. � � ft. Depth to limiting factor - -F-< -= in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. •Eff#1 `Eff#2
Z ( Z - Z 10, 5'/ C / K" r w F . Y
/ b y/6 S ,•.., I ^ 4 7
if
tl
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L
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' — �' 715 - 246 -4516
r -
Property Owner _ Parcel ID # Page of
Boring
a Boring # pi Ground surface elev. 2 ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 12, ID C4 Y
)
F-I # Boring
C] 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 GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etfi#1 •Etf#2
a 11 E] Boring
� # Ground surface elev. ft. Depth to limiting factor in
Pit - Soil Application Rate
Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDlff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2
• Effluent #1 = BOD_ > 30 220 mglL and TSS >30 < 150 mgA- ' Effluent #2 = BOD 130 rtg& 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.
SOD4330 (86(00)
r
•
_ Soil Test Plot Plan
Project Name Country View Ridge LLC Shaun B'
Address P.O. Box 176
New Richmond Wi 54017 CST 26900
Lot 23A Subdivision Country View Ridge Date 512 /05
NE 1/4 SE 1/4S 7 T 30 N /R W Township Richmond
R Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Survey Iron/Nail
System Elevation 96.4/96.2 *HRpSameasBenchmark
307' property line
1
Scale is 1" = 40'
unless otherwise
noted
6 '
B.M. B -1 B -2
20 90' 100'
30'
B -3
45'
99'
2% Slope
L88' y
line
100th St.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTI FORM
Owner/Buyer v
-��
Mailing Address ,.� C �"` �� `'�" � ` 7
� ai ��
Property Address lo g
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location 1�4 r/a 0 4 1 2 r /a , Sec. 7 , T,�_QN R. Town of
Subdivision Z04 n
,Lot #
Certified Survey Map # , Volume , Page # ._--
Warranty Deed # , Volume , Page #
Spec house ye no Lot lines identifiable G 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.
Uwe 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
propert described above, by virtue of a warranty deed recorded in Register of Deeds Office.
NATURE O APPLICANT(S) 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. 08105)
U 2656 061 774312 ��
STATE BAR OF WISCONSIN FORM I - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED RE I CROIK CO DEEDS
This Deed, made between Gerald A. Kieckhoefer, Jr. and David RECEIVED FOR RECORD
J. Kieckhoefer Grantor, and Country View 09/14/2004 10:20AN
Ridge, LLC Grantee. NARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT 0
the following described real estate in St. Croix County, State of Wisconsin
(the "Property ") (if more space is needed, please attach addendum): REC FEE: 13.00
TRANS FEE: 1410.60
See attached Exhibit A COPY FEE:
CC FEE:
PAGES: 2
Recording Area
`Ik me and Return Address
A V� tJ"'l - -VT- Vo
26- 1025 - 40-000
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 ? day of 2004
D� -
* Geral A. Kieckhoe Jr� * David Z JKi 2 coefer
* *
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. 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. 1 - 1"9
U 2656 P 062
Exhibit A
Located in part of the SE % of the NE %, the NE % f the SE' /<, the NW Y- of the SE'/ and the
SW Y- of the NE % of Section 7, Township 30 North Ran a 18
Of St. Croix. State of Wisconsin described as foliovl s:l 9 West. Town of Richmond, County
Commencing at the East quarter comer of said Sect! n 7, this also being the Point of B
Thence S00 ° 37'10 °E along the East line of the SE'/
Thence of said Section 7 a distance of 880.9 tnning;
S89 ° 18'55"W on the northerly line of a Ca ed Survey Map recorded in Volume 3f Pa e
3752 a distance of 610.00 feet; Thence S00 °37 "E on the westerly line of said
Map 428.42 feet (Record 428.50 feet); Thence S89 °�8'S2"W along the south line of the Ce N Survey
'1384.45 feet,
SE '/ of said Section 7 a distance of 1146,36 fea Thence N00 °33'534W e
N 0 57'22 "E 1048.00 feet; Thence N51 °00'00 .00 feet; Thence
"E 25 Thence N88 ° 2235 "E 507.00 feet to
a point on the East line of the NE of said Section
' /.
the NE ;Thence S ° 40'35 - E along seid East line of
% of said Section 7 a distance e o 248. 0 feet to the Point of BeginnIn and the
terminating. g re
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
Contingency Plan
�tion #1. system fails, determine cause of failure, use alternate area and install new
system'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 #220000
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Parcel #:- 026- 1296 -27 -000 04/24/2006
PAGE 01 P
Alt. Parcel #: 07.30.18.1558 026 - TOWN OF RICHMOND
Current _X1 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
11/29/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-owner
O - COUNTRY VIEW RIDGE LLC
COUNTRY VIEW RIDGE LLC
PO BOX 179
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1638 100TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.852 Plat: 10 /090 - COUNTRY VIEW RIDGE LOTS 1 -27 026/05
SEC 7 T30N R18W PT NE SE COUNTRY VIEW Block/Condo Bldg: LOT 027
RIDGE LOT 27 (1.852AC) Tract(s): (Sec- Twn -Rng 40 114 160 114)
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
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