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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. m� we 0 c gy pp ° J 41 Oat (.86'8192 3 *f 8£' OOS) W cn - -- ,6L'8 L9Z 3„0 L,L£.00S - - -- 3„0 I42.00S -_ --------------------- M ,08'L L_ 3 „O L,L£.00 S —_ M otlgnd oLA ol PoloolPea - ,�� 133US H1001 -- — — — — — — — 4 09'09L - -- - -- ,5 74 -------- - - - - -- M.0 L,MOO N - o ;uowoso3 O I — ADMSAIJQ }ulor ir) ){ocg 6u!pllne rn O? I ri i O in M � w N h N o t0 0 o o o ;n WI I COD � V - -- r 6*'*QZ �9i�'96 ,£0 L `� 3 - I co Ui L9'£Z L i) �� M,.90,8£. LON - -- i 00 N �I �! I 0000 z a < N `o Z 0 mow M� N c I m Q m m■ o � mi n o I � N � 8 ° n W co W / ( 5 M„ fi£', 8£'.00N) I N lr it Lo P4 Z b'8Z b 3 0 L 4mos In � ao r N rT 00 ��oq�es s ✓ 00 8 o 8 i a; rn r tp 88 'g�+ t0 ----- - - - - -- O 8 N co uI a7iQ • ,J III I �i. 86 r� - - -- , � � `� - N \�; O F�l 3 Z0`�� \ ,, -- ,£0'ZS£�Zga� 3.0t,89 -LON -90 Z Z�l� -,S9 L6 -- 'I/ \'- 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 �- - - - - -- ---------- - - - - -- - -- r r ! P. L 1 r r r N Ztd WdOT:OT b 00Z bt `G ZSZtiTCSSZZ: ON Xdd 0 - 1 - 1 S3WOH ONI83030: W083 4 n W \• . 1 1 1 O 'now r r i te t tel 8 N r !g N � r 4 RCS NHS N cam N fir I v -r i 1� ltd WdOT:OT b00Z 01 ' ZBZTTCSSTZ: ON XbA 3 S3WOH ONINBABO: W083 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