HomeMy WebLinkAbout026-1153-17-000 Wis consin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
' Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
499152 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:
RFK Construction Richmond, Town of 026- 1153 -17 -000
CST BM Elev: Insp. BM Elev: BM Description: 5 l — 1; C SectionlTown /Range /Map No:
/bp G �� 19.30.18.1155
TANK INFORMATION ,.,55 , ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION t/• 1 BS HI FS ELEV.
r 4
Septic Benchmark
Beafng Alt. BM
F: 6 ebb WILI 01>A- 9
Aeration Bldg. Sewer
Holding St/Ht Inlet p y3 b
p.b
TANK SETB C INFORMATION St/Ht Outlet 7'.3 'TS.. Z 5
TANK TO L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Z
.
Septic t /1 — I y 5 Dt Bottom
Dosing Header /Man. 4Z • - 7
Aeration Dist. Pipe 9. C q2 r
5.5 72.3
Holding Bot. System / o . / q1
'S
afc-,
Final Grade
PUMP /SIPHON INFORMATION 95 ' Z
Manufacturer Demand St Cover
GPM qr;1 3. 5 97.
Model Numb
TDH LI Friction Loss System Head TDH Ft
Forcemain Length 1 Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Tr PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 (0 5
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR /v�d
Type Of System: / UNIT
Model Number:
> /o y5 AJ)�
DISTRIBUTION SYSTEM /Vo r4 1 e—
(o e
Header /Manifold #f Distribution x Hole Si e x Hole Spacing Vent to AAAir I ke
Pipe(s) 2.tidGO Cn
Length Dia 4 Length Dia Spacin
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over 7 Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center J 7 Bed /Trench Edges \ Topsoil \ Yes No \,Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 944 146th Avenue Unknown (NE 1/4 NW 1/4 19 T30N R18W) Glen View Lot 17 Parcel No: 19.30.18.1155 ,,
1.) Alt BM Description = " Ckc; ,41%1_5
2.) Bldg sewer length=
�
/ Z
- amount of cover =
3
Plan revision Required? Yes h x<No
Use other side for additional information.
Date In/etCo r's Si ure Cart. No.
SBD -6710 (R.3l97)
Safety and Buildings Division County r
201 W. Washington Ave., P ox 7162 t r Q)
Madison, W1 5370 62 Sanitary Permit Number (to be filled in by Co.)
IvisConsir
(608) 266 -31 1
Department of Commerce
Plan I.D. Nu be
Sanitary Permit PP VED
In accord with Comm 83.21, Wis. Adm. Code, ersonal information you provide
may be used for secondary purposes P acy Law, s15.04(1)(m) roject Address (if different than mailing es
AUG 2 j 2-096
I. Application Information -P rinyMFInfoiin tion �5� r 4`+- 11K of
Property Owner's Name arcel # of Block #
I
Property Owner's Mailing Address Go a J ) G A ) 1 e(rty Loca g
l �� A
0`J G ' /., V, Section /
City, State 1 qZip � o Phone Number J v T _ Q N; RaE or
Il. Type of Building (check all that apply) `? 0 QS /o[y4„ 5 LAOMar� Subdy' jisio Name CSM Number
or 2 Family Dwelling - Number of Bedrooms J /' �jJ J L) 1 '
❑ Public /Commercial - Describe Use C
, C _ n w 3 ❑City_ ❑VillageATownship of f
El State Owned- Describe Use t eX�+
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) �c�7 -
A ' ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision E0 Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner t
IV. Type of POWTS System: Check all that apply) ' L S
Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
�_ —� ❑ Aerobic Treatment Unit ❑Recirculating Sand Filter ❑
Constructed Wetland ❑ Pressurized In- ound El Holding Tank ❑ Peat Filter
Recirculating Synthetic Media Filter eaching Chamber ❑Drip Line ❑Gravel -less Pipe ❑ Other (explain)
Dis reatment Area Informatio
D n
—
Design Flow low (gp (gpd) Desig;Soil Ap� tion Rate(gpdsf) Dispersal Area Required (sf) Dis ersal Are Proposed System Elevatio S J7 � `
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Ifteel Fiber Plastic
Gallons Gallons of Units nn Concrete Constructed Glass
New Existing &4— F
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit T
Dosing Chamber
VII. Responsibility Statement- I, the undersign unite responsibility for installation of the POWTS shown on the attached plans
Plumb is Name (Print) Plumber' ature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip C )
VIII. Coun /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Iss Issuing ent Signature
Approved ❑ Approv Surcharge Fee)
❑ O
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER: 3, t� 4b
t. sopac to*. s fl l" t fWar and
dispersal call must all be servibes / maintainer
as per management plan provided by plumber. `
\ b
2 AN seback f"UtranW is must be makttained 1f J �0 �� �J,t{6 `^'�-
as per appNoabte code / ordinances. j n U c.
Attach complete plans (to the County only) for the system on paper not s than 81/2 x Il inches in size
SBD -6398 (R. 01/03)
s'
A9itV4'! M!T'ZY?
130/ LAN
PROJECT RFK Homes DRESS 1390 Neal Ave N. Lake Elmo Mn 55042
r
1/4 NW 1/4S 19 / f 18 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8 BEDROOM 3
CONVENTIONAL XXX IN -GROUN /101(00 SURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 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 BEST Filter
❑ BOREHOLE O WELL «H.R.P. Same as Benchmark.
Alt. BM Top of Survey Iron (�P 96.4 SYSTEM ELEVATION 93.0/92.7' 5.5' below qrad
391' Property Line
B.M. c,A VsDesigned Using Please note: survey was not
� CC'yk Conventional Powts completed at time of testing,
Manual Version 2.0 setbacks from lot lines may
Well is to meet all change. Installer must verify
setbacks required bALong Vent all lot lines and setbacks
WDNR before installation.
ARC 36 Biodiffuser Scale is 1" = 40'
Leaching Chamber
with 25.0 ft2 of Area unless otherwise
1 " noted
3 611 Grade at System Elevation
170'
B -1 5%
100' 30' Slope
Vents 90'
5'
B -3
2 -3' X 65' Cells with >3' Spacing
'r perty Line
Please note: tested area may be
B -2 10' cut prior to installation!
ST
10'
Pro Town Road Pro 3
Bedroom
House
430/ P LAN
PROJECT RFK Homes >�RESS 1390 Neal Ave N. Lake Elmo Mn 55042
1/4 NW 1 /4S 19 / / 18 TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/30/06 BEDROOM 3
CONVENTIONAL XXX IN -GROUN /10(00 SURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 26
IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark,
Alt. BM Top of Survey Iron @ 96.4 SYSTEM ELEVATION 93.0/92.7 5.5' below qrade
391' Property Line
B.M. Plans Designed Using Please note: survey was not
Conventional Powts completed at time of testing,
Manual Version 2.0 setbacks from lot lines may
Well is to meet all change. Installer must verify
setbacks required by Vent all lot lines and setbacks
WDNR before installation.
>6 „ ARC 36 Biodiffuser Scale is 1" = 40'
of Cover Leaching Chamber
with 25.0 ft2 of Area unless otherwise
5' Long
11 79 noted
Grade at System Elevation
36"
170'
B -1 5%
100' 30' Slope
Vents
90
5'
B -3
2 -3' X 65' Cells with >3' Spacing
Irc perty Line
Please note: tested area may be
cut prior to installation!
B -2 10'
ST
10'
Pro Town Road Pro 3
Bedroom
House
r
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County C
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must ` E r
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Revi ed by
Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.14 (1) (m)).
Property Owner Property Location
/ i I
Govt. Lot 14 S 9 T N R E (o W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CS M# /
G t�S e,✓i �ir�
City late Zip Code Pjaone umber ❑ City ❑Village ` ToWn Neares Road
)7 Rraln
New Construction Use:A Residential /Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe: - -__ __ —. -- - - -- -. -- _ --
Parent material l�/G Cs�i - c/'X ) x✓ ,✓ Flood Plain elevation if applicable ft.
General comments �✓ � � tJ� %°� � 3 , 0/
and recommendations: �
Boring Gods s � 0 �.
o Boring # �.
C71 Pit Ground surface elev. ft. Depth to limiting factor Ion in.
Soil Application Rate 1.
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
0 - 3�z --- S 1 S
y 1 r S s ;v) ,¢ Al l,:7 1
r
G2 Y 9g y
® Boring # J B Pit onng Q, 2
Ground surface elev. ' V ft. Depth to limiting factor r ✓L, in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
2 -z� t�
0-•i o y S , z
93 D
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Marne (Please Print) Signs CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 � C� 715 - 246 -4516
r '
Property Owner _ Parcel ID # Page of
FT Boring # [D Boring
Pit Ground surface eleA 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
�
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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
F-I Boring # E] 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 GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
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.
SOD-8330 (8.6100)
Soil Test Plot Plan
Project Name Lakes and Hill Development Sha rd
Address P.O. Box 10598
White Bear Lake Mn 55110 TM #226900
Lot 17 Subdivision Glen View Date 7/18/03
1/4 N W 1/4S 1 9 T 30 N /R W Township Richmond
B ing ()Well PL Property Line County ST. CROIX
BM` or VRP Assume Elevation 100 ft. Top of Steel Fence Post
ystem Elevation 93.0/92.5 *HRpSame as Benchmark
t. B Top of Survey Iron @ 96.4
l 391' Property Line
. M . Please note: survey was not
completed at time of testing,
setbacks from lot lines may
change. Installer must verify
all lot lines and setbacks Please Note: Tested area
before installation. may not be suitable for
desired building area. Scale is 1" = 40'
Check system location
before excavating. unless otherwise
noted
170'
100' B-1- 30' S%
Slope
5 ,
90'
B -3
a�
0
B -2
98 ,
97'
Pro Town Road
m UNPLAT_TED LANDS
.. R�3 ni
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s0000'toE -- 500+00'10'E 605.11 sol liolri•t _ w.a]a
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SEE SHEI
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ZIF4 H-01� 1.
Z/ 0 a,
Mailing Address _ v
l
Property Address 'f
('Verification required from mamung & Zoning Department for new construction )
Parcel Identification Number
D �-'
ad' /�s'��
City /State .
LEGAL DESCRIPTION / C-` "
i
'/4, Sec. , T 3 1� N R W, Town of
Prop Loca
�a
Pe
l2 r, , # .
Subdivision Lot �--
`i , Volume �- , Page #
Certified Survey Map
Warranty Deed #
/ 5 S ,Volume 2� , Page #
Spec hous yes no Lot lines identifiable ( De n
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 Coup Sanitary
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
r journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
owner and by a master plumber, proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
wastewater disposal system 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. Itwe am/are the owner(s) of the
property 4 above, by ;OF e of a warranty deed recorded in Register, of Deeds Office.
�b
..
DATE
NATURE APPLIC (S)
en
:k�
* Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Dept L #
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)
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
C
' go ency Plan
ption #1 If 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 an other failing m
p y a g co ponents as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715- 246 -5148
Shaun Bird #226900
AGE 2783 1 33
__ i
6
1 I
� I
No (nss�39 E 473-60 473.651
S.F. 133.0
49
N88
.DES) 351.81'
. 930.00 I
O 88.83' 1 440.64'
[948.791 I
0
.cy 88,027 S.F.
(2.02 ACRES)
}
91,513 S.F. "
( 2.10 ACRES)
927.00
/ .�.
L.B.O. EL.
SS = 1
406.08'
S86'34'47 "E 1 I i
k 4 ,80.41'
58.48%/ 787.19' 1 [948.'
N 91,764 S.F. / 1
(2.11 ACRES) .a, / / 1 I
N = 927.00 &/ wR
cp N L.B.O. EL. ,; 1 I cn
DRAINAGE 1 L ''
5 EASEMENT 1
924.80 1 `1 I
� H.W.L. = 1 : I
� 1
96,668 S.F. / 543.43'
(2.22 ACRES) / N89 59'5 "E 80.79
/ 1 90.82' Op
L.B.O. EL. = 923.00
71. 390.82'
s so \ 1
0 �
u
,
A19,3 16
�A
71,264 S.F. 17
(1.64 ACRES)
= 927.00 81,015 S.F. 18 '
o L.B.O. EL. i I I
3 (1.86 ACRES) �A,/ / / aye I
o L.B. EL. = 927.00 0 ' / ,� 88,801 S.F. I
15 ,� i z'� (2.04 ACRES)
I
// L.B.O. 927.00
.B.O. EL. I
74,037 S.F. M
�o ° ' ' h
(1.70 ACRES) N / /
923.00 -' \, N C
O•
e L.B.O. EL. _ •� y
�� •� � � '/ // 30.32
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U 2 9 5 1 P 19 3 - 74.���5�
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIR Co., WI
RECEIVED FOR RECORD
This Deed, made between Hillvale Development Limited Liability 11/06/2 M 11:30AH
Partnership Grantor,
and RFK Construction, Inc., WARRANTY DEED
Grantee. REMPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 951.00
COPY FEE:
(if more space is needed, please attach addendum): CC FEE:
Lots 5, 9, 17 29, 30, 31 and 41, Plat of Glenview in the Town of PAGES: i
Richmond, St. Croix, Wisconsin.
Recording Area
Name and Return Address
030 - 1056 -30 -000
030. 1055 -90 -000: 030-1055- 95-000: 030-1056 -20 -000:
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any.
Dated this day of November 2003
* * H7lvale Development Limited Liability Partnership
s * �
AUTIIENTICATION // ACKNOWLEDGI[NT
Signature(s) STATE OF LA a — )
racy L T ) ss.
County )
authenticated this c + — aaO t F r Y Public___ _ _ ,
"sate O Personally came before me this � day of
�nsi
November 2003 the above named
Hillvale Development Limited Liability Partnership
* by Richard Nelson
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the
authorized by § 706.06, Wis. Stats.) inst and ackn wle a same.
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016 Notary Public, State of___
My Commission is permanent. (If not, state expiration date:
(Signatures may be authenticated or aclmowledged. 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 8011-655 -2021
WARRANTY DEED FORM No. 2 -1999
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