HomeMy WebLinkAbout026-1153-30-000 Wisconsin Departmvntof Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divisfon
INSPECTION REPORT Sanitary Permit No
463363 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 I Richmond, Town of 026 - 1153 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
I� I G - ST 19.30.18.1168
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 3 f4 / Benchmark h5
Alt. BM J 1,C) / /
Aeration Bldg. Sewer 3-1 6 17,1
Holding St/HtInlet St/Ht Outlet 7
4 Q (0,
TANK SETBACK INFORMATION 75
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
Septic 7 90 A4 Z-7 � i Z-7 i Dt Bottom
Dosing Header /Man. /r_ � _ �• 9�j1 3�j
10•T -�
Aeration Dist. Pipe cy
Holding Bot. System /� l
2
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
M
Model Numb 7T —7,6- 3 r l
TDH Lift Friction Loss Syst ead H Ft T Z_ T 9
� 93. 3
� ,
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width 7—Length \\ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liq i� d Depth
DIMENSIONS < CZJ Z \_
SETBACK SYSTEM TO J /L BLDG WELL LAKE /STREAM LEACHING Manufacturer: /� 1 ..rye ,
INFORMATION , CHAMBER OR 9 J. $ d - -,
Type Of System: ` � � r , �ab , 1� � UNIT Model Number:
DISTRIBUTION SYSTEM ZT
I
Header/ManifolI /) Distribution x Hole Size x Hole Spacing Vent to Air Intake
Z Pipe(s) '*__1 \ w V
Length Dia 4 Length \ Dia Spacing
SOIL COVER x Pressure S ystems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center (� ' Q Bed/Trench Edges Topsoil
W es No es No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1462 92nd Street Npw Richmond, WI 54017 (SE 1/4 NW 1/4 19 T30N R18W) Glen View Lot 30 Parcel No: 19.30.18.1168
j JJ
1.) Alt BM Description =FaJti °r`G.l•� f-- d�
2.) Bldg sewer length = Z-7
- amount of cover = 3 1
Plan revision Required? Yes G & o5 D "1 IS
Use other side for additional information.
Date Insep s Sig ure Cert. No.
SBD -6710 (R.3/97)
F,
Safety and Buildings Division County 1
201 W. Washington Ave., P.O. Box 7162 -'� , rr
Madison, WI 53707 - 7162 Sanitary Permit Number to be filled in by Co.)
NV1119consin
Department of Commerce (608) 266 -3151
Sanitary Perm ZV4� h (; Ep State Plan I.D. Nujnb l
In accord with Comm 83.21, Wis. Adm. in rmatio provide /
may be used for secondary pu es ' 1 ` )(m) Project Address (if different than ,, mailing address)
I. Application Information - Please Print All Information
NTY
Property owner's Name ZONING OFFICE arcel # Lot # ' - tslocic
30 02 /s3 o
Property Owner's Mailing Address Property Locati
/ '/4, �, Section
Ci State Zip Code / Phone Number
„7 J / b t% /'� �!' /ire on
T .&N; R /A/ rW e
II. ype of Building (check all that apply) / / 3 0`1 77,t" A.vri d A c _
`
Y r 2 Family Dwelling -Number of Bedrooms �`/ 4 h �Ywz* .Z, Gta L.R4W- l. (4 P Subdivi 'Name CSM Number
❑ Public/Commercial - Describe Use /� '
❑ State Owned - Describe Ustl� JEST, C�ZG f �7 0 ��f/� ❑City ❑Villa own ip of
III. Type of Permit: (Check only one box on line A. Com )lilete line B if applicable)
A. System 11 Replacement System [I 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. ofPOWTS System: (Check all that apply)
n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- round ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
L�
Recirculating Synthetic Media Filter aching Chamber ❑ / VC-t )
Line ❑Gravel -less P' er (explain) ,B
V. Dis ersaVFreatment Area I formation: ! UD FC�� 5 T1a .
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Area Proposed (sf) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site 1 Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank /
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility State ent- 1, the undersign sume responsibility for installation of the POWTS shown on the attached plans.
Plum is Name (Print) Plumber' store MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, ip C
VIII oun /De artment Use On
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued rls�jng ZA Signature ps) Surcharge Fee)
❑ Owner Given Reason for Denial
IX. Conditions of ApprovallRea s for Disa proval.�1
1 S ptic tank, effluent filter and le"
dispersal cell must all be serviced /maintained O
as per management plan provided by plumber.
2..' I setbac ryqulremen s mus a main alne
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)
YN/8 LAN
PROJECT R.F.K. Homes RESS 1390 Neal Ave N. Lake Elmo Mn 55042
1/4 NW 1 /4S 19 /T 30 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 3/25/05 BEDROOM 4
CONVENTIONAL XXX IN- GROUND URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chamber 28
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.3/94.2'5' below qrade
Alt. BM Top of 1/2" Pipe @ 99.8'
209' Property Line
Pro 4 Bedroom House
Plans Designed Using 10'
Conventional Powts
Manual Version 2.0
Scale is 1" = 40' to
unless otherwise -
noted
Well is to meet all
setbacks required by o ,
WDNR B -3
2% Slope
45' A14' BM 1
0 r 0 l9 � � �D
2 -3' X 88' cells with >3' spacing 10 o
30'
V B -1 0
Vent 50'
>6„ Standard Biodiffuser
Please Note: Tested area of Cover Leaching Chamber
may not be suitable for with 3 1. 1 ft2 of Area
desired building area.
Check ��em i��a -gi 6 Long 11"
b efore excavati 34" Grade at System Elevation
145'
Property Line
PLO LAN
PROJECT R.F.K. Homes RESS 1390 Neal Ave N. Lake Elmo Mn 55042
1/4 NW 1/4S 19 /T 30 N/ 8 W TOWN Richmond COUNTY ST. CROIX
P
3/25/05 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN- GROUND V11 URE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chamber 28
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.3/94.2'5' below qrade
Alt. BM Top of 1/2" Pipe @ 99.8'
209' Property Line
P ro 4 Bedroom Hous
Plans Designed Using 10'
Conventional Powts
Manual Version 2.0
Scale is 1" = 40' S
10
unless otherwise -2
noted
Well is to meet all
setbacks required by 0 1
WDNR B -3
2% Slope
45' pd4, BM ��
TP °f
2 -3' X 88' cells with >3' spacing IF
30'
Vents 5
50'
Vent
>6 „ Standard Biodiffuser
Please Note: Tested area Leaching Chamber
Y
ma not be suitable for of Cover with 3 1. 1 ft2 of Area
desired building area.
11"
C'heec ay3lem lacatis 6' Long
b efore excavati 3 4 „ Grade at System Elevation
145'
Property Line
COUNTY ENiENT`
ST CRO ENAI�ICB ACrRE
SEPTIC - T Folilvi
SHIP CE TIFIcAT
OyvNE g
ewe., SSc�`f�
Owner/Buy"
Mailing Address
l
ss Departmcnt for acw construction) _ --C
Property Addre - "lion re4 d ' ���3- 32 lc
(Venfic
C M Parcel Identification Number .
ritylS.tate
_g
P TIO w, To
L ,/' TN vcm of
LEGAL_.D S ' /
1 / /,, Sec. F-- I,ot #
ProP`Xty J
page #
Subdivision r- Volume ---
Certified Survey Map # Volume
2 Page #, 1�
Warranty Deed # Lot lines identifiable /s 0 no
housep
no wsates. Properms =
Spec lure failure to hat you put into the syatcm
your septic system could result is its , by a 'ceps P
ed trss�•
S use and �_ y ea rs or sooner, if needed by al system. by a
bmProper c onsists off pt�� out the s � " a �t n=t staSe is the waste disP act stion form. s�� by M e Owns sal�tystem
function of that (1) the ou. site
wee 1 of sludge-
can affect the to St. Croix Zoning pu erifyt less than
The property oar agrees to plum or a licensed p II �e Septic tank. (if
plumber, janraaco n&ti �� (2) sft0 inspection and Fop sal system' ith the standards
is is prop" operating and ague to y�iaiain the private se g , 5� of Wisconsin- 30
0 WitIM
nequ 8z==t of 1latural P-M Zoning Office d have rand the =a abov o f Commie and the Dap rcturacd to the St. Croix County
I/we, the and et by the D*" ;j . tamed "rust be completed and J✓
set fort septic sys bas been mat" b
M ating a y� expiation data• DATE
of the
OF AP LIGP+N'r owners) of the SiC�N�:l'[TRE , I (we) am (arc)
A form are true to the best of my (our) k
O'VPNE that all atatetaeats oa this deed Tecorded in Register of Deeds Office•
I (we) C x ibe by ,fi of a warranty f!,
the property described above, DATE
' the ZO�B Department ifffs'
SIGNATLU OF APPL pen -nit being revoked by
' mis- r��ted result in the sanitary P
`* " ". Any �°'an on that is deed from the Registcr of Deedsdo in th warranty deed
- Oare warrautY if reference is ma ,
ss Included this appueation: a copy of the certified survey sP
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
year. Please note: a larger filter is being installed in
2. Eff luent filter is to be cleaned once a
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 . nc Plan .
�p�#1 ystem fails, determine cause of failure, use emate
aria 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 -45
St. Croix County Zoning 715- 386
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code n
County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ` �' t r
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 02 3 6 - -we)
Please print all information, a wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , 2
Property Owner Property Location
i 9
t2 9, J � s- /. j " j&/1L Govt. Lot !M LA /a S /9 T30 N R Id E (o W
Property Owner's Mailing Address _ Lot # Block # Subd. Name or CSM#
City fate Zip Code P one,Number ❑ City ❑ Village To Neares
k
ro Co d New Construction Use Residential / Number of bedrooms
e derived design flow rate GPD
Replacement ❑ Public or commercial - Describe: ___ - - - - -- -- - —
Parent material l�i.Cst '> Flood Plain elevation if applicable IV/'67 ft.
General comments
and recommendations: % � f �� t/r�J(.'^J
M El Boring � ��e d� FE-W Boring # l �5 Pit Ground surface elev. ft. Depth to limiting facto in.
Soil lication Rate � 1
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2
p `!Z 3/, - 5c " rn ran ( e s a , s °/
C- rr 5 l c 6)-,
a-1 C/ 3�
® Boring # Boring "�
Pit Ground surface elev. ' ✓ ft. Depth to limiting factor 12• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
rn r es r ri S �
Effluent #1 = SOD > 30 < 220 mg1L and TSS >30 < 150 mgW Effluent #2 = BOD < 30 mg/L and TSS < 30 rnWL.
CST Nam (Please Print) re CST Number
Sig
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �� �_ . �, 715- 246 -4516
bo
Property Owner _ Parcel ID # _ Page of
[37 Ong # ❑ 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 GPDR
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
A 3 . `5 L vn M F� �- JL
d 93 qo
(�o
a 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
a Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit
Soil iption 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
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' 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.
SBD -8330 (8.6/00)
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun
Address P.O. Box 10598
White Bear Lake Mn 55110
CSTKi #226900
Lot 30 Subdivision Glen View Date 7/18/03
1/4 N W 1/4S 19 T 30 N /R18 W Township Richmond
F1 Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1/2" Pipe
System Elevation 94.3/94.0 *HRpSame as Benchmark
Alt. BM Top of 1/2" Pipe @ 99.8' Scale is 1" = 40'
unless otherwise
noted
209' Property Line
2% Slope
Please note: survey was not Please Note: Tested area ` B -3
0'
completed at time of testing, may not be suitable for
setbacks from lot lines may desired building area.
change. Installer must verify Check system location
all lot lines and setbacks before excavating.
before installation. 45' Alt
.M.
0'
B.M.
30' "
B -1 5
98' 99' 50'
145'
Property Line
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-Parcel #: 026- 1153 -30 -000 03/28/2005 04:47 PM
PAGE 1 OF 1
Alt. Parcel #: 19.30.18.1168 026 - TOWN OF RICHMOND
Current XI ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
* RFK CONSTRUCTION INC
RFK CONSTRUCTION INC
1390 NEAL AVE N
LAKE ELMO MN 55042
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1462 92ND ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.760 Plat: 1984 - GLENVIEW LOTS 1 -43 026/03
SEC 19 T30N R18W PT SE NW GLENVIEW LOT Block/Condo Bldg: LOT 030
30 2.760AC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
19- 30N -18W SE NW
Notes: Parcel History:
Date Doc # Vol /Page Type
11/06/2003 745953 2451/143 WD
10/21/2003 744287 9/88 PLAT
09/03/2003 738635 2398/458 WD
2004 SUMMARY Bill M Fair Market Value: Assessed with:
21058 34,600
Valuations: Last Changed: 07/01/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.700 31,400 0 31,400 NO
Totals for 2004:
General Property 2.700 31,400 0 31,400
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
U 2 9 5 1 P 19 3
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS
Document Number
WARRANTY DEED ST. CROIX Co. WI
RECEIVED FOR RECORD
This Deed, made between Hillvale Development Limited Liability 11/06/2003 11:30AN
Partnership Grantor, WARRANTY DEED
and RM Construction, Inc..
Grantee. REKIT #
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
(if more space is nee d, please attach addendum): COPY F££:
CC FEE:
Lots 5, 9, 17 29, 30 31 and 41, Plat of Glenview in the Town of PAGES: 1
Richmond, St. CrobWWisconsin.
Recording Area
Name and Return Address
030- 1056 -30 -00 O2 6 —/ d,
o3a>oss- 9o-aoo 03o loss- 9s-000 o3o- ios6 -2o -000
Parse do Nu>� r (PIN)
This is not — ' t[omesteaQ- pretfe
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of November ' 2003
* * Hillvale Development Limited Liability Partnership
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF LAIa — )
ra I r ) ss.
t irn�...
County )
authenticated this day o PubPublic
to 0 ' ""'6nSln Personally came before me this day of
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.) ins end 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 acknowledged. Both are riot necessary.)
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wt
STATE BAR OF WISCONSIN 800.655 -2MI
WARRANTY DEED FORM No. 2 -1999
32
C
74,625 S.F.
(1.71 ACRES) \ \\
N - --
S88 - 57 - 5 0 - F 479., - -- - -- — -- 3,-- - - - - --
1 'w 1V
Tz� ro� 2,
31 � ; !, F
[930.60 106,697 S.F. i i (2.45 ACRES)
'e' j 3
91
66'
23
120,152 SY a
(2.76 ACRE 1 :
a .
123.? ! ,
(2.83 A
INI
s
Tye u
o° F IN.
INI
28
U
88,740 S.F.
(2.04 ACRES) % A
o / a