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Home My WebLink About026-1153-41-000 Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 487901 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 -41 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No: O(,, . - ?— I� — G� ( 19.30.19.1179 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /Z Benchmark c l 4 66 Alt. BM �� rFi Aeration Bldg. Sewer Holding St/Ht Inlet (� III . ZS TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L - WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,, ZS j 7`Zb q,3 9 3 l Dt Bottom 1 Dosing _ "- ` Header /Man. `], 3 7 • S Aeration - ° "' Dist. Pipe I'd . Holding Bot. System b c,J PUMP /SIPHON INFORMATION Final Grad ' 43 111, Manufacturer GPNlnd St Cover 6 -% (I� O Z� Model Number + TDH Lift Friction Loss Systerr�y d Ft N - t� Forcemain Leng a. Dist. to Well ; ,12 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. j id uDep th ,_ DIMENSIONS V SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: is C / I141 / UNIT Model Number. DISTRIBUTION SYSTEM �a( ` +1 lb = z w Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Intake Pipe Z s) \ h , Length Dia Length Dia Spacing �r SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S dded xx Mulc Bed/Trench Center Bed/Trench Edges \ Topsoil Yes (] No N" Yes j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1490 92nd Stre ewPkhrt3ppd, V1�(I " 54017(NW 1/4 1 T30N R1 9W) Glen View Lot 41 Parcel No: 19.30.19.1179 1.) Alt BM Description 1 X IL 2.) Bldg sewer length - amount of cover T Plan revision Required? Yes No 1 , 3 16 �( Use other side for additional Information. Date Insepctor's Si ature Cart. No. SBD -6710 (R.3/97) a County n Safety and Buildings Division < • 201 W. Washington Ave., P.O. Box cJ or Madison, WI 53707-7162 Sanitary Permit Ntunber (to be filled in = byCO-) (608) 266 -3151 $: � o Department of Commerce State Plan I.D. Number Sanitary Permit Application ---- In accord with Comm 83.21, Wis. Adm. Code, personal information You fferent provide project Address (if di than mailing mailing address) may be used for secondary purposes Privacy La I. Application ormation- Please Print All information Lot# Block# arcel # p Owner's Name - - t pmp ovation property Owner's Mailing Addr 1 �. Section r ✓ 0 Zip Code Phone Number (circle one) Ci , State N, <E or W J QRl S t Su t Name CSMNumbcr of Building (check all that apply) 4 5 •�� II. Type (C r 2 Family Dwelling- Number of Bedrooms Q public/Commercial - Describe Use ❑City_Ovillag p of ' Q State Owned - Describe Use Type of Permit: (Check onl one box on line A. Complete line B if applicable) 6 III. TyP y Q Other Modification to Existing System S ystem ❑ Treatrnent/Holding lank Replacement Only A. New System Q Rep lacement List Previous Permit Number and Date Issued ❑ Change of Q Permit Transfer to New B. [] Permit Renewal ❑ permit Revision plumber Owner Before Expiration Check all that a l Single Pass Sand Filter IV. T e of POWTS System: < 24 in. of suitable soil Q At Q > 24 in. of suitable soil ❑Mound ireulating d Filter Q Q Non - Pressurized In- Ground ❑Mound _ Q Aerobic Treatment Unit ❑ Rec Constructed Wetland 0 pressurized ln- Ground [3 Hold Tank ❑Peat Filter Q Other (explai Chamber ❑Drip Line ❑Gravel -less Pipe Recirculating Synthetic Media Filter Q Leaching S ystem Elevation V. Dis ecsal(rreatment Area Information: Dispersal Area Required (sf) Dispersal Area Proposed (sf) Desi Flow (gpd) Design Soil Application Rate(gpdsf) _b S F Capacity in � -1 A g !'OC � 0 Prefab Site •ber Plastro t -V e _ Constructed ��s Total Number u cnir �Wjj�� \ Concrete VI. Tank Info dons Gallons of Units W �� • �IC�E. /1 New Fx��B Tanks Tanks Septic or holding Tank Aerobic Treatment unit Dosing Chamber responsibility for installation of the POW 1 S shown on the attach Business phone Number VII. Responsibility Statem t- I, the undersigned, Number MPIMPRS Nu Plumber' Nam nt) Plumber's Si r Plumber's A ddress (Street, City, Stale, Zip Sanitary Permit Fee (includes Groundwater Date issued ,� eat Signature (No Stamps) VIII. Conn /De artment Use On \ /KApproved Q Disapprov Surcharge Fee) _ 2&5 Do ven R for Denial IX. Conditions Approv SYSTE NER: 1 Septic tank, effluent filter and dispersal cell must all be serviced mind 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 8112 x 1l inches in sux SBD -6398 (R. 01103) PLOT PLAN PROJECT RFK Homes ADDRESS 1390 Neal AVe N. Lake Elmo Mn 55042 1/4 NW 1/4S 19 /T 0 N/ DATE 9/24/0 19 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 5 BEDROOM 4 CONVENTIONAL )00( IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TA K SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 104.2/103.0 5 below grade Well is to meet all setbacks required by Plans Designed Using W DNR Conventional Powts Manual Version 2.0 j ent Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area 3 4" Grade at System Elevation Alt. BM Top of Survey Iron @ 96.3' Please note: survey was not Scale is 1" = 40' completed at time of testing unless otherwise setbacks from lot lines may noted change. Installer must verify y all lot lines and setbacks before installation. ST 50' 40' 2 -3' X 88' Cells with >3' spacing > Pro Tow R( Propert Line Pro 4 B -3 Bedroom 6 'r ; House 13% �pe' 0' 80' * B.M. IF B -2 It. 30 Vents 5' 513' Property Line 150' 41255 T PLAN PROJECT RFK Homes DDRESS 1390 Neal AVe N. Lake Elmo Mn 55042 1/4 NW 1/4S 19 19 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/24/05 BEDROOM 4 CONVENTIONAL )00( IN -G E CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE lons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 104.2/103.0 5' below qrade Well is to meet all setbacks required by Plans Designed Using WDNR Conventional Powts Manual Version 2.0 Vent >6 „ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " 34 51 Grade at System Elevation Alt. BM Top of Survey Iron @ 96.3' Scale is 1" = 40' Please note: survey was not unless otherwise completed at time of testing, setbacks from lot lines may noted change. Installer must verify all lot lines and setbacks before installation. 50' ST 40' 2 -3' X 88' Cells with >3' spacing B -1 Pro 4 Pro Towr R, Propert Line Bedroom B -3 House 13% Slope 0' 0' IF 8 B M. 3 0 B -2 Vents 5' 513' Property Line 150' r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings ' in accordance with Comm 85, Wis. Adm. Code C .. n County , L f � i � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. ZR !ewed by Date I Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). SAN Property Owner Proporty Location I Govt. Lot MR �A S /� T 0 N R E (o W Property Owners Mailing Address Lot Block # I Subd. Name or M# City late Zip Code o�ne,Number ❑ city ❑Village To Nearest Road New Construction User Residential / Number of bedrooms Code derived design flow rate" GPD ❑ Replacement ❑ Public or commercial - Describe:_ - -- Parent material <�L Cs't�[ / �X ) �V Flood Plain elevation if applicable /y/ "Y ft. General convnents and recommendations: 0 Bring M Boring # Ground surface elev. ! • ft. Depth to limiting factor in. Pit —�--- 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 to i o ®Boring # Boring L Pit Ground surface elev. /0?' Z 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 f-3 1 rn "�` LS 222 r 7 22 S m6- 1 F t Z ao i 1 0- loo � Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 4017 ,_ /�— 0 715- 246 -4516 Property Owner _ Parcel ID # Page of FT Boring # ❑ Boring j� 2 J 54 pit Ground surface elev. ' ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L- 2 I G (• a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n• 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 a 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 J '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 (R.6100) R 'Soil Test Plot Plan Project Name Lakes and Hill Development Shaun Bird Address P.O. Box 10598 ZJ4 White Bear Lake Mn 55110 CSTM #22900 Lot 41 Subdivision Glen View Date 7/18/03 1/4 N W 1/4S 19 T 30 N/11 W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 f Top of Steel Fence Post System Elevation 1 04.2/103.0 *HRpSame as Benchmark Alt. BM Top of Survey Iron @ 96.3 Scale is 1" = 40' �— unless otherwise noted -- Please note: survey was not �B M completed at time of testing, setbacks from lot lines may L �B. lt. change. Installer must verify Please Note: Tested area .• all lot lines and setbacks may not be suitable for before installation. desired building area. 107' Check system location 105' 109' before excavating. o B -1 � H B -3 80' 3% Slo 0 ' 30' B -2 5 ' 513' Property Line 150' SEE SHEET 1 Y 1 1 177 i. M 1� r i 1 1 133 133' , 1 N �— I j 1 1 i ® i I ! 03 I 1 4 i i® /�/ 4 N N is• i O x ;�--'j m N N0177,011W 517Y 1 n 155.m' 170.00 45.78' _ �, 1 • i 1 • ' � W � I E - � � �� 1 � 1 � N I • g i 1 iSr : I 11 I M I m 01 1 = 35 m r 0R A81ACE I I • M T- 1 m I i I ; I I? z 6 I • 1m1s 4 to ( m1 Z i ! I rAS - N • N K i i ! 75! 74' 435 ° 25- n I >� J, n j3S o 1 M m MW 4S m i t ! M m• • N • I H i I I • �•n ! I �' // CL m a i ` 1 ; a M m to m /, Z: • • i Ii i ! 250.97 m 7 SR' / 503'4753% 459.90 if I I IJ 1 709.46• .CQr. /l /i j i / 43.W W i t N0190'08'W 300.00 9► i i ! v i , If , 10 / I j 1 0 1 (3) ! I i -i Z i oll 1 ! ! I 01 - i O1 N! 1 I ! I IiJ , !! i + 1 �i aQi 1n I Z I , 1 1 1 OI 2 - - - - -- II �� 1 3Y; 33' u I Y \ I Xi � 1 � •� 1 i� ,�li � � M ,�`�;� \ \ � L .W�O[I - )„000p00i •m I i I I A i l •`��",� �! • i N Q. - --- li i O.i m M in J ► m M f vs 3a C4 eco 1 1 i , Y • M f .� Y om_ /:%'\\ i m 171 r N00'05'49 "E 748.40' » RO�•y - -� 157177 �m rc MM N � €ad UNPLATTED LANDS ibll°. 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 E ptio inge y Plan n #1. system fails, determine cause of failure, use alternate area and install new ' 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 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND J/ At �.� OWNERSHIP CERTIFICATION FORM OwnerBuye l Mailin g Address / 3 1`'!J kbt / A_Ie� Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 006 - Y53 ' W - OM 6 LEGAL DESCRIPTION Property Location 1 /4 , /U' -tom 1 /a , Sec. �E_, T30N R W, Town of Lot # / Subdivision a�1't/ �/�"rv.Lc/ � Certified Survey Map # , Volume , Page # Warranty Deed # :7 qs ? - 3 , Volume 2 S� , Page # 1 T3 Spec house yes no Lot lines identifiableo 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. I/we, 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 prope described above, by virtue of a warranty deed recorded in Register of Deeds Office. ,9 IQ- SIGNATURE OF A PLICANT(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. 08/05) U 2`i51 P 143 74nDs, 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 11:30AH Partnership Grantor, and RFK Construction, Inc., WARRANTY DEED Grantee. EREWIT # 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 needed, please 4WJh addendum): COPY FEE: CC FEE: Lots 5, 9, 17 29, 30, 31 an 41, Plat of Glenview in the Town of PAGES: 1 Richmond, St. Croix, Wiscons' . Recording Area Name and Return Address 3 -1 1S W 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 * * HIDvale Development Limited Liability Partnership r * � AUTHENTICATION /f ACKNOWLEDGM[EM Signature(s) STATE OF l/ldn— ) racy I Tt t ) Ss. � County ) authenticated this N°tpry Public - -- - -- te °" V's—co 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. Slats.) ins and ackn wl 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 not necessary.) L I * 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- 655.2Ml WARRANTY DEED FORM No. 2 -1999 o ---- A ----------- --- o � 8 I _ANDS IUN 33' 33' i N-- - - - - -- N 43 I Z fib' - ------ 96,664 S.F. 0 1 NT a1 (2.22 ACRES) EAS ME I - -- ------- - - - -- s i 4_ w 100. N88'22'59 "E 455' .33 I - -- ---- - -1 - -- i I � 9 125.12' 9+2.W 42 I o ; 192.58 71,927 S.F. I R to (1.65 ACRES) I N N88'22'59 "E 478.66' Z I I L o0 (� 10 41 39 ;° i _.. 87,241 S.F. ^ ( 4,299 S.F. I m 2.00 ACRES) �. EL. = 929.50 I - 1 + W ; ° N88'22'59 "E 513.09' I 68, I N I 11 �� 2 10D 4 I 11 1� 1 T ' 6, 0 133' I� 33' �. (2.2 1 66' ,. - -- -- -- H- AVENUE_ = =— �w \ s • L4 34 \ L4 ^'- N 81,425 S.F. \ \ 4Ln+i Ln (1.87 ACRES) \ \ M Z 35 124,079 S.F. 90' A (2.85 ACRES) 4, 380. u_ L.B.O. EL. 927.00 f S83hg� 6 "W �• 33