HomeMy WebLinkAbout026-1137-17-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
463158 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:
New Horizon Homes Inc. Richmond Township 026- 1137 -17 -000
CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No:
fC(> / l 20.30.18.973
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic G4- Benchmark
Dastng_ fC Alt. BM Z. < /c"C,. 7
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet r
775 / -y5
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic j Dt Bottom
Dosing Header /Man. 7 . M 1 1 . - L(—
Aeration Dist. Pipe 7. `Iy- 9`7 Zt,,-
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM z
Model Nu ber
TDH I lLik , Friction Loss ystem Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS v
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: r
INFORMATION CHAMBER OR 'G r II '
Type Of System: i UNIT
Model Number. �
6 8, t'��` v •
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air taker
Pipe(s) \� t ,_•
l l_ength �__ 1 7IDia Length �. Dia Spacing
c,
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over i Depth Over j xx Depth of xx Seeded/ odded xx Mulched
Bed/Trench Center �j Bedrrrench Edges Topsoil Yes -*'
No 1 _? Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 1082 148th Avenue New Richmond, WI 54017 (SE 1/4 NW 1/4 20 T30N R1 8W) Golf View Acres Lot 17 Parcel No: 20.30.18.973
1.) Alt BM Description = � ���, ,� �. ,
2.) Bldg sewer length = 2 f
- amount of cover = J
Plan revis
s de for additional information. Yes
Use other
`` �7 A�
L J
_
Date insepcto s� Signatu Cart. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County /�
201 W. Washington
M. ox 7162 J J��
Visconsin Madison, WI 707 Sanitary Permit Number (to be filled in by (o.)
(608) 2 3151 ® elVE ;I rp 1
Department of Commerce
�C. r State ran I.D. Number
Sanitary Permit Appllcatl 2
In accord with Comm 83.21, Wis. Adm. Code, personal informati you vide 5 Zon
may be used for secondary purposes Privacy Law s15. X XC ON Pro' Address (f different thatt [nailing address)
_ ; 11 O� , j /�,�,,
L Application Information - Please Print All Informati - E Z `7 a /"� ZA -
Property Owners Name Phrcel # Bloch #
�,/ ,ter #
Property owkei Mailing Address Property Location
--
Section
City, —
/ State Zip Code Phone Number
ve l-C " p / Z; Y&
liI. of Building (check all that apply) S u �, , c `, ` '
S
Pablubdi�ron Name CSM Number
or 2 Family Dwelling - Number of Bedroos i C m_
ommercial - Describe Use aa
State Owned - Describe Use City_ Village Township of
III, Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ew System Replacement System Treatment/Holding Tank Replacement Only Oder Modification to Facisting System
B • Permit Renewal Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. of POWTS System: Check all that apj4
oa - Pressurized In- Ground Mound z 24 in. of suitable soil Mound < 24 is of suitable soil At -Grade Single Pass Sand Filter
2 - Wetland Pressurized In and Holding Tank Peat Filter Aerobic Treatment Unit Recirculating Sand Filter
Recirculating Synthetic Media Filter Chamber Drip Line Giavel4ess Pipe Other (explain ) !�Z e/. - - 7 Q - -W - h ,
V. DispersaItTreatment. Area ormation: �
Design Flow (gpd) Design Soil Application RaWgpdsf) I Dispersal Area R"pirc d (sf) Dispersal Area posed (st) System Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Ste9f Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New I Existing
Tanta Tanks
Sepac or Holding Tank
Aerobic Treatment Unit
Dosing Cbasnber
VII• Responsibility Stateme - 1, the nerd n e responsibility for installation of the POWTS shown on the attached fans.
Plumbers Name (Print) I'lumbeeLgWAirc MP/MPRS Number Business Phone Nu
z �/j
Plumbers Address (Street, City, State, Zii )
VIII . Coin me artment Use Onl
Approved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signatu (No Stamps)
Surcharge Fee) 4 2 51D
R
2-
IX. Conditions APP
SYSTEM NER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
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 $112 x 11 inches in she
131N/VR T PLAN
PROJECT New Horizon Homes IncADDRESS 1475 Hwv 65 New Richmond W 54017
SE 1/4 NW 1/4S 13 / 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/18/04 BEDROOM 3
CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Topo f 1" iron pipe ASSUME ELEVATION 100° Filter Zabel A -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
SYSTEM ELEVATION 92.6/92.5' 4' below qrade
Well is to meet all B.M. 1
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
230' Property Line 115'
B.M. #2 is top
130' of 1.5" pipe @
99.78'
operty Line
Vents
50' B -2
10'
B -3
60'
2 -3' X 69' Cells with >3' spacing
10' B -1 30' S
25'
Pro 3
Bedroom
House
Property
Line Vent
>6 „ Standard Biodiffuser
COPY of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
'Long
11"
Grade at System Elevation
34"
i
r -
AMI
I
LOT PLAN
PROJECT New Horizon Homes Inc431:NIR ADDRESS 1475 Hwv 65 New Richmond Wi 54017
SE 1/4 NW 1 /4S 13 ! 18 W TOWN Richmond COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/18/04 BEDROOM 3
CONVENTIONAL XXX IN -GROU RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Topo f 1" iron pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 92.6/92.5' 4' below qrade
Well is to meet all B.M. #1
setbacks required by Plans Designed Using
WDNR Conventional Powts
Manual Version 2.0
230' Property Line
115' B.M. #2 is top
130' of 1.5" pipe @
99.78'
operty Line
Vents
50' B -2
10'
B -3
60'
2 -3' X 69' Cells with >3' spacing
10' B -1 30' S
25'
Pro 3
Bedroom
House
Property Vent
Line
>6 „ Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
Grade at System Elevation
34"
Vftmnsin Department of Commerce SOIL EVALUATION REPORT Page --- of
Vvision "afety and Buildings
in accordance with Comm 85, Wis. Adm. Code county
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S-� • C r oi x
include, but not limited to: vertical and horizontal reference 'redion and
percent slope, scale or dimensions, north arrow, and d� n nearest road. Parcel I D d 2 l/ �� �� �U `�
Please pdrit all i R Date
Personal information you provide may be used for purpose l?rirgy
s. 15.04) (m)).
Property Owner Property ocation
R ,,1,, � �
lv urlr d Nelson— f GovL Lot h 1/4�jG 114 SZ�j T N R /� E {or)40
Property Owner's Mailing Address 5 T (;,fi of # , Block # Subd. Name or CSM#
ny State Zip Code Phone Number ❑ village [Town Nearest Road
® New Construction Use: ® Residential/ Number of bedrooms 3 _ y Code derived design flow rate 4 50 CoUC� GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable fl
General comments el e u • cj S• d
and recommendations: 14L4.
Boring
a Boring # qlo d ft Depth to limiting factor lot -
® Pit Ground surface elev. �_ In ' Soil Applica tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cant Color Gr. Sz. Sh. *Eff#1 'Eff#2
I C) If to (Z -- '51 Z-ff-) k rn�r e- S 1vc 1 • 5 S
Z 14• lb r LF c.l ZmSbk ,mi' cS
Boring # Boring I {
Pit Ground surface elev. '7" • ft Depth to limiting factor �� in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. M unsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 I 'Eff#2
I o -1 to Z -- 2 r (v� 5
z ► - ID — icl Zm m c-
'3 4 -112 10 '- S O m ( 1-
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL
CST Name (Please Print) 'nature � _�— Z533b9
A cionn Schu ker
Address Date Evaluation Conducted Telephone Number
S'— O/ ��15)2yl -'100$
i _
Property Owner N e ISo n Parcel ID # Page 2 of 3
F3] Boring # ❑ Ong
Q pit Ground surface elev. y _ 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
� � -I 2 Sil Z �r c Iv . 5 • $
Of e-
F1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft Depth to Nrrriting 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 -1 Boring # ❑ Boring El Pit Ground surface elev. ft Depth to uniting 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
'
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.
SB"30 cx.mroo)
o
PAGE OF 3
NAME tit 1 LOT# I LEGAL DESCRIPTION SF ' /.kE'/e,S?O T - -i;C,N,R1 5 E (or)
SCALE: 1 ,, = Y 6
BM 1 ELEVATION /00• b
BM 1 DESCRIPTION +
BM 2 ELEVATION q q. F Sec. 2 l-
BM 2 DESCRIPTION 4pe 1,L " D ✓,_ c_P
SYSTEM ELEVATION
ALTERNATE ELEVATION QS•
CONTOUR ELEVATION Pc
B^^(
,.y Yope k
� ,o QG
?IAN G • • f
54 j ■
■
Fl. / a
�
SIGNATURE — DATE
I _
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
cy Plan
Optio7in If system fails, determine cause of failure, use alternate area and install new
sted 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
.................... .......................................... - ....... - ........ - .......... -.- ......... I ....... ........... .. .................... .............
;.,EFTIC TA.714K NIAINTENI A,:(`it_'I~ AGFI- ,L -Ef T
AND
;zilF CERTIFICATION FOR.TV
E.)'���1'i r' ?F�i7`�': ;' ... �L� -!`✓ �' �: �;.. F '.�.- -- - S- irY'...I�`slsrr...��. �,..f,.dJf„z. ._ ..... , . ... ._... ._. ...... _.........,.
(Verifica ion requ.ircri Brain Planning Department for new r. • ..._..... »,•,,. ,..,,;,, ,.,.,,.
Cit y/" , ta.te Parcol Identification flu. m. b•. r�.._.._... _._.-- _._._.._�_._.,.._.._.__..
JJP
LE
C1 �1tv.,1../., °.
C'cri: i. 'i;etl I >t,r.± iNImp ; ...___ __.. _, 'Volurn -v __. _ }'air Y
.__...._.__._ ___... _.
ti ,:t.r ; All y ±e e; ._ ... `1. ��....� V��ltatt ;e ................ I �z4,.. Fl �.1 _..._,. .
Spar, .iouse !'1:S 1:.j no Lot line's identifiable i:::1 yes U no
LUpro pe: V016 aie and tnainlen,ance of your septic system could result in its premature failure to handle Wastes. Proper mon.tennee
consis ! -, of puz,xpia: out the septic tank every three ye..= at' sooner, d uee.drd by a iieenscd pumper. W hat you pill, into *.e. system
can air ,ct the True. ::Tian of the se ptic tank as a treatt:aent stage in the waste disposal system
The p ;ro :: ,: °:y owner agrees to submit to St. Crom Zoning Department a certification.forru, signed by tbe. m ilner.:ixM by a
mute~ olumbv,, icn ::tney�nplatnbor, zcstz%ctadpl'umber or a huc>ascdpumper verifying that (1' the ou•site wa,towate,t daspw - 4i- aystcm
is in p- )per op... it t'.: iQ condition and/or (2) after inspection and pumping ('if necessury)., the septic tank is less than tY.3 fitl! ilk; %sludge.
Itwe, is undersi. vo .-d have react• the above. recluimments and agree to maintain the ;private sewage disposal system with .dar �49 adards
set rots a, hereiai: ;. ,.et by the Depart rout of Commerce and the 'Depnrtrnent of Natural Resewrces: State of 'Wisconsin. Cat:61iration
statinp,Vlat your ;; ; rtic system Uas been maintained. must be completed and returned to the St, Croix Zoning. Off ce'i-yl 3aia 30
days o rhr, 67 expi llfin"I datc.
D AIV
MAIN E'
I (we) o:, : that all t-tatements on this form are true to the best of my (our) knowledge, 1 (we) ant (arc) the, ow'flor(s) of
the or - ,)erty dvw..!ri+ izd above, E y virtue at a warranty deed recorded in Register of Deads Office
'• "t''
Any hif,;i nation that is nus- .represcnted may result in tbo sanitary petrn.it being revoked by lie Zoning Dop.►rttneu`..
Itar..ude with .rh ►s applicati -im: a'stamped warranty deed from the Register of Degas oilke
a copy of the certified sluvey ntap if refbrence is made W the wexianry decd
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U. 2979P 542 -7 -7 -7 58.i l;l
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Eric L. Hall and and RE rT y R D
and wife Grantor, New Horizon H mes c. 10/20/2004 01:15P11
rantee. WARRANTY DEED
Grantor, for a valuable consideration, conveys and warrants to EXEMPT #
Grantee the following described real estate in St. Croix County, State of
Wisconsin (if more space is needed, please attach addendum): REC FEE: 11.00
TRANS FEE: 117.00
COPY FEE:
t 1 olMew Acres, Town of Richmond, St. Croix County, CC FEE:
Isconsin
PAGES: 1
Recording Area
RETURN TO:
Title One Premier Group, Inc,
Hudson, WI 54016
026- 1137 - 17-000
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 October , 2004
t
_-
* Eric L. Hall * Sarah L. Hall
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Eric L, -H and Sara L. _ Hall, husban d_and STATE OF W;sc msLl'1_,.. )
wife ) ss.
Sj . Gf O i X. County >
authenticated this day of October _. , 2004_
ti
J Personally came before me this___ `� day of
-
, p'Z the above named
dL}.Ob2 f•
* Kristina,tgland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed 10
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. ����'� -y ���...• «.,,DiL �'�
PHIS INSTRUMENT WAS DRAFTED BY
Attorney 4lstina O land * _� �G : S
,
Hudson, WI 54016 Notary Public, Stat o
My Commission is permanent. (If not, state Axpt te: °�..•`��+ ��
(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., 1 du Lac, wI
STATE BAR OF WISCONSIN 800-655 -2021
WARRANTY DEED FORM No. 2 - 1999
7Y &9S
Parcel #: 026- 1137 -17 -000 10/25/2004 10:17 AM
PAGE 1 OF 1
Alt. Parcel M 20.30.18.973 026 - TOWN OF RICHMOND
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): * = Current Owner
* HALL, ERIC L & SARAH L
ERIC L & SARAH L HALL
118 PINE CIR
SOMERSET WI 54025
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 1082 148TH AVE
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 2.040 Plat: 2004 - GOLFVIEW ACRES 1/39 026/01
SEC 20 T30N R1 8W PT SE NE GOLFVIEW ACRES Block/Condo Bldg: LOT 17
LOT 17 2.040AC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
20- 30N -18W SE NE
Notes: Parcel History:
Date Doc # Vol /Page Type
01/28/2003 707309 2122/268 WD
08/21/2001 654365 1703/354 WD
06/07/2001 647648 8/53 PLAT
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
30,700
Valuations: Last Changed: 06/20/2002
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.040 29,200 0 29,200 NO
Totals for 2004:
General Property 2.040 29,200 0 29,200
Woodland 0.000 0 0
All 2.040 29,200 0 29,200
Totals for 2003:
General Property 2.040 29,200 0 29,200
Woodland 0.000 0 0
Total 2.040 29,200 0 29,200
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
UNPLATTED _LANQ5_
' GRAPHIC SCALE
100 0 50 1 200 101
(
D FEET
S. 1 inch = 100 ft.
ASSUMED BEARINGS REFERENCED TO THE NORTH LINE OF THE NW 1
p c J OF SECTION 21, T 30_ N., R i p� SLIMED TO BEAR N 9 °50'17 "E
ssoo ��SCO!/1is+�
�\ 87,263 sq.ft. fill
2.00 acres
Todd M. Hendershott, RLS 2362
Registered WiscR Land S ry yor
Dated this day of 2001.
S1g°1
201 � �', 0
2 0 80 00, 5
87,744 sq.ft. 6
8 \ \ 2.01 acres
348, 30
.9S• \ \ \S \ �ryh
18
\ \ \ \ \ ? �O '�� "��� 87, 443 s
\ O• .�� \ �� "�
> 9 2.01 acs
z
89,476 sq.ft. v 80' RADIUS EASEI
2.05 acres - TEMPORAR
AU DE
ROAD EXTENSION TC
\ P