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Home My WebLink About026-1119-13-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM CountySt. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita Personal information you provice may be used for secondary purposes [Privacy Law,j.15.04 (1)(m)]. t} t y q �� Iga ❑ Cit ❑ vlgftfii&r ' 1 rOwnSh p State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 3200i -13 -000 f4 Q d P. 0 5 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic G lL Benchmark A BM Do Z .S d L Aeration Bldg. Sewer ` 3O ing St Ht Inlet Q r TANK SETBACK INFORMATION 10/ Ht Outlet TANK TO P / L WELL BLDG. Air i to ntake ROAD , Air Septic 7 _7/ 23/ NA Dos' NA Header / Man. Aeration NA Dist. Pipe M 1d,3 , Hol g Bot. System * i ia;s 0 . 0 PUMP/ SIPHON INFORMATION foal QY0.� _ X a turer Demand Model N er PM T Lift Friction m TDH Ft Forcemain Length Dia. Dist. To Well SOILPAkSORPTION SYSTEM BED TRENC Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIGNS I l - zS' 3 1 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING [ Manu acturer: SETBACK A B INFORMATION Type O Mo el umber: System: U - >S 0 NIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Z I" Dia- �_ Length ,/ 4[4-- Spacing 7— � � 7 sd � SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil InSn i-ctior l #U Yes I ❑ No Inslo #2t No / LICOMMENTS: (Include code discrepancies, ersons present, etc.) >' 6 Location: 1283 146th Avenue, New �ichmond, WI 54017 (SE 1/4 NE 1/4 22 T30N R18W) - 223018708 Pondview Meadows -Lot 13 y� wet( os 1.) Alt BM Description =� /�� 2.) Bldg sewer length= z,3 r 3.� �/g� C (r v �-�? , 6tiy kRy lower -, 3 - amount of cover 1�+� � l � N Stpar�%ti,,, r+�aercdF �f / b" �el� �� 3� 0�►Ser ✓ate, "o,• Uri iv�5{alli� �rc� jw-f QS Cr�fc eon YO �� Plan revision required? ❑ Yes No Use other side for additional inform tion. SBD - 6710 (R.3/97) Dat I Cert No. 4 w 0 0 N� r li ry I Z y6 I AV c. 3�(0 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 20I W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 lVi sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County ` State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number . I. Application Information - Please Print all Information Location: Property Owner Name >Srop Loc�t on 1V - e e / 1 / w /wa 1/4 1/4, SX T 3�),N, R E (or W Property Owner's Mailing Addn:0 Lot Number Block Number — City, State Zip Code Phone Numtibr - Subdivision Name or CSM Number II. Type of Building: (check one) �� 0 City p r , Vill �. 1 or 2 Family Dwelling -No. of Bedrooms a S PPr 1'�i -L '.Town of ❑ Public /Commercial (describe use):_ sw /, g f y t0` 6 ❑ State -Owned x. Nearest Road Par � ber( ) So he 5 � o III. Type of Permit: (Check only one box on line A. Check box on 9 - ld) D a I l - 13 - 0 00 A) 1. 19 New 2. ❑ Replacement 3. ❑ Replacement of 4. _.1 _- ' 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ;l Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground _ ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade _ ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: l} - /00 5 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation ate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) 7-_1 c 102. $S Elevation 66(3 495 8S / o r -_a _�oa ss�, 106 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks S� _ ❑ ❑ ❑ ❑ 086) 1 0 � ct -u-� -' ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown n the attached plans. Plumber's Name (print) Plumber's Signature (nos ps): C I O PRS No. Business Phone Number AD amo Plumber's Address (Street, City, State, Zip ode) ZZO IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin A ent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) --� Determination Z 2.S D 0 ZL Zpp I VA L7 X. Conditions of Approval /Reasons for Disapproval: / I �c iaS7 /I, Gr�crr�k1`ac�LcrPrS ✓ccacr�xtien �Tro,�S. SBD -6398 (R. 07/00) r r lv6 J,3 o� ys = 3 -)6 / oo fv ao' 31 ' aq 8 Ajv USX X��c.z 7 - 3 V � Department of Industry SOIL AND SITE E V A L U T`IpfN� -- E PORT Page 1 of 3 Labor uman Relations Ntision of Safety & Buildings r w I H 1 . AcIm. Code in acco d t L R 83.05,. W s COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inchesrt site. Plan Mil i , h" e, but 1 h. Croix PARCEL I.D. # Po int not limited to vertical and horizontal reference arrow, BM , directio and of slope, scale 6r dimensioned, north and location and distance to nearest r ( ) 0 /a " P nce ad: !' - I 65 -50 -000 _ VIEWED BY DATE APPLICANT INFORMATION PLEASE PRINT ALL INFO NAT 026 - 10 ION DDk'j�� PROPERTY OWNER: 0 Richard Derrick GOVT. LOT 1 bJg 1 /4,S 22 T 30 N,R 18 r) W PROPERTY OWNER':S MAILING ADDRESS LOT #I § SUBD. NAME OR CSM # 1310 Hwy 65 l n a I Pondview Meadow CITY, STATE ZIP CODE PHONE NUMBER ❑CITY VILLAGE ]TOWN NEAREST ROAD New Richmond, WI. 54017 (715)246 -5425 Richmond 146th AVe. ( New Construction Use [K J Residential / Number of bedrooms 4 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 4 bed, gpd /ft - 5 trench, gpd /ft Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate A bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) area A= 102.37/B= 101.27 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material Glacial drift Flood plain elevation, if applicable na ft L Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK Unsuitablefors stem ®S ❑U ®S ❑U ®S ❑U ®S El El CRU ❑S :E1 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft y, <t� Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed jTrench Cade .................. ................. .................. ................. 1 1 0 -10 10 r 3/3 none 1 2csbk mfr Qw if n p .2 s 2 10 - 10 r 4/4 none sicl lcsbk mfr 9w if .2 .3 � Ground 3 25 -80 7.5 r 4/4 none sl lcsbk mfr na na .4 .5 elev. 106 ft. Depth to limiting factor o z . es 80" y 5, yo% Remarks: Boring # 1 0 -9 10yr 3/3 none 1 lcsbk mfr gw if .2 .3 . 2= 2 9 - 10yr 4/4 none sicl lcsbk mfr gw if .2 .3 2 Ground 3 18 -84 7. lcsbk mfr na na .4 .5 y elev. 10 6.20 ft. Depth to limiting of 10 a �r facto (k ` yb � Remarks: � CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. w Richmond WI 5 O17 Signature: Date: 4 - 22 - 99 CST Number: m02298 4LE PROPERTY OWNER Richard Derrick SOIL DESCRIPTION REPORT Page? PARCEL I.D. # 026- 1065 -50 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft ht in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed !Tw& .....3 „ 1 0 -9 10 r 3/3 none 1 2c 1 mfr qw if n .2 2 .9 -22 7 r;vr 4/4 nnnim q r 1 1 r M_r Ow if .2 .3 Ground 3 22 -82 7.5 r 4/4 none sl lcsbk mfr na na .4 .5 - elev. 10 5.10 ft. Depth to limiting factor (02. 821, a 3�•P ' � Remarks: Boring # 1 0 -9 10 r none lmcfr mfr CTw if .2 ' .3 " 4 2 9 -21 7.5 r 4/4 none scl lcsbk mfr Cjw if .2 .3 • ` Ground 3 21 -82 7.5 r 4/4 none sl lcsbk mfr na na .4 ' .5 elev. 10 — Depth to - limiting factor 82" Remarks: Boring # 1 0 -10 10 r 3/3 none 1 2c 1 mfr gw if np .2 , 2 10 -23 10 r 4/4 none sicl lcsbk mfr gw if .2 .3 Ground 3 23 -48 7.5yr 4/6 none sl lcsbk mvfr gw if .4 .5 4 48-88 4 none sl lcsbk mfr na na .4 .5 10 1 Qt. Depth to limiting factor 80" Remarks: Boring # ................. Ground elev. i ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) ' L ERVICE STEEL S SOI S Gary L. Steel Richard Derrick 1554 200th Ave. CSTM2298 SE4NE4 S22- T30N -R18W New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #13- Pondview Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. N 1 =40' BM.= top of NW lot stake @ el. 100.00' Alt. BM.= top of SW lot stake el. 98.90' 10� c Gary L. Steel „(� 4 -22 - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _A ✓CGt' `b' J' VCffe 7V=:5Ma -1 Mailing Address _ , ` 0 , 9'X 2- gWder W1 5VO23 /-,, /a�3 Property Address L- 13 l�oN1) 1°lGZe1 /�l Ef} /�r1 Gc/5 - lq6 - Aw A(dw - n&we (Verification required from Planning Department for new construction) City/State /(/; Lo�J, Gt10 Parcel Identification Number - 02ti o�a .30, JS.70e LEGAL DESCRIPTION Property Location IVr__ %., S '/., Sec. . T N -R-ILW, Town of 91G4M4AJ0 Subdivision &AIP0 pla-P& J5 I Lot # � Certified Survey Map # , Volume , Page # Warranty Deed # Volume Page # Z(p Spec house ❑ yes fg no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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 The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 Zoning Office within 30 days of the three year expiration date. 6 SI ATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) 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 pr9pefty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG ATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r , ,s Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft R5 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 � r Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. SA4 L1__4r_j 67 �7�s) 3 3 vnl 1480 PACPE 326 KATHLEEN H. WALSH 9TA'1TL BAR QF W5CONSW FORM : • 1998 REMSTER OF DEEDS 5T. CROIX CO., WI 7This , made between Ric L Derrick indivv and as RECEIVED FOR RECORD r I oren JR Derrick Rase H Derrick Joao L rrtcIt 12 - 28 9:30 0 NA �' YARRA)RY DEED EM PT FEEL COPY FEEL Grantor, conveys and warrants to Dovid A tiansrnan and Yvette M• INN FFEEt 0.00 � t, w d aid wife Grantee. Recording Area Granter, for a valuable consideration, conveys and warrants to Grantee Na eturrr address County, State of Wisconsi ' x!C(STINA OGLAND the following described redl estate in Sc. C j86�_ Ztl2 (The "Property "); , Estreen $ 0SIand P.O. Box 359 Hudson JS W1 54016 026-1065-50: 026-1065-10 Parcel identitkatioe Number (PIN) This is" honmteud property. Lot 13, Pond 'View Meadows in the Town of Richmond, St. Croix County, Wisconsin. Exceptions to warrunties: Easements restrictions and rights -of -way of record, if any. Dated this �2-1 4 V day of Decenber, 1999 '— —'—� � IhM l ad L. Derrick, Individually attorney-in- fact for " Loren P. Derrick, Rose H. Derrick, Jan L. Derrick and Robert J. Derrick AUTHENTICATION ACKNOWLEDGMENT Signature(s) Riehntd L,_DGtrick ndividua11 and as STATE OF WISCONSIN ) f "act for I nren . Agrrick Rase H Derrick. } ss. Ccunty JoAr I Daric& and Robert J ,Derrick _ ' ----- Persoratiy came before the this day of June , 1949, the above teamed avtitenticate�i / �th�is A toff 1 l day of December, 1990. to me known to be the person(s) w;w executed the forgoing instrument and acknowledge the same. " Kristin Ogland TI I'LE! MEMBER STATE BAR OF WISCONSIN (If txx, _ — Notary Public, Swte of Wisconsin authorzod by $ 706.06. Wis. Slats.) My Commission is permartent. (If not, state expiration date, THIS INSTRUMENT WAS DRAFTED BY - Attorney Krlsfitw Ogtand Hudson, W1 54016 ( Signatutts may be autheiCcated or acknowledged. Both are not neeesaary ) •'Vamcs of lic"ons signing in any eapteiry should be typed Dr pritued betow incir Signatures WAKRANTV GEED STATE SAR Or WISCONSIN FORM Na a • IM ihFOAUMIONPROMSSIONAO6.OMPANV FONGtrULAC.IV! SCOOS•2021 f W m N89`4�' +034 8.25' 589'43'03" W 380 ,66': 4 1 4 6TH A V 33` 33' ` CD m 12 cu �,-0 CD cu N L,.1 N 2,005 ACRES 87,318 SQ,FT, o 05 3 V. 10, PC, NI _ - - - - -- - ----- - - - - -- S89'43'03" 3 8068" i M o OWNED BY z 17.2 °+ sm v _--------------- W � cis p ----_---_—__--_-- �- o i I ° ' LUI 3 m 3 � ! 11% M Us 0% I I C, Li LJ M_ N N ni 2,005 ACRES cu W M 87,323 SOFT. I =-- �'--- P� = - - -� I OWNED BY OTI- i,i o S89 °43'03 "W 380,70' : � 19.1 ° + E C H N ' W OD " 14 ' r 00 2,005 ACRES ° 87.348 SQ.FT, cv 1 \ \ r ,r a , r 75�03 22 V `� de i 22.2' 15 2.006 ACRES 87,362 SQ.FT, CA �� •, .�,�� rrr 2,003 ACRES t .�L . . _._ 87,264 SOFT, 2 -000 ACRES 05 87,130 SQ,FT, fr 5