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HomeMy WebLinkAbout026-1119-18-000 r /* t Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,WTJTo.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑ Vi To of: State Plan ID No.: Pishko, Deniset�con��ownship CST BM Elev. Insp. BM Elev.: BM Description: Parcel T� -18 -000 TANK INFORMATION ELEVATION DATA °22. j 91 113 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ICS I(S-D Benchmark , �� I go — .0 Dosing � � t. �S cls q t Aeration Bldg. Sewer go.oc} ' Ho St / Ht Inlet 2. S - :f7 - ' TANK SETBACK INFOR St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air intake Septic 5_0 r 2 0' NA Dt Bottom 1 6 , • ZZ Dosing > S t " -t 30 NA Header / Man. Aeration NA •L1i i Z (00 Hold in Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer S Demand St cover 10+0 Model Number 0 S GPM TDH Lift Friction System _ TDH Ft Forcemain Length 0 ` ia. 2 " Dist. To Well ) SOIL ABSORPTION SYST TRENC Width / eng h f renches PIT No. Of Pits Inside Dia. Liquid Depth D IME N 3 DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Man_ L er: SETBACK INFORMATION Type Of r 1 �� Moe Numbe System: Cph\j , ^' 3fl 5 S OR UNIT CHAMBER r DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing 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 I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 10 /3( IO #2• / / Location: 1293 146th Avenue, New Richmond, W1 54017 (SE 1/4 NE 1/4 22 �W1- 223 18713 Pondview Meadows -Lot 18 1 ate s 1.) Alt BM Description = rQ �e`" ova j_`L 2.) Bldg sewer length = 2, 41 � Y 3 I ( S q) 4s. t3 [0 � �I 93 • F,S / - amount of cover= > 20" del , 2 a Zg Ct3 t5 l - S8 q, a fq $, C t3`f(�• to `�' w� // Plan fevi io rn 4 i Yes ❑ Use other side for addition PI Information` N V*AA) to Inspector's Signature Cert. No. SBD -6710 (R.3/97) O C o 9 1, ] Q ?,,f 1 x � C �_ � � � ` i r ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: i �. F� _ H�� ..�P • ry �, , �� .� a .�,,. � � __._. as ,� ,.m � ..�� �� �. ��� m 14 . . . . . . . . . . . � � 4 t q k I m 1 •_ �® II I _ ...._.. ......... t dew' r �,�. ®? �- •- � ®��...,A. mm I F -4� m.�_. • __n �.�_�� _ m.�� �a° AL E _ �� Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 lV i sconsin Personal information you provide may be used for second purposes P 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 % 3 :t_0_33__2_ I. Application Informati - Please Print all Informati Location: rope Owner Name Property Location EI 14 S/4, S MN, (or) W Prop Owner's Mailing ddress Lot Number Block Number Q 0 k /-/ 7.3 U City, State Zip Code Phone Number Sub 'vision Name or CSM Number �.Z. S yon s (r II. Type of Building: (check one) 0 City tit 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village ❑ Public /Commercial (describe use):_ / ✓ �.� own of ❑State -Owned ` � t " Neatest Road /,n Parcel mbe U III. Type of Permit: (Check only one box on line A. 0k if app ab e) 6- 24 , — II I ° t (49 60iD aa• 3 s. 13 A) 1. New 2. ❑ Replacement 3. ❑ R }acautent c `c4, _ 5. 6. ❑ Addition to System System Tank Existing System B) Pe i NU m ,:er Date Issued ❑ A Sanitary Permit was previously issued IV. Type OWT S s yp y to — I Non- ressurized In r o Mound ' r Wetland k,� L ❑Sand Filter ❑Constructed et and 4"� P g � J� x $� � ❑ Pressurized I - ound ' 3 9 $ t (IS) Holding Tank ❑ Single Pass ❑ Drip Line ❑ At- Aerobic Treatment Unit ❑Recirculating ❑Other: 3 X Tf- Say LI �S V. 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil on 5. Percolation Rate 6. System Elevatiot 7. Final Grade Required Proposed Rat day /s . ft.) (Min. /inch) q C/ 75 / Elevation VII. Tank Capacity in Total # of facturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing structed ,Tanks Tanks ❑ ❑ ❑ ❑ beo -- ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for_.. Plumber's Name (print) Plumber' - Business Phone Number Plumber Address (Street City, State, Zip Code`)�� Q . County/Department Use Only ❑ Disapproved Issuing Agent Signature (No stamps) 14 Approved ❑ Owner Given Initial Adversi' -__ .____r_......._._._.___ a Determination _ ...".._ .__.,..._..._._.__._._...d_.o•- j-_ _`' X. Conditions of Approval /Reasons for ' dt.co+u ,�-<< s.�-k� ►�� b.�w.���..�.0 4 cam s:,;�r_ < SBD -6398 (R 07/00) 4 •��� U /i C jn � b� • t �f" cxa�.b� � 7r c� 3 � i 1 Xn �8 � G- 3 _ �j y 10e) 9 13, OP J ,e,4 q 3, &5 �2 7' f r :Miso-onslrl Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations _ Division of Safety &Buildings in accord with ILHR 83.05 Wig FRCELI.D.# Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan mustinpKide but not limited to vertical and horizontal reference point (BM), direction and /o of slope, iaa' j . ©t; dimensioned, north arrow, and location and distance to nearest road x 026- 1065 - - 000 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMALON F r a R IEWEDBY DATE 00 e'i(I ri461f- r.l ) PROPERTY OWNER: ',PROPERTYIWTION Richard nerrick 'N 1 / 4, S 22 T 30 XR 18 ) W PROPERTY OWNER':S MAILING ADDRESS SLOT # - .. B1 OCK # `, SU .NAME OR CSM # 1310 H "65" 1 rr` at Pondview Meadows CITY, STATE ZIP CODE PHONE NUMBER ❑CITY GE DOWN NEAREST ROAD New Richmond WI. 54017 (71$ 246 -5425 Richmond Hwy 65 [ New Construction Use [x] Residential I Number of bedrooms 4 [ J Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate . 3 bed, gpd /ft •4 trench, gpd /ft Absorption area required 2000 bed, ft 1500 trench, ft Maximum design loading rate .3 bed, gpd /ft •4 trench, gpd /ft Recommended infiltration surface elevation(s) 94.75 trenches ft (as referred to site plan benchmark) 3' below surface Additional design / site considerations grade spaced to code. recommend mound for system longevity. Parent material glacial drift Flood plain elevation, if applicable — na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for s stem ®S ❑ U ®S ❑ U Ga S ❑ U �] S [I U [Is R3 U ❑ S CCU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 9 -21 10yr 4/4 none sicl lcsbk mfr 9w if .2 .3 Ground 3 21 -80 5 r 4/4 none sl lcsbk mfr na na .4 .5 elev. 9 Depth to limiting factor 8 Remarks: Boring # 1 0 -9 10 r 3/3 none 1 lcsbk mfr Qw if .2 .3 2 ' 2 9 -19 10 r 4/4 none sicl lcsbk mfr QW if .2 ':.3 Ground 3 19 -84 5vr 4/4 none sl lcsbk mfr na na .4 1.5 elev. 9 Depth to limiting factor , 84" v Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. ,Pme., New Rich and WI 54017 Signature: Date: 4 -23 -99 CST Number: m02298 PROPERTY OWNER Richard Derrick SOIL DESCRIPTION REPORT Page 2 of 3 + PARCEL I.D. # 026 - 1065 -50 -000 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bb� Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench - 2 Ground 3 17 -80 5 r 4/4 none sl m na na na ? elev. 9 Depth to limiting factor 3.&S g 3 o/6� Remarks: Boring # >' 4 1 0 -15 10yr 3/3 none 1 lcsbk mfr gw if .2 '.3 Ground 2 15 -25 7. r 4 4 f if .2 .3 elev. 9 - Depth to - limiting factor 80" Remarks: Boring # .2 2 12 -27 10 r 4 4 none sicl lcsbk mfr Qw if .2 i .3 Ground 127 elev. 95 ft. Depth to limiting factor 80" Remarks: Boring # 13 Ground elev. 1 ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) _ __ 1 STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Richard Derrick CSTM2298 New Richmond, WI 54017 MPRSW -3254 SE4NE4 S22- T30N -R18W (715) 246 -6200 town of Richmond lot #18- 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 C el. 100.00' Alt. BM.= top of NE lot stake C el. 97.15' -2 - JDV ir 5 - X10 y.' O C Gary L. Steel 4 -23 -99 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 34 Number of Bedrooms 3 Design Flow - Peak (gpd) 5 Estimated Flow - Average (gpd) DD Septic Tank Capacity (gal) I cvf� Soil Absorption Component Size (ft Z -_V Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) V�z - g. rn eN 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 l 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 components operation must be assessed by inspection at least II include recording the levels of ondin , if an years. The inspection shall p 9 Y once every three ye p 9 , 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 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. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ®. �5clo�' �o Z S — Property Address (Verification required frorn Planning Department for new construction) City /State A)Au1 Parcel Identification Number LEGAL DESCRIP'T'ION Properly Location ' /,, '' /,, Sec. Z. , T _ 3 6 N -R Town of Subdivision ��i�iJ Lot It 1 . Certified Survey Map It , Volume , Page It , /Warranty Deed # JA 7 1 ,Volume V Page # Spec house ❑ yes bCjio Lot lines identifiable Kyes ❑ 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 die 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, journeyman plumber, restricted plumber or a licensed pumper 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 (lie private sewage disposal system with the standards set forth, herein, as set by the Department of Conunerce and die Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to die St. Croix County Zoning Office within 30 7 dte three year expiration date. C NAta /) / 2 10 3 StbWATftE OF APPLICANT DATE OWNER CERTIIICATION I (we) certify that all statements on this forni are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of die property described above, by virtue of a warranty deed recorded in Register of Deeds Office. V r, - Pk kb / J, ATURE OF AP LICANT D TE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this A llcatloa: a stamped wawa pp p my deed from tlrc Register of Deeds office a copy of the certified survey map if reference is made in die warranty deed } oil ,i;.. �t • ,�. 1 , fir { � ��.1483•,� 198 6i6.r18 ti srAU UR Or M ISlCONSIN FOtM 2 - Its "Mm H. W al WARRANIN RESISTER OF BUDS AWAS ST. CROIX CO. N 1115 Dead, made iIgEM FU ll� 81- 10.1001 Iona �t L Derrick IM W" No �.. awe CRT CM FEES a. Granw. conveys and warrants to Dtmise C. PWtko. a simle n!rlim. T0Mi30ER FEEL 71.76 UM IN Fr-.s 10.H Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin Recording Ara ■propefty.): Name and Return Address • rw 1 C. �8 N.�,u� wrsyoi ? 026-1065 -50; 026.1065 -10 Parcel Identehatn. Number (PIN) This k boalessad property. Lot 18, Pond View Meadows in the Town of Richmond, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. } ' Dated this q day of January, 2000 f • • 18chard L. Derrick, individually saMI -in-fad for Loren D. Derrick, Rose H. Derrick, Juan L. Derrick and Robert J. Derrick AiT111ENTICATION ACKNOWLSDGMEM Signatures) Richard L. Derrick. individually and as STATE OF WISCONSIN ) ggorne9- in -fatx for Loren D. Derrick, Rose H. Derrick. )as. Joan L. Derrick stet Robert J. Derrick County ) Personally came before me teas day of Jane . authenticated this day of January, 2000. 1999, tee above named b me known to be the person(s) wbo executed the foregoing instiumeet and • Krishna Ogland acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If no d Notary Public, State of Wisconsin authorized by 4 706.06, Wis. Stets.) My Commission is permanent. (If trot, state expiration date: TWS INSTRUMENT WAS DRAFTED BY ) Attorney Kristioa OglaW Hudson, W15416 ..a (Signatures may be authenticated or acknowledged. Bads are not necessary.) 'Names of persons signing in any capacity should be typed or printed below their signatures wAaaAMr n® $TAU a42 0/ WISCOM M FORM W.r•IM s10R%"T10M PROFtissX*ft8 COSirurr FoNO ou w w ��� � z� ¢ I I — f ( ,SL' 00 9 M 18S'009 M„L2,2Io00N ,� In i\ oI and 3H1 31 a31VOIC13(I 60 %D ° ao 83/'1 ❑d (IV3H3AO ° % - D 4 w L— A 3❑ - 1H9 Id ,9 'H' — J CD Lr) F A aVO8 33b1NOdJ4— - ¢ 3 \ ` ££Z SNVdl aid N3Vff13S 'l' ❑'Q u) \ r '0, \� its S• CL/ ; �� 9 O \ _�, �� ........ ............... '-' o s O . E W \ \� •; ' ' v S �� W C � e cs z \ T U 0 N \ W k �. t p ! v m Cv Li O \ r' 00 \ z W N06'48`40'`W 307,70' J L 3� o Lv i 00 ---------------- i o in � w� Z 0 h 0 - .. w cs � i W I, ti < ON ' ¢ a U') W ' - -• -•- e•-•� o 0 >! 3 •' ch o Z; (U f p; I I; Lfl i W T 00 W' U. 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