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HomeMy WebLinkAbout026-1135-03-000 0 (n p C fl 0 o d* c d o d M CD a :� (D c CD 3 CD l ,� xt 3 - � (D o w 0 (D CD "0 F � _« (D A N ° C f ' • S ,a 5• <. � n W 9' Fes+ rYl p d ^+ 7 2 W 3 O c CD 01 w @ � !I 7 L" Q Z d N O p a �p r •�t l 1\ O a o N N CD N W p R o 0 W W A � sD C c : W O O � 3 C O p �� ❑ v iD a N V a O O O CO A l CD V N o o o n r v> �• o o N o CL CD O O O ^ �y�• :r I N N W � c N N 3 c ,00�, D fD O x i O1 '6 S COD 3 o O N 3 d L < 0 - N 3 O z z D o m CD (D � V F m g m "ft. o ° CD (v N O CD N W S CD m o v 3 W _ CD ' n O A Z t p z (D o' C/) w a c W m o 3 z 0 3 a - c 3 '. m 00 N N z _ m 00 CD Ro CD A W W (n W 3 O c a— c Q 0 a N 3 :� S T 7 N (D C cD O � 3 a 0 C 0 3 -o I� (D O O 7 S O O O _: C A 7 S W CD 4 CD 0 en CL S N 6 0 Z O CD a O c O 3 (D _N W S < O (D p " N CL c I0 N cD p ffl 0 Oo o 'b CD Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division A INSPECTION REPORT sanitary Permit No: 395286 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: P.C. Collova Builders, Inc. Richmond Township 026- 1135 -03 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ,r r w (COO 1 aw. *.* 135' 4. Dosing tit Alt. BM Q6 •�� Aeration 76 Bldg. Sewer -1 r Holding St/Ht Inlet �J , GQ 12, or' TANK SETBACK INFORMATION St/Ht Outlet 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic A S �/ Dt Bottom 55-31D Dosing „ t / Header /Man. $ Z / 93•�fg Aeration Dist. Pipe . yl- 93• S - 5 " w 1. Sso q"o Holding Bo*. System • is Q 2 . �(o Final Grade (y ' O S.1a PUMP /SIPHON INFORMATION Manufacturer Demand St Cover V i GPM (0.6 00 4S•3a t "� Model Number C� I TDH Lift Friction Loss l System Head T Ft Forcemain Lengths Dia i Dist. to well UZ SOIL ORPTION SYSTEM D RENCH 9Vidth Length INo. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN 3f 1 SETBACK SYSTEM TO PIL jBLffG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number. e4mw . 2 - 2' a 3� LY DISTRIBUTION SYSTEM I LD S7 Header /Manifold Distribution x Hole ize x Spacing Vent to Air Intake �,, a Pipe(s) 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 FE-1 Yes [0 No Fjz] Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D / Z / ( Inspection #2: ---� Location: 1441 141st Street New Richmond, WI 54017 (SE 1/4 SE 114 24 T30N R18W) Evergreen O Parcel No: 24.30.18.933D�1//��''�+ 1.) Alt BM Description 2.) Bldg sewer length =�p i ` �' S��" (iar► r w sru - amount of cover = > 2 r{ �, If`T �,� �T�'� 5 � i � 3 )`CW4J__ Plan revision Required? ILYog ❑ No Use other side for additional information. l n r Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) rtd!/'�� Safery and HuiWin s Divisitn ° 'y r 201 W. wasbi"toa Ave- P.O 8ox 7I62 S -! WT J37 D7 - SUt Addnas oe r ant 4 Ct► m roa Wa Sani Peru Application act sZc�p W WSW watts C=W ISM. % fs. AAM Code, persooei WMtkM YOU PM yea d Cbtok if Raviaian I. A�►p3i0rw�gt b oxmuttioa 3ltW ED, Nuse ar pergr t atAa �' Puce} NUmber ! c C 1�° u %demos �£C tVFR Prepeetp 'a bulw Adiratt Ur 7 _ p L CJ Ty c Mr Hlaalc Nwnoer ! Cky, am* 3 F� � F qC `x�' s a q tape CSM Number 4 ,v v 0 7 ; 7 Yee l u �tlidtcss Type at ( an tw up*) 3 « iW4 oaa+ Ti 1 of 7 lh avy Owaq - 34WAR d awkwme 6ifia- M PUbitotL'ottttAtrabtl - va 0 Sto oww IQ. Tyga of ptt73tit1 (Chtch tntq+ oaa bone an 1Lsa A (numbaWi*j adNM far SAtIM ttre). Comp so !left S if *pp}iabie) -- ---- -- , 3 � Ba�9eceraeat of 6 G Additlan eo � ar Co (0 3 0 • / g �3•� on s xt Dw Issued 3. Y it liaaitsey u%k praviouly laaud pt a umbtt I Parmia E that e�ppiy)Gtttmbtrlaf tebate►a It Tor ie Umal tut) •� t y ;Nna - Peaatuittd ta•Qeo+tcd lac) binw !7 1 0 6uj poor So © CoAM wound 22 C peasafad 1%4kooad 41 fl Nowft Ttdt at D 9isstt• Ptae sl D Dtlp Labe 4S L� A 46 TtasAxaae t?Oii 49 0 Rea}rsu" 30 Gl 02M. 010 cAo-mbers -- !�M► d A an uUan 6ystem 8tevatioa 1 }'teal d Citl tr 3�►ye1$q,Pt.) f (M1n.Rpcb} �, 8lavauan ' 'U 'Tt it qr At Toil Number i Attnyifaeturer Prettb site g�eal ! 2y6er i P!t>sUc tibdloAe a! Y'safu ; t:oAtA�ta Coatteuoad Cfkss — JIM. Tab Tal t vm �. ty � four of 1'4WT8 s� as t4a ettsebed • t a r puaiAaal Pboaa Nualw J ,lla u ) d 7 Mu law t E Osoundwalrt W A Ta �tnt gtsatuso (xo 9ztm�a? JkAPFe vO ®�'� iitstahtgtt Fat? dO i © oww (*a blftW Advarae • � Z�- �' �p • ` n,Q- ALL 4tZ4*wl SBY43I8 SIN 0510 ,• G t 1ln ,rlc i` /c� U z /tea / hWW f CG 106, s - / L ly a -3 x y4 T►-c�c s �6 c6.o.�be it X82 � ' a: rA ,&l � f4 G , L � %lam � � ,��.' /� v 1, � � .� live v 9 v �.e � �/1 �� 1�sll 7~e�✓d ��"�. <<di.e..�..yO� felt, MY, 0 62 e � d I,' 7` I _ . WiscoUln Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code I ' Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and C 1r0 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Pleas �` �{��nt aN rnformafsoih Re 'awed by Date Personal information you provide may be used fors opdary'purpFses *wacy Law, s 1 S' �4 (1) (m)). �� Property Owner -t .' ,, w_ operty Location l Govt. Lot S f 114 5 Gc11 14,S 2_ 4.1 T 3a ,N,R I F E (ore Property Owner's Mailing Address "' ,;^ Lcrt # Block# Subd. Name or CSM# C . ver Teen dv City State Zip Cod P4l4R1`aG t❑ City ❑ Village Town Nearest Roafl -11 New Construction Use: Residential / Number of bedrooms Addition to existing building Replacement N Public or commercial - Describe: Code derived daily flow (& 0 U gpd Recommended design loading rate • S bed, gpd/ft • ( trench, gpd/11 Absorption area required bed, ft 00id trench, ft 2 Maximum design loading rate bed, gpd/ft 60 trench, gpd/14 Recommended infiltration surface elevation(s) 7 ?_ • Z _ ft (as referred to site plan benchmark) Additional design /site considerations , y /?_ - /_ d Parent material 6C�'�� -' (I Flood plain elevation, if applicable ­IV 00 It S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 'ElS El � ❑ u ®S ❑ U S El U ❑ S �U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure G �' 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Z lo y ILA S r rrl�ib� c S — S •S Ground 3 l --- r��S b ` m cs elev. -toz. 0 r �cft. poi 10 Depth to limiting factor 1QLin. Remarks: Boring # p -1Z 0 1 .axab ;n -� - CS ta 10 Vt- )� .s •r 2 Z '4 5' Zm . k c 5 � 3 t _� I 5 __.____ m5 Sc rYll Ground t �j r `� (0 i � 5 f_ C S elev. i 4 (0.56 ft . cy/-4 2. Za Depth to limiting factor _amain. Remarks: CST Name (Please Print) ignature Telephone No. Am Schu rwkcr Y7-y0 Address Date CST Number 2-113 Wb 5L Wl! SH O / Z SOIL DESCRIPTION REPORT PROPERTY OWNER 1 Page Z of - PARCEL 1.D.# 0 7 3 Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 0 _1 I I Z ;� 2rrahk rn4 C5 1 v-Q Ground 3 (® elev. l3� 5 S m C S _ L} 1% ID �4 rLfl 3 L cS 5 (o Depth to limiting fgptor Remarks: Boring # 3_ o !� 3 Z 5�' ! 2bk rn�r C_ 5 e (u - rrb It m r �s .. .. yr L11co — L I m5 fir- cs — Ground rn) C5 — elev. F Depth to limiting ! Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 6 31z Si 2 k n C )v SO Ground ; 9 ft. Depth to limiting f for -It in. Remarks: Boring # x Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) d PAGE OF_�> NAME C0 (t C) J G LOT# 3 LEGAL DESCRIPTIONS F- 1 /4- c Ad��4, S 21 T30 ,N,R «1 E (ora) SCALE: 1 "= 1 �6' BM 1 ELEVATION BM 1 DESCRIPTION nc4 , r BM 2 ELEVATION �CG 'y Z BM 2 DESCRIPTION SYSTEM ELEVATION 2 • Z ALTERNATE ELEVATION CONTOUR ELEVATION /tJ/ DATE SIGNATURE - -� l 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 r health department. g p 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 Des f n Specifications Sanita Permit Number cj Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average ( pd) , Se tic Tank Capacity (gal) Soil Absorption Component Size (ft) Type of Wastewater Donibstic Table 2: Soil Absorptio n Component - Limits of Reliable Operation / Septic Tank Component Soli Absorption Component Design Flow - Peak ( pd) 1 - ►d• � Maximum Influent Particle Size (in) 1/8 Maximum BOD (m /L ) 220 Maximum TSS (mgfL) 150 Table 3: Maintenanc 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 se and outlet filter shae e ssssed at least once every 3 years by inspection. T e outlet filte shat[ be cleaned essary to ensure prope,r��r3tion. The filter cartridge s ou no be remove 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 Sol; 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 Irnpending 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 are assessment, maintenance personnel shell 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- Inures In diameter shall be secured by an effective locking device to prevent aaaddental 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 oompllanav with oSHA standards for entering a conflned apsce. The 111012040" within the a 000 or other treatment of holding tank may contain 16that gases, and rescue of a person them that Interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Cade when the tank is no longer used ars a POWTS component, 11 A s*gd 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 6011 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 prohlbited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction Is snow cover emporary, b co difficult r om may lead to hydraulic failure by freezing. This type of failure s Impossible to repair until weather conditions Improve. In general, soil compaction over this component will reduce diffuslon 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 Absorpuon CcrrWnent Plantings of doWrooted tress and ehwbs directly over of within ten +gat of the oornpwont should be Avokted since root lntruslp into the component may GiNtrUotwssdr V4W flow. Contlnpenoy Pisa In the event of system fail a new system could be Installed In an alt ernate mss. With the Irtstslletlan of s dim* valve, " exlstinp system could also be *AW OW a period of Om to four y ears. It is Ow property "men responeb to mslntsin the Alternate area free from any Piantinp of tress, shrubs, eta In am of fai6m of the on inlai system, the alternsft area will be needed. If gMy traeo, shrubs, em have been planted on this ai MMIS area, they whl have to be removed et property wwners Sypimee, N OWnAte area is destroyed, there an other sttematiw sy that teen I» used, in which, could resu t in added #van" to me property owner, Any tank abandonment shall be done in accordance with Wisc. Code 83,33, Any Queet!Oms ""rig this code, pieen corded your local Zonir+d dlltaoe ter oontsot the irtetsiliN piurrtber. (' los t) �. � 1, win la � er► Kim r' aLLOI.A I.NC r-rLN= NL. - r at. 0_ 2001 0r 3.�AM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne./Buyer '�. �. C6 Ilcvo. Mailing Address 7 0 - ?rcpeny Address l 5 fie Ve ^fication :cquircd 'rum ('tanning r- .7.1 -rit r-1 xw ccristr_ction) C1tyiSWC U �.; c 1 ,tmd wTi t arcs, Ice : :L'fc� :ioa Number LEGAL DESUUPTi0N Prover:/ Lccaucn5- SW Scc. 14 St:iidivisicn �l`�f�1(�C71� Lo r _ 3 >✓ -ru c ?r v- ,r, -r,,, Warrant Deed �1 Scez Lcusc ` vZa ._. ;:a SYST :YIALMIN ACE is erg: c 3aGtaai ,ateua:.:.cai�out ._,.,_cud;erllti... cr�;;t�_ :.+ ,.. as -- czasi:ts Pump the tit M is every t� T T - - of ing out rep .arc ar setae_, if �^cd v a' :area gttr✓^er. WC= •.ou put zta be ^ sL cza , *T^ the funcd= of t c :rYCc 3ai a: a :; ea. neat age iu '11 arastc damx c:ai s rem TBe prope: y owner ag=es to ==t to SL Cviz Z,:aiug No= W^ct s a-rtiucatioa Ietm, :; pcd L;: ovr --=. and ',y a trastrs•P�� 1� :mot: eted plaWbcr ar a1c:.nsed autr„^e *. -e-:ft :..a, rL (1; ;he en -site ms;c-vstc.i�;r_al :ystr s in prcper epersti=g e=dition and/cc (Z) at'--: ia^ectioa recd - U= La (ii acs-r e septic ::aic s Iesr tia I.n lalI of siudg r/we, the uad=ipmd :lave r=d the above ;egtiire ..meat+ and i2=-- to assiaui; 'Ic prirate st -wagc di ^osai sys;rm with the =iaduds set forth. he. is set � the begs,- tz'��t o: tatverce and the Dg4rmcat of ;oar= i Zesacuecs, Statc or hW :sc rsia Cestifk:doa s=ting that your septic r nt= his beta maintained must be cetr_pleted and rett- to r_.r St. Croix County Zanirg Of witbil: 30 Says year exS.intica te, SI •r F APPLIC.k > ATE OWNER CEIiT'iFZCATTON -aiy dut all statctaerts on this Corm arc true to the :=-: of my c s) k-nowledge. ? (we) ani t s^? 'hc ownet(s) cf the top" dc= ov oy ue ni a ry deed recorded in - Zrgistcr of Dee:is C'Mce. C� •i TiJRE OF APPLIGt.L. IrA i cc Any info r Lion t at is wiS mcresented = ragu�t In die Mails g _ aaaaa� y ry pet-ait bein, *evol cd by tltc Zoning n ,cpsrtmcrt. " Include with this sppileatlen: s - tanivcd warranty decd from the :Rrgister of t".ceds afrtce I c^.ry oC the cartifed survey map if referent: is made in the warranty decd FROM P C COLLOVA BLDRS, INC PHONE NO. : 715 549 5911 Jul. 21 2001 01 :54PM P1 02i'Cdr00 7.12 11:33 FAX 716 384 4667 REGISTER OF DMMS Qn01 tTA7f tae Of WtmCCUSb►AXLM j.. 194 Dewaset Nuaxt ��t,Aiv'TY DtZT� _ _ � FOt�Q� s 1Wt s`w ea.t r]arrtefc r ardwor, and P ? 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