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HomeMy WebLinkAbout026-1127-37-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and 9uilding D vision Sanitary Permit No: INSPECTION REPORT 395164 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: Rossi, Tom I Richmond Township 026- 1127 - 37-000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark p U 2. ZS Z.a Dosing Alt. BM Cho .Z 9.v� Aeration Bldg. Sewer �Z 5- d 9�s Holding ff1 Inlet TANK SETBACK INFORMATION Ht Outlet 1 13 - 75 - G a Sv TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S a Septic r I � r .}- / 0 f DtBottom S j ZZ (y 3 3 Dosing / 5 �-� 3, Header /Man. fy Z- FYI B Dist. Pipe s c 0y. 05-- av Aeration M / Bot. System Holdin IK s— / Final Grade PUMP /SIPHON INFORMATION Manufacturer GP man St Cover 6 5 Model Number (-D TDH Lift Friction Loss System Head TDH Ft 6z lY 9 Forcemain Length / Dia. a Dist. to Well Z SOIL ABSORPTION SYSTEM (� aap/� DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 � � Z S 3 SETBACK SYSTEM TO P WELL BLDG WELL LAKE /STREAM LE Manufa u r r: INFORMATION C MB Type Of System: �- o r /S � , S Uv / Model Number. V DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / �� Pipe( s) p / l l-engthj _ � : . �Dia�_ Length 4 • Z5- 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 ❑ Yes [k No Fs] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1'0 / 46 Inspection #2: Location: 1347 144th Street New Richmond, WI 54017 (NE 1/4 SW 1/4 25 T30N R1 8W) Richmono Parcel No: 25.30.18.847 1.) Alt BM Description = 600' � 2.) Bldg sewer length = 33 - amount of ver = ± y /C 3� Asc ✓vOS;w�- ?' i" r t "'t e l�Jir �rA e a, GL` Plan revision Required? ® Yes No Use other side for additional information. �- Date 11 Sepctor's Si nature Cart. No. SBD -6710 (R.3197) k -T Sanitary Permit Application Safety & Buildings Division * In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 See reverse side for instructions for completing this application 10 sconsin Madison, WI 53707 -7302 Personal information you provide may be used for secondary purposes Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) - o er not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Numberk(e to tlre}ylqus application State Plan I. D. Number 3 S ~' I. Application Information - Please Print all Informatigfi qW Location: Property Owner Name - *t ' yt Property Location ! t 1 /4s 1/4, N, R j Property Owner's Mffilffig Address e Z 3, / of Number Block Number City, State Zip Code Phon ' • = „ Subdivisiot Name o M Number A IL .� I. Type of Building: (check one) ❑ city 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Village ❑ Public /Commercial (describe use):_ CyTown of ❑ State -Owned , 400 Nearest Road - Z S 3 0 Parcel Tax Number(s) III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ANew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 0 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: _ , ].Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min /inch) G�►Z ,� Elevation ,� / ✓ .7 ✓ 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 fir, ® ❑ ❑ ❑ ❑ ,� ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the u dersigned, assume responsibility for installat' of the POWTS shown on the attached plans. Plumber' am ri I Plumbe 's Sig e o stamps MP/MPRS No. Business Phone Number s Pl tuber' Address treet City, State, Zip ode) 1 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) �(] Approved ❑ Owner Given Initial Adverse Surcharge Fee Determination Z Z s" a X. Conditions of Approval /Reasons for Disapproval 7`f J Y1 /rfl� /0 ir aA Ser , �c J M PC V- k0 -1.-U t r � e rf Yeta#%, 1- ke- r{C""I, f z. � / s �� , � / raa�c // / �0 5�2y 3 4`o 3 , — rA ;S 54/ /t iv� i5 c�e5= /sr ✓G+ Yom✓ G� 3 �/✓w� VeSiaenel T►l adG1,'t�bn er a beCirov+v� Lda�d re6,11 SBD -6398 (R. 07/00) 3- I -- 0 eo - - _ - a � \ II 7 _ _.ter.- _ -_,, -_ __ -__� - -__ _ -_._ _.___ PAGE of PUMP CH AMB ER C9055 SECTION AND SPECIFICATIOKLS �S , VE WT CAP - T VENT PIPE /APPROVED LOCKING WE ATH E RPR oo F - JU LI CTIOM DOX MANHOLE CoVLR W ITN 25' FROM DOOR, T WQIWING LABE WINDOW OR FRESH I2,MIU. I AIR INTAKE GRADE I y" MIfJ. IS' M•I Lt. COIJDUIT __ - -____ la'nlr�. �\\\ ---- - - - - -- PROVIDE I - - - -- IAILET � AIRTIGI {T SEAL_ I I I APPROVED JOINT A APPROVED JOIWT W/ PIPE I I W/ PIPE EXTENDING 3' I I I ALARM O T ONTO SOLID SOIL I II ONT O SO SOIL D I I ON C i (' L LEV. FT. PUMP— , - -� b O FF D CO N CRETE DLOCK RISER EXIT PERMITTED OWLy IF TAWK MAIJUFACTURCR HAS SUCH APPROVAL 3" I}PPAoVEN BEDDIriG % - T►4►sK SEPTIC E SPECIFICATIOMS DOSE TAWKS MAIJUFACTUREK: (JUMOER OF DOSES: PER DA-4 TAWK SIZE: _ GALLOWS DOSE VOLUME // p ALARM MAUUFACTUR.CR: NC IMCLUDING DACKFLOW: / & ! GALLONS MODEL WUM6EK: CAPACITIES: A = _ a ?J INCHES OR —'Z2 SWITCH TIPE:.�C� / B= IwCHES OR GALLONS PUMP MAUUFACTURER: G = INCHES OR .//7 - C I A LLO►JS MODEL UUMDER: - 14 / / ��IL D- _INCHES OR - Z,.LW ALLOIJS SWITCH TYPE: L.,az MOTE' PUMP AMD ALARM ARE TO pE MIUIMUM DISCHARGE RATE �:e� GPM INSTALLED OU SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEELI PUMP OFF ALID OISTRIBUTIOLI PIPE.. ,� /,� FEET + MIiJIMUM NETWORK SUPPLY PRESSURE . . . . . . . . �" FEET + ��5 _ FEET OF FORCE MAIM X 1l-z on►tFRICTIO►J FACTOR.— FEET TOTAL Dy1JAMIC. HEAD — FEET - I LITERWAL DIMEWSIONC F TXWK: LEWGTN iWiDTH jLIQUID DEPTH SIG�JED. LICENSE NUMBER' c - OAT E: I "#bonsin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 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 refereripe Print (BM), i and Parcel I.D. percent slope, scale or dimensions, north arrow, an¢tocfitiorj acid distande tb hearest road. P endin a Please print all it ormation. R we y Date Personal information you provide may be used for so6ond7ry purpo etir }w, s. 15.() (A(m)). 3 Ve Property Owner Property Ucation R J C Deyelopmnt, Inc. rr t vt. Ot NE 1/4 SWI /4 S 25 T 30 N R 18 R(or) W Property Owner's Mailing Address Lot #/ ; lock # Subd. Name or CSM# 1868 Ct . Rd. C r ichnonrl Hi 11 s City State Zip Code Phone Num City ❑ Village K7 Town Nearest Road New Ricbmonq WI.1 54017 1 ( 715-y Richmond a New Construction Use: ❑ Residential / Number of bedrooms _ 4 Code derived design flow rate 600 GPD ❑ Replacement • ❑ Public or commercial - Describe: Parent material a ] ar a I d r - i € t: Flood Plain elevation if applicable ft. LICI General comments and recommendations: trenches 3.50' below grade spaced to code F-11 Boring # Boring Pit Ground surface elev. 9 5.8 0 ft. Depth to limiting factor + 10 Q 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 1 0 -9 10 r 3/3 none L 2msbk DSH cs 2 9 -17 7.5 r 4/4 none sicl 2msbk mfr UK if -4 -A V1 3 17- 4 0 -88 5 4/4 none sl 2rnl fr Liv na 0 _ g3, f na na .7 ✓ P. �p 2 F Boring # �[ Boring 2 13 Pit Ground surface elev. 9 6 . 2 0 +100 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 1 0 -10 10 r 3/3 none L 2msbk 2 10 -2 7.5 '' 4 mfr Liw I na m na na 71 1. aJ 92. Po ` Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gary L. Steel 02298 Address Date Evaluation Co ucted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 10-19-2000 715- 246 -6200 i N ~ Property owner R J C Developmen , Inc . Parcel ID # pendinq Page 2 of 3 M F&] Boring # ❑ Boring Pit Ground surface elev. 9 5 . 3 0 ft. Depth to limiting factor + 9 4 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. I 'Eff#1 I 'Eff#2 L 2msbk DSH CS if .5 .8 2 r 4 none sicl 2msbk mfr QW if .4 .6 ✓ 3 21 -80 7.5 r 4LE none sl 2msbk mvfr .5 .9 4 t 49 5 - O 4] Baring # Boring ❑ ® pit Ground surface elev9 5 . 4 0 ft. Depth to limiting factor + 9 5 in. - To - i — iApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 I 'Eff#2 1 0 -11 10 r 3/3 none L 2msbk DSH cs if .5 .8- 3 21 -80 7.5 r 4A none sl 2msbk mvfr Q w .9- 4 mfr n ❑Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. F1 pit Soil lication 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. SBD -8330 (R.6/00) it * STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. RJC Development, Inc. New Richmond, WI 54017 CSTM2298 NE4SW4 S25- T30N -R18W MPRSW -3254 town of Richmond (715) 246 -6200 lot #37- Richmond Hills N 1 " =40' BM.= top of 1" pvc pipe @ el. 100.00' Alt. BM.= top of 1" pvc pipe @ el. 96.90' A j;� sC Gary L. Steel 10 -19 -2000 V + � M' � 1 1 �A \ � � V . . . .,. . _ . _. r v . y.. • V �r� I 1 � � �.rl �. 1 I Curves Pumps MMRS FEET � ��-- 1SIZE' /4" Solids WE15H 70 --�-- WE10H _ O W E07H �06 40 — 10 WEOJM __ _ — �— WEOJI 5 - - - - - -r. IO IT- 01 0 0 10 20 30 40 60 60 70 60 60 1 C4 110 120 GPM L L 0 10 20 ,0 ml/h CAPACITY 7►. .t' �`,`,�r+w p.�1 r lrV', .1 l ,µ� ) "�ci PI 1 : 1' ! G0UIDti PUP1P S. ' r L. METERS FEET 120 MODEL 3885 3s ' I - 1-T- SIZE 3 /4 1 Solids 110 WEI5HH — ^ I — --- 100 fA • I_ — I —� 25 60 _ 70 _ 1- _r —� -�— 20 _ 15 Tr T 20 fi 0 10 w 00 40 50 to 70 )(A) 110 Ix GPM 1 L. _ 0 10 _N 30 m'/h CAPACITY •10" 0owlas Pvmp#, Ina Ehc+lw wry. 1 r�� C)le. ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address A r —: ' Property Address �1 1 (Verification required from Planning Department for new construction) City /State Parcel Identification Number ile�/o — / /�7 LE GAL DESCRIPTION Property Location j 'A, Sec. , T . - �3� N -R s W, Town of Subdivision , Lot # ._ Certified Survey Map # , Volume , Page # Warranty Deed # Volume & 7 , Page # 3 Spec house 0 yes no .Lot lines identifiable,Z yes O 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, joumeyman plumber, restricted plumber or a licensed pumper verifying that( I) the on -site wastewater disposaI 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. Uwe, 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 bt crnnpleted and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are tntc to the best of my (our) knowledge.. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE Any information that is mis•rcpresentedmay result in the sanitary permit being revoked by the Zoning Department. '•••" •• Include with this application: a stamped warrant deed from the Register f P o Deeds office Y g a copy of the certified survey map if reference is made in the warranty deed f . 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 '3 Design Flow - Peak (gpd) S Estimated Flow - Average (gpd) Septic Tank Capacity (gal) d Soil Absorption Component Size ft P P ( ) 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 �� ��� • VOL 166 7PA GE 221 STATE- BAR OF WISCONSIN FORM 2 - 1999 6492487 Document REGISTER OF DEEDS Number WARRANTY DEED KATHLEEN H. WALSH ST. CROIX CO., WI This Deed, made between RJC Development, Inc., a Wisco nsin RECEIVED FUR RECORD Corporation - - -- -__ - - - - - - -- -- ____ - - - - -- _ -- - - - - -- 06 - 2001 10:20 AM - -- -- -- _______ WARRANTY DEED Grantor, and T homas J. Rossi an d Nanc M. Rossi, husband and wife. EXEMPT p CERT COPY FEE: -- _— - - - -- - - - - - -- COPY FEE: - - - -- - - -- -- _. _ „- - -- TRANSFER FEE: 89.10 - _. -- RECORDING FEE: 10.00 Grantee. PAGES: I Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (ifmore space p 1s needed, please attach addendum): Lot 37, Plat of Richmond Hills in the Town of Richmond, St. Croix County, Recording Area Wisconsin. Name and Return Address Pt 026-1127-36 Parcel Identification Number (PIN) This is n _ - homestead property, Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. %) (is not) Dated this 1 day of Jun 2001 - k- - qBJo evel m�Inc. -- -- - -- — -- — H. Carlson, President AUTHENTICATION y ACKNOWLEDGMENT Signature(s) RJC Develop Inc' a W i sco nsin Corpor ation, STATE OF WISCONSIN ) by John H. Carlson, President . - — - — — -- -- ) ss. authenticate 001 County ) Personally came before me this day of the above named K ristina O_ ---------- - - - - -- - - -- -- TITLE: MEMBER STATE BAR OF WISCONSIN _ _ — -- (If not, — _ — — — — to me known to be the person(s) who _ e xecuted the foregoing — — instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) - -- T'IIIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland • — — _.— .._____ — „_ H WI 540111 —`— — Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures mac be authenticated or acknowledged. Both are not necessary.) � Names of persons signing in any capacity must be typed ur printed bclmv their signature. udormaron aroiass,o,,s comp�„� tuna a� cam. Hn WARRANTY DEED STA'rE BAR OF WISCONSIN 8006552021 FORM FORM No. 2 . 1999 �o CL "OIi z U - x g V h J? z N -4 Uj v IC, I N Qi t I \ -. 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