Loading...
HomeMy WebLinkAbout030-2110-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 383976 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: Davis, Dan I St. Jose h Townshi 030- 2110 -40 -000 CST BM Elev: ' Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchm S �Z • L! D Dosing Alt, BM Ste Aeration Bldg. Sewer Holding St/Ht Inlet 'D. }s I T SETBACK INFORMATION St/Ht Outlet Io •9S �( • t I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic .r r r Dt Bottom Dosing Header /Man. ��. 1 11 IL Aeration Dist. Pipe Io 6 !, o 2 1 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover N1 _1 1 �•l�� ��•$�I Model Num 13 P-A 103-9 TDH Lift i n Loss System Head TDH t For cemain Length Dia. Dist. to well S L ABSORPTION SYSTEM pp BED/TRENCH Width , Length t No. Of renc es PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth DIMENSIONS 2 SETBACK SYSTEM TO /L BLDG WELL LAKE /STREAM LEACHING anuf yy���!! r INFORMATION Ty Of S stem: CHAMBER OR v�iL' -� YP Y C'W f gc� UNIT Model Number. ` DISTRIBUTION SYSTEM , Header /Manifold D �Hole ze x Vent to Air Intake 4 ' ' 9 O t LengthDia 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 I ❑ Yes ❑ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�// D 1 Inspection #2: -- 7____r__ — " Location: 1129 32nd Hudson, WI 54016 (SE 1/4 SW 1/4 6 T29N R19W) eer t ave ' n t 7 , Parcel No: 06.29.19.908 1.) Alt BM Description � 2.) Bldg sewer length = **6 9 Z - amount of cover = j c+Z ", /u vv� �� c `h � 3) ah *evoa � e«14 P R&' �f Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) 4 1e 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 14sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 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) for the syste a ef�6t 1 an 8 -1/2 x 11 inches in size. County Stat4anitary Permit Number ❑ Check if r^idn tpjYr6Vi6us . application State Plan I. D. Number I. Application Information - Please Print all Information E Location: / operty Owner Name Property Location O t K S h 1/4 544)1/4, S T ,N, R (or Property er's Mailing Address Lof Number Block Number 7 r City, State Zip Code Phone.I�inmber ubdivision Name or CSM Number �. ,05 0 f - O I ( 7L , ) _ �. EE OF II. Type of Building: (check one) - "' ❑City �/ 09 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village /'-- . _ X Town of ❑ Public /Commercial (describe use):_ ❑ State -Owned s SE -& -bP.� 9 r� _ - Pk - 1 cc::' Nearest Road 30 in 14 t+ ` Parcel Tax Number(s) III. Type of Permit: (Check only on box dn line M. Check box on line B if applicable) 0 -0 A) 1. 9 New 2. ❑ Replacement 3. ❑ Replacement of 4. // 5. r q. qD 6 6. ❑ Addition to System System Tank Only co • eZ q . Existing System $) El Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 09 Non - pressurized In- ground ❑ Mound ❑ Sand F'tter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank - 3ss ❑ Drip Line ❑ At -grade ❑ Aerobic Treatmi— ling ❑ Other: X q3 ?S V. Dispersal/Treatment Area Informatin— 1. Design Flow (gpd) 2. Dispersal Area 3, Q 1 �j �C / 6. System Elevatioh 7. Final Grade Required /AlPit, Pc 1✓/�} ✓� r � l r Elevation Lot) 5-00 J� ® f� sS VII. Tank Capacity in' S n A Ut 5 Site Steel Fiber- Plastic Information Gallons �/� L t, n )n- glass New Existing W aed Tanks Tanks L K W �' � ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on ched plans. Plumber's Name (print) Plu er Signature (no slam s): PRS No. Business Phone Number Plumber's Address (Street, City, State, Zip ode) _ — p IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I Ant Signature (No stamps) �pproved ❑ Owner Given Initial Adverse Surcharge Fee) \\ I � / 6 Determination doh- 1 C) I -L1G( ge (�- X. Conditions of Approval /Reasons for Disapproval: Fle .et plat 1'N — &S I� Wi mss. I� ✓��'� , b� � i 10 L `-lie M,0,I A 4 t, k,a Ce, �` SQpfT e,FP (u� n leer a p i 6✓� ✓►� r o L,..� ; :.y, SaoC G c �YtS 1° b ►V� iDcr SBD -6398 (R. 07/00) �"C�J�1, 21,E G ( of p— , I `"J► Y . U J i ' 1 : 1 , 1 r i s ' i ; , f —- Sd GL a (�( �,,- , z r� rcxs g, �L UNO� s uA 0 &'P AL %J — - -- - t ' , i c ' , : - Y 1 S r n 1 � c , i ' }_ r � ... �. _ � _ _� _ -_ � t _ -__ t _ . t � _. -t-A I - I Ir -- - - T A 4 L 1 A 7t f.4 1 A Wisconsin 0,9partment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Divisior1ofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030- 1024 -70 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION VIEWED BY DATE (r a(/ - 9E PROPERTY OWNER: PROPERTY LOCATION Daniel C. Davis GOVT. LOT SE 114 SW 114,S 6 T 29 ,N,R 19 : k(or) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 1129 30th. St. 7 na Deer Haven CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ [RTOWN NEAREST ROAD Hudson, WI. 54016 (715 381 -5264 1 St. Joseph I 30th. S [x] New Construction Use ]c ] Residential / Number of bedrooms 4 [ ] Addition to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow 600 g pd Recommended design loading rate • 7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 857 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft gpd /ft Recommended infiltration surface elevation(s) 91.80 ft (as referred to site plan benchmark) Additional design /site considerations alt area system el.= 90 30' & 88.50' Parent material outwash 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 fors stem 1K] S 1:1 U :K1 S El KI S El ®S ❑ U ® S ❑ U EIS ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots PD ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - $e� 1 0 -10 10yr4 /3 none 1 lcsbk mfr cs 2f .--2 2 10 - 30 10yr4/4 none sicl lcsbk mfr gw if .2 3 Ground 3 30 -84 7.5yr4/6 none ms Osg ml na na .7 IL elev. 9 5.8 ft. Depth to limiting factor +84 Remarks: Boring # 1 0 -11 10yr3 /3 none 1 2msbk mfr cs 2f .5 $ ' 2'< 2 11 -32 10yr4 /4 none sil 2msbk mfr gw if .5 E 3 32 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8 1,2- Ground i elev. 9 5.5 ft. Depth to limiting factor - +84" S Remarks: CST Name: -- Please Print Gag L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave—New Richirn-orA Rich -o WI 54W7 c Signature: Date: 7 -24 -98 CST Number: m02298 l i PROPERTY OWNER DAniel C. DAvis SOIL DESCRIPTION REPORT Page - 2 PARCEL I.D. # 030 - 1024 -70 i Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench `` 1 0 -10 10yr3/3 none 1 2msbk mfr 9w 2f .5 `..... ' >' 2 10 -30 10yr4 /4 none sil 2msbk mfr gw if .5 . D Ground 3 30 -84 7.5yr4/6 none co s Osg ml na na � elev. r+�'e�irti'�►m —� 9 4.3 ft. Depth to D 3. I'mitin fa +84 30 (o Remarks: —� Boring # 1 1 0-10 10yr3 /3 none 1 2cpi mfr cs 2f �np •� 4 >" 2 10 -27 10yr4 /4 none sici 2csbk mfr gw If .4 5 ,(o 3 27 -84 7.5yr4/4 none co s Osg ml na na .7 Ground elev. 92. 1ft. ` �L Depth to limiting factor +84 Remarks: Boring # 1 0 -8 10yr3 /3 none 1 2msbk mfr gw 2f .5 2 8 -19 10yr4 /4 none sicl lcsbk mfr gw if .2' . 3 19 -80 7.5yr4/6 none ms Osg mvfr na na .7 Ground elev. 9 1.5 ft. Depth to limiting factor +80 1 1 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD -8330( R.05/92) STEEL'S SOIL SERVICE Gary L. Steel DAniel C. Davis 1554 200th Ave. CSTM SE S6 T29N - R19W New Richmond, WI 54017 MPRSW -3254 town of St. Joseph (715) 246 -6200 lot #7 -Deer Haven This soil evaluation was conducted to satisfy.a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of nail in Boxelder tree C el. 100 Alt. BM.= top of 2 pvc pipe # el. 91.90, I�'J I 3 go` to Clip, tip` Str q 5 3gz Gary L. Steel 7 -24 -98 Page of MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained in according to Comm 83, Wis. Admin. Code, the in- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD- 10567 -P; June 11,1'999), 1. This POWTS has been designed to accommodate a maximum daily flow of galIons of domestic wastewater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except as provided in Comm 83,03 (4)m Wis. Admin. Code, 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch. NR 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank- baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent intervals may be necessary. 4. Any pump, alarm or related electrical connections shall be visually checked for defects and tested to confirm that they are operating properly. 5. Reports for all system maintenance shall be submitted to St. Croix County Zoning in accordance with Comm 83.55 Wis. Admin. Code. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code. 4. Anytime a failure or malfunction occurs, it shall be reported to the owner of thds POWTS. Repair or connection of such failure or malfunction shall comply with Comm 83, Wis, Admin. Code. 5. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. T In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: The failing c, oiuponent shall be reniace This may require a new soil evaluation to determine iA here a new soil absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admir... Code. 9. Name and number of local health agency Croix o un Zn t g - 215 -3$¢-4680, 10. Name of service contractor in case of failure or malfunctio Schmitt & Sons Fxcavatine ?15- 549-6 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer L2 I)A Mailing Address 1- /7 Ar Property Address /IA 2,&,n S (Verification required from Planning Department for new construction)_ City /State Liz. Parcel Identification Number -a-2a —76 LEGAL DESCRIPTION property Location 5E -Y4, a ` 4, Sec. T N -R_ f W, Town of .S �, s Th< . Subdivision 11 . Lot # 7 Certified Survey Map # , Volume , Page # Warranty Deed # -52 OM , Volume _ ! 3 75 , Page # O Spec house (3 yes ❑ no Lot lines identifiable 9 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 masWr p journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / fd 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 • , ., �, PAGEOOO +> ' STATE BAR Mr GP jCU IN FORM 3 - 1982 ' rc QUIT CLAIM DEED DOCUMENT N o. REGISTER'S' OFF f ST. CROIX CO., !YI a Daniel y�Ll and Karen p. Davisr hushand and .' wife• _ —_ -- -- NJV 0 6 199$ D and K CQns tructic+n fc2� H�al� -L? d• • M quit-claims to _, ' — - -- Re star d t)aodt. i the f escribed real estate ;n d St . CrOT X _ -- County, State of WI5COr.51n' TMiS SPACE RESERVED FOR RECOFlD DATA `' Y1 NAME AND RETURN ADDRESS „ ; KR1S'f]NA OGLAND Zilz, Fs?Peen &, Ogland The West Half of the Southwest Quarter; the West P.O, Bu, 359 4 Half of the Northeast Quarter of the Southwest fludsoh, WI 54016 Quarter; and the North Half of the Southeast Quarter of the Southwest Quarter; all in Section 030 - 1024- 80 -�00; 030 - 1023- 90 -OUO Six (6), Township Twenty-nine (29) North, Range 030 - 24 60 - OOQ Nineteen (19) West. PARCEL 10EN11FFlCAilON NUMBER ..= Excepting from this conveyance s parcel of land in the Southwest Quarter of Section 6, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the West Quarter corner of Section 6, as the PLACE OF BEGINNING; } there East on the center line of Section 6 for 1897.4 feet• thence South parallel to the "Nest # + line of said section for 1147.88 feet; the West parallel to the center line of said section 1897.4 :Let to the West line of Section 6; thence North on the West section line of Section 5 for 1147.88 feet to the PLACE OF BEGINNING. 4a Excepting therefrom Lot 1 of Certified Survey Map in Vol. 9, Page 2590, and Lot 2 in , Certified Survey Map hi Vol Certified Survey Map in Vol. 11, Page 2987, and Lot 3 of . 11, 1 Page 3253. FE V af.. lhis f c n It _ homestead property kis not) Oct ober A.D , 19 3s Dated this _ = f—k -- day of .. �GYI�s�.— (SEAL) mi l( a C� (SEAL) Daniel C. Davis Karen P. Davis u • (SEAL) (SEAL) ACKNOWLEDGMENT i -...'-BEER HAVEN N MART OF THE SW 1,/4 OF THE SW 1/4, PART OF THE NW 1 0 'NE NE 1/4 OF THE AND PART OF THE EE 1/4 OF THE c , 7'29N R 19W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCC i " = 100' 20 200 300 UNPLATTED LANDS S89 °5c?' 2_2 "W 1339 39' - S+ 3' +/- 4'+ 342.24' 330.00' 601.15' 529.15' { 0' 672.14' 6 33' 13a' I 7 ! 8 3,208 ACRES '� S Wt /4 `rr 139,725 SQ. FT. NE1 /4 - SK1 /4 3.0 ACRES SW1 /4 v• SEt /4 - SWt /4 T 31,659 SQ. TT. z 3.108 ACRES o 5 Z � j e ' er 135,384 SQ. FT. S �, Z 1 )4 ALRLS �7 SQ. FT. v x S89'32'S6 "E 672.27' 342:26' — 610.39 R BUCK RUN NOW 4f"W ��q.. J01NT / 5. 40' _ q ?g ss DRIVE/ / �, © JEMOWD EMP I N89'32'56"W 798.28' UL ORARY CRES s r/ n e U iQ. FT. 3.^u08 AC ES ;� 1 N00'77'G4 "E - 50.00 — 131,030 S . FT. 3 y 500-Y 7' :A­ * 3 3.004 ACRES N 5C. `� N N 130,855 SQ. FT. C 0 13E N S89'56'00 "E 1196.67' i =2^•.26' 35 1.21' 3 ;-3' 7.5' +/- of \ S89 . SOUTH LINE OF \HF N1/2 OF THE SE1 /4 43.29' n \ \ \ LOT 28 3.460 ACRES 150,736 SO. FT. I LL - o t� ,