HomeMy WebLinkAbout030-1037-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety aed Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 430413 0
GENERAL INFORMATION 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:
Nestrud, Jamie I St. Joseph Township 030- 1037 -10 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
', '.' G 1 6 M-_tL 1 11.29.19.123
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
� 5 �6 U
Dosing Alt. BM
Aeration L P- P °f�— Bldg. Sewer
Holding SUHt Inlet
TANK SETBACK INFORMATION- t/Ht Outlet
95
5 cr h L1a -;- 7
. � . (o v
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 5 ` 0 1 m- - 3
Septic > 3Od �v o r �U ,- Dt Bottom
Dosing Header /Man. -,-
Aeration Dist. Pipe 5 8-39 c14 1
r-4 °] . Z 9 3 .4 (_
Holding Bot. System SW T I G 3
J - N W /o r 92,5
PUMP /SIPHON INFORMATION Final Grade Z 4L(
Manufacturer Demand St Cover
GPM +_70
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length I Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 2 ) 1-4 -?-- --
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: ^j° r UNIT
Model Number.
S T 7
Co.-? (/Q, YL L+'� , V"" , L{ 1. k ,
DISTRIBUTION SYSTEM �` "u
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air ntak e
Pipe(s) _ _ _
Length -7- 6 Dia Length Dia Spacing 1 .";-
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center y 2 Bed/Trench Edges -- Topsoil
6 0 ,. ', S 1 a /__V 0 Yes [ No FI J_ Yes � No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ( 2 /L( / Inspection #2: / /__
Location: 753 Crestview Trail Hudson, WI 54016 (NE 1/4 NE 1/4 11 T29N R19W) 40 acres \ Lot Parcel No: 11.29.19.123
1.) Alt BM Description = ST. C ov ✓ N �' Sys m 4FZ'a/pTl 3 Z r. S L.r (c. c _:�. f I b -e A'
2.) Bldg sewer length U y ) g_o° �'l� � w a Y F i •m c c e ./V
i . S ' tea o w n r 1 { L e I /J
- amount of cover = > (�' 'c4 -d- . 1 1� r p ` z JG U S
S� '3(a b4. tow n'�s'42 M ev cl
P la n Use revis No
e others d de for additional inform on.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety & Buildings Division
201 W. Washington Ave.
Sanitary Permit Application PO Box 7302
N* In accord with Comm 83.2 1, Wis. Adm. Code Madison, WI 33707 -7302
Department of Commerce Personal information you provide may be used for secondary purposes (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 I 1 inches in size.
Couny Stale Sanit Permit umber ❑ Check if revision to previous application State Plan I. D. Number n
I. Application Information - Please Prin Information Location: 63 /
PropelLtowner Name Property Location 2
v 2 1/4 1/4 S I I T- N. R or W
Property Owner's Mailing Address i + Lot Number Block Number
City, State Zip Code I P one umber Subdivision Name or CSM Number
I Type of Building: (check one) ❑ City
1 or 2 Family Dwelling - No. of Bedrooms: Qhi �*` 3 �: j ❑ village
O PubliclCommercial (describe use): e — Sn'own of
O State -owned T
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Ne st Roa /
A) I • ,New System 2. ❑ Replacement 3. 11 Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System 03v - le) -000
B) Permit Number Date Issued
O A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
Non- pfmssurized In- ground _ ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
O Pressurize In- ground ❑ [folding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade Aerobic' reatment Unit 13 Recircul i g ❑ Other:
V Dispersal/Treatment Area Information: 3 �• /
1. Design Flow (gpd) 2. DispenslArea 3. Dispersal Area 4. Soil Application 5. Percolation ate 6.S levy 7. Fi I
Required Proposed Rate (Gals. /day /sq. ft.) (Min.Anch) L Elevation
C 00 S`s 8 .� -- 9
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plaatic
Information Gallons f Gallons Tanks Con- Con- glass !�C h�
New Existing w Z crete structed 5h
Tanks Tanks 92 -ac. c
❑ ❑ ❑ ❑
VII Responsibility Statement.
1 the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
PlumWis Name Plumber's SI ,(ne ttarrrps): MP/MPRS No. Business Phone Number
'Ji na Aleedk�_ A.
Plumbbees Address (Stmt, City, State, Zip Code)
/ �P�// jS61i
VIII County/Departm nt Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date I sued s nGi g7l$ q� Siprature (No
Determination 1 )
Approved 13 Owner Given Initial Adverse Surcbuge Fee) da (��
' — 2 . 3 4477
IX. Conditions of Approval /Reasons for Disapproval['' - j eQ�}i s
YSTEM OWNER: D v
1 Septic tank, effluent filter andC .�Z w�icQl� /UzG� rGV51c- 1'Yr ��D J.4 -gyp
dispersal cell must all be serviced / maintained 6t4u e`, Syh(em, on LA
as per management plan provided by plumber.
2. All setback requirements must be maintained p3
as per applicaDle coae/olTllnancu314�_.
p 8 P/0 M, CA/k/ Slode- Wlndars;
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1321
Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 03 1037 -10 -000 `
Please print all information. _ _ _ eviewed - Date
Personal information you provide may be used for -RE sCE", D 5.04 (1) m)).
Property Owner Property Location
Nestrud, Donald N A Y 3 ovt. L na E 1/4 NE 1/4 S 11 T 29 NR 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# �� Q� - 0
1194 42nd UU 1 na l na 40 Acre ending JVyV N
City State Zip Cod PhonqgpmtDdrOFFIC ity J Village d Town Nearest Road 7 S ' ffytu�
Hudson WI 1 54016 1 715 - 549 - 6598 St.Joseph I Mound Dr
OM New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
J Replacement I Public or commercial - Describe.
Parent material Sream terraces and pitted outwash plains Flood plain elevation, if applicable na
General comments
and recommendations: System elevation 93.40ft, trenches spaced and depth to code 4.25ft below grade.
Boring # I Boring
fe Pit Ground Surface elev. 97.65 ft. Depth to limiting factor 140 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 10yr3/2 none sil 2msbk mfr cs 1f .5 .8
2 10 -6 10yr4/4 none sicl 2msbk mfr cs 1f .4 .6
3 16 -28 7.5yr4/4 none I osg mvfr gw lvf .7 1.2
4 28 -76 7.5yr4/6 none ms osg ml gw na 7 1.2
5 76 -140 7.5yr4/4 none vcos osg ml ns na .7 1.6
Boring # I Boring (b�
U' Pit Ground Surface elev. 97.65 ft. Depth to limiting factor 140 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2
1 0 -12 10yr3/2 none sil 2msbk mfr gw 1c .5 .8
2 12 -19 10yr4/4 none sicl 2msbk mfr gw 1f .4 .6
3 19 -34 7.5yr4/4 none V M S osg ml cs na .7 1.6
4 34 -76 7.5yr4/6 none ms osg ml cs na .7 1.2
5 76 -140 7.5yr4/4 none vcos I osg ml ns na .7 1.6
l�5 3 a'
" Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD mg /L and TSS S30 mg/L
CST Name (Please Print) ?- Signature: ; /� CST Number
David J. Steel - , Y— _� 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017
5/19/2003 715- 246 -5085
Property owner Nestrud, Donald Parcel ID # 030 - 1037 -10 -000 Page 2 of 3
F3j Boring # J Boring
i/ Pit Ground Surface elev. 87.85 ft. Depth to limiting factor 140 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/2 none I 2msbk mfr gw 1 c .5 .8
2 10 -21 10yr4/4 none sil 2msbk mfr gw 1f .4 .6
3 21-45 7.5yr4/4 none sicl 2msbk mfr cs na .4 .6
4 45 -51 5yr4/4 none sl 2msbk mfr cs na .5 .9
5 51 -63 7.5yr4/4 none vcos osg ml cs na .7 1.6
6 63 -140 7.5yr4/4 none Is osg mvfr na na .7 1.2
F-1 Boring # I Boring
,".J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F-1 Boring # I Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
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 S.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.
L
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 1564 Cty Rd GG
CST- POWTSM Donald Nestrud New Richmond,WI 54017
Lic. #248956 NEI /4,NE1/4,S11,T29N,R19W Bus.(715) 246 -6200
Town of St. Joseph St Croix Co. Fax (715) 246 -9372
40 Acres
Legend
1 " =40'
♦ = Benchmark Ele. 100.00Ft
Top of 1/2" PVC pipe
• = Alt Benchmark Ele. 100.30Ft
Top of 1/2" PVC pipe
= Borings
Boring Elevations
B 1 = 97.65Ft
B2 = 97.65Ft
B3 = 87.85ft
B4 = 00.00ft
N
S� �
�` S � �� a L ��D �p ✓
61A-y- 2 -0 N Z01�1
.Q l3q ,
a2-
7
-i�- 6 3
,to4—
Cv(�er
03/29/1994 03:47 6515789312 GREG THOMPSON PAGE 03
S'1' CROIX COUNTY
SPFF TANK MAINTQNANCH AOP.P PMI?N'i'
AND
OWNERS111P CBRTIPICATION FORM
OwnaNBOyer ___, Sri ►� c . _d —+5.._ ��C-
Mailing Addven // ' -
Pmpo+ A &aw c asp S110
.. (Vs'rificaliert te"IFed Rom planning Uepaatntent for pew cueshaclim)
aty/31ate Parcel Idenlificelie►lt Number O
Pnqmty Location Y +, ' /.. Sec. . '1'� N R_[ W, TOW11 of
Lot N
8ubdivlalon G 2 %te,�
CWIMW 8tttrvey Map N ` . Volume ra N A 01
Wtal"V peed 0 . Voluttte , Page N
SM b0 O Ya 0 no Lot liner► ideuliGdble)�' yes O im
� ° g' w>ta "� .o(> � araerN ward tesait ka ptanalure lsilwe to bowls *agree. groper aralataasaee
eotrvla p� ofpw"bg vat the "PNc tank every tbrea years or aoouar, k needsd b ". What you put In% tiro t+
y a licensed putap
gut rilbet 00 96Wdon of the septic teak sea emahneat Nags in lire we#,* dt poai system.
ataMer 'tie PIP HY o*tiar 10 to aabrait to St. tarok Zoaing Dgpa(enaat a cmti(katton torn% signed b On ewttet and by a
�l�ri�pl •�bsr. s 11ceoMdwnp�er �iht�lh.t tt) d» oa -da w.nir.ar�IrPo.1 eyesw�
r 4 P Oppe apnwg twodttioa and/or (1) . flea and pumping (lf aeceaary) the tolmic talk Is lea tips UP lefdodge.
N'W* �' ltadasigtted Mro new the
wt %dk Mdk a set by an D to maintain the private sewage ditpoea! tAaadenll
111 t Ok fg tint YM 01010110 syetesn been
Depattmeat of Nahual Ilet►oarcee, Sts /s of NYoeNSlit. d�Ao�en
newt be cootplated and reNuned to the St. Crok Cvun
deye Of 60 flare year ex Lion date. t� ; h TAldai t#DIa witM� �
7VR8 O�A��
� DA'I'g
Qwft-
awte ot!1a are true Io Un beat of my (our) knowledge. 1 (we) em (are) owttar(s) of
the ducttbed above by virtue of a,M r deed reroided in Register or Deede OMce.
c
7V11E
OF APPUC NT
DATE
r• " • ' Any btfamalon that Is mia - repr
. Y,n a
twh In the nitawy parmit beleg revoked by the Zoaiag D
Me OpW1111e1t1, �••••r
•• Indamle vttb e rppNeaN.w: a sta
atPad Vwrwl r dead Item as Rsglste( or Deeds offko
s eopy of 4110 e0111A.d wtvey map If relt"tenee b node In the wattanty decd
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 q3O YJ 3
Number of Bedrooms
Design Flow - Peak (gp u U
Estimated Flow - Average ( d)
Septic Tank Capacity (gal) d 0
Soil Absorption Component Size (ft S
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow -Peak ( pd) O u 8
Maximum Influent Particle Size (in) ► 1/8
Maximum BOD r , ( m /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 componenCs 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
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.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester & Sons Excavating 386 -9020
J Z1Gtlf' lhl -' 86
�(
KATHLEEN H. WALSH
r REGISTER OF DEEDS
STATE' BAR OF' WISCONSIN EUItM 3 - 1998 ST. CROIX CO., MI
Document Nundicr QU11 CLAIM 11 RECEIVED FOR RECORD
03/07/2003 09:30AN
Donald J. Nestrud and Virginia M. Nestrud, husband and wife, quit-
claim to Jamie 1). Nestrud .Ind C hristine NI. Nestrud h band send wife, as EXEMPT A 8
survivorship manta proper y, Ic o owing lescrlbcd real estate in St. Croix REC FEE: 11.00
County, State ol Wisconsin: TRANS FEE:
COPY FEE:
The NE 1/4 ofthc NI? 114 ol'Section I I, Township 29 North, Range 19 Wes(. CERT COPY FEE:
PAGES: 1
Recording Area
Name and Return Address
Hendrik W. Van Dyk
VAN DYK, O'BOYLE & SILER, S.C.
Post Office Box 118
New Richmond, WI 54017
I
030 - 1037 -10 -000
Parcel Identification Number (PIN)
This is not homgstead property.
Dated this day of , 2003.
r
*Donald J. Nestrud
"Virginia M. -Nestrud
AUTHENTICATION ACKNOWLEDGMENT
Signatures) Donald J. Nestrud and STATE OF WISCONSIN )
)ss.
Virginia M. Nestrud St. Croix County )
authentic t d this 6jt 1l , da of a rc li 2003. Personally came before me this day of —
H C1 4_ V , , 2003 the above named
• ttendrik W. Vran Uyk to me known to be the person(s) who
executed the foregoing instrument and acknowledge the
TITLE: MEMBER STATE BAR OF WISCONSIN same.
(If not,
authorized by § 706.06, Wis. Slats.)
"
THIS INSTRUMENT WAS DRAFTED BY
Hendrik W. Van Dyk Notary Public, State of Wisconsin
P..O. O. Box 1113
VAN DYK, Ox 8 SILER, S.C. My Commission is permanent. (If not, state expiration date:
, 20_.)
New Richmond, WI 54017
(Signatures may be authenticated or acknowledge. Both are not
necessary.)
Names of persons signing in :nry capacity shuuld be typed or printed below their sigiuTimes
QOI'I CLAIM DF.FII STAIF: BAR OF w tar ONSIN
FORM No-1 1094
INFORMATION PROFESSIONALS COMPANY FOND II'J LAC. WI 904855-2021