HomeMy WebLinkAbout030-1055-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
• Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 408219 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:
Buttke, Frederick I St. Joseph Township 030 - 1055 - 70-000
CST BM Elev: Insp. BM Elev: SM Description:
160 J Ac
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 2
Do ing Q Alt. BM J
Aeration Bldg. Sewer 3
Holding nHt Inlet •�
TANK SETBACK INFORMATION St/Ht Outlet Q L q
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 S / / N Dt ttom
g Header /Man.
Aeration Dist. Pipe
Holding Bot. System IL Q 3 `jL • 30
(, L
Final Grade
PUMP /SIPHON INFORMATION X S U ?.5'. 3
Manufacturer Demand St Cover /
GPM 30 G .
Model Number
TDH Lift Friction Loss tern Head TDH t
rcemain Length Dia. Dist. to
SOIL ABSORPTION SYSTEM 10 r
BED/TRENCH Width Length No. Of Trenches f ?AD :- 1M ` ENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 / / 2,5 Z
SETBACK SYSTEM TO 10 P/L JBLDG IWELL LAKE /STREAM G Man�act r:
INFORMATION A ER R
Type Of System: (SD r 6y) I I O r Mode m r.
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
/ fi Pipe(s) / + __
Length Dia Length Dia�L Spacing N
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
- -
l Yes JI No _ ,Yes iJ No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:_ /L/ Inspection #2: / /
Location: 1429 Ridge Run Hudson, WI 54016 (NE 1/4 SE 1/4 23 T30N R19W) NA Lot I ,� Parcel No: 23.30.19.198S
1.) Alt BM Description = j� CoUetr
2.) Bldg sewer length /
amount of cover = j kS(AL btfeJ a� l � n tv,'1 bC ItiSCC� Ia f (puCv
3, J 0 � s e ry 3ry— p .�oC S , 1.54 e / - 1 � rte 2 - --
Plan revision Required . r » Yes No � �
Use other side for additional informati o , Z
SBD - 6710 (R.3/97) _
Date sepctor's Signat Cert. No.
Parcel #: 030 - 1055 -70 -000 10/24/2005 09:51 AM
PAGE 1 OF 1
Alt. Parcel M 23.30.19.198S 030 - TOWN OF SAINT JOSEPH
Current X', ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
FREDERICK E BUTTKE O - BUTTKE, FREDERICK E
542 6TH ST N
HUDSON WI 54016
Districts: SC = School SP = Special P ddress s): * = Primary
Type Dist # Description * 542 6TH ST
SC 3962 NEW RICHMOND L ''" ( 6G
SP 1700 WITC O'1 y J
( q Z O (
Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE
SEC 23 T30N R19W E 40A OF GL 2 Block/Condo Bldg:
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
23- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
07/23/1997 453/111
2005 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 05/31/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 38,300 26,500 64,800 NO
AGRICULTURAL G4 34.000 4,900 0 4,900 NO
UNDEVELOPED G5 5.000 12,000 0 12,000 NO
Totals for 2005:
General Property 40.000 55,200 26,500 81,700
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 55,500 26,500 82,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Safety do Buildings Division
201 W. Washington Ave.
Sanitary Permit Application PO Box 7302
1*16co In accord with Comm 83.2 1, Wis. Adm. Code Madison, W153707 -7302
Department or Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
T D - L [Privacy Law, s. 15.04(I)(m)) :F15 2 .z�p state owned.
Attach com fete tans to the county copy on) for the sy stem , on paper not less than 8 - 1/2 x I I inches in size.
County State Sanitary Permit pp ! ion o revious application State Plan I. D Numb
I. Application Information - Please Print all Infoi mation Location:
Property Owner Name Property Location
Alll� 1/4 6t' 1/4, Sdj T N W ? E or
Property Owner's Mailing Address ST C t Lot Number Block Number
T RI
City, Stage Zip Code Phone N fiber Subdivision Name or CSM Number
5 .5 y�D/
II ype of Building: (check one) «a , rs ^ / - o City
tiY I or 2 Family Dwelling - No. of Bedrooms: 4 � "ti /c� ` s,� ❑ Village
�, �
• Public/Commercial (describe use):_ I�I'uwn of
—
• State -owned - -- - — - -- _____- .__ - -_ 67 T 5e -
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Near e oad
A) `( New System 2. ❑ Replacement 3. ❑ Replacement of 4. O Addition to Parcel Tax Nu iber(s)�
dr^ ak,
System Tank Onl Existing System
B) -- Fe -
ermit Number Dale Issued
O A Sanity Permit was previously issued
IV. Type of POWT System: (Check all that apply)
K Non- pressurized In- ground ❑ Mound ❑ Sand Filter O Constructed Wetland
Pressurized In- ground ❑ I lolding Tank ❑ Single Pass O Drip Line
❑ At -grade ,} 4 ❑ Ac oobSc'1'reatment Unit 13 Recirculating ❑ Other:
33
3Y3 4 �
V Dia ersaVTreatment Area nformation: 2 3 x 6$ -
1. Design Flow (gpd) 2. Duper (Area 3. Dispersal r 4, Soil Application 5. Percolation Rate 6. System F, ya 'on 7. Final Grade
Require Proposed Rate (Gals. /Jay /sq.11.) (Min. /inch) 1� 1 Elevation O
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
ewli - -- -. - - -- -fie-- - - -- -
- - -- - - E) -- ❑ ❑ O ❑
VII Responsibility Statement
I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. _
Plumber's Name 'nl) Plumber's Signatunq,(no s tamps): MP/MPRS No. Buslneaa Phone Number
.�
,t7tu M."j Q,� 1
Plumber's Address (Street, City, State, Zip Cod
Vlii County/)epar ment Use Only
O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signature (No stamps)
[,Approved O Owner Given Initial Adverse Surcharge a) sn
Determination 22S D� "Ze�2
IX. Conditions of Approval /Rea for Disapprovali
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
1�
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Sf (fro)
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. 3o - / 0 .55 - - 70
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner 1 !-�/ Property Location
F red 8u 7T0 Govt. Lot N E1/4 1/4 S,Z3 T 3 N R 1 E (or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
S4 a b+�. S +, A1or +�'
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
Hudson w )S 0 r
❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate 150 - 300 GPD
Replacement ❑ Public or commercial - Describe: -
Parent material '' ac; A ou4 vjo S Flood Plain elevation if applicable ft.
General comments ,
and recommendations: m 5�55� `�' S '/�' ► � .. , C' �j }�
T, I C 9�.�s r• �; PP
r T COY
Boring # ❑Boring pu q
T ® Pit Ground surface elev.
Soil Application Rate
Horizon Depth Dominant Color Redox Description T@%�4u?e; StrtictuPe Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color % ��},5� -5fi. *Eff#1 *Eff#2
I 0 -S I0N F SL a F' & K mr as aF •S -9
IS `!R ` F S aF56K MFA C I F .5 .`i
3 is - 7,5YK FS o1FSt3K mFa cw IuF .S
y 5s -? S SIR `'��I FSL RPSig K r- 9 C�
S • pt? S y� y ly � I F `1 5 `IR 618 14 "A
Fa-1 Boring # ❑ Boring
23 Pit Ground surface elev. 9q, 13 ft. Depth to limiting factor �_ 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
I 0 -% l0 \Ip 3 1a FSL a F&R mFK 0s a F . S ,
a 8 )0 v FSL o?F'S43k MPR C W I F .S
3 -SS TSS -/R q1q LS O -S9 rn L Cut 1V
y 55 -1 7,s vR SIy -- FS 3 FS8K MEE C W .9
s la -100 SE '1q F) -),S U /7 19 FSL a PS6 '9
`"
34.E �o.t� 3 orazo� 30 9ra�el
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
f '�)onhC" S k aa I - )q ,
Address U Dale Evaluation Conducted Telephone Number
a00��' S4 Spar P1ra;f' ~ f W1 syaa, o -� ®1 - ��s - ay8 -.3sn
SBD -8330 (R07 /00)
i
Property Owner Fre igo*k Parcel ID # Page - of
Boring # ❑ Boring p
3 ® Pit Ground surface elev. 1 DA ft. Depth to limiting factor gs 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
0 -9 10v FsL a FUR MFR G aF .5 .9
a 9 -19 0, 5gp"N FS o?FSQK rm FR C IF .5 .9
3 1� -SS 1,5 U 51q FS a JCSQI{ FR ew 1 11F .5 .9
y 55 -u sw 451 I FSL aF mFR CuJ — .5 V FS 164
t5- joci 51014 7.61 P,6 F Boring # E] Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor 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
F-1 Boring # ❑ El Pit Boring
Ground surface elev. ft. Depth to limiting factor 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
' 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.07 /00)
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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
Design Flow - Peak (gpd) 3du
Estimated Flow - Average (gpd) Uu
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft () o_ ce4j iN 3
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) 0(3 Ct
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) „/ 10 220
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. Th outlet fiite shall be cleaned as necessary to ensur
p rope r operation. The filter cartridge should not be removed unless provisions are made to
retain so i s m he 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
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 Excavatin g 386 -9020
Tri- County Sanitation 386 -2130
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM,
r
Owner/Buyer Lk e
Mailing Address
Property Address Z Y- I �, AJ A
(Verification required frorA Planning Department for new construction) Lm
City/State 1, . J Parcel Identification Number .30 -/ Q. h 5 7 0
LE GAL DESCRIPTION
Property Location N.r ' /,, '/•, Sec. �3 ,, T .,;Sz N - R2W, Town of f
zSubdivision ajlkg- Lot #
Certified Survey Map # -- Volume , Page #
y
Warranty peed # - 9 a 95 Y ; , Volume Page #
Spec house ❑ yes Od' no Lot lines identifiable ❑ yes ❑ no
SYSTEM MAIN'J��1 ►�NCE
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 fora, signed by the owner and by a
master plumber, journeyman plumber, restrictedplumber 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.
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
� rQW - ER CERTIFICATION
t'(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 prop6hy.described above, by irtue of a warranty deed recorded in Register of Deeds Office.
'0-4-
SIGNATURE OF ' P ICANT 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
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DOCUMENT NO, I WARRANTY DEED
STATE OF WISCONSIN —FORM 9
t; �^ THIS SPACE RESERVED FOR RECORDING DATA
F_
THIS INDENT(iRE, Made by J o cph it i if] oil anti 'Ulw I i
ttus llttlld anti w i_ f't c
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grantor S t , LI' V 1X Cou�vv, Al�ivconsin, hereby com'et's and tE- ut:+nt¢ � � •, to i'i'C(it,'I'1Cfti 1., iiUttl�v Il1l +I t'
grantvc
of ; I CI•t� I � RETURN 70
County, 1Visronsin, for the cunt of
Five thou" atri w' '! llo,'W() dol
the follow in); tract of land in L I' U 1 `.
Countv, Mate of thi =c"ns;n;
I',li tl r'I'(': ( Ii U�I'I'l1Ii.1;i {.Of n r Ili 1`C (.I ri'i .��� �11b. f1
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IN 1Vl I N 1
dt�' of t
SI(I 1 :A`ill `Si:.ALf:1) IN PRESLNCE, of
—� - -; -- i (SEAL)
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fit. Croix ronnty,
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the above named
I arr.otl tttlrl Af!.CI iaL ,Vr tnt0o, }hush,ul ;ul�: t.
to me known to be thq peror..3_ t�h;t execote,l the foregoing instntmrnt an acknowlq'igel t�e Sol e.
NO Wn, . 4ar(1
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NOTARY I "'
SEAL /
This instrument drafted by � � Notary Public � • C r o i x _.County, 6Vis.
win. W War(] ' y'' u n Attorrw 'vewRichmdf
- - -- - - _ bfyCommissioo(Exptres) (Is) Perinaiieilt
ct t hat all instruments to b , 453 — c
(S«tton 59.5t or i the Wl Statutes provides witu❑ t hat recorded "hall Gave plainly printed En typowNtten thereon the
i names of the grantors, grnnteES, witnesses end notary). �i
WARRANTY DEED SLATE OF WISCO \SIN, FORM �C) 01Y A 11 i
M. C. ell E,a Ct: MiLW.UrE[