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HomeMy WebLinkAbout030-1056-20-000 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: PENNY RIERMANN CST BM I ANK INFORMATION Insp. BM Elev: TOWN OF SAINT JOSEPH TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well 501E ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT quep DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DIMENSIONS No. Of Pits Inside Dia. Liid Dth ELEVATION DATA County: St. Croix Sanitary Permit No: SAN-2020-090 State Plan ID No: Parcel Tax No: 030-1056-20-000 Section/Town/Range/Map No: 23.30.19.199D DISTRIBUTION SYSTEM STATION BS HI FS ELEV, Benchmark Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man, Dist. Pipe Bot. System Final Grade St Cover Header/Manifold Distribution Pipes) x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing JUIL (:VVtK x Pressure Svstems Only xx Mound Or At.Grade Svstamw []nlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1466 78TH ST 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? Use other side for additional information. L_ _�� I Date Inspection #1: Insepctor's Signature Inspection #2: Cert. No. S�i�/�a�-ago County Sanitary Permit Application ST. GROIX GOUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING &ZONING DEPARTMENT �,����JI information you provide may {� used eco ary pos ST. CROIX COUNTY GOVERNMENT CENTER � [Privacy Law. S. 15.04(1)( � � 1101 Carmichael Road � $ Hudson, WI 54p16-77f0 n (715)386-4680 Fax (715)386-4686 Atta h complete plans for the systems on paper not less than x i i inches in size. St. Croix Q�[}� Sanita Permit # ❑Check if revision to previous application � I `{'LL ��� COmmUnit D velopment � i. Application Information -Please Print ail Information Location: Property Owner Name � F• 1/41VE 1/4, Sec �Z YtY� �\ Y 1, ��r1 ✓� 3D N, R (�i E (or W Property Owner's ailing Address�h r1Q� Sk Lot Number Block Number 1 �-� 1��p - - City, State Zip Code Phone Numer Subdivision Name or CSM Number New �:���, s�11 _- I�ype of Building: (check one) � amity ❑Village Town of 1 or 2 Family Dwelling - No. of Bedrooms: ��' ��SC ❑ Public/Commercial (describe use): ❑ state-owned Nearest `5ad��h II. Type of Permit: (Check only rr It�e Check box on line B if applicable) Parcel Tax Numbers) 630 �DSIe 2D •ODD A) 1.❑ Repair 2.� Reconnection 3. Non -plumbing 4. ❑Rejuvenation . . Sanitation 2 3 • 3p . 1�1 I�q B Permit Number ) Sanitary Permit issued � � �� � � Date Issu�e—d1 �+, ��/, r' 2- I " Ll�v tate was previously � IV. Typ f POWT System: (Check all that apply) Non -pressurized In -ground ❑ Mound z 24 in. suitable soil ❑Mound <— 24 in. suitable soil ❑Mound A+0 rl� ❑ Sand Filter ❑ Constructed Wetland ❑Peat Filter ❑Drip Line • ,� �0, ❑ Pressurized In -ground ❑ Holding Tank ❑Single Pass ❑Other (/VfJ ❑ At -grade ❑ Aerobic Treatment Unit ❑Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) / 2. Dispersal Area 3. Dispersal Area .Soil Application Rate 5. Percolatio Rate 6. s e evatio 7. Final Grade 7� / Required Proposed (Gals./day/sq.tt.) / (Min./in ) i'� n Elevation VI. Tank information Capaicty in Gallons Total # of Manufacturer Pref b Site Con- Steel Fibe PI tic GallonsT�a)n s �, (' j, ( /�, /T� Concrete structed glass New Existing Tanks Tanks w �X J�n1T�!!4 T1 s ► � Zsv .� ,� ❑ ❑ ❑ ❑ VII. Respo sibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non -plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non -plumbing sanitation system. Plumber's Name rant) Plumber's (no stam ): PRS No. Business Phone Number �iln,r, ����� Z313 4 `7!'S io-� L• Szb Plumber's Address (Street, Cit�yy, State, Zi ode) N lo2-a $ s�'w�e ttw �i �t,,Tc�c.�. (� S 4 � % VIII: County Use Only Disapproved �' Sanitary Permit Fee Date Issued Issuin gent S' n lure (fro stamps) gyred �` r en Initial Adverse _._ IX. Conditions of Approval/Reasons for Disapproval: � � � � �� L� D� �� � j,�� U y � C � /_�• %/� ��' SYSTEFtI OWNER: 1. SelyNc trek, effluent filter and n %� �% yn� dispersal veil must,bg�icedhnaintained �'1 De � Vrl. ' �L. 71 � 3. b� 9 plan provided Isy plumber. o ,per management 411 setbrck rnyuirements must be maintained ��r applicable code/ordlnences. � ) 11�' �D� /�� �1'') , �e Coy d� �S �n Ll/ (�/ [., , ����A � T. CROIX COUNTY ZONING OFFICE/ CERTIFICATION STATEMENT FQR UTILIZATION OF EXISTING SEPTIC TANKS) This is to certify that I have inspected the existing septic and/Qr dose tank presently serving the following residence: (Street address) 1466 - 78th st New Richmond, WI at: SE '/a, NE '/�, Section 23 , Town30 N, Range 9 located W, TQwrl of St. Joseph E. , St. Croix Couty Wisconsin. Upon inspection, I certify that I have found the tank(s), to tiro best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. n Most recent date of inspection or service 4-12-2018 Did flow back occur from absorption system? Yes No X if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1250/750 Construction: Prefab Concrete X Steel Manufacturer (if known): Age of Tank (if known): Wieser Concrete 20 yrs Per7nrt number (if known) 514940 C �� (Li used Plumber Signature) President 4-10-2020 (Date} John Pelke gallons Other (Print Name) 231346 minutes (License Number) MP/MPRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 i;elke Plumbing & Well Drilling, Inc. N6298 State Hwy 25 Durand, WI 54736 7i5-b 7 2-�L6b iohn@pelkeplumbinQ.com April 10, 2020 St. Croix County Zoning c7ffice St. Croix Government Center 1101 Carmichael RD Hud-son, VV1 54�ib xt: Bierman site 1466 — 78`1' ST New Richmond, WI 54017 Tliis lefter is to confirm that i inspecfed the septic system of the properfy listed above . At that time the system appeared to be in working order. Pump and controls in septic tank were intac The New home is being built in the sAre location as the previous house. �L,U�, gvp/ Regards, !)�M` Sohn Peike Pelke Plumbing &Well Drilling, Inc. Owner/Buyer Mailing Address Property Address (v City/State ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ion required from Planning &Zoning Department for new construction,) Parcel Identification Number b V _ l (� � zy _ UUJ LEGAL DESCRIPTION TC4.r f u)4L b k bA-3 Property Location 4 , Sec. z , T ) N R W, Subdivision Plat: Certified Survey Map # Warranty Deed # Spec house ❑yes ❑ no Volume Town of �c� tV \ (before 2007)Volume Lot lines identifiable ❑yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Page # Lot # 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 all every tlice 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 of the St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning &Zoning Department a certification form, signed by the owner and by a master plumber, 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. I/we, 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 Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. Ihve 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. L4 Number of bedrooms vvv� M SIGNATURE OF APPLICANTS) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning &Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed, (REV. 04/12) , .• •. 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Im `s F E2 La a o E` o71 1 29 ail Will g §p va �R iS Sarah Borrell From: Steph McCormack <steph@mccormackclassicconstruction.com> Sent: Tuesday, May 5, 2020 10:17 AM To. Sarah Borrell Cc: Ben Hetzel Subject. RE: Riermann - house plans Attachments: Riermann PDF.pdf � Tl fs na l orig►na ed frojrt a i ext rnal samNce Verify t e eg91BY o _ cl ckrr�g fj o_r op "P.) IWAIIWItt� Good morning, The client did change their mind during the time of submitting. The plan with the gun case in the office is current and what will be going in for the building permit -so there will be no closet in the office. Thank you, StepFi �t-tcCor�nack Designer eZ Drafter WcCornzack CCassic Construction 57212816 Ave Y fudson, WI 54016 (p) 651.283a 6053 (fl 715.549.9230 From: Sarah Sorrell[mailto:Sarah.Borrell@sccwi.gov] Sent: Tuesday, May 5, 2020 10:00 AM To: 'Steph McCormack' <steph@mccormackclassicconstruction.com> Cc: Ben Hetzel <Benjamin.Hetzel@sccwi.gov> Subject: Riermann - house plans Steph, We're in the final stages of review. We have two house plans submitted for this property. The office upstairs includes a close in the first submittal and that same area is a gun case in the second submittal. Can you please provide the agreed upon house plan? We will make sure it is updated for both Land Use and Sanitary. Also, I am including Ben Hetzel to this email as he is the staff person that will be taking the lead on review. Thank you, Sarah Borrell � Community Development -Land Use and Conservation Specialist 1101 Carmichael Rd Hudson WI 54016 T: 715-386-4683 Sarah.Borrell@sccwi.gov i Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Riermann, Fred H.L St. Joseph, Town of CST BM Elev: insp. BM Elev: BM Descriptio { Ul7 t o t J� TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration ,v Holding TANK SETBACK INFORMATION TANK TO PUMP SIPHON P/L WELL BLDG. Vent to 'Intake ROAD Septic Dosing Aeration Holding INFORMATION O TDH Lift Friction Los System Head Forcemain Len gt Sr Dia� 0 Dist. to Well 11 SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. C DIMENSIONS SETBACK SYSTEM TO P/L INFORMATION T f System: YP y , 2I DISTRIBUTION SYSTEM Length Dia 'Length pia SOIL COVER x Pressure Sys Depth Over / Depth Over Ile Demand GPM"'' % TDH Ft Spacing ELEVAIIVN UAIA county: St. Croix Sanitary Permit No: 514940 0 State Plan ID No: Parcel Tax No: 030-1056-20-000 Section/Town/Range/Map No: 23.30.19.199D WAR,, nchmark - .: - 1 M1,00M qmpyl AM oZ u/1'v�.(/�� PIT DIMENSIONS No. Of Pits LAKE/S REAM LEACHING Manuf urer r CHAMBER O D UNIT Model Number: -� x Hole Size x Hole Spacing ��d c�2 xx Mound Or At -Grade Systems On Ixx Depth of xx Seeded/Sodd Depth Bed/Trench Center S BedlTrench Edges (Topsoil I Q Yes COMMENTS' (Include code discrepencies, persons present, etc.) Inspection #1: / 3 /% Inspection 112: / / Location: 1466 78th Street New Richmond, WI 54017 (SE 1/4 NE 1/4 23 T30N 19W) metes & bounds LcI Parcel No: 23.30.19.1999D III- 1.) Alt BM Description = �OV 3 vG�-� d� 2,) Bldg sewer length amount of cover = /) Plan revision Required?, Yes IVo I 0 �� --C�—�- Use other side for additional information. �_ _—_�____� __ — L-- — — Date Insepctor s Signa ure Cert. No. �laccmeer+� commeree.wi.goV Safety and Buildings Division as County 201 W. Washington Ave., P.O. Box 7162 ' �w ^ ®n s i M Madison, WI 07-7162 Sanitary PermitjNumber (to be filled in by Co.) Department of Comtrterae / :State Transaption um er Sanitary Permit Applicatioan., r_`t1 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form Ftothe approernmental unit is required prior to obtaining a sanitary permit. Note: Application formr state-owned PO Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary _ • purposes in accordance with the Privacy Law, s. 15.04 t m Stats. I. Application Information — Please Print All Information ' Property Owner's Name Parcel # Property Owner's Mailing ddress JUL Property Location l Govt. Lot t �� /, t/,, Section City, to Zip Code Phon u ZONING OFFICE ircleone t T N; R E o V R. Type o Building (check all that apply) Lot # Subdivision NameB Y 1 or 2 Farnily Dwelling —Number of Bedrooms (�' w",',� L�ZNII �!� lS4 t n J / Block # ❑ Public/Commercial — Describe Use ❑ City of ❑ Village of CSM Number ❑ State Owned —Describe Use 0 Town of_�� 1H. Type of Permit: (Check ne bo a A. Complete line B if applicable) A' ❑ New System Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ New List Previous Permit Number and Date I u B. ❑ Permit Renewal 0 Permit Revision ❑ Change of Plumber Permit Transfer to Before Expiration Owner / IV. TXpe of POWTS System/Component/Device: Check all that apiElyj.' Moun 4 in. offs itab� soil Non -Pressurized In -Ground ❑ Pressurized In -Ground At -Grade 0 Mound .> 241 f suitabl soilie?i( r e r j�/ 5 ❑ Holding Tank ❑ Other Dispersal Component (explain) r catment e p V. Dispersal/Treat ent Area Information: I Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevati 7 i VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .n E V New Tanks Existing Tanks `_ %�' ` / o 44 B P w U in v rn w C7 Septic or Hoiding Tank I Dosing Chamber '11I. Respogsibility Statement- 1, the undersigned, assume responsi i or installation of a YOWTS shown on the attached plans. s amc (P ' t) Plumber's S' a , MP/MPRS Number Business Phone Number , ,...:-c-'s . dress (Street. ity, State, Zip ode) VII punt. Department Use Only... Permit Fee Date sued Is mg Agent 'igna Disapproved 0 %i"cr Givcn Reason for Denial IX. Conditions efApproval/Reasons for DisapprovalCV SYSTEM OWNER. 6'� //�/� L6/ I/�✓ ciu 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained W !� as per management plan provided by plumber. -� tSA 2. A per applicable Ct7klidlrtlfdfPll�Pl 7'. zt'- XW uV PVC. /NSIVdEc r lWoc pc. v Ear r, lNFI� rRAron 9/17; BI`/3 �174t: Cm!-sc�Q c,�-2/�c,�T CC, 97.GG I �R J j49 85.3 L ,Ln 0 G � 6b vr r � � i V � „ rEX15dnNG ORi� .Q MS N�HOLE W%INLET — RIM 9ZZ0.5 INV . 917.0 A ' Poo 364 A. c t 1 �RAuJiNG. Fog t'cm:: Reo R/F,em.��,v ,tYGG 78ryS. £CClJ I?IcCkM0 AIO 0 I /7--Af4devtC EX. GARAGE�I n ,4 c�E/I Ac-c= G Q�4E Gr4,02 Aro/1 '7a EXISTING ORI� E �s AT IdM r RIM = Meb INV = 914.4 i STORM MANHOLE W/INLET Rim 928.0(ka?ROx? / V ExlsnNc GARAGE 7 INV OUT = 902 WALL T. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Vent to fresh air intake Water Line a Owner Propert City/State Legal Description: Lot _ ..3 Block ,AIA Subdivision/CSM # SE t/4 .&E t/a, Sec. ,2, , T,3,0 N-R.Z Town of Tank manufacturer 4U.ESA=2 Size ST/PC / Setback from: House 4$ Well Pump manufacturer �oE�r ,�,R Model 9tg Alarm location #0 a c -' TANKS ONLY) Setbacks::—S`�r Meter location SOIL ABSORPTION SYSTEM: Type of system: �E1Vs.4Z Width _3 Length .2.,Number of Trenches Setback from: House 1 6' Well 60' P/L /oo"` Vent to fresh air intake _ /00 7L ELEVATIONS: Description of benchmark ,Q�/ �N P��1�= Ti�'��" Elevation d� o Description of alternate benchmark lgoiTar/ TI& se� ow cA©iAr Elevation O ,� S Building Sewer 93ST/HT Inlet �,L ST Outlet PC Bottom Header/Manifold Top of ST/P( Distribution Lines (�) % 9 / � (Z) /n5�- // ( ) Bottom of System ( () 9 %, 71(1) /`% Final Grade (1) 1616 6 (2) /D / , 0 ( ) Date of installation Permit number 3 ra,5"3 State plan number ( % Plumber's si naturekntiv,��nc license number ;�2/7y/ Date Inspector itA.6 w- Complete plot plan `�3 •Wisconsin Department of Commerce Safety end eyiidings Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s,15.04 (1)(m)), TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic �j- � .�� Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic �/p�p � --D 9 � NA Dosing � /md r �� f r' �� � NA Aeration A Holding PUMP /SIPHON INFORMATION Man urer �, 4(� Demand) � Model Number �S M TDH Lift �p�'�b Lriction stem �„� TDH �S,�Ft Forc ength ��I Dia. �, � t Dist. To County; St. Croix Sanitary Permit No.: 344653 State Plan ID No.: Parcel Tax No.: STATION BS HI FS ELEV. Benchmark , (BZ OS•b ��, D Alt. BM ',�•Yf u f �• l , Sn Bldg. Sewer (2,5-1 93, �� � St/Ht Inlet 3�a/ 92.6/ Dt Bottom /��.Sti �, ag Header /Man. 6, �o c�q. ,Z Dist. Pipe g R, /� Bot. System q�,�. Final Grade � �p1,0' q �• � � St cover �� � SOIL ABSORPTION SYSTEM �I�� ��,�,,,�,�,-S F��`t'r�►r,G. TRENCH DIM N I Width r 3 Length ,� / No. f T nches PIT DIMEN I N No. Of Pits Inside Dia. Liquid Depth SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manuf ctur r: �, .� SETBACK CHAMBER INFORMATION T�peO � / f % � � (� Mo a Nu�berr 5 stem: ' 5 �6 � OR UNIT DISTRIBUTION SYSTEM �- JZ +/ Z�" H �-�eL Header / nifold e< Distribution Pipes) I x Hole Size (x Hole Spacing Vent To Air Intake i Lengtft� Dia. � I Length— anng /!iD 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 /7rench Center Bed /Trench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) inspection #1: / / Inspection #2: Loeaiion: 1466 78th Street, New Richmond, WI (SE1/4, NEl/4, Section 23 T30N-R19W) - 2330.19.199D .� � a� �P � ��5 �G��„I�.��:��„�c� Plan revision required? ❑Yes j� No Use other side for additional information. Date Inspector's Signature Cert. No. 0