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HomeMy WebLinkAbout030-1071-40-000 Wisconsin Dgpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515216 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: Conway, Thomas R. I St. Joseph, Town of 030 - 1071 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: / � Section/Town /Range /Map No: /DC� B vy\ CAS 26.30.19.253N TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ^ 5 CAPACITY STATION BS HI I FS ELEV. 34 W Benchmark 160 no cl � 1Z /L� _ A bjee L - Alt. BM Aeration V Bldg. Sewer Holding St/Ht Inlet -, 5 rt ' TANK SETBACK INFORMATION c 1 ? J TANK TO P/L WELL BLDG. Vent to Air Intake ROAD . Z y, /1 1 r _ 3 Dt Bottom Dosing / K, Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer GPMand� Model Number TDH Lift Friction Loss System Head TD Ft Forcemain 1 1�� ia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO BLDG WELL LAKE /STREAM LEACHING Manufa urer: INFORMATION CHAMBER OR Type Of System: UNIT Model rum der: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length is S SOIL COVER x Pressure ms Only xx Mound Or At Grade Systems O Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil M Yes 0 No [�] Yes 0 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1378 Frog Pond Lane N w Richmond, WI 54017 (Gov't Lot 4 26 T30N R1 9W) metes & bounds Lot Parc No: 26.30.19.253N - a= r.. t� Go�e� 64 1.) Alt BM Description = J 2.) Bldg sewer length = 7 J - amount of cover = 41 e Z— GOJ 1� + 1/`Gn7 e (� d" Lm Plan revision Required? Yes �1 No _ - Use other side for additional information. Date Insepctor Signatur Cert. No. SBD -6710 (R.3/97) commerce Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 i sc o ns i n Madison, WI 5370 6 Sanitary Permit umber (to be filled in by Co.) Department of Commerce 5 Sanitary Permit Applicatio State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 1 m), Slats. I. Application Information - 'Please Print All Informatio Property O er's Name Parcel # ,07,4< ) � J t4 ),i U -*2' ��_ - //,-, 71 - -A19 Property Owner's Mailing Address Property Location /I Z53 /a z� ZAE I Govt. Lot t XJ) City, State Zip ode / p PLAN OFFICE ! _�� 1A Section � CL circle one II. Type of Building (check all that apply) Lot # T 0 N; REo 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ❑ Public /Commercial - Describe Use ❑ City of El State Owned - Describe Use CSM Number ❑ Village of �, w ---"-' 0 Town of III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ TreatmentfHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ El Transfer to New of Plumber Change List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl ❑ Non- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) ersa reatment Area Information: Design Flow (gpd) Design Soil App 'cation Rate(gpdsf) Dispersal Arep Required (sf) Dispersal Are Proposed (sf) System Elev lion VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p v $ New Tanks Existing Tanks / 2 2 y v in Septic or Holding Tank Dosing Chamber VII. Respons' ility Statement- I, the undersigned, assume responsibil' installation o the POWTS shown on the attached plans Plumbe 's a (P i t) Plumber's ignatur MP/MPRS Number Business Phone Number 5 J _ Titmber'rAdaress treet, City, State, p Code) VIII. Coun /De artment 10se Onl pproved 1 Permmitt Fee j� Date Is uedd C, Issuing t Signatur ❑�vr Given Reas or Denial $ tp�V. /� Z �+ I . Conditions o fApproval/Reasons orDisapp val (� Z D i�aje , tA�J OK, k� Qf /4 /1C�A�1 We. Attach to complete plans for the system and submit to the County on on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 t j `0 .L� %5 Ti % t 5� ® SL Y A/w x+�Irt1 0 • avJ4 cvJ Jy�e f ����s �°��,��� rya 6 ,�� ��-� . y C71�5'Ti�jG �oct_S,� /Js,°iJ,�ti1� x� �� y �'�'�` l ! �o � y5� o�� ;� ;, .� �- /L;,,)C.�/ /� /.fit'74'- ,iC�I1i.�� v�s..nvJ� ch: �ise'- ,� /c^� Fi �// �� -- —_ L�,� -,v�,� � __ T CONCRETE HOLDING TANK DESIGN INDEX AND TITLE SHEET Project THOMAS R CONWAY Owner THOMAS R CONWAY Address 4378 FROCK POND LANE NEW RICHMOND WI 54017 Legal Description NE— NE-- SEC26-- T30N - -R19W Township ST JOSEPH County ST CROiX Subdivisim Name Lot No. Parcel 1D Number 030 - 1071 -40 -000 Plan Transaction Number Index and title sheet Page 1 Holding tank specifications Page 2 Site pian Page 3 Management & Continency Plan Page 4 Designer KIM A 9 Signature T Phone No. 715- 755 -3145 License - Number 224263 Date 12/27/09 Designed pursuant to: Holding Tank Component Manual For POWTS SOD4057f -P (R.M9) Verstott Z O {03/04) Page 1 of A HOLDING TANK SPECIFICATIONS 2 If one- or two- family, number of bedrooms �,- .... Non-residential estimated flow per day 2000.0 Minimum holding tank volume required 2520.0 Total holding tank capacity proposed (gal) 1260.0 Tank 1 capacity (gal) 84 X for round tanks 4260.0 Tarik'2 capacity (gal) WEEKS Tank -i-canufacturer S.J.ELECTRO Alarm manufacturer ~41 Alamo, model• number Tank in Exterior Dimensions in Ibs Ibs in ft Information Liq Level Length I Width I Height Tank t Ancho Wt Soil Cover Max Bury Tank 1 58 84 84 68 't6e 4f?'�. 8 Tank 2 58 84 84 68 -469q - 8 li (� HOLDING TANK CROSS SECTION Ma cover with locking 12" min. 4" min. device and waming label Finished grade �y �� Junction box E— Vent pipe 18„ Blind plug to seat t oaer�a 7 .Inlet 12. Not Manhole and vent locations may be 46,0 -in reversed Tank 2 Tank 1 3 in. min. bedding under.tanks. Anchor tanks as necessary to negate buoyant forces. Electrical as per NEG 300 and Comm 16. Note: All tank joints, and joints between tank openings and piping are sealed watertight. Project: THOMAS R CONWAY Transaction Number: Page 2 of 4 HOLDING TANK MANAGEMENT PLAN This Private Onsite Wastewater Treatment System ( POWTS) has been designed, and is to be installed and maintained- according- to. Comm- a Was. Admin. Code the- Holding -Tank Component Manual (SBD- 1.0571 -P 6/11/1999}, and the ST CROIX County Sanitary Ordnance. 1. This POWTS .is designed to accommodate an estimated domestic wastewater .flow of 504.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the second tank reaches a level of 12" below the inlet invert (at which time the alar -m- will. activate) the - pumper listed in- the - current - Servicing Contract must be- called to empty the tank's contents and dispose of therm in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch. 281, Wis. Statutes. The discharge of wastes from this holding tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding 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. S. In the event that this POWTS fails- and cannot be repaired, a code compliant replacerment holding tarn may be installed in the same location (a new sanitary permit is required for such a replacement). Connection to municipal services would also be considered at this time if they are deemed available to the property. 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code. 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer ........................... KIM A OCONNELL Phone: 715 - 755 -3145 b. Service Provider ................ Phone: c. County Zoning or Health Dept. ST.CROIX Phone: 715 - 386 -4680 11. I Project: Transaction Number: Page 4 of 4 ON EPH LOT 1. 628 66 225' 140TH AVE. .... _.._.,_.._. ._.._.._.._.._.._...._.._.._.._ co 253G N CSM VOL 2lh G 5056 co LOT 1 N 253F"° 560.37 R � a4 W OUTLOT 1 cs 7 -4497 3G °�' 2 GOVERNMENT LOT 4 ra w 253S 253A - 30 253C ° ■ 253C �O A� 253T f 253.1 6 25 2531, s ° 253L 531 253J 53 53K 253K 253 253M 253N 253N � >..253 0 I` f- � y ti k 4 1 iA P. IV ke S �� d �; I V n x- 04/20/09 MON 12:38 FAX 715 386 4686 ST CRX CO ZONING W002 HOLDING TANK SERVICING CONTRACT Contract Date / ✓°� 0 This contract is made between the Holding Tank Owner(s) Name(s) and Pumpe ' Name l HOMA R. CO - f We acknowledge the installation of (a) holding tank(s) on the following property: rovide legal descriptions:) 1378 FRob POND LAMF NEW MCH M000 VJ 1 51017 70..sn; e1= sr. _1015F Pw 0 1071 40 -000 --------------------------------------------- 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the III pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local overnmenta unit and the o named above within ten 10 business g 1 e C unty am b O days from the date of change to this service contract. Owner(s) Name(s) (Print) Ow ex's Signatures) Subscribed and sworn to me on this date: "TH R_ CONwgY 2 I v 3 I D Toda s Date Pumper's Name (Print) Pumper's Si natu Notary Public Signature C� 2/, Pumper's Registraton Number Commission Expiration • r DOCUMENT NO. NAitRARTYr` L/G�D THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 —1982 519614 �,... _ . VOL 10 9PaIFT27 HAZEL E,.- "FELIO, a single woman residing in_ Rock ,. REGISTER'S OFFICE ! ST. CROIX CO., WI County,... sconsi n - - -- - - - - - - -- ii Recd for Record - . - - - -- - -- -- -- . . - - -- -• - -- - - -- - JUL 2 9 1994 j; - - -- i conveys and warrants to _7H0MAS_. R.._ C0NWAY.,__ a -- - - of -_ - -- s : 15 A. Ramsey..Collnty_, -- Minnesota ! 0. I - - - - -- - .. - - -- -- - - - - -- - - -- - - -- -------- - - - - -- Register of Dads ------------ - - - - -- --------------- - - - - -- ---- - - - - -- -- - - i ............... --------------------------------------- ....--- _.- . " " "..---- ----- -.. .- _ - --- "- __ -_ - -- RETURN TO ... _. ,I for - $1..00. and- other. good- and..valuab -l:e con- sJder_ati_gn ..... .. ----------------------------------- - - - -- the following described real estate in ------------ Croi County,��•_` .State of Wisconsin: .Y Tax Parcel No: -___- A part of Government Lot Four (4) of Section Twenty -six (26) Township Thirty (30) North, I Rage Nineteen (19) West, described as follows: Commencing at the Northeast (NE) corner of the Northwest Quarter of the Northeast Quarter (NWI /a NE' /a) in said Section Twenty -six (26); thence West 628 feet; thence South 269.5 feet; thence South 43 30' East 484 feet; thence South 50 East 462 feet to the point of beginning; thence South 50 East 66 feet; thence South 40 West to the East shore of Bass Lake; thence Northwesterly along !! said shore to a point South 40 00' West of the point of beginning; thence North 40 00' East to the point of beginning; together with an easement consisting of permission to use a strip of land not over 2 rods in width for purposes of ingress and egress to said property I located along and which said strip of land shall be g the North line of Lot 4 in said section ` Twenty -six (26) and the Northwest Quarter of the Northwest Quarter (NWI /a NWl /�) of Section Twenty - five (25) all in Township 30 North, Range 19 West to connect with the present highway now located in said Section 25. j Commencing at the Southeast (SE) corner of above tract of land, thence northeasterly (NEly) along the East (E) line of said tract of land to the Northeast (NE) corner thereof; 'i thence at an angle of 90 to the right in a Southeasterly (SEly) direction to the north line of the south fifteen (15) rods of Government Lot Four (4); thence west along said north line This _...._.5 -- ,''lot____ - - - -_ homestead propert (CONTINUED ON BACK) (is) (is not) i I Ii Exception to warranties: li j i � Dated this -- - - -- 25th ------- ---- - - - - -- -- - - -- -- day of -------- -- - - - - - -- -- July -- 19.9 4 - - - - -- (SEAL) _ (SEAL) I ! Hazel E. Fel io - - - - - -- _.. - ..._..._ .. .___ I. __(SEAL) ___(SEAL) � - - - -- -- ------------------------------ "-- - - - - -- -- - AUTHENTICATION ACKNOWLEDGMENT Signature (s) ------------------------------------------------------ _ STATE OF WISCONSIN ss. --- ---•---- -- - - - - -- ----------------------------------------------------------- ___ RQG k ---- ---- -- --- -- --- -- - - - - - - county. authenticated this -------- day of --------------------------- 19 ------ Personally came before me this ---- 2- 5 ------- -day of July--- _ --- - - ---- 1�J_ g4__ the above named I I — - --- ------•----------- l --- -- ---- --------- ---- - - -- _ ------ - - - - -- --- ----- - -- - -_ _ ----- - Hazel_..E., Fe io ----------- - - - - -- - - -. -. l -------------- - - - - -- -------------------------------- - - - - -- -- - - - - -- -- - - - - - -- - - - - -- !j TITLE: MEMBER STATE BAR OF WISCONSINi - (If not- ------ ------------- -•--- - - -- -- ------ ----- --- •- -•-- -- - - - - -- _� ' authorized by § 706.06, Wis. Stats') to me xn_ri to } who executed the .fore * mstrvmen and aek 'owle"d ve the same. THIS INSTRUMENT WAS DRAFTED BY - I I William J. Gilbert Attorney •• -- - WI 54016 ..^ •_._ . - - - - - - -- - - -- t 206 Second Street, Hudson, Notar �6 h • Public _ -- ..__.._- . County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) Oct. 15 19 95 ) date: ---- --- -- ---- - - - -- - - --- - -- - -- - - --- "Names of - persons signing in any capacity should be typed or printed below tbei + sigtnat n +* s ommm� r Wisrnnsin I rnal Rlank (fin Inr, pp _ V VOL 1089PA.E428 of said south fifteen (15) rods of Government Lot Four (4) to the shore of Bass Lake; thence Northwesterly (Nally) along the shore of Bass Lake to the point of beginning. From an iron stake on the North line of said Section Twenty -six (26) which is a distance of Thirteen Hundred Twenty (1320) feet West of the Northeast corner of said Section Twenty- { six (26), go south 3 East a distance of Seven Hundred Two and five - tenths (702.5) feet, } thence South 72 East a distance of One Hundred Twenty -nine and five - tenths (129.5) feet, thence South 10 54' West a distance of One Hundred Thirty -two and five tenths (132.5) feet to point of beginning of parcel to be conveyed herein; thence South 10 54' West a distance of Sixty (60.0) feet, thence North 50 West a distance of Sixty -six (66.0) t feet, thence North 40 00' East a distance of Thirty -five (35.0) feet, thence South 75 East a distance of Forty and six- tenths (40.6) feet to place of beginning; being a part of that - parcel recorded in Volume 333, Page 4, in the St. Croix County Register of Deed's office; together with an easement over the access road from the above described parcel to the town road as now opened and traveled. (This deed is given in satisfaction of a Land Contract dated September 1, 1976, recorded September 2, 1976 in Vol. 542, Page 294, Doc. No. 335263 in the office of the Register of Deeds for St. Croix County. Parcel #: 030 - 1071 -40 -000 10/30/2009 01:36 PM PAGE 1 OF 1 Alt. Parcel M 26.30.19.253N 030 - TOWN OF SAINT JOSEPH Current ! j(1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - CONWAY, THOMAS R THOMAS R CONWAY 1038 SEMINOLE AVE ST PAUL MN 55118 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 26 T30N R1 9W PRT GL 4 COM NE COR TH Block/Condo Bldg: W 628 FT, S 269.5 FT, S 43DEG E 484 FT, TH S 50DEG E 462 FT TO POB S 50DEG E 66 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) FT, S 40DEG W TO BASS LK, NWLY TO PT S 26- 30N -19W 40 DEG W OF POB, TH N 40DEG E - POB ALSO COM SE COR ABOVE TRACT; TH NE ALG E LN more... Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1089/127 WD 07/23/1997 542/294 2009 SUMMARY Bill M. Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 110,900 47,000 157,900 NO Totals for 2009: General Property 0.000 110,900 47,000 157,900 Woodland 0.000 0 0 Totals for 2008: General Property 0.000 110,900 47,000 157,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST C RO � x cO UNTY October 21, 2009 Mr. Tom Conway L-�2_ 2 — s'-� 71 1038 Seminole Ave. ST. Paul, MN 55118 Code Administration RE: Land Use Permit Review for Principal Structure in Shoreland District 715 - 386 -4680 #26.30.19.253N -1378 Frog Pond Lane, Town of St. Joseph Land Information & Dear Mr. Conway Planning 715- 386 -4674 1 have determined that your proposed project to reconstruct the roof on an existing Real Property principal structure will not require a land use permit. This decision was based on 715- 386 -4677 the site plan and building specifications that you submitted to the Planning & Zoning Department today. The cabin is located within the Shoreland District for Bass Lake, Recycling 715 - 386 -4675 but the project will not require any change in the existing structure's footprint. Filling and grading will not be necessary to complete the project, but does require a building permit from the Town of St. Joseph. The site plan indicated that the cabin is approximately 80 feet from a channel between Kelly Pond and Bass Lake and is 100 feet from the lakeshore, which meets the minimum 75' setback from the OHWM pursuant to Section 17.31(2). Please contact the Town of St. Joseph to obtain the required building permit. If you have any questions or concerns, please contact me. Si 4, Pamela Quinn Zoning Specialist Cc: Town of St. Joseph Building Inspector ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715 - 386 - 4686 FAX ' ,I , �, I 9 V� r i D I ��_ o, $ p I I I � \ �t �o i � , � i ,r � `\ � W �� __. - -- __ A I � F a r m a � '+'r n -( RI Q � ,\\ � D ' T ,\ \\ \ \ .Q�c 1 , ,,� � � , �,� I ...�. / x �..._ F � j ,�� o / 0 - - -�. i �____ _ -��-_l � 0 J $ I \L O v i D � L L M N S � 4 �o s N i : J uj o l � i � Z IL � OZ I Q W � x p 9 a I ...._..__. ___........_._._�_ r Ia _ f IFI L. O i ' t r co s