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HomeMy WebLinkAbout030-2031-90-000 \ - - - - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sgfety and Building Division INSPECTION REPORT Sanitary Permit No: 515117 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Kilbane, Geor ann I St. Joseph, Town of 030- 2031 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: D I'VC — 23.30.20.452A TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION %1F ELEV. Septic Benchmark ooh . is& v Dosing ST �� /� r � Alt. BM 0 � /0 3 - 0 Aeration T � Sewer L/ 6 O / 6 Holding St/Ht Inlet St/Ht Outlet TANK SET CK INFORMATION <S�/D' 9� TANK TO P/ W L BLDG. Vent to Air Intake ROAD Dt Inlet Septic + O r 90 ' Dt Bottom Dosing �^1 7 # Z , 3 or Header /Man. ' s ` 5 qZ• Aeration Dist. Pipe lam V Holding Bot. Sy ILA Final Grrade ' PUMP /SIPHON INFORMATION Manufacturer GPM St Cover 3 i r ' 3 / Model Number TDH Lift Friction Loss ys e TDH Ft Forcemain Len Dia. Dist. to Well a, SOIL ABSORPTION SYSTEM - &�4 -- BED/TRENCH Width / Length � No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 11D� 2 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM EACHING ManJ�fa - tu r:" Y INFORMATION HAMBER O // Typ f System: f , / N , l l / i / UNIT Model Number / DISTRIBUTION SYSTEM Gtmyw�l -e llV p 0 Bader/ �O istribution _n (J/f x Hole Size x Hole Spacing Verit Air Intake () r V. Pipe(s) ! 41t BM Description ?s?O Len Dia ri 2 Length Dia Spacing —7 SOIL COVER gnY x Pressure Systems Only xx Mound Or At - Grade Systems Only _7 F1 Depth Over / Depth Over ropsoi x Depth of j xx Seeded /Sodded xx Mulched Bed/Trench Center �j Bed/Trench Edges l Yes E] No � Yes 0 No q G :OMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / 3 /� Inspection #2: scation: 132 State Rd 35/64 HOULTO WI 540082 (SE 1/4N \ 23 T30N R20W) / N , AA Lot /- Parcel No: 23.30.20.452 D�Cr o ` l'j'!? 5 j i 1 0 �C -� 0 and fD��C_ _' 'Idg sewer length = Z amount of cover =� ({ l Avu 1% / base iision Required? Yes /No (, �r side for additional information. l/ 0�t] Date Insepctor's Si ture Cert. No. (R.3/97) PA l D RECEIVED AUG 112009 C*"V jVA UOUN Safety and Buildings Division County j PLANNII.i & ZONING FFICE201 W. Washington Ave., P.O. Box 7162 cS /- , f ) t ( c n a Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Number Sanitary Permit Application State Transaction 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 min ses in accordance with the Privacy Law, s. 15. 1 m , Stats. I. Application Information - Please Print All Information Property Owner's Name Parcel # 0 2 property Owner's ling Address p`"P`rt' L oca t i o n x{52 R l .S % liV ,` ..� S �` n Govt. Lot City, State Code Phone Number �� y. %, Section 2 T y N; R� o W II. Type Building (check aIl that apply) Lot # Subdivision Name 2 Family Dwelling — Number of Bed Block # ❑ Public/Commercial — Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned — Describe Use y �� +� own of Z w S�• III. Type of Permit: (Check 0 one box on line A. Complete line B if applicable) A' New System Wement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) mit Transfer to New List Previous Permit Number and Date Issued B. ❑ Permit Rer G PU r a h t1 Y c Before Expire f !— y t SIVt 1 Cci.4-u� I V. Type of POW _ /32 y on- Pressurized , � / .24 in. of suitable soil 11 Mound < 24 in. of suitable soil ❑ Holding Tank e� _ ❑ Pretreatment Device (explain) V. Dis ersallTres Design Flow (gpd) / i " 3 sf) Dis 1 Area Proposed (sf) Er, v VI. Tank Info Manufacturer y a Septic or Holding Tani � Dosing Chamber VII. Responsibil J - C L 2, 3 lation of the POWTS shown on the attached plans. Plumber' Name (P MP/MPRS Ntmtber Business Phone Number / 7�✓ = .!� /I Plumber's Address VIII. Conn /De artment Use Onl Permit Fee Date ued Issuing A t Signature PProved ppr° $ / 1 ✓ , tSG� ❑ en Reason for Denial IX. CondJh:M jE ypllrYl,ftWns for Disapproval 3' 61.k 5�b�'eM•. 'd"o w ° 'd 1. Septic tank. a " dispersal c-1 st all �servfr;es l mainta'lnedservlces / mainta'med as per manay! 1 ent plan.pmvided by plumber. 2. All setback requirements nw,* be rraktt ned ttae to fet 01 ns or the system and submit to the County only on paper not less tban 81/3 :11 incises in du SBD -6398 (R. 01/07) Valid thru 01/09 P VT PLAN PROJECT Georaann Kilbane ADDR Ss 1544 Twin Sorinas Road Houlton Wi 54082 SE 1/4 NW 1/4S 23 /T 30 /R W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/8/09 BEDROOM 3 CONVENTIONAL XXX IN -GROUN P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE < 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 91.2/90.4' 4' below qrade Conventional Powts A>6" lit Manual Version 2.0 Quick4 Standard -W 80' Leaching Chamber ell with 20.0 ft2 of Area 5.8ft^2 /pair of end caps 1320' Property Line Grade at System Elevation 25' 34" 25' Tank location approx. Existing 3 5 Bedroom T Drainfield unknown House Z-0 Old tank is to be pumped h6l 30' Scj and buried y0 l o i 6�`� _.�,✓� 120 100, B.M. '7 B -z 300' 35' 115' 0 ' ss 55 T 1,1 L 2 -3' X 68' cells with >3' spa cin B -1 (: 901 Slope SCAT is 1" _ 40 unless otherwise B -3 q ' noted LeG _ OPY wy 35/64 r C� P T PLAN PROJECT Georaann Kilbane ADDR Ss 1544 Twin Sarinas Road Houlton Wi 54082 SE 114 NW 1/4s 23 /T 30 /R W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 8/8/09 BEDROOM 3 CONVENTIONAL )0 IN -GROUN P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Plans Designed Using SYSTEM ELEVATION 91.2/90.4' 4' below qrade Conventional Powts ent Manual Version 2.0 >6 „ Quick4 Standard -W 80' Leaching Chamber of Cover with 20.0 ft2 of Area Well 5.8ft ^2 /pair of end caps 80' 4' Long 12" 1320' Property Line 34„ Grade at System Elevation 25' 25' Tank location approx. Existing 3 25' Bedroom T Drainfield unknown House Old tank is to 20' be be pumped and buried 120' 100' B.M. B -2 300' 35' 35' 0 ' 10' 2 -3' X 68' cells with >3' spacing B -1 00' 10% Slope Scale is 1" = 40' unless otherwise B -3 noted Hwy 35/64 REcEivE® . $ PAID AUG 112009 Wisconsin Department of Commerce ST CRGIXCGUNTI6t IL EVALUATION REPORT Page of Division of Safety and Buildings PLANNING & ZONING OF I in accordance with Comm 85, Wis. Adm. Code County L 7 Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must Ax include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 2 Cj�S percent slope, scale or dimensions, north arrow, and location and distance to nearest road. a - - 2 0 31 - / l/ - 020 Please print all information. Revi ad by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location 1 10 Govt. Lott, 1/4 lkd /4 S 3T N R Z E (or Property Owner's Wiling Address Lot # Block # Subd. Name or CSM# City State Zip Code v PhoiWNumber ❑ city ❑village Xown Nearest Road ❑ New Construction Use Residential / Number of bedrooms Code derived design flow rate JU GPD si�Repiacernent - [I Public or co erciai - Describe: Parent material (';1L4- z,— k5e Flood Plain elevation if applicable �1 ft. n - - - - -- - -- and recor mendrabons: G/ �e ( n , - ,/ J 7 r � o System Type eD /L/Z/ e ,L,. - 7Z 4 System Elevation F- / 1 Boring # ❑ Boring APit Ground surface elev. / 5- 2- ft. Depth to limiting factor / /l� 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 I 'Eff#2 2 .� 1 ' 61 .L u © Bori # C] #oring pit Ground surface elev. ' ft. Depth to limiting facto/ 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 g Z , s' ---- A, Ilk M ?�- �5 • Effluent #1 = BOD > 30 < 220 mgll and TSS >30 150 rrlg/L ' Effluent #2 = BOD 1 30 mg& and TSS < 30 mg/L CST Name (Please Print) Sig na CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �-- 2 715- 246 -4516 Property Owner _ Parcel ID # Page of a Ong # E] Boring (a,� // –(pi Ground surface elev. [O( ft. Depth to limiting factor in Soil Iication Rate Horizon Depth T Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 /C7 Ito - V 0- ° - _#r S w) 1 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 F-1 Bo4ing # ❑ pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF 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/_ ' Effluent #2 = BOD < 30 mg/_ 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 (8.6/00) Property Owner ^ Parcel ID # Page of ® Boring # ❑Boring /� " Pit Ground surface elev. °� ft. Depth to limiting factor / in. Soil AppliI cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 7 - 1 S A-I F Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDM 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. see -8330 (RAW) Soil Test Plot Plan Project Name Georgann Kilbane Shaun B' Address 1544 Twin Springs Road / Houlton Wi 54082 CST #226900 Lot ------ Subdivision -- --- --- Date 8/8/09 SE 114 N W 1/4S 23 T 30 N /R20 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe m v 91.2/90.4 System Elevation HRP Same as Benchmark 80' Well 80' 1320' Property Line IF 4 25' 25' Tank location approx. Existing 3 25 Bedroom T Drainfield unknown House 20' 100' B.M. B -2 300' 95' 35' 35' 0 ' 10' 93' 50' B -1 00' 10% Slope Scale is 1" = 40' B -3 unless otherwise noted Hwy 35/64 i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE A GRIMMENT AND I OWNMSI'IiP CERTIFICATION' FbRM Owner/Buyer U Mailing Address Property Address (VeriS.d. required from Planning & mug for new won.) /State Parcel Identification N f 3Q 'c2 y 31 Ci ty - LEML DESCRIP'IZQN Property Location'!. , (� 1 '/4 , Sec. j , T � N — 0 W, Town of b S Lot # Subdivision Certified Survey Map # , Volume ` page # 1 5 Volume page # Warranty Decd # ' ' ho»e yes no Lot limes ible y'� no � I S YSTE M p�'i'R'NA= AND OWNER CERT CATION Improper use and ice of yoga septic sys= could in in paed�tnae ° pm into Who penance comsiata of p imaq�aug out the septic tank evary three years or sooner, ifi ceded. by ft system can WOOL the fl> lion of the septic tank as a treatment stage in the disposal $yg� C � res - biIitie:s we s ML&d in $C•o mom. 83.52(1) aad is Chapter 12 - St. Croce S�'�y fi P & :�8 Depsrt�►t a aardfication form, signed by the The property owner AVON m submut to St. Croix County Planning that (1) the on site owner and by a mash pbsmbe n joutneyr+ m plumber, rafticted plumber or a li P'� >f neoagsarf), the septic tank is wastewater disposal system is in proper operating condition exWor (2) attar ' r nspect on and p=P M9 less than 113 6x11 of sludge, t the pzivatie sewage disposal with the L t the undaarsi�aa a have the the above res f C and ag ce and tbreo o f Natural Resou roM State of Wisconsin. standards set fob, herein. as net by the DaparCwot of Comm 1,� & Certification stating that your septic system bas been wed must be compl sad returned to SL Croix County Zoning Department wiotbin 30 days of the @tee year eupirstion date. I/we; that all sbtamrents 1 on this fo�maa are true to the beat of my /our knowledge. 1/we am/are VV owne(s) of the PVT OW above, by vhtm of a warranty deed recorded in R r of Doe Is C�ce. Nu mbe: bedroo SIGNA OF APPLICANTS) DATE ** *Any information that is 1z wanted may result in the sanitary permdt being Iievokod by the Plemsing & zoning DePartl ** if Inclade with this application a recorded warranty deed from the Register of Deeds Office and a cagy of the certified survey maP ref c= is made in the warranty dead. I WV. 0"5) 1 I Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned ponce a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is notexceed those required as per Comm. 83 Contingency Plan Option #1. if system fails, determine cause of failure, use altemate area and install new =Iftw replacement area. ll system at a lower elevation, by removing chambers, removing biomat, ystem. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 -386 -4680 Pumper Tom Mondor 715 -246 -5148 Shaun Bird #226900 `�'— :mo arncc ,ttacRVCO IOR RCCORO.N6 Owr� STATE BAR OF WISCONSIN FORM R -- 10M. if lvr_:� �r=er 2 -- - -- - - 1rw1ZirER5 OFRCE r! ZT. CRQ, x CO., WIS, ....... - - - -- -- _ _.. - -- - - - - -- ___ - ... -.... -- -- - -- ....._. -- Red's. #a ._, ,- :.! this i {; .................. - - - - -- _._..- ---------- -- -- -------- - - - - -- ­ 00Y _. �! _Rita W Koelln - -- R 30 1 conveys and warrants to �! - - -- - - - ...... - --- - -- - --• • ----- .--- -..Oieorgd�?n..T� lba e n -. _------ --•--------•-- -- - - - -- - --- - ----•-- --- - - u I it --- - . --• -- - ----- ------ •--- •--- ------... --..... - .... ... . ..... .._.................. ...... 1� ..... .... ......... ................ ............... ...-... _..- .- _....- ..... .... .... ...... ....-- _ - - -_.. . -. -.. RETURN To I� --- - - - - -- ------------- - -------------------------------- --- ---------------------- - - --- - ------•.-.-.._..--------- �i .... .. .. ... ... ........... ........... . ... _. ... _... ... r- . St . .Croix i, the foll . described real estate in _____.... ..................... .................County, c` state of Wisconsin: i �i or Northwest One— v452p paao East Orin^ —halt (El j`) T ax Parcel No:..._.__- . Quarter (N;v 1!" i , ec .1c)n z:s, • owri No z:., Range 20 West, Town of St. Joseph !i n lr $n2 4 f f� �I �I 1� u !{ L u 1: �I This 1S ri6t - homestead property. Ii -- 15 •. ----- I ( ) (is not) r { r Exception to warranties- Dated this .................. ........... d of ..................... ����BtQ !; -................ ............................... 19. 0 7 if �t 1� .� - (SEAL) ta. . 1 �. ..... (SEAL) Ri W. Koe ------ •- - - - -- ------- - --- -- - - - - - -- . ii - 1i - {'• ----- ------- ----- - - ------ --- ------------- -- (SEAL) .... (SEAL) j I * ;. i j; AUTHENTICATION ACKNOWLEDGMENT { Signature(s) ------------------ y / ~N� ----------- ---- ------- --- --•-------------- STATE OF ARISE is ........ At authenticated this -------- day of __- _- ____•--- -- -- ---- - ----- 19...... Personally came before me this ----- v...._day of Q . JI `r ®E!it!. .......... 19. "-- the above named a - ---- -------- ------ -- ----- ----- - -------------------------------------- --- .................................................... ••.... .. ................... TITLE: MEMBER STATE BAR OF WISCONSIN .............. .... .. ------------------------------------------------ .......... (If not- ----------------------- authorized by $ 706.0E, Wis. Stats.) to me known to be th erson --------- who executed the foregoing instri d . the same. THIS INSTRUMENT WAS DRAFTED 81 s._ Lee N. Johnson ------- ------- :. _. .....:......-- ---- --- ..__.. ----------- ------- -'------------- --- --•°••--- 800 Title Ins. Bldg a ---- ------- ...... ' Mp-Ls__ MU-- 5a4D_ l .... --------------- -------- _ -- Notary Isublie�. WIS. --- -- ••- _..... -- (Signatures may be authenticated or acknnwledged, Both My ComiiTission. 4A _ c ern. R tinn are not necessary.) - ? date: �i/RM• W ... . ) "am Imum •Nsmes of persons s[Hnina in any capacity should be tyned or pr:ntcd holow th.ir s;¢nstpT -_•gy, tl�71 1iQ. M.,IS, Con.penT� STATE HAM o. wisc:o 2 — tYS2 N Stti FARM N .. Stock No. 13002 ,,, «..... n.