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Home My WebLink About030-2038-40-000 Safe vi Commerce PRIVATE SEWAGE SYSTEM may erx� �C ounty: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal iMomiatlon you provice may be used for secondary purposes (Privacy Law, s.ts.04 (t)(m)l. 384159 Permit HoIde7s Name: 0 City 0 Village Town of: State Plan 10 No.: arrette Charles St. Joseph Townshi T BM Elev..; Insp. BM Elev.: 8 Description: [ :Pa!r]cee Ta x No.: U /OO 0- 2038 -40 -000 TANK INFORMATION iLEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q d Benchmark O Alt. BM 8 1 d o fev er -f = s 12 _T_ Aeration Bldg. Sewer T Holding St Mt Inlet JS� oa G , s� TANK SETBACK INFORMATION Ht Outlet TANKTO P/L WELL BLDG. ventto ROAD D Air Intake Septic > / I s' NA _ — — NA Header /Man. fr, Aeration Dist. Pipe t,(, ". 33 f ,- 2 Holding Bot. System �'s (? � L PUMP/ SIPHON INFORMATION Final Grade 9. /0 102, YG >o a Demand St cover Model Number TD 'ft Friction S to TDH F Loss Forcemain Length Dia. Dist. T Well SOIL ABSORPTION SYSTEM S BED/TRENCH width Length , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - 3 1 3 , ' 2_ SYSTEM TO P / L I BLDG WELL LAKE/STREAM L M n u SETBACK E INFORMATION Type Of ,/ / M odel Number: System • — DISTRIBUTION SYSTEM Hea er / �Mani o Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ? Length , 5 Dia. _ Length T,796ia. Spacing / 6 6 / 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 ❑ Yes p No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1: T IZI / Inspection #2: Location: 1364 CTH V, Houlton, WI 54082 (SE 1/4 NE 1/4 25 T30N R20W) - 253020480C -Lot 1 1.) Alt BM Description= wi'`�ow 5; / y 2.) Bldg sewer length SOU 4 ewer s We / - amount of cover ' ;•�Qt7Sev%/t t io.. e a�.„,� , 5 i- 51�2 1�d :tn r7l � Z4 Ck Prrl �. ea . � � � s�ara►r,�®r (/CPS`- �c�i►L �,� ;�,�� v,r. Ca Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (P —IM7) Date inspector's Signature Cert. No. � ) See fG (:30 o e o e e S l ,� x -- /3� , C v - V Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Nv isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the sy stem, o n paper not less than 8 -1/2 x 11 inches in size. County State Sanitazv Pe rt Number ❑ Check if revision to previoys State P lan I. D. Number S� I. App ication Information - Please Print all Information Location: Property Owner Name Property Location 1/4 114 T� ,N. (or Property Owner's Mailing Address Lot Number Block umber City, Sta Zip Code PWRe Nurr f Subdivision Name or CSM Number )z H. Type of Building: (check one) ✓ — ,5 P¢' -,(t ❑ City 0 1 or 2 Family Dwelling -No. of Bedrooms : _� 4. on (aQs+1S . ❑ Village ❑ Public /Commercial (describe use):_ P'Town of ❑ State -Owned - y l Nearest Road Z) �j X -/ 3 - �S t� C ZA 1 }� `00 �' Parcel Tax er(s III. Type of Permit: (Check only o box on line A. Ch eck box on line B if app cable) 2 S. 3 • 20 • 8DC A) 1. X New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation VI f. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned assume res ponsibility for installation f the POWTS shown on the attached plans. Plumber's r Plumber' Signa tam MP/NIPRS No. Business Phone Number Pl be s Address (Street, City, Sta , Zip de) y �� 1 < < c L IX. County/Department Use Only ❑ Disapproved 111 nity Permit Fee (Includes Groundwater Date Issued 2ssing Agent Signature (No stamps) A Approved ❑ Owner Given Initial Adverse ge Fee) Determination t X. Conditions of Ap roval/ for Disapproval •(�_ �! � (� _�,� / es l9 ` / -r C` S tl � uGw " — "" — ce s id-Ce , " Q 6# 6#- In - Cep is s ►� -� � J am. � ` ( 1 s SBD -6398 (R. 07100) �"""' �"' �'�/ � QK S ` �- ;z0tUG' C- AOIA /71 w � jlm� , �f r�C ��oe .�! lea - �S�l �itcif,!- �✓�r�s' / DD�� I. �- �5:�43 - 7 - �i3,G�/� ay' � 97c Ij /&-s jz _I Y- saw mss' 7�0�/ -ar,,J lyzw C 63,Gy ✓��s'e asks �Jx�� k ,d�,Jx� 7 -- I i i I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ( of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County c r t7 P Attach complete site plan on paper not less than 8 11 1 s m iz Ian must include, but not limited to: vertical and horizontal r { W dd f�ctio(i and Parcel I.D. percent slope, scale or dimensions, north arro aqd tion aQd distartce'to hbarest road. p?j 0 — O 8 q0 — M Please print al rma \ {L �t�i `, Reviewed by Date Personal information you provide may be used fo r dary purporas i (Pr ivacy Law, s. 15.04 (1) (m)). ` t�Q Zee Property Owner f - q 1 1 70 Froperty.Location O k c r-C S Ic. r r e GFtCIX Go .,hop S 1/4 n p L1 /4 S,�, S T U N R.7- O• W Property Owner's Mailing A�d COUN L # ' Block # Subd. Name r CSM# 3 t t`� U 2Ct�INuo — Grr �l City State Zip Code Phone= 'el" _ City El Village 1( D o wn M�OMi k�toUd ! 1 K New Construction Use - .residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Cl Public or commercial - Describe: Parent material b It f Food Plain elevation if applicable ft. General comments (` t and recommendations: o `t t h e 4 4 Gt Y /� Boring (] / F11 Boring # Ground surface elev. "1 L •o s ft. Depth to limiting factor 9 in. ❑ Pit 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 d -2-1 lop -11? — S A M.5h V r QLi 2� P • S r 60- 97.,5 Vr 51�P F11 Boring # ® Boring Q • pg. El Pit Pit Ground surface elev. 9 ft. Depth to limiting factor - iin• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff r in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 g 0 —o to yr � Z -- S I �, M � SO -90 `l. r s 4 S � s rn I 7 lyl 02, SGc s Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) Si CST Number I K os -.. 5 C �� A � Son 22-7 3 9(0 Address Date Evaluation Conducted Telephone Number GI 2.46 -).c i Y 3 Property Owner L P f`@. t C cel ID # _ Page of Boring # ❑ Boring 1 ❑ Pit Ground surface el r� �'� Depth to limiting factor Q 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 n - ID z r-7 -- %( aMs6K Fir C w Z 'S .'Tk 1, 0 1 -10 to r qlq — S t ( '�. e•�sbk r1 r t� . S, O •� Boring # ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F 11 pit 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 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L I 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.6/00) 3 C 4, X 2 'e- 3 S g CA - 9-,& V �- joscp►, - l.J1 20Lo O C 4 F 1 O H I o� ti I� S4, �Scc, I' = 30 � T O p o1- ptr C p1 4 boo a 1, s•G' P cOpc Ol o� 227 3 $(. 132 99 .83 ► -lo 1��4�,n� �0�.2 .ti M 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) SO Estimated Flow - Average (gpd) 3csD Septic Tank Capacity (gal) c5ts0 Soil Absorption Component Size (ft 4t Type of Wastewater Do estic Ors Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) s 44-f -" Maximum Influent Particle Size (in) U 118 Maximum BOD (mg /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 &t,c nk and outlet filter s hall be assessed at least once every 3 years by inspection. Th lte s hall be cleaned as necessary to ensur proper operatio The filter cartridge t 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 R 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 ST CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT AND LO OWNERSHIP CERTIFICATION FORM p< < Ar OwnerBuyer zotA"N- O� rtCe: Mailing Address / 9 (2,,& u� 1 l/� Property Address /�9s f�,i t J� _ fi _•.. (Verificatio required from Planning Department for new construction) ,� , //� City/State 61 J.T - s As Parcel Identification Number 6 - Yo LEGAL DESCRIPTION Property Location _� F_ %4, ,6C '/4, Sec. ,--Z.S' . Town of � - _ Subdivision Lot # Certified Survey Map # , Volume s , Page # _7Z7 Warranty Deed # s',�gs , Volume /s'>, , Page # Spec house ❑ yes [0 no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE 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 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. 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 OWNER CERTIFICATION I (we) certify th t a statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the a ove virtue of a warranty deed recorded in Register of Deeds Office. SIG P CANT 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 soy_ 15 0PAGE 616 STATE BAR OF WISCONSIN FORM 3 - 1998 1E=.35995 QUIT CLAIM DEED KATHLEEN H. WASH REGISTER OF DEEDS Document Number ST. CROIX CO. WI RECEIVED FOR RECORD This Deed made between Terrence Rene Barrette 12 -28 -2000 11:40 AM QUIT CLAIM DEED Grantor, EXEMPT # and Charles Augustus Barrette CERT COPY FEE: COPY FEE: TRANSFER FEE: 87.60 RECORDING FEE: 10.00 Grantee. PAGES: 1 ' Grantor quit claims to Grantee the following described real estate in St Croix .County, State of Wisconsin: Recording Area Lot 1 CS 2/337 parcel # 030 2038 40 000 Nam and Return Address SENE Sec 25 T30 R20 6ivez'fft (! W _ 030 2038 40 000 Parcel Identification Number (PIN) This 1 S homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this 1 ay of Octobe _ 2000 (SEAL) - (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, i 55. C 1?- 0 t x County. authenticated this day of Personally ca }e� before me this 0 � ( day of �Itc Z-fl - , the above named ,. �rr� —new e ne bc�rrc�e- TITLE: MEMBER STATE BAR OF WISCONSIN .�✓ to (If not, y?; me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) ,g % instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Arp -j Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: natures may be authenticated or acknowledged. Both are not 3ary) 'IV must_.4€tvoed or orinted below their %ionat— CERTIFIED SURVEY MAP PART OF SE 1/4- NE 1/4- SEC. 25, T -3U - N, R -LU -W ST. CROIX COUNTY MON. NE COR. SEC.25 T -30 -N, R -20 -W M M N 5d f S 88 51' -43" W _ -- 400.00' -- 1 1 P.K. 19`C - 349.99 a y .01' 6 a PLATTED_ % 0 0' LANDS / Ul 2 ALL BEARINGS TO ' TTHE E LIINE- WOODLAND_ LOT I Y (' SEC. 25, ASSUMED BEARING -DUE NORTH Hies = 3.43 A. (� to O In :D bu � _ 0 O 1. Z I Ih I 'EAST LINE SEC-25 0' 25 50' 100' 0 ,y 19/0 a . Q 11 12 SCALE 1"- 100' y\, 19• /�► , 349.99' 50.01' P.K. F D N 88 - I - t 17 1916 - e - 51 � -43 a E N -- 400.00 - I OD AAES 0. CONIyELL 1 50' 0 It 21,1or of Deed 0 $1. Croix cool' . 0 4 (V � W iscootiu O- 1 1/4" X 24" 1RON PIPE SET N 9 WEIGHING 2.27 LB. PER LItXfff0yE� / 5 �rll[[ ��// C.T.H. ° E a N1Nlttllll �0! yGoJVIKI �'r. ST. CROIX COUNTY MON. �� ., T DEC 15 1976 T- 30 -N R -20-W 5 .•�. > GENE C. -+�+ ST. CROIX COUNTY = SHAFFER r:�>EtIre rqW►�RUMENT DRAFTED BY G.C. SHAFFER 5 -1325 • HUDSON wt� Zot*" CAST Wis. I& b Su ,+ APPROVAL OF TrIIS tAINOR SUBDIVISION DOES NOT MEAN AP?ROVAL FOR SEPTIC S- -7 SYSTEM. REFER TO H62.20 CERTIFICATE OF TOWN OF ST. JOSEPH I, BEATRICE A. NORELL, BEING DULY ELECTED, QUALIFIED AND ACTING TOWN CLERK OF THE TOWN OF ST. JOSEPH, DO HEREBY CERTIFY THAT THIS CERTIFIED SURVEY MAP HAS BEEN APPROVED BY THE TOWN BOARD OF THE TOWNSHIP OF ST.'.JOSEPH THIS . 9th DAY OF EEMMR,.. 1976. - - BEATRICE A. NORELL, TO LERK Vol. 2 Page 337 Certified Survey Maps See reverse side for certification St. Croix County, Wis. o g ? 2) ° 9 T} $\ $ g \ S o ° m m. m§ 8 Q o Q- 2 \« f 2 0 c fn °§ C-ƒ q 0 / s§ E 9 d/& q CD pr w t 2 § k 2 k = 2 k/ 3 CD o % 8 « CD o > In t = n 3 = 8 S . o @ § 2 ƒ \ \ \ k § E CA } 0 0 0 ��- J G = % k < z 4 = ■ (a co) § % > O 0 �_CD EEf f N) 3 / § \ _ > \ 0 2 . =g / / c { \ U (D / 7 } k \ i % o k \ a 5 f ) 2 — @ ± a / ¥ CA c a z m ` m § . ¥ z E . / 2 a p , { A 7 T $ / U CL < \ / \ . , 2 i % > � �8[ / 8a— g$ Ka& wig { / c .r 0w3- % 22(+ ,L f — 7§\ ,E§ 7 / }I � 1=—D'f . > 0 \ ƒ � / 0 \ Q) 0 % / \ _o �§ 0 i � �7