Loading...
HomeMy WebLinkAbout032-2022-20-250 0 7 ? \ 2 ? / k rr _ 7 � w 3 ° k / \3 § \ \ CD o + \ ( 9 m � R k / R E 2 / [ ± _ ] j ® g) \ i § i XD ; ƒ \ 2 G / G \ 0 \ / $ ® E E C ! o G E o ( } \ ° m \ v > 2 E -. E , m E w \ \ \ / / 2 \ � o »Gad \ \ \ \ 0 E ƒ (D � § ■ _ G q CL o o 0 \' / g ■ ■ 4 \ 7 o v A j CD � \ CD ( f } ( \ � { f z z O ƒ m G o o / { R \\ �� ! \ (§ ' § G ¥ § [; 2 , :& J m � C/) \ Banc rm j / § § \ 2 \ \ CD , g R ) / 4 k/ � 5f o = w «_ c — = §j§ /� »E _ / \= \ ƒ / ° w M \/\ E« z £ = a o e § z % /k =_ � E �f N 2 k j CD § § � t \ -n � / z CL \ / \ } Cl) » � ! § K ) ) 6 G / r . % � � G e o \ % § � 7 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 395107 0 GENERAL INFORMATION 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: Mayer, Mar gene Somerset Township 032 - 2022 -20 -250 CST BM lev: f Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY - TATION BS HI FS ELEV. Septic 1 r - ! nchmar� ( 1 0041 loo Dosing r ®Q� - Nt.�, BM afid Aeration Bldg. Sew r Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION " ��. �� 7 TANK TO P/L WELL BLDG. 5Veto i r Intake ROAD Dt Inlet Septic ( 2 z /� Dt Bo 00 (�`� 3 �1 "77 Dosing Header /Man. (// - Aeration Dist. P. oe - / - - ' 1 Holding Bot. System i Final Grade PUMP /SIPHON INFORMATION y.;'i�ir/l%�» f �' /�,✓ o pt rZ �.5 /� ` z� Manufacturer _ , nd St Cover 'l GPM Model Num ! /1f tip 3 C TDH Lift Fri c Loss System Head TDH Ft •� j�'. p 1 Forcemain`- - Dia. SOIL RPTION SYSTEM /�� �° -fit u_, e D1 ENSION � / RENCH Width Length +� No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI �� >_ J SETBACK SYSTEM TO P/L ., " BLDG WELL LAKE /STREAM EACHI G Ma f cturer: � E INFORMATION HAMBER R { QL lx��Z Ty p Of System: �[ > _ _UNff Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution ' �� yy �. �, i x Hole Size x Hole Spacing d f! Pipes) �y i lI -.1 S l5 � Length Dia Length / Dia Spacing _ . 7 / SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / .u1�4i Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center >,n� °= e rench Edges Topsoil Yes I No Yes No COMMENTS: (Include code discrepencies, persons present, /4 6 etc.) Inspection #1: - , - , > / ) d - l Inspection #2: Location: 1787 38th Street Somerset, WI 54025 (NE 1/4 NE 1T30N R19W) 063019551C10 N/A Lot 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = ' — f —?C Plan revision Required ?] Yes Use other side for additional information. Date Insepctor's Sign ure Cart. No. SBD -6710 (R.3/97) D�3 �R 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 144stotisin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)J (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application. State Plan I. D. Number 5� • �ro k 3 9 -�-- I. Application Information - Please Print all Information Location: Property Owner Name Property Location 7- t C 1/4 Cl /4, S T Q ,N, R (or) Pr s- Mailing Address - _ Lot Num er Block umber 17 97 7 ' 1 " S l - lS�i4 City, State Zip Code Phone Number Subdivision Name or CSM Number p II. Type of Building: (check one) ❑ City M 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village ❑Public /Commercial (describe use):_ ($ Town of ❑ State - Owned s ot7ew Y & 7 - Nearest Road - 38 � %. Parcel Tax Number s) C III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) l 97 C- A) 1. ❑ New 2. CA Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System Systep Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ;dNon- 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) cj /. "7 S ✓ Elevation 1 00 66 7 ✓ /Nfi /G T/1/+i0 ,7S ✓ �8 7S S. 82 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks _ 4 ❑ ❑ ❑ ❑ � SO SO V ` ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of th e POWTS shown on the attached plans. Plumber's Name (print) Plu a 's Signature (no stamps }: M� N� Business Phone Number 'r— 'Y 7 �5 - -G Al A�-#1-7 / 7 7 bL- ; 'e- Plumber's Address (Street, City, State, Zip Code) S IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fe (2 � Determination PZ Z 5 Z z X. Conditions of Approval /Reasons for Disapproval: ada,t doh e,1 per 6 -F3. e r W�aw k n +i ��ev M �t ihS�a��PP QhIX �� �rui Gec� � } a�C'� u r� v S ✓c'Gou+►x �.. da o�. 5 . SBD -6398 (R. 07/00) I a , 9y : t � 3 � �o S o►� Co u-v 5 - , I , Er -LL— - r — -- t , W. ' fie- , , : '3110 —� �frr4pL�C U6rArr – I , rL.90.75 CAL. �'9, 7,r }EL, g8� 7s , o _ y , i t e _wz Q 1 ft k 1 T 14 I I # � 3 I � � I f L- 4 - P -1. -In 1065 * Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 032- 2022 -20 -250 Please print all information. Re ' ed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). — -- Property Owner Property Location Mayer, Margene Govt. Lot NE 1/4 NE 1/4 S 6 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1787 38th St. '" ` na na 38 Acre Parcel City State, Zip Code Phone Number City J Village jA Town Nearest Road Somerset I WI I 54dZ5; 715 -247 -3649 Somerset 38Th St. New Construction Use: id Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement -J Public or commercial - Describe: Parent material Pitted glacial drift Flood plain elevation, if applicable na General comments and recommendations: Area suitable for a conventional septic system with a 0.5 gpd /sgft. rating. 4 step trenches are recommended. Possible elevations 91.75', 90.75', 89.75', & 88.75'. Boring # A Boring Pit Ground Surface elev. 92.63 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0-17 10yr3/3 none sil 1mpl mfr cw 1f .2 ✓ .3--' 2 17 -27 1Oyr4/4 none scl 2msbk mfr gw 1f .4 ✓ .6 ✓ 3 27 -36 7.5yr4/4 none scl 2msbk mfr gw - - - - -- .4 ✓ .6. 4 37 7.5yr4/4 none sl 2msbk mfr cw - - - - -- .5 ✓ .9 ✓ 5 47 -67 1Oyr5/4 none ms Osg ml cw - - - - -- .7 ✓ 1.2/ 6 67 -100 5yr4/4 none sl 2msbk mfr - - -- - - - - -- .5 ✓ .9 Boring # �J- Boring 1e Pit Ground Surface elev. 94.70 ft. Depth to limiting factor 101 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 I *Eff#2 1 0 -18 1Oyr3/3 none sil 2mgr mfr cw 1f .5 .8 ✓ 2 18-45 1 Oyr5 /4 none ms Osg ml gw - - - - -- .7 ✓ 1.2 i 3 45 -101 5yr4/4 none 2msbk 2msbk mfr - - -- - - - - -- .5 ✓ .9 ✓ 3 ,r d * 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 Thomas J. Schmitt �.2ao� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 7/16/01 715- 549 -6651 I Property Owner Mayer, Margene Parcel ID # 032 - 2022 -20 -250 Page 2 of 3 37 Boring # �j Boring Id Pit Ground Surface elev. 95.82 ft. Depth to limiting factor 102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 - 10yr3/3 none sil 2mgr mfr cw 1f .5 ✓ .8 ✓ 2 9 -16 10yr4/4 none sl 2msbk mfr gw 1f .5 .9 ✓ 3 16 -34 10yr5/4 none Is 1 msbk mvfr gw - - - - -- .7 ✓ 1.2 4 34 -54 5yr4/4 none sl 2msbk mfr gw - - - - -- .5 .9 ✓ 5 . 54 -102 10yr5/4 none sl 2msbk mfr - - -- - - - - -- .5 ✓ .9 ✓ 4] Boring # = Boring 17J Pit Ground Surface elev. 91.89 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 1mpl mfr cw 1f .2 .3 ✓ 2 9- 9 10yr4/4 none sil 2msbk mfr gw 1f .5 i .8 3 19 -44 10yr5/4 none Is 1 msbk mvfr gw - - - - -- .7 1.2 ✓ 4 44 -100 5yr4/4 none sl 2msbk mfr gw - - - -- .5 ✓ .9 F-1 Boring # Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 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 —A ..,otPr;oI otro, t, f —t n]-- ,..»,root the r1--t —+ .t AAR_ MA-11 1;1 — TTV A02 -')f A_R'7'7'7 b psi ,o I�dr�e 3a BM 62 9.7 4 wa y Iltus4P �. a� k �')O r a e' /��/� �i�0e '6�/ Aj G© -feel o -1 , . /0 _ b�; XV k/ Ste►, s py`, L-�� s`3oo'4uS— ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer f "IA &Jfr�CNLE I l'`?"��!.k:-:7 Mailing Address 78 _3 8 '' Property Address f 7 �3 S Tfr S'7- (Verification required from Planning Department for new construction) Ci ty /State rS't3Nrf= Zl)j . Parcel Identification Number 0 3,� — A - 2 D - 9SO LEGAL DESCRIPTION property Location _ A1,F V,, Aug ' /,, Sec. �� TAN -R_W, Town of �So/'7E s� . Subdivision IVA . Lot # .. IVA Survey Ma # Volume _, Page # Certified Su y p Warranty Deed # 13;L , Volume G . Page # Spec house ❑yes 9J no Lot lutes iden tifiable 2 Y es ❑ 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. p � m , g certification form, signed by the owner and by a The owner a to submit to St. Croix Zoning Department a certi master plumber, joumeymanplumber, restricted plumber 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 t forth, here' as set b 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 th se rth, in, y offi within 30 C ounty Z on i ng Offs e St. Croix Co Wing tY days of the three year expiration date. / SIGMA OF APPL C DATE OWNER CERTIFICATION g ( the owner(s) of I (we) certify that all statements on this form are true to the best of m y (our) knowled I (we) am (are) 'bed above b virtue of a warra deed recorded in Register of Deeds Office. the property described y tY SfGf4ATU10 OF APPLICANT DATE * « * « ** A Formation 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 , �� .3, D or malfunctions identified during maintenan described i it m #2 above shall be repaired in - dmin Code , col w i t h Conim 83, Wis, A 4. Anytime a failure o r malfunction occurs, it shall be reported to the owner of this POWTS. Repair or connection o f such failure or malfunction shall com ply with Comm 83, Wis. Admin. Code. 5- No one should enter a Se - an 0 without being in ful septic or o th er t tank for y r eas on coinpliance with OSHA standards for entering a confined space. The atmosphere within these tanks may conmin lethal gases and rescue o f a person from the interior of the tank may be diff or impossible. 6. NTo product for c hemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Jkpaitment o f Commerce in accordance -Aith C 84, Wis. Admin. Code. nn 7, In the event that tI oracomponer-It Of th p VTSfails grad ca ot be repaired, the following contingency plan i proposed This may require a neNv soil evaluation to determine where a new sod absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance w i t h C omm 83.33, Wis. Ach-nin- Code, 9. Name and number of local health 1 0 . N ame o f service contractor in case of failure or malfunction;.- QML=aYa1iD9 NAY" f Page nr1ANA ��Nf P , ,his private ()asite Wastewater Treatment SyA an (POWTS) has beet: designed ;ins is to be in;lalled and maixitained in af>K=dingto Comm 83, Wis. Mmin. Code, the in- Ground Soil .kbsorrtion Component. Manual for private: ()nsite wrasLcwater Treatment Systems (SBD- 10567 -P; Sane 11, 1999 1. This POWTS has teen designed to accoinniodate a maximum daily flow of 600 gallons of domestic wastei vater -per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following` a monthly average of 30 mgL fats, oil and txease a monthly average of 220 mg/1., POD 5, a monthly average of 159 mg/L TSS. Wastewater shall not be disciiarpd to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tabled. I & 2 at a point of standards application, except as provided in Comm 93.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The followirtg maintenance shall occur wlthiD three (3) years of the date of installation and at least once every three years thereafter 1. 'I'he septic tank shall be puinped be a certified septage servicing operator, licensed under s2.81_.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tans volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one -third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch, NR 113 Wis, Admin, Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing; operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tmik filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer`s specifications. The filter cartridge shall not be removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent# intervals may be necessary. 4. Any pump, alarm or related electrical connections shall be visually checked for confirm that they defects and tested to co are operating properly. 5. Repons for all *. maintenance shall be submitted to St, Croix County Zoning in accordance with Comm 93.55 Wis. Admin. Code. 532785 ' (ntN.1 STATE tMl< ASSOCIATION tall TW LEGAL gMW Of THI VW Fix aft-- 1 ms. _ 011ciai rr+.,.sr,., e.c ewu w r«. sent Of TH CORM, Q _ -- UIT CLAIM GEED k nots ailIen by �t�r�r eegem�c• That Ashton State Ba nk, a Iowa Corp -- in cc.isideration of the sum of Ir Zero Dollars & No /100----------------------------------------------------------- jj in hand paid do hereby Quit Claim unto Margene V. Mayer, and Margene A. Mayer____ 'I �I t i Grantees' Address: all out right, title, interest, estate, claim and demand in the following described reel estate situated in x St. Croix ty Gr�isco IT� � � —Coup sra, �o- : ! Attached "Exhibit A" hereto made a part thereof. OT k � 1 Rerdtl fur AUG 21 IQ A Lt 12:00 P. . fta•...J�Gf_�:ut.1 � P i Each of the undersigned hereby relinquishes aff righ +s of dower, homestead and distributive share in and to the ' above described premises. a II i Words and phrases hrrein. including acknowledgment Imweof, shelf he construod as in th singular or plural number, and as masculine, Feminine according to the context. _' D 19 95 Terry G. ser, President .r.r. 317 3rd treet, Ashton, Iowa 51232 P. i f Abram) ..,,. AMW twlis ,MN 95 19 \_J r r O Karen A. Simington, Trust Officer �� 317 3rd Street, Ashton, Iowa 51232 (Gr.etee"t Addres) i Dated 19 i (GreeFe - Address) f � fe " t STATE OF IOWA, COUNTY OF Osceola - - -- ss: On this 11th day of Aultust , A. D. ISM_" before me, thin undersigned, a Notary Public in and for said County and Slate, personally appeared Terry G. Moser, Pr and Karen A. Simington, Trust Officer _ FC o a' my Commission E)O" to me known to be As identical persons named in and who executed the o„r 1- lin - aka foregoing instrument, and acknowledged that they executed the same as their voluntary act and deed. Note Public in end for d Counbf and State now Sept. it" am aaM ease 11Tti a6 s; sE .._ r MF as 's TWh"` -1Y—M'sa: 3 ` ' ;_ .,+; .; .. <#' «:- a •: :.;. s .. .. -. .a. f a. Y"i'.o 'k -AAA, ?J'aS�:w "Exhibit A" 4 '` VOL IVXG)FA : - NEh of the NEh except that part lying West of the Town Road, also except that part cf the NEh of the NEk which lies North of aline South of, parallel with and 75 feet distant frem the center line of the main railroad track as now located, Als.: that part of the NWh of the NEk lying East of the Town Road, All in Section 6, 2ownshio 30 North, Range 19 West, St. Croix County, wiscolnsi.n b t t' S i i