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HomeMy WebLinkAbout032-2128-00-000 1 Depadment un onerce Buildings Div PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix ` GE NERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal Wbrmatlon you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)(. 384108 Permit H er',s Name: ❑ City ❑ Village ❑ ToWn of: State Plan ID No.: New and Scott Somerset Townshi CST BM Elev.:- Insp. BM Elev.: BM Descri ion: Parcel Tax No.: (� •'D / -t) UD d� C$r qk 019-2129-00-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 2c Benchmark of 10 O0, p r Dosing Alt. BM Aeration Bldg. Sewer 1- Holdin St /Ht Inlet Z 1 TANK SETBACK INFORMATION St /Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Ot Inlet Air Intake Septic 40 .0 SZ NA Dt Bottom Dosing NA Header /Man. Aeration NA Dist. Pipe �• �� oZ r Hol tng Bot_System PUMP/ SIPHON INFORMATION Final Grade Manu cturer Bel ,. Model Num GP TDH Li Fri I System TDH Ft Length L oss Dia. Fi F Dist. To Well SOIL ABSORPTION SYSTEM (L3 K ,, L, QAII� 4� BEO /TRENCH Widt l 1 L n th No.Of Trenches PIT No. Of Pits.: Inside Dia. Liquid Depth DIM ENSIONS 'JJ / g� s e� 3 D IM E N S I ONS SYSTEM TO P/L I BLDG WELL LAKE /STREAM LEACHING T Manu acturer: SETBACK CHAMBER — ' 1 '� INFORMATION Type O I / Mod Num er: System: ��x� r 5,10 q l5 '� OR UNIT DISTRIBUTION SYSTEM Header / Mani old � Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length lam Dia. 1a. Spacing > 1� 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 [] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) K M } Inspection #1: oS / 31 / oI Inspection #2: - - I L � Location: 538 164th Avenue, Somerset, WI 54025 (NE 1/4 SW 1/4 9 T30N R19W) - 0930191142 Wagner Estates -Lot 14 1.) Alt BM Description= • 2.) Bldg sewer length= SZ ' t o • ---� - amount of cover = ��. 3) �r. Q, - tau �t I • 4 ' 1 , Z a &S = Plan revision required? ❑ Yes WNo -- Use other side for additional infor at on. %2- 7 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. r �� •�1� �F' ' ' C G 4,1 1 fl �� O �' m �� Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 P g PP �Wflseonsin 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 com lets plans (to the county copy only) for the s sici on aper not less than 8 -1/2 x I I inches in size. County State.SaniLa Pp 0 Number ❑ C�e& if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information t' U Location: Property Owner Name F , : , Property Location 1/4 S T e ,N R or Property Owner's Mailin Address ;" ; } ;��: " :r� a i T -.) Lot Number Block umber / l City, State Zip Code r P ; ne Nump Subdiv ion Name or CSM Number l II Type of Building: (check one) __`.- ❑ City ,11i( 1 or 2 Family Dwelling —No. of Bedrooms:_ ❑ Village ❑ Public /Commercial (describe use): (9 Town of ❑ State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road t� A) 1. ,IO New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued "" ha ° 40- 00 IV. Type of POWT System: (Check all that apply) -IOD ' q,30, gi l a XNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At grade o ❑ Aerobic Tr atment Unit ❑ Recirculating ❑ Other: s J, 8 •2S V Dispersal/Treatment Ara Information: I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./ /jq. (Min. /inch) Elevation I� i VI Tank Capacity in Total # of M act er Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility for insta ation of the POWTS shown on the attached plans. Plumber's ame tint) Plumber's Si atu a (no sta MP /MFRS No. Business Phone Number PI mber's ddress (Street, City, State, Zip Code) VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) I RA proved ❑ Owner Given Initial Adverse Sur arge Fee) Determination , OD f IX. Conditions of Approval /Reasons for Disapprov I: SBD -6398 (R. 07/00) /9AJ T� y � _ e� - 1 J - : i 4i - 39 *7 : h 7 / r A ' I i O L a� i nsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of (vision of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8' /z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, an ' lance to nearest road. Parcel LD.# APPLICANT INFORMATION - pl all nforetnaatn. 032 - 2034 -95 1D#9.30.19.606 Personal information you provide may be used r s , dary l: rpoa,(Pnvacy Lbw, 15.04 (1) (m)). viewed ate f Property Owner L ' roperty Location Gay len Schilling, Buyer: Greg o` nsonr 'G vt. Lot NE 1/4 SW 1/4 S 9 T 30 N,R 19 W Property Owner's Mailing Address a i-qt # Block # Subd. Name or CSM# 498 150th Avenue ` 14 Plat Of Wagner Estates City State ',Zip Cody Rhgr�imber] City ❑ Village ❑Town Nearest Road Somerset WI 025 71$ -S'49 =473' Somerset 501h Street ❑ New Construction Use: Resl al lNurtier of rooms 4 ]Addition to existing building ❑ Replacement [] Public or comet€ i describe Code Derived daily flow 600 gpd Recommended design loading rate •5 bed, gpd/ftz .6 trench, gpdff Absorption area required 1200 bed, ftz 1000 trench, ftz Maximum design loading rate .5 bed, gpd/f? .6 trench, gpd/ftz Recommended infiltration surface elevation(s) 96.75'. ft (as referred to site plan benchmark) Additional design / site considerations In stall trenches using high capacity infiltrators. Parent material Glacial till Flood plain elevation, if a plica ble na ft ` S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank \ 1 1 U= Unsuitable for system ® S ❑ u ® S E] u ❑ S ❑ U ❑ S ❑ U ❑ S ®U L] S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft Horizon Texture Consistence Boundary Roots Borin 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ! Trench 1 1 0 - 10yr3 /3 None A 2msbk mvfr gw 2fm 0.5 0.6 •S 2 174Q 10yr3 /2 None 1 2msbk mvfr cw if 0.5 0.6 ,S' Ground 3 40 -62 10yr4/4 None sil 2fsbk mfr aw - 0.5 0.6 .f elev 99.87 ft 4 62 -88 7.5yr4/4 None sl till 2csbk mfi - - 0.5 0.6 • S Depth to limiting , factor Remarks: —_ —_ -- -- -- - 2 1 0 -11 10yr3 /2 None A 2fsbk mvfr cs 2f,m 0.5 0.6 2 11 -32 10yr4 /4 Non sl 2msbk mfr cs 2f,lm 0.5 0.6 ,S Ground 3 32 -96 7.5yr4/6 None s & gr. Osg ml - - 0.7 0.8 a elev - ' 100.90 ft Depth to limiting factor $ >96' Remarks: CST Name (Please Print) Signatu Telephone No. James K. Thompson z— 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, 54020 5/8/00 3602 1233 I I ERTY OWNER: Gavlen Schilling, Buyer: Greg Johnso SOIL DESCRIPTION REPORT 1233 Page 2 of L I.D.# 032 - 2034 -95 ID#9.30.19.606 A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPD/ftz Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed Trench 3 1 0 -11 10yr3 /3 None sit 2fsbk mvfr gw 2fm 0.5 0.6 2 11 - 7.5yr5/4 None Sil 2fsbk mvfr cw if 0.5 0.6 .y Ground elev 3 21 -41 10yr4 /4 None Sil 2msbk mfr aw - 0.5 0.6 102.49 ft 4 41 -59 7.5yr4/4 None sl till Icsbk mfi dw - 0.4 0.5 Depth to 5 59 -105 7.5yr4/4 None s & gr Osg ml - - 0.7 0.8 limiting factor >105 "R4 -�f� Cog .9 k e} . Remarks: 4 1 0 -14 10yr3 /2 None Sil 2fsbk mvfr gw 2frn 0.5 0.6 ,T - 2 14 -22 7.5yr5/4 None sil 2fsbk mvfr cw if 0.5 0.6 .57 Ground elev 3 22 -32 10yr4 /4 None A 2msbk mfr aw - 0.5 0.6 .5 104.03 ft 4 32 -81 7.5yr4/4 None Sl till 1 csbk mfi cw - IM 0.6 Depth to 5 81 -92 7.5yr4/4 None sl till Om mfi - - 0.3 0.4 limiting factor >92" o I Remarks: 5 1 0 -9 10yr3/2 None sit 2fsbk mvfr gw 2frn 0.5 0.6 2 9 -19 7.5yr5/4 None A 2fsbk mvfr cw if 0.5 0.6 ,S' Ground - -- elev 3 19 -32 1Oyr4/4 None Sil 2msbk mfr aw - 0.5 0.6 -5 4 32 -62 7.5yr4/4 None s1 till 2msbk mfi cw - 0.5 0.6 S Depth to limiting 5 62 -91 5yr4/ None A till 2msbk mfi - - 0.5 0.6 "5 ' factor >91" Remarks: Ground elev Depth to limiting factor Remarks: py . 30.r B L ow / pla orcJ �Yner E.s&16-e ♦ .06/a T. o (2 ro �'k Co., w/. P, —9a 4 s lope / I nn L� C V 8 ■ Pr F.mo�r 5 y SE�rn c a ■ /.38.38 BI Proposed pu-b U- rcoLd Qnch a.r/C: 7oPo�'lo�.5���'. A Al . je . e P s + Management Private Onsite Wastewater Treatment Plan g 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 g O Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) _ N Soil Absorption Component Size (ft') S Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) (otv $•� Z - OK Maximum Influent Particle Size (in) 0 1/8 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 se d outlet filter shall be assessed at least once every 3 years by inspection. The utlet fi hall be cleaned as necessary to ensure proper operati The filter cartridge should not 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 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 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 01!21/2001 08:48 715 - 684 -5638 SCOTT NEWGARD PAGE 02 01/1!/20f+1 12:34 715247306 SEL SLE EXCA "VATING I PAGE 02 ST CROIX COUNTY SEPTIC TANK MAINTENANCE ACABEMBNT AND OWNERSHIP CERTIFICATION FORM Owrtte"uyer 5, u ri t f 11.CL M ailing aaa>•$ _ _7 10 0 +� . Lt i 1. �. Property Address 5y (Yeriflcatien required frons Planning Depstpnent for new coasInKtion) City /State er - parcel Identification Number • LE GAL 9910I 03� �d3 9S I Q,�R1d T Pro – T -RW, Town of Q perry 1v.7catiots '1. , Sec. , Subdivision � —A �j Lot i1 ,4' Cetrtlfled Survey Map k , Volume � , pass 0 -� Warrataty Deed M Z-1?U.99f , Volume ' �,., page ty Spec house © yes no Lot lines identifiable x1 yes 0 no improper use and rnairtsnanet of your orptic: system could result iA its premature failure to handle watt s. Proper Maintenauee consists cf pumping out the scpiic tank every three years or sootier, i f needed by a Ii Awt:d purnper. What y W put into the syatest can alYbct the ft heron of the soptie tank sa a treatment stage w tt:e waste disposal system. n4 property owner agrees to submit to St. Croix Zonis= Depemnent a certification form, signal the **ter and by it master plumber, jouineymanplumber. restri: tedpl umberorslice nse4purnperverltyinzgthst (I)theon•sitewast terdisposalaystem is in proper operating condition and/or (2) after inspection and pumping (if neresssry), the septic teak is less o 113 full of siadre, Uwe, the undersigned have read the above requirerncnta sad agree to mairdaio the private sewage diaposat a to with the standards set forth, herein, as set by the Department or Commerce and the Department of Natural Resources, State of W consia. Certifieatieo Atari that your septic syste has been maintained must be completed and returned to the St. Croix Coubty in Offi within 30 days r the three you oxpt ion date. ATURE OF LICANT DA OMZEI, CEYtMICATION I (we) earthy that all sutements on this form are uw to the best of my Our) knowledge. I (we) s (arts) the o wner( c) of the bed a , by vinue of 0 watrtruy deed recorded in Register of Deeds Qfllce. o � NA APPLICANT DA 004.049 Any inforrnation that is mis- represented ml result In the sanitary permit being rcvoked by the Louis t Dopefftilnt. •••••' •• include with the$ apptteativn: a stamped wsRanty deed trot# the Register of Deed$ oftfce a copy of the certiAcd survey map if refcrencc is made In the warranty de 14 1576wi 571 6 116, 4 - = ) 'ED 4EI 5TAFF13ARO: lhj8C(JNSINFORV12-099 KATHLEEN H. WALSH Documew Nufft'r WARRANTY DJ REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Nottingham Development, LLC,- RECEIVED FOR RECORD tyGre;_John& , its sole member, 01 -18-2001 9:30 AM WARRANTY DEED Scott Duane-N—esia= and EXE9T # --- CERT COPY FEE: 5 1, hushiiiind and COPY FEE: TRANSFER FEE.- 166.20 RECORDING FEE: 10.00 PAGES: I Grantor, for a valuable cornideralion, conveys to Grantee the following described real estate in St. Croix — County, State ofWisconsir (ifmo"e space is needed, please attach addendum;: - " - .t �14 Recording Ale% L 4, ogner Estates in On Town ofSomerse;, St. Croix County, Name and Rctum Address -VntVnsik-- DAVID J. ESTREEN 304 LOCUST STREET HUDSON, WI 54016 t, 307 032-2034-95 P dcmir Nj This j riot homestead property. OU (is riot) Exceptions to warranties: Ease rnerts, restrictions And rights-of-we) of record, i ally. Dated this day ut - January 2001 �Nonsv�SbDemlapm I,LC Its we ber ALTHENTICATION ACKNOWLEDGMENT STATE OF WISCOrSiN County avtheami,atcd this Personally came bcfbic inc this day of - - -- / C M u{/ / t� __ _ — - -- - .1saaary 001 the above named Nuttin hem DeveMP meat, - LLC,by Grcj_joh�nn its sole member, TITLE: MEMBER STATE BAR OF WISCONSIN to me known re be the person(s) w)u exccoted the foregoing (if not, instrument and acknowledged the same &LIthorized by § 7U6.06, Wis. Slats.) THIS INSTRUMENT WAS )RA BY Attorney KriItina 0gland Notary Public, Statcof Wis(; fludsom SWR My Commission is permanent- (If no. state expiration date: (Sijimures maw be authent-ca:eLi cracknowledged Both arc not necessary.) NammC6 of PCrMS signing in any UPI&Cit) must be aped of primed below their signature, jq,r on F.aasa,mao Comps y FcfW do Lac VW STA rE BAR OF WISCONSIN WARRANTN DEED FORM Nc. 2 - 1999 � � s C � ..a. Ira :I •1 I..i . V Lf! �•, • . • rrN _'—• - _6 0 1100'1) 00024' I I I ;1 n • j. 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