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HomeMy WebLinkAbout032-2129-40-000 and buildings Division County - - ^� 201 W. Washington Ave., P.O, Box 7162 _ sconsnn Madison, WI 53707 - 7162 ire Address pe tment of Commerce A Sanitary Permit Application S �'�' ? o t 3q I 4 In accord with Comm 83.21, Wis, Adm. Code, personal infortnadon you provide ❑ Check if Revision may be used for vxondary purposes Privacy Law, s15. 1 m I. Application Information — Please Print All Information D State P lan I.D. Numb Property Owner 's Name Parcel Number � _ _1 Property Ow r s Mailing Address Property Locadon 1 ::E K ,A ; S TX-N, R U Z5 i City, Stare Gip Code Lot Number Block N ber 15 V1-1 Subdivision Name @Sfvl"fr U. Type of Building (check all that apply) � tt1.a t �!112116 Doty ,WSJ 1 or 2 Family Dwelling - Numbcr of Bedrooms _ .. _- ❑Village ❑ Public /Conunercial - Describe Use _ �- OTownshi ❑ State Owned Nearest Road III. Type of Permit; (Check only one box on line A (numbering scheme for internal use). Complete fine B if applicable) For County use A I New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑Addition to S stem I Tank Orel Existin S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit; (Check all that apply) (numbering scheme is for internal Ilse) 44fi(Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 5o ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 Q 9Chcr _ V, D' ersal/Treatment Ar Info rmation: S Design Flow (gpd) Dispersal Area Dispersal Area Soil Applicauon Percolation Rate ystcm Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation I - ^� -- - - ' / Plastic VI. Tank Info Capacity ear Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons of Tanks Concrete Constructed Glass Now Existing Tanks Tanks Septic or Holding Tank _ r 7/- Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibaity for installation of the POWTS shown on the attached plans. Plumber' a (P ` ) Plum is na re MP/MPRS Number Business Phone Number Plumbers Address (Street, City, State, Zip Code L VIII, County /De artment Use Onl 5 Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse ZZ�- 2� < Dete rmination IX. Conditions Conditions of Approval/Reasons for Disapproval t 6� is j-u- app cmhA 4.Q,seo t�+o,�c J�(kr as pg.` Atwch complete ptwu (to the County only) for the "em oo paper aot Ieaa than Uri x 11 tncha In dse SBD -6398 (R. 05/01) �,, / /r.E�J ,Sr - "fie 7 -=viS! /�19d�� -/ l•�/,=L�S - � I AO': 7ir,61e- �, � y/ �i¢sul� �O�y:° // .off✓ SL�- ����- srC /,� ' �..3G'� � /y'6�l r �tvr: /rC��s.ta J I y/ Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S � i C I - 6/ A/� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Piea li(IV li f ih(bz'mation. Reviewed by Date Personal information you provide may be used f smt ry ' purposes Triva(glaw, s. 15.04 (1) (m)). PrODertv Owner // Property Location U oy /J 'ter% t 1 . Govt. Lot S 1 1/4 /►' 1 /4,S �3 T > ,N,R / !(or)o t Property Owner's Mailing Address { � Lot # Block# Subd. Name or CSM# City State zi�Caale Phplae JtMber Nearest Road ❑ City ❑ Village ;K Town Iry 4 mowlt UU.T I M , 1 -7 �� , �� S0Me1J-e ,-- a -e as i New Construction Use: Ea ResideritlaW.Nuii�W edrooms _ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6L gpd Recommended design loading rate v bed, gpd /fi trench, gpd /fT Absorption area required JrI 2 bed, ft 7s® trench, ft Maximum design loading rate o bed, gpd/ft _ - trench, gpd/ft Recommended infiltration surface elevation(s) C7.3e° / ft (as referred to site plan benchmark) Additional design /site considerations , ,l Parent material CU P2 �f• �S �' red pc Jh z4I.,u / Flood plain elevation, if applicable yft ft S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U 1Z S ❑ U ® S 1:1 U 9s EJ U ❑ S R U ❑ S © U SOIL DESCRIPTION REPORT - Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 -s /Dr/r % �(/% .S /� r �'I L c w c �- 2 / 5-16 t/ % S / L /his /'I'1 �� C- 6v 7 C Ground ( � 6 7.S �y � V � /' /i/ q1 2 * 9 ­ . fi •5_ 'f 5 /t S S M . 7 o (J .4 Depth to limiting factor in. Remarks: Boring # 1 04 j0 %f G C V t-�' 3C .. a , Q kl 2 2 6 -16 /o rb S� /m 65 0 7. syR , I / 1��S �, iL 16,E W/1 W/1 �J Z/� , S 6 .� G round . ) i -V- � t / 44 MS © ( � mL C � � � .7 ; ' O qt ft. Depth to limiting 7 ` 5 in. Remarks: F lease Print) � Signature Telephone No. Date CST Number 9� --/92 a ,--e S�n?,e 4s 7 -zy O6 2��3�y PROPERTY OWNER 1 3 6 121 �Oa ✓� a� SOIL DESCRIPTION REPORT Pag& , o PARCEL I.D.# L D f " Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Ground 17- 4 7Sr� /v � � �fc0� / "T - CZ Z C el7' Y bU 7�r�S � � _ �i� � CAS � yi. L Depth to t� �Z 7S �/� �� �S /, ! L — t o e • T limiting 31i&1 factor T 120 in. Sy 90 Remarks: Boring # SL. /m 16a AV, Q S 36 Ground �8,�f� 7.5�� pt 6 /. /�i S (�S /' IL I j Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # i U- y la`�� % S �m L C li. C *4 S l�'y►Sb�lc� "(S 3C . .S` 46 N14 C- Gr 2�5 ���� /"/r y/1s� f 2#)f /�1�/ f Depth to limiting 7 - 10A - in. 0A in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER Page 3 of 3 Name ga//'Y 430a'114r"61-11L Brian Parnell Address ?7?- /6 -0 "' 1 au e CST 231314 N w 1?"C 4 A"Oa- j 14 T. Date 0 A Benchmark I ch- el' y e e /00,0 A Benchmark 2 ❑ Soil Boring 1 - - 1 Suitable Area 1 40' Scale 't L 0 i I T PID 1 7 irAlBrr I 1 1 Lj I j, I I j — T K 1 - 777 r, Al 1 7V .... .............. w . ` $ � ;� /T fi a''�' � ���� � ?� �` ll �`��� �� -- \( �((\ \• � L'�1�� \ \` , �i ��p /.�Y � � _ \ \� r �� 6 - 8 3I1 . / i .' /,,, � B k � i l l ' - 1 2A SUM �� i XT 42 v l T �OlK, IJ �.....\\ �� �Z fj ITS - S 3 4 4�O SQ.FT, �N o' S SA G ( � �A ,C�2.E S , ( ( 5 1 4 16068 9 � �`J� SQF'T AQ)ACRES a1n/ R 1 l I 4 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Huge Jof FILE INFORMATION SYSTEM SPECIFICATION Owner Septic Tank Capacity al in NA Permit # 90311 Septic Tank Manufacturer bjgcxS o NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model ❑ NA Number of bedrooms ❑ NA Pump Tank Capacity al -f NA Number of Commercial Unit NA Pump Tank Manufacturer ANA Estimated flow (average al/day Pump Manufacturer ANA Design flow (peak), Estimated x 1.5 ) gal/daZ Pump Model 6NA Soil Application Rate gal /da /f•t Pretreated Unit III fluent /EI'I'lucnt (Quality Munthly Average* t..j Sancl /Uravel I"ilter• to Peat Filter Fats, Oils & Crease (FOG) S30 mg /L r Mechanical Aeration LJ Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection ❑ Other: Total Suspended Solids (TSS) <150 m L Manufacturer Pretreated Effluent Quality 0 NA Monthly Average" Dispersal Cell(s) <30 m /L 0In- ground (gravity) o In- ground (pressurized) Biochemical Oxygen Demand (BODs) g o At -grade o Mound Total Suspended Solids (TSS) <30 m At-grade o -line o Other: Fecal Coliform (geometric mean <10' cfu /100mL Maximum Effluent Particle Size '/v inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every o months -5e ears Maximum 3 rs) Pump out contents of tanks When combined sludge and scum equals one third % of tank volume Inspect dispersal cells At least once every o months 3 ref year(s) (Maximum 3 yrs) Clean effluent filter At least once every ❑ months ears Inspect PUMP, I)III'llp controls & alarm At least once every o months o eur(s ) ,ANA Flush laterals and presSUre test At least once every o months o ear(s) o NA Other: At least once every ❑ months ❑ ear(s) ff NA Other: At least once every o months o ears z' NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of• the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third ('/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 1:3, Wisconsin Administrative Code, The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s), If high concentrations are detected have the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: �_� �.J Pace " System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. The area within 15 feet down slope of any mound or at -grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac T ment system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLJER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone i __ z ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 'Owner/Buyer Gl r S M C3, 1� Mailing Address 1 S l Property Address S (Verification required from Planning Department for new construction) City /State — 7 Parcel Identification Number t(9 Z-� LE GAL DESCRIPTION Property Location , :Y '/ _ '/4, Sec. _ 13 , T -30 N -R �)9W, Town of _ _,� ✓_sk Subdivision '1 �45 , Lot # �. Certified Survey Map # , Volume , Page # Warranty Deed # �'�s� , Volume ./� , Page # / 9l Spec house N yes O no Lot lines identifiable k yes O 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 an(Uor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, 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 he completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration te. r 'a A.A J-,-) & �� SIGNA F APPLICANT DATE QWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described bove, by ' rtue of a warranty deed recorded in Register of Deeds Office. 12CL A-A.14 SIGNATU F APPLICANT 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 I VOL I .3 F) PA C1 196 / r t STATE BAR OF WISCONSIN FORM 3 — 1 ��c�) U:.i QUIT CLAIM DEED DOCUMENT NO. Frank Keith Boardman a/k/a F. Keith Boardman_ a aingLe T. CRr�X : U., W! person AUG U 6 1998 ' quit- claims to Barry Boardman — 9 A M —�— 1 ;he following descTibed real estate in S Croix County. State of vlisconsin', PHIS SPACE RESERVED FOR RECORDING DATA NE 1/4 of SE 1/4, SE 1/4 of NE 1/4, and the NE 1/4 of NAME AND RETURN ADDRESS NE 1/4 EXCEPT Lots 1, 2, and 3��of Certified Survey `1aP VAN DYK, O'BOYLE & SILER, S.C. filed July 7, 1997 in Vol. "12", Page 3295 as Document Post Office Box 127 No. 561969, all in Secti.n 13- 30 -19. New Richmond, WI 5401i 032 - 2047 -80 -00 C PARCEL IDENTIFICATION NU ER # 032- 2046 -50 -000, and -� 032 - 2046 -10 -000 EXEMPT t This is not homestead PTOPerty. XiC (is not) Dated this U day of A.D., 19 98 — . • Fran Keith Boardman (SEAQ (SEAL) E 1 i \ v { c°•i Y RNER N z /1 O_ Cu lf') � 1 g80 <1 1 0 T, w o / .66 v I ll l 4 EAST QUARTER MM SECTO 13 0 �I i 160TH AVEN11r a T B O A R D M A N E � j 1 I PART OF THE NORTHEAST QUARTER OF THE NORTHEAST QUARTER AND PART OF THE N� �.._.._.._.. +.._..1.._..� ALL IN SECTION 13. TOWNSHIP 30 NORTH, RANGE 19 WEST, TOWN OF SOMERS T A RUM i I a 1 E I A a 147 lw.W to 13 " m C- !4726' K1 L70M W. j 1 p 1 I 1 �illi0k 71LCW 77.72' 17n —735 I'll w. 29 W nrr t1r 6slh.rt mwr d 23120' 7166' 17LAW 0.!6'37]012'• at ,,1 i d h— PI•L El—UW.66L]6' L.. _.. _.. _..1..._.. _.._. J E-F 1 720' M.1 n.1Y mu 6777r7LYw 9 2.7 d Or •-t dkw d 160th Aww1 Oil 1!101 12126' 301{ SM7'1L6 M wr 10 o YAP sM • n..lh.rl) �A,n.im d tlr e.•hr0u H 167.110' 700.14 4.66' a6 Jl $7{V W rW w j 7qf W 9k. d.Aa. 70 Twn lloai Ebwtlsn2764S 11 233 14L61' 1 0D 4621 tls 66 T 13, LaM. PLINK i yt Wwr OF tnMEFI6E7 t 2uoo 4"r 4om• 11"23 se 4. LL am 60. a 107 7 11100 W7.64 toaN' IMOd'16'E NO 1 r-M 16720' 160.14 16161 I 04 112a'0m N5 0-P 23120' 1JL47 131.16' I 33W4r I 111 NO 1 197W 67.72' 0.l. j FT 20.14]' n31T M n >iD UNPLATTED LANDS I UNPLATTED LANDS WEST LINE OF THE SE 1/4 OF THE NE 1/4 SEC11ON 13 NCC'04'14'E 11107.ff'7 ' —� -- -- ---- 711n.10' ---- -- � •� � '\` 70. '-�- — ��-- ' IOr�.ao = -- _ ..—. 60' RADIUS TEMPORARY CUL -DE -SAC EASEMENT � TO 13E REMOVED UPON \ i wrrs r.� \ OMSON OF THE L O T 11 ��'• ,• \ \ f ROADWAY. - 214,010 SQ FT \ \ \\ 4 91 AQ4ES L OT 12 1 N 3=952 Sa FT j w6r rrs.lur ® \ ' I A \\ ' d 1J AOWS 1 j Nf 4 41.E \\ A `�© `'1 I It It 371.4E LOT 10 " 16Q &'P5 54! FT .16B ACRES 1 j j g 77NYW N41Y4' �ae.n, Q 1 M I 1 JA 423 SO I� p ig n A >< ' q 1 1156 t; +; i� 7.49 ACRE E p® y� $ \ ti 1 A ll, ;• \\ I I i , A C \ LOT 8 - - -- ^tYap�(�y ��1• 249,&36 SO. FT. %,% 5 74 A CRES gig i x � _ L O T 8 70 � 21.x, 440 Sa FT. R � 1-0 2 490 ACRES j rrr.».w 134730 S j .100 Aa 800'00 e" us Ey 731./C 442 NORM-611M GUAM LM !00'Ob'BM W 293L44•— id S07'02 ` O T '01 "E i 1 375.45 159,918 SQ. FT. 0 3.67 • � 2 . O ACRES 38.97 -d co GI N00'00 ' 50 "W 256.61' (o ca soy 00.73 II �� O 0' p/P,1pyg8'5�� N0 029'03_W r tiJ3� c v D ► -' S09ti c E � !ENT 82.34' SJeS N 9� (D y . s. �9 \'�• y o _ S G7 \ • lr MAIN 4 6.68' - _ + 0 •• O O � \ a� N'7112�9 t *9 6q. f N.W. 95 EASEMENT 4i 1 (Q ' O. 4.9' N. W.L m r � � � ��. g �01 f 6g. s ! v Go I Oj \ mss. \ .r s pa ?�. 1 ��N. ' � �, •'�� I .... . OT9 � � oti •. � �� O -� 0 249,8J6 So. FT. 6 ti , \ �I 61 00 5.74 ACRES _ kY �1 �•6 MINIMUM F.F.E._958.9' �s'" SZ� � ° p p 'Z -�/ ��� �t��6 r : � •••• �% w P� CST' \ • NO2'45'58*W 72.20 , / F " P AB p 2 6.64 N07ro3�•E L 4 T .......... " � . �� t; 213, 440 SO. FT. _ ti 4.90 A CRES z w -pt MINIMUM F.F.E.,954.6' n 0 2 � N 1 00 � D EAST UNE OF THE NE 1/4 -- ----- - - - - -- S00'00'56 "W