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HomeMy WebLinkAbout032-2129-70-000 Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Coungt:. Croix INSPECTION REPORT GENENAL INFORMATION (ATTACH TO PERMIT) Sanitnfgnit No.: Personal information you provice may be used for secondary purposes (privacy L.aw (1)(m)). Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.: ev.:- / Insp. BM E ev.: BM Description• Parcel Tax No.: [Ov.b W.D 1 I tsv •J� w � (z - , '- L 32 -9 /2-y - 7d —d-� TANK INFORMATION ELEVATION DATA • " TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV_ Septic fee s �o Benchmark ��{.(o ftlis `ao . o' Dosing G ' 3.6(. �o3.20 Aeration Bldg. Sewer (• Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic > 35 5 --� NA Dt Bottom Dosing NA Header/ Man. 8•�D D, Aeration NA Dist. Pipe 6 Holding Bot. System < 1 0 .3s PUM / SIPHON INFORMATION Final Grade CIE. }-e Manufa urer St cover Model Tbe GPM TDH Lift Lrictio tem Ft Fo ain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM(u) c,�.as 24j— •�,�,,,� `�^ BED / TRENCH Width f Len yy t t��F � No f T enches PIT No. Of Pits Inside Dia. Liquid Depth DIM ENSIONS 3 (a5•�T «.I Z DIMENSION Ma nufa rer: LEACHING SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ' �.— INFORMATION Typeof IS I �3 bs' CH UNIT M R ' - e Numb System: DISTRIBUTION SYSTEM -I�s�&a -t 'lt<� P SL r--d2 1.6 -+ /L I:7' 3!'° Header / u I Distribution Pipes) �Hole Size x Hole S acing Vent To Air Intake Length g�- Dia. t pacing 7 �D SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only xx Dep Depth Over Depth Over th Of xx Seeded/ Sodded xx Mulched Bed / Trench Center Bed /Trench Edges Topsoil [] Yes [I No ❑Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc ? nsDection #1:0612 (Inspection #2: Location: 1557 89th Street, Somerset, WI 54025 (SE 1/4 NE 1/4 13 T30N R19W) - Boardman Estates -Lot 11 1.) Alt BM Description= 2.) Bldg sewer length = *4 - amount of cover = > '5 - ..A C"" Plan revision required? []Yes CJ No \ � Use other side for additional information. I �uv HIE[ SBD -6710 (R.3197) Date Inspectors Signature Cert. No. I - 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 lV iscotisi n Personal information ma ou provide be used for second u Madison, WI 53707 -7302 Department of Commerce y p y purposes (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not -- state owned.) Attach complete plans (to the county copy onlyAr ern,, er not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ' if revisiomtk prey )Qus application State Plan I. D. Number I. Application Information - Please Print all Informa ,,; I" E. IVIF 1 1 1 1 1 ; , Location: Property Owner Name j ' Property Location t p � ® 1/4 1/4, S T N, (or Prope rly &s Mailing Address C,'901Y Lot Number Bloc umber �- ZON;NG OFFI City, to Zip Code r'�, Phone Number- Subdivision Name or CSM Number II. Type of Building: (check one) ❑ City a 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑Public /Commercial (describe use):_ Town of ❑ State -Owned Nearest Road }yam P u er(s) _ r - III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) So? 0 A) 1. JZ New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. '30 J9. 11 ST 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) —loo . 0 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade r ❑ Aerobic Tre tment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation ate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./ y /sq. e ft. (Min. /inch) Elevation c c r i VII. Tank Capacity in Total # of anufacture 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 responsibility for insta ation of the POWTS shown on the attached plans. P ame rint) ` Plumber's S MP/MPRS No. Business Phone Number - _ s _ 5 JA" 'I // � P umber's Address (Street, City, S te, Zip C de) � — If ZICAO�Irz �� IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) �( Approved ❑ Owner Given Initial Adverse Su*arge Fee) Determination I- Pa15. LM 12 - ?0 -2660 X. Conditions of Approval /Reasons for Disapproval. SBD -6398 (R. 07/00) ✓ ef / �,EiJCr/ /1�r� / �: �, a �.�'T�ck'- f_,C /D"o. o � �,��r, � ��� /ov �.����'x� �� R P j. $1 I 0 a - F S tJ r ,b J�iC�'ha • 4 Wisconsin Department of Commerce SOIL AND SITE EVALUATION j Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APP LICANT INFORMATION - Please priW,1 ipn. Reviewed by Date Personal information you provide may be used for sec o 110& s 5 (PrlV44 LA,_,'s� 5.04 (1) (m)). 12- ZO Proi)ertv Owner s' < Qroperty Location � rp E y e Gpvt. Lot ( 1/4 1 /4,S T Q ,N,R Property Ow er's Mail* n Address to Block# Subd. ame or CSM# 6t e- Ci State Zip Co* Phone � _ Ci E l Village ® Town Nearest Road A0.1 1.</ � SDI ;`�. ' :( 71 2 s'6.c6 G2 O e New Construction Use: RResidentia / Naunbet o I)Ie s Y_ Addition to existing building ❑ Replacement ` ❑ Public or commercial - Describe: Code derived daily flow y yC) p Recommended design loading rate ° 7 bed, gpd /f? ' 3 trench, gpd /ft Absorption area required 8-s7 � bed, ft' 7 U tren g ch, ft Maximum design loading rate ° 7 bed, gpd /ft ' © trench, gpd /ft Recommended infiltration surface elevation(s) O f • / ft (as referred to site plan benchmark) Additional design /site considerations p �jI Parent material �2 � r ��` t/e O�-• fl J �t /� �f Flood plain elevation, if applicable w4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I [$ ❑ U © S El u ® S El ©s E] U ❑ s [Z u EIS © U SOIL DESCRIPTION REPORT W` Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda ry Root GPD /ft2 Roo in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 -2 /OXX 9 p /11,4- L- S ( y,' C w C Ground ZJ'l�o 7sri�` �A INS ©J IL 2 .7 of elev. , Depth to limiting fac or ?/ in. Remarks: Boring # C a 2 1/,% Z? "� �Y /v 65� �Gk �� ct s C 3 � 3ii -1 7_! Yv :a / / �� f I CAS 1'�G c U- 2 �h -7 G fl Ground i O elev. q2 °7 ft. Depth to limiting factor X!�_Iin. Remarks: LA CST Name (Please Print) Signa re Telephone No. A - J" Address 7 Date r ST u ber � j� A PROPERTY OWNER f "yr 'F0Ct1 ` n ^'U" SOIL DESCRIPTION REPORT Page _Z_ of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure z g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 .1 -b Z I MSJ* Cw C 6 - 31 /0/-k 3 -Z Z MA Ml� cx s 3C * 5 6 .5- Ground `7, /,l l /tom A)l OS A 16 o e } le Depth to limiting f f ctor ( -.2 )0 3.Z,' Remarks: Boring # ZA56,t of 3C .77 ', dog 3 4- 0 7, sY % A14 /�lS C>S �'J)� 4 Ground elev. �ft. Depth to T(- �Z o limiting factor , j Z in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Be T rench Boring # O /D I tW % T 4 Z h1 L C w 3C 3 27 7,- - 9 i 3 k 1l S�`L Z r�► sbk rn '� of z . S '. 6 s Ground Y '� 7�y�1 ��/ //I1,4 M3 PU "y el v. Depth to T D limiting y 25t? in Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNE, '&L CA Page 3 of 3 Name ffy j Brian Parnell Address &7 CST 231314 Date Benchmark 1 Naz l �/i Odk /00. Benchmark 2 Ties /00, 0 ❑ Soil Boring J Suitable Area 40' Scale i f LO 7 ge I C3 r 671 i (I 31 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 3 53835 Number of Bedrooms Design Flow - Peak (gpd) 5'ro Estimated Flow - Average (gpd) u Septic Tank Capacity (gal) — N Soil Absorption Component Size (ft Type of Wastewater Domes is Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow - Peak (gpd) o 3 _T_� 2 - — 4S Maximum Influent Particle Size (in) 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 septic and outlet filter shall be assessed at least once every 3 years by inspection. T utlet i ter hall be cleaned as necessary to ensure proper opera tion. The filter cartridge 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 -0f 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer j 1_4I c_ k saw 1 �� Mailing Address 161 COL &^ '7r A00-4 .j S�n� use E t lJ.i- -5_* Z' 5 ,,,0 Property Address �S 7 `) -1-h S�reej -F (Verification required from Planning Department for new construction) CityAt'e n., Parcel Identification Number 032 -(D a..d o3Z-261 -S S�bt LE GAL DESCRIPTION Property Location S ' / <, � '/4, Sec. _,Z,:;�_, W, Town of So me-c Subdivision 6oa rd tMart Lot # fL____ Certified Survey Map # Volume , Page # 1­-Ac� C W4m� Deed # Z � yf� / , Volume ,L , Page # Spec house O yes io Lot lines identifiable - 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 Toning Department a certification form signed by the owner and by a master pluinher, journeyman plumber, restriCrd plumber or a licensed pumper verifying that (1) the on-site wastewater disposaI 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. 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 date. SIGNATURE O APPLI A C NT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ovmer(s) of the properly described above, by virtue of a \�arranty deed recorded in Register of Deeds Office. 2 l lDD SIGNATURE OF APFCC ANT 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 � arranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1559 STATE BAR OF WISCONSIN FORM 11 - 1982 6337�i LAND CONTRACT REGISTER I. WELSH REGISGEft OF DEEDS Individual and Corporate ST . CR O I X CO., WI (TO BE USED FOR ALL TRANSACTIONS WHERE OVER RECEIVED FOR RECORD $25,000 IS FINANCED AND IN OTHER NON - CONSUMER Document Number ACT TRANSACTIONS) 11 -15 -2400 10:10 AM LAND Fm CT, by an TRACT d between Barry Boardman, a /k/a Barry A. Boardman, LAND CONTRACT ONN ", whether one or more) and M_a[, Jackson and Cynthia J ack so n, CERT COPY FEE: and wife, as survivorship marital property, ( "Purchaser ", whether one COPY FEE: Vendor sells and agrees to convey to Purchaser, upon the prompt and full TRANSFER FE 12-00 nce of this contract by Purchaser, the following property, together with PAGES: 2 profits, fixtures and other appurtenant interests (all called the Property ), oix County, State of Wisconsin: Recordin Area PLAT OF BOARDMAN ESTATES IN THE TOWN. OF SOMERSET Name and Re1m Address T. CROIX COUNTY, WISC • Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 118 New Richmond, WI 54017 032 - 2046 -10 and 032 - 2046 -50 (Parcel Identification Number) This is not homestead property. 1 1, liq 1101 I ?o r >� a,a 7 #� s r W T ACRES;; 295 X 245 T�8 /fir N MA k% ���Q� "p r� �t���V - �,i��. Air �� '�r"'`_.� -h,.�- • ._ �� �� � r . �i / xA —$11' "�,CRES �i\bQ �. \�� �\ lllllllllll'i�� lll��� 1 I11�� I \�\ �� ��,)� � /iI'JT,'!. /A'�LfXLd ��� /I;�l�l� ��r / / � � _.�� // � \ a 132 � I I �• \) \ � V � %�� �o \� - / 'Y1�� '3440 SQ,FT, ,p SAC D � � / /� I / �� /� /' � /'X��w i \� '_-�� �' /���'� I III I � // I 1 � � ,\ ,_ \' �•• /� \\ \ ._� ✓ / 0 / Q I'Z2243 SQI.T� / -:a,s� ACRES I � . �:; BE R�`���NE.D BY DwN�R