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HomeMy WebLinkAbout032-2129-90-000 0 3� n c §; $M � ® 2 / E ° & $ C S , \ E ® _ 3 w - 2 } A o§ 2 3 § § 2 k ( \ \ § § § \ 2 ; ` fA ■ Cl) { ■ e E l 7 1 CD (a 0 %..� c C B 7 E a \ 2 - o $ % C 4 m \ § 2 Z f §§ Co n r- (a CL 2 i 7 E t . \ CD 0 0 0 2 * c ) § co) § 0 . \ \ / 7 E 7 \ \ \ C- & � rr z ° E co z �� 3 = & o o ] + g o ' 0 ° as/ \ /7 �- Bg § [»° 2 fi{ 3E CD 0 co k \ CD ¥ a § ■. / 7 7 D § $ 0 �2 $ J � ) C.0 r o ` m / » z } k % z �k / z �\ Z % C # 2Eƒk c . = CL c CDC Z % � 2 J \} . 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Permit Holder's Name: City Village X Township Parcel Tax No: Williams, Ken & Shirle I Somerset Township 032 - 2129 -90 -000 CST BM Elev: Insp. BM Elev: BM Description Section/Town /Range /Map No: `/ / U (D ' 0 !V/X /ivV �"� —�—� 13.30. 1 .1160 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic W %� Benchmark Z-_73 *Z7 �Od Dosing Alt. BM goo. Aeration B ldg. Sewer � }vD1Q /` � y, ,Z.3 Holding S t Inlet � 3. 4 l 9Z. TANK SETBACK INFORMATION ( S Pt Outlet --7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 2 Septic 100 0� D ftk� > Dosing He aader /Ma n. S 2 av I Aeration V Dist. Pipe Z [ 0 B r� Holding Bot. System X11 --7 cle PUMP /SIPHON INFORMATION Fin G t, Manufacturer Demand St Cover r /� GPM Model Number /64 f(o. 33 TDH Lift fn Friction Loss System Head TDH Ft l t v T Forcemain Lenq �4 Dia. Dist. Well I Vl SC r SOIL ABSORPTION SYSTEM 1 3a BED /TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREA LEACHING anufacturer : i INFORMATION Ty Of System: CHAMBER OR -y � , 3D, �' �O Model umber: DISTRIBUTION SYSTEM !C S / rL Hi ader /Manif Id Distribution x Hole Size x ole ; g Vent to Air Intake Q N Pipe(s) ' ,.-7� Length j_ Dia Length Dia 1 pacing 3 _ 5V SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over De Over xx Depth of xx SeededLSodded x ulched Bed/Trench Center ' Bed /T rench Edges Topsoil r/ Yes No Yes r No COMMENTS: (Include code discrepencies, persons present, etc.) pinspection #1: /0 /2—(0/0 Inspection #2: Location: 1568 89th Street Somerset, WI 54025 (NE 1/4 NE 1/4 13 T30N - W) B rdm n t tes t 13 Parcel No: 13.30.20.1160 - 1.) Alt BM Description = - 31% ��� 11 / � r 2.) Bldg sewer length = ,1 10 /f l j�� 0�/2i.(yvi ( 2 /]x6i" - amount of cover = Plan revision Required? Yes No Use other side for additional formation. - SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buil s Division County W 201 W. Washington, Ave., Box 7162 �_ t4V , isconsin Madison, W 537W444 ti� Sanitary Permit Number (to be filled in by Co.) Department of Commerce (60 266 - 3151 Sanitary Permit Applic ion '/" S e Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal in f rmatiof yo provide may be used for secondary purposes Privacy Law, s I _ ��Q Project Address (if different than mailing address) I. Application Information - Please Print All Information :� p Q c Property Owner's Na me Parcel # (- /A 0 ) ! J Block k 6N + � � -( W l 1`� �► Q3 a- ) ►a910 6 o 3 ' Property Owner's M ailing Address J Property Location City, tate N -A, 'V F- 'k,Section 13 tY. Zip Cade Phone Number Q ' la ` - j� s S circle one) of Buil T N; R E or W II. Type g (check all that apply) od ,'1 or 2 Family Dwelling - Number of Bedrooms S ubdivision Name C-Shl blu .❑ Public /Commercial - Describe Use &PR A INDN f &S t Jr ❑ State Owned - Describe Use ❑City_ ❑Village O'ownship of 5om o III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. 1Kpe of POWTS System: (Check all that a l ) Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single kss Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow ( Design Soil Application Rate(gpdsf) Dispersal Area_Required (sf) Dispersal Area Proposed (sf) System Elevation g VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units f( C � Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit � Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's S y na a MP /MPRS Number Business Phone Number 7 Plumber's Addre ss (Street, S City, State, Zip C 1 e) 1 1 Ni o VIII. County/Depaftment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued IZin ge nt Signature (No Stamps) Surcharge Fee) p ❑ Owner Given Reason for Denial 2 3 3 0 IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and aW dispersal cell must all serviced /maintained as per management plan provided by plumber. far; � 0 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) b/ V/v t / r / /, «/k/ _S d ncl r.s A /�ML �P.r . .. . 3Id� �y i Al /I 0"w —tI 3o d 1 � V pi iN r (U-e41AV luu.0 50 , �W p • A p Np�l iN Onk. �R -u��ev O 100 .0 y p ll�. / /. fl v t. / CA/k/ e cvi nde r.s �� S ► ti� e, l� P 1 l I rn J O Y 1 iNo,Y- x Ind K1 14V l uu. u Sa a Q grni Npl) IN OA� �Rtt�I�PV d 10o -O `` L 'lis or?s D�Partment of Commerce SOIL AND SITE EVALUATION Divisic ,1f Safety and Buildings Page of 3 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 5 f ., percent slope, scale or dimensions, north arrow, and location .and.distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please printall inf rmatiwt _ 4 , ev ed by Date Personal information you provide may be used for secondary purpo Erivp Y w, s. is (m)). 0 3/30/0 Prope wner op rty Location rl ���i�r>1¢� 1U)( 6(;A Lot S 1 /4N� 1 /4,S �� T _70,N,R /9 0 (or)© Property Owner's Mailing Address 0' YAt_# Block# Subd. Name or CSM# r� 9 9 �N� 6 �� 6L& r� -� �DIx��Ma� GS afrS City State Zip Code Phone Ku ber City ❑ village EH Town Nearest Road 5)rnes•e-i- (A--' -4 1 - 5 (7it ') ZYa Y�, s'or�r�� e�' 16 th a, -c New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate • S bed, gpd /fi • 6 trench, gpd /ft Absorption area require bed, ft X00() tren // ch, ft Maximum design loading rate • S bed, gpd /ft e b trench, gpd /ft Recommended infiltration surface elevation(s) D, 7 ft (as referred to site plan benchmark) Additional design /site considerations ,/fi Parent material C� 22, 3s' ei N - e-V 0 u f 61'Q--S y /� /a•'�� Flood plain elevation, if applicable '4 14 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I Zs ❑ U [X[ S❑ U ®S ❑ U ® S ❑ U ❑ S 21 U ❑ S 2U SOIL DESCRIPTION REPORT C w, FES . ?_ar,q Borin g Texture # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench i 0-5 /0 /A /V / c 6" L S - Ground 3 777 7,.Sj' y /'�� L ZAj ��l Cf S Z . ,e elev. p 2/n S 77- 7- S OAs yh . 7 - Depth to S 8�' �/S 7 S//� / AI/f L _ 7 s limiting factor > S in. Remarks: Boring # 1 ®f, ,( // 2 Z 6-1 6 -� /0 NA SL 2ms6� XI 3 17 -32 1 / � 2rr►S mil. Ground q 32 -76 �S% �A L 2h t" f e lev. S 714Y 7 S R d/n i 1 l L- C w 6 S s l � � 7 : o ,y � 1� 7, fy'LQ Depth to limiting AK In. in. Remarks: CST N me (Please Print) Signature Telephone No. ugh' a atr► .e / / a ZY7 �2 0 3 Address Date CST Number ��- /yz a4,e So /h ,� / sft w� ��ZL/ 0 0 23 3) Y y �^ PROPERTY OWNER �Ir, &4 m" &4 m" Mu'" SOIL DESCRIPTION REPORT Page L PARCEL I.D.# ® .T 13 Boring Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench /1/ Ground .3 &X S 161- elev Depth to limiting actor )U n. 2 Remarks: Boring # // X Z s- 22 /D1W % L Zi7s,6e ^, p,- as 3c 3 22- 5& �z lv�/� / Ground NZ S/ /l / /�� S h ey.7 � Depth to ° limiting factor jDS in. 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 # �n�Ja� �. a S 3C .5 3 16 -31 0Y �/ IVA �L 2,hi6k Mi- Ct f 2r+ � � W6 � Ground 3 �{/ �� Z A Jhk ✓ s , /'1�1 e elev. C ft. S A 7T�� / �� ✓ C j'Y1 L C G 1-f s 7 r b 76 /Zo 7. AYR !V S on f Depth �- to limiting factor / jZD ' n. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) O Page 3 of 3 Brian Parnell Address e79 - 160 CST.Z3j314 -4 U-Z - Date a y 00 A Benchmark I -T4 Oak -1ree FL, 10C.O A Benchmark T17 06 7 .cf EZ, /00.O ❑ Soil Boring 1 - 1 1--I Suitable Area 1 40' Scale T L I pf M L 14' A9 T TI 7 I j � l � � � � I j l� I! �� i I I � Cof rT -7-7- 6 SO FT, b uff F �,� 215' FT X2,344 SUI j /���•r` I �� 1�l /� � r0~ � \ 'iio N! 1 `: I l l /\ 1` t 9 ll� �r � 6 %PLAT_ VDU DA, -- I` ,fit T'� BERrNED' Y � \ =4,87, %ACRES �_ �R f 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 Desig Specifications Sanitary Permit Number S3 ©5 Number of Bedrooms Design Flow - Peak (gpd) (t 0 - � Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) ' 40 o 0 PL Maximum Influent Particle Size (in) i 1/8 Maximum BOD (m /L) dd 220 Maximum TSS (m /L) 1 SU 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 sep ' nd outlet filter shall be assessed at least once every 3 years by inspection. T �ot shall be cleaned as necessary to ensur proper operatio The filter cartridge e removed unl ess 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 components 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. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning office 386 -4680 Boumeester & Sons Excavating 386 -9020 S'[' CROIX COUN'I'V SI?PTIC 'TANK MAINTeNANCI? AGRPI?M[sN'1' AND OWNERSHIP CBRTIFICA'r1ON FORM r l , Owner / uyer � S �' N� � r ( I I � M I Mailing Address 9M ' Property Address S 13 r ` ,- s ' ,N (Verification required from Planning Department for new construction) City /S(ate N Xo jS)A � � S (. Parcel Identification Number 03c g' 9 LEGAL DESILRLPTION Property Location Sec. 3 , 'C b N -It W, 'Town of SO MR KAA Subdivision 08 0 M A r p, S � 1 Certified Survey Map # �3 Volume , Page # ( g Warranty Deed # r 7 4 Volume o , Page # Spec house 0 yes Q no Lot lines identiCable I& yes CI no b '"p' o Per We sad maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance cm isb 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 fiunetiou of the septic tank as a treatment stage in the waste disposal system. The ProPGF(Y owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a n In �°rPI�.J�ymanPlumber, reslrictedplumber• or a licensed pumper verifying that (1) the on -site wastewaterdisposal sygsm Proper operating condition and/or (1) ; colon and pumping (if necessary), the septic tank is lea than 113iflitl of sludge. Uwe, the undersigned have read the abov + w and agree to maintain the private sewage disposal standards let fork be eia, as set by the Dev"attrnent and the Department of Natural Resources, State of tt is 0ertiticatlioo abtiog dot yM "Ptk system has been nui must be completed and returned to the St. Croix County Zouiog Omoe widths 30 days of the three year elpirstion date. SiONATURB OF APPLICANT DATB t' u I (we) scribe)+ that all statements *; t*, &* are true to the best of my (our) knowledge. I (we) am (ate) the owner( of the property described above, by virtue of a,wWrody deed recorded in Register of Deeds Office. . .SIt3NATIJRB OF APPLICANT � � . DATE Any information that is mis -repr tnay� cult in the sanitary permit being revoked by the Zoning Department. !. . Include with this applteation; a stamped, decd from the Register of Deeds office 0 copy of die certified survey map if reference is made in the warranty deed 2 i • lam. 't � .._ -- � �,,. t r a+ r ..�: � � ..... �� � mi l• !� ( ;O py i U 2 12 5 P 4 13 - 710 761 4 • STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. VALSH REGISTER OF DEEDS ocument Nu mber ST. CROIB CO., VI This Deed, made between Barry Boardman A /K/A Barry A. RECEIVED FOR RECORD Boardman, Grantor, and K enneth C Williams and Shirley C William 01/30/2003 09:30AN husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin (The REC FEE: 11.00 "Property "): TRANS FEE: 240.00 COPY FEE: OT 13 )LAT OF BO ARDMAN ESTA TES IN THE TOWN OF SOMERSET, CERT COPY FEE: ROIX COUNTY, WISCONSIN. PAGES: 1 Recording Area Name and Return Address Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 118 New Richmond, WI 54017 032 - 2129 -90 -000 Parcel Identification Number (PIN) This is not homestead properly. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this ( �A 0 day of J0,-Q , 2003. *Barry Board * * AUTHENTICATION ACKNOWLEDGMENT Si natures N ,r IJa4 rd STATE OF WISCONSIN,_ - _ ) ss. 4- J County ) authenticated this? day of o—k4 2003. Q %/ Person - lly came before me this day of 2003 the abnN named * 0 v-� to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person(s) who executed the foregoing instrument and (If not, acknowledge the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler VAN DYK, O'BOYLE & SILER, S.C. Notary Public, State of Wisconsin My Commission is permanent. Post Office Box 118, New Richmond, WI 54017 (If not, state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE OAR OF WISCONSIN FORD? No. 2 -1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800- 655 -2021 MINIMUM F.F.E. - 960.1','1 -- p 956.1 , ll C3 `yl DRAINAGE EASEMENT S 38 O • �► 0 2 s N m 9 , 4 5 r*i y 1 0 5.0 4' N11 23 "W Oo ' 01 RAI / C -T\ Z f0 » NO2'19' "E - NAGE w D f � SO D N �d'EASEMENT 5.4 I 37 H.W.E. aol `'! W 1 J 939.1' t? it U1 Z I \/ � Gil 1 I Sy�•49 51 E+ i (,1 _I u -• 10 0.73• I 501 S2'46"E m / 00 � ��7815''V NOO ANVAGE EA 82.34' — C y - S09ti o•. =NEWT r,� '98•� v 1 •► all N „�•: IQ LOT °�, co `\ yF vi 1 r s,� y ', o .$OI.• f I �; s 326 SO. FT. "3 7.49 AC��� �' . y 41NIMUM F.F.E.-949.0 -5 J O o� �• J �;o. 0� 509 .3842E \ p" L O T >4 132, 295 SO. FT........ . �0 I ......................... 3.04 A CRES MINIMUM F.F.E. - 948.0' Q - -- - -� � --- 61.78'— ------ - - - - -- — 5 99.66 , _ T i • -- - - - - -- S02'00 ---- - - - - -- S02 �S c - - -- 369.82'-- - - - - -- — — — — — — — — c� 1 4 • ................................. ............................... ........................ M 00 L4 `° co L D r L O T 7 ° (f, O 0 . w 84, z a N 130, 730 SO. FT. r 130, 3.00 ° z 3.00 ACRES MINIMUM f 4 � "' m ------ 201 4.21 - - - -- 442.97' f ,; e.