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HomeMy WebLinkAbout032-2130-00-000 Wisconsin oepartmentof Commerce PRIVATE SEWAGE SYSTEM —_ safety and BuIldings Division °U �f: Croix INSPECTION REPORT GENERA. INFORMATION (ATTACH TO PERMIT) sani WPM tNo.: Personal information you provice may be used for secondary purposes (Privacy Law x.15.04 (1)(m)). Permit Holder's Name: City Vi la e o : State Plan ID No.: o Barry SorT�ersetol'oZnship ST BM Elev.; Insp. BM Elev.: BM Description: Parce 0 3x yo -00 -000 v� Z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - 5 O Benchmark 2.3 2. �fo Dosing_---__ - Alt. BM Z rS O Aeration Bldg. Sewer 2. 1' Q Holding S / Ht Inlet fy Z Z TANK SETBACK INFORMATION t Ht Outlet TANK TO P/ L WELL BLDG. Air i to ntake ROAD Air I Septic ���� r ��� r ' NA D __ _ ., NA Header / Man. Aeration Dist. Pipe ' 1 • Y 7 6 Holding Bot. System L / f ° Z 19 PUMP/ SIPHON INFORMATION Final Grade Ma ufa _ Demand St cover Model Number- _ GPM TDy f lift Friction S tem TDH Ft [7 Forcemain Length Dia. . SOIL ABSORPTION SYSTEM I BED/TRENCH Width Le th , No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM I N S DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM M n LEACHI G u r. ur SETBACK C A BE INFORMATION TypeO M e Num r: System: �S O DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. / Length � Spacing 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.) Inspection #1: l( /f /0- Inspection #2: I I Location: 1586 89th Street, Somerset, WI 54025 (NE 114 NE 1/4 13 T30N R19W) - 1330191161 Boardman Estates -Lot 14 y0 s Y � s�- w v l/�, h ,e� 1.) Alt BM Description = Wi" s � ws 2.) Bldg sewer length =3o ^-9 - amount of cover = ' Yz'" /s ad r� lac & � a e4 ?� o�serua,F,•�„ti / ,��ps lhc //� iw PlI reisl equir ff es "-A dNo Use other side for additional information. SBD -6710 (R.3197) Date Inspector's Signature Cert. No. ,� o ver —�""�` I �. �`�� �� � �,� �� �t�Y` `' IAA ��'� i�� �� �� , �� � , . <, _ { �� � q t' �i f 8'9 Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave, reverse side for instructions for completing this application PO Box 7302 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 om ned.) Attach complete plans to the county copy onlyY'V)r t e . er not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number 1 5 - 1 r revtiir pre application State Pl I. D. Numbe / I. Application Information - Please Print all Inform Location: Property Owner Name 1 Property Location > , Fn > 114 1/4, S N, o jVl Property Own ailing Address -- 4UU7 Lot Numb Block iber k ST CROIX --'t COtlNry i sl City, tate Zip Code ,r' °., 1SA661t Subdivt ' Name or CSM Number II. Type of Building: (check one) —0.s p� City • I or 2 Family Dwelling -No. of Bedrooms : [rta►wA oµ s ❑Village Public /Commercial (describe use):_ Town of • State -Owned Nearest Road Q — —D 3 Parcel Tax Numbers) III. T ype of Permit: ( Check only one box on line A. Check box on line B if a licable A) I. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Additio i to System System Tank Only Existin S stem B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ,Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic TreagnenWmt, ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: —, 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolatio Rate 6. Syst6m Elevg Min 7. Final Grad Required Proposed Rate (GalsJdayq. ft.) (Min. /inch) Elevation VII. Tank Capacity in Total # of Nhnufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks VIII. Responsibilit a I, the undersigned, assume responsibility for 'nstall ton of the PO TS own on the attached plans. Plumber am Plum s Si MP/MPRS No. Business Phone Number - _�/ _ � � = s -��� lumber's Address ( et, City, State, ip Code) IX. County /Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss ing Agent Si ture (No stamp Approved ❑ Owner Given Initial Adverse Surch a ��S ' 1Ti� B.Z L ?_ce>1 Determination Oa X. Conditions of Approval /Reasons for Di approval: 4. rla l>cC 4 S+�r�ic 5 ,1ew� - -0-" &"5 t � r nl� o w� p u r ¢, W • anQM o s r 7 Jlxa. ol LAN 8/ '/6� I,iSiL " 4 me a __ •_ _ __ �I _; �I __ _ _ _ _._ - __ __ __ __ __ __ _ __ s _. _� _ � _ __ - Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page J 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 51 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please pry tlon. R viewed by Date l , Personal information you provide may be used for secp�ary�pu fprivpcy' aw s. 15.04 (1) (m)). Prope Owner �j Property Location All �'q Gt// / ✓C7fe�iti►'rG : `� a .' x . f t Govt. Lot N E 1/4 IVC1 /4.S / _ T �O .N ,R / 0 (or)l� Property Owner's M Address tot # Block# Subd. Name or CSM# Q �j Fl 7� — Ct (! e4 City State Zip C "de PhonaNQ ffi f Nearestt Road Al t°w Ghl�t�.: �� ( 7� U ,❑ Ci ❑ village � Town / 6oa � Ct vG Q L � oPq -e �r J "t" r' 0-New Construction Use: 2FIesidenti l oo I ourfiOe_b� e6ms Addition to existing building ❑ Replacement ❑ Public or commerciaT- Describe: Q Code derived daily flow � �� � ��-- 6 �� 77gpd Recommended design loading rate bed, gpd /fi i v trench, gpd /ft Absorption area required gi bed, ft ��0 trench, ft Maximum design loading rate ' 7 bed, gpd /ft o b trench, gpd /ft Recommended infiltration surface elevation(s) 9 � • ft (as referred to site plan benchmark) Additional design /site considerations Parent material C O P2 f Flood plain elevation, if applicable AY ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank 6, U = Unsuitable for system ZS ❑ U �S 1:1 U [ S❑ �t U ®. S❑ U F-1 S 2 U ❑ S ® U / SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench % ,�ls L S /fn iri c e4- 3c Z j x -/d /Did % lt�l 5L l mfd lr c . V Ground /( -3' 7s J'oP �A MS o sf C w 2/� Depth to limiting -� 90.20 f ctor 7 22r in. 3 6 Z Remarks: Boring # 1A G ley /�i� c 3� ;.� J 2 11 -2 o pe IMJ6h Inv',- X1 36- '.... 3 2y y2 , r 'IS dl � C 4- 2 Yr . 7 � Ground 7 /ZS �� %� 6 A PS �S /'7L 9 ft" _. Gp Depth to limiting factor 7a,!�Jn. Remarks: CST N me (Please Prin Signature p Telephone No. r> a •, I"Cc /n t° l �i�- ®� A1= ZW_ .?Z o3 Address ate CST Number �9� aw SD/'re�sef wz 2pl 23 �j j � � j PROPERTY OWNER V 4'I'ry . 1300 dma ., SOIL DESCRIPTION REPORT Page 2- _ r df PARCEL I.D.# L.._ ©� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 4 to Y ti S /rnsw,- m Z, c w 3 sir .� 2 � �� �> y� / N,4 S L , � & t 3 a r Ground 3 27 y �r� 6 /ir 5 V� / ,� G �V 2tn .7 0V T q�ft. y Y2 �i 7, % IVY M S of M L- Depth to limiting 7 '�T in. Remarks: Boring # l a 1 9 ®t � ,-7 B MS Ct 3 C S 3 X- - 7, % IV A In S QS YnL c w 2 ^ 7 .8 • � Ground sZ - lofl 7 S j� N n) S ®S�— �t / �� •� � I� 7 /b ft. Depth to limiting factor ) , LX 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 # /� r L G w .3 5 2 7 -Zl 7- kA � jms�c 'khVC' Ct 3 c s y 1 �iA mS S 1'hc c w ZM ,- ;, 8 Ground 7 / �/( DS Depth to limiting factor 7 1-3 ' Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) OWNER Page 3 of 3 Name Brian Parnell Address I CST 23 MeNew ft, C Date ii 14 � 06 A Benchmark 1 A J /5"'Oeet Tie faz �— A Benchmark 2 J; 1 - rlee /00. ❑ Soil Boring 1 - 1 ,- -i Suitable Area 1 40' Scale 7 77 -2 -� I T-p - -- i V-4 - c- 4e4 e-i 10 L i Ohz At" 7, An . .............. . -T-7 Ir 111 1 �' 11 LV 245' l ' \' \� � � ! - -- .1' ! 1 �o. / r s � ,�• is i i A \� ��i I ietJ, CRE� }Illil��u� Irl, 2 At RE � / e � i' s' � 1 i rk � . � `.= -��� •/ � y ..- -,_._. �, ;21344'0 SO-FT 14 90 N I E�1P RY f�'j�1� 'SAG v:��_ - D. e 1606 8�' SQ '36 te r. ° V Q �1224 3 SQ,F.T, o r. �= % «arse; ACR . �. oiR ES BE - " Rill ED By,.; , � r f i ..a 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 S Number of Bedrooms Design Flow - Peak (gpd) S'U Estimated Flow - Average (gpd) L:rD Septic Tank Capacity (gal) ovv w Soil Absorption Component Size (ft2) 3 _ ► �c Type of Wastewater D mestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) z oa `w c� Maximum Influent Particle Size (in) 1/8 UU 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 tank and outlet filter shall be assessed at least once every 3 years by inspection. The u e alter shall be cleaned as necessary to ensure proper operation. 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer u Mailing Address I /'J �4�' A 4 Property Address (Verification required from Planning Department for new construction) City /State T Parcel Identification Number LE GAL DESCRIPTION Property Location '/4, '/4, Sec. -�;, T -RW, Town of Subdivision �� , Lot # � . Certified Survey Map # , Volume , Page # Warraa De # �� 24 5 5 , Volume ,Page # 9.(p Spec house Ca yes ❑ no Lot lines identifiable M yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 D a certification form si gned b the owner and b g g P g Y Y 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 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 g P g P Y 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 be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / / ( SIGNATU F APPLICANT bATE l * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * « « «s ** 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 Y91�.3��P�CE1�6 l` c� GS4505 STATE BAR OF WISCONSIN FORM 3 – 1Q82 QUIT CLAIM DEED 9OCUMENT NO. Frank Keith Boardman a /k /a F. Keith Boardman- A st ngt p _ T. C R 01 X C0., `A/! person _ .u:'.: t: „r , ta,.urd i quit4laims to Barry Boardman AUG U 6 1998 _ - 9 A M Rs later of Des” the following described real estate in St. Croix County, State of WiscomAn: THIS 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 Map filed July 7, 1997 in Vol. "12 ", page 3295 as Document VAN DYK, O'BOYLE & SILER, S.C. No. 561969, all in Section 13- 30 -19. Post Office Box 127 New Richmond, WI 54017 i 032- 2047 -80 -000, EE PARCEL IDENTIFICATION NUMBER 032 - 2046 -50 -000, and 032- 2046 -10 -000 This is not homestead property. )Okk (is not) Dated this --3 U day of LL1 _ A.D., 19 /�, �'e••�. (SEAL) (SEAL) • Frank Keith Boardman (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Frank Keith Boardman State of Wiscons ?n, Ss. County authentic this 0th da of 1 , 19 98 Personally :-ame before me this day of 19_ —, the above named • Hetdrik W. Van Dyk TITLE: MEMBER STATE BAR OF WISCONSIN (If riot, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Hendrik W. Van Dyk VAN DYK O'BOYLE & SILER S.C. Post Uttice box • New Richmond, Wisconsin 54017 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is oermanent. (if no(, state expiration date necessary.) 19 ) • Names of persons signing in any I.apxty should be typed or printed below their signatures. 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