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HomeMy WebLinkAbout032-2136-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395239 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Harden, Daniel Somerset Townshi 032 - 2136 -60 -000 CST BM Elev: Insp. BM Elev: B Description: v� l0o t f P TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / Q Benchmark 0 � Dosing / Alt. BM �' Q Aeration Bldg. Sewer Q � I Ho ioig Ht Inlet Y i �y 3� S Ht Outlet TANK SETBACK INFORMATION Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 � / r J Dt B Dosing ! Header /Man. 5-10 3 Aer Dist. Pipe t' S. 00. 7Z Q 3 `, / Holding Bot. System X G, Y o Final Grade PUMP /SIPHON INFORMATION y/ , Ma ufacturer Demand St Cover GPM Model Number TDH Lift Fri ' oss stem Head TDH Ft Forcem in Length Dia. Dist. to we SOIL AB ORPTION SYSTEM ` s BED/T EN Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME � S 7 o' z SETBACK SYSTEM TO T P/L JBLDG IWELL LAKE/STREAM L G Manufa r. c rs INFORMATION T e Of S stem: C AMBE OR - ►� YP Y > �/ s IT Model umber. 7 DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to #f Thilp ke p l re Pipe(s) / - 7 Length - I Dia I Length Dia Spacing (0 - 7' ' �- SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of TMededlSodded Mulched B T ed/Trench Center Bed/Trench Edges Topsoil [* Yes [W No rul Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�_l� 1_ inspection #2: ! / Location: 1555 84th Street Somerset, WI 54025 (SE 1/4 NW 1/413 T30N Stonewood Lot 6 / Parcel No: 13.30.19.12/08 1 1.) Alt BM Description = 4Vr 6� CIECri G �etC3 (�f9h rar% I �W wel 0 S S Cjr y-ih ast,� IJfC S '� 2.) Bldg sewer length = /0 ` - 4owlj eo'_ J' t yo Se -amount ofcover= W(1l bt - fie" p tr rlu"er - z' e 4r -, Al4i 4e /6 L'1�.61� tam � � Plan revision Required? [11] Yes No Use other side for additional information. 0 Date ep or ure Cart. N . SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 T a ka t I �7�O�SI� Madison, WI 53707 - 7162 Site Address Department of Commerce t� S J�S -7 s T (( Sanitary Permit Application Sanitary Pe rmit Number In accord with Comm 83.21, Wis. Adm. ,Code, personal information you pi6vi4- 0 Check if Revision may be used for secondary purposes Privacy Law, s15. Y • .', I. Application Information - Please Print All Information, tate Plan I.D. Number Property Owner's Name �' w 4cel Number - (-. t 3 .mod l 9- l zoo' Property Owner's Mailing Address w rty Location Gf © S - f - u A W %: S )3 T 3d N, R 19 w 9 City, State Zip Code Phone NuimRei ,< '� Aot Number Block Number Subdivision Name CSM Number II. Type of Building (check all that apply) 9 �(� ❑City X i or 2 Family Dwelling - Number of Bedrooms J `� s� f e r P` r A,,5 s � " " ❑VIDage ❑ Public /Commercial - Describe Use C SD�LEI�L� ❑ State Owned Nearest Road M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1JZ-New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use system I Tank Only Existing S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number 7 5ate Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ 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 ❑ Other V. Disp ersal/Treatment Area Information: 27 } lL C_ S / E JIUI]ER / F1L 1 .kATb2S Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. ays /Sq.Ft.) (Min./Inch) Elevation 14S ✓ 375 3 77 ✓ 1, Z L `7 99. y A %aZ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existin; Talcs Tanks Septic or Holding Talc 16M mo o E / /(] � Dosing Chamber JCS VII. Responsibility Statement- I, the undersigned, assume responsibility for installs ' f the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's i nature MRq NImber Business Phone Number 7 V2 71 - Z9 y- 3l V Plumber's Address (Street, City, State, Zip C e -13ny- ZqS 1\, P ES QZ- VVI 54 00 9 VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Age>tt Signature (No Stamps) Surcharge Fee) ❑ Owner Given Tnirial Adverse. l 2 Determination `( EK. Conditions of Approval/Reasons f or Disapproval �/ / �/ 5 }/S P 6n ay ex / � s� eee., -, ff 1 /( ivy / ak, 4, I ✓O,L'.in � D oavej, wkkS4- 6. � q1 u / 2 6 o 0% � l 15� Attach complete plans (to the County only) for the system on paper not than 8M x 11 Inches In size SBD -6398 (R. 05101) DM EL ANC i iO R- I-IAKn�.N 361 11) 70 s T -s E-0 /J k* 5 /3 ? 30 �J, k 19 w Am so,o , Wf ER «t �y01h L07 H � ?o�w'oot� m,PQS 2232 '- 12 B �D Lcaa�n lade Z,AL LVCCKs s9PrjCTAfU- WfTd !)av A )0a 6Z o a 2 7A FYZ�E .s Wf R 22 41611 A� �T1f Sly �iti'Q EI2 jArIMAT y�b 43 b TD?' LcT STAKE -9L. lot) ' �u NmAR�C -t�- Tar' nt l " STeCL /, a �aL .8a�ua� condtp Department of Commerce SOIL AND SITE EVALUATION DiVisiion At tafety and Buildings Page � of Bureau of Integrated'Services in accordance with Comm 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 percent slope, scale or dimensions, north arrow, and location andlb=nce to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please pr m ltnformxtion. Re we by Date Personal information you provide may be used for second ry purposes (P r, 1% 15.04 (1) ( )), r� 14 Z 3LA Property Owner Pr6pert t Location ell J Gokt.�L S , 1/4 1/4,S T . N,R E (o&1j Property Owner's Mailing Address ST CRD�ic Lot,'#_ Block# Subd. Name or CSM# City Stat Zip Code r) Number ity ❑ Village 21 Town Nearest Road 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 7 _ bed, gpd/ft trench, gpd /ft Absorption area required gi bed, ft trench, ft Maximum design loading rate � bed, gpd /f1 — I -Y—_ trench, gpd/ft Recommended infiltration surface elevation(s) '92 ft (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U [RS ❑ U IZ S ❑ U ®S ❑ U I ❑ S 2u ❑ S Z U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft h PW 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 3 elev. 5 Depth to i limiting q �/ factor 2 0. Remarks: Boring # ' S .S Ground elev. Depth to V limiting factor c m in. Rem rks: CST Name (Ple Prin Signature Telephone No. Address Date CST Number I 1 PROPERTY OWNER 1 ° SOIL DESCRIPTION REPORT page, of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 PW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench Cods , - ell ..... rj i Ground elev. AMY—ft. - D — Ai .� Depth to limiting factor ' >,9 Remarks: Boring # x j Ground elev. Depth to limiting 7 6 C, ,, 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 # AIZ 5 Ground c _ elev. Depth to limiting , factor `� -- ' n ' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) se b G L 4� - e-/ r r ' r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNRR.SHIP CERTIFICATION FORM OwnerBuyer -12,4 N t EL. A wO L o R l " A !L D G' n! I Mailing Address to I /o T N S 7, H S r nr vtlt 5' ¢ o G( Property Address 1 5'5 - s - R q 0,--) S (Verification required from Planning Department for new construction) City/State to Parcel Identification Number 632— 2134- t6 00 0 LEGAL DESCRIPTION Property Location 1 /4, AI W ' / 4, Sec. /3 , T_0 o N -RA W, Town of Subdivision - .57 - o lve!5' wo 00 Lot # Certified Survey Map t # , Volume , Page # (0 / Warranty Deed # ssg f , Volume 16 2 q Page # Z Spec house ❑ yes B"no Lot lines identifiable eyes ❑ 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 and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 be completed and returned to the St. Croix County Zoning Office within 30 three year expiration date. c fQ ATURE OF ~ LI 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 pro described a ve, by virtue of arranty deed recorded in Register of Deeds Office. 0 SIGNATURE OF APPLI ANTI 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 ' Management Plan Private Onsite Wastewater Treatment Absorpti Component Septic Tank And Gravity in- Ground S oil Pursuant to Comm 83.54 Ws. Adm. Code each Private Onsite Wastewater Treatment' System (POUTS) shall include information and procedures f or mai by d the tm agent, the parameters of Comm 83 and 94, and the conditions appr or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This managemen l Manual p fo�Private ns to Wastewater ate�r Treatment Systems Sgp nd Soil Absorption Component 10567 -P (R.6199). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms 3 Desig Flow - Peak {g pd) 3D0 Estimated Flow - Avera e { } y 51) Septic Tank Capacity (gal) 1000 Soil Absorption Component Size (ftZj St,� 30 Ct�fl Type of Wastewater Domestic Table 2. Soil Absorption Component - limits of Reliable Operatkm Septic Tank Component Sat Absorption Component Design Flow - Peak (gpd) y5D If So Maximum Influent Particle Size (in) 118 Maximum BOD5 (m ) - 220 Maximum TSS (m L) 150 i l Table 3: Mainbanamm Schedule Septic Tank Inspect and'or service once every 3 year$ Outlet Filter Inspect once a year and dean at least once every 3 years Soil Absorption Component Inspect once every 3 years Seatic 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 k 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 outlet filter 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 ff the r i t � 85 -01 -00 10:32 RECEIVED FROM :715 386 4685 P -82 U5 'U1- U1 TU 10 :3,) Manage ',.:r:. +... r; . ,a Sc nt c '� a-;;< _;r�l S, "i Absorption Component filter is equipped with a'; _ 'I' Kali be s'ervr rer:', ii the alarm is activated continuously - Intermittent filter c, -A ilrjxer:ding continuous alarm. The septic tank shall have i's c:_: ;'.: r:;r;:-,,cd why;, ;;,t; vo!urne,df scum and sludge in the tank exceeds 113 the liquid volume of t "he t3nK. If the contonts 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 Mail it'aia iess inan mayirnum scum and sludge accumulation in the tank. Manhole tilers, ac(:e� _: ..d ,..avers should be inspected for water tightness and soundness. Access r3r:c ; ;;; ti; < l ^r :.. --!vi .e a. assessment shall be sealed watertight upon the completion of servic�. = n c Anirg deemed uisound, defective, or subject to failure must be replaced. Exposers 3cct; s : ;, n r:ct� :,, eate ' than 8- inches ;n diameter shall .be secured by an effective locking unauthorized entry into the tank. No one shorief; -n- r a zx pt ;c or of er trearment or holding tank for any reason wit o?N being in full compliance with OSHA standards for entering a confi .'ed space. T he atmosphere within the septic or other treatment of holdlm rank may contain lethal gases, and rescue of a person fro rr !`, ': ?:`:; ti r -).F Vie tank may be. difficult or impossible. Tank abandon; it <:, is rc ;;0l- dar;ce ,, 'Zh Comm 83.33, Wis. Adm. Code when the tank is no longer used as r��1'. i m cnen . io +l A.b ,r_g r lion Comp rent The soil absorption cc rnporEnt serving this structure is designed to accept domestic wastewater from a residerti:.-I fa3 ility. The Emits of operation of this component are shown in Table 2. - The longevity c. .3 sc , j component depends greatly on proper and timely maintenance, and system u-� i w; .i 1 or b--r ovi the limits of reliable operation. Good water conservation practices by all cce.-.Upam arld the ins.allation of water conserving plumbing factures are key factors in ex!ending the useful life of this component. The soil absorption ;...-: ce - ption mist be assessed by Inspection at least once every three years. Tip+: in st•=c Tian s`in's inckide recording the levels of ponding, if any, in the observation pipes, and _. .i: -;1 �l : nspection f or any evidence of surface seepage or discharge from the component. On sites, areas of erosion should be identified and reported to the owner for rap3ir surface discharge of domestic wastewater or sewage from the system is prohihite' ;;.:_: c. ;, ;aside: Yd a human health hazard. Traffic around or uve( 61 :> -Iii absorption component should be avoided particularly during winter months. The com p;ic. -L :n or removal of sncw cover over the component may lead to hydraulic failure by fretizir ;! ;. J n ic type of failure is usually temporary, but is difficult or impossible to repair until - �n�Vions improve. In general, soil compaction over this component will reduce diffus :: , -r: into the sail and dispersal cell, which may lead to more intense, and earlier, ar.!-: g`:r:; of tt,e zc:l. 2 05 - 01 - 00 10 : 34 FiF�'. _: I '1F.0 F ROM : 7l5 386 4686 P-83 t0 STATE BAR OF WISCONSIN FORM 1 - 1998 6+x#3581 ..WAR ANTY DEED vq ?HI Fr=N H. WALSH �z * At 1� 9 J REGISTER OF DEEDS Document Number V('l P rte, ST., EF.'(1Ty, CO., WI " This Deed made between Na m ria Ente, rnricec --D— RECEIVED FOR RECORD L ,e, 04 - ?4- ?001 9:30 AM 1ID1Z i i a h i 1 i t f'mm� _ — — - - - -__ WARRANTY DEED Grantor, FYFMCI? 4 and __ —Dazt - y-e —A -_Ha and T o r i A rl harden CERT COPY FEE: hnchan anti -wi fc. ac cttrui vnrh COPY FEF: ' s h ip mari t 1 TRANSFER FEE: 156.00 - property _ RECORDING FEE: 10.00 — — -- — PAGES: I - - -- — Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St rrO..LX County, State of Wisconsin (the 'Property'): Rucerdlrg Area Name and Return Address �- Lot 6, Stonewood, Town of Somerset, Heywood & Cari, S.C. St. Croix County, IVisconsin P.O. Box 125 Hudson, WI 54016 032- 2046 -90 -000 032 - 2046 -60 -000 Parcel Identification Number (PIN) This 1 S not homestead property. (is not) 4 'I Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, Indefeasible in fee simple and free and clear of encumbrances except easements, covenants and restrictions of record, if any, Dated this /7 _ day of HERMIE ENTERPRISE LLC (SEAL) By All (SEAL) r Ba rbara A. Gevi (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Barha -a A. Geeing State of Wisconsin, ss. p My f „.J - -- authenticated this County. Personally came before me this . day of � the above named Samuel Cari TITLE: MEMBER S TE BA WISCONSIN to (I( not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood f, Cari, S.C. by Samuel R. Cari P.O. Box l 2 5 , Hudson, WI 5 4 016 Notary Public, State of Wisconsin -res — My commission is permanent. (If not, state expiration date: (Sign atu may be authenticated or acknowledged. Both are not ) necessary) , Names of perms signing in any capacity, must be typed or printed belnw their signature, WARRANTY DEED STATE BAR OF WISCONSIN wscwsm Legal Blank Co.. Inc. FORM No. 1 - 1998 Milwaukee, wis. • �/ \ ( 0 O /' / O/ N W co bib AMR 1 2 00 '► _ / .' • i S08 �• - L O T 5 , 132, 953 SQ. FT. OD OD 0 3.05 ACRES 41 y 00 MINIMUM F.F.E. = 942.8' I v / �' ' h • S s O m v F m OD PD I r D � �a+ rn Ul rn m m t '( z /', SRS. r N 's i LOT 6 2� ' CENTER ' \� �� rO � D (D <o x 75 Z r ► i m i i o V 1 70,907 S0. FT. cn I m rn o a, m io 3.92 A CRES Z I 0, w ; ; i ,�• \� i MINIMUM F.F.E. =922.8 g r U. s� 427.87' ' 226.06' 7d25 -,r W O 66.16 O NORTH —SOUTH QUARTER LINE -- DIUS TEMPORARY ---- --- - - ----- S00'07'33 "W 2621 E — SAC EASEMENT NOTE " OVERALL NORTH —SOUTH 1/4 L SOUTH 1/4 CORNER --- - - - - -- S00 "W 5241.26--- - REMOVED UPON SECTION 13 -30 -19 SION OF THE ROAD. (FOUND ALUMINUM COUNTY MONUMENT CURVE RADIUS ARC CHORD DELTA CHORD BEARING A —B 233.00' 152.50' 149.79' 37 S18 "E AND TOWNSHIP 0 —P 167.00' 109.30' 107.36' 37'30'02" S18 "E TO PARCEL, C— D(TOTAL) 167.00' 210.70' 197.00' 72'17'15" S00'58'47.5 "E CROIX COUNTY (LOT 15) 167.00' 186.20' 176.70' 63'53'01" N05'1 0'54.5 "W (LOT 14) 167.00' 24.50' 24.47' 8'24'14" S30'57'43 "W M— N(TOTAL) 233.00' 293.96' 274.85' 72'17'15" S00'58'47.5 "E (LOT 1) 233.00' 133.31' 131.50' 32'46'57" S20'43'56.5 "E LOT 2 233.00' 160.65' 157.49' 39 S1 5 "W K— L(TOTAL) 167.00' 1 184.11' 1 174.93' 1 63'09'59" 503.34'50.5 "W