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HomeMy WebLinkAbout032-1031-80-000 Wisconsin D,partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Ssfety and Building Division INSPECTION REPORT Sanitary Permit No: 514809 0 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: Baillar eon, Raymond I Somerset, Town of 032 - 1031 -80 -000 CST BM Elev: Insp. BM Elev: BM Descr' ion: Section Town /Range /Map No: �b1� b ` 11.31.19,151 C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /D Benchmark 0,5 / /V 15• Dosing Alt. BM -T 6 2 h Aeration Bldg. Sewer 1 Holding St/Ht Inlet IV TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / n �— Septic / f !1 Dt Bottom / Dosing Header /Man. Aeration ,� Dist. Pipe ' T4D Holding Bot. System �,l 9f 1 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM . J Model Number TDH Lift Friction Loss em Head TDH Ft Forcemain Length ia. Dist. to We ! i f SOIL ABSORPTION SYSTEM 3 BED /TRENCH Width l Len tth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS !� �� SETBACK SYSTEM TO I PIL BLDG WELL LAKE /STREAM ACHING Manufacture INFORMATION CHAMBER OR Ty Of System r �5r 0; J U Model Number: DISTRIBUTION YSTEM ) Header/ nifol Distributio x Hole Size x Hole Spacing ] Vent to it Intake Pies 2' '1rSf t/ Length Dia Length _ Dia % Spacing 7 �- D �� p/ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 3 C G !z. Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center �r j J� Bed/Trench Edges Topsoil I Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: fJi 3 1 Q/ Inspection #2: Location: 633 Lakeside Lane Somerset, WI 54025 (SE 1/4 NW 1/4 11 T31N R19W) NA Lot Parcel No: 11.31.19.151C 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan revision Required? _' Yes /IN ' � v� Use other side for additional information. Date Insepctor's Sign atu e Cart. No. SBD -6710 (R.3/97) comrnereeml.gov Safety and Buildings Division County 201 W. Washington Ave., P. Box 7162 sconsin Madison, WI 53707 Sanitary Permit Number (to be filled in by Co.) t i c epau ntant of Comtner" Sanitary Permit Application State Transaction N tuber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropria vemm unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned P S are oject Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for s :are co 33 p urposes in accordance with the Privacy Law, s. 15.0 1 (m ), Stats. 1. Application Information - Please Print All Information f i Property Owner's Name RECEIVED Parcel # / d a-- 1,931 ,1a - Property Owner's Mailin ddress ' l i O`/ 3 0 C 2007 Property Location ", / 6 1 3� i Govt Lot City, State Zip Code Ph T e . SC COUNTY ,� ' /., /., Section J C D d ZONING OFFICE ircle o �S -, • .?/— N; R�E W [I. ype of Building (check all that apply) Lot # 1 or 2 Family Dwelling Number of Bedroom _ Subdivision Name Block # 11 Public/Commercial - Describe Use 1C►[Qr^M'�' ❑ City of ❑State Owned - Describe Use CSM Number ❑ Village of Z A , b4- 3 CA .4,4 V44 Town o !'el III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System cement System y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B• [I Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner � •' GL IV. T e of POWTS System/Component/Device: Check all that a 1 ` on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Du ersalrfreatment Area Information: 2 Design Flow (gpd) D oil App rc 'on te(gpds0 Dispersa Area Required (sf) Dispersal Area Propos (s0 System Elevatio / - s' � r 3 /1-12-- S9 3 ✓ Vt. Tank Info acity in Total # of Manufacturer Gallons Gallons Units E e New Tanks Existing TanksI o d °� R 0. t, Septic or Holding Tank Dosing Chamber VII. Responsibility Statement 1, the undersigned, assume risibility for installation of the POWTS shown on the attached plans. Plumber' ' ame (Print) Plumber's re MP /MPRS Number Business Phone Number 'T Plumber's Address ( Street, City, State, Zip d VIII. County/Department Use Onl Approved Permit Fee Date Is red Issuin ent Signature teen Reaso Denial �So 3a d7 IX. Conditigyeggreasons for Disapproval D 4 - o Ieai 1. Septic tank, effluent filter and 1" v dispersal cell must all be services / maintained /'� .�+ „ _ L ✓ef. . as per management plan provided by plumber. IQGC.1 Ol- 2. All setback requirements must be maintained , A , V as icable code / ordinances. r �-r a ' ' . W is Ir iN4661 Attach to complete plans for the system and submit to the County only on paper not less than 8 In x I1 inches in size 'jr 04S Q�� rte/ ��rOtts� SBD -6398 (R. 01/07) Valid thru 01/09 J 4t�(e I nn 4 61ck S ` 4 - db �. G0CQ_5L. . PLO PLAN PROJECT Ravmond Baillaraeon DRESS 633 Lakeside Lane Somerset Wi 54025 SE iia NW 1i4S 11 /T 31 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 11/28/07 BEDROOM 3 ' DATE CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark. SYSTEM ELEVATION 89.3/89.6 4' below qrade Well is to meet all setbacks required by WDNR J4'Long t Quick4 Standard -W Plans Designed Using Leaching Chamber Conventional Powts with 20.0 ft2 of Area Manual Version 2.0 5.8ft ^2 /pair of end caps B -3 Vents 34„ Grade at System Elevation lake side lane 2 -3'x 96' cells 120' with >3' spacing_______ B -2 0 ' Pool 2C ST Well 80' 15' 30' B -1 15', M * Existing Please note: system is to Old tank is to be bedroom be installed along pumped and buried house contours, @ 4' below grade, soil test does not state slope direction, % of slope nor the contours match the borings, this will be corrected and determined at a time of installation - WDRESs N PROJECT Ravmond Baillaroeon 633 Lakeside Lane Somerset Wi 54025 SE 1/4 NW 1/4S 11 /T 31 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/28/07 BEDROOM 3 _ - CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Base of Siding ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 89.3/89.6 4' below qrade Well is to meet all setbacks required by WDNR fj >6" uick4 Standard -W of Cover eaching Chamber Plans Designed Using ith 20.0 ft2 of Area Conventional Powts 8f A2 /pair of end caps Manual Version 2.0 4' LonB -3 Vents Grade at System Elevation lake side lane 2 -3 96' cells 120' with >3'_ spacing_____ _ B -2 0 ' Pool C 80' 20' ST 25' Well T 15' 30' B -1 15 5 ' • Existing 3 Old tank is to be bedroom Please note: system is to pumped and buried house be installed along contours, C 4' below grade, soil test does not state slope direction, of slope nor the contours match the borings, this will be corrected and determined at time of installation RECEIVED NOV ,7 0 2007 Wisconsin Department of Comm rce SOI EVALUATION REPORT Page of Divi &ion of Safety and Buildings ST.ia& Com 85, Wi . .Code Coun ZONING OFFICE t y Grp f Attach complete site plan on p an x Inches in s\Cti t include, but not limited to: vertical and horizontal reference point (BM) di Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distest ad. Please print all information. Revie by Da Personal information you provide may be used for secondary purposes (PrivacM (1 /� b Property r Pr o L Ion r r P r Q ovt. Lot �( 1/4� 1/4 S T 3` N R/ E (or Property Owners Man Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village Tow Nearest Road � c ).15 _ yne-f 5�T ❑ New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate --GPD *eplacement ❑ Public or co ercial - Describe: - - - -- - — Parent material / , �� t ' Flood P l a in elevation if applicable � - -- ft. General comments � ` L and recommendations: 7- _ _ 41/`3 n Boring # Boring J ❑ Pit Ground surface elev.ft' Depth to limiting factor _7/� 5� in. Sal ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 IL r Z- c r rf tI ® Boring # rgr Boring ❑ pit Ground surface elev. 55= ft. Depth to limiting facto in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM / in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 C o � - , air ,3 rl 5 Effluent #1 = BOD > 30 < 220 ax SS > _ mgA. ' Effluent #2 = BOD < 30 mglt. and TSS <_ 30 MgIL CST (Please Print) _ CST Nurrter r Address Date Evaluation Conducted Telephone — �� / (ooff otte-not LLL8 A.L.I. IO I5 I£-99Z-809 W lua wuedap aga;oeluoo mold letw03 alewalle ue ul 1ef]21Ltu paaa so saotnaas ss000e of ooueiscsse poau no(;I -io4oldwo pus iapinoid aainias f4lunuoddo lenbo ue sc aoiaunuoZ) 3o ivaunndoa aq.L UAU 0E > SSI pue - U 6 w 0E > 5 408 = Z# wan813 , 116w O L > OE< ssl Pue lftu OZZ > O£ < ° QOg = L# luan&3 . Z#43. L#1l3. 4S zS �� ioloQ 'luo'J •zS •nib Ilesunw ul �1/QdJ slooa tiepunog aouals!suoQ ales! IloS ainp"s axW.L uogduosaQ xopou iopQ lueulwoQ 41deQ uozuoH u! JO1oe1 of 4ida(3 8 - vale aoeNns punojE) Pd 6uuog ❑ # 6uuog D ❑ j_ _J U.M. 0.43. •4S zs lopQ •luoQ •zs -no Ilesunw •u! �1JQdJ s3�2i NePunog aoualslsuoQ airgortgg a�rgxal uogduosea xopaa QOM lueunuoQ L a<dea uozuoH ale�l uogeol I!oS w joloq 6uglwg of 4idea 31 •nala eoe;uns puna!D 1 !d ❑ 6uuog ❑ # 6uuog 4//z ............ 3W Z03. L#dl3. 1 4S 'zS •JJ jopQ 'luoQ zS 'no Ilesum ur OWE) sloop{ ,C(epunog aoualslsuO3 ami3n4s a.(nixal uogduosaQ xopaa Jo!oQ lueulwoQ 43dea uozuoH alert uoqeDlid I!oS na a aoe ns una P d u!o — � mpe; 6uglwq o3 yldaQ 3} l I P E) ❑ 6uuo # 6uuog PrI to e6ed # QI I =ed L `o - ?;!4 , /j f jaumO dl.(adad Property Owner tI 0 1 " .- ' 2 Parcel ID # Page of D Boring # oring ❑ pit Ground surface elev. ✓' ft. Depth to limiting factor 5 /m in. Soil Application mate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fY in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q Boring # E] Boring 11 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30:E 220 mg1L and TSS >30:5 150 mg/l r , ` Effluent #2 = BOD, < 30 f o& and TSS S 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. :$SW83300"W) Soil Test Plot Plan Project Name Ray Baillargeon Byron Bird Jr. i / n Address 633 Lakeside Ln. Somerset Wi. 5025 CST #220527 Lot Subdivision Date 5 /22/1906 —Count ST. CROIX SE 1/4 NW 1/4S11 T 3 1 N /R W Township Somerset Boring Q Well PL Property Line# Alt. BM ,BM or VRP Assume Elevation 100 ft.Base of siding System Elv T -1 =89.3 T -2 =89.3 H.R.P Same as BM SCALE 1" = 40' Unless otherwise Noted > 500' to PL B3 95' 120' 2 > 500' Driv to PL 0' Pool 30' 94' Well 1 5' 55' 15' 30' 93 60' Ex Septictank BM 3 Bedroom hc use 95' Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system-fails, determine cause of failure, use alternate area and install new syst ested replacement area. Option #2 Install system at a lower elevation, by removing chambers, removing biomat, an install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715 - 246 -5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address .3 G �� 5 I v` �" �� S Property Address (Verification required from Planning & Zoning Department for new construction.) l City /State Parcel Identification Number "- Zb �/ ~ g� —0-90 LEGAL DESCRIPTION S ' /kJ /a Sec. // , T �N R�W, Town of S Property Location ocation � V i/a , i j Lot Subdivision h Certified Survey Map # , Volume , Page # Warran ty Deed # / D / �' , Volume , Page # Spec house yes e_-2— Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the Commerce and the Department of Natural Resources, State of Wisconsin. standards set forth, herein, as set by the Department of Com p ted and returned to the St. Croix County Planning & ed must be comple tics stem has been maintain p Certification stating that your septic y Zoning Department within 30 days of the three year expiration date. I/we certify that all statem on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the pr described above, by v' of warranty deed recorded in Register of Deeds Office. S GNATURE OF APPLICANT(S) DATE ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) yk.. fi a Si'S 1V82� rH16�'BPACC R68ERV.CD P„QA �l�P OA[A aoE t �o I STATE I)AK (�F• WISCONSIN. FULi111 3 ' _QUID ;CL.AIM � ' �t ' c _ 4a rsi..1. s n`d P B31� laragebn andet> y- ff — IIe� — - ''^T.l�^^^�" � l z t I1, r a v St Cr r 1 E a c€p3a 4ountY� a the foil I i ' ioecrtbcci real estate _�n _ �� , <g7 NIC OF_NEW °R C�1 ---- e "t14 "^'M F.r�j .d YT�IS, . _v i (ICTVRN �3 ': f t to of �1 iaconstn Il c _ 1 � P O BOk Y28 -�� "�� • � � � �'�T ldca£`ea in th�So�tlr"e:'tst S�arte� of -the �L N±ew Ki'"a�t�srl�l W� S401� i�a9 eY (SE 4 "zNk1 e) cif rSec 11: ��w ' - t+7oz`ts� nshp 3 j � O �' `preUr lit Vt1 r p age827, en Tax ? 1)sir'ce�l b Noa ` eri I.BurV m °�. — `h � t► � � icy- �rc an— eX t_esat� i.o�` ., � �,^ �- °' __ t ' � .. L he tQ !, he Sa't tk -1 of a or T ' r e "=iAle p tce� to ° 4�te -thy e�,s Heiae SN,or1t paralelwa thl th2E�s lithe bf th,��� Fb3�t,� T t� 3se3� -�h or Ft mat- ;- a'�p� x`i�t '7470�eet We�st�of the p� ��n�.,.�g �,... ,s,_ 3`m ._,,^ +� t..t).�4a' _.- _"'�.} .�f- hc'}T�n •tn no sz acs .."$ � '� ` .. -. �l R� )"te l�"��' Ot the 2 /UV lE'E.'4 1.v a.i� �r.v "' y :: � - - , • - •• - f , A ,yS 1/ eye pr ofh , S; deed is to �e�ease r tpa Ls a }in .er tP� 1� a gnnle o "�rtd do ra ���' or S�C'roS�x C4Z)u�nty 0 c T ° {� ©17' Page 201 a3 Do0856 _ - h L - a � l s v '6 to 7s. �: �� a c�y� .., � .r - _ �:_t �� —:_ - — '�- =-•" c estead ro P erty O ` t � P C snot) ; 'r9th da�af Amu t _ y ss r x v SEAL) -� ' 4 T dchurt , President ;(SEAL) I' (DEAL) e i i A rd ice- Pre�xdent .. z _.t.._ N W L E D Ci YV� E N N.SIN . - - Btgndture ($) : ss i _ _ StL''o1X County i - 1 _ _ f autt,enttcske� "tLica: tiny ot.._: 1 � --- Ya o �iiy t came befoee me this 19 .� r? _day of s - - Au ils LD the above named 88 o .. - -.. 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