Loading...
HomeMy WebLinkAbout032-2177-12-000 g 7 , o k % 2 / 0 ° & �� 0 e 3 \\ �f( §_§ cs +�o g e 2 J © / >£ §I c i \ ® §/ E § § � § E c ty ® : > E � 0 0 0 % § co co § i § o v 2 + c G g d § :3 ] 7 - � 2 \ Q \ % / CA — G $ ƒ O @ / i \ � a g E a � k M } J = ' � o o .. M / ) � E § / 2 o FF ® a f 2 # � aEE7c /k @ / k / -R 2 f ) 2 / a o< z CL cn CD §k // kw aEa { � f�a 7 \0 } \ $]/ mm= % 2/i 2 % 0 / � J � ■ 0 <§ q -o �f c O '' m o M �1 Q! W 0 N C 7 d N O w C i t Fri 4 a N j M BCD _ n R) Q d ,_ N O O n 3. CD O C O O a O N I: O O a O 3 ° m U> z lD (0 D N O co CD 3 a. XF 3 O ° o � a CD OD N CD i Z 0 0 C n r cn D Z O O O m �• o O n N N N ^' a cr C IN 9 A C N 7 7 pl p _ I � N N CD Z N Z_�,o c - D = fl« C) c ° <_ �� � < (D(D y �. m d a CD c �y� C j a -°o ° p N. aft N 3 C x CD II O ? w ° a a) m Z m m 0� O 2 > 3 D7 O A 2 n o 9 m A Z o CD ;7 y a O CL 0 y m 3mm Z -' N m v m o m CD z CO 0 a a N v O a 3 N O M CD _ n o c Q D N o y C(n Cn a C 0 03' O a C (D �� 3 CD 7 Q C (D N C 70 m N ° II Co N N j N W a O II z D) O O CD CD 0 ID (r d !III in .iZ, < a C CD 7 D O O N �� CL Oz CD (D � CD O o N N N CD a 0 (D a - ° O A O C+a CD W � O l ti w O CD 0 a Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453377 0 GENERAL INFORMATION (ATTACH T 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: Plourde, Richard Somerset Township j 7 - Q CST BM Elev: Insp. BM Elev: BM Description: 2 _ SectionlTown /Range /Map No: 16r /0 ' J [�� C � 11.31.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark a7zb 160 Dosing Alt. BM Gzrc:3 Aeration � � Bldg. Sewer Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet I Z A q 7.-r I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet c' Septic � � j r I � / � Q _ Dt Bottom Dosing �3 / 1 i / _ Header /Man. "7 0 A CrV -7 if Aeration Dist. Pipe $ 71 Holding Bot. System Lc' Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM I A Model Number TDH Lift Friction Loss System Head TDH Ft i Forcemain Len' t. t Dia. z i I Dist.-to J SOIL ABSORPTION SYSTEM -5 Wiz,.. Y BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: f ; r 1 n (� % UNIT Model Number: 6 --AX t �a ! - 9 � U r i t � DISTRIBUTION SYSTEM r �� ( `� S i6�. Header /Manifold 7 IDistribution -'L Size x Hole Spacing Vent to Air Intake Pipe(s) \ Length ` Dia T Length Dia \ Spacing ` ` �� SOIL COVER Pressure Systems 0 I xx Mound Or At -Grade Systems Only x s e ny y y Depth Over J Depth Over xx Depth of xx Seeded/Sodded 1 xx Mulched Bed/Trench Center f �! Bed/Trench Edges Topsoil \ 11 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �1S / / Inspection #2: Location: pending (Cty. I $ 220th Ave.) Somerset, WI 54025 (NE 1/4 SW 1/4 T31N R19W) Hidden Hills Lot 12 Parcel No: 11.31.19. 1.) Alt BM Description 2.) Bldg sewer length = - amount of cover= Plan revision Required? es L No T-T i Use other side for additional information. Li _ ___l ___ —_.___ __ __ —___ ____ L — n - 1 A S (R.3/97) Date Insepctoes Signature Cart. No. Safety and Buildings Division County r N y r isconsin 201 W. Washington Ave., P.O. Box 7162 Madis on, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608)266 -3151 --, Sanitary Permit Application state Plan l'D. In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Ptiviwy Law, sI5.04(1)(m) Projcct Addr s (ifdillcrenr Ui ru maihny u i I, Application Information -- Please Print All Information M ±� •� /t'l j` ' """ ` Property er's Name i a J 0 Parcel # Lot # / Block # r i Property Owner's Mailing Address r roperty Location _i L •-- .— .��.�: .� >....._...�_..1 , �a,i., Section City, State Zip Code Phone Number TYj, N; R (c ircle If. Type of Building (check all that apply) 13 a Subdi ision Name ❑ 1 or 2 Family Dwelling — Number of Bedrooms ❑ Public/Commercial — Describe Use ❑ State Owned — Describe Use 3 D� sr l S ❑City, ❑Villa Township of�, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) T /Zer*�i a b A. J4' New System y Q Replacement System ❑ Treatment/Holding Tank Replacement Only C1 Other Modification to Existing System B. C3 Permit Renewal ❑ Permit Revision C3 Change of 0 Permit Transfer to Now List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S stem: Check all that a pply) .4 Non — Pressurized In- Ground ❑ Mound a24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ M -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized - Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter — Recirculating Synthetic Media Filter Kaohing Chamber ip, Line ❑ Gravel- Pipe 0 Other ex la' ) V. Dis ersal/Treatment Area In or ation: h Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (if) Dispersal Area Proposed (sf) 1 System Elfflluim 3 8 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site er Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks. Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Respon sibility Statement- I, the undersigned, ass3prne responsibility for installation of the POWTS shown on the attached plans. Plum r' am (Pri Plumbe s Si e MP/MPRS Number Business Phone Number Piumbor'a Address (Street, City State, Zip S VI11. C66n /De artment Use Onl Sanitary Permit Fee (includes Ground er pate sued Iss n A e gnatur (NO ps? proved ❑ Disapproved Wa C Surcharge Fee) �. �) d� Da / � ❑Owner Given Reason for Denial V IX. Conditions of Approval/ asea isalrp>� lJ 6 1 STEM OWNER: /' 1 Septic tank, effluent filter and s fuj "1614V%4A1i"t dispersal cell must all be serviced / maintained as per mana ement plan rovided b lumber. 0-h- 2. All setback requirements must be maintaine as per applicable code /ordinances. 3 m 0►'t-s Attach complete plats (to the County only) for t�system on paper act lesa 11 In s4sr 3 r J D SBD -6398 (R. 01/03) ,ox ��� -Sid - s� ��- 7'.3�� R /9t j ob I T o ;,)e i I { I I �I I I ! _y_ ---- -r - - 1I I r C� I � I I t I I ! I i I I I � I I n I I i — /.I l 7k l - �T I I r I � I I I I I li I � w I 1 - -- - -�- - _ I I I e�-� cz?® c ,r sus � B .ate / 3 71 Zil- �St t,EN� ST CROIX COUNTY SEPTIC "TANK MAINTENANCE AGREEMENT 'AND' OWNERSHIP CERTIFICATION FORM Owner[Buyer ivlailinb Address — �� � .S Property Address - Y1 (Verification requi ed from Planning Department for new construction) City /state Parcel Identification Number I11 QESCRIIIT Property Location t /., Y, ,Sec, T,V + N.Rjj_W, Town of Subdivision Lot #. Certifi(d Serve 1F1a # y p ,Volume ,Page # !2vS �, , ced # 552.3 I Volume 12 01 , Paga #. 3q( spep house Q yes eno Lot lines identifiablex--Yes O no T 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 soplic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix lolling Department a certification form, signed by the owner ::r, a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) the on-site wastcwatcrdisposal 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 /wc the undersigned dcrsi ned have read ead 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 days of the three year expiration date. blUNA7 URE OF APPLICANT 6 1 ¢ DATE CERTIFICATION l (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the properly described above, by virtue of a warranty deed recorded in Register of Deeds Office. — y SIGNATURI~,OF APPJ -ICANT � DATE • «. « «.. Any information that is misrepresented may result in the sanitary permit being revoked b the Zonin D Y 8 P .. «... Include with this app ication; a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN. page of C,:2— FILE INFORM6T SYSTEM SPECIFICATIONS Owner Septic Tank Capacity O NA Permit # Septic Tank Manufacturer •P" Q NA DESIGN PARAMETERS Effluent Filter Manufacturer -- O NA Number of Bedrooms O NA Effluent Filter Model O NA Number of Public Facility Units IN NA Pump Tank Capacity a l _Z NA Estimated flow (average) al/day Pump Tank Manufacturer S NA Design flow (peak), (Estimated x 1.5) Pump Manufacturer "' al /da "'' `` `"'` ''` ANA t Soil Application Rate �S �e al /da /ft' Pump Model ANA Standard Influent /Effluent Quality varage" Pretreatment Unit NA Fats, Oil &Grease (FOG) 530 mg /L O Sand /Gravel Filter r. Q Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection Q Other;!,, 1 Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L a In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 36 NA O At -Grade - O Mound Fecal Coliform (geometric mean) 510 cfu /100m1 O Drip -Line Q Other: Maximum Effluent Particle Size Y in dia. ❑ NA Othen O NA Other: O NA Other: Q NA "Values typical for domestic wastewater and septic tank effluent. Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every; yeast s„ 8 (Mau(fnum 3 years) O NA ear, - Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal c.oll(s) At least once every: O monthls) (Maximum 3 yews) 13 NA 19 year(s) Clean effluent filter At least once every: ❑ month(#) O NA .® ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) -a NA Q earls) .. Flush laterals and pressure test At least once every: 13 month(s► ;;:; 3 NA ❑ year(s) Other. At least once every :: O monthls) p3 NA O earls) rOher. O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cert ifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and-to check,for any ponding of effluent on the ground surface. The ponding of off luent on, the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. mm- When the combined accumulation of sludge and scum In any tank equals one -third (Y or more of the tank volume, 'the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized cpmpopents,'pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer, A service report shall be provided to the local regulatory authority within 10 days of completion of any service event - �a GMW (4 /01) r Page cz of START UP AND OPERATION r'• . r,; l�; For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting prcducts,pr of for chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bu discharged to the dispersal cells) In one large dose, overloading the collie) and may result - lwthe bookup Or surfa0o discharge of effluent, To avoid this situation have the contents of the pump tank removed by a Soptage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually pp eratin the* purnpy'oontrols to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise-disturb or compact, the arua within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diaspers;'disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbioide ; ;lsMost- Mraps;..Milolostions; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine... t ' ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the systern is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings s" • The contents of all tanks and pits shall be removed and properly disposed of by a 8eptage. Servioing Qperator. • After pumping, all tanks and pits shall be excavated and removed or their covers rem0vod .and.thevold space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN ' If the POWTS fails and cannot be repaired the following measures have been, or must.be.taken,...to, provide. a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system, The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a now so)I and site evaluation to establish a suitable replacement area,' Replacement systems must comply with the rules in effect at that time. O A suitable replacement area Is not available due to setback and /or soil limitations. Rarring advances in POWTS technology a holding tank may be, installed as a last resort to replace the failed POWTS. e Vus of been alus d to identify itable area. �Upon ail o the POWYS a soil and sit al a rformed locate a itable l n ant ar is availabl* *,holding tan - may llad as a last resort t e the failed P O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at th, infiltrative surface. Reconstructions of such systems must comply with the rules In effect t that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES,' DEATH MAY.RESUM RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWYS INSTALLER POWTS MAINTAINER Name Name ;, Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83,54(1), (2) & (3), Wisconsin Administrative Code. Wisconsin Department of commerce SOIL EVALUATION REPORT Page _ � of 3 ri /;sik)n r Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. q / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 2 to 3 Please print all information. Reviewed by Date i Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). P Owner Property Location Govt. Lot 114 114 S T N R (or Property Owner's Mailing dress Lot # Block Subd. or 6Siai City Sta e 7jp Code Phone Number ❑City El Village C3 Town Nearest Roan ,V , New Construction Llse Residential / Number of bedrooms Code derived design flow rate (i GPD ❑ Replacement Public or commercial - Describe: Parent material (flood Plain elevation If ap icableR � General comments // ) //,,,,,, and recommendations: - 57`1'm �� ' ' 4 0 7 70 0 `�.� ' 4'.Y APR 1 6 2004 atz p�CC.�`t issuo,tce . /3y U ")-'2 OIX t. ❑ Boring S OFFICE F71 Boring # pp11 ter I Wr Pit Ground surface elev. � ft. Depth to limiting factor 5 ' //S In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Gm in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eif #1 'Eff#2 s 4 4 k' 4 . r 4 9 T� 9 Ong # ❑ Boring s t'o J pit Ground surface elev. ft. Depth to limiting factor - '- 4L— in. Sal 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 AIIJ 24L 4 7 y � q 9 � v� 4 `� • Effluefit #1 s BOD > 30 : 220 nVL and TSS >30 < 150 mgll. M #2 OD 1 30 mg& and TSS < 30 nVIL CST Name ) Signature - CST Number Address Date Evaluation Conducted Telephone Number r � i Property Owner - " Parcel ID # Pays � of - Boring 12 ❑ Boring # ,M Pit Ground surface elev. J7 ft. Depth to limiting factor > _ in. SoiI lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Etf#1 'Eff#2 G _ , q R Q Q 3 ' s i N. " oQA ❑ B o ri " g Al ❑ Bori ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application R; (e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff# a Ong # 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 GP /tf In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 Effluent #1 = SOD > 30 220 mg/L and TSS >30 1150 rnWL ' Effluent #2 = B00 < 30 mg/L and TSS < 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. 264.8777. S804330QtAft) 19,n IL J OT L l IL " Document No. TRUSTEE'S DEED 552 311 r� 32O�Pa�3� �-,�'p'N ItEGlSTcn� L�r�� "s at CROIX co,>�n Firstar Bank Wisconsin, We Firstar Trust DepartmsK Trustee of the trust created under the WID of Ralph Wilfred Plourde, ASV 18 1996 3 for a valuable consideration► conveys, without warranty. to Richard at 4:30 P . M Plourde, the folkm" desdi Croix County, `V-A� `% 0 'hk State of Wisconsin: ltssKa�.ees SW % of Sec. 11, T31 N. R19W t Except that parcel contained in CSM Volume 3, Page 847 Filed on 8-20 -1979 Return to: Richard Plourde 624 220th Ave. Somerset, WI 54025 032- 1031 -95. 032 - 1032 -10, 032 1032 -30, 032 - 1032 -44 (Parcel Identiftation Number) This Is not homestead property. 1 Dated this day of laooAk c . 1998. FIRSTAR BANK WI SIN t BY: its STATE OF WISCONSIN ) P as. Eau Claire County 8 the above -named P Ily came before me this day of 199 of instrument and to me known to be the person who executed the � M acknowledged the same. Notary Public, State of VVbconsin My commisslon 3& 0 A. MANM c Ex THIS INSTRUMENT DRAFTED BY: A. M� Mr a 1 a' Stephen R. Schrage - Lawyer Tp State Bar #01013907 `� 9 %OTARY PUBLIC � ft of Wisc ° ° �r Moto LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SOMERSET COMPUTER NUMBER 032 - 1031 -95 -025 Parcel Number 11.31.19.152A OWNER NAME: First RICHARD L Last PLOURDE PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 1 N 31 N RANGE 19W%160 '/44 Line Description Line Description TPTAL ACREAGE 61.680 PLAT LOT 1 S E C J 1 T31 N R19W PT NE SW 15 1 4 02 & PT NW SW EXC PTS TO CSM 16 3 -847 & CSM 17 -4608 17 18 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit �X O N- 1 / W; xf Z .,_`... X r -1 N00 332.57' lol X30- \ \ � r :F L4 y o y ©�� = V �� � _ F Ul y co a J X A o A Ln I ..292 242 \ to / � 'I