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HomeMy WebLinkAbout032-2122-50-000 Wisconsin Oe of Con>rr>erce PRIVATE SEWAGE SYSTEM Safety Tito Bdk*Vs Division C ount f : REPORT S'{. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary 28 e Personal Irdommsition you provice may be used for secondary purposes (Privacy Law s.15.04 (t)(m)). 38 4128 Permit Holder Name: ❑ City ❑ Village MTown of: State Plan 10 No.: iswell, Chris Somerset Township T BM Elev.: Insp. BM Elev.- BM Description: Parcel Tax No.: I I o " � - = C 032 - 2122 -50 -000 • Ste- lae -lam. TANK INFORMATION 0 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark o 0740 Dosing Alt. BM o 1. nil r Aeration - ' Bldg. Sewer &.4 Qb • 9,.' Holding ✓$ -- St /Ht Inlet ��Z ' TANK SETBACK INFORMATION St / Ht Outlet �-.( o C1 .go TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Ot Inlet Septic �, / NA Dt Bottom -� . _ 3v ' U. - I � to Dosing NA Header/ Man. � 10 7b Aeration NA Dist. Pipe 10.80 %-400 Holding Bot. System '2_4 12 Z S', o l ' PUMP/ SIPHON INFORM`A110N y' ,...- Final Grade L,a, wet. v to I I m. 26 Manufacturer errand St cover �,s" . o Model ber GPM TDH I Lift ­,� Ion S tem I T Ft Forcemain Lengthy Est. To well SOIL SORPTION SYSTEM TRENCH Width t Length No f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSI SYSTEM TO PA L BLDG WELL LAKE / STREAM LEACHING Manufacturer : SETBACK , n CHAMBER INFORMATION System: ��2. / S,i; ORUNIT Model Numbe DISTRIBUTION SYSTEM Header! of d Distribution Pipe(s) x Hole Size Hol cing Vent To Air Intake Length Dia. 4 Oia. pacin �' > 9 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 #l: 02 1MIDI Inspection #2: — 7 - 7 Location: 2120 76th Street, Somerset, WI 54025 (SW 1/4 SE 1/4 13 T31N R19W) - 1331191104 Rocky Knoll Estates -Lot 9 1.) Alt BM Description ='_ 4� je � �$ 2.) Bldg sewer length = 3 0 ` ; I f - amount of cover Plan revision required? ❑ Yes .g No R ( g4 F th for ad itional i ormati 02- 2 S o �, �10 (q.3/9� �_� �� Oat Inspector' SignatuyleC�10a 1 S No. Cert . i � 8re.se..r.� r ..pi'.c,c..�,,} yam, �- ��' s,,r�{�ep�:elµ,,���•�o.(� r Safety & Buildings Division oZ� Sanitary Permit Appiicatioi� 201 W. Washington Ave. in accord with Comm 83.21, Wis. Adm. Code V 1 1 6.4consi See reverse side for instructions. for completing this application PO Box 7302 n Personal information you provide may bo: used. for woC daq purposes Madison, W[ 53707-7302 Oapartmnrri dt Commerce.. (Seal mit completed form to county rf not [Privacy law, S. U5.04(l)(m)f. state owned. - Attach com late lens to the county copy on for .the stern; on pap not -I/2 x 11 :mates in size. County . State Sanitary Permit Number 0 Check i i_avission aids appic State Na i.i. D. Number I. Application Information - Please Print all Information Property Own Name perey ..oration 1 /4, S1,3 T3 1,N, W"IE (or)(9 Pnapmrty Ownces g Address CO t? C?�F� J trip lea Block Number Z— \ City, State Zip Code `, Subdiv-isi m Name or CSM Number P �..,.. _ -- y` c II. Type of Buildings (check one) 0-5. S 040 VA' S. © City • 1 or 2 Family Dwelling - No. of Bedrooms : ❑ Vi14,g R5 Tow if • Public/Commercial (describe use):_ • State - Owned s t?>» cr Nearer; F oad 70 III. T ype of ermit: Check only one box on line A. Check box on line B if applicable) ✓� ,� ! • ! `/. �� A) 1. cK New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. O Addition to sy stem System Tank Only „_ Existing System B) Permit Number' ate Issue D A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ` ' (melon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Col strutted Wetland 0 Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Li ri i Line ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ O ar: V. Dispersal/Treatment Area Information: 1. Design Flow ) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6.5 is Zia Elevation 7. Final Gde ra Required Proposed Rate (GalsJd ft (Minlinch) ✓ 7 E 7� ,377 Y .7 Cc,�� 9 S s Z / 7J VII. Tank Capacity in Total # of Manufacturer Prefab Site : leel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks - ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersi ed, assume res ns . ility for installation of the POWTS shown o ched plans. Plumber's Name (print) Pl Signatm (no s): RS N Business Phone Num er Plumbees Address (Street. City, State, Zip Code) / IX. County /Department Use Only Cl Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 4.'s g Agent Si hue (No stamps) [,Approved 13 Owner Given Initial Adverse Surge Fees �s 2� ( _ Determination X. Conditions of Approval_/RfaSons for Disapprotial: W. �. loE> s� -b. Z 9' 7 Wiz. tom" - -- - - - - - -- V ' i a - -- - - - - - - - . - - - -.y' w� -- _ . -- - -- - - -- - - - -- - - -- . Wisconsin Department of Commerce Division of Safety and Buildings SOIL AND SITE EVALUATION Page ' of Bureatrof Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direQtion and percent slope, scale or dimensions, north arrow, and location and distance to neargstroad. Parcel L # 63z= /03790 - Gov APPLICANT INFORMATION - Please print all inform #tion. A° eviewed by Date Personal information you provide may be used for secondary purposes (Privacy aw, s. 15.04 (1) (m))., 6 Property Owner Propei 14iceiipn , 1/4 j 1/4,S ,N,R 4P(or)j Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City JJff State Zip Code Phone Number Nearest Road 4df01 to syo /� (pis )5yy fF7 ❑City ❑��Ileg� Town Io a rc ,S©�t r New Construction Use: (Residential / Number of bedrooms 7 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: ,Q Code derived daily flow �6o gpd Recommended design loading rate o bed, gpd /ft ` v trench, gpd /ft Absorption area required S" <2 bed, ft 7� trench, ft Maximum M design I a o loading rat o bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 9.s. a ft (as referred to site plan benchmark) Additional design /site considerations Parent material . /10 191k (f 2 P" //,0 Flood plain elevation, if applicable // 4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U unsuitable for system s ❑ u © S❑ u © s❑ u ®s ❑ u ❑ s Z u El s p u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench / Zhu . Y 5 2 /10 _1Z 7sY/Z 6 / yy S� ° Z 2Asak Al / .s Ground 3 3z 9f AW % /Y /, / `l s oS --- v7 ' log ev � ft• Depth to limiting �f gs •2o , M f t f a t r in. Remarks: Boring # 2 2 IZ 7 IVA fL /Al.sAr %/h e y ; , J Ground Depth to limiting factor /DY in. Remarks: CST Name (Please Print) Signature Telephone No. 6 Vrl n 7 parli if `:; 71 = Z� ,72-03 Address �� , fc�f'� Ar Da te, y 2,3 I.3 I S� Num ber PROPERTY OWNE -" ` SOIL DESCRIPTION REPORT Page 2 or 3 PARCEL I.D.# 0 Boris # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench N C 2�1 • y IVA Ground 1 7 - 97 IPM/ 6 A/4 d L — • 7 ,' d'' 4 T I v. . ft: Depth to limiting z - Z- factor 9 7 in. Remarks: Boring # - /z kA- y 2 1-3Z IV A- f! L Zhsilt d.Il, yw Ground A Depth to limiting � cto 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 # 0 4 0 % Al A- C V , as - � Depth to limiting fvt r d in. Remarks: Boring # Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) c OWNER Page 3 of 3 Name G � C. Brian Parnell Address CST 23131 Date A Benchmark 1 Benchmark 2 1 - V. 6 7,y ❑ Soil Boring ;_ _i Suitable Area ✓1" = 40' Scale AP ! ' I °1d I ,R �s M ^ Z ' o I L f ; e � c r A — su 2 5o)(v q 2i2,ur r • m � " u .�' "� �. 1N3' NII�NJJ � I I �^ O I q �?� p N O I'� r / w �� �z cn Ir d D T A ZJ £ d �� O O QA CD Tc 11 �' v 0 I c z, m m c� / �' D CT1 O a 1� (D 9 9 I G Gj I > m (/) (O 9. I' m m C.4 C x y � o � 1 0 16 i G I O m x Io .. �� O Io z 4U3T o 707 �. . TOW GAD r I� I� i � -=160' m N'2�1'00 ^�• 3 � ;,..0/ 50 "W 'D --6fi7 ,� \ 70.,33' - n O �__... , Niz•37.00 ;' 9 3.2q• ,, =6 � I o - -- _.. 12• U� f 70 .33' -267 S 1'14 42 o z . pL17 Mrs r o. r*i 0 y.. o o IM, I - `' 41.91' w.� O . M I� 7J u � IT N �., „513.21'. ` - X 5.28' � \ 102 r N rn C,d D m I M - - rn L v_ .p n IQ D OD A C p v o > 21) - r O O ,-' m I D C") O -� z U� O to G� D ci rri O > O p Q N' � m.c� d -1 Z77 ,'ikJj I w I cn p O m (A D rn �` iII 0 Y (A 0 103 240.01' 231.00' I i 1' 1 I 218.00'- 33 OB' . — 5013319 "E.689.Uf• •)E SE 1/4, SEC.. 13 i m\\ .O O `.SQ 7 p �\ m UNPLATTED L MELVIN AND FRANCES BRI"AUJ_L � — — — — — — ° 7 ONED AG –RES 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 Number of Bedrooms Design Flow - Peak (gpd) - b Estimated Flow - Average (gpd) o'b Septic Tank Capacity (gal) Soil Absorption Component Size (ft' Type of Wastewater D mestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 6vo �� z - as t Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Tab le 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 outlet filter s hall be cleaned as necessary to ensure p roper operat 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 r- • 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. 3 ST CRCIX COUNTY SFPTfC "'A-NK MAINTENANCE AGREEMENT AND OWP CER'T'IFICATION FORM Owner/Buyer (.s'vr A Mailing Address Propelly Address a I - ,0 Sf (Veriftaattou rcquircd from i Planning Department for new construction) City /State Parcel Identification Number d- �. - 2 / 'Z Z Q _- L E GAL DESCRIPTI Pro I_,ocatioz' q a/� 'J, t C. 1 T I W Town of ply -- , �. — —� ._..N- / cZ Subdivision A O A11 Dec- �� Ll 70 �e_v0 4 Pials P, 95 LO # �_ Certified Survey Survey Map # Volutb.e , Page # _ Warranty Deed # 63 y Z 7 / 1 . Voltune %5 Page # Spec house ❑ yes f. no Lot lines identifiable J 'ryes C] no SYSTEM MAINTENANCE Improper we and maintenanceof your sel pc system eould result in its premature failure to handle wastes. Propermaiatensnce consists of pumping out the septic tank every thr( a years or sooner, if tieddod by a licensed pumper. What you put into the ryctem can affect the function of th e septic tank as a tmi anent stage in the waste disposal ayetem. The property owner agrm to submit to St. Croix Zoning Deputmcut a cortiftoatioa form, signed by the tamer and by a masterplurnbor, j oumeymanplumber, restt'ictedpl- trnber or a licerueApumper verifying that (1) the on -site wastewaterdisposal system is in proper operatiug condition and/or (2) after in: ection tad pumping (if necessary) the septic Neale is lees than 1/3 full of sludge. I/we, the undersigned have read the above require heats &ad agree to maintain the private sewate disposal system with the stsrndards set forth, herein, as set by the Departmeta of Com tierce ¢tad the Department of Natural Resottecea, Stato of Wisoonsia. Cc:taiS3oation statiq that your septic system has been maintalnel I must be completed and returned to the St. Ctolx County Zoning Office W 30 days of the three year expiration date. siraNA•I M OF APPLICANT DATE O WNER CEltTM TA ION I (ale) certify that all atatomonts on this ; ►rm are true to the best of my (our) knowledge. I (we) am (are) the o wner( r) of the propeay above by virtue nf a wam ity decd recorded itx Register of Deeds Office. SIGNATURE OF APPLICAt4'T' DATE Amy information that in mis represented rr ay result in the sanitary permit being revoked by the Zonixxg Department. •• "'�' Include with this application- a stamped wan lnty deed from tho Register of .Deeds office, a copy of the c rtifted survey rnap if reference Is made to the warranty deed VOL 1585PAGE 192 r� G3S271 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between M & G, Inc. RECEIVED FOR RECORD 02 -09 -2001 9:30 AN WARRANTY DEED Grantor, and Chris M. Wiswell and Jennifer M. Wiswell, husband EXEMPT D and wife, CERT COPY FEE: COPY FEE: TRANSFER FEE: 117.00 RECORDING FEE: 10.00 Grantee. PAGES:: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 9, Plat of Rocky Kroll in the Town of Somerset, St. Croix County, Name and Return Address Wisconsin. Eagle Valley Flank 102 N Washington St. Croix Falls, WI 54024 032 - 2122 -60 Parcel Identification Number (PIN) This is not homestead property. (K) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this CO of February 2001 M & G, Inc. « « Mic ael G. Ger ain, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) M & G, Inc., by Michael G. Germain, President, STATE OF WISCONSIN } ) ss. County ) authenticated thiday of February 2001 Personally came before me this day of the above named + Krist U La nd TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) • Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals company. Fond du Lae, WI WARRANTY DEED STATE BAR OF WISCONSIN eoo- 655- FORM No. 2 - 1999 Located i part of the Southwest Quarter of the Southeast Ouarl NCRIN 114 COOWN CTK1N 13 -31 -19 (rOUhV 2 1RGY APE) / O r Im I 80' RAO. TEMPORARY CUL -DE -SAC ESMT. 57 046'E UNP' -ATTEC N UNPIATTED LANDS r/e se 77.1 — — — — .roe»r tw[ c� ,? c'si 1/s 1* 74 a ,rte . I µ88.04'29'E 827.04 -4� +v� .$Ol•14'4 a� r•die' • 0 I 141, I LOT 10 I 12 A% 131,078 S0. FT- 1 3.01 ACRES erY �� wbSOa•29'E LC go c /� 159,8E t N m � rM,,,,,,cc U3fJauT L�� � d _ I I 3.67 "' 130,858 S0. 3.01 ACRES Z + I �o iv Q� r r '� tesew'�"E p�a� t"A LO* x O%W �� 191,16. Q J 4.3 9 alb f LOT 8 F �" 292 S0 _ 131. _ WNW 3.01 ACRES \ 588 04 • 260.64' 45.2 e..rev s� i 1 S88 29'W 510.23' I I I I c� I � I a HSE ; EX HSE I ; I mm Y I o of � of 00 0 r i -i'I I Ni�I H ; I z �Ivi QI I � �I0I I �'"� I 0 1 � `a 4 �n I I El S�pf/1HMEST CQ�D' ER o� ■�Y Cr 2tO1 \ �� I 1 J " SECDQV IJ -Jl -19 THM poftTlom of ut tbatt H AVE — — (AU,U Ca kc) �� ; L is m et ro ° µgg•01'47"E �SgB 7 � S88'28'S5 -W 510.20