HomeMy WebLinkAbout032-2147-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Divi ,
` INSPECTION REPORT Sanitary Permit No: 408287 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:
Pe per, Jeff I Somerset Township 032- 2147 -50 -000
CST BM Elev: Insp. BM Elev: BM Description:
16 0 1 1 0 6 ) .4 5 t , ' , -A(-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic O Benchmark 14 /O '(00
Dosing j Alt. a M`�
f #,
Aeration Bld�er
e f 7
Holding_ St/Ht Inlet
7• (s� 9' • /�
TANK SETBACK INFORMATION St/Ht outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
CA s �-
Septic / o ^ / Dt Bottom
/
Dosing He Man. I (
Aeration Dist. Pipe �� I
Holding Bot. System t IW I
Final Grade
PUMP /SIPHON INFORMATION Z gcp _ 44 A4
Manufacturer emand St ver
M b.
Model N ber
TDH Lift Friction Loss System Head TDH Ft
Forcemie Length ia. Dist. to We1I
SOIL ABSORPTION SYSTEM
BED/TRENCH Width �� Length �' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS —I---
SETBACK SYSTEM TO P/L 6 JBLDG WELL LAKE /STREA LEACHING Manufacture _�
INFORMATION -I CHAMBER O •�4e(_
Typ Of System: UNI Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Ven Air Intake ti"t�
r Pipe(s)
Length Dia Length Dia paang
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over IDepth Over xx Depth of xx Seeded /Sodded Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes * N Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/�/ UZ Inspection #2: / /
Location: 532 214th Ave Somerset, WI 5 (NE
114� SW 1/4 15 T31 R1 9W) Oak Haven Lot 15 Parcel No: 15.
1.) Alt BM Description rYla'(J�d ��D +v �I 'I / g " Z-
2.) Bldg sewer length = �± ct il� brzl t]w'
- amount of cover
Plan revision Required? '; Yes No
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctors Signature Cert. No.
I
Safety and BWdnW Division ` cmw
201 W. Washington Ave., P.O. Boa 7162
` Madison, WI 53707 — 7162 Site Address
Department of Commerce f -.- /— d a. o /DSO �2— 2-14
--
Sanitary Permit Application Sanitu � Permit Number
In accord with Comm 8321. Wis. Adm. Code. personal information you provide (bride if
my be used for Law, s15.040 Ataw
L Application Information — Pkase Print All InformadOu RE G '
Plan I.D. Number 7 4-'
Property Owners Nam J 9 5 20 02 r Number /S. 3 /. /q, 210 Co
—v -�5
PmpertyOarnersMaitiog Sl" C�71���� Location
;S4 T N. It
City. State zg+ code Number Number✓ Block Number
Subdivision N _ CSM Number
II. Type of Building (check all that apply)
Al' or 2 Family Dwelling - Number of Bedrooms ov!gage
0 Public/Commercial - Describe Use
❑ State owned N earest Road .- Ave—
M. Type of Permit: (Check only one boa on line A (mtmbering scheme for internal use). Complete line B if applicable)
A New 2 0 Replacement System 3 0 Replacement ofl 6 0 Addition to For eoumy use
Tank
B. 0 Check if Saz tart' Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (C,hedc aI1 thayapply)(nambe<ing scheme is for internal use)
z,/ on presstuized le-Ground
210 Mound 47 0 Sand Filter 50 0 Constructed Wetland
o p In -Ground 410 Holdwg Tank 48 0 Single Pass 510 Drip Line
45 0 At - Grade 46 0 Aerobe Treatment Unit 49 0 Recircalaft 3o 0 Other 2 S
DelmJ—
V. Area Infw;;;';
Design Flow (tom Dispetsal Am b6persal Area Soil Application Percalatiod ftw System Final Grade
V5 Raoe(Gals./Days/S9.Ft) (Min•/fncW & o �
6 �
VL Tank Info Capacity is . Total Number Manufacturer Prefab Site Sted Fiber Plastic
Gallons Gallons of Tanks Concrete Coin Glass
New Ta� /Z
floft Tank
aw0m
VII. Statement- r espansib0ity for installation, of the POW" shown on the attached phms.
tm(Print Phtmber's MP/11�RS Number Business Phone Number
Phbeels Name
Plumber's Address (SUect, City. State. )
- �g - -- / �' &&,:"z ' ' 2/,
VIII.
Approved ❑Disapproved Permit Pee (iaeltdes Groundwater Date Q lsstted Agent Sigmsaue (No Stamps)
Surcharge Fen) V `� I
❑ owner Given Initial Adverse
Determination
" diitions of Approval /Reasons for Disapproval y, /1s S - `/o 0 01 / 44, n 4
� bu�1C5YN�
b VG ✓ ;A -W IoYCD✓ GowirYl,CC�cj lbn6frv� fraY1�
b � .n �Gl •mo t �.�l �i tsar- ' h4-d e o f v 1wa.k � Lrw�i..�ss• pPd c %ri c g. b u s
�u w�bl �5{ l( wfi w►✓'rd Zo rwQ1 !� t / SfK�I�w 5 Selo hJ Gs�H�/�.� N A60 `d1Z
` i >,, t SGfYI 1�V S f t° !. P�T4��b �rOC✓ p G61r� N�Gt�.� t OK6 1 V A
Attach oisopiete Plans )tor ,�thei� on paper oat Ins than 3512 1 In sire
ewo
eRnlI4R !R 05 /011
PL T LAN
PROJECT Jeff PeDDer A RESS 22 0 South Ave. E ADt 11 N. St. Paul Mn 55109
NE 1/4 SW 1 /4S 15 /T 31 TOWN Somerset COUNTY ST. CROW
MPRS Shaun Bird 226900 DATE7 / 24/02 BEDROOM
CONVENTIONAL )00( IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SI 1260 gallons LIFT TANK SIZE DOSE TANKS
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chamb 30
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
Vent SYSTEM ELEVATION 94.0/93.2
>6„ Standard Infiltrator Plans Designed Using
Leaching Chamber Conventional Powts
of Cover with 31.1 ft2 of Area Manual Version 2.0
6' Long 12"
34" Grade at System Elevation Vents
B.M.
B -1 38'
2 -3' X 94' Cells with >3' Spacing 33'
B -3 81 ''
4 %Slope
1 '
Vents 50'
10' B-2
T
20'
208'
0 3 Bedroom
House
Town Road
PL QT kAN
PROJECT Jeff Peaaer A RESs 22 ' 0 South Ave. E Apt 11 N. St. Paul Mn 55109
NE 1/4 SW 1/4S 15 /T 31 / TOWN Somerset COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/24/02 BEDROOM
CONVENTIONAL )= IN- GROUND P SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SI 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 933 # of chambersf_ E6
,BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 94.0/93.2
Vent
>6" Standard Infiltrator Plans Designed Using
Leaching Chamber Conventional Powts
of Cover with 31.1 ft2 of Area Manual Version 2.0
6' Long 12"
34" Grade at System Elevation Vents
B.M.
B -1 38,
2 -3' X 94' Cells with >3' Spacing 33'
a
B -3
4%Slope
I
1 '
Vents 50'
10' -2
T
20'
208'
0 3 Bedroom �s
Ouse
Town Road
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
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. 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
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --I-- of
Division of 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.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information Reviewed by Q Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot NE 1/4 SW 1/4 S T N R I (or) W
SIQJ th is 31 19
Property Owner's Mallir4kddneis Lot # Block # Subd. Name or CSM#
AI State Zip Code Phone Number El City El Village R] Town Nearest Road
Elk River MN 1 55330 H 61 2) 441 -8888 Somerset I 21.Qh. Ave.
[a New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 6 0 0 / GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material o 1 i wa G h Flood Plain elevation if applicable Y� ft•
General comments
and recommendations: N•
Q
trenches @ el. 93.90, spaced to code 3.50' below grade ", srcRc7(x 1
CE
Boring `
Boring #
F pit Ground surface elev. 97.40 ft. Depth to limiting factor +100 in. ,
it tion 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
1 0 -16 10 r4/3 none sl 2mgr mvfr gw 2f .5 .9
2 16-1C0 7 5 r4 6 none ms os ml na na .7 1.2
Boring # Boring 97.70
2 ® pit Ground surface elev. ft. Depth to limiting factor +100 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
1 -15 10 r4 3 none sl 2m r mvfr gw 2f .5 .9
J
Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg /L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature T Number
Gary L. Steel of 02298
Address ' Ela - te " 15v - aluatiorf Conduefed Telephone Number
1554 200th. Ave., New Richmond, WI. 54017 6 -1 -2001 715 - 246 -6200
I
Property Pag 2 of 3
a Owner Parcel ID # 9
p rty ��r�1�1-- �-- ��ti
Boring # ❑ Boring 95.70
3 [� pit Ground surface elev. ft. Depth to limiting factor +90 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
1 0 -14 .5 r4 4 none S1 2m
2 1
?� o
Boring # ❑ Boring —
❑ Pit Ground surface elev. it Depth to limiting factor in. Soil Ap lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Boring
❑ Boring # Ground surface elev. ft. Depth to limiting factor in.
F1 pit 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 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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.
SBD -8330 (R.6/00)
t
•
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Gerald J. Smith New Richmond, WI 54017
MPRSW -3254 NE4S - s15- T31N - R19w (715) 246 -6200
town of Somerset
lot #15 -Oak Haven
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40'
BM.= top of 1" pvc pipe @ el. 1 0.00'
Alt. BM.= top of 1" pvc pipe @ 1. 97.00'
IL
u
Q�
j �� t
R7
� G!aryVIL. Steel
6- 1- -2001
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OvcnerBuyer ^�
2
Mailing Address
property Address off-- a f - r
(Verification required from Planning Department for new constructton)—
City/State Parcel Identification Number
LEGAL DESCRIPTION ��
Lora OWo 2—F %,- L 4 Z V•, See, __, T !L_ N-R4/Zw, Town of .
Property Lot #
Subdivision Q A , 1�' ��—
�` Page # �
Certified Survey Map # . Volume —� .
Warranty Deed #
r , Volume / S Page #
Spec, house y - Lot lines identifi yes D no
S MAIN'T'ENANCE
improper use and maintenanceofyour septic system could result m its premature failure to handle wastes• rmaintenance
consists
out the s tank every three years or sooner, if needed by a licensed pumper' What you Par into the system
can affect t pumping � c the fimetion of the septic tank as a treatment stag e in the waste disposal system -
The property owner agrees to submit to St. Croix Zoning Department certification form, signed by the owner and by a
masterplamber, Journeyman Plumber, restricted plumber or a licensed pump, verifying that (1) the on -site wastewater disposal sy stem
is is proper operating condition and/or (2) after inspection and pumping (if nay), the septic tank is less thaw 1/3 full of sludge.
the vate sewage disposal system with the standards
U the undersigned have read the above requirements and agree to maiurtainf Natural Resources, State of Wisconsin. Certification
set fordo, herein, as set by the Department of Commerce and the Departm Ogee within 30
sating that your septic systc bas been maintained must be completed and r brood to the St. Croix County Zoning
;U;5 'oa date.
DA''
LICANT
OWNER CERTIFICATION knowledge I (we) am (are) the owner(s) of
I (we) certify that all statements on this form are true to the best of my ( Our)
the described a e, by virtue of a warranty deed recorded in Register of Deeds Office- c SIM /
D
O APPLICANT
* * ** 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 decd from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
LOT 4 j LOT - 5
i LOT 6
I
I -- ------ - -S89'1 5 -- 5331.35' --------
4FST 114 LINE I I R- S89'26
S89' 15'22 "E 1332.87'
221.97'
'16.41' 205.56 221.97' 221.97' 221.97'
o BDVCHMARK-
rOP OF PaV PIPE
ELEVA new 920.90 LOT 15
130, 684 SO. FT. R s
3.00 ACRES
MIN. FF£ -902.3
LOT 16
130.684 SO. FT. 6.90
100 ACRES ;.� 1 Few
MIN. FF£ -902 3 00
All
'� I �.► 13 'a
O' w \
LOT 14
co
n I r co
g ui 130.684 SO. FT.
g i 3.00 ACRES 0
LOT 13
r s�ti 130,684 SO.
3.00 ACRES
sus `N ���• MIN. FFE -90:
V
• � I
.......... . .............. j... ..............
"AG ,raw
IIAV — — — - 221.97'— — — 221.97' I I
eszs' i .9a• - - -- - -- 221.97' ---- --- 221.97'-
IE7P I- - - - - N89'15'22 "W 1330.94'
TON
N89'15'22 "W 626.33' i
- - - - X13.16' - -- — - - - - - -- 313.17' -- - - -- - - --
..... ............................... ..............................
33
I I
0 I
00
LOT V 0 in LOT is 4
130, 747 SO. FT. 130, 747 SO. FT. Q - --
t
100 ACRES 0 v 3.00 ACRES
0 uQi �° I
z I
0 r I
I 0� $
Z 1� z I ;
V 1933P 927
STATE BAR OF WISCONSIN FORM 2 - 1999
6 HLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., MI
This Deed, made between Forest Oaks Condos, Inc. ED FOPECORD
07 -25 -2002 9:30 AN
WARRANTY DEED
Grantor, and Jeffrey M. Peper and Heather J. Peper, husband and EXW7
wife, REC FEE: 11.00
TRANS FEE: 125.70
COPY FEE:
CERT COPY FEE:
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
Name and Return Address
Lot 15, Oak Haven, St. Croix County, Wisconsin. DeMd J. EWM
304 LlocxJSt.SbVd
Hudson, WI 54016
W l ^ x p-
032- 2147 -50 -000
Parcel Identification Number (PIN)
This is not homestead property.
(9) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of July 2002
Forest Oaks Condos, Inc
• * Gerald J. Smilffi, President
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St. Croix County )
authenticated this day of .Z
' Personally came before me this day of
July 2002 the.aboue named
Forest Oaks Condos, Inc., by Gerald J Srn#h _jresj0egt, .,
TITLE: MEMBER STATE BAR OF WISCONSIN
person
(s)
w ~
to me known to be the P xe s hot edlth or 'C
e$ air+
(If not, instrument and acknowle ed the sa C. ; � 0
authorized by § 706.06, Wis. Stats.) . ; t
THIS INSTRUMENT WAS DRAFTED BY * r R ,
Attorney Kristina Ogland Notary Public,lState of Wisconsin I' Y
Hudson, WI 54016 My Commissiow.iicttermmr—ri -(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 Proressionais c ompany, Fond du lac, Ana
STATE BAR OF WISCONSIN 800. 655 -2021
WARRANTY DEED FORM No. 2 - 1999