HomeMy WebLinkAbout032-2134-20-000 County:
Wisaansin De0artment of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division 4 INSPECTION REPORT Sanitary Permit No:
399689 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:
Ellingson, Brett Somerset Township 032 - 2134 - 20-000
CST BM Elev: Insp. BM Elev: I BM De
/Od csT fl L
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Benchmark
Septic , r W A b� Moved ed I SL y + �� 1 �
Dosing (� Alt. BM
S d rr de
Aeration Bldg Sewer
1 4ewti4o4y vi 16
Holding _ SUHt nucL f
St/Ht Outlet f � r 9 -, ,.
TANK SETBACK INFORMATION `j
TANK TO P/L WELL BLDG. Vent to Air}ptake ROAD Dt Inlet
Dt Bottom
Septic / > loo i I f
Dosing V Header /Man. (OZ.7 S Zg Gl7 Z
Aeration Dist. Pipe ) �+� )0� 'S Z q -7. .
I
Holding Bot. System 102.,7( r Z
Z S
Final Grade Z ��
PUMP /SIPHON INFORMATION io �. 7• (0 / • 0
Manufacturer �` e d St over
GPM
Model Nu er
TDH Lift rictjsrt "Loss ] System Head TDH Ft
Forcemain Length Dist. to well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width J* Length No. Of Tr ches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 10 1
SETBACK SYSTEM TO P /L� BLDG WELL ( LAKE /STREAM EACHIN M fa ctturer:
INFORMATION A
CHAMB R �
Typ f System: / l00 / IT Model Number:
��n�/. �•3 0 >
DISTRIBUTION SYSTEM
Header /Manif ld Distribution x Hole Size x Hole Spacing Vent to Air I n ke
" Pipe(s) / ^ a (p '
Length Dia Length "l r Dia L h�n - spacing I (O '
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
ver {� Depth Over xx Depth of
Tx Seeded /Sodded xx Mulched
Bed/T nch Center ✓ 1 / Bed/Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �0 / / 0 Y Inspection #2: / /
Location: 678 207th Avenue Somerset, WI 54025 (SE 114 NE 114 23 T31 R19W) Whitetail Trails Lot 9 Parcel No: 23.31
1.) Alt BM Description = 80- �^ � 6 3 5 7 =J k f 0'yi
Bldg sewer length = G/
2 ) 9 g (C)
- amount of cover = f/
Plan revision Required? Yes "o
Use other side for additional Information. �� `✓r'+'l
Date Insepctor's tignature Cert No
SAD -6710 (R.3197)
r
Safety and Buildings Division County ��
201 W. Washington Ave., P.O. Boa 7162 S i C PD I )C
�s�on Madam. Wt 53707 - 7162 Site VN
Department of Co mmerce �{—� 20i-
Sanitary Permit Applie Sanitary Permit Number
In accord with Comm 83.21, Rris.lfdm..Code, perso
tin be used for seen m) �.\v i ❑ Check if Revision
I. Application Information - Please Print All Informa ' f i _ State Plan I.D. Number
Property Owner's Name r- 2 ,
«, n���� � Parcel Number 3.3 ( 19
Property Owner's Mailing Address $ nN Property Location
1 000 SE 1UE iA: s T3I N R i ` f V(
City, State Zip Code S Lot Nup�ber Block Number
�� r-- �
STILLVJ`ATEu2 M N 5 52 - b�� I Subdivision Name C Number
Ullf11TCTW1 - 7KA S
U. Type of Building (check all that apply)
WS pQ/' t OrL► i ❑Clry
&b or 2 Family Dwelling - Number of Bedrooms .44 c , .
❑Village
C1 liU
PubCommcrcial - Describe Use Township SCM CQ2 Cr-
State Owned Neatest Road
Z 3 x 68- 7 cos
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A. 1 XNew 2 ❑ lacement System 3 ❑ For County use
�P Y Replacement of 6 ❑Addition to
-- system I I Tank Only System
B • ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)
44ANon - Pressurized In -Gtrnmd 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic T tmetu Unit 49 ❑ Recircoiatiog 30 ❑ Other
V. D' reatment Area Information: Q l� {a R �f! C t T `l S 0 E rV w 0� R Fl TR A TD S
Design Flow (gpd) Dispersal Area Dispersal Soil Application Percolation Rate sum Elevation Final Grade
Reg '( Proposed 0 Rare(Gais./D ys/SgtFt) (Min./Inch) Elevation
Usiun YMfn&,6 22 LOW Ocs
VL Tank Info Capacity in Total Number Manufacturer Prefab Sim Steel Fiber PI
ns astic
Gallons Gallo of Tanks Concrete Constructed aim F.zistiag
Tarots Tanks
Septic or Holdeas Tank��
Dosing Chamber J�
VII. Responsibility Statement- I, the undersigned, assum responsubih'ty for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) 's Si RS umber Busit>ess Phone Number
jav : !L32- L I Z-
Plumber's Address (Street, City, State, Zip Code)
E UL Zq5
VIII. epartment Use Onl
K .Approved 1 0 Disapproved I Sanitary Permit Fee (urcludes Groundwater Dam Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
13 Owner Given Initial Adverse . Lam' ,
Determination • W. 3D ZM
IX. Conditions of Approval/Reasons for
l
Attach —plete plea+ (to the County only) for the system on paper ant lest than 8112 X U htches In AM
SBD -6398 (R. 05101)
Aker . rao ^,SOti - SE ( N AL S Z3 T .3 l , ),�2 1 `I
2 Z�R V !� �ASS�L �ornRSET Ttn/SP.
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�® E&-Y-'V UVVKY-, = 70F n l ' r��e P) PC E L .lot �`
�b kT 9. rn. T OP o r J " P Y c eJ PE - -- '79,
t7 SO(C R oR K) I
267 - rr\ ITV
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� Ao — JASSEL horn Qs E7 Tws P.
S`t"I LLWRTE P— M N L O - T - t + G I WH METAI L T NLS
mPk r ZZ3Z`12
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� "TR�I�Ctlb w►�� �� tJl�If [�i9�.
S rO - Fwlj u2SEtt JNFJ L 7 2A l O k S EA,C%
J600 SAL WEEKS SEPTiL
T,/j K- A -too 2A&E ,ILTEIZ $7�
0 0
II
13ED-
�J�` kt)6 )V\
ToP e)r J Pft FL )ou"
�,A ALT m. TOP o N 1 "PVC PIPE- --L 9 ?.:3
tl SO(c ►Ro2Jjobs
:33`I
267 - rr\ �v�
12 -19 -1995 6: 31 PM FROM �'� I /� P. 1
1" c e C 6d ULl OLi ^ '
labor and Human Relall ns w, + O V I L Anw 11 "Y t tM d C r V n 1 Pape or �
Division of Safety A Build
In accord with IL R 83.03, Wis. Adm. Code COU NTY
Attach complete site on paper not less than a 1/2 : 11 inche in size, Plan must include, but
not limited to vertical and horizontal reference point (DAM, directipn and % of slope, scale or PARCEL I.O. B
dimensioned, north arrow, and location and distance to nearest road. pending
1 T
REV BY DATE
APPLICANT NFORNA ION PLEASE PRINT ALL INFORMA ATI
PROPERTY OWNER: PROPERTY LOCATION
Fo GOVT. LOT SE 11` NE 1/4,S 23 T 31 ,N,R 19 War) W
PROPERTY OWNER'S MAILING ADDRESS LOT a BLOCK • SUBD. NAME OR CSM e
11160 N.W. 9 nor Tihitetail Trailse
CITY, STATE 21P CODE PHONE NUMBER QCITY OVILLAGE JUOWN NEAREST ROAD
Elk River, Iii. 55330 612) 441 - ••8888
I. New Construction Use jx) Residential / Number of bedrooms 43 I j Addition to existing building
I Replacement [) Public or commercial describe
Code derived daily flow 600 gpd Re=rnewed design loading rate . 7 bed. gpollt .8 trench, gpW
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd/ft 8 branch, 90
Recommended inflltradon surface eleration{s) _ 96_ R5_ . _ ft (as referred to site plan benchmark)
Additional design / site consideradons at- area 91 A ft Ill, = Q6
Parent material outwash Flood plain elevation, if applicable na h
rU 7-Unsw te for S cONvWTK Wk MOUND IN- GFIOUNO PRESSURE AT•GgAD SYSTM IN FLL FIOLOING TANK
tabla fo stem ®S p u ®S p U S❑ U C� 5 C�7 u f� S p U O S IRU
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon in. Munsell Qu, Sz, Cant Color' Texture Sz. Sh. Consistence Bauriby Room Bed ttirlltl
1 0 -24 10yr4/3 none is 2mgr mvfr 9K 2f .7 .8
1 2 24 -96 10yr4/4 pone ins Dag mvfr na na. .7 .8
Ground
dev. ,
Deo to
101 ft.
limiting
factor pf' 96.3
�•
Remarks:
Boring # 1 0 -11 10 r4/3 none is
y 2mgr tttvgr gw 2f ..5 .`• :6
2 2 11 -33 10yr4 /4 none is Dag mvfr 9V If .7 .8
3 33 -90 10yr4 /4 none bas Osg ml na na .7 :'• .8
Ground
eta.
10 ft
Dep
m
limiting S� 0
factor ,
X11
Rertaairks:
FAddr ,ss,. Na,. - Please Ptint L. Steel. 'Phone: 715 -246 -6200
1554 200th. A ew Rictttttond 54017
' h.... nor h. \...._•�... ...,u.w.
12- 19 -199B 6:32PM FROM P.3
PROARTYOWNER Forest oaks Condos SOIL DESCRIPTION REPORT page 2 o J3
PAAC1cl.1.Q � penidtiq
Boring # Horizon Depth 1 Dominant Color Mottles Texture Structure C.ons6l = t3oiffldwy Roots GPD /ft
in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. Bed Twch
1 0 -17 10yr4/3 stone 81 2mg Orr
' 2 17-96 10yr4/4 none fns Osy turf r r1a na .7 .8
Ground
elev,
1
Depth to
limiting
factor
+96" W. .
Remarks:
Boring #
1 0 -25 10yr4 /3 done sl 2mgr mvfr gw 2t •5 .6
4.1 2 25-88 10yr4/4 none fns 089 w,#fr rsa na .7 .8
ftw
Ground
elev.
99, ft
Depth to -
Gmifing
lactor ._
+86
Remarks:
Boring #
1. 0-8 10yr4/3 none al 2tngr mvfr gw 2f .5 .6
2 8 -27 10yr4/4 norm 18 Osg mvfr 9w 1f .7 i •8
3 27-9 10yr4/4 none ms Osg tai na r1a .7 .8
Ground
elev,
1 3 9. 5 Ft.
Depth to
limiting
i
Remarks:
Boring #
Ground
efey. I
D
limiting
factor
12 -19 -1995 6:31PM FROM P•2
STEEL'S SOIL SERVICE
Gary L. Steel Forest oaks Condos, Inc. 1554 200th Ave.
CSTM2298 SEV0A S23-- t31N -MW New Richmond, WI 54017
MPRSW -3254 town of Screrset (715) 246 -6200
lot #9- Whitetail Trails
N
1" -40 ,
BK.= top of 1" pvc pipe C el. 100.00
Alt. BM.= top Of 1" pvc pipe 8 el. 99.30
Ile
ti
t �
+ i
Gary L. 1
4 -18 -2000
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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 !o
Number of Bedrooms
Design Flow - Peak (gpd) q50
Estimated Flow - Average (gpd) 300
Septic Tank Capacity (gal) i CO G
-Soil Absorption Component Size (ft 376 OW t Ot CHIP Sip,cw,�
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) (Std 3q" z"
Maximum Influent Particle Size (in) 118
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 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 se and outlet filter shall be assessed at least
once every 3 years by inspection. Th outlet Tilt shall be cleaned as necessary to ensure
p roper operati The filter cartridge shou 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.
i around or over the soil absorption component Traffic should be avoided particularly a o p p
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.
fi
2
S "I' CROIX COUNTY
SL-PTIC "TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIi:ICATION f
Owner[Buyer Btu ELL W-i-CD
Mailing Address 22-� [/,AK-) 'I PAS L STILLWATE2 _ N\J\1 55DItZ
Property Address G 2 O- A v-e.
(Verification required from Plannini, Department for new construction) -
City /State Parccl Identification Number ( o 0 ' ��� (�3a "a �,3S " 0.C)
LE GAL DESCRIPTION
Property Location S& V1, g' '4, Sec. 2 - 3 , T 3 N -R — l W Town of
t C T 1 E�"}t I ill L
Sub... OFCertified Survey Map # l�l T Volume ,Page # 1
T,- 41 /
ce
l� 2'° 7 6 Volume , Page ,f
Spec house yes ❑ no Lot lines identifiable yes ❑ 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 syster
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 wastewaterdisposal 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.
Uwc, 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 Zoni.ttg Office within 30
days of the three year expiration date.
SIGNATURE OF APPLICANT DATE:
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) ant (are) the owners) of
the property described above, by virtue of a %%aranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
" "" Any information that is nits - represented may result in the sanitary permit being revoked by the Zoning Department.
" Include with this ap a stamped warrant deed from the Register of Deeds office
pp p y
a copy of the certified survey map if reference is made to the warranty deed
• Ve1�6n -SFa,E�20
STATE is
-
TEBAR OFWIS _ .
WISCONSIN! FORM 2 1999
WARRANTY DEED KATHLEEN O WELSH
Document Number REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Forest Oaks Condos, Inc., a Minnesota RECEIVED FOR RECORD
Corp oration
01 -04 -2062 3:35 AM
iJARRANTY DEED
Grantor, and Brett C. Ellingson and Alison E. Ellingson, EXEMPT 11
CERT COPY FEE:
COPY FEE.
TRANSFER FEE: 120.00
RECORDING FEE: 11.00
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, Whitetail Trails. St. Croix County, Wisconsin. Name andRet KPb < §TfNA OGLAND
ESTREEN & OGLAND
304 Locust
Hudson, WI 54016
032. 1060 -60; 032- 2135 -30 -000
Parcel Identification Number (PIN)
This is not homestead property.
(yt) (is not)
Exceptions to warranties: Easements, restrictions and rights- of record, if any.
Dated this 1� l ►1 day of December 1 2001
IT ks Condos,
' • Gerald Smith, P esi ent
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
G ) ss.
S+-C� e� County )
authenticated this day of
Personally came before me th. Wllt day of
December 2 11 the -a eve named
{ Forest Oaks Condos, Inc., a Minn@sofjt oratan; Gerald
Smith, its President
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) wT % e u d the foregoing
YO
authorized b 706.06, Wis. Stats.) instrument and acknowledged thgpw
THIS INSTRUMENT WAS DRAFTED BY
A ttorney Kristina Ogland Notary Public S to of Wisconsin
Hu dson 54016 My Commission is er anent.
(Signatures may be authenticated or acknowledged. Both are not necessary.) J
• Names of persons signing in any capacity must be typed or printed below their signature. Wormaaon Prorsss"Is company, Foos do Lw, wn
STATE BAR OF WISCONSIN 800-M -2021
WARRANTY DEED FORM No. 2 -1999
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