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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. _._ A I� Lc) - P' wfi rl L TKNLS SSta�3Z d AI P1-S ZZ3Z`12 N Z Tko,)CVtD wi'w SrflE.vV(u���2 �n/F /L"rRt�TOt2S €./�C�� /6CO of AL WEEKS SEPTiL T/I to K - A- ioo 2A c ILTE� Bye `f _✓ I o a Olt g'z 3 ►L �® 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 )6pL -Tr ALL "S ati �SE ( A/ Ai�' * S 23 T 3 I , �j k 1 `C � 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 N � "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 zO C L_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . mC � �2 ' COO ' I 1 , I I ' � 1 I , ' l ' I , ' '0 1 ' ' 1 1 I , z � G 1 I , O D U 1 I I , ' 1 r ' f ! 1 1 ' ' 1 t , N , 1 , ; I I , _ Q �- 5 t w � r 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. 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