HomeMy WebLinkAbout032-2093-80-200 = �dment of Commerce
PRIVATE SEWAGE SYSTEM
y end � omsion Ou %W. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.:
Personal inform pr
information you ovtce may be used for secondary purposes (Privacy Law, s.15.04 (txm)]. 3134156
Ar
Eaaek H e� s Name: ❑ City Village ❑ own of: State Plan 10 No.:
Chad Somerset Township
Elev.; Insp. BM Elev.: B Description: Parcel Tax No.:
b 032 - 2093 -80 -200
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic P Benchmark ( 5 /06
Alt. BM
I
anon Bldg. Sewer
4olding St Ht Inlet Z a
INK SETBACK INFORMATION St Ht Outlet J ,
4NK TO P / L WELL BLDG. V A i i to ntake ROAD
1tic LI � Z 3 � NA
NA Header /Man.
1y,3�
oration NA Dist. Pipe A J'/ - /00.
<�Iding Bot. System ` X M _
UMP /SIPHON INFORMATION Final Grade M l3.�0 /oo. /
mand St cover x
fod umber G
DH Lift Friction S TDH Ft
oss
orcemain Length Dia. Dist.7owe11
`SOIL ABSORPTION SYSTEM )7S Je ".AA
4ED / TRENCH Width r Le th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
E 1 3 . Z 3 DIMEN
Manu du er:
SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM
INFORMATION Type O System: CHAM E Mo e N m er:
( `
DISTRIBUTION SYSTEM
Header/Manifold / Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length t /y Dia. / Length jp 7-5 " Dia. Spacing 3
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mul7
Bed /Trench Center Bed / Trench Edges Topsoil ❑ Yes [I No ❑Ye No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: q l20 /a4 Inspection #2: / /
Location: 2025 77TH street, Somerset, WI 54025 (NE 1/4 SE 1/424 T31N R19W) - 243119917C Hanson's
Turtle Lake Hills -Lot 3 y t y s ,,. �o.ra ,�
1.) Alt BM Description = �,-� o s�a0 P(�� P�4"'`�`�S'�``,• /,�
2.) Bldg sewer length = Z3
- amount of cover ='
Plann evision ' Ilft ] Yes ❑ No
Use other side for additional information.
S8D -6710 (R.3/97) Date lnspectoe s Signature
Cert. NO.
r .: p 2026 2 ?S Sanitary Permit Application Safety &Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
` See reverse side for instructions for co eting this.appikation
PO Box 7302
isconsin Personal information you provide may .. us�d'for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s 5,04(I)(m)] (Submit completed form to county if not
�- y state owned.)
Attach complete plans (to the county copy only) the syste of less ffA 8 - 1/2 x 11 inches in size.
County State Sanitary Permit Number Check if revision to previous applicati State Plan I. D. Number
-� - -
r.r
g rini
I. Application Informal - Please Print all Information I Location:
Property Owner Name i Property Location
P
zomNGOF IC! " 1/4° r 1/4, N, (or
Property Owner's M cling dress ...+ <` of Number Block N ber
S —�_ ' )
City, Sta Zip Code Phone Number � Name or CSM Number
II. Type of Building: (check one) a.s P.. 13 City
A 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village
❑ Public /Commercial (describe use):_ Town of
❑ State -Owned
Nearest Road
K �� ZS , �2M s Parcel Tax Number(s)
III. of Permit: (Ch eck only one box on line A. Check box on line B if applicable)
A) 1. JgNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
91 Non - pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: _/C
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolati n Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /dayy/sq (Min. /inc Elevation
, 9
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
❑ ❑ ❑ ❑
�c G =�
"I/- ❑ ❑ ❑ ❑
VIII. Responsibility Sla temen
I, the undersigned, assume responsibility for installa 'on of the POWTS shown on the attached plans.
Plumber's ame Tint) P slam MP/MPRS No. Business one Number
Plumber' ddress (Street, City, State, Zip ode
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
P , Approved ❑ Owner Given Initial Adverse Surch a Fee) �. p
Determination 2,,?- 5- OD M� 6 Z'�O I 4
X. Conditions of Approval /Reasons for Disapproval.. * F RA11U c C
- 6sko►jerc- v uc. w«rn1TA/N 1 �0 - FK- 7# EF u F10 -a its f6e- AAOWL Fr 2 s
F 1 LL — KAA-`( 9E I� �b2 � EP O JE 2 C��� -g&C f3 `I
u
D1` Sott.. COCE2.
SBD -6398 (R. 07/00)
c�
:
t
1_
O
O IN
I zz
1
V
�J `J
0
c AIN
y ,y a
VCSconsin'Department of Industry, �.R l ~ Y Z
r `�'i0y[: L..I
-Labor and Human Relations ND SITE EVALUATION � � ,. Page of
Division of Safety and Buildings /�� 44n, cord f ith s. ILHR 83.09, Wis. Adm. Code
J ` r " ='
Attach complete site plan on pap ` less thap 8 1/4 x Wigrl i 1 Plan must County
include, but not limited to: vertic Wan horit, r fen e�point ( irection and St r 1
percent slope, scale or dimension rth arrow, on and a to nearest road.
+ . Parcel I.D. #
Cpt}I °'Y .^U
APPLICANT INFORMATION'S all " tion. Reviewed by Date
Personal information you provide may be use A� a acy law, s. 15.04 (1) (m)).
Property Owner Property Location r1
t h S Govt. Lot r_ 1/4 S E 1 /4,S a y T 3 I ,N,R I E (or)®
Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1 y�
3 �J �Gtlt� 3 P. 1 Akv\56V: S urtlG k
City State Zip Code Phone Number ❑ g
Ci t . ® Town Nearest Road
5 51 01-1 ( 1.1 X -.0 D New t ❑ Village
r a0 tti Q�e.
New Construction Use: ® Residential / Number of bedrooms 3 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 450 gpd Recommended design loading rate • S bed, gpd/ft gpd/ft
Absorption area required qQ0 bed, ft 7 5 0 trench, ft2 Maximum design loading rate _ bed, gpd/ft s _(c_ trench, gpd/ft
Recommended infiltration surface elevation(s) I.;LtS %,71j 7 3.4 +5 , 9� .b(p 1 ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material ;3y kci a 4. t''. 1 C A n L ZJ Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = unsuitable for system ® S El ® S ❑ U ®s ❑ U ® S ❑ U ❑ S f� u ❑ s 19 u 4
SOIL DESCRIPTION REPORT v( 1 '2ZM - nova. C_Q� " /J'
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
1 0- K 3 S l. 1F r mf
a l�•A5 1 c x10 % fr Lw 1 F , 5
Ground 3 -y ,< Q q/3 elev. 5 a M5 m Fir 4%0-2 1 vr - S
S S f iL 3 � s o' YW L. • q_
Depth to
limiting q8 ;
factor
L00 in. -: • %/73-3
Remarks:
Boring #
0.1 I Dy 3 - S L 1 r 'M j Fr
'7.1 v 3 L. • S VAv F Y- Gam✓ 1 F
Is -aq Y — e. M r��r c..,..� 1 F
Ground 4 lai s Y P, 41 /4 S L I a m "fe Gtti? Vl� I I S :.Lo .S
elev. �"—
l c eft. S 4n. 0 5 3J' S L. , M f r . 5 , .5
Depth to
limiting
factor
9 b in. Remarks:
CST Name (Please Print) Signature Telephone No.
S+ V- K_ 1S -.a q 9 - 8V
Address Date CST Number
PROPERTY OWNER a SOIL DESCRIPTION REPORT
.Page °l of 1
PARCEL LD.#
Bonn # Horizon Depth Dominant Color Mottles Structure 2
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots
Bed ,Trench
3 p- o YQ3 6 Car r 9s. a F
-7
-I I f_3) t. 4.S b -S rnvF C \F •9 7
Ground . 4 �.c Xp 14 14 - --- s L o� v`n5bk vv- IF Gw 1� g
9%. 7�ft• -40 `4 'R 4/q S L A S bC ►r.�r � w (JF � S'
Depth to 40- S R 3 I — 5 L a M S K,
limiting
factor
n.
Remarks:
Boring #
\ o -9 oO- 31
q e. ' L b- tnvfrr
3 3 s X \Z 4 i 3 S L AYh5bX MFr GtAl IqF 5
Ground `((L 3/ — S L. a r► , b k r^ F.. ; , 'S
elev.
9 � • Cb ft.
Depth to
limiting
factor
'9 0 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 # I D -$ R 31 3 �'—' 5 L r v Fr F
3 11 •.19 7, S YQ q /Y a ft M F' Y" C. v>
Ground y x9.43 6 YR y S L oArr b K M F r e— v°. I v
elev.
loc , ft. 93- 5Y Q 3 / SL .1 rw s
Depth to 48 4
limiting
factor
"A) in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
' Remarks:
SBDW -8330 (R. 08/95)
-
I!
—
`�/A
I
ji
I
w ! I t9 g
r j
I
1 �I
I
-' -t-- - - �- -; - - -� --+
i
r I
r �
i
I
— p - -- �h9'oloe
lo
:
_fifer _
IA
i
4 , r r
I � I
-- it
r
�-- --� --
I
r I
All
i
,
i
• � r
i
;
'
;
i
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 corn management Ian lies with Comm 83.54, Wis. Adm. Code, and the In- Ground
9 P p
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 S
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) D'D
Septic Tank Capacity (gal) l 2 o y
Soil Absorption Component Size (ft2) <a�S
Type of Wastewater Do estic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorpti Component
Design Flow - Peak (gpd) E. z - as PL I
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspec 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. Th ou et filte s hall be cleaned as necessary to ensure
ro er o eration. The filter cartridge p rovisions are made to a should not be removed unless
P A Q g p
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
ST CRM got**
alePTIC TANK MAtNT A"a
AND
owrftstsxlr csRT rtrcATroN voles
owna/94yor
Matltns Add r�
.Property Address a `
t
Vertftestian re 4 u :re,t P rom Q�
I'lanntn8 rnrtment fir is" c onnntttien)
c ityl state Aareol REontifit;t►tiort Number 1132 — 2d` t3—
Lm a r AC BM110x
Ptaperey Loc ation 0 ' /,, -, , ' / • , See. , T L N •R., .W, Town of / ( � /
S+ebdivieion ` G s rV Lot did 3 . b� 2. Ti
� certmad surv Map M � 3 39 , velu ..,.. ,..,_., Paso M
Wdrrnnt) Deed M ,.� '",Z�._..r volume ~ 1� � Past M • —�
Spet: house Q yei''�.no
1& lines identifiable Lyres ❑ no !*
I mproper ust acid mAirttnsnee of yr" ,? tystan+ :OUIV in its promstwe "ulatf to handle wastes. )'rvpar me�nteean4s'�
to-,sists of surrprnj ew ;he sepal tarts vwy 1:ree ytSn 4t eeeitet. a44dad by s Ii;anaed ph:mptt. Wha yoW pit into 1114 SYsaAr..:K
cat 4j(YK9 INC tuac of 1,114 NO t: tank as a "A"Ment Stage rn ;IK 'Wit* "posal system.
Tthc propetty owner %stew iq ttbmit ;o Si Crain zci nie` Depae tent a a4Aincation mitt. Signed by the Qw snd by.
rrasterptumbe► . re srrre;rd p'ut'nbersra 1 ;etntedpt:AlA4r verityrrnS that 11);h4 on•sit4 wastowaterdimelsil c yst
to proper (2) 6 I elfw6eft and V;Imp ns (i( necessary), th4 sovite mAk to Nu ettar. It, NO of stwlRe;
1,'w;, .he ,rnderrtrsled 114.1 t lt3 ;above rcyu '011wu IN :i pte to rttarmairi the prtvate ww4gs drsp ill tymm rr,ttt M Stsr+asrA
Sot forth. I•erain, as set by the Deparrenr of Ciononcree and the Ikpirin>+nt of NAN. -II Iteseu►ces, N.@ 4f Wiseons:n. Wer.C411011
satins that your sop` +. system his be trs�rtatr cd rn,tst tie co and m1Vm d to the St Croix C*w.ry Zeroes 0!11e4 within
dare or :brut year expirstion dote.
$I , — F O F APPLIC DAT r
I (Vm) eartio tttit nil statements on flus ran sit ttt,a to the best Of my (out) kl+ow144st3. I (wa) am (an) o Rs)
the pro rt described *A e, by V,it Of • w orrinly deed tctoteled in Reoisme of oteds ofnet.
SION S.Tt,' B APP iCANT DATA
s••••• Any iaferrtuaors shit Is nt+a•►amenttd may result is , he an,ury pertstis barn$ revok4d ty the 240ias paparpnettt.
e• ti Sten a start► d waffa died Nim the Admot at on& sfrw
rattuda wkth tUa epp to pe h'
s egty of sh4 6410e6 aavay trap if wn e41111ee to tesade its Ilse vtrs%pq Safi
10'1 �alellrtirl 9N241/rti�i9�� S1sfl'� WI Mti�t •���t —Iii!
is
VIR 1594PAGi 207
STATE BAR OF WISCONSIN FORM2 - 1999 IS. 39Z54-di
Document Number WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
ST, CROIX CO., WI
This Deed, made between Sarah K. Halvorson Bruce Halvor
and Jaclyn Halvorson, husband and wife; — RECEIVED FOR RECORD
_ — OS 02 -c'001 9:30 AN
Grantor, an Chad YARRANTY DEED
D. Maac a d Angeline J. Maack, husband and
Ef(E!IPi N
wife, - -- - CERT COPY FEE:
__ - - -- — COPY FEE:
TRANSFER FEE: 115.50
- - -- 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):
Part OfOutlot 1, Block 2, Hansen's Turtle Lake Hills First Addition in the Recordin; Area
Town of Somerset, St. Croix County, Wisconsin, described as follows: Name and Return Address
of f Certified Survey Map filed December 23, 1996, i Vol. 1 1, Page KRISTINA OGLAND
31 c. No. ATTORNEY AT LAW
P.O. BOX 359
HUDSON, WI 54015
03 - 2093 -80 -200
Parcel Identification Number (PIN)
This is not _ homestead property.
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 06i ('s not)
Dated this day of February 2001
c
+ Sarah K. Halvorson Bruce � Halvorson
O aclyn Us Iverson
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Sarah K. Halvorson; Bruce Halvorson an Jac STATE OF WISCONSIN )
Halvorson, husband and wife,
— — -- ) ss.
--77� UA" County
authentic led this�(Jday of February 2001
Personally came before me this day of
- -- -- _ , the above named
+ Kristin Oglan
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stars.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY i �— - - -- —
A ttorney Kristina Ogland
Hudson, WI 540 — — Notary Public, State of Wisconsin
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. k✓orm+lipn Profe++10 -4 camp+ y , FoM a, Laq vn
WARRANTY UEED STATE BAR OF WISCONSIN 80M.55 - 2021
FORM No. 2 - 1949
" fiZ uo��OOS ,�c # 109 9 44 40 8qL jsQ.3
N,u ;it ►ZS LO M „hZ I So LOS
4-+ ! 00 • Eds -"�
O o ►9Z tlz
� L N
W N ,U t� O U e.1
U).
U W V) 8 Cal �1 vWi,n
W a ►”! O O
O � Gil !-•-I
r1 0 C
o all
7
N p L a ►9L•h00L 311IIZIZ9oLON. M
b O ° °� I OOfi O,
4+
0
5
W -C W
Ic M M
w
4-1
' c N i C76 3ubZI M LON o �n
M
G N 2c cn
3 O f--1 m
v ... - if I u N p7
d a'� ► I. `ar �1 w� o
�- ri ' ti1 O v u ci h CV
P N W
( cm
0
LL a�
V) 0 o v u rl
r-• 0 • � rI m W
v' N 0 L.LJI C i` o G�
LC �. t:J •� ' SCI J{ � ,�V1 .�
ri � aCl 111 �q
V 1� ££ £s ..Jl 13e0u o0y
fS �1 m '*D
LLJI d' �I 3 S ZON
In p • dalvollaa t7 ,6
ra I ..11 w w 'G L
4 4-1 .,A ... NI g 9 1 -1 � V
O 00.1
M, H U
<< s
A O 4--I L. L
N a ril C)l `'�2 a ¢ 2 8,98' w
N 3 r
.c (-A ¢ o
rn 4j I ca _ g =,I•s,,�, M c.,
4A r-4 1�4 W A01 o+ - rn -
4J r4 r N E l l
r a e V1
a C-`
a Lj w ^/
A U i Y Zt
Z� cn P4 en U•,
-I N Lt', Q cN� �1 2 a ^," x N N
4. c