HomeMy WebLinkAbout036-2002-60-000 Wisconsin Deparldient of Commerce PRIVATE SEWAGE SYSTEM count
Safety and Buildings Division 6t. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 383970
Permit Holder's Name: ❑ City ❑ Village own of: State Plan ID No.:
Eiffes, Otto Stanton Township
CST BM Elev. Insp. BM Elev.: BM Description: Parcel Tax No.:
I tTO •� r ` 036 - 2002 -60 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic k-5 jotoc Benchmark s• 3 /� , b
Dosing Alt. BM
Aeration Bldg. Sewer •3!0 5 s q
i
Holding St/ Ht Inlet c S, 2'
TANK SETBACK INFORMATION St /Ht Outlet 10.t� D �jS.
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet
Air Intake
Septic �,. Z 5 f ' r NA Dt Bottom
Dosing NA Header /Man. IL-5C
Aeration NA Dist. Pipe
Holding Bot. System X1 93 q2-
PUMP /SIPHON INFORMATION Final Grade s "
St
Manufacturer Dema Over iw � c to ,q7J
Mod umber GP J
TDH L tion S stem Ft Loss
Force ain Length Dia. Dist. To Well
SOIL A R P ION SYSTEM -p a ,,,,, a r� �.� -- -••� --
REN Width 1 Length f No renches PIT No. Of Pits Inside Dia. Liquid Depth
1 I N J7 l0 Z• M V DIMENSION
LEACHING �1 Z r_
SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM �'#' I
INFORMATION Type O I r CHAMBER M e Numb
System: 60" . to 3o ~ s o ± OR UNIT ca;
DISTRIBUTION SYSTEM
Header /Mani I 4 Distribution Pipe(s) x Hote Size x Hole Spacing Vent To Air Intake
Length Dia. ngt Dia. ; pacing �J I
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 : o� os o I ns ec Ion
Location: 1813 147th Street, New'Richmond, WI 54017 (SE 1/4 SE 1/4 31 T31 N R17W - 3 311 Oak
Rid a Estates -Lot 6p fflA ( �, _ „� 1 1 L t N N -
1. Alt BM Descri = y `t'' - c '` - - t J b
2.) Bldg sewer length = _ (( t
- amount of cover = t t� �/ C : Cl2 2-1
12-1 2
Plan revision required? ❑ Yes No
Un thet side for addi ional info
nation.
n.
V �`^ 3 Cu _ c. ►+� Date / Inspector's Signature ^ Cert No.
'SB D-671 (R.3/97��� ) A, \o -v(.,4 a�fLo. '10 W an-1C l i � �� 1'erew. tam y- I r72s p�.
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
®�SCOnSln Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(i)(m)] state owned.)
Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County / State Sanitary P�� Number ❑ Check if revision to previous application State Plan I. D. Number
d / J "' ---------�
I. Application Info rmation - Please Print all Information Location:
Property Owner Name ,f �� Property Location
[% o �^ S 1/4S� 1/4, S Tj ,N, R (o W
Property Owner's Mailing Address p Lot Number Block Number
City, State Zip Code Phone Number j Subdivision Name or CSM Number
14I. Type of Building: (check one) ❑ City
1 or 2 Family Dwelling -No. of Bedrooms : 0 Village
❑Public /Commercial (describe use):_
Town of
❑ State Owned ��� ? �
Nearest Road
,-y7f� S
Parcel Tax Number(
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) .31- 3!, J 6
A) 1. ❑ New 2. g 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)
Non pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade 1 eroble Trea ent Uni ❑ Recirculating ❑ Other:
-3 (oZ • S� �aa w Qn, - 5D
V. Dispersa reatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /da sq. ft .)) (Min. /inch) _ / _ / Elevation
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
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Pjllu 's Name (print) Plumber' nature (no stamps): MP/MPRS No. Business Phone Number
Pl er's Address (Street, City, State, Zip C
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss ing Agent Si re (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharg Fee) -
Determination 22 �
X. Conditions of Approval /Reasons for Disapproval:
E'tC,`S{-i hq S Mx.o�k L -Q- 4 c.o g C1 F C,
SBD -6398 (R. 07/00)
PLOT PLAN
PROJECT Otto Eiffers ADDRESS 1813 147th st New Richmond Wi. 54017
SE 1/4 SE 1 /4s 31 /T 31 N/R 17 w TOWN Stanton COUNTY ST. CROIX
`
MFRS Byron Bird Jr . 220527 �� DATE 4/26101 BEDROOM 3
CONVENTIONAL XXX At-j 6ade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .9 ABSORPTION AREA 500 # of chambers 3 Q
BENCHMARK V.R.P base of sideingAlt BM#grade ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL sH.R.P. NE corner of House
SYSTEM ELEVATION T- 1= 94.4T 2 94.2T - =94.0
LVent
f
CC dewinder High
pacity Leaching
Cov amber with 17.2
2 per chamber
Grade at System
Long 34 Elevation 7 � r
25' S' PL
� 1
25' \
e1A V4
6'
32' 100'
ob pipe
4 62.5 P
30'
6' 3 bed house Alt BM
Well 20'
L t5' S B2 �.
dw
20'
Garage
Driveway a!
B3
N
PLOT PLAN
PROJECT Otto Eiffers ADDRESS 1813 147th st New Richmond Wi. 54017
SE 1/4 SE 1 /4s 31 /T 31 N/R 17 w TOWN Stanton COUNTY ST. CROIX
MFRS Byron Bird Jr. 220527 — DATE 426/01 BEDROOM 3
CONVENTIONAL XXX At.1drade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE E3 LOAD RATE .9 ABSORPTION AREA 500 # of chambers 30
IL BENCHMARK V.R.P. base of sideingAlt BM#grade ASSUME ELEVATION 100'
❑ BOREHOLE Q WELL *H.R.p. NE corner of House
SYSTEM ELEVATION T- 1= 94.4T- 2= 94.2T -3 =94.0
LVent
f dewinder High
C pacity Leaching
Cove amber with 17.2
2 per chamber
Grade at System
Long 3491 Elevation ?
25' S' PL
1
25'
36'
32' 100'
ob pipe
4 62.5 P
30'
6' 3 bed house Alt BM
Well 20'
i 1 ,
2
BM st 5'
dw
20'
f
Garage
Driveway o1
B3
N
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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. Q pry,
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3
Property Owner Property Location
Q r r Govt. Lot j�1 /� 1/4 S T f/ N R 17 E (o
Property Owner's Mailing Address / 1 Lot # Block # Subd. Name or 7M#
City tate Zip Code Phone Number ❑ City ❑ Village I,Tow Nearest Road
r
i
❑ New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD
Replacement ❑ Public or commercial - Describe:
Parent material l ee. Flood Plain elevation if applicable ft.
General comments
and recommendations:
[71 Boring # E] Boring
9
Pit Ground surface elev. 119. ft. Depth to limiting factor J in. 'R Soil Application 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 *Eff#2
ar �? `f• a r a 9v. 0 �
Boring # ❑Boring
Pit Ground surface elev. Z ft. Depth to limiting factor zzz in.
Soil Application 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 *Eff#2
4 A5
7
I
9 . `f
5io.`f /92.`{
* 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 Na Please Print) - _ Signature CST Number
Addr Drake Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
a
I
Property Owner Parcel ID # Page of
Boring # ❑ Boring �
rw Pit Ground surface elev. ft . Depth to limitingffactor in.
Soil Application 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 *Eff#2
4�?
" -9Y Yo
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application 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 *Eff#2
F-1 ❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
El pit Soil Application 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 *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.07 /00)
l
Soil Test Plot Plan
Project Name Otto €iffers Byron Bir Jr.
Address 1813 147th st
New Richmond Wi. 54017 CSTM #2 ' 20527
Lot Subdivision OakRidgeEst Date 4/26/0/
SE 1 /4 1/4S T 31 N /R W Township
Boring 0 Well PL Property Line County ST. C R O I X
,BM or VRP Assume Elevation 100 ft.base of siding AItBM # grade at house Elv 98.6
System Elevation T-1 =94.4 T- 2 =94.2 H.R.P. *NE corne o f h ouse
25' 5' PL
B1
25'
36'
32' 100'
P
30'
6' 3 bed house
Well V 20'
ts 15'
B2
B 6 st 5' �--�
dw
20'
Garage
Driveway
B3
200' PL
I
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. Plea a note: 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.
Contingency Plan'
1. If system fails, determine cause of failure, use alte rnate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
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•
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address Z� / -3
Property Address —
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location /4, 2L /4, Sec. T�N-R Town 'of
Subdivision fJ �� ��-� . Lot #
Certified Survey Map # c . Volume- . Page #
Warranty Deed # e °? ��/ Volume ���`� . Page #
Spec house O yesAno Lot lines identifiable J yes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper ma intenancc
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
ti The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by
master plumber, journeyman plumber, restricted plumber or a licensedpumperverifying that (1) the on -site wastewaterdispos�l system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fall of sludge.
I/we 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 Zoning Office within 30
days of the three year expiration date.
--
SIGNATLYRt OF APPWANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the ov ner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE
OF AP CANT EkTE
* * * * ** 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 deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
Vn1.1506PAGE 109
62 1 999
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 Michael J. Monteith, a single person RECEIVED FOR RECORD
04- 28-2000 8:00 AM
WARRANTY DEED
s and Joan Eiffes, husband and wife EXEMPT N
Grantor, and Otto Eiffe
" CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 372.00
RECORDING FEE: 10.00
PAGES: 1
Grantee.
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 Retur q� ress
of 6 A Ridge Esta tes Addition to the Town of Stanton, St. Croix �gI Realty Title
County, Wisconsin. 400 South 2nd Street
Suite #115
Hudson, WI 54016
036 - 2002 -60 -000
Parcel Identification Number (PIN)
This is homestead property.
Oy) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this '1i(O day of April 2000
« • Michael J. Montei
AUTHENTICATION ACKNOWLEDGMENT
Signatures) Michael J. Monteith, a single person STATE OF WISCONSIN )
) ss.
County )
authenticated this day of April 2000
Cam- Personally came before me this day of
the above named
. Kristina Ogland
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. irtc —soon vroressionWs company, FON du Lac. N
STATE BAR OF WISCONSIN 800-655-2021
WARRANTY DEED FORM No. 2.1999
In presence:
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2 66 3 ^ 66.00' .�
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STATE OF WISCONSIN)Sc
29 M C� ST. CROIX COUNTY )
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\.k 1 1 0 10 STATE OF WISCONSI
o a ti ST. CROIX COUNTY
9 0 °° 66 .0 0• 04b 96;9o' ti� office, there ore no ur
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