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HomeMy WebLinkAbout038-1192-30-000 Vft "°I" Depafbvwd of Commeroe PRIVATE SEWAGE SYSTEM sled Division County INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pwsonat Intl nation you provbe may be used for secondary purposes [Privacy Law, s.15.04 (1xm)1. 384199 s Name: ocity0village own o : Sate Flin 10 No.: Star Prairie Townshi CW M Insp. BM E v.: iption: Parcel Tax No.: 1� UD O o 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark , Z d Z Sl Alt. BM Z - Z :. - Bldg. Sewer p , 0 I q tlelding / Ht Inlet Z r TANK SETBACK INFORMATION E P/L WELL BLDG. veatto ROAD Air Intake 7 �S 10' NA y �Z N NA Header /Man. 9 , j. Dist. Pipe Bot. System L PUMP/ SIPHON INFORMATION Final Grade , y ' x acturer and Model Num G •ft Friction em TDH Ft Forcemain i Length Via. Da . SOIL PTION SYSTEM BED / width 3 length s/ No. Of Trenches PIT NO. Of Pits Inside Dia. Liquid Depth Dim Man r: SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM INFORMATION T iO04 AMBER System: e T L � ' -F Si/ �S• - ,PO D �c` DISTRIBUTION SYSTEM Header/Manif Distribution (s i / x Holesize x HoleSpacing Vent / To=inlale Length �� Dia. 7 Lengths Dia. Spacing '7 Length / 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 E] No ❑ Yes O No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: '? /IT /a( Inspection #2: Location: 2207 129th Street, Star Prairie, WI 54026 (SE 1/4 S 1/4 11 T31N R1 W) - 113118991 Huntington Meadows -Lot 7 1.) Alt BM Description = 2.) Bldg sewer length= 1 - amount of cover Plan revision required? ❑ Yes ❑ No Use other side for additional information. SOD-45710 (lZ W7) Date Inspectoessignature Cent. No. a-F 5 4 1 ,,,) r 22 Q •� Safety & Buildings Division l 201 W. Washington Ave. ' Sanitary Permit Application PO Box 7302 T ns n In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302 Ciepartmem of Conn eme Personal information you provide may -be d fgr seta purposes (Submit completed form to county if not [Privacy Law, S. 15,0¢ )("] S$D- 6398T6 state owned.) Attach complete plans to the county copy 0 for the s ste on a er not less than 8 -1/2 x 11 inches in size. County State Sani Permit Number eck ii j" vious�appl' tion State Transaction 1. D . Number St. Croix ''' W - r✓ I. Application Information - Please Print all Informati n Location: Property Owner Name C , : n n Property Location El Andy Munson —' E ST C ROiy� SE 1/4 SE 1/4, 11 T 31 N R18 E (or) W Property Owner's Mailing Address f - Lot Number Block Number 2249 Co. Hwy C ' Zpltlt(�i( C?PFiCE 7 City, State Zip Code h Number Subdivision Name or CSM Number Star Prairie, WI 54026 71.5= 248 -3857 Huntington Meadows II Type of Building: (check one) City Property Municipality 4 LjVdlage Star Prairie 1 or 2 Family Dwelling — No. of Bedrooms: . ; own of Public /Commercial (describe use): 0 State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Ruatite Add: 2207 129th Street A) [ 1. New System 2. rl Replacement 3. rl Replacement of 4. MAddition to Parcel Tax Num s System Tank Only Existing System 038-1192-30, 113#11.31.18-991 B) Permit Number Date Issued P ermit was previously issued I ^ 1 11 , 3 1 . [ V . C 1 C 1 Type of POWT System: (Check all that apply) 6JNon- pressurized In- ground 13Mound rl Sand Filter 8 Constructed Wetland Pressurized In- ground E3 Holding Tank [I Single Pass Drip Line At -grade Aerobic Treatment Unit n Recirculating Other: V Dispersal/Treatment Area Information to 0-t 3 .3 7S % /S 4 S�atsJino�i n 1. Design Flow (gpd) 2. DispersalArea 3. Dihpgml Area 4. roil Application 5. refcolffi ion Rate 1 6. System Elevation 7. Final Grade 600 Required Proposed Rate (Gals. /day /sq_ ft.) (Min. /inch) Elevation 500 514.2 0.8 na 93.9 97.0 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks septic tank x 1,200 1 Wieser Concrete L 11 U 11 U VII Responsibility Statement 1, the undersigned, assume respon ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): MP /MPRS No Business Phone Number Dale Hudson �Q L 220853 715- 684 -3378 Plumber's Address (Street, City, State, Zip Code) 820 Main Street, Baldwin, Wi 54002 VIII County/Department Use Only Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 1 Agent Signer (No stamps) Approved Ej Owner Given Initial Adverse Surc e Feed Determination I IX. Conditions of Ap roval /R Disapprov �j. fS tan Q `bs.. �If. a& S A -� ecsw i S i19.�.etit5 � �o-•w�. tv� �vl S . �nd wlw nson P / rol0. l a 7 1 do cwS 5 E!' SEY v T..314� k /B w., Scale:l =y Z 70.00' i eastI►12Y1C. � J U / i / o / � / 8 pr ma rr 5 y e l ao (,z,) - 6-eo cA¢s l of 3'x 93.75' as, �Sh:��(� / ProPOSCCf (,2cX180.Q CJieSer�p' nC' • %/! GQc.(, french (30 6ot�z /�. *y "scA. s/ 0 Rd.C.io o/' Weil ■� �-= / � �P�• o �o oS2� �� 7 - j �• ' t3a L%x To -I ccJ ��x9¢ ssccm¢..(2 lei' \ a � it C� • ,C�• irl. ,a d �iJ� /'Ocl E /etr = 9(0.00, \ 1 \ cle -Sac. lz9ly S.3 ' 0, 3-30-0 �n �r 1'►ilwnso� P �oj4 / ♦ Electz£'� !0 7 N nn /af t Al 6r1, vn �llt 1 ,,v.s 5 k4' SEI'y Sec. 7 :3 ///. ,f? /B w., ; %. r Z 70 60 dia%ngg,- eASAM"t C u i i o I � / 8 e J'a)o (z) tr en cAtS l of 3'X F3. 7S' 7 /5"h * 4 (►".4iiy / sf�c w%oder ; n �; if for- cj,.4 ., 6 -, rs / Propo3c{I (,ZCJO9ep cJ i eser� v ' nC'• /ir eGcA 0 (.3D -d t / abo /ef. l s.r L ej Ja ce.nen _ _ s� s.n ,Frea / �j•o�o 05 e,� 81 — — -- — l edroom — o •' � anc.{ a o uJcz� 4s5ck ne leer' \ -0,(. Eletr = 96.00." \ 1 1 \ 1 1 -Sa C- 1 1 1 S.3 Wisconsin Department of Commerce SOIL AND SITE EVALUATION ®ivision of Safety and Buildings Page of Bureau of Aitegrated Services in accordance with CoF(O 83.09, Wis. Adm. Co Attach complete site plan on paper not less than 8 1/2 x 11 inches in sib.-,Plan must_ County include, but not limited to: vertical and horizontal reference point (BM) /direction and lip �x percent slope, scale or dimensions, north arrow, and location and disgrace to nearest road. Parcel'1.D. # i APPLICANT INFORMATION - Please print all informotion. , 'Reviewed by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s:.15.04 Property Owner Property G � Govt. Lot 1/4�� 1/4,S 6 E (069 Property Owner's Mailing #ddress Lot 4— Black #.` Subd Name or CSM# city to Zip Code Phone Number ❑ Vill , Town Nearest Road ❑ Ci ty [New Construction Use: .TResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 gpd Recommended design loading rate _ bed, gpd/fi trench, gpd/ft Absorption area required bed, ft ;F / trench, ft 2 Maximum design loading rate _gi bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material / r rim Flood plain elevation, if applicable It S = Suitable for system Conventional Mound In- Ground Pressure AT Grade System in Fill Holding Tank U = unsuitable for system S ❑ u ❑ u �S 1:1 u MKS ❑ u ❑ S [emu ❑ S u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench x Ground elev. _ 9�ft. s r•. Depth to limiting 4 , factor Z Remarks: Boring # F J _ �/ d1 y Ground elev. ; _2L .2 30A G Depth to limiting fa in. Remarks: C T Nam (Please Print) Signature Telephone No. ,ZK� - 761 Addre Date CST Number SOIL DESCRIPTION REPORT PROPERTY OWNER Page _� of PARCEL I.D.# <G I Boren # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground V Depth to limiting 3 Z factor -XgL Remarks: Boring # l Ground elev. C� 6 7 , Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring # Ground elev. Depth to 30 limiting factor Remarks: oring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) Soil Test Plot Plan Project Name' C�y � /, Byr Bird Jr. Address a 2 a ? o /G►'�f! � _. STM X0 d S ,;z 7 Lot Subdivision Date 1 /4 1 /4S// T om/ NIRW -.- Township I3oring O Well PL' Property Line County a BM or VRP Assume Elevation 100 ft System Elevation 0 *HRP s r I 5q P 4 0 Scale 4' = 10 Ft. When Dimensions aren't stated Q Y Q .Z7 � f CD V j S. — R _ o m ' Z 0 R _ o _ n ID � > fa � Q D A Q Iw 0 — o Q 6 0, Q Q "n Ej w o N X a C) 7 7� D Imo- INVERT -•I 0 lI 1 m Cn � O =' J W T/ o - C� � = i v w � J Conventional System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The ut et filt s hah be �� eaned ac nerescary to ensure yroper operation The filter cartridge should 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Cold weather installations (October - February) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS_, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contineencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to your county zoning or health inspector. Pg. 4 Of 5 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A l - Mulling Address .Z.�`f c V E. _ /0Z,6 Property Address '7 ,/ -,�u.. �,'�, oa �o .. /2� �' (Verification required from Pia . g Department for new construction) 12a° City/State ?far { � � Jt),', Parcel Identification Number d3,'-- /D f Q- S"D -606 LEGAL DESCRIPTION Property Location 5 %, y,, See, TLN -RW, Town of Jfarir/' Subdivision �o eQ 0 S Lot # 7 Certified Survey Map # Volume . Page It Warranty Deed # 61161 Volume ,AI? Page # -3'7# Spec house ❑ yes & no Lot lines identifiable M yes ❑ no SYSTEM -MAINTENANCE Improperuse and mat.,ten scp fic systemeouldresaltinitsprematmiefailureto handle wastes. Propermamteaaace consists of pumping out the septic tank every three years or sooner, if needed by a licensed pamper. What you put into the system can affect than function of the septic tank a treatment stage is the waste &Vosai :system. The. pmperiy owner agrees to tabmit to St. Croix Zoning Dgrtmart a .certificatio form, signed by the owner. and by a ma P 7 restdctedplumbcror a liceasedpm>perve fying that (1) the on sits wastemterdisposal system is is pnoper operating condition and/or (2) after inection and pumping (if necessary), the septiatank is less than 1/3 fu11 of sludge. Uwe. the Undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortk hcxein. as set by the Depattmcai of Commerce and the Department of Natural R csoutces, State of Wisconsin.. Certification stating that Year septic system has beta maintained must be completed and returned to the St. Croix County Zoning Office within 30 days. of 00 dwee year expiration date. SI TURE OF APPLICANT D 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 owact(s) of above, by virtue of a warranty decd recorded in Register of Deeds Office. SIGAMURE OF APPLICANT DATE « « « « «« ,may 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 Dccds office a copy of the certified survey map if reference is made in the warranty deed 1,489PAGi 374 Es:31- STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH REGISTER OF DEEDS Doenim—t Numb- WARRANTY DEED ST, CROIX CO., WI This Deed, made between Clay A. Edina RECEIVED FOR RECORD 41-07 -2000 9:45 All Grantor, conveys and warrants to WARRANTY DEED Andrew . Munson EXERPT 11 CERT COPY FEE: COPY FEE: TRANSFER FEE: 57.00 RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address First National Bank of New Richmond 109 E 2nd Street PO Box C New Richmond, WI 54017 Pt 038 - 1049 - 50-000 Parcel Identification Number (PIN) This is not homestead property. of , Plat of Huntington Meadows in the Town of Star Prairie, St. Croix County, Wisconsin. Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this % day of January, 2000. "Clay A. 9n w AUTHENTICATION Signature(s) Clav A din ACKNOWLEDGMENT authenticated this ay of January, 2000. STATE OF WISCONSIN ) ) ss. - 'Kristin Ogland County ) TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this _ day of (If not, 2000, the above named authorized by § 706.06, Wis. SLats.) to me known to be the person(s) who executed THIS INSTRUMENT WAS DRAFTED BY the foregoing instrument and acknowledge the same. Attorney Kristin Ogland Hudson, WI 54016 , Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If trot, state expiration date: necessary.) ,) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM IVn. 2-199" INFORMATION PROFESSIONALS COMPANY FOND DO LAC, WI 000 - 6652021 UNPLATTED -- LANDS ---------------------- NORTH L /NE OF THE SOUTH 112 OF THE SE 114 OF THE SE 114 OF SECT /ON 11 _ — — - S89'04'54 "E 995.61' - — — - - 944.15' _ y — 348.00' P64DING AREA k P` 4� M 60' WIDE DRAINAGE ESMT H. W. E. = 178.1 °' A _ .> T S89'04 54 "E 161.58' W I S8 - E 241.92'�� O h $ LOT �- DRAINAGE EASEMENT N� f �°`� N ti z F { i �, w a °a .Ir o N 65,950 SO. I ° 1.51 ACRE` Q � w �\ �n ; ��O^ 77,436 SO. FT. z w c i �n o JN h 1 ACRES o'�° .Z Q C'4 LOT 1 i ``� 6 • IA S89 '04'54" z t - —� — I 103,613 S • 23.81' 28.74' °� - S89'04'54 "E I o I in . Q. FT. z 0 w I o 2.38 ACRES / v I z 25.31' ! E b ° = C14 / 1 W S89'04'54 "E ( 89'04'54" >= LOT (V co 268.47' 175.34' Lo , 65,778 S( \� ©_ I — © 1.51 AC C) S89'04'54 "E • • Fo o 00' o p 40. Z I \ / Z N89'20'22 "\ LOT 5 Y : 21.00' �•� � LOT 8 96,265 SQ. FT. a 2.21 ACRES I 33' 33' I m : ci 71,493 SO. FT. LC Lo M 1.64 ACRES � o o N I ih o 66,676 t o o I m: o N 1.53 N N .......... ............................... I I Z ... I I • • • • • 100' • BLDG. •SETBACK • .. •I•