HomeMy WebLinkAbout038-1189-20-000 Wisconsin Departmant of A rnmerce PRIVATE SEWAGE SYSTEM Cou
Safety and Buildings Division ,
INSPECTION REPORT St. Croix
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)l. 384129
Permit Holder's Name: ❑ City Village own of: State Plan ID No.:
ayes, Rick Star Prairie Township _ Iq 4 T]
ST BM Elev.:. / Insp. BM Elev.: , j)escription: Parcel Tax No.:
f2L)t._ 038- 1189 -20 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ��-t r5�0 Benchmark 0D.0 r
Dosing - Alt. BM
Aeration Bldg. Sewer 52 m
Holding - St /Ht inlet ci* '3Z
TANK ETBACK INFORMATION St/ Ht outlet . &,4 c `f. o8 r
TANKTO P/L WELL BLDG. Airl to ntake ROAD bt Inlet —
Air I
Septic '-f Z S t $.5 I -- NA Dt Bottom
Dosing t'► E°: L NA Header / Man. "t 3.D-
Aeration NA Dist. Pipe 3.03'
Holding Bot. System
S
PUMP / SIPHON INFORMATION Final Grade " 5
Man cturer - _ St cover
y
Model Num - GPM
TDH Lift , Lr System TDH t
I (
ForcwrCa I Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width r length N f Tenches PIT No. Of Pits kInside Dia. Liquid Dep th DIMEN IONS
DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING act TeSETBACK :
� INFORMATION Type O �. 02 r p r+ =� OR UNIT CHAMBER Num � e u
System:
DISTRIBUTION SYSTEM � Nom(- f/L.
Header/ ni old Distribution Pipes) x Hole Size x Hole Spacing Vent To Air Intake
u -
Length �— Dia.
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over u Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center '10 Bed /Trench Edges Topsoil ❑Yes ❑ No ❑Yes O No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1:01 Inspection #2: --= �
Location: 2145 134th Avenue, Star Prairie, WI 54026 (NE 1/4 SW 1/4 l 3 T31N R18W) - 133118964 Northgate - 1,ot l S
1.) Alt BM Description = _ 51
2.) Bldg sewer length= a>� 8
- amount of cover = > LA Z
Plan revision required? ❑ Yes "No Kb' � Z
Use other side for additional information. `f 8 l o
SSD -6710 (R.V97) Date Inspector - s Signature
Cert. No.
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Safety & Buildings Division
#k - Z I,`i S l 3 ; ° Sanitary Permit Application 201 � W. Washington Ave.
In accord with Comm 83.21, Wis. Adm. Code
PO Box 7302
14 s consi n may reverse side for instructions for completing this application
Personal information you provide ay be used for secondary purposes Madison, WI 53707 - 7302
Department of Commerce (Privacy Law,S 1�:04(1)(m)] (Submit completed form to county if not
state owned.
Attach complete plants to the county copy o f6rfhe siLstem,,on pap &,notivss than 8 -1 /2 x 11 inches in size.
Co State S�r Permit Number _ `UCheck to previousppp 1 'on State Plan 1. D. Number
I ,�.
I. Application Information - Please Print all Informat I\Y Location:
Property Owner Name =, 1 r 1 Property Location
` 1/4 - zA /4, S / T 3 i,N, WJn (or) 00
Owner's Maitin A \ r , Lot Number Block Number
Property d •'`�
Ci , State Zip Code qN � : i .' Subdivision Name or CSM Number
7� "YL 6- 5 Z IV o xnt C ►ATE
II. Type of Building: (check one) 41r, (�+� S i vev ❑ City
❑ 1 or 2 Family Dwelling - No. of Bedrooms : ❑
V i
❑ Public/Commercial (describe use):_ ]no L S F I T wn f
❑ State - Owned
Nearest Road
Parcel Tax Number(s) 0 C . o o 0
III. T e of Permit: Check only one box on line A. Check box on line B if a lica le , 11. IF - '7(a
A) I. New 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) - IE
&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. Dis ersal/Treatment 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 (GalsJday /sq. 1) (MinJinch) Elevation
,qs-o -? 7,S- 3. o '7 C? -% 6 97,-S
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks I Tanks
t�ct7 ue v .'L
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on ched plans.
Plumbers Name (print) PI is Signature (no stamps): Business Phone Number
� S C zZ% 71 7 /J - - -.2
Plumber's Address (Street, City, State, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signa (No stamps)
Approved ❑ Owner Given Initial Adverse Su ar a Fee) `
Determination :L 2801
X. Conditions of Approval /Reasons for Disa pr oval- rn
lam_ Ct f
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Wisconsin Department of Comme ce ) SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County � �
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
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. 0-3 S'
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). F ( b '
Prope Owner Property Location
Govt. Lot ,5 1/4 115W1 /4 S 13 T / N R E (or) >d!
Property Owner's Mailing ddre s Lot! Block # Subd. Name or CSM#
C' State Zip Code Phone Number
Dn El city ❑Village Town Nearest Road
z ;2
La Construction Use: ❑ Residential / Number of bedrooms
� _ Code derived design flow rate
❑ Replacement F3 Pubic or commercial -Describe:
Parent material _ Flood Plain elevatio if applicable '� -- - �
General comments .0 �`F >>
and recommendations: "---1
P
F_/1 Boring Boring c� r'
g ❑ pit Ground surface elev. /�i �J_ ft, Depth to limiting factor >�y� in. ~ y
tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0 L t� I(2 / Z ct S 4,
z -a a' d YN ��� s K �� cz w iF
/ O Sr' L
1
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 /ff
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
CST Nam (Please Print) Si ature CST Number
w
Il w
Address Date Evaluation Conducted Telephone Number
3 � 2 4/ �` s/ /n•r r �� 'sY�ty ,� ` � = d ( 7� ',268= 6'6�
Property Owner Parcel ID # _ Page of
a Boring # ❑ Boring —
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Applica tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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 /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. ' 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.6100)
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
4 COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 038 -
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION [ Rr . IEW D BY DATE
Zw
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT INE 1/4 SW 1/4,S13 T 31 N,R 18 FXor) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1416 Third St. 15 na NorthGate
CITY, STATE ZIP CODE PHONE NUMBER [:]CITY ❑VILLAGE 29OWN NEAREST ROAD
Hudson, WI. 54016 (715) 386 -3674 Star Prairie 214th Ave.
jc� New Construction Use [=:I Residential/ Number of bedrooms 4 [ ] Addition to existing building
I ] Replacement [ I Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft gpd /ft
Recommended infiltration surface elevation(s) 04 _tin ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for s stem ® S El [OS ❑ u ® S ❑ U Gi S ❑ U 1R S❑ U ❑ S Z U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
......1 1 0 -12 10 r 2/2 none 1 2msbk mfr gw if
.51 .6
2 12 -26 10 r 4/4 none sicl lcsbk mfr QW if
Ground 3 26 -84 7.5 r 4/6 none ms OSQ ml na na .71 . 8
elev.
Depth to
limiting
factor
+84 11
8
Remarks:
Boring #
1 0-12 10yr 2Z2 none 1 lcsbk mfr if .4
4 .5
2 12 -24 1 4
Ground 3 24 -84 7.5 r 4/4 none ms os ml na .7 .8
1'
elev.
Depth to
limiting /
factor _ / -
+84 1 1 s r polx
ZONING OFFICE j.
Remarks:
CST Name: -- Please Print Gmy L. Steel Phone: 715- 246 -6200 -' / C j
Address: 1554 200th. Aye New Richmond, WI 54017
Signature: Date: 10 CST Number: m02298
PROPERTYOWNER Greenwood Enterpris DESCRIPTION REPORT Page _2_of_-
PARCEL I.D. # 038 - 1055 - 10 }
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trend
.................
..................
.................
..................
.................
3 <` 1 0 -8
2 8 -24 10 r 4 4 non sicl lcsbk mf
Ground 3 24 -84 7.5 r 4/4 no e Cos
elev,
98 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
1 -
4 <`> 2 11 -22 10 r 4 4 none sicl 2msbk mfr w if .4` .5
Ground 3 22 -84 7.5 r 4/4 none cos osq ml na na .7 .8
elev.
97.9 1t. —
Depth to -
limiting
factor
+84
Remarks:
Boring #
1 0 -10 10 r 2 2 none 1 2rnsbk mf if .5 .6
5 = <' 2 10 -23 10 r 4/4 none sici 2msbk mfr aw if .4 .5
Ground 3 7.5yr.4Z4— none Ms osa I Mi na na .7� .8
elev.
9 7.8 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
Mom
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
Y
STEEL'S SOIL SERVICE
Gary L. Steel 1554 200th Ave.
CSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW -3254 NE4SW4 S13- T31N -r18W (715) 246 -6200
town of Star Prarie
lot #15- NorthGAte
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
3 1 =40 1
top of 1" pvc pipe C el. 100
✓Alt. BM.= top of 1" pvc pipe @ el. 98.30'
�t
'b 1
I.
�i
Gary L. Steel
10 -28 -98
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 12
Number of Bedrooms 3
Design Flow - Peak (gpd) S�'D
Estimated Flow - Average (gpd) '3w
Septic Tank Capacity (gal)
Soil Absorption Component Size (ft') < <
Type of Wastewater DoYnestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorpt'on Component
Design Flow - Peak (gpd) [A
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 22
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 s and outlet filter shall be assessed at least
once every 3 years by inspection. Th outlet filter hall_ be cleaned as necessary to ensure
proper operation. The filter cartridge shoul 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.
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
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
ST CROIx COUNTY
SFpTtC A-NK ,MAINTENANCE AG REEMI - ?NT
AND
OWt CE,RTIFICATION FORM
Owner /Buyer '
Mailing Address � ! - i zJ A4 ± -4 %�C' _ o x �j r-
Property Address
(Verification required from i Planning Department for new construction)
City /State Parcel Identification Number 0 3 L-7 //F _
L EG AL DESCRIPTIO
Property z.acabiam /�,54?! /, C. 13 . T3-L--Y-R,/W, Town of �_•
Subdivision 4� ` j — -- > Lot #
Certified Survey Map # b a 3 S'O -3 Volume 7 Page #
Warranty Deed # ( . Volume Page #
Spec louse O yes'. no Lot lines identifiable Z yes EJ no
SYSTEM MAMENkNCE
Impropa use and maintemuceof your sel Iie system eould result in its premature failure to bandle wastes. Proper znaiutensnce
consists of pumping out the septic tank every dart a years or sooner, if ateedod by a licensed pumper. What you put into the system
can affect the function of the septic tank as a trmt tmeut stage in the waste disposal system.
The property owner agrees to submit to 5t. Cxoix Zoning Department a cortiflcatian form, signed by the mmcr and by a
master; plurabor, journeyman plumber, restrictedpl umber or a licenitAputnper verifying that (1) the on -site wastewaterdisposal system
I s in proper operating condition and/or (2) after in: �eetion ozd pumping (if neeessary), the septic =k is lass than 1/3 full of sludge.
Uwe, the undersigned have read the above requirri hunts and agree to maintain the private sewage disposal system with tht standards
set forth. herein., as eet by the Department of Cout serve eased the Dopartruont of Natural Resources, Stato of Wisoousin. C.ertiffoation
stAtiag that your septic system has been maintainer I must be completed and rcturnod to the St. Ctolk County Zoning Office w6in 30
days of eC year ex ' on date.
�64XTUiKF OPLICAW DATE
OW CERTMI T� ION
I (aye) certify that s.11 statomonts on this ; ►rm are true to tho boat of my (our) k owledge. i (we) am (are) the owner(&) of
tie prope described abo by virtue, of a watts 1ty decd recorded its Rtgktrr of Deeds Office.
DATE
"•�' "•
Any information that 6 mis- represented rr ay rosult in the sanitary permit being revoked by the Zoniug Department. ••••'•
Inctuda with this application' a stamped wart tnty deed from tho Register of Deeds office.
a copy of the a rtified survay intp if reference is rttnde in the warmaty deed
JAN-17-2001 12:02 FROM- METROPOLITAN MEDHCAL 651-232-4325 T -159 P.006 /006 F -364
VOL 1404 rnt 51
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Pam Quinn
Subject: Meet with Lisa Lebreck
Start: Thu 10/7/2004 8:00 AM
End: Thu 10/7/2004 8:30 AM
Recurrence: (none)
651 - 232 -4135
3 years old - addition
Regarding septic, wanted to meet with Kevin but he will be out of state.
038 - 1189 -20 -000
13.31.18.964
2145 134th Avenue - Northgate Lot 15 septic system is not where they had planned, so
check our inspection report and information
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