HomeMy WebLinkAbout038-1191-10-000 Wistonsin Department of Commerce
Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count &. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita j§jnANo.:
Personal information you provice may be used for secondary purposes [Privacy Law, 115.04 (1)(m)].
Permit Holder's Name: ❑ City ❑ V111pge rie `�ownshi State Plan ID No.:
Smith, Michael A. JTai M"dl p
CST BM Elev.; Insp. BM Elev.: BM Description: Parcel W-1,191-10-000
- 1 -10 -000
d fi
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
k h
B
Septic Benchmark q /d d
p r O4 d . � l l�
Alt. M
Aeration Bldg. Sewer z3
Holding t Ht Inlet �, 4 y
TANK SETBACK INFORMATION 0 / Ht Outlet s ,
TANK TO P/ L WELL BLDG. Air I to ntake ROAD
ir
Septic 7 _, NA
D NA Header / Man.
Aeration NA Dist. Pipe t " d
Hol Bot. System Lam) 7./ ?S
k b
PUMP/ SIPHON INFORMATION Final Grade -5: 3z
Ma cturer Demand cover
Model Number
TD H Ift Friction m TDH Ft
L oss ea
Forcemain Length Dia. Dist. To we
SOIL ABSORPTION SYSTEM ff
BED/TRENCH width Len th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 . s r Z I I DIMENSION
LE HIND Manufacturer:
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM '1 (
INFORMATION TypeO CHA B Moe Number:
System: ���
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length I SE15 - Dia. J A W Spacing 1' � ��
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/ Tr nch Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1• 1 z/ /DD Insnection #2:
Location: 1329 214th Avenue, New Richmond, WI 54017 (NE 1/4 SW 1/4 13 T3 IN R18W) - 133118981 Northgate -Lot 32
1.) Alt BM Description= k5e -s lover ) 70 14,,A 4 -f y 4
2.) Bldg sewer length= - 3 o h a
-amount of cover = >I P / r, -) h , 6;� ; ��/ ; j a >�N
3) W rjotS in SlwIl a, ;rt
z4 L`&# 4 r -4roA� h oc e ell
Plan revision required? ❑ Yes Q No
Use other side for additional information. Z
{ SBD -6710 (R.3/97) Da t 4 inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH "
SANITARY PERMIT NUMBER:
�m
T
i
} .fi .., -- 't > _ ..+. -m, .� .� .._,_¢� ._._.._.... _�........4...- ..........�. � � ...i ...�._... .,.s .s
a E i
a =£
1
E
3
t
E
a
Mm. 8
3
f
7
s f <
3
C 9 S 3
+ I
13 Z g Z( Safety & Buildings Division
Sanitary Permit Application 201 W. Washington Ave.
In accord with Comm 83.2 1, Wis. Adm. Code
1 See reverse side for instructions for completing this application PO Box 7302
Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
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 Sani Pe it Number El Check if revision to previous application State Plan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name Property Location
Y /
,S (f // � 1/ �1/4, S T ,N, R Cor
Property Owner's Mailing Address Lot Number Block Number
Cit ,State Zip Code Phone Number Subdivision Name or CSM Number
II. Type of Building: (check one)
1 or 2 Family Dwelling -No. of Bedrooms:
O Public /Commercial (describe use):_
Gt I /Y( vt/
❑ State -Owned
✓�� /1
t
III. T ype of Permit: Check only one box on line A. Check box on line B if applicable) 039' -1 -1 0 — 13,
A) I. PrNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 1 6. ❑ Addition to
S stem 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 a r XGS' t ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/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. ft.) (MinJinch) Elevation
3.7 3s /.-7 - 96 a 1 1//-
VII. Tank Capacity in Total # of Manufacturer Prefab Site f Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks I Tanks
❑ ❑ ❑ ❑
LtJ -e-P
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans.
Plumbers Name (print) Plumbe ature (no stamps MP/MPRS No. Business Phone Number
PI ees Address (Street, City, State, Zip Code) _
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I uing Agent Si ature (No stamps)
Approved ❑ Owner Given Initial Adverse s>harge Fee)
Determination o
X. ConditiQn /Re sons for Disapproval:
0 a we (oaFX S-� a� kt�Lreew► /
41 eb r.n� ip rK� I
"_ C _ a
PLOT PLAN / �
1'RUJI:I °�' i�iac/ S/ytl AllURESS ` /7 A` /4��
1/4S 13 /T ? N /R W TOWN COUNTY G,c
NIPRS Byron Bird Jr. 220527 DATE 1 ,2 2 BEDROOM
CONVF.N'1'IONAL >= IN•GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
A9UUND SEPTIC 'TANK SILL' / ' LINT TANK SIZE DOSE: 'TANK SIZE
z
HOLDING 'TAN SIZE LOAD RATE /, 2- ABSO AREA ; 775—# aT clu tubers �z
BENCHMARK V.R.P. ASSUME IsLI;V��'i'lUN 1001 // r
❑ BURElio O WELL /� ��'
fd
Vent SYSTEM ELEVATION' s
12,1 Sidewinder High
of Cover Capacity Leaching
Chamber with 31.8
ftA2 per chamber
6' Long 16"
34 11 Grade at System Elevation
yfx..
�/°
G 6< �
aye
e
i
Wisc Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labbi Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, 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 S 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 - 1055 -10
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION VIE ED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
Greenwood GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 N,R 18 :k (or) W
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
14 16 Third St.
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE JaOWN NEAREST ROAD
Hudson, WI. 54016 (715) 386 -3674 Star Prairie I 214th Ave.
New Construction Use I ] Residential / Number of bedrooms 4 [ ] Addition to existing building
(] Replacement [ ] Public or commercial describe
Code derived daily flow 600 g pd Recommended design loading rate • 7 bed, gpd /ft •8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) 96.00 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 fl S El EkS El ED S El ® S El U ®S ❑ U EIS ® 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 0 -12 10 r 2/2 none 1 2msbk mEr aw if .
2 12 - 10 r 4/4 none sici lcsbk mfr aw if .21 .3
i
Ground 3 26-84 7.5 r 4 6 none ms oSq ml na na .7 .8
elev.
99 ft.
Depth to
limiting
factor
±R4 •�
Remarks:
Boring #
1 0 -1 1 2msbk mfr qW if .5 .6
• 2 2 12 -28 10 r 4/4 none sicl lcsbk mfr c if .2 .3
Ground 3 28 -84 7.5 r 4
elev.
9 9.5 ft.
Depth to , ; cuqVLU
limiting
factor _{
+84" ST CR g9� )
Remarks: `i` ZONING �FtC
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200t1flAve., New Rich and WI 54017
Signature: Date: 11 -2 -98 CST Number: m02298
1
PROPERTYOWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page 2 3
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 Trench
...3... 1 0 -9 10 r 2/2 none 1 2msbk mf r gw if .5 .6
2 9 -29 10 r 4/4 none sicl lcsbk mfr gw if .2 .3
Ground ms osa ml na na .7 .8
elev.
99.5 ft.
Depth to
limiting
factor
+84
Remarks:
Boring #
1 0 -14 10 r 3/3 none 1 2msbk mfr gar if .5 .6
4 2 14 -26 10 r 4/4 none sicl lcsbk mfr gw if .2 ' .3
Ground 3 26 -30 10 r 5/4 none sil lcsbk mfr gw na .2: .3
elev. 4 30 -84 7.5 r 4/6 none cos os ml a n na .7 .6
99.5 ft. q —
Depth to —
limiting
factor
+84"
Remarks:
Boring #
1 0 -13 10 r 2 2 no 1 2msbk mfr if .5 .6
S `" 2 13 -30 10 r 4/4 none sicl lcsbk mfr gw if .2 .3
Ground 3 30 -84 7.5 r 4 6 none ms 0scl m1 na na .7 .8
elev.
9 9.7 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
Lj
Ground
elev. j
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
STEEL'S SOIL SERVICE
Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave.
CSTM2298 NE4SW4 S13- T31N -R18W New Richmond, WI 54017
MPRSW -3254 town of Star Prarie (715) 246 -6200
lot #32- 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.
N
1 = 40 '
BM.= top ofl" pvc pipe @ el. 100
Alt. BM.= top of 1 pvc p ipe C el. 99.80
� 3 5��
to t 01
Gary L. Steel
11 -2 -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 3 351
Number of Bedrooms
Design Flow - Peak (gpd) - v
Estimated Flow - Average (gpd)
Septic Tank Capacity (gal) I «
Soil Absorption Component Size (ft) z C�
Type of Wastewater Dorfiestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size (in) 1/8
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 ti and outlet filter shall be assessed at least
once every 3 years by inspection. Th ou let filter shall be cleaned as necessary to ensu
proper operat The filter cartridge shou d 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
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM �j
Owner/Buyer rc es jM �,
i7
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State �e A c � Parcel Identification Number
LE GAL DESCRIPTION
Property Location / ' / �i y Sec. ,j T—ZZN -R�W, Town of _ 57'
�i"c� ✓r� L
Subdivision �r.� t J �� , Lot # ✓�
Certified Survey Map # _ , Volume , Page #
Warranty Deed # 0 , Volume / �, — s�� , Page # /�
Spec house yes ❑ no Lot lines identifiable R' 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 system
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 wastewater disposal 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.
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 th three year xpiratio date.
SIGNATURE O - APPLICANT DATE
OWNER CERTIFICATION
I (we) certif that all st tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the property scrib d abo virtue of a warranty deed recorded in Register of Deeds Office. >>
UR
1 �
SIGNATE APPLICANT DATE
* * * * ** 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
R 1 N'u
STATE BAR OFI 1 WISCONSI FORM I — 1982 ;! 632698 Y/
WARRANTY DEED KATHLEEN H. WALSH
REGISTER OF DEEDS
DOCUMENT NO. jj ST. CROIX CO., WI
RECEIVED FOR RECORD
Greenwood Enterprises, Inc.
This Deed made between 10 -30 -2000 11:30 AM
a Wisconsin Corporation WARRANTY DEED
EXEMPT Y
Grantor, CERT COPY FEE:
and COPY FEE:
TRANSFER FEE: 68.70
a wi ft� aG anrvi vnrahi n trtarT a nrrT,t, Ij RECORDING FEE: 10.00
PAGES: I
Grantee,
Witnesseth That the said Grantor, for a valuable considerati
conveys to Grantee the following described real estate in �`• '9r.4 THIS SPACE RESERVED FOR RECORDING DATA
County; State of Wisconsin: I NAME AND RETURN ADDRESS
910bS IM 'uospnH
911# 21!nS
19ojIS PuL 41noS 0017
9111 AI OU eu!P3
!l o� uan9a
038- 1191 -10
PARCEL IDENTIFICATION NUMBER
of the Plat of NorthGate, recorded in the Office of the Register of heeds for
St. Croix County, Wisconsin o 20, 1999 in Volume 7 of Plats, at Page 46, as
Document No. 603503.
;
r
This is not homestead property.
(is) (Ls not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Granter
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions
and reservations, if any, of record
and will warrant and defend the same.
Dated this 27th day of October X92000
GRraWCOD ENPFI22�2I , INC. -
(SEAL) Ay: L _� 'lx 1a (SEAL)
es E. Rusch Presi
(SEAL) Ay: (SEAL)
h gcretary
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin, lI
y ss.
St _ (`rei x Count J
authenticated this day of 19_ Personally came before me this 27th day of
October, 2000 MY _ , the above named
James E. Rusch, its president and Mary R
R tt sc, its secretary
TITLE: MEMBER STATE BAR OF WISCONSIN
(if not,
authorized by §706.06, Wis. Stats.) to me known to be the person s w I tl /fsregomg
ant and acknowledge the sam ` �Gi; " \'1 ••• '•. ?
THIS INSTRUMENT WAS DRAFTED BY V
Mary R. Rusch, Greenwood Ent Inc _ 7 } r• : 3
New Richmond, Wisconsin 54017 Notary Public, St. Cro cQ u ity,•W�s.
(Signatures may be authenticated or acknowledged. Both are not My i ion is� eff��anent. If *tpte exPirat da[�y
necessary.) l� �.GC/�1_
- u-- a
• Names of pawns signing m any opacity should by typed or printed below the stgnawres.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY DEED Form No 1- 1982 MiAvaukee. WIS.
LCD ❑ ,_ cl 13
j a
N
�• , I co
til
I I ra I
I
r , r -94 Cl
C1 ❑
13
rl
a ` O AA D i�
- o E3
I — t,Z • — r� Cf�_ p CJ Z
0
X71
ri1
❑
if ,
Ll