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HomeMy WebLinkAbout038-1193-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count . Safety end Buildings Division Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitao8fglo.: Personal information you provice may be used for secondary purposes [Privacy Law,X.15.04 (1)(m)j. Rsufllda@ & , NiM ❑ City ❑ V8tw Rrhl r T -owns ip State Plan ID No.: CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel 08"193- TANK INFORMATION ELEVATION DATA (R, 100 k TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ��( Benchmark 21 0 0 Dosing 3'r� Aeration Bldg. Sewer 5_. Holding St/ Ht Inlet TANK SETBACK INFORMATION St /Ht Outlet �o•� 9f, .o TANK TO P/ L WELL BLDG_ Air I to ntake ROAD Dt Inlet Air Septic S 2 ( f NA Dt Bottom Dosing NA Header/ Man. �•(oo RS%3`f r o � Aeration NA Dist. Pipe (.p 9s' -34 Holdin Bot. System $ '1�0 9 0 PUMP / SIPHON INFORMATION F' 5'.Q Man acturer Demand `J� � 3cS X8.(0 Model Nu er GPM T Lift L riction System TDH Ft H ead For ain I Length I I SOIL A , AS , ORPTION SYSTEM KW/kR fNCB,,J Wid)h Length N Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIM EN 1 N 6a- DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING a M nufa urer: _ c SETBACK CHAMBER -I- INFORMATION Type Of r / e um er: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) Hole Size x Hole Spacing I Vent To Air Intake Length � Dia. Leng ia. Spacing > 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 InS ecti0 #1C7 Yes / [3/ In S eFtIbn #Qj No / / cn MMENTS: (Include code discrepancies, persons present, etc.) Location: 2167 134th Streeet, Star Prairie, WI 54026 (SE 1/4 NW 1/4 13 T31N R18W) - 1331181001 Pine Acres -Lot 6 �� Sr 1.) Alt BM Description �°� °-� 2.) Bldg sewer length= 30 -amount of cover = I "+ sa; 3) C� s�-J � �r.� P. /;�, tn„ C�; � 3 �i.S►- r•�^ -� d 2�-�. ¢��ol�/ �CCt.Q�T^"^�'� . Plan revision required? ❑ Yes K No 1 0 — + 1 Z-{ I DI �s�$ Use other side for additional information. SBD- 6710(R.3/97) Date Inspector's Signature Cert No Sanitary Permit Application safety 3 In accord with C Wm 83.21 Wia. Adm. Code 201 W. W� t o n Ai e. Sea reverse side for ` tnstrtidiotta for oot{ns ttm application PO Box 7302 aetuct nt:�,Ce nnesea pw"W infompd M YOU POVIde lacy be mod ry purposes Madison. WI 53307 -7303 [t'tivsay I.aw, s. IS. 1� j y (Submit completed form to county if ►tot A the state C,Q owned, as vow mot x a-In 1 I t` s >tmbw Stan 1. D I. A tcation Informatics • Piem Print al information l Nopaty Oww Ibma Location• y S E1 M S 1 3) R w ' _RT Number s S S h Subdvbdan Name ar CSM Number I 9 �, or 2 F Qcre� IL Pu ' a of Enildlag: (check are) :0' S ❑ t 1 amily Dv►�cgttt6 _ �, � , ❑ State-Owne Cvmmerdal(describeusey, P Town at G ` -9 , Newest Road Leos .7 as III a of PenUI Check only one box on title A. Check box on Etta B if applicable) 3 _ 31. ! O A) t_ New 2 system S Teak On l 4 � S ' b. Addition to Bj ❑ ; h Existi fasued IY. Type of PAWT Stem: (Clerk an that app,) und ❑ Mound ❑ Sand Filter O Cbnsttucted Wetland ❑ At ❑ Aero Tank ❑ Sbgft Pass ❑ Drip Lbte V, p Unit ❑ Recirculating ❑ Other t. atnment Area Into­" Y 0 �; , ,�� N A g 3, 7 1 377 7?S VII Wank Ckpacib' is Total d of Mantifiv*= Prefab Site Sted Fiber- Plastic u Information Oattons Oath Tanks Uoa. con. i � New Tanh cleft structed i po ( ctSers z 0 0 0 ❑ ❑ ❑ VIII, Responsibtilty Statement I the vadersigne& asauma for of the POWTS citosaa on the attached ♦ ` °"� to " as s 3 7 f5 -a sr3S IX CauntylDepartment Use only ❑ Paadt Feo Data lamed )(Approved ❑ Gen hutiaJ Advetsa Pee C� � tiro 3 2�is. -- 2 2� � 1C. ndttioas of ApprovallReasons for�Dha - pp ' 15 ✓�Q, f*14; a ��, ; , �„ Is ( I " Cl l + ,t p 6r- _ 1 I a 1 - _ I - - I i _I TIP P6 i � i I I I , � i � I � -� f Tom jj ` I I I i � I r i �� � ----- ------ --4 ---------- 1 T I L -4 - -- ---- ---- G } I { i j � i � 1 � ' I I � _� � 1��i ! �!�; j j i � � � I '!�� j j �2 04 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and �� &,e percent slope, scale or dimensions, north arrow, a d distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Pl `e print all infer ion. t endin Personal infomrabon you provide may be used 'ftcondary purges Low, Law, .15.04 (1) {m)). Viewed�By Date Property Owner 1 Property Location Lakes & Hills Development 09vt Lot 1/4 NW 1/4,S 13 T 31 N,R 18 W Property,Owner's Mailing Address "," ` _= of # Block # Subd. Name or CSM# a ', ;T t 6 - Pine Acres Ity State ', Zip Code P ❑ City []Aage Xr own Nearest Road 134 TH ST. New Construction R�si�fential IA6 liar^ drooms 3 �fAddition to existing building - Replacement Use. [} Public " 6f lal describe Code Derived daily flow 450 gpd Recommended design loading rate 7 bed, gpd/(t .8 trench, gpd/ft Absorption area required 643 bed, ft 562 trench, ft Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 93.9 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - -- Flood plain elevation, if applicable --- -- ft $= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank u= unsuitable for system ❑ S ❑ u ® S ❑ u ❑ S ❑ u E S ❑ u ❑ S ®u ❑ so u SOIL DESCRIPTION REPORT _ 1 2coo Borin # Horizon Depth Dominant Color Mottles Textur Structure Consistenc Bounda Roots GPD/ft2 exure _ g in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. ry Bed Trench ---- - - - - -- 1 0 -10 10yr3/3 -- - - - - -- I lmsbk mvfr as if .4 5 • `� 1 2 10 -23 10YR4/3 --------- - - - - -- 1 1 msbk mvfr as 1 of .4 .5 �{ Ground 3 23 -45 7.5YR4/4 I - cs I osg ml gw - - -- .7 .8 . elev - 98.4 ft. 4 45 -93 10YR4/6 ` ----------- - - - - -- s o ml - - -- - - -- .7 .8 Depth to —} limiting - -- factor >93" 5� •Y `1 • `� Remarks: 2 1 0 -11 10YR3/3 --- --------- - - - - -- 1 Im sb k mvfr as if .4 .5 • `( -- - — - 2 11 -26 10YR4/3 ------------ - - - - -- 1 I msbk mvfr as lvf .4 .5 Ground 3 26 -50 7.5YR4/4 ---- - - - - -- Cs osg ml gw .7 .8 elev ___ - ___ — _ - _ -- 98.0 ft. 4 50 -89 10YR4 /6 ------------ - - - - -- s osg ml - - -- - - -- .7 .8 I Depth to limiting �, G �• �, factor I l >89" Remarks: -- - - -- -- — -- -- -- -- CST Name (Please Print) Signature: Telephone No. Jacque Hawkins gAer ` �, �2..,..,� � 7 4 d YY 4� Address 4 - -�, - -� — Date CST Number Ref # / j y �'r3 4/8100 ? 378 PROPERTY OWNER: Lakes & Hills Development ^ T S OIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D.# .Pending Depth Dominant Color I Mottles Structure I GPD� Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots 'Trench Bed 3 1 0 -10 10YR3/3 ------------ -- - - -- I Imsbk mvf7 as if .4 .5 •`� 2 10 -25 10YR4 /3 ------------------ I Imsbk mvfr as 1 of .4 .5 . `{ Ground eleV 3 25 -52 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- .7 .8 . } 97.8 ft. 4 52 - 89 10YR4/6 ------ - - - - -- s osg ml - -- 7 8 Depth to limiting facto , -- — 9" �� — --f — - --� Remarks 4 1 10 -12 10YR3/3 ----------- - - - - -- I 1 msbk mvfr as I f .4 5 • `� 2 12 -26 I0YR4 /3 I Imsbk mvfr as 1 of 4 .5 Ground el 3 26 -51 7.5YR414 ------------- - - - - -- cs osg ml gw - - -- .7 .8 ' 97.8 ft. 4 51 -88 10YR4/6 - ---------------- s osg ml - - -- .7 .8 �— Depth to limiting factor >8 H o Remarks: 1 0 -10 1OYR3 - I Imsbk mvfr as If 4 .5 2 10 -21 10YR4/3 ------------ - - - - -- I Im mvfr gw Ivf .4 .5 Ground -- — 3 21 -49 7.5YR4/4 - cs osg ml gw 7 8 a elev ------ - - - - -- --- - - -- 98.1 ft. 4 49 -90 f 0YR4 /6 ------------------ s osg m1 - - -- - - -- 7 .8 Depth to limiting - — factor >90 Remarks: Ground — — elev _ — — -- -— -- -- - ft. Depth to limiting — - -- - factor Remarks: Q C nt n N 00 U' p+� c Q c I r1 � y . y r I { M � •� n Sy fil f n . � ._.. •�zi f 1 � 0 t fro 1 ' • • • • V �"� O W a. :. Bb r m O ►�► r O �' C c io N CL cr _ m �' c v C 0 r •0 5 7 o w p'N � p` 1 0 N 0) x M W ..r. �` d rt5 Q2 2 t o m _ P E3 ;) Invert t 1' p }. D �� Private Onsits Vi�asimvrrater Tr�nwit Sytsltvm Ift !--gon w t Plan Septic Tank And Gravity fn4round Soil Absorption Component PUrStu" to Comm 83.54 VA& Adm. Code each PriviEe Onsits Wastewater Treatment SYS ( ) stw8 ktdude irkw akm and WacatMes for maiming to systsm within the PW*MMWS of Comm 83 and 84, and On con khans of approval by the department, agent, or govemrryentai unk The approved Plans and permits for system are an fly at Ow county zoning or heaffh department. TWO menag=W t plan aMON w8h Comm 63.54. Wit. Mm. Code. and ft !n- Qr� Soil Absotpdon Compono t Mwwd for Pdvate Onsft Wbstewater Treatrnent Syekwa S8Q- Table 1: tam P'errnit lw,NnlDar Number d - Bedrooms DesWi Fktw - Peak ( UITIRIN €NW - A o Tank Sob She 5 Type of wassawater ©omsef c Table 2: Solt LJM is of Tank Flaw - Peak o 0 37 724 how th nr► k*uent Parilde Sias 118 no Moo ""I TSS 150 Table 3: Nllkwb�w Schedule Tarn armor ser0a once wyaq 3 yes QuIM Mar once a yaw and dean at IWM arse every 3 years SaN &nap@rA onasymy3 Seotle Tank The septic tank shall be awin#ained by an b&4&W cad to service septic tanks under s. 281:48. Stets. The comarik of the septic tank shah be d�apoaad of in amocdance wig NR 113, Wis. Adm. Code (Serving Septic or Holding Tanks. Pumpft Chambers, Grease tnterpaptors. Seepage Beds. Seepage Pits, Seepage Trends. Privies. or Portable Restrooms). The operating aocddion of the septic tank and outlet titter shad be assessed at least once every 3 years by inspection. The ou8et fter sW be cleaned as necessary to ensure proper operation. The (titer cartridge sttouki not be removed urlfess provisions are made to retain solids m the tank that may slough off the finer when removed *ern its erx4oe ure. Ef the 05/02/01 WED 10.27 FAX 715 386 4686 ST CRX CO ZONING WJ uuz • 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 alarm 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 wfien 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 kx*dng device to prevent accidental or unauthorized entry into the tank. No one shouid enter a septic or other Maabnent or holding tank for any reason **hoot being In hdi compliance with OSHA standards for entering a cwWned space. The atmosphm within the septic or other btiabr�ent of holding tnk may centaen lethal gases, and rescue of a person h m the Interior of the tank may be alYftuit 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 surf 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 s Septic Tank and Soft Absorption r-OmPonent Pliendngs of deep-rooted trees and shrubs directly over or vd hin ten bet of the coffporong should be avoided since root intna;ion into the component nw obsbUO-A wastewater flaw. * jT. uAJTA ZJ E ; = 586 -468J ** plumber = Calvin Power. - 24.r -5155 Replacement site will c:e that foil tested area by C3T (# ) * replacement site :rust be left undisturbed, or management/ contingency plan must be modified .and filed with the zoning office, outlining the steps to be taken in event of :3eptic systBr failure]. 3 04/26, 11:08 6124290033 i TOTAL DESIGN PAGE 01 r ? 1 5 2 5 1 38 . �rrr QS 3t3 O a~ CALVIN POUERa 5 S-1- CitOIX COUNTY ^; SEPTIC TANK MAINTENANCE AGR.FC:MCN "t" AND 4 O WNERSHIP CI RTtt'1CAT10N f'CaP.h4 ortHu.ycr 961 Ile e- �;lir Address erty Address `(V't:riftCatic>t7 required from Planning Uc }�aCtmcnt for n ew cnnS(N= Ett)rt) � ..� �� �--- " 000 Parcel Ide,11tificatiott Numbcr l.� tate A pt:rty Location; `I,, /., Scc ..�. — Lot 0 aiv cam, '— trfifIed Stit .�Ap Volume .......__.,.^-- -.�—�. Page W olumc 'arranty Deed d4: ef- 52 - , yes no S' ,� no no t_ot lirtet idcnk +fial�le` } }tzt i RP., 13 vtC .: N( ", T'F Z , rr7 cot.7ld result in its pre.rriarurc failure to handle wastes. Proper wait +tr.tlarlc1 f ou tic•,ys C at you ,l.st 7r , ,to thr, sy.•.t tn�; roperu�a'cand'maintcrtst7cea y P j' �nsist.s of purrtpin$. out the acptir :aTll; every three years or Bogner, if needed by a lictnsco ptttnocr. l7 I n ai[ect the fruic.1�4i1 or: the septic tank as a treatment stage to the wa3tc dispgaa system. the ovrrr7cr and by a pr+aph! Q'v}tet agrees to submit to 5t, Croix Zoning Degattm nt C terdisosal systcrA t7� ( ) t he orr•sit waslewap ! .;9tcC Plumber, jatkrnbyrnan Plumber. testrtctcripltrmbet or a ticettsadprtsrtp & Y 8 in proper operati sg'condition and/or (2) after inspection and pumping (if rtcccssary), ale scpftc tan/ is 1c�s than l/3 foil of siu i r. Y' "It1tCai7�t1 -at lysicm With t'�vc, the ttrtdcrsig t fo mod have read the above reQu�rntTlCn�e and the Department of tNahtral Res ource S ate or Wis 7 tCc,,t�lrl;. . z'tt+, bcrela, s4t by the [aeparttrtent G :.sting that your st+, lit sy8tern has been ma of intained nt,tst be, completed and retursted to the at. Croix County Zoning Ciff rcc "'ray Of Ulu (111Ct 'knot 9"P'irativra date. VATS .ylt;N'A t`UT' . 'OPIM 1 LICANT rr yr ,r..11i �r�CAr O that all staterncnta an this forrn ar�d tru rccordea tb ibt( -r o vt4kl Wrist, t (wc} am (a:n} the r,«nr..r(s) o Ile {7topc�*y dea d above, by virtue of a warranty >ic. S1Clwill "t'U, l"7. k1 l- .r :...�+• t7or��rtrrr :'t Any lh{tion that is mis- rcprescsttctl may resu in titli xtrt6ttrY permit t,r:irg rc:vclktd toy the I k ++ inclutta a °titx tttlIs n nt;enlion a sttrnped warranty ctced frgnt ttyG RegisGt r of Deeds a in 1 t.carrarit dcnd cagy of the certified sutvay if rcfcrCtaac +s n�a�9c in vhc 3 VOL 1640ma 636 STATE BAR OF WISCONSIN FORM 2 .1999 tI� 14 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between L akes and Hills, In a Minnesota RECEIVED FOR RECORD C orporation, _ 05 -16 -2001 10:00 AM 6ARRANTY DEED Grantor, and James H. Schlaeger and Christine Schlaeger, husba EXEMPT li CERT COPY FEE: and wife, COPY FEE: IRANSFER FEE: 77.70 RECORDING FEE: 10.00 — — — PAGES: I 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 Lot 6, Pine Acres, Town of Star Prairie, St. Croix Car'ity, Name and Return Address hismnsin• KRISTINA OGLAND ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 Pt 038 - 1054 -90 -000 Parcel Identification Number (PIN) This i not — homestead property. (K) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this day of May - 2001 Lakes and Hills, Inc * * By Richar S . N Ison, President * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Lakes and Hills, Inc., by Richard S. Nelson, its STATE OF WISCONSIN ) President, ) ss. _ County ) auttisatleat his , 'day of May 2001 �i Personally came before me this day of a the above named * j06* an ? MN STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing — instrument and acknowledged the same. 706.0 Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY • T – Attorney Kristina Ogland _ Notary Public, State of Wisconsin Hudson, WI 54016 V 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. Information Profemonals company, Fond du Lac, WI WARRANTY DEED STATE BAR OF WISCONSIN e00a55-2021 FORM No. 2 - 1999 } m to 2 OZ •s ,/t W L .�s•fZZ 41 0 O C I� N p Tito I I t \- - -- to I 2 y co \ v .09ZZz \ \ 3.SZ.6S.68S cr cr O � w \ (A w rr^^ V I� a t o M \\ ^ v to r O to q� co ,C •� ' \\ ' \\ t6 -ry/ ry Lo CJ ID c ,� \ 1 \ te a• � •� Q � ti mss. 9 /" .a W I Al