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HomeMy WebLinkAbout038-1112-20-120 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building f'- vision INSPECTION REPORT Sanitary Permit No: 399660 0 GENERAL I NFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou p rovide may be used for seconds p urposes [ Privacy Law, s.15.04 (1)(m) Y P Y rY P P I Y Permit Holder's Name: City Village X Township Parcel Tax No: LeQue Construction Star Prairie Township 038 - 1112 -20 -120 CST BM Elev: Insp. BM Elev: BM Description: M.o / LW-0 I e4ic - CST la" TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer � rt Holding St/Ht Inlet '� 1 1• �' TANK SETBACK INFORMATION SUHt Outlet %�D 9$ • �� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y / �t Dt Bottom Dosing Header /Man. 10`10 qS L o� Aeration S) ! • 5 3' J to -% 5% f I ' Holding Bot. System I2,;f Tf .03 . /2` PUMP /SIPHON INFORMATION Final Grade Manuf urer Demand St Cover ar+ t GPM C S-D Model Number TDH Lift Friction System Head TDH Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM .(„e `( 'a) 5- `{ BED /TRENCH Width Length No. Of Tie ches PIT DIMENSIONS No. Of Pits Inside Dia. Depth DIMENSIONS SETBACK SYSTEM TO P/L BL G WELL LAKE /STREAM LEACHING Manuf�p INFORMATION CHAMBER OR 5zk s Type Of System: ?� r UNIT Mode `mbe : DISTRIBUTION SYSTEM Header /Ma ifold c , Distribution x Hole Size x Hole Spacing Vent o Air Intake l ./ Pipe(s) ,' t �t 9 p Lengtha Dia Length Dia 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 Yes 1 3 j No Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: – 7= -- t — Location- 1923 104th Str t New chmond, WI 54017 (NE 1/4 SW 1/4 28 T31 N R18W) Red Pine Corner Lot 3 P e No: 8.31 1 - 40 1, 65 IC5 1.) Alt BM De crlption = tr5[ ST w -c._6L 2.) Bldg sewer length = 55 - amount of cover = > �}Z,� ,: c v •e/i, PI�n PSv+V Required? i�'-IJ Yes No �Q Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division Co 201 W. Washington Ave., P.O. Box 7162 S t N visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce Lac Stf ]� / � Sanitary Permit Application Sanitar Prrt� er m loft In accord with Comm 83.21, Wis. Adm. Code, personal information you r vide --1 El Check if Revision may be used for secondary purposes Privacy Law, s15 I. Application Information - Please Print All Information / State Plan I.D. Number Property Owner's Name � Parcel Number Ju .e✓ S Property Owner's Mailing Address gg ° perty Location w )� E 'k, -A; S T3 N, R I d� r City, Zip Code -~ ;Phone N ICE t Number lr� ber Subdivision Name CS um q N �- .S O 1 ��t r� ` L � `�`� 3 check all that apply) .�s OCi ty S� of Building Y II. ( PP P Type 1 or 2 Family Dwelling - Number of Bedrooms 3 []village ❑ Public /Commercial - Describe Use Coo —hip ❑ State Owned / a Nearest Road y III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 A New 2 =Repilamemnt System 1 3 ❑ Replacement of 1 FExisew ddition to System Tank Only system B. [I check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use} A tin 44 Non - Pressurized In-Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Disne rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./ Days /Sq.Ft.) (Min./lnch) Elevation 375 3?? 61 fi p C A )- 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanis Septic or Holding Tank x _ Dosing Chamber VII. Responsibility Statement- I, the undersigpedassume responsibility for installation of the POWTS shown on the attached plans. Plumber's Nam (Print) P ber's igna MPIMPRS Number Business Phone Number t a r s� Plumber's Address (Street, City, State, Zip Code) ni d c L) VIII. Count /De artment Use Onl Approved ❑Disapproved ��' Permit Fee (includes Groundwater Date Issued Issuing Agent Signs re (No Stamps) Surcharge Fee) 11 Owner Given Initial Adverse ZZS- 01 ?A2— Determination IX. Conditio of pproval/Reasons for Disapproval 4 4 to-A tnita.tu,� e tlYw�uvlt'.,v��'►�'LS Attach —piete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches in he SBD -6398 (R. 05101) y S L,. N �21K w S s 7' �a` � ► � �� ��� � vest.. � � �o�' �--3 Cro i T I I -10 -mo A d Z ��1 'L `/g VgSaS T3l t- SY0 /7 �ri�`� r e. SZ' C'✓�o P a � 9 111 a - - !d t� s � � c., /�4�..p 1(W tu.`�s •�S I qa3 1b`f S� a� M wl,-Cvz� 0. 30 I ) I' I f 3 i � 2 ' OV r o SOIL EVALUATION REPORT a in aoaomonm with c omm m Wis. Adm. Cade Aftchcwmpjftsft pbnonpwwnotkw&m a U1 x t, >. P, ma in sine. Plan mwt ST C Po kwkNl% bu tttot &vftd to - -dad and tn*ftcnW „tan»,a, polrt (BM), dk*dkn and Panosi Lo. twntatopa,sataar m,nwo ancw,andto ttbttard I'll was - 11) Mm" print ON ks tfflwawL by Pa MW"%wneswpwp 'd Mgbumoodfw 00 day pwpompWkgq ee.,aiso4(l)bw) Oq �cTbZ t�+graea►O+Nner ' I '2 ca , k1 vS OaYt teat IV E S ti�t�S Whit T ' k R i�rj w toter Bkm* Stbd Nww or � + 0 Ra r,, fl city 'tam NeareNt ad' k�S �' c7l� W7 IS) 7(00 -p� /(7 k + tai c�e«C��rr #adrooms ____ CoftdwMaaaesign low raft � Gpo 0 Fkpkmnwt 0 Pe,tat C or cn m mdwA - oaaoftew t�aeitntalerw tlaWFbi► de minnir*W*O* AI /„P Gon"oonrsmnts r' red rrwanrtmrdatlwuK ,�, ❑ soft 9 T L pit aot�na autaae eta+►. S a �+ «r bn%V t�> /a v oamry t Doplb Dombwt Caim Redoat Dwatfion Tao*" Stn ne tbrr�Isienod Roots flL QtL SL Coat c wr ter. St. Sri ms l rntf r 3 , / 3 /L .Z o r (oK Cos tlGr t- ml 7 m S mV--ft ©. Ktaad a�oa.ra+►. 99 A Dopm ft I r�iiR, "tour >, 91 In Solt won Jai _,. Rate T,erdun, CI' Roots c 3L.1 in+r Qz .35 °� 36 ZO r s/ rn Sal A l 4 Lo R-S , S , 9 Nom t7ltt►Nrt t:bb > 30 < Z ip � and TSS >3D j tstl a* • t�>< e2 a 800 3o ngii, and TSS < 3D nqt csr doer Address Date Evskdon Oad�oded Tait oone't+�anber XL V P Propert OIAN r l l � IB Pwcxg ID 0 039 -1 It a . a� - ►a d 3 Pit srwtroe a4w. `` (0 fL DepM io ira0 0 ltrlydor in soft Anakation Rat, lkxb n Depth Oco - 'mlkCdw PAdwDeecit" TW*M Strudwe Owebteinm Mcundwy Roala In. Munsef ML SL Ccxt Mier ter. Sr- 'at a D - r3 s __q M5; CA U) I r AA M /M -5 MV5 8orirg # ❑ a ound senses aiev. 9 7. ft i}epth w ffmting r,Z- / 6 soil iLrte Undw Depth Donirw d Rsdooc Descrta n Ta�rl" Structure, ©unti a Bwwwy Boole lop in. Munsd Qu. Sz Conn cabr dr. Sa. Sh 'fit ap 3 2 tr, m cZ I r .S . o .. o SA fn-5 / s mv� � — 7 r z 2 � 9 111 yyr )YI04r — — T /. Z U Q pa t�rou.rd see(roe abv it and a imp tflretor in W Fioe M Depth Dw*w d cdw Redmr DeaoipiM. Tea M Sys bon we6ft R ,,,, ' MR In. Mrare 11 Qu. sr- Cont. Cebu t;r< sz St►. • EMuent *1 = SOD > 30 1220 mg& and TSS >30 1 150 mgt. • Effluent #!2 SOD, < 30 mglL and TSS 180 nVOL The Department of Commerce is an equal opportunity service provider and employer. if you need asfristance to aoawtt services or nee& material in an alternate format, please contact the department at 609-266-3151 or TTY 608- 26448777. sID4W OtA" n i • so` �or� pa 3 3 1V I `/ ag 7 t R c� a s s� q u o KA,6 m 1&o X 11 Art ` 7o t6 3 0 � r X b 7J 7 t` t t )MAUI ig x co Go - a w c � � CL V .. `i 'Z + x V .� y dj ' w ( I l Z 3 3 y ■/� ■��./ acv+ a %.} p ; + ' ! t '� n♦ +: tjA Rt w v � i v f Ac u f� � 40 P rivate Onsite wa ulgr Treabnent system Plan Septic Tank And Gravity in -Ground WI Absorption Component Pumuasa to Comm 83.54 V ts. A&n_ Code ead► Pry Onsite Wwwwow Treaftrwm 5 ystem (POw S) SW kmkm a inI01moij©n and proammas for mWnft the sysWn within O w p"MOW3 of Comm 83 and 84. and the cwWWOns of approval by the dot agent, rwj or health fsl unit. The apprtxVOd pis and pemft for system are on tNe at the county departrnem. This ffWagwrrent Plan oortrplies with Comm 83.54, We. Adm. Code, and the In -ground Soil Absorption Component Marwai for Private Ora ft Wastewater Treaknent Sysh"M S8D- 10567 -P (P-6 ,9). Tarr* 1: brn Design nbw flo w ff ! 12 4 d flow - A SOM T4K* S c MM *a T of tNars�rstsr Oomest c Tab* Z: Safi! • L knit Of RINWW Opandloot Tank Soil Floor - Ptak p o 0 3 7 Carnponent Mtextrrwnt !rte Particle Sine 1/8 Meudmutrn Mgdmunt '220 158 Tab* 3. Main /amnof ed dta Sacdc T kwPOd and/or service once M 3 yeam SON a�W Fftr kwow once a Yaw and dean at least once evefy 3 yms kwpW onca wMy 3 _._. The sePbc tank: shall be maWmned by an MdMduai certilled to service septtc tar" under s. 281.48. Stets. The contents of the septic tank shah be disposed of in ecoa+t run with NR 113, Wts. Adm. Code (SerAckV Sapttr or Holing Tanks, PwnpkV Chembffs, Grease lntwca S OOPOge Beds, Seepage Pft. Trench � Seepage .Privies, or Portable ) . The oPwatlng cordon of the ssxi outlet 81ter sal be assessed at least once every 3 yews by W on• T shah be deaned as too ensure i oyeratjon The titer � not be removed Povtstans are made to retain sOkb In the tank "W may slough off the tiNer when removed *m its endom". If the Management Plan for a Septic Tank and Soil Absorption ComPonnt filter is equipped witt'n an aim. the Mw shall be 9arvioed If the Nam is advated conticnuously. Mterc�ritternt fiftf alarms may kWim" stvp flows or an MVerOW9 Contirtuoue alarm. The tank shill have ilk cm *mft n moved when the volume of sour and stodge in the tank exceeds 113 the liquid vok ime of the tank. if the cordenfs of the tank are not removed at the time of an MN* modenascs personnel shad advise the owner or when the next service needs to be performed to maintain less tt►an rnaad"m scan and sludge motion In the tank. Manhole risers. a«xss nsers and covers should be insPWW for water tightness and soundness. Av©ess openings used for servile an d ash sitnaN be aaaled wad UPOn the completion of service. Any opening deemed unsound. defbt11ve. Of su*d to failure must be rapt M& Egad aooass o M*p 9r' Ow Mriches in diarnew shall be secured by an of cUve lodging device to prvvea aocidentM or unauthorized entry into the tank. liter errs w1ftr a Wad for any r�pon � 6eft1Q tirif� 80 s or eri� entering a conffned space. flier l of No/e#M "I* eery' aaNdpo ft" pmr, and nee of a parson Mee on Meer for of so W* a y he ODOM a' MnprnasiHle. Tank abandonment shall be in acowdance with Comm 83.33, Wis• Adm. Code when the tank is no longer used as a POWTS component. S rnent The soil absorption Mnponent serves this structure Is designed to accept domesk wastewaw *om a residential facddy. The Wn is of operation of this component are shown in Table 2. The longevity of a sod a wNption componen depends li99 On praW and ,, N * *W* fjW and systmem use wsihkn or below #ale lirrft of nel" operation• Good water camemeW MmUces by all ooapants and the inslailation a wader CorteervaV p n9 hxfnmas a m key factors in extending the useful ffe of this eanponeM. The soil absorption cages nMrs operation must be assessed by Hnspedion at least once every years. The ubpecftn shall include temp the lev6b of ponckng, if any. in Ow observMO n pipes, and a vkKW insperfion for any evidence of surface seepop or discharge from the a WXW& On steeply "t'q I**, afew of Wasion should be idan8fbd and reported to ttrs caner for f+apalr. The SWIM (115CM199 of daneatic WOMwater or f rom the system ns prohibited aM considered a human he&" hazard. TrafBC around or over the sod atemptiorn corn W*o 3WAd be avoided pw*Mhy during witoar nXWOM The cumpe coon or removal of snow Cover over the component may bad W hy*w,*c fallure by ****Q. This bps of faipue is u s u aNy Wmporaryr, but is dif #*A or impossible b nip W untN weather Condiho w improyva. In general. sod won over this component will mduoe diffusion of ctagW ire the soN and dispersal cell. which rn " lead to more intense, and earlier. Organic clogging of the sal. 2 -- -- ' M Plat for a Sapp o f deep -tamed ttssc and shrubs 000 OvOf or VAh n W � t be avoided s root comps ems. 6T. CKulx zjNJNu = 586 -4680 * plumber = Calvin dowers - 2 46-51 35 * Replacement site will be that soil tested area by C:3T { 3# ). * Replacement site must be left undist or management/ contingency plan must be modified and filed with the zoning office, outlining the steps to be taken in event of septic system failure. 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � c Owner/Buyer •2 t Mailing Address / S� 5 QC"a%.'W4 5 0 l Property Address �- f ` / /V TC i c� c� Lc (Verification required from Planning Department for new construction) City /State Parcel Identification Number n 38 0 - I LEGAL DESCRIPTION Property Location -&5 ' /,,w ' /,, Sec. ,::I, Tj_N- R_,�W, Town of Subdivision _� e --�- Q� /Ifj , Lot # 3 Certif ed Survey Map # 4 4 y 77 2 9 , Volume L . Page # NO f s Warranty Deed # Volume 1 55 % . Page # 3 Spec house Of yes 0 no Lot lines identifiable q yes O 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 wastewaterdisposal 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 34 days of the thre ear expiration date. t2 SIGNATURE OF APPLICANT 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. I l GNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *• IncIude 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 Vn11551PAsE343 + 63 1 924 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Lee C. Kellaher and LeAnn G. RECEIVED FOR RECORD Kellaher, husband an wife, _ _ 10 -17 -2000 9:30 AM WARRANTY DEED EXEMPT k Grantor, and Br A. LeQue and Gerald A. LeQue CERT COPY FEE: COPY FEE: TRANSFER FEE: 90.00 — RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croiz County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Part of the NE U4 of the SWIM of Section 28 -31 -18 described as follows: Name and Return Address Lot 3 of Certified Survey Map filed December 11, 1985, in Vol. 6, page KRISTINA OGLAND 1615, Doc. No. 407739, St. Croix County, Wisconsin. ATTORNEY AT LAW P.O. BOX 359 HUDSON, W1 54016 038. 1112 -20 -120 Parcel Identification Number (PIN) This is not homestead property. Of) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this CP S day of October 2000 . + • Lee C. // Kellaher + + LeAnn G. Kellaher AUTHENTICATION ACKNOWLEDGMENT Signature(s) Lee C. K ellaher and LeAnn G. Kellaher, husband STATE OF WISCONSIN ) and wife, ) ss• -- County ) authenticated this 16O g daay of October 2000 Personally came before me this _ day of _— the above named s Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Q 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Or Attorney Kristin Ogl Notary Public, State of Wisconsin Hudson, WI 540 16 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I .) ' Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company. Fora du Lac, ion STATE BAR OF WISCONSIN 800-655.2021 WARRANTY DEED FORM No. 2 . 1999 407739• CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE 1/4 OF THE SW 1/4 OF SECTION 28, T31N, R18W, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. APPROVED N DEC O 4 1 4 F ILED OWNER CA 3P DEC1,1198 FAT. CROA C :)UNTY RICHARD WIER x H JAM a @*Nft COIIMHE14%:VE PAAK-i rl ^Nt*No A H ~ wliq p M 3077 LYDIA CT. ,,��� �,�;uNS COMMIff o „ M wM �selMh ROSEVILLE, MN. 55113 w c e LEGEND 40 a I -4 C 11� x 24 IRON PIPE WEIGHING 1.68 LOS/LIN. FT., SET. O rn R • 1 IRON PIPE FOUND. 1 N 1/4 CORNER t ' SECTION 28 o CO. MONUMENT 1 M f r1 i b Ci y p,. �.. ' . � �,',,'y ' .;,� ���Yi1 c tq� r T l ti 1 } °�..; t r t ' � Y� nfi .. ',• r'I �� ►., unQlatted_ lands _ owned bY_eletter n Cf. () OcsG a PRIVATE S89 ROAD 1315.88 d 345.42 EA MEN!) 345.42 + ' 312.52 5 31.2 312.52 I� tr o x c rct NI O O O A OD I1 Oi OD O O. CD O N tt n g LOT 1 y o° LOT 2 tnI LOT 3 N w LbT 4 0 0 _ _ - _ ac 10 312 312. 6 6 _ 312. 312 1, x rn ►► o �'I to CENT ERLINE TOWN R)A N89 64 !I E - x M rn SOUTH LINE OF THE ME 1/4 °c 1 O N OF THE SW 1/4. O -n s "' uO Qlatted _1gL►d$_QgOgd_by_ot�eC$ _ � x I = o. i b��1�SRlldf� o C r ''y'�. S 1/4 CORNER KENN 61 ALLEN G. , 'i SECTION 26 so 100 00 `'r NYMAGEN 3 x 6 high S•1407 IRON PIPE �s HUDSON, Wis. s J `\ this instrument drafted by Douglas Zahler Job no. 85 -13 Vol. 6 Page 1615