HomeMy WebLinkAbout040-1010-70-000 f - -
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 488199 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J.
Permit Holder's Nam® City Village X Township Parcel Tax No:
Conom, Nick & 31ance Troy, Town of 040 - 1010 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
pfl,p I I CO -0 Z k8XL4C S; 03.28.19.42a10
TANK INFORMATION U ILEVATION DATA
TYPE MA 4UFAC �EF3 „ „ CAPACITY STATION BS HI FS ELEV.
Lop 1 �.� �
eptic j Benchmark � CD 35
q Alt. BM
Aeration Bldg. Sewer r
o Ing t Ht net f
S. L ••S 6�l}
TANK TBACK INFORMATION
St/Ht • �(o �S 9�
BLDG TANK TO P/L WELL ent to Air in ROAD DfI
X92 .
ep Ic Dt Bottom
> s- as +
osmg Header/Man. •3�P �� r
era Ion Dist. Pipe („ , b • '
o mg B ot. S ystem
F inal Grade I e� > I t . 2.0 `j� •SL'
PUMP /SIPHON INFORMATION µ� 2.b .IZ'
m anufacturer Demana over
PM p I CtU .03 r
m odel um r
I rIC LOSS ys a rlea
orcemain rgin o r� l J.. `f 0 11U. Of I renul TIM U. UT 1-115 mbi0e U14. ILIqu
IM 3 r 61' 4 0) CEACHINIS
INFORMATION I I CHAMBER OR
UNIT
k4 A
• ' 2 0, m
b AR 111telkle
Pipes r
Length Dia Length Dia pacing 2 +
Will VEK x Pressure Systems Only xx Mound Or At - Grade Systems Only
Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes N
/CO MMENTS' XI code is ep pre nt, a c.) Inspection #1 J � Inspection #2:
cation: (n 6 , 08 T w ad Hudson, WI 54016 (NW 1 " /4 SE 1/4� T28N R1 9W) NA Lot 2 ,- p Parcel No: 03.28.19.42a10
1. Alt BM Description =
t
2.) Bldg sewer length = )p
- amount of cover
3)
i 3 , P1an to ` Yes No ' �, --
Use other side for additional i nformat ion. J __
--- -J -��t� In o ignature —
SBD -6710 (R.3/97)
Safety and Buildings Division County
AN ME 201 W. Washington Ave., P.O. Box 7162 St. Croix
jsconsin Madison, WI 5 Sanitazy Permit Number (to be filled in by Co.)
Department of Commerce (608)26 315 CEfV Y J / 7
Sanitary Permit Applicatio s an I.D. Number
In accord with Comm 83.2 1, Wis. Aden Code, personal information j ve 4 Proj Address (if different am mailing address)
may be used for secondary purposes Privacy Law, aI5.04(1
L Application Information - Please Print All Information � 08 ower Road
Property Owner's Name I I#: Pending Lot # Block #
040- 1010 - -000, lot 2 Na
Nick & Blanche Conom
Property Owner's Mailing Address Property Location
608 Tower Road NW 1 /4, -LW- V4, Section 3.
City, State Zip Code Phone Number
T 28 N; R 19 W � 24 — AD
Hudson, WI 54016 (715) 386 -2937 •
IL Type of Building (check all that apply) ,
X 1 or 2 Family Dwelling - Number of Bedrooms 3 C "r 6¢'r n �a� Subdivision Name CSM Number
❑ Public/Commercial - Describe Use 1 _ L Lot 2, CSM Vol. 12, P .3492
❑ State Owned - Describe Use , 6 ff Lj da - o 16 4- []City ❑Village X Township of TroV
III. Type of Permit: (Check only one box on line A Complete line B if applicable)
A • ❑ New System ❑X Replacement Sys tem ❑ TreatmenUHolding Tank Replacement Only ❑ Other Modification to Existing System
R. ❑ Permit Renewal El Permit Revision ❑Change of 11 Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1V. Type of POWTS stem: Check all that apply) O
X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: Three trenches @ 3'X 64', forty eigh4ttotaI)L 16 per trench) "Quick 4" Infiltrator Chambers at 19.1
ft. /chamber + 3 r end caps = 934.20 sq. ft EISA
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf ) Dispersal Area Proposed (sf) 1 System Elevation
450 gpd ,/ 0.5 gpd sq. ft. ✓ 900.0 sq ft ,/ 934.20 sq ft EISA / 94.00' ✓
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units �} -7 Concrete Constructed Glass
New Existing
Tanks Tanks L✓ �0 0 sz
Septic or Holding Tank 1,500 _ 1,500 1 V4ser Concrete X
Combination ST/PC as 2 comp. ST
Aerobic Treatment Unit
Dosing Chamber
VIL Responsibility Statem nt- I, the and d, assume res r installation of the POWTS shown on the attached pliam
Plumber's Name (Print) lumber's gnature MP/MPRS Number Business Phone Number
James K. Thompson =--- -_ MPRS #30021 (715) 248 -7767
Plumber's Address (Street, City, tp Code)
340 Paulson Lake Lane, Osceola, WI 54020
VI11L County/Department Use Only
Approved ❑ Sanitary Permit Fee (includes Date Issu Issuing Signature o )
isapprov Groundwater Surcharge Fee) /,, ap s ,L �.
El er ' en Reasi al yL� b✓
IX. Conditions of Approval/Reasons for Disapproval �5�.
SYSTEM OWNER: 3' E �/���, A,° �(� 1, J V� � �dl d
1. Septic tw*, *Muert filter and V
dspersal cell must aN be, services / m aintained
as per management plan provided by plumber.
2. AM setback requirements must be maintained
as per applicable code I ordinances.
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size
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R ECEIVED
MAY 2 4 2006 1983
Wisconsin Department of Commerce SOIL EVALU ORT page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Ad ST, CROIX COUNTY A. .E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inches in size. Phan must St. Crob(
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. I.D.
0 - 1010 -70 -100
Please /stint all information. Revi By Dat
Personal information you Provide may be used for secondary purposes (Privacy Lew, s. 15.04 (1) (m)). ,) w
OL
Property Owner Property Location
Nick & Blanche Conom Govt. Lot NW 1/4 SW 1 S 3 T 28 NR 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
608 Tower Road 2 CSM Vol. 12, Pg. 3492
City State Zip Code Phone Number City _j Village 0 Town Nearest Road
Hudson WI 1 54016 1 (715) 386 -2937 Troy I Tower Road
New Construction Use: 601 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement J Public or commercial - Describe:
Parent material Glacial drift Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for co nventional POWTS @ 0.5 gpd/sq.ft. I nstall three trenches at 94.00' u sing 16 Quick 4
Infiltrator chambers per trench (48 total).
Boring # I Boring >107" in. Soil
e Pit Ground Surface elev. 99.25 ft. Depth to limiting factor Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0 -14 10yr3/2 none I 2fsbk mvfr as 2f,vf 0.6 0.8
2 14 -25 1Oyr5/4 none sicl 2msbk mvfr cw lf,vf 0.4 0.6
3 25-40 1Oyr4/4 none Is Osg ml gw - 0.7 1.6
4 40 -107 1 Oyr5/6 none s 0 sg dl - - 0.7 1.6
-- T
2 ] ri
to
Boring # Boring
1� Pit Ground Surface elev. 98.57 ft. Depth to limiting factor >106" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 -11 1 Oyr32 & 4/6 none Usil fil Na dsh aw 2f,vf Na Na
2 11 -26 1Oyr2/1 none I 2fsbk ds gS Alm 0.6 0.8
3 26-36 10yr4/3 none sl 2fsbk ds gw - 0.6 1.0
4 36-42 10yr4/4 none sil 2fsbk ds cw - 0.6 0.8
5 42 -54 7.5yr4/6 none gr Is 0 sg ml cw - 0.7 1.6
6 54 -106 1 Oyr5 /4 none s/Ifs 0 Sg ml - - 0.5 1.0
Loading rate of horizon H#6 red to refid educed permea lity associiat with irregular, discontinuous bands of 10yr4/4 Ifs.
" Effluent #1 = BOD ? 30 < 220 mg/L an TSS >30 <_1 mg/L Effluent #2 = BOD <30 mg/L and TSS <,V mg/L
CST Name (Please Print) \,Signatury. J CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 5222006 715- 248 -7767
Property Owner Nick 8& Blanche Conom Parcel ID # 040- 1010 -70 -100 Page 2 of 3
F Borng # Boring
1/ Pit Ground Surface elev. 97.87 ft. Depth to limiting factor >112" in. Soil Application Rate
Horizori Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -18 1 Oyr3/2 none I 2fsbk mvfr as 2fm,1 c 0.6 0.8
2 18-27 1Oyr514 none sid 2msbk mvfr cw 2fm,1c 0.4 0.6
3 27-46 1Oyr4/4 none Is Osg ml gw 2fm 0.7 1.6
4 46 -112 1Oyr5/6 none s/ls 0 sg dl - if 0.5 1.0
Z�
Loading rate of horizon H#4 reduced to reflect reduced permeability associated with irregular, discontinuous bands of 1 Oyr4/4 Ifs.
F—I Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Dep Dominant Color Redox Description tion Texture Structure Consistence Boundary Roots GP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F—I Boring # _j 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 GP
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 = SOD - 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.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner / t yer 1lL4 g 06 14 n C-4 e �n O•r�
Mailing Address X008 �cJer /�octo� c��S� 4 SS/D /G
Property Address 6-ame.
(Verification requir6rfrom Planning & Zoning Department for new construction.)
City /State Parcel Identification Number OeID - /,0 /D - ]0 - 000
LEGAL DESCRIPTION
Property Location n IJ 1 /a , SCO 1 /a , Sec. c3 , T 2ff_ R__/�_W, Town of _7;�o /
Subdivision /1A , Lot # 2-
Certified Survey Map # 585�3Z3 , Volume Page # 3 S/
Warranty Deed # 3 '>` , Volume Sad , Page #
Spec house >es no Lot lines identifiable es
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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
necessary), wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping ( if the septic tank is
less than 1/3 full of sludge.
Uwe, 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
SIGNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08105)
DOCUMENT NO. /� l 9TAM OF wISCONSM —FoR�1 9
32
VOL 5t.�Q PA d M >t ee vre raft DATA
THIS l[ND ENTI.M1 *,lade b Sister Helen E. Lieffring
} REGISTERS OFFICE
as personal representative of the Estate of_- j ST. CROix CO WISe
John J. Lieffring, Reed for Ro=d thIOLIEth
i
day o1! ctob«�r __ A.D.19_ 5
St . CrOix . _. County. Wisconsin, hereby conveyr &U*AAAX
to Nicholas Conom and Blanche J. Coriom, - hu.sbwid t_19_>:QQ___ A ,,
and wife as ,point tenants,
Rh(istor of Oaado
of _ _. St . CTOlX __. Cottnty, Wisconsin, for the sum of
Forty. eight Thousand --- -------------- - - - - A.Qlla.x-s._.
i
Ole following tract of land in _._S t ._Croix County, State of Wisconsin;
All that part of the Northwest Quarter of the Southwest Quarter
of Section 3, Township 28 North, Range 19 West, lying Northerly
of the Highway. ti
A parcel of land located in the Southwest Quarter of the Northwest
Quarter of Section 3, Township 28 North, Range 19 West, Town of
Troy, described as follows: Beginning at the West Quarter corner
i of said Section 3; thence North 0 0 34' East 165.00 feet along the
section line; thence South 89 East 1320.00 feet; thence South
0 0 34' West 165.00 feet; thence 'forth 89 °50' West (assumed tearing)
1320 .00 feet along the South line of said Southwest Quarter of the
Northwest Quarter to POINT OF BEGINNING.
f i
7i �; of
1�1 4r
A
i
I
IN 'FITNESS WHEREOF, th^ :aid grantor _.. ha -$____ hereunto set _fir____ -:._ hand and seal __ this.__.. 19th_.
day of September _ , A. D., 19 75 ,
s
SIGNED AND SEALED IN PRESENCE OF � � � '` _ (SEAL)
? SISTER HELEN_E. - LIEFFRING
! AS P REPRESENTAT OF C4 �, �
t�iLr- STATE. ut - - -: -- E FFAiNO X
_ (SEAL) i
j f
STATE OF WISCONSIN,
St. Croix _- _______— county. } 4
l
Personally came before me, this 19th _ _ . ,f o (___ September A. D_. t9 75 .
the above named Sister Helen E. Lieffring to me known to be the Personal
Representative of the estate of John J. Lieffring, and
to me known to be the person who ese ❑,e.', the fa egoing insttu�t� t a(�d leknowledged tbtt same.
i This instrument drafted by Notary Public _ ._ St C _ _C000ty, Wh,
JOHN D. HEYWOOD, Attorney
� My Commission fS� ![s)
Hudson Wisconsin - - -�
(.4eetien 5e.31 (1) of the WternneW atatutee prowtdoe that atlInstruments to be recorded shall have plainly Printed or tTPewrMM thereoa t"
names of the wanton, araatees, witnesses and notary).
R
WARANTY DEFO- -STATE OF WISCONSIN, FORA NO. 9 ». e. gnats ae.. sunsses
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1 n n Cony i is System Management Plan
Conventional
P Y g
- 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- 10705 -P (N.01 101). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be <_ 15' below service pad elevation. 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 outlet filter shall be cleaned as necessary to
ensure proper 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 to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October - March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BODS, 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.
Contingency 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 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 the installing plumber, Jim Thompson at (715)
248 -7767 or the St Croix County Zoning Department at (715) 386 -4680.
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Parcel #: 040- 1010 -70 -100 05/25/2006 10:54 AM
PAGE 1 OF 1
Alt. Parcel #: 03.28.19.42A -10 040 - TOWN OF TROY
Current • U ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
NICHOLAS &BLANCHE CONOM O - CONOM, NICHOLAS & BLANCHE
608 TOWER RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 608 TOWER RD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 4.917 Plat: 3492 -CSM 12/3492
SEC 3 T28N R1 9W NW SW BEING LOT 2 CSM Block/Condo Bldg: LOT 2
12/3492
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
03- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
2006 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 09/06/2005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 4.917 71,500 156,300 227,800 NO
Totals for 2006:
General Property 4.917 71,500 156,300 227,800
Woodland 0.000 0 0
Totals for 2005:
General Property 4.917 71,500 156,300 227,800
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 301
Specials:
User Special Code Category Amount
i
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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