HomeMy WebLinkAbout040-1187-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
430059 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)[.
Permit Holder's Name: City Village X Township Parcel Tax No:
Bowman, Thomas Troy Township 040 - 1187 -50 -000
CST BM Elev: f Insp. BM Elev: BM Description: « Section/Town /Range /Map No:
M. 1D t� . o � 1 . /z ,PAC— = csT a AA 36.28.19.E
TANK INFORMATION U ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark ,
�-a 2. • S`� oz • 3 Ur7 • D
Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic , Dt Bottom
seswil r � r y Header /Man. i
. S [,
Aeration Dist. Pipe �.�
Holding Bot. System 7 -ri f 9 .ST/'
Final Grade K
PUMP /SIPHON INFORMATION 2
Manufacturer Demand St Cover \
Model Numb ,
�1 tti s• � �6.
TDH Lift n Loss System Head 7DH Ft „
e#- S•� � 94.62
Force Length Dia. Dist. to well
OIL A SORPTION SYSTEM
RENCH Width Length No. Of Trenches PIT DIMENSIONS No. 0f Pits Inside Dia. Liquid Depth
DIME S 3 1 q3 � \ C 3 /
SETBACK SYSTEM TO P/L j8LDG WELL LAKE/,STREAM LEACHING Man ctt gr
INFORMATION Type Of System: ZZ I A �, ` 5 CHAMBER OR el Nu a 2
Model Number: '
DISTRIBUTION SYSTEM UJ welt - f /L
Header /Manifold tl Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pi (s)
Length �QQiS Dia Le 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
L Yes Fj No Yes
COMMEaVTS: (Include code discrepencies, persons present, etc.) Inspection #1 / t Inspection #2: /
Z S
Location: 60 W Woodridge Dr River Falls, WI 54022 (SW 1/4 NW 1/4 36 T28N R1 9W) Oak Ridge Acres Lot 45 Parcel No: 36.28.19.
1.) Alt BM Description = 5 S� -
2.) Bldg sewer length f �OeS
amount of cover = ? w•'S � cv�•"'� q
3 � �` 1 �� ice„ • c �,� � s�, •�-� �� .^�.`^` va -Q,�,e . �- . � 3 ' 4 S
Plan revision Required? K
Us o er s � for a�diti �! Ifo fj e at No S _, _- ____- ___ -__—
`� �►U n Lz — C CA ti pteG�lQGI f p Insepctor`ytigna re ` Cart. No.
SB 6710�R.3/97) - �� / � 1
Safety and Buildings Division County
in 201 W. Washington Ave., P.O. Box 7082
/
7s� nsln Madison, WI 53707 — 701r, Sanitary Permit Number (to be fi lled in by Co.)
Department of Commerce (608) 261 - 6546
Sanitary Permit Applieati State Plan I.D. Nu7m r
In accord with Comm 8311, Wis. Adm. Code, personal inf n you E! g�
may be used for secondary purposes Privacy Law, s 15. (1 xm) L Proj t Address (i ifferent than mailing address)
s
r
1. Application Information — Please Print All Information
, �.�j L) t 2�C3 o
Q�
Property Owner's Narne P f N Lot N - Block N
Property Owner's Mailing Location
' fir.
f& yti Lam' Section 3 6
City Zip Phone Number
/ .,
Fa /s e�� / le
ap � T � N; R�E
IL Type of Building (check all that a
PP Y) ✓ � /ST/
t94 or 2 Family Dwelling - Number of Bedrooms f Suomi Name CSM Number
t
❑ PubliclC.ommercial - Describe Use ® i°
❑ State Owned - Describe Use ❑City_ ❑village ownsltip of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A-
❑ New System 'g4eptacenteut System Q Treatment/Holding Tank Replacemew Only ❑ Odw Modification to Existing System
B. ❑ Permit Rawwal ❑ Permit Revision ❑ Gunge of ❑ Permit Transfer to New List amour Permit Number and Date Issued
Befae Expiration Phrmber Owner y3 ,
IV. Type of POWTS S Check an that ap ply ) - ,Q 4 7
K Nou -Pressurize In -Own ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single: Pass Sand Filter ❑
m zed
Caastructed Wadd ❑ Pressuri In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ . �Q
Rec=' latin Synthetic Media Filter bin Chamber ❑ Drip Lice ❑ Gravel -less Pipe ❑ Otha (explain
V. Dispersal/Treatment Area Information: 1 5fj= 04
Design Flow (gpd) I Daisift Soil Application RatoWT—f Dispersal Area Required (sl) Dispersal Area Proposed (st) System
b - 3 - VI. Tank Into ty is Total umbs � � ^ � Prefab Site Stal Plastic Qtdlons Galk Units ^ Y 1 / Concrete Constructed Glass
T= TTanks O �'
Septic - Hots Tads lip L)
bL
Aeeebiic Treatment Usk
DosingClisamber �d O�
VII. Respo nsibilt Statement- L the Undersigned, assume responsibility for tosttlb POWTS shown an the attsebed plans.
Pi 's Name (Print) P g Isture RS Business Phone Number
Plumber's Address (Street, city, S Zip )
VIII.
OUR rtment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date ng A Signature )
- �`
❑ Owner Given Reason for Denial S Fee �0 0 3
IX. Conditions of Approval/Reasons for Disapproval
L lie"
f 3
3 a-a s I t-
AaaeY empkte plane to ire G.rty.aty) rer tie syetaa .a set ten tMao stn : lads la
SBD -6398 (R. 08/02)
"(4V t%A J. ✓-
CST- POWTSM Thomas & Cathy Boman New Richmond,Wl 54017
Lic. ##248956 SW1 /4,NW1 /4,S36,T28N,R19W Bus.(715) 246 -6200
FIfj Town of Troy, St Croix Co. Fax (715) 246 -9372
Lot 45, Oak Ridge Acres
,'' Legend
0"'.81 1)) = 40'
♦ u Benchmark Ble. I00.00Ft
Top of UT' PVC pipe
a = Alt Benchmark- Ve. 3 00 -OOFt
1 Top of 1/2" PVC pipe
D = Borings
Boring Elevations
B t = 99.25Ft
t. 132 = 99.25Ft
t B3 = 98.95ft
B4 = 00.00ft
3
7/1 - N-14
Yh tev, f1toceh Y)
we-
ti
"aveu a..jwe.► - -
CST- POWTSM Thomas & Cathy Boman New Richmond Wi 5401`'7
Lic. ##249956 SWI /4,NW1 /4,S36,T28N.RI9W Bus.(715) 246 -62
Town of Troy, St Croix Co_ Fax (715) 246 - 9372
Got 45, Oak Ridge Acres
Legend
1" = 40
[y ♦ u Benohmark Ele. IOO.00Ft
Top of If2" PVC pipe
+ = Alt Benchmark, Ele. 1 00
�� j n Top of 1/2" PVC pipe
7d ❑ = Borings
Boring Elevations
B 1= 99.25Ft
B2 = 99 25Ft
B3 = 98.95ft
134 = 00.04I't
3
era + -"J I nn 1 twa. v S 7/1 -Pe14
�,c s ue eta v;� Flow Tox k '17h ltt 3a" & -(w gkJe
we e
3 '� y
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that I have inspected the septic tank presently serving
the # (� f..y �
QM l-t4 residence located at: %, /c.� %,
Sec. 2 4 , T ) W N, R W, Town of 7n St. Croix
County, Wisconsin. Upon inspection, I certif that I have found the tank and
baffles to be in good condition, and it appears to be functioning properly.
Last time serviced
Did flow back occur from absorption system? Yes No (if no, skip next
line.
Approximate volume or length of time: gallons minutes
Capacity:
Construction. Prefab Concrete K Steel Other
Manufacturer (if known) :
Age of Tank (if known):
V&� Z4" zu'l
(Signature) (Name) Please Print
(Title) (License Number)
0
(Date) '
Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or
licensed disposer (NR 113 Wisconsin Administrative Code)
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
- -
Plumber (applying for sanitary permit) Certification:
In accepting the above statement regarding existing septic tank condition, I
certify that the tank, to the best of my knowledge, will conform to the
requirements of ILHR 83, Wis. Adm. Code (excent for inspection opening over
outlet baffle).
Name 6 ¢ Signature
MP /MPRS
ST CROIX COUNTY
SEPTIC TANK MAINTBNANCB AGRBBMBNT
AND
OWNP-RSIIIP CBR71RCATION FORM
Owncr uycr
Mailing Address '� (�L
Property Ad&= _ �. f' . — Il e � C
(Ycci mtioa
rcqu'md flom Pi=quing Dcpattmcat for mw coas�uctioa)
n
city/state �i1__ j/�__ ,� �' �,�/,` Pamd Identification Numbs
L=AL. DF:.SCRrP'rr�ty
tion / Scc.
� pcdy Loca � , —�' � . T 21 N -R-N W, Town of
Subdivision -
Lot #��.
mad Sty BE # voLune
page #
watnatp Dced vote 7
Page #`
Spot. hom 1:1 Ym no Lot 'Hum idcai wbk es
y no
oa�nsisi�s� am aze"°° � as° oeoframra cs9 �coa�daemlcmiaPiacetal� .r.Psnper
caasffcct�e, cEme a ,� � .v t)wpotm*dws st
inic.radeis3,sftiL
MmI obmt to St esoix rodoc '
=dfi=fim fo=, sipod by604m =mdby a
r�oi�oapl�ar :FeooZQOd Qaac(�Qre�6e�0a
is mptvpw cawn"arm af krfi R mc madpopiccif o° .dc zqd"Ws�b I=d m wfad[ of
. odba�neaeadmo, abo„ �eao�ca�a�. ad�aocto, mintaint6epoir�s� ,pe�os�icys�m.ri�d�i�i�mdabds
foci.6c*ims 1byfeD oro===adtheDgmmcacofl judR mm,M eofWmood,_ a
� t: sysdEeatlnsbocaam m dod rcbuoyodtoQreSGQ uCouaty►7.mia�•OW=witbm30
� �1�adatic,
SICNAIM OF APPLMWr
DATE
0 •�CA�ON
T (�� c�4' � vi oo � foaar acc tnrc to the best of my (om3 I0 - I (w�c am (are) the owaoc( of
abovC, by vidue of a wamnty dood woordod is of Dm& UtS
S[CTTATt18B OF APrIYYCA2Ir
� Lld3
DATE
AV iafoa ut4at t6tt is mist y is &e 't s•.•••
Y
b«ag rcvok�od the Dopattmaat.
t►Y
" Iadadc with this alrpti dou: a sumpod wausaty flood 6om the Rgodw of Doody oMcc
a Copy of the CWI&d su ma p if m emoc is snack in the warc+rnty decd
� c
` ►r�rc System Management Plan
Puisuant to Comm 83.54, tiis.Adm. Code
f
Sect
ic Tank
The siaGc tank shdi maintained by an individual certified to servica septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accirdance with NR 113, Wis. Adm. Cade. The operating condition of the septic tank and
outlet triter sliall be assessed at least once every 3 years ty inspection. Tne outlet Sher shall be d aped as necessary to
ensure proper operation. The filter carUidge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed %m its enc!csure. if the filter is equipped pith an al° m , the tiller shall be serviced if
• the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. T'ne -
septic tank shall have its patents removed when the volume of sludge and scam 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 a triennial assessment, maintenance personae! shag advis
the a
the' of when the next service needs to be performed too makitain less than maximum scut and sludge acxmulatfon in
tank The addi'6o' n of biological or chemical additives to enhance septic tank performance is genera tly not required.
However, I such products are used they shall be approved for septic tank use by the 0e13artment of Commerce, Safety and
Euridings D'nrisiom
Pum - . a Tank
The Pump (dosing) tank shall be inspected at least once every 3 years. Ali switches, alarms, and pumps shall be tested to
!Gy PmPer operation. if an effluent filter is installed within the tank It shall be irispeded and serviced as necessary.
At- rade Component and Pressure Distribution Sys
tem
To
.or s ru s s oul a planted or allowed to grow on the component. Plantings may
be made around the perimeter and the component shall be seeded and mulched as necessary
to prevent erosion and to provide some protection from frost penetration. Traffic (other
than for vegetative maintenance) on the component is not allowed. Cold weather install-
ations require the component to be heavily mulched for frost protection.
Influent quality into the at -grade system may not exceed 220mg /L BODS, 150 mg /L TSS and
30 mg /L FOG. Influent flow may not exceed the ma:iaum design flow specified is the permit
for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral,
lateral be flushed of a=rmulated solids at leas<once eve 18 months. When a and ti is recommended that each
compared m am " intest when the ever pressure test Is performed It should be
sy�n was installed to determhne if orifice r«oggkV has occurred and It Orr= cleaning is
reRuirW t o maintain equal disbtbutbn within the dispersal cell,
Observation pipes within the dispersal cell shall be* checked for effluent ponding.
Ponding levels should be reported to the owner and any levels above 4 inches considered
as an impending hydraulic failure requiring additional, more frequent monitoring in
accordance with- Comm 83.52 (2).
General
'mss ay§tem shall be operated in accordance with Comm '82-84 Wis.Adm.Code and shall be
maintained in accordance with it!s component manual SBD 10 570 - P (8.6 /99) -local and
state rules pertaining to system maintenance and maintenance reporting..
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
PUMP tank abandonment shall be in accordance vAM Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
paW7'S co mponents -
SeptiC Of pump � -
tank manhole rimers. access risers and covers should be inspected for water tightness mid soundness. Access
openings usecl for Service and assessment shall be sealed watertight upon the completion of service.
unsound, defective, or subje� to failure must be replaced, P �Y o & et d eemed sh
� secured by an effective � d Exposed access openings greater than 8- inches in cfiameter shall
locking device to prevent accidental or unauftftjd entry utto a tank or component.
Caen Le '
P to* or my of Its components become defective the tank or component shall be repaired or replac.9d to keep the
o"Caft condition. _.
ff9k
Pte, PXV co . alarm or related wing becomes defective the defective compowt shall be '
or replaced with a component of the same or equal performance,
If the at -g =ode component - fails to acceptiastevatitr ' nr lye3ris - to discharge wastewater to
the gitound surface, it may be necessary to install an aerobic pre - treatment unit or .
.replace the component. Additional site andL soil'evalnations may need to be done. and
additional plans may to be prepared and approved by the Department of Cotpmerce,•
Safety and Buiidiugs Division. -
Questions A out the operatioa maintenance of this system should - be direcked to:
- The County -,Zoning Office at Z 6-7(x? 1PtRRAe J1 388 -9Z Yo
The system installer at t) 3 1gSR Wp� -!�.
The tank manufacturer at 3ZS - q SH �VlLSL
The effluent I filter' manufacturer at Atp - ZZ( - $ Z 7-r _ZL
Thy `� • _ 6.3 o- .8z.O -�L� ,j GovL.ps
DOCUMENT NO. STATE BAR OF WISCONSIN —FORM I
WARRANTY DEED
150 0 577 THIS SPACE RESERVED FOR RECORDING DATA
THIS DEED, made between _ 3atne c I. _ R r i Ck REGISTEERS OFFICE cnn $r, CRQIX CO., WIS.
Rec'd. for Record this 17th
Grantor day of .- -I'll;, A.D. 19_18
and Thom S. Bowman a nd Kafh 1 c+c+n M_ R wmaa
htish.ind :Intl wife as iCint tenants ` 3 0 A • }
Grantee,
Register of 006V i
W i t n e s s e It h, That the said Grantor, for a valuable consideration I
RETURN TO
conveys to Grantee the following described real estate in _St, ix
County, State of Wisconsin:
Lot 45, Oak Ridge Acres in Town of Troy.
e
Tax Key No.
i
TRAWSCER
FEE
f
d rhis i s n ot _ homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And Times I.- Frickcnn �I
warrants that the title is good, indefeasible in fee simple and free and clear of encuml- 3nces except
restrictions and easements of record
and will warrant aid defend the same.
i Dated this 14th day of JUG , 191$.
i
(SEAL) / Y3Z I �X, (SEAL)
* *_ James 1, _ Fri cksnn
(SEAL) (SEAL)
i
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF WISCONSIN
19 ss.
PIERCE County.
14th
Personalty came before me, this day of
* July the above named
i TITLE: MEMBER STA'rE BAR OF WISCONSIN ,fames Erickson
(If not,
authorized by 4 706.06, Wis. Scats.)
This instrument was drafted by
i
C. M. Bye, Attorney to me known to be the person who executed the form
going instrument acid acknowledged the same. u
River Falls, Wisconsin
(Signatures may be authenticated or acknowledged. Both
Larson
are not necessary.) Notary Public p f r iree County, Wis.
My Commission is perthanent. (If not, state expiration
date: 3L7 , 19Ix..)
•Names of persons signing in any capacity must be typed or printed below their signatures.
•ARRANTY DEED —STATE BAR OF WISCONSIN, FORM NO, 1-1977
• 1315
Wisconsin Department of Commerce SOIL EVALUATION REPORT P age t of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.
040-11 -50 -000 ✓
Please prin a Revie By Date
Personal information you provide may be sod for ri Law, s. 5.04 (1) (m)). D b
Property Owner Property Location
Bowman, Thomas Or Cathy MAY Govt. Lot na SW 1/4 NW 1/4 S 36 T 28 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
60 W. Woodridge Dr. S z_ c;fzoiX COUNT 45 na Oak Ridge Acres
City State r Glbt6er J City _j Village a Town Nearest Road
River Falls I WI 1 54022 715 -425 -9016 Troy I W. Woodridge Dr.
I New Construction Use: y_J Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
0 Replacement I Public or commercial - Describe:
Parent material outwash plains and stream terraces Flood plain elevation, if applicable na
General comments
and recommendations: System elevation 95.00ft, trenches spaced and depth to code 4.25ft belo grade 6 X—
a Boring # I Boring
0 Pit Ground Surface elev. 99.25 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(t'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -23 10yr3/2 none sil 2msbk mfr gw 1f .5 .8
2 23 -37 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6
3 37 -96 7.5yr4/6 none ms osg ml na na 7 1.2
Fil Boring # I Boring
0 Pit Ground Surface elev. 99.25 ft. Depth to limiting factor 96 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
1 0 -17 10yr3/2 none sit 2msbk mfr gw 1f .5 .8
2 17 -34 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6
3 34 -96 7.5yr4/6 none ms osg ml na na 7 1.2
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L " Effluent #2 = BOD S30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signatur CST Number
David J. Steel I 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 5/15/2003 715 -246 -5085
Property Owner Bowman, Thomas Or Cathy Parcel ID # 040- 1187 -50 -000 Page 2 of 3
3] Boring # J Boring
V Pit Ground Surface elev. 98.95 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0 -17 10yr312 none sil 2msbk mfr gw 1f .5 .8
2 17 -32 10yr4/4 none sicl 2msbk mfr cs 1 of .4 .6
3 32 -96 7.5yr4/6 none ms osg ml na na .7 1.2
F-1 Boring # - Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2
F-1 Boring # - J I 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 P
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
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.
. Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 1564 Cty Rd GG
CST- POWTSM Thomas & Cathy Boman New Richmond,WI 54017
Lic. #248956 SWl /4,NW1/4,S36,T28N,R19W Bus.(715) 246 -6200
Town of Troy St Croix Co. Fax (715) 246 -9372
Lot 45, Oak Ridge Acres
Legend
1" = 40'
♦ =Benchmark Ele. 100.00Ft
Top of 1/2" PVC pipe
• =Alt Benchmark Ele. 100.00Ft
Top of 1/2" PVC pipe
❑ = Borings
Boring Elevations
B = 99.25Ft
B2 = 99.25Ft
B3 = 98.95ft
B4 = 00.00ft
Y
�cu$e
S
$ f1
3
0 �- eP
(� r A radd Sys
3 `
fi x - - j3- -03