HomeMy WebLinkAbout042-1057-20-400 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety an Building Division
1 ] , INSPECTION REPORT Sanitary Permit No:
430145 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 Name: City Village X Township Parcel Tax No:
Dalton, Steven I Warren Townshi
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
cVD .& ' CST av%• 1 20.29.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer �• (�' p . (ob
Holding St/Ht Inlet 1Z .4 71-ST
St/Ht Outlet
TA SETBACK INFORMATION 12 -40 9 7.5 - 4
TANK TO P/L WELL BLDG. [Vent to Air Intake ROAD Dt Inlet
Septic t Dt Bottom
ti
Dosing Header /Man.
Aeration Dist. Pipe /j 7 9
G2
Holding Bot. System
Final Gr e
P MP /SIPHON INFORMATION t i .(oL 1-(09
Manufa turer Demand St Cover
GPM
Model Nunker
TDH Lift Friction Loss System Head TDH t
Forcem n Length Dist. to well
SO ABSORPTION SYSTEM ��. Q S6 -_ P
BE /TRENCH Width L@` No. Of Trenches IT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth
DIMENSIONS d� S
SETBACK SYST TO P/L BLDG WELL LAKE /STREAM LEACHING Manufactur �:
.:�_
INFORMATION CHAMBER OR (
Type Of ystem: t 1 UNIT Model Number:
S I•v
DISTRIBUTI O S rPTEM
Header/Mani fol Distribution x Hole Size S acing Vent to Air Intake
L� i I`, ( Pipes)
Lengt o - - is TLength 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 T Mulched
Bed/Trench Center Bed/Trench Edges Topsoil —
�y Yes No L-71 Yes
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1::sA yQ7'� Inspection #2:
Location: 816 106th St Roberts, WI 54023 (SW 1/4 SE 1/4 20 T29N R1 8W NA Lot 4 Parcel No: 20.29.18.
1.) Alt BM Description = e„ - _ S 1 `� `t 1 7S. 3 G f
2.) Bldg sewer length= Ito t (9f N '
amount of cover = > �2 9f °13.90 '
3) 5 � is i on 3. 9T , r I s .+�Z -0121 Z Use others de for additional • Yes No
information.
SBD -6710 (R.3/ 7) Date Ins epctoes Signature Cert. No.
I
Safety and Buildings Division County n r
201 W. Washington Ave., P.O. Box 7162
i seonsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in J
Department of Commerce (608) 266 -3151 3 0 � 7
Sanitary Permit Application State Plan I.D. Num er
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Information - S�C� / �� ST,
z
Property Owner' Na me ;P rcel # # Block #
Property Owner's M ailing Address Property Locari
Z 9 V C.� E J' GL/ t/ , -$) t /a,Section [ �
41 City, - Zip Code oneliimber
�� W ) / circl one
N; Ij/ E r W
H. Type of Building (check all that apply)
1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CS M Number / -7 i
❑ Public /Commercial - Describe Use
❑ State Owned - Describe Use ❑City_ ❑Villa wnship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System p y g P Y
❑ Re S ❑ Treatment/ Tank Replacement Only Other Modification to Existing System
❑ Permit Revision List Previous Permit Number and Date Issued
B. ❑ Permit Renewal
❑ Change of El Transfer to New
Before Expiration Plumber Owner
W. Type of POWTS System: (Check all that apply)
n - 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 -Gr and ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recir
El Recirculating Synthetic Media Filter hing Cha ber Drip Lin Gr v 1 -less Pipe ❑Other (explai t
V. Dispersal/Treatment Area Information: A / 1
Desig low ) Design Soil A�cation Rate(gpdsf) Dispersa A re�,Required (sf) Dispe l ArePr pose r m , d (sf) E evatt n �
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S' el Fiber Plastic
Gallons Gallons of Units 7�n D Concrete Constructed Glass
New Existing (�tJ s' 14 -I'm
Tanks Tanks l r
Septic or Holding Tank 7
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned/
strrtte responsibility for installation of the POWTS shown on the attached plans.
Plum r''s Na me (Print) Plumber's nature MP /MPRS Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zi ode)
VIII oust /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee Includes Groundwater Date Issued Issuing Age t Signature tamps)
Surcharge Fee) I `
❑ Own er Given Reason for Denial
IX Conditions of Approval /Reasons for Disapproval
0 / -► v � �� �, S �� /Q� �-ee � A%ue�� /0d /� 9I
ouJ �
t I e p1 s to a ounty kly) for the system o paperrs t an 81/2 x 11 inc s
nnT% i nn in n tn�mN
* N1 IS 61b
AN - '
PROJECT Steve Dalton 0 80th Ave Roberts Wi 54023
SW 1/4 SE 1 /4S 20 /T 2 W TOWN Warren COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE7/26/03 BEDROOM 4
CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 2 8
IL BENCHMARK V.R.P. Top of 112" Pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 95.5/94.3 /93.0 4.5' Below qrade
Benchmark was
reestablished due to the
poor nature of they
original benchmark ,
UO3
Vent
ALong Standard Biodiffuser _
Leaching Chamber
with 31.1 ft2 of Area
" Plans Designed Using
Grade at System Elevation Conventional Powts
34" Manual Version 2.0
2 -3' X 57' Cells and 1 -3' X
63' Cell with >3' Spacing
0 4 Bedroom ___31
Ouse �-
Observation Pipes
' B -2 9%
80' Slope 3
0
0
0'
30'
B -1 0 ,
Property Line M
240'
' LOT PLAN � � 30 1 f �
PROJECT S teve Dalton ADDRESS 1070 80th Ave Roberts Wi 54023
SW 1/4 SE 1/4s 20 /T 29 / 18 W TOWN Warren COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE /1/03 BEDROOM 4
CONVENTIONAL XXX IN -GRO N PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1 260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28
IL BENCHMARK V.R.P. Top of Wood Lath 6" High ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL H. R. P. Same as Benchmark
SYSTEM ELEVATION 95.5/94.5 4.5' Below grade — ww,, -
Vent
>6 „ Standard Biodiffuser
of Cover m er
with 3 1. 1 ft2 of Area
6' Long 11 " Plans Design sing enti
Grade at System Elevation Conv al Powts
34" Manu ersion 2.0
0 4 Bedroom
House
0' T 30'
iO 2- it >3' Spacing
B -2 9 %°
80' o O(D
-3
c�
0'
B 40'
Property Line 5 M.*
240'
- rn
G
. LOT PLAN
PROJECT Steve Dalton ADDRESS 1070 80th Ave Roberts Wi 54023
SW 1/4 SE 1/4s 20 /T 23$ / 18 W TOWN Warren COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/1/03 BEDROOM 4
CONVENTIONAL XXX IN -
GRO N PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 28
BENCHMARK V.R.P. Top of Wood Lath 6 " High ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL - H.R.P. Same as Benchmark
'
95.5/94.5 4.5 Below rade —
SYSTEM ELEVATION q Wwi-. -.
Vent
>6" Standard Biodiffuser
of Cover m er
with 3 1. 1 ft2 of Area
6' Long 11 " Plans Designed Using
Grade at System Elevation Conventional Powts
i
34" Manual Versi 2.0
0 4 Bedroom ONN
H ouse
0' T 30'
Io B -2 2-3'X 88' ells with >3' Spacing o
9% �
Slnne
80' _ —� F,
-3 0 S�
0'
j 40' Pro a Line .
�3 , 240'
Vn, U I ��
k -j
Wisconsin Department of Commerce SOIL EVALUATION REPORT ✓ Page I of
Division of Safety and Buildings
in accordance with Comm 85, Wis, Adm. Code
,r � 4 1 County 4 Crin , y
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. G
Please print all information viewed y Date
(
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
ieve � � +o� Govt Lot S w 1/4 s F1 /4 S � T Zq N R (� E (or)(&
Property Owner's Mailing Address Loy Block # Subd. Name or CSM# 6 1`7
y6 q Rd v 0 �
City State Zip Code Phone Number ❑city ❑Village ®Town Nearest Rand
I�o�So wl S ya /G (7 /S`) 38(0-59 d�, �of(andt c.{
® New Construction Use: ( Residential I Number of bedrooms 3 - y C ^ , ` d�ed desig ,Aow ate `' GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material G QP WC( qFloWod levation if applicable General comments 5 ✓f fr✓� C�C (f � '` + and recomm �dati �P 4 So 1 pa
c{,t(t4G � O' E c"
F1 Boring #
Boring L
® Pit Ground surface elev. "QC ft. Depth to limiting factor in.
Soil 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
i o -to S;I Zmcbk . $
'J `f` -12D ILA � `1 I b -` ►�5 QS m I —" • 1 � • 2
Boring # ❑ Boring
® pit Ground surface elev. /00 ft. Depth to limiting factor t� in.
Soil 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 j *Eff#2
J
2 Il- 18. yl SL 2 r05 UK
4 I 10 ! rnS o rn t _ - 7 /. 2
5
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Nam (Please Print) Signature / CST Number
Address Date Evaluation Conducted Telephone Number
2/ 2,
an on
Property Owner Parcel ID # I ° T Page 2 of
❑ Boring
Boring # Q ft Depth to limiting factor Z 1 in.
®pit Ground surface elev. q� � P 9 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 I *Eff#2
(0-31 r ti
F-1 Boring # ❑ 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 GPD /fF
I
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
F-1 Boring # E] 11 pit Boring
Ground surface elev. ft Depth to limiting factor 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
* 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.
$BD -8330 (R.07/00)
I
PAGE 3 OF
N AME �` LOT# ''/ LEGAL DESCRIPTION-Sul YU I Y ,S ?o T —29 N R, I S E(or)WJ
SCALE: 1"= /
BM 1 ELEVATION /
BM 1 DESCRIPTION j612 a4 lc. +A- G 14 L L % L.
BM 2 ELEVATION f 9- g
BM 2 DESCRIPTION Ap a4 k+� 10" 4! Z t-. PC �
SYSTEM ELEVATION P 9.5'• 36 Luw• (L I 3d
ALTERNATE ELEVATION �
CONTOUR ELEVATION q - ?.ov, qg c K.% 7 q oo 160-00 �C
I
I
'
u
a v
\o ff 0 0 0°
I
8' 3
I
SIGNATURE . DATE
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
Contingency Plan
1. If system fails, determine cause of failure, use alternate area and install new system or
install system at a lower elevation.
2. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715- 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROIX COUNTY
SEPTICTANK MAINTENANCE AGREEMENT`
AND
OWNERSHIP CERTIFICATION FORM
i
Owner/Buyer (S `' -- �c: ...
�.�
Mailing Address 0'14 4,t�) 0 � �� V )o
G J
Property Address O I �� ,
(Verification required from Planning Department for new construction) (— i1
City /State Parcel Identification Number
LEGAL DESCRIPTION
Property Location 5 l- '-' 1 /., Sec. °� . Te W N -R i W, Town of
Subdivision �` Lot #
Certified Survey Map # - 7 O S `� , Volume 7 . Page #
Warranty ed # e Pa
Volume e # j
h' g
Spec hour yes ❑ no Lot lines identifiabl ✓;B�es ❑ 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 r e owner agrees to submit to St. Croix Zoning Department a certification form, signed b the owner and by a
Pop rt3' i�' � eP gn Y
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, here' as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that y se tic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of th e r expiration date.
71 P-3
SldN OF APPLICANT D E
OWNER CERTIFICATION
I e) 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 prop des c ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
IZ Z
SIGNATURE OF APPLICANT DA E
* * * * ** 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
164'7PAUE 516 /z
VIZl. .
` 646674
STATE BAR OF WISCONSIN FORM 2-1999 KATHLEEN H. WALSH
Document Number
WARRANTY DEED REG ISTER OF DEEDS
This Deed, made between Archie Denucci and Ella Denucci, as RECEIVED FOR RECORD
Trustees of the Archie Denucci and Ella Denucci Revocable Trust dated 05-25 -2001 11:00 AN
September 14, 2000 WARRANTY DEP
EXEMPT A I`l
Grantor, and Steven M Dalton a single person _ CERT COPY FEE:
COPY FEE:
TRANSFER FEE:
RECORDING FEE: 12.00
PAGES: 2
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
Name and Return Address
SEE ATTACHED First Federal Savings Bank LaCrosse
201 So. Second Street
Hudson, WI 54016
This deed is given in fulfillment of that certain Land Contract between the
parties hereto dated December 12, 2000, recorded December 18, 2000 in 0
Vol. 1568, page 213 as Doc. No. 635444 Number (PIN)
This is not homestead property.
iod (is not)
Exceptions to warranties: Easements, restrictions and rights of way of record, if any.
Dated this Ay� day of May , 2001 eew &45W
- * Archie Denucci �_—
•
* Ella Denucci
* AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St C t: • y County ) CL
authenticated this day of Personally came before me this "' y day of
May d`' named
Arehle Denucci a nd Ella Deno cc e hie
Denucci and Ella Denucci Revot bl usAdate V her 14,
2000 t '
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the personk o eac • t the egoing
(If not, instrument and acknowledged rft��agte2 Q ; r
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney David J. Estreen Notary Pu ic, State of Wisconsin
304 Locust tree4 Hudson, 1 54016 My Commission is permanent. (if not, state expiration dat
z. n�
(Signatures may be authenticated or acknowledged. Both are not necessary.) —
9- - ,
or pri nted below their signature. dam aeon v ,ates.wnai: comwm• Fond W"55S 2021
• Names of persons signing in any capacity must be typed p STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 2 . 1999
• �
VOL 1647PAGE517
PROPERTY DESCRIPTION
A parcel of land located in part of the SW' /. of the SE`/. of Section 20, T29N, R18W, Town of
Warren, St. Croix County, Wisconsin, described as follows: Commencing at the SE corner of said
Section 20; thence S89 °10'58 "W 1302.28 feet along the south line of the SE %, of said Section 20;
thence N00 0 08'34 "W 371.09 feet along the east line of the SW' /. of the SE' /. of said Section 20 to
the point of beginning; thence N00 °08'34 "W 280.52 feet along said east line; thence S89'5 1 ' 26 "W
358.70 feet; thence S22° 19'20 "E 108.35 feet to the point of curvature of a 433.00 foot radius curve,
concave westerly, whose central angle measures 24 °22'00 ", whose chord bears S10 °08'20 "E and
measures 182.76 feet; thence southerly along the arc of said curve 184.15 feet; thence N89 °53'54 "E
286.08 feet to the point of beginning. Above described parcel contains 2.00 acres, 87,120 sq. ft.
ROAD EASEMENT
An easement on a parcel of land located in part of the SW' /a of the SE' /. of Section 20, and part of
the NW' /. of the NE' /. of Section 29, both in T29N, RI 8W, Town of Warren, St. Croix County,
Wisconsin, described as follows: Commencing at the SE corner of said Section 20; thence
S89 0 10'58 "W 1602.70 feet along the south line of the SE' /, of said Section 20 to the point of
beginning; thence S02 1 20'40 "W 35.21 feet; thence S87 °55'37 "W 66.17 feet along centerline of 80
Avenue; thence NO2 °02'40 "E 415.07 feet to the point of curvature of a 367.00 foot radius curve,
concave westerly, whose central angle measures 24 °22'00 ", whose chord bears N 10 °08'20 "W and
measures 154.90 feet; thence northerly along the arc of said curve 156.08 feet; thence N22° 19'20 "W
135.25 feet; thence N89 °51'26 "E 71.27 feet; thence S22 °19'20 "E 108.35 feet to the point of
curvature of a 433.00 foot radius curve, concave westerly, whose central angle measures 24 °22'00 ",
whose chord bears S10 °08'20 "E and measures 182.76 feet; thence southerly along the arc of said
curve 184.15 feet; thence S02 °02'40 "W 375.11 feet to the point of beginning.
R
APPROVED - 7Izn9a8
ST. CROIX COU NTY VOL 17 PAGE 4444
Planninn Zonina and Parks Committee KATHLEEN H. WXLSW —
I REGISTER OF DEEDS
ST. CROIX CO., MI
RECEIVED FOR RECORD
p 01/15/2003 04:00PA
C gtKecorded within
end void days of REC FEE: 17.00
al dale approvaal l shall be BEARINGS ARE REFERENCED TO THE COPY FEE:
gull SOUTH LINE OF THE SEI /4 OF SECTION pm$ PAGES: 4
ft1 20, ASSUMED TO BEAR S89'10'58 "W
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Vol. 17 Page 4444