HomeMy WebLinkAbout042-1057-95-000 I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 395192 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:
Zuehlke, Mindy K. I Warren Township 042 - 1057 -95 -000
CST BM Elev: Insp. BM Elev: BM Description:
c� . �' loo •, ' i csT 6 '-
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
.98
Septic ' ` ES f Benchmark p ' ;/ If
)M .n
Dosing Alt. BM !
Aeration Bldg. Sewer
Holding Ht Inlet a2- l�
TANK SETBACK INFORMATION S Ht outlet ,4 6'S71',
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 1 16 1 Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe 0 Cr 133 9 11 C ie z3
y o.}�
Holding Bot. System ( (( r tt f
9$� D 9 Q� 23
PUMP /SIPHON INFORMATION Final Gradeg2�
Manufacturer Demand St Cover i4bot►t
GPM
Model Num5kr
TDH Lift Friction Loss System Head TDH Ft
Force n Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
REN H Width Length No. Ofe ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM �� O � 1
SETBACK SYSTEM TO P BLDG IWELL LAKE/STREAM LEACHING u ur�:
INFORMATION Type Of System: ' I�f CHAMBER N T OR
Mo I lel Num be r.
l
DISTRIBUTION SYSTEM (L.
[Header/Manifold ' rr Distribution x Hole Size x Hole Spacing Vent to Air Intake
1 Y Pipes) �ngth Dia Length Dia Spacing
SOIL OVER 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 �] No no Yes [] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 12- 05 '— / O_ Inspection #2: - -- - - r ---- 7 —
Location: 824110th Street Roberts, W 54023 (SE 114 SE 1/4 20 T29N R18w) NA Lot 5 Parcel No: 20.29.18.320G
y ,
1.) Alt BM Description = t'�`�' ` I rv
2.) Bldg sewer length = l
- amount of cover = q6 �N ' O f
3) A��• s:�, :� ��,t� .o �k s��. �� b5 = l3• �
Plan revision Required? ❑ Yes No
th r s' e f r additions jOrywaji�n.
r aotj g . 1�•lrt(/ Date Insepctors Signature Cert. No.
4) ID-6710 (R.3/97)
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
Vvisconsir personal information you provide may be used for secondan purposes Madison. WI 53707 -730"
Department of Commerce
v (Submit completed form to county if r
[Privacy Law, s. 15.04 1 , �I .
,�,� i � state owner
Attach complete plans (to the count' cop) only) fort ' stem. on a er'n6T-less an 8 -1/2 x I I inches in size.
County 2n r✓ State Sanitary Pe e t Number ❑ C lriyfevisi 0 vious application State Plan 1. D. Number
Iw /�
I. Application Information - Please Print all Information J Location:
Property .O�jwner Name O ; - -- Property Location
L 1/454; I /4,SZdT N.R or
Property Owner's M iling Address Lot Number Block Number
A/P_
City, State Zip Code Ph � �� Subdivision Name or CSM Number
D Z 3 t 2 -�IZ7 C! / 6 R
II Type of Building: (check one) �/ ❑ City
SIL 1 or 2 Family Dwelling - No. of Bedrooms ❑ Village
❑ Public/Commercial (describe use): XTown o
❑ State -owned Gt/Cc 0 !��✓� 5
III Type of Permit: (Check on!)' one box on line A. Check box on line B if applicable) Nearest Road
C) o k S1 4-
A) 1. J9 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existing System U 9 /V 5 4 S 6
B) Permit Number Datetssued
❑ A Sanitary Permit was previously issued u . - ZA 'Zc L
V. Type of POWT System: (Check all that apply)
Non - pressurized In ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At - grade 7 - 2 0 Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dis ersallTreatment Are Infor ation:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) --j j P f [� ZZ Elevation
Q ICSj .
f«0-
VI Tank Capacity in Total to of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
W ❑ ❑ ❑ ❑
See l�c� iDDt7 /rloo P l,J��s C
❑ ❑ O ❑ ❑
VII Responsibility Statement
I, the undersigned, assume resp onsibility for installation of the POWTS shown on the attached plans.
Plumber's Name ( print) Plum is Signature (no stamps): MP/MP RS No. Business Phone Number
t(� ✓ / J !YI .!r ti-�.- - Z_ 61 2' — 7 l — 772- — 7�
Plum rs Address (Street, City, State, Zip Code)
3� / 2 8 2,UO Yk,,
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued su' g Agent Signat a (No stamps)
Kpproved ❑ Owner Given Initial Adverse Sarge Fee)
Determination urch
Z2 5 a A '?C0 �
IX. Conditions of Approval /Reasons for 'Disfa�_pproval: 1 /� I * t�
I --o'e- r id 3G ° 6J& r"�' `�° s�(S,Iew..aX¢1/+�nt-teti.. rwtam " V Coe�Q 1 —
gu, 4 'SYSW41, Ste' .�t,f .R.QWA; -�, OL, Gt)owl. 5t.! t5 - T w� 6e-
vc,r�
A6 �! ea .
SBD -6398 (R. 07/00)
JOB - - --
TIMM EXCAVATING
SHEET NO. OF
Route I Box 192
WILSON, WISCONSIN 54027 CALCULATED BY ✓�'� DATE
(715) 772 -3214 (715) 386 -5443
MPRS 03224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 2051 L� Inc.. Groton, Mass. 01471 . To Order PHONE TOLL FREE I- W225 -M
JOB
TIMM EXCAVATING
Route 1 Box 192 SHEET NO. OF
WILSON, WISCONSIN 54027 CALCULATED BY Z DATE 7 O/
(715) 772 -3214 (715) 386 -5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
SCALE
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PRODUCT 205.1 �Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1 -B00 -225 -M
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P
Labor and Human Relations age of 3
Division of Safety &Buildings i ac cord wioh ILR 83.05, Wis. Adm. Code
COUNTY
4 ST G�Pr�i'?C
Attach complete site plan on paper not less than 81/2 x 11.u> s in`sfz ®.Plan must include, but
not limited to vertical and horizontal referdri a point (13M), dire on and ,%;6 slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to, nearest road.
APPLICANT INFORMATION - PLEASE PRINT ALL IUFORMATIQN.11 IEWED Y DATE
PROPERTY OWNER: " PROPERTY LOCATION
T)A R Y L. J' � S GOVT. LOT E va S va s� Z
l
S T
_ 9 NR E 8
or W
1
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM #
P�.uDIV ( r-
CITY, STATE ZIP CODE PHONE NUMBER OCITY QVILIAGE fQMN NEAREST ROAD
ROZ - s w I. SY02 -3 (73) 7yy- 3542. Ae eE,v I WO ). Sr.
(vNew Construction Use I ker Residential / Number of bedrooms 3 1 0 V_ I J Addition to existing building
j I Replacement ( I Putlic or commercial describe
Code derived daily flow gpd Recommended design loading rate bed, gpd/ft trench, gpd/ft
Absorption area required bed, ft / trench, ft Maximum design loading rate 7 bed, gpd/ft trench, gpd/(t
Recommended infiltration surface elevation(s) S - -3 It (as referred to site plan benchmark)
Additional design /site considerations u,SE T;p"emirs — S-ee /V 0 7"ES elk A6 4
Parent material SGS S'9 - 13 VRk-4 ,4,eDT - 6- /.4ciiF/ Flood plain elevation, if applicable A"14 PP It
S = Suitable for system CONWIO MOU ND-' IN D PRESSURE A T— T -G BA0E S FILL HOLD U= Unsuitable for s stem BS L� S p U LEIS p U CC'S
❑ U LA'S E U ❑ S
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure PD/ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed re:
0 .
f si �'^ R S 3 f . S
Ground /O 31 � --, S / 7� S6 /l�+�i CS , S k
elev.
Depth to
limiting r�
factor
-3 '.
Remarks:
Boring #
z.
I-11-J-7 to 10 y � — 57 z, 5k 3 vf
Ground 2-7 -7.5 Y/� F/9
/ S� Z-�t S�i,� /y►+`�i CS $ G .5'"
elev. �'�j0 l0 (/
Depth to
limiting
fac r
Remarks:
CST Name Print R O Q e R T ?A L 6 R i C !1 T Phone: �. 3 F(_ Peg -
ress: O , A je'( kp. j+V WI. 5LtOI& 4 hA I q c srly
Sgnature: POU � Date: CST Numb.
I
.� V�"J
ORIGINAL, 1 33 - /3 13 , 's
5 7Z
Tbif�l test
C117 - i4G� Pi e v
for 4 conventions �c amt
;4
PROPERTY OWNER � U "Rf SOIL DESCRIPTION REPORT Page �1' of 3
PARCEL I.D. fl L� T
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch
`43 z /o �� y/ 5 1 1 Z S d,�,�, ° �s s , G • s-
Ground Yk Ll S 2 S� /l � �/ �
Depth to /l<i D, S G�,� .7 • S 1 f
limiting '
factor �� l
Remarks:
Boring # t% - /L �� Jiic' 3��- -- Si� �7 sdiE' /r"� 7�� �' S , y •S `f
If -4e
Ground
elev. o S /D f/R 0- Gv -
1,,e-- 72 — '
Depth to
limiting `✓ ^ D . /� y C' S . 0, S' GPt 7 i • . }
WtDr
Remarks:
Boring # 2,''"' ._.
- /0 3 tf • `f •S •�
R A —
e /o yc' s/y e. S. D S d ,�
/ °/ 2-�-- ft. .�-
Depth to =.
limiting
factor
Remarks:
Boring #
n >
Ground
elev.
it
Depth to
limiting
factor
Remarks:
can 01311^10 ncMm
� ' i
i j
r'
3
L o T.S
S u t,%EsrED Sy STEM
( SCA
K 6�.- - r 1k Ea at, 17 0 = �3,¢ c� ti o F �o,•T
low 'V pex,3 c-G4. ly . p
-Z , J A Eeh 'Q� ,- R B S
6 7 6
qb VON
�S
2 sue.
I/G
V
5 2
•
�7
�M
v
/00,0
1 —1 -
I
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St.
Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on "the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
1 If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water- saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly.
6 No paper products other than tissue should go into the system.
No chemicals should go into the system.
8 Avoid surge flows of water; try to spread laundry throughout the week.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
1 If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3 When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7 Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8 Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
an
'4 k e, 1 . �� ST CROIX COUNTY
f
��, SEPTIC TANK MAINTENANCE AGREEMENT
iD AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer i A J, _ « ,Ad e _ 142
Mailing Address
Property Address
(Verificat ion requir ed from Planning Department for new construction)
City /State L-e-I - lA / i- Parcel Identification Number 6 657 - g$ -6 a 4
LEGAL DESCRIPTI
Property Location 5C /4, S V4, Sec. Zd , T 7-9 N -RAW, Town of &ja ri S .
Subdivision Lot #_.
Certified Survey Map # 5 2� z 7 , Volume !D , Page # Z 6 7z-
Warranty Deed # o bi 3 , Volume / 3 Zq , Page # - 3(65
Spec house ❑ yes no Lot lines identifiable ,S yes ❑ 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, restrictedplurnber 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.
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 Zoning Office within 30
days of the three year expiration date.
off/c/ l :te
SIGNATURE 6F 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.
Z440-4L.(-e — D b' l 0/ l NC O/
SIGNATURE 6F APPLICANT DATE
* * * * ** 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
. t' ` ' , 1 � titatr: liar ul 1Yiscur.siu Lulu, l t'181 °�s °:
In
IVAI<RAN7'1' UElsl)
D OCUMENT NO. -- --
•1'IIIS 1) EED, made between Matthew J. Briggs and REG I ER S. OFFICE
Brerida. L. Briggs,, husbNnd r-nd wife ::)T, CR04 CO., WI
Rac ". for 'tArartl
JUN 05 1998
cilani,ri• 8:30 A
Mindy K. Zuehlke, a single person /
of 0•%ds I
r
. _ i11K Si•ACE II FO11 r1EW11U1N6 DAtA � ._
NAME ANU r1E I WIN A01111E55: +.
1V1'1'NISS51s 1'11, '171x1 the said UI:Nt1ur, Icrr :1 valuable c"llsidclal on i
cullveys to Giimee the following desci ibed seal estate ill ST . t✓ `
Comity. State of Wiscotlsin: Parcel 1
9 Part of SE } of SE and the NE } of SE i of Section
O hip 29 North Range 18 We t St. Croix County, _
20, Town= —T v
Wisconsin described as follows: t 5 f Certified Survey
0, p age 2872 PAf10EL IUEIi I1Fl(Ar1UN NUMBER
Map filed Jant.ary 25, 1995 in Vol.
Doc. No. 525427.
Parcel 2
t Part of SE } of SE } of Section 20, Tow -iship 29 North, Range 18 West, St. Croix
County, Wisconsin described as follows: Commencing at the Sr,- lthwest corner of Lot 5
•i a e 2872, St. Croix County Certified
of that Certified Survey Map recorded in Vol. 10, p g
Survey Maps; thence N00 feet to the point of beginning being the Northwest
corner of said Lot 5; thence S85 ° 06'16 " 154.41 feet along the North line of said Lot 5;
thence N47 ° 53'44 "E 389.67 feet along the Northwesterly line of said Lot 5; thence
N87 ° 24'21 "W261.48 feet; thence S34 °57 "W317.1 feet to the point of beginning.
TRAY§FER
...homesicad Noma f
.. This ..... is...... 1 1 • r• FEE
(is) (is 1100
Tugetlier with all and singular the hetedilanlctlts and appuitcnanccs thelcunio beluugiog:
Aud ... Grantors— .. _ .. ...............................
warrants ilia, dlc title is good, indefeasible in fee simple and free and clear of encwtlblaoces except
roadways, easements and restrictions of record
and will warrant atld defetld "A sane.
.... 19 9 a...
Dated this Jay of ... Lune .
z
(S UA L) (SEAL)
Ma thew J. i .._
• ........... ............................... . ......... Nr`
(S CAL) MrX Q 'K CAL)
• ... ........... ............................... .Idrenda..L...11r7 ggs• fi .r . v
AU'1'11EN'1'ICA'I'!ON ACKN0%VL0,GM9N'1'
`,• STATE OI: WISCONSIN
} 'a Siguatwe( s ) ..............................
ss. n
...... ........... .. S(:.... Croix County. l
authetlticated this ...... day of ................... 19 .... 1'ersutlally cattle befule me Ibis ...off............ day of
June ........................... . 19 98. the above 11211ted
— E Rri oar.
FILED
£ JAN 2 5 1995 ►
KATHLEEN H. WALSH
SLLC
52542`7 Z ro CO.. VA f0
CERTIFIED SURVEY MAP
DARYL JONES, Zdtal .
Part of the SE 1/ he SE 114 and the NE 114 of the SE 114 of Section 20, T 29 N,
R 18 W, Town of Warren I-
St, Croix County, Wisconsin. a
UN A T T ED L ANDS
O Indicates 1" x 4" iron pipe_ ing ° 3
1.13 lbs. /lin ft. set N 89•/4 "E 389.00' m
312.26' 1 7
O 1 I 2 2
Owner's Addr as: W N L o T 2 '
1126 80TH AV y !u 2.232 ACRES
I I ( N
4
Roberts, WI 54023 QI 21 0
97, so. FT. 1 N W
j 2.0/9 ACRES EXC ROAD
J .0. 0. W.
2 0 67,911 SO. FT. I I O a
ti
33/.4/' 1 37.1 j V j
N 89 1 14 ' 46 " E 3189.'00' i O
W
99 y 1 , N 89 • 14 1 31 /. �9 389. 00'
L p� $ I
9 I q
LOT 3 1 03 I e
tu Q S 06 '18" E E /14. 4/' O 2.875 ACRES I O i q al !u
co
l W W
H 123, 247 SO. FT. I r Mlco c
N M Z. 192 ACRES EXC. ROAD p ~ I
R. 0. W. I O Q
y • ^ //2, 900 SO. FT. 2 O
I � W
N
Q o
Lo T 3 W N 89 14'46 389.00' I i
�1I M o 350.10' v
W I 3 8 O
5.334 ACRES o m I 33 , 33 a
p
Z33,212 SO. FT. O I W W l 6 6 �
W� C
5.236 ACRES EXC. TOWN ROAD 0 L Q T 4 I O J
�I