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HomeMy WebLinkAbout034-1084-20-020 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building 'Division Sanitary Permit No: INSPECTION REPORT 430560 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: 2 Kostman, Stacey Springfield Townshi 034-1084-20- CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 1 1601 661A I I 28.29.15.5558 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER_ CAPACITY STATION BS HI FS ELEV. f'~- Septic Benchmark 6 63 5 cc Dosing Alt. M gig )i U 1101t Ifl Aeration c•r. Bldg. Sewer cl,qs 61r Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELLLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic A , . V-3 Dosing Header/Man. A- off, 75 Aeration Dist. Pipe Holding Bot. System c) zi,. 9r~//T -i/ Final Grade PUMP/SIPHON INFORMATION c0' 71, cfic~, ,.rte Manufacturer J ~~d c4.14 - 'G. GPM Demand St over 'T Model Number ltJ Z 7 Ae, TDH Lift73,~ Friction Loss System e A_ TDH Ft S Forcemain Len ? Dia. Dist. to Well G- z SOIL ABSORPTION YSTEM BEDITRENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth % i DIMENSIONS SETBACK SYSTEM TO L P BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: /p DISTRIBUTION SYSTEM - Header/Manifold Distribution x Hole Size ix Hole Spacing Veto Air Intake ~C Pipe(s) Length Dia r Length_~ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Dept of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil es No Yes [J No COMIMEN: (I I e dis rep cies, perso Rresen etc Inspection # Inspection #2: / / (6 _W ''-v"`11 e5.5 5B Location: 2930 73rd Ave son,54027 (1x1/4 SW 1028 T29N RI 5W) Hersey Lot Par II No: 28.29.1 -L r 1 8 tom- 1.) Alt BM Description = P 2.) Bldg sewer length - amount of cover O rl~lJ~P1` W - amount of cover Plan revision Required? E11 Yes No Use other side for additional information. Cert. No. Date Insepc swig ure D SBD-6710 (R.3/97) ~ ` A Safety and Buildings Division County s . 201 W. Washington Ave., P.O. Box 7162 r°' ' iscans~n 6-0, l Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608 2669 Sanitary Permit Applicati n s Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informs on yo v 017 may be used for secondary purposes Privacy Law, s15. 1)(m 2003 P ject Address (if different than mailing address) I. Application Information - Please Print All Information ST. R IX COUNTY ZONING OFFICE Property Owner's Na me Parcel k 5 Lot X Block H 1.$- c. e a bay v~ O Property O is M ailing Address Property Location c9g,?o 23 ly Ale City, State Zip Code Phone Number ~k,~w 'k•Secdon S-`/02 71 - - 3296 q~ circle o ) 11. Type of Building (check all that apply) T; N; R. /,circle org X 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use 2 E~ ❑City ❑ t"age Wl ownship of III. Type of Permit: (Check o ne A. Complete line B if applicable) A. ❑ New S stem y Replacement System D Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) 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 ❑ RecircuI 'ng Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Cham r ❑ Drip Line ❑ Gravel-le s Pipe ❑ O ( plai) V. Dispersal/Treatment Area Information: -/Ofl QUA- /3a Design Flow (gpd) Design Soil Application Rate(gpdsf) sal Area Required (sf) peKfa. posed (sf) Syst levation ~ O offVITank Info Capacity iTotal Numr Manufacb Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /ate x Aerobic Treatment Unit Dosing Chamber 00 r 1 ~t VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number Plum s Addre ss (Street, City, State, Zip Code /da0r°.r wl `17 VIII. Count /De artment U Onl Fp-proved ❑ Disapproved Sanitary Permit Fee (ino udes Groundwater Date Issued su' g Agent Signature o Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER) r 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained aL&VVQ"JQ as per management plan provided by plumber. C~~ 2. All setback requirements must be maintained as per applicable code/ordinances. Attach wmplete plans (to the County only) ror We system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) T Halverson Bros. inc. 1020 N. Broadway - MENOMONIE,WI 54751 Phone 715-235-0651 - Fax 715-235-8503 N r i I 1 n L AdO c u wiEJ,E2 l ~ ivv i .,WO- ■ pNv~®ay 442 dp7 IOG.U, 7'0/0 0-12 Lht// OWN -gi P'!f API 'Told 6,44 <on - - - r ' . Halverson Bros. Inc. 1020 N. Broadway - MENOMONIE,WI 54751 Phone 715-235-0651 - Fax 715-235-8503 k I C-fly copy L e r 3 tell L-4 zQiAYoe) i u&h1~ G/~ES~~ Ir~Ct~ 6vv 'Y /0010' 1C■~ = d~A► _ ~oo.vrod do~e~~~ ~~g~N ~~Dad`►J,~~~ 2 = - i 1 ' ORIGMIAL 1921 Wisconsin Department of Commerce SOIL EVALU RE ED Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wi Adm. Code Certified Soil Testing unt~ Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must ~ C j St. Croix 4 03 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 ad. Parcel 1. D. Please print all information. ST. CR 34-1084-20-000 ZONI (fib BY Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 1 _ _ ' Property Owner Property Location /WV Kostman, Stacey Govt. Lot NE 19 SW 1/4 S 28 T 29 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2930 73rd Ave. 78,8 8 Hersey Plat City State Zip Code Phone Number City Village )6 Town Nearest Road Wilson i WI 54027 715-772-3226 Springfield 73Rd Ave. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material loess over sandstone _ Flood plain elevation, if applicable NA General comments and recommendations: install trench system w/ 0.5 gpd/sq ft loading @ system elevations 2.5' below surface contours as trench center lines 171 Boring # -u Boring ri Pit Ground Surface elev. 96.3 ft. Depth to limiting factor 70 in. F 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 1 0-11 10YR 3/2 - sit 2 m-c gr ds cs 1f/m .5 .8 2 11-18 10YR 5/4 - sit 2 f sbk ds cs if .5 .8 3 18-24 1OYR 4/6 - sl 2 f sbk dsh cs If .5 .9 4 24-30 10YR 6/4 - fs 0 sg dl cs - .5 .9 5 30-70 1OYR 8/2 - fs 0 sg dl cs - .5 .9 6 _;Q,-74 SS BR SSBR by general resistance to penetration; poorly sorted-not quite weakly cemented; occasional 10YR 4/4 Ifs bands: 31-32 & 1/2" @ 48, 54, 61 ❑ Boring # Boring Pit Ground Surface elev. 95.4 ft. Depth to limiting factor > 86 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 1 0-11 10YR 3/2 - sil 2 m-c gr ds cs 1 f/m .5 .8 2 11-20 10YR 5/4 - sit 2 f sbk dsh cs if .5 .8 3 20-33 1 OYR 6/4 - fs 0 sg dl cs if .5 .9 4 33-86 1 OYR 8/2 - fs 0 sg dl - - .5 .9 10YR 4/4 Ifs bands (0, m, dsh): 1" @ 33, 1/4" @ 44, 49, 54, 57, 63, 65, 70, 72, 74, 82, & 85" w/ blotchy pedogenic development sometimes just bel w these bands * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluen #2 = BODS < 30 mg/L and TSS < 30 mgr CST Name (Please Print) Signature: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/8/2003 715-233-0398 Property Owner Kostman, Stacey Parcel ID # 034-1084-20-000 Page 2 of 3 ]Boring # Boring Pit Ground Surface elev. 95.7 ft. Depth to limiting factor 82 Soil Application Rate istence Boundary Roots QPDtft1 Horizon Depth Dominant Color Redox Description Texture Structure 7sdS in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 /m 5 8 1 0-7 10YR 3/2 - sil 2 m-c gr gs 1f 2 7-14 10YR 3/2 - sil 2 f-m sbk dsh Cw if .5 .8 3 14-18 10YR 5/4 - sil 2 m sbk dsh cs if .5 .8 4 18-24 10YR 4/6 - sl 2 f sbk dsh cs - .5 .9 5 24-40 10YR 6/4 - fs 0 sg dl cs - .5 .9 6 40-82 10YR 8/2 - fs 0 sg dl cs - .5 .9 7 82-86 10YR 8/2 f2f 7.5YR 4/6 fs 0 sg dl - - .5 .9 F3a]Boring # Boring ✓I Pit Ground Surface elev. 95.7 ft. Depth to limiting factor 82 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 10YR 4/4 Ifs bands (0, m, mvfr), typically irregular & discontinuous: 1/2" @ 75; 1/2" @ 66 & 69; 1" @ 38 & 50" w/ some pedogenic development ju t below the bands Boring # goring 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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. SBD-8330 (R.07/00) Certified Soil Testing ~4-~o1~4-zo-din 1 u t"~+ z 21 ~3-~-d SL~ C ac„~5 OSX) sge i 4a. I V l\ C54'.~ ~4S'} ~ C'tb.z) ~Sho she (t~.o) t-k i4 13M (1eAav or 1 e~ 2 .4~ til ~q SS eA" o- ~o w E4 ADC 1; Management of this system is critical. Asa cSystem ondition of approval of these plans this system reviewed with the owner, and the owner must be provided with a complete set of plans including this management sec develop with the adsorption system or any other system components, the installing plumber, HalversoBros. management Plumbing, 715-section235-must065 1be or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. section. If problems , Proper functioning of an on-site disposal system, "septiiccc syste," is signifcantl into the system and the level of contaminants in that m y dependent on the volume of water which flows volume. The lower the volume of water and the lower the level better and longer the system will function. Typical system components include a septic tank or compartment greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a of contaminants, the to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption e11 to to settle out solids and contain protect ground water quality and public health. pump tank or compartment recycle the water in a manner to I . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank befo to contaminant load design criteria. re normal use begins to ensure adherence 2 Install water-saving appliances whenever and wherever possible. 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. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching be required to maintain a functional system at start-up. ntennce I. The septic tank must be inspected every three years by a prop y li ensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined equals one third of the tank volume. scum 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter m and solids volume 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- must be back-washed into Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistent) onded cell. in-situ soil adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements in the adsorption their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate menu will accompany If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. T capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, an circuit from the pump. two days should pass before any necessary repairs can be made. The system allows reserve 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system, and no more than one or 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off system. into the system area, 1 l . Warning: Do not enter septic, pump or other treatment tanks, death may result because they ma contain frost depth. oxygen. area. Y lethal gases or insufficient Wastewater monitoring of volume and quality is a normal ~equaement for low effluent may become necessary if problems develop. Any necessary monitoring shall be done in accord with sthenequirem requirements of Comm '83.54- (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. and/or installation of additional treatment components or conversion to a holding tank may be necessar. Additional testing, desiantn2, Y Page 8 of 8 11113103 13:41 FAX 17152358503 HALVERSON BROS, 001 11/13,03 TULT 1Y:18 FAI 718 388 MS Qbo01 ST CROIX COUWM SEPTIC TANK MADfMANC@ AGREUMU AM OWNEPSM CBRTMCATiON FORM t O.vWOSUypr -e- IL Ac6 , : Mailing Address a~7 73C Prop xty Address r r ` (Vorificadaa mad from Planning Depargaent tat wor day " S` ,2Q'_ CilylStabc &.11,1Sa t~,-/f _ parcel ldmddcWon Number Plapaty Lo=ad= %,X W. sea ~ T-2-`*7'-N R,-1.LW. Town r SabdWon Cawed Surrey Map # . Volume Page # R wanwty Deed # Vow= 23~a 2 For # 5b Z i Spec louse O Y" ~Q on Lot Um idwdfLablo 0 yes ❑ no ~ BYB1~i MA~N~lNCE lnmpsttper=e o o4 mabderaaceof yaw scpda system could rentlt in its pwnu tuna faftwe to hand e wastes. Pieper nwholevatm aaedts sdposopbg vat Ale eeptie Unk every duet yens or - a n i c, tf eeodod by a liooosod j a I, F Wbat 70o Put ioro ms wjW* n qn allFzt the fimotlm of tits aepeFa t~oakk as a ~ in Rla: grasOg deposal syamm. The pupow ewer agtoo: to aabmit to St Csoix Zoning Delta unad a ead8adon fad dpod by On owner and by a toasW Vkaglbw jomwywanpiembm maftwW plambwar a bwoodpumperMaifA4 mat (1) the ots-sioe waroawstardiapo syaoem is is poupes opo acdos coodidas and/or (1) afters impeetioo w4 pusupbe Cif neownw). the septic tank is lag tbm W eta of a1odea. r Uwe, the mdonigood have read ft dwm regadneetwu ad agree m malna n do pdvea w wags dtapoad aywaaa WO do stndods vet foelb, haelo, as so by tba Dap gbna t of Cvamcm and flee Depar mrnt of MUwd Resoaoa„ State of Wisooosia. boa t' ~dg t~ Jr s has boea maintamod,t be oomplded and auzmd tp due St cwix camw zmbtE OIBoe wI&I- 30 "Ibf die bogie date. i c 1L~! r- I OWNER C&&T21CA3M I eater chat all satemeess on thin tame an true w tbo bear of any (acs) imowia%C. 1(we) am (arc) t>sa owe"(a) of dwadheA above, by virtue of a w#tttW deed recorded is Ragisoer of Doody OiTM SIGMA OF APPIXIANT DATE anger Any iofbsmaboa that is mii-reps od m y mWt io the sguitawjmmit bdo tevokM by dw ZoolaE Deputsoca "'o" gg b dada wW this apptkadmi a lbm* d vuo= s dood ftm do Roglslor of Deeds offs a oaP1r of the aattitied tastvry asap if rs~eedoe to made bs the wasait+0.Y tined Nov 07,03 09:05a ABC SEPTIC 7156652112 p.4 J STATE BAR CIF WISC-' NSIN F'G;iM 3~ h~ Dac:t.murn N1,rnt:s~r . 11)3$ QUIT C" fJIM ~ - DEED ,/.23~Q 2 ~~~3~:~sLLEk'?r `NM ;c,,FIE Cti This Deed, RECEIVED FCR II riftrf C)~-t C~'" ~.:•<r _1 _.t. ~r.¢_~_ ~L+._... r rantuf, ~ T~{~tv li _ ~-...._._f . _ _ _ _ _ _ it E'. g 7'i'Ak ,f- c Tw r,.~ it _ . Itrrl rldf:hs h S.. ;ifou'rt}; t9etia;rE~cc1 tryl trsl.t.c• tti atc Of lvscansa;: r / ktR, "'t 1 7d }trWrrr Addr05; .Y 1. 1 ~ { • ( ,j F'arcet (1s n~ 1 v v ~#`°rg40drtrttraifa ~1 'Ingi~ilttaF wit?t :til a > xrr:~arr:rnt ri ~v. { 1 ltd, C[t1~IPIte ell SA "'•h~~ l.)%1~,CG !1115 ._r~~_. r ~ ~ w 1, 8i P AUTff ENTIC,,"j`1C4-1, ACKNUWI.EDC'MEN'T lterrwegstit SUlte of Wiscos~si:~, Nov 07.03 OS:06a ABC SEPTIC 715GG52112 p,6 QUITCLAIM DEED s ` iss$ went Number This . Deed - made between ~ 1•= - and Grantor, Grantor quit claims to Grantee the following Count S described real estate in y. State of Wisconsin. !1 Recording area a~ 13 Name -d Return Address r- IU •l Q 5~ACey S -Fin fA (V LO tso IV 0 1l1 ~ ~ N -r Lv r S s-'f 0 Parcel Identifiruion Number (Mj This * iT- homestead property. (is) (is not) ,`g1111+i t!! p!~` ` Together with all a .~~~~K 11I QQ i~~f FPurtenant rights, tttl 3 Dated this Rl f day of fl z. * ' * f rrnn +t~~~ tl11l~~ * (SEAL) _ t = (SEAL) AUTHENTICATI G gnature(s) z •9l~ • •8L..0~~~,, '71 ACKNOWLEDGMENT ~f~~+►tlrNlNtNi State Of Wisconsin, henticated this jn ss. Y of 5 . ' County. Personally came before me tl-tls - day of . ~ t~ 141p At7rtVn Tamo•{ Nov 07 03 09:06a ABC SEPTIC 7156652112 P.5 ~r+lttttutrrr~ ii ♦♦r♦♦♦r ~Y K.06 Together with all a • ' ' ' ~4,, pPurtenant rights, tixwtexe~tsA q Dated this day of 0 = * * - .em~'••_ UBt.~ 10 4 ~ ar}ii~~1♦♦~ (SEAL) r♦p~ urr/~~i~j " C © pTKJi'! (SEAT.} AUTHENTICATI011,, : ro G V81.~ . ~2` ACKNOWLEDGMENT Signature(s) ";111111t10 State Of Wisconsin, { t !e ss. authenticated this day of C." V T r0 i nt)L Persorra1lY came before me this day or ~-yam a -The above named L r ~ Ana. •7TIU; MEMBER SPATE BA F WISCONSIN (If not, authorized by §7pg,gg y~, Sca me known to be the person to who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED 13Y t / L rn P ~o~ s c " Notary Public, State Wisconsin (Signatures my be autbentlca MY commission is permanent necessary.} or acknowledged. Both are not (If not, state expiration date: Names of persons signing in any cap-kY must betYPed or printed below their signamm , QUIT CLAIM DEED - STATfi $Att OF WISCONSIN FORM No. 3 - 1998 Vaisconsin L GO Blanc Co.. Inc. MUwaukee, Wis. ,q NSZ Q~. P N 1~ a sa - - x I V T. 4 J{ sy tb c. . / `+r .►a ` 1 is ~ - . - - ~ ~ ----...r iv guy . ° cS T. • "1 Cv ~ ~ Ca 4 a © Q 0 'lei n ~ a cl, co 7 o C, ~ nat ` w o Gi ~ o '';F-T +r s ' O In j J} P P V CC• . 7't7~. P./ yw L'd ZTT~S99STL OIld3S OHd WLD:ao 60 LO AOW