Loading...
HomeMy WebLinkAbout020-1353-54-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561003 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)i. Permit Holder's Name: city Village X Township Parcel Tax No: Schoeder, Steve & Michelle Hudson, Town of 020-1353-54-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 36.29.19.2054 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURERl CAPACITY STATION BS HI FS ELEV. Septic J-~ 7 y Benchmark /gam /Z66 Zz 5 ID71- gang Alt. BM Aeration v Bldg. Sewer /'d 2 55 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Adf U' I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing - - Header/Man. Aeration - Dist. Pipe Holding Bot. System • ~ PUMP/SIPHON INFORMATION Final Grade G 7 Manufacturer Demand St Cover / GPM 3 . 7 /d3 fr l ~io Modt umber TD Lift Friction Loss System Head TDH Ft - Forcemain Length Dia, Fist. to Well - SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length pp No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Depth ill.n Liquid Depth DIMENSIONS l l.0 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: T DL p9L e Model Number: LGA_- 4 ~ e A. DISTRIBUTION SYSTEM r 52 - nt to Air Intake Header/Manifold !B Distribution x Hole Si TxHole Spacing tvze ' Pipe(s) Length Dia Length .Dia ,Spacing C r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of,, xx Seeded/Sodded xx M ched Bed/Trench Center Bed/Trench Edges $rv Topsoil - 11 ° Yes ❑ No es -1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 639 Hillary Farm Rd udson, WI 54016 (NE 1/4 SE 1/4 36 T29N R19W) Cottonwood Ridge Lot 54 Parcel No: 36.29.19.2054 1.) Alt BM Description = d ~O J 4 ; " ' d ` d 2.) Bldg sewer length = ® o~~~ . C~~.~ ~W - amount of cover = Plan revision Required? ❑ Yes No - - Use other side for additional information. - - SBD-6710 (R.3/97) Date Insepctor's!Signature Cert . No F~ County Safety and Buildings Division S 201 W. Washington Ave., P.O. Box 7162 $ P Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 c Sanitary Permit Application 1E ; r i State Transactign ]N umber in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS-are subp iced Xo Project Address if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide K Pllfondary purposes in accordance with the Privac Law, s. 15.04(l m , Stats. L Application Information - Please Print All Information Property Owner's Name Parcel # ~L I d - Properly Owner's Mailing Address Property Location Go Lot City, 91-ate Zip Code Phone Number , , Section (circle one T ~N; RE H. Type of Building (check all that apply) Lot # L~1 or 2 Family Dwelling - Number of Bedroo 142 Subdivision Name D ❑ Public/Commercial - Describe Use 2q ,10 2- e-vo--o, El city of 0IC ~ ❑ City of ❑ State Owned - Describe Use I CSM Number El Village of Z d;a4- Geld w Z5+-ZS ®'l'ownof ctolgQn III. Type of Permit: (Check o y one box on line A. Complete line B if applicable) A New System El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner , 04 IV. Type of POWTS System/Component/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil /p/.!5 r ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) L4 s V. Dis ersaVYreat nt Area Information: Desig n Flow (gpd) Design Soil Application Rate.(gpd Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation ~j 000, loll VI. Tank Info Capacity in Total # of Manufac er Gallons Gallons Units P~ ~Y rL if o v ~ Existing Tanks New Tanks 2 2 -6 2 J o 0.U rn" 2 wC7 ep ' r Holding Tank Dosing Chamber .1 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plum Signa MP/MPRS Number Business Phone Number Plumber's Address treet, City, State, p Code) V . Coun /De artment Use Onl Approved preved Permit Fee Date I ued Issuing ent Signa rven Reason f.r Denial X7.5 l 1~ /z 7 IX. Condit , easons for Disapproval 1. Septic ank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plurro 2. Ataetback fequWaments must be meintalmW in PK vokvii~dodo / of irms; Attach to complete plans for the system and submit to the County only on paper not less than 81/2 a 11 inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 2- Owner's Name: 5eZde ~Q ✓ Owner's Address: Legal Description: V4,,- C5,0 et Q 1~, y~ u Township: d,S County. Subdivision Name: Lot Number. ~LT! Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. License Number: Date: Phone Number 4:C/- 2,Q: Signature i Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 ✓ A~ Olws d c c alp 2- 4 -C4 X - 1 /eo.~ f e v.,~ S~~a eq~.. X 4z , a-o. K3 - f6. -Z, Z ~v1~S~ faH Lv ao,l R~d~~ -to 00 f~ w ~ r 5T y KNU[nWN PLUMBING & =T' • f C' W qty CONTRACTING, !LC L. ~~~a r ~~Ng O u 7~ 92'TISMS7:6484 mms Soil Absorption System Cross Section 144 ft Final Grade 4' Schedule 40 PVC Vent Pipe With Vent Cap ft Leaching Gf'~ Chamber 1~'~ft ~ System elevation ft ft Soil Absorption System Plan View ft ~ft IIIIIIIII! i Leaching Trench 1 _Lft Vent Or Observation Pipe Chambers 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model .7_b 7'o,- EISA Rating b sq ft per chamber Soil Application Rate gpd/sq ft bD gpd Design Flow + ~o Soil Application Rate EISA Chambers 2 rows of,.` chambers each. i Page of 0 Filters l.~ ?L-525'EFFLUENT RLTER_ _ F he PL-525 Filter is rated for _ t over 10AW GPD (gallons per day) 1/16s Filtration Slots = Ahm making it one of the largest fitters i6--.-its class. It has 525 linear feet 06/16" filtration slots. Like the AmcM PC P,olylok PL-122, the Potylok PL-525 has an automatic shut off ball installed with every fitter. Wen the fitter is removed for -cleaning, the ball will float up and t t temporarily shut off the system so the effluent won't leave the tank 66 Lb= FL of VW W other filter on the market can ' ~ OW :Hake that claim. ,amoco F The PL-525 Effluent Filter should ' operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the fitter be cleaned every time the tank is pumped or atleast every three years. If the installed filter contains an optional:. alarm, the owner will be notified ' ;an alarm when the filter needs servicing. Servicing should be done by a certified septic tank c~ pumper or installer. = AvWAWCSh*W ~f U.S. Patent No# 6,015,488 --s eaean~ar~.c t : 1. Locate the outlet of the 5,871,'"°"~d , septic tank z 2.. Remove tank cover and pump tank if necessary. PL-52E 3. Glue the filter housing to ( A 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and c om- the fitter is not centered ' F - Pdlt PL-525 out of the housing- mercial waste flows up to under the access opening . g_ 10,000 Gallons Per Day (Gt'D). use a Potylok Extend & -5 Nose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the center fitter. See page. back into septic tank. septic tank. 19-21 for Extend & Lok information. 6 Insert the fitter cartridge back 2. Remove the tank cover and into the housing making sure pump tank if necessary. 4. Insert the PL-525 fitter the-,filter is properly aligned into its housing. 5 a_nd. completely inserted. S. Replace and secure the t septic tank cover r, 7 Rp'olace septic tank cover. , V Private Ousite Wastewater Treatment System In Ground Management Plan PuMMMt to SPS 38354 was. Atha. Code each Private tnsde wasWwate r Ticatmeut System (POWTS). Sball include information and pmeedures for the system within ft paramet= of SPS 383 and 384, and the conditions of approval by the depardneul, agent, or 8avemmental unit The approved plans and permits for the system will be filed with the county zoning or health dent This management p1m complies with SPS 38354, Vim Adm. Code, and the In-G rawd Soil Absorption Component Manual for Private Onsite wastewater Treatment Systems (Version 2 ) SBD-10705-P (N.01 /01) Table 1: System Design Specifications Pewd Number Numbear of Bedrooms Design Flow GPD Soil Size - fL ' Tank Capaci~r GGal- Gal. Pmmp Chamber Capaca Table 2: Soil Absorption Component - Limits of Reliable Operation Seat-c Tank on Deli Flow4'eak GPD Component Max. Inflnenot Particle size NA 1/8 loch Maximum BQD S NA 220 Mmdummt TSS m NA 150 Mmdatum FOG CIA 30 Table 3: Maintenance Schedule Sepfic Tank Inspect and/or service once eveg 3 years ou t Filter Should ' unpect once a year and clean as needed- Pump Chamber once every 3 if 'cable Soil -on Co nent Service Provider Power's POWTS Regulator t Croix ioning - - A 1' 9' - TOPN OF HUDSON, STXROIX COUNTY, r SWITij-E 383,84' s` I 500 rF/ J / i } ` } } 2.230 ACRES i 97,154 SO. FT. { 4 - t { cu fu I rui { r ' / 55 10 2.261 ACRES ' f t 98,510 SQ. FT. / I 56 • ♦ S9- • . i 2.655 ACRES 115,640 SQ. FT. : ` . • H. W.L 992.0 Sop co I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Zan Property Address 39~ /7" I'4'4Ce/' znze ril n K~ (Verification required from Pl ng & Zoning Department for new construction.) City/State 4:5, ah Parcel Identification Number LEGAL DESCRIPTION Property Location '/4 , [-_'/4 ,Sec. , T _,g-N R /7- Town of Subdivision Plat: Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0 yes Q'no Lot lines identifiable es 0 no 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 wastewater disposal 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on thi 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 wa anty deed recorded in Register of Deeds Office. Numbe of bedrooms SIG 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. 09/07) State Bar of Wisconsin Form 1-2003 8 1 1 0 8 9 3 WARRANTY DEED Tx :4088008 Document Number Document Name 968573 BETH PABST REGISTER OF DEEDS THIS DEED, made between Darlene S. Krear f/Wa Darlene M. Sorenson ST. CROIX CO., WI 12/03/2012 12:53 PM EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), and Steven J. Schoeder and Michelle L. TRANS FEE: 180.00 Schoeder, husband and wife PAGES: 1 ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, c3gether with the rents, profits, fixtures and other appurtenant interests, in Address St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return needed, please attach addendum): David J. Estreen 304 Locust St. Lot 54, Plat of Cottonwood Ridge in the Town of Hudson, St. Croix County, LHudson, WI 54016 Wisconsin [-21151 FA 020-1353-54-000 Parcel Identification Number (PIN) This 1S NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: Easerrlents, restrictions and right-of-way of record, if any. Dated November 30, 2012 (SEAL) (SE * - AL) * Darlene S. Krear, f/k/a Darlen M. Sorenson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Wisconsin ) authenticated on ) ss. St. Croix COUNTY) s Personally came before me on Novemberr3;b„12012;; * the above-named Darlene S Krear; f/{t/a barleni 'may orenson TITLE: MEMBER STATE BAR OF WISCONSIN jj// wn to b e the ed`e reQoln authorized b Wis. Stat. § 706.06 g (If not, ledged the sarne4( fF a ` k~ acknow THIS INSTRUMENT DRAFTED BY: Attorney David J.Estreen - + e .~:..~(,•,;;,;,,.+,;~,.,,r?~~r,y,,_.:, Notary Public, State of Wisconsin';;` 304 Locust St. Hudson, WI 54016 . My commission (is permanent) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. I-2003 'Tly8? game below signatures. INFO-PROT" Legal Forms • (800)655-2027 • infoproforms.oom r =7Tk E. - ~ ~ std ry SOIL EVALUATI)N RE~ DiYgroilOfSaieZyand9ipdtrSs , , < L t. Pap-/-d -3 I j _ iflaaC~l0eMi1i1~iQ1~i1t$.t~6. ~rl. rAde 'p kxkdLbut"imledfatradicalandbariaoniatsNINE ropump.diadianaad perosntabpe.acaburdms~kx~s.mNbmo anilloeaEtoaandd 110 lb on-med Pja2d Pie prat aff Ivormo1 ba bl Oats pwrai.~~.tosrsiaoyalrpnw~a..u~►b.r.asiersa+ortAr~owo..sl•arca..a+sssrn~g p - i;oPadi►Loce6ae . d Gott Lat ~ IN -.e 1M 3 6 T N R ~ E lProPeftOwnW*llM19 tot# aock# SUKN~earesw 41 Z r N -e COY arNmC MtKIot UserrkrPAd*WWfN=bmraf- lolvms_ _ CodsdWvSdd@Mpflowrals_ ppO ❑ ❑ Pn6icar - - COW Pa~anta~eladaf FlWdptebde~oelfgw adbbe 111~1IL Qene~etuan-I -O `r.•a c /~s«}! .wc rl~tiis,~rrg® r~nrc~ .c-c/os.:dn ~ I pr f "«.r,►L~I--✓-Gt n < <®/~~t/ u~- ~ ~•s,.sr ~ 2 ~'-~Ly/v7'~ ry . ~~iws~ I A►rt O/r/G5r' FM e /lo ri 2Ei~. J cr t j'~ 'S! /u/~ 1/d iqr w~d ~ - ~.ry~ K SSta~(~ t', T~ 70 error- I+7 cy e FMe oA C4.w 4vvli- Z rvlr~[6' /~C1i191H/~ 4 ~ifG~/%1~ f^ ❑ o © PS s~rfaosaby o 3 D" AD soft bdkw kt fiaritnn 040 Dadm*Cab Radm 9oi Rate Dssaion Taedus ~e Casienos Ram- OPW h illurna! (irl SL Cant COIN er: ft Sts 7,r-e-cr 'l3Ct 'Eiit;2 S S F e- z 3 Z -'1/ o 3 LS - L L,* s 4% S, 70 ,Z r~ dotadaaEaasalsv_ J°° , nbf~or in. +lad= coo DwAimt calm Sai Rate 1 R. lima Oesdbon Taste skocbm Oa rw Rods C on iftl Oat St Cant C*r Or. &L OL - .s LS &X Apr i-7 e NJ `S e z 014 t .7 rl 23 `~usit~t=800 >3t1e2~DtgLtt~d1S6~8D~~Da~II. Ott=BOD"c9D _ sspRaad'I5Q;~30aapF~ CST Neap alt p" CSTNnnber Y ✓ ~Y FA .S'l"w Eedas6an C=Wt ad TabOwo Nwib w eCd LG~X/~ ~1 -'+r z- CAM ig.RJ= 14 PmpwliOi"°'►~n"' PnaoeiO# 8=-+ /3S3 -,s y~se° pqp ¢w~llaaiew oz • IL Depeobeaiapeer~or 75/ iR Sae Rab Wohon 0*6 Poffib tlt tik MONNOWD -Tam SMMM CMedde Af ',Nn► . r4mb OPW h t4 unle CALL CwLcdor joL UL h ~ r1f 'eeekl '~2 as 3 a►f 7 9 2 v A!r-- L c,v F d G S rsr~ f./~ . S= F-7 G X - . F o #fdNl` r" 77~N C Q ~f ❑ ~ Q ~ S. apdbwo~tsaar ~ FloAaan MP& Oo t ft*KD@ TQ*m 8 u*m emdale mwoft floats ttew e1a OL9t Llaa cllor 'E= IL ❑ ❑ PR -OWN rmaieNc t7rpr~beiaeUgiador in Sae Baia Molfam Danineut Cdw lledoa0e *ftk. Tam Skidoos 8artdeq Boats h eW" Cls.Sz Cat Cdw ~Sz .mil ~~atdt=004>9t1_1~2Dpppil_aad'fIB~~Dc'~o+gol! •E~uaet~2: 90 ~ dDOis3 nglLsnd't!6s_BtFaglt - ~ C ~i ~ 0~ 6~tlli jC~ t~ l t Ityoo NNW smbllr b sooeae sle~r~c or _ BOCd nlMaiei 1a an alloo a O~ Gown 4*odo a t llt dol r alm or Tff 66&264•a7T1_. . ~lR~ ;pr 1 Al I ~ • t~ P N ~ 1 h' IK k t, ~ t h n n n ` V 4 ~ ri ~a A ~ \ 1 e z A u ^ g r ~ ~ V s a ~ / ti ,W f Al ~~~nNr Go 4 vn.7 y 4 ~s R \ ~ ~ P o i O M1 n I t ~