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HomeMy WebLinkAbout020-1376-32-000 K 0 \ A � o 0 Ll o \ � � G $ � 0 )o � ;pe t } � \ §\ I 7i§ 7 (D / % / 0 � � § _« § \ a m § � .f § 0 z k 7- U) j k 7 ƒ ) k \ k \ n �f t \ � mo §% �§ » \]\ §E§ ■-z a. # \/) §)w w¥¥ % z ® z § t r U) ) 2 $ ) ~ R . _ - Z ©§ 0 a W 0 /R / k .3 } a b 2 � k \ a a a i ' k o B -\ k o ■ Q I § & z . . : = ` c 0 ° j § 2 _ Q o § I } % ( k \ � 2 � 9 C DC ¥ r $ G - - E ) m k k ; S a 7 § £ @ CD co Cl) c 0 � o a = 2 § J ® $ © \ R 2 2 / ) 2 / ■ � _ a " CL » & ' a § 2 I t o ) a a 0 3 0 r • Wisoor;in DeparWw t of Commerce �ety�sul Division PRIVATE SEWAGE SYSTEM Count INSPECTION REPORT S. Croix GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitNo.: Personal Infoanation you provice may be used for secondpurposes secondary purp (privacy Law, s.15.o4 (1)(m)). 384158 Permit H •s Name: ❑ City 0 village Town of: State Plan l No.: ill, John W. Hudson Township T SM Elev.; Insp. BM Elev.: BM Description: Parcel Tax No.: a'O , v cv . D r 020 - 1376 -32 -000 TANK INFORMATION ELEVATION DATA r Z p 1 -��- TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1,.� x o.� -S Benchmark -3-35" Dosing Alt. BM Aeration Bldg. Sewer Sb Holding St/ Ht Inlet �• zl TANK SETBACK INFORMATION St/ Ht Outlet �• 3 'B TANK TO P / L WELL BLDG. V f stake ROAD Ot Inlet '--- Septic >15 I NA Dt Bottom Ong NA Header /Man. Aeration NA Dist. Pipe ' �g Holding Bot. System �• $ PUMP/ SIPHON INFORMATION Final Grade �, p M ufacturer Dema St cover Model mber G TDH Friction S tem TDH Ft LOSS For main Length Dia. Dist. To w SOIL ABSORPTION SYSTEM a2 6110 TREN Width / Len No f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEIETCMS D IMENSI ONS an t urer: SETBACK SYSTEM TO P / L I BLDG WELL LAKE /STREAM LEACHING INFORMATION ype ^^�,, / i CHAMBER M e Nu er: System: 1.t7� } �� �—"-' ORUNIT DISTRIBUTION SYST Hea a ani o DHole Size x Hole Spacing Vent To Air Intake Lengt 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 06108101 Inspection #2: Location: 910 Florence Lane, Hudson, WI 54016 (SW 1/4 SW 1/4 14 T29N R19W) - 1429192293 Sweet Grass Farm -Lot 32 1.) Alt BM Description = 2.) Bldg sewer length 3) � -amount of cover Plan revision required? Y ❑ No t r de for add' ' ormation. %010 R."7)� I � � Date InspectoesSignature Cert. No. - '% i j IF V V 910 PL&CejucE Sanitary Permit Application Safe y & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 2 11 W. Washington Ave. �� See reverse side for instructions for completing this application PO Box 7302 `� sconsin Personal information you provide may az'Y purposes be use d u oses dison, WI 53707 -7302 Department of commerce [Privacy Law, s. 15 ,. )(m)]�' \. (Submit comple d form to county if not state owned.) Attach complete plans (to the county copy only) fo s system, n paper not less than 8 -1/2 x 11 inches in si County State Saint Permit Number ❑ he�Jf if re isiott:1P ious applicat n State Plan I. D. Numb L Application Informsal - Please Print all Information sa Location: Property er Name n Property Location Property Owner's Mailing Address r a C` "` " , Lot Number Block Number City, S Zip Code Pho i "� Subdivision N ame or USM Number I. Type of Building: (check one) ❑ city j q 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Village ❑ Public /Commercial (describe use):_ 15 Town of ❑ State -Owned Nearest Road Parcel Tax Number(s) _ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) "2 1 3 A) 1. K New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 0 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed W tland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade 2 3 , Y ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevatio 1 7. Final Grade Required Proposed Rate (Gals /�sq�ft.) (Min. /inc � - v/, 3 Elevate VIT. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fib r- Plastic Information Gallons Gallons Tanks Con- Con- gl s New Existing crete structed Tanks Tanks ❑ ❑ E ❑ ❑ ❑ 1 ❑ E ❑ VIII. Responsibility Statemen I, the un4ersigned, assume responsibility for installa 'on of the POWTS shown on the attached plans. WPIurfiter's :Address-(Stri-e—t, e (p int) I� Plumb 's Signa a o MP/MPRS No. Business Ph ne Number City, State, Zip ode) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I Issuing Agent Egnature mps) App roved ❑ Owner Given Initial Adverse Surc ge Fee) n - Determination 22 S. CD Maa t� (p Zao X. Conditions of A p oval /Reasons for Disapprova �S � � 3C 2 25 t � < �Le �.U-� A i s� $ N { c4,,aCo�e$�oe Ce, , ,wK_c Q e,n ' aw�OC she 4 s C Q SBD -6398 (R. 07/00) ��O�gppu}�0� �� ,(¢�ivtm �ar RANAU U at P.- Qk - - - -- O Dv b Q � 1 � a \� 3 13 1 � J w a _ 1 0 < < f ` ARIn Department of Commerce SOIL AND SITE EVALUATION 3 Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County L include, but not limited to: vertical and horizontal reference point (BM), direction and J - • C � G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please pr �l fnforrpation. riewed by Date Personal information you provide may be used for secon " rjrputposespayacy l.aw s. 15.04 (1):(m)). ` Property Owner tt Propel y Location I C, ,, ,1 Govt. Lot 1/4S& J1 /4,S/ `1 T Z I ,N,R / R E (o & Property Owner's Mailing Address _ Lot # Block# Subd. Name or CSM# City State Zip Code Phone Ni7lribW ['City El Village (� Town Nearest Road ou I 15 461[14 c la v\�-e New Construction Use: [Residential / Number of bedrooms 3' Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 7 _ bed, gpd/ft gpd/ft Absorption area required S5 7 bed, ft2 75-0 trench, ft 2 Maximum design loading rate 7 bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s z tr R / 3 Z Go�. %� 3 Z ft (as referred to site plan benchmark) Additional design /site consider ations ,j,OD _e r— 9Z G Z L c' �' "` ''— °/l 0 C Parent material C) U T // (--J C - S h Flood plain elevation, if applicable - 6 - 4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S ❑ u I ® S ❑ U I] S ❑ u ET ❑ U ❑ s EJ u ❑ S ,® u SOIL DESCRIPTION REPORT AK 5 i zoo ':S? N � Boring Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots r� in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench y 14 5,1 M C__5 • `. end m3 05 rn i c s — . - 7 ; ' g Depth to limiting r ' 9q in. facto Sy /rt n Remarks: Boring # 0 -11 /U r I2. SL Z . �v Z )1 w LIM 1 Zf ri�' c. - Ground elev. Depth to limiting factor _9i�in. Remarks: CST Name (Please Print) Signature / Telephone No. Aricu `✓l tit a r - / '7if - --/ ` G /GD S­ Address Date CST Number SGOG'�1'` y -��_ou zs3 30 .bra • PROPERTY OWNER C��" SOIL DESCRIPTION REPORT 7 3 Paget . of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 6 2 SC Imsb CS Ivc Li 16 vc , 41q S; I 2 , c 5 Ground 3 =g5 l� V/(.0 --------- LS -- elev. Depth to limiting , 32 90 • tz factor in. sv-TVRl•Z bR•t��o3•i Remarks: Boring # Z �3 o - I �d r3 i m ;s . YC �1 2 mc� Z � C S (P LH - Ifi tAv rqtc,, s c' m Ground elev. 9 6•G Z ft. Depth to limiting f ain. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # X M4b C5 I v •P Will III Z iZ - �tg LIN I m 6 -` . s' (cc i m5 I c,5 .7 • $ Ground `— elev. Gy 82 ft , Depth to 90 3Z limiting ��{ o ; fac�r � in. Remarks: Boring # . z a�a Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) I PACE OF 3 NAME S +o u 4 LOT# 3 Z LEGAL DESCRIPTION 5w V4 - 5 0 1 /4,S 14 TZ-4 ,N,R iq E (or) 10 -- 1 "= /0 1 ELEVATION q q. 3 BM 1 DESCRIPTION o�Z "p,c p: p 14+4 Hr/ Fia!b. §9 2 ELEVATION / p v . 0 BM 2 DESCRIPTION i'o V p , �O¢, 1 SYSTEM ELEVATION " .c r g 1.3 Z Low {r�U ALTERNATE ELEVATION ►, oD g Z. G Z X CONTOUR ELEVATION I ,c7 , �\ � 1 Pit • (32 �i C31 I ` I SIGNATURE DATE -' —� Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms 3 Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 6i7p Soil Absorption Component Size (W) Type of Wastewater D estic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorp ion Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) U 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter s hall be cleaned as necessary to enss r� proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge 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 an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must . be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 I ST CROIX COUNTY lT; SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) City/State ij Parcel Identification Number -a-Z,2 LEGAL DESCRIPTION / Property Location %4, -,LL '/4, Sec. T--4L`N-R Town of li s Subdivision Lot # � . Certified Survey Map # , Volume , Page # Warranty Deed # Volume /. -- s,T , Page # Spec house ❑ yes jZ no Lot lines identifiable( 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, 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. I/we, 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 habeen maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yeai� expiration \ te SIGNATURE OF 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 owners) of the property escn ove_by o a warranty deed recorded in Register of Deeds Office. I SIGNATURE OF APPLICANT DATE ** 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 c� STATE BAR OF WISCONSIN FORM 2 - 1998 6�S2g2 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between — 02 -09 -2001 11:00 AN RTCHARn n emnrr TANET Pa ST0UT hr,al� and and wife _ WARRANTY DEED r . EXEMPT N Grantor. - - - -- - CERT COPY FEE: and COPY FEE: hil and and TRANSFER FEE: 143.70 �" fe ' — RECORDING FEE: 10.00 - -- — PAGES; 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in qt �CrOj x County. State of Wisconsin: Re:;n't,7inq Arita Lo 3 2, Plat of S weet Grass Farm, Town of Name an d Return Address Hudson, St. Croix County, Wisconsin. EAGLE VALLEY H BAN�n ,` N.A. 1301 Ccu Hudson, " 54016 020- 1176 -'1 -ono Parcel Identification Number (PIN) This i c not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 1 R day of F e b ruary 2001 (SEAL) / (SEAL) gichard O Stoitt Janet P— Stout (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin. 55. qt C r o ix County authenticated this -- day of Personally came before me this 3' day of January 2.0.1_ — , the above named R • chArd n Stout a - nd - Janet P Stout TITLE: MEMBER STATE BAR OF WISCONSIN -- to {' (If not. he person _g_ who executed the foregoing authorized by §706.06, Wis. Slats.} „ ru t - dray Qwledge the sam THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr Hudson, WI 54016 N_cp ` isconsm My E ermanent. (If not, Late expiration date: (Signatures may be authenticated or acknowledged. Both are not , ., necessary) Names of persons slgnmg In any cap—ty must be typed or primed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Biank Go., Inc Mil . WARRANTY DEED FORM Ne. 2 - 1998 Milwaukee. Wis. r 1 I DR UN/10 R N . , 1 � i O W46'3sP'E 384.01' 1 LOT 57 , Z ELIENV. BUI 6 I Z I 1 09 AC RES 0 FF r 1 o - : -- �1� A rn . J m ° LOT 35 0 2.00 ACRES rn OqC l i o y 87134 80 FT z A z • I g 1 $ , NOW49ME 984.21 W MIN BUILDING ' ELEV. = 866.0 N LOT 34 I p N NN'4 2.00 ACRES S 87165 eo FT I I I NOW46'S" 384.41' 1 Z a 1 C i I Q J • i 26 26 r 1 NO N LOT 33 I 1 111 2.00 ACRES 87131 80 Fr C20 . We $61, - IV Ce 286,38 LOT 32 \ \ �0 200 ACRES y \ \ •F M1 \ � I 87279 LOT 61 MIN BUILDING ELEV. 900.0 rA i \ \ 2.16 ACRE N 83888 80 F �° 1 Q .► >P E gi \ LOT 31 \ _