HomeMy WebLinkAbout020-1365-24-000w~`~eparhnentofCommerce PRIVATE SEWAGE SYSTEM
Stafety euw twildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal intormation you provice maybe used for secondary purposes [Privacy Law, s.15.(M (1)(m)).
Permk H ei s Name: ^ City Vi la a own o
'.C. Collova, Hul~son Township
T 8M E ev.s I Insp. BM E ev.: BM Description:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~-~s D~U
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P / L WELL SLOG. vent to
Air Intake ROAD
Septic ~S~-(- -~.~~ ~ S/ ~® NA
Dosing NA
Aeration NA
Holding
PUMP I SIPHON INFORMATION
Manufacturer Demand
--- -
Mociel tuber
TDH Lift Friction System TDH
Forcemain Length Dla. I-I .Dwell
SOIL ABSORPTION SYSTEM !t t\ , Q ,... ~ o~
ELEVATION DATA
ount
Sit. Croix
Sani3>~4147 No .
State Plan ID NO.:
Parce Tax No.:
020-1365-24-000
STATION BS HI FS ELEV.
Benchmark (p•~ 9'~- f ~`
Alt. BM ~j p qb ,~~
Bldg. Sewer (o -82 q . $ q ~
St/Ht Inlet ~ ~_~ ~' -p/
St / Ht Outlet ~-.Q b q3. }-~ ~
Dt Inlet `'~ ~~
Dt Bottom ~---,
Header/ Man.
• ,f
,f2 9 3-S~'
Bot. System q;s° Q 2. Z(
Final Grade ('o.~d ~S Sf I
St cover
~-
~..~,
BED /TRENCH width i Len th v ~, N O Trenches PIT No. Of Pits Inside Oia. liquid Depth
M I 8~~ IM N 1
SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man
~ dur r:
~
~e
~
SETBACK .
W
INFORMATION Type O ~ I
~' ,
^' Q'S
~~~ CHAMBER
OR UNIT M e Num er:
`
C
System: "'a $ ~ -
u
DISTRIBUTION SYSTEM
Header / am old ~
h ~ Distribution Pipe(s) x Hole Spacing Vent To Air Intake
8 '
}
Dia. ~
lengt ength Oia. Spacing 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 Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: o~{/O3/0 ( Inspection #2: -~-°~--
Location: 654 Laurie Lane, Hudson, WI 54016 (SW 1/4 SW 1/4 15 T29N R19W) -1529192184 Riverpark
Meadows -Lot 24
1.) Alt BM Description =`~s~ ~tr~~°"~ ~~~-w~~w~Y'~+~
2.) Bldg sewer length 1S+p u
-amount of cover = 2'f ~ ~' ~ ~'~~
3~-~-. ~,~,.. ,~.~ ~ ~ ~~'~ s y sue--
Plan revision required? ^ Yes )~" No r
U oj,~sr s' e r ad itional i ormation. 0(, O ~( O( ~ ~ 2
`~ C~ I~CL Cert. No.
SBO.6710 (R. 7) t ~ O~`to (~ Inspector i Si nat re ` ~ ~~ ~/ G
~~~ C'~VPe~r"t„ ~ e k ` h ~ sue.! , t . z fO~.~o~) ~ ~ d yea ~ Scar
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• ~~, Sanitary Permit Application Safety & Buildings Di
~ In accord with Comm 83.21, Wis. Adm. Code 201 W. Washing[or
iseo
nsi See reverse side for instructions for completing this application ~ PO Baa
i
n
Department of Commerce Personal information you provide may be used for secondary purposes Madison, WI 53707
[Privacy Law, s. 15.04(I)(m)] Submit Com Ieled form IU Coun[
( P >'
state ov
Attach com lete tans (to the count co onl )for the s stem, on a er not less than 8-1/2 x I 1 inches in size.
County State Sa~ta Pe it Number ^ Check if revision to previous application Stale Plan 1. D. Number
I. A lication Information -Please Print all Information Location:
Property Owner Name Property Location
~~
Sc~l I /4 S LatS l4, S ~ ~
RI
Property Owner's Mailing Address ,
Lot Number Block Nun
City, State
~
~ Zip Code Phone Number
~ Subdivision, Name or CSM Number
~
~c
d-cc~~ j~t.. ~ /( c /S
) S~ - Sy77 /
~.u.«. ~CC
II Type of Building: (check one) ^ City
I or 2 Family Dwelling - No. of Bedrooms: ~ ^ Village
O Public/Commercial (describe use): j~'I'own of
O State-owned
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road
~
A) I. ~J~iew System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s)
S stem Tank Onl
B)
^ A Sanita Permit was reviousl issued i~rtrit-ldtnrrber 4,v~e S OZO-1 S_Z - Date Issued
IS. 2q , Iq • Z'S~
IV. Type of POWT System: (Check all that apply)
I~Non-pressurized [n-ground ^ Mound ^ Sand Filter ^ Constructed Wetland
^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line
^ A[-grade t r
^ Aer bic Treatment Unit ^ Recirculating Other:
2) 3 X ~8 • ~ S c
ll s ! ~
_ ..-`
e
e
V Dis ersaUTreatment Area Information: ~~
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
~,f ~~ ~~ Required Proposed Rate (Gals./d~ay/sq. ft.) (Min./inch) / Elevation
VI Tank Capacity in Total ~ of Manufacturer Prefab Site Steel Fiber• Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing Crete structed
Tanks Tanks
.~
s Jy~~"'y
1 G/CJ
` `'~'Z~~ ^ ^ ^ ^
^ ^ ^ ^ ^
VII Responsibility Statement
1, the undersi ned, assume res onsibilit for installation of the POWTS show on the attached lans.
Plumber's Name (print) Plumber' ign a (no stamps : P PRS No. Business Phone Number
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Plumbe
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VIII County/Department Use Only
^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
Approved ^ Owner Given Initial Adverse Sur
rge Fee)
Determination ~
2 , Qa , ~ ZOO
~XOConditiops of Approval /Re sons for Dis~~o~l:~`~~ ~~~ ~ off, ~b SYti~,
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SBD-6398 (R~ 07/00)
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Tuesday, July 31, 2001
P.C. Collova Builders, Inc.
654 Laurie Lane
Hudson, WI 54016
Regarding septic inspection for P.C. Collova Builders, Inc..
Dear Applicant:
r
Location of Property in St. Croix County:
Municipality: Hudson Township
Subdivision or Plat: Riverpark Meadows
Certified Survey Map:
Lot: 24
Address: 654 Laurie Lane
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
Hudson, WI 54016-7710
(715) 386-4680 FAX (715) 386-4686
A septic inspection of the above reference property was conducted on June 04,2001.
This property is located in the SW 1/4 SW 1/4 of Section 15, T29N R79W, Riverpark Meadows (Lot 24 ),
Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found
to be code compliant fora 3 bedroom home.
If you have any questions regarding this, please contact our office at 715.386.4680.
Sincerely,
Kevin Grabau
Zoning Staff
cc: file
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Wisctmsin Department of Commerce
,,. Division of Safety and Buildings
Bureau of Integrated Services
SOIL AND SITE EVALUATION
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
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 road
APPLICANT INFORMATION -Please print all information.
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
,.~ ~O f / Govt. Lot 5 ~
Property Owner's Mailing Address Lot # Block#
i - `lbw ~l ~Lt-I
Page _~ of
County
. ~rG
Parcel I.D. #
Reviewed by Date
I/ 0 n
1/45(,V 1/4,S/Cj
Subd. ame or CSM;
IV~~ ~f~
~~
T Z y ,N,R / y E (or)
City [`~[, <,, State Z.ei~p1C~oxde P~hyo+ne Number ^ City ~^ Village [~ Town N/e~arest Road
l-(~..fl~„~}i`7 ~ ~~/ ~~ 1-TU/10 ~ ( (i~ ~ ~~'~~}~~ l-I/ I~rV~f"7 I L CC U(I~2_ IG r~
[~- New Construction Use: Residential /Number of bedrooms ~! Addition to existiny building
^ Replacement ^ Public or commercial -Describe:
Code derived daily flow ~ gpd Recommended design loading rate • ~ bed, gpd/fi2 ~ trench, gpd/ft2
Absorption area required `~S~ bed, ft2 ~~ trench, ft2 Maximum design loading rate ~_bed, gpd/ft2 ~ trench, gpd/ft2
Recommended infiltration surface elevation(s) ~~ U G ft (as referred to site plan benchmark)
Additional design/site considerations +~//•~/eu• ~Z' S~
Parent material fll i ~'(.~ t'a S~j Flood plain elevation, if applicable ~ ~ ft
S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank
U = Unsuitable for system [~ S ^ U ®S ^ U ®S ^ U ~ S ^ U ^ S (~. U ^ S ~ U
Boring #
Ground
elev.
y3. Sv ft.
Depth to
limiting
factor
//9 in.
Boring #
Ground
elev.
9~ft.
Depth to
limiting
factor
I1 in.
SOIL DESCRIPTION REPORT
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench
! v- u l v z --, L.5 I m mfr L v.~' • `t ~ .~
Z rr--iq l~ r~11~ `- ms I cS - . -1 ; •8
`ll• o ~ ,
3°~6G
Remarks: --~---~.
trt ice:
i
v~ . A~ ,
Zr ~,;
~-t' 1, ry.
Remarks:
CST Name (Please Print) Sign Telephone No.
Address ~~-° Date CST Number
~lUg Cec~tr 5-~. ~`~ ~m~e~, (,LJI Sya2.S //-x-99 25339
PROPERTY OWNER ~~ ~ ~O tf ~ SOIL DESCRIPTION REPORT
PARCEL I.D.#
Boring #
Ground
elev.
quo ft.
Depth to
limiting
factor
1~in.
Boring #
y
Ground
elev.
¢G~~ ft.
Depth to
limiting
factor
~~in.
Boring #
1
Page ~ of
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed .Trench
I v-g iv .-31z - LS (m mfr ~S tv~ .-1 ~ .B
Z ~-lZl tl~ r~l~la - mS ml c,5 - .1 ; • $
Remarks:
~ o-I ~ ~ 1L - ~S I -~ ~ (v ~ . ~ ; . ~
2 14-i I r `i ~ to -- rnS m I LS - , l ~ ~
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench
2 I L-Il~j l U r ~ - vr, Yl'1 ~ c. S ~ .1 ' . ~
Ground
elev.
Depth to
limiting
fact
~in.
Boring #
Ground
elev.
ft.
Depth to ~~
limiting
factor
in.
Remarks:
Remarks:
SBD-8330 (R.9/98)
. ,,
NAME ~~~ (~~ (~G U
SCALE ~ 1 "_ l ~ U ~
I~~ ~M ELEV . G, Sv
DESCRIPTION- /rip o-~ 2"
M2 ELEV. ~y~9~
DESCRIP~'TON-~, p a-~z np
SYSTEM ELEV. ~/~UU
~ ALT. ELEV. rjZ.Sc~
CONTOUR EL• EV . 1/l v p
PAGE 3 OF 3
LOT # Z y LEGAL DESCRIPTION SCu'SW=/U -Z~~~ -~
N'
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 (POWYS) 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-
Table 1: System Desian Specifications
Sanitary Permit Number ~j ~
Number of Bedrooms 3
Design Flow -Peak (gpd) Sb
Estimated Flow -Average (gpd) 3 c~
Septic Tank Capacity (gal) ~ ~
Soil Absorption Component Size (ftz) 3~ z - -~`
Type of Wastewater omestic
Table 2: Soil Absorption Component -Limits of Reliable Operation
Septic Tank Component Soil Absor tion Component
Design Flow -Peak (gpd) 8'Of~ 3~ '' x
Maximum Influent Particle Size (in) 1/8
Maximum BOD5 (mg/L) 220
Maximum TSS (mg/L) 150
J
~..~
Tab le 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 se tic tank and outlet filter shall be assessed at least
once every 3 years by inspection. Th outlet f e shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain soli sin a 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 wifhin the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank maybe 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
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT ~~
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ~. ~ . ~ ~ ~ oVA _ g (c~ tt S ~N t...
Mailing Address -70~ ~u • ~t d , ~' /~i/Qsu-v I,v L ~ ~-v 9 (d
Property Address _ ~z5`~- ~r.~iE ~N~ l~jlr/c~yv,/ W.~ ~-y /!.P
(Verification required from Planning Department for new construction)
City/State 1'1 UPS e n! ~ ~ Pazcel Identification Number o 20 - 136 5 -- 2`~ - dib
ts. 2a .19. 2t8~f
LEGAL DESCRIPTION
Property Location ~~ %,, ~ /,, Sec. (~ , T~N-R~W, Town of v~Su ~
Subdivision ~ - ~~ ~- ~~ ~4%4~w S Lot # a
Certified Survey Map # '~~ Volume _ ~ ,Page # ~---
Warranty Deed # _ (r 4' ~ ~. ~o ~ Volume l ~~ 9 ~ ,Page # `t"~Z--
Spec house ^ yes'~no Lot lines identifiable yes ^ no
SYSTEM MAINTENANCE
Improper use and maintenance of your sepde 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
masterplumber, journeyman plumber, restrictedplumber 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.
Uwc, the undersigned have read rho above requirements and agree to maintain We private sewage disposal system with the standazds
set forth, herein, as set by the Deparhnent 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 e y az ex irati daft.
ZI of
~/ /
NATURE OF APPLIC NT DATE
OWNER CERTIFICATION
I we) certify that all statements on this form are true to the best of my (our) knowledg6. I (we) am (are) the owner(s) oC
the p city c ' ed above, by virtue of a warranty deed recorded in Register of Deeds Office.
~ /z//~ j
NATURE OF APPLICANT DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Deparhnent. ****'`*
*• Include wttlr tuts 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 decd
5TATE DAR OF WISCONSIN FORh1 2 - 1981
v 64621EiT
•
t4ARf1,At:7Y DEED
COCUM6N7 NO
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~ ~2 KATHLEEN N. uflLSH
6TG1CkDIX C
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Mar~orie ltalernee, Frances August and Faul ICstner
Au tenants n cununa^ --
a k/a Frsncis O7-Ofi-)999 9:30 AA
August YARAIINTY GEED
_ E1EM'I 1
iunvc,D tud WUr7n731c •`C• •o_ ova Ru cots, Ltc., a CERT COPY FEE;
CORY FEES
• . Nlsi:onsln Corporaticn TRAfiSFEA ifft 1310.0
' - kECCRDII~ FEE: 12.90
'~' - PAGE9: 2
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of Certified Sut•/ay 1laF recorded ltl Vo1,7 of Curclfled
Survey Tlapss, page 2009 as Doc. No. 441309. also excepting 02U-1010-20
• the ratircad right of wa>. 020]026-90•
020-1025-94 I
NE 1/4 NW L/4 Sec. 15-T29N-R19W excepting tharetrcm Lot 1p~nce/u',Inulcliiuvtutileen
of L'ertifled Survey hlap recorded 1n Vol, lU of Certified I
Survey Mapc, paga 2701 ae Doc. `To. 3C7:TB. '
ttl: l/+ NE 1/G Sac. 15-T29N-R19W •
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to Ire Y.nuwn to he person ~ n1w tuwted the ferrgdrg
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(Sldra;cr<s nmy ba nua•antleo:ed ur aknow'sdd:d. Ililh ~tt nol -.ly coiunlc.ion h pannment. ;If net, ume eetpirtiun dmx: '
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