HomeMy WebLinkAbout020-1395-26-000S
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENE~tAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
'ermit Holder's Name: t~ City Village X Township
Carria a Homes Inc. ~~ ~ ~5~~ Hudson Townshi
;ST BM Elev: Insp. BM Elev: BM Description: n
CJa.~ / C9b.~ ~ w~ es>~-~-r¢~ =CST rw~
SANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~ w~ /~
Dosing y } /
( •v~ta ~~
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic ~ 7 ~f ~ Z/ ~
Dosing ~~ C~
1. ~~ ~ 3r', r
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer / A n ~
Model Number GPo-~~ /dLl
TDH Lift. ~ Friction Loss Syste
rorcemaln ILeng[n~St uia.2lt
n
SOIL A ORPTION SYSTEM (S'
RENC Width Length 1
DIM NS ~ ~ t3•y
SETBACK SYSTEM TO ,7
INFORMATION
Type Of System:
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r11CTQIRIIT1~11-1 CVCTPM
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ELEVATION DATA
lot ~ S. [.,.... ~.,~~)
county: St. Croix
Sanitary Permit No:
399576 0
State Plan ID No:
-~
Parcel Tax No:
oZ~ - `/S - -aao
025 ~ ~ ge ~ ~ ~ p?yo2~
STATION BS HI FS ELEV.
Benchma
~
j qn
loz.gn
1 ~~o
Alt. BM
~~ O'Z,. ~ ~
Bldg. Sewer , D- Z) QZr`sr
StJHt Inlet )p, ~3 ~ Z• t}'
St/Ht Outlet
Dt Inlet
Dt Bottom ~ ZD ~, ~ r
Header/Man.
.1vD
9 3.30,
Dist. Pipe
Bot. Syste • ! ~
Final Grade ~ -
StCover 3 9 ~ 9 ~ • o
1AENSIONS No. Of Pits
/STREAM LEACHING
CHAMBER OR
_~, UNIT
S
t >~~ ~
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
l1
~ Pipe 52 i {-
Length Dia Length Dia Spacing
Cf111 ~`~1VGR .. o_,......._., c,.~s...«~ n.. i.. ..., ru.,,..:.: nr af~rarlo Svsfams 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 discrepencies, persons present, etc.) Inspection / ~ / 7/ Inspection #2: 'T'T^
Location: 854 Highlander Trail Hudson, WI 54016 (SE 1/4 NW 114 25 T29N R19 Scenic Hi s Lot~JFO P rcel o: .
1.) Alt BM Description (o' ~ GQ~°r` ~ ~- L S'~,~5i~"'° "v+^ w'~''~
2.) Bldg sewer length = 2` ~~~ -(~ ~-/f
- amount of cover = > 3~ a So ~ ~ ~'~ t~.St~+°' ~ ~
3\ ~ 1•`S ~ ~' ""`~"- ~w ~p~.-.$~z ~ fie- C~,"t 5 r ~ ~t~,f~0+~,
/ -T--I r-- ~I
Plan revision Required? Ye^ No II ~~ ii
Use other side for additional i formation _ 1--_ I ___
,~,,,f Date +„ \ Insepctor's Signature Cert. No.
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~' System elevation w,~s~loG~'erC~l~Eo.n~sdre iCiat thechamber louver would be installed in soilsw ith a soil application rate ~f.7. ~ ~ ~.,, _
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Wisconsin Department ofcommerce - SOIL EVALUATION REPORT
Division of Safely and Buildings
page ~ of
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ach complete site plan on paper not
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mection and
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indude, but not limited to: vertical and horizontal refers t1(~ Parcel LD. ,
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percent slope, scale or dimensions, north arrow, a F \ ahd.d' nearest road.
,1.,. _ ~.~ : / , '
Please print all 1 ~` n. R by Date
.
Personal iMormaUon you praride may be used for ry pu Law. >:K9 a•S+'t (~) (m))• . ~ Z LaJ
Property Owner Pry Location
f! ` . J I~ ~~ ~ ~;) 2 ~ Q GoVf.1 5 L 1/4 lv W 1/4 S Z5 T Z9 N R 1 ci E (or1aU
Property Owners Maifaig Address •--~ g'i G ROi L Biodc # Subd. Name or CSMIf
(SJ ~ Z O S~ i I I Way- r7~ NTY ~ ~ e ; ; .
City Sta13e Zp Cade
~ ^ ~Fdlage (~ Town Nearest Road
_
......
®New Construction Use: ® Residential / Number of bedrooms 3 _ ~{ Code deriived design flow rate DSO ~(o O O GPD
^ Replaoernent ^ Public or oommerpial - Descrrbe:
Parent material ~U ft.,~J0.s (.~ Flood Plain elevation ff applicable N I'~ ft
General comments S ~ S ~ rYL e. L e Jaf.b n - ~/. v o
and recommendations: ~, ~~ e, l -e.,J 0.{-•`d r` - -~I ~ , ate
~nng # (°~I Bonng _
Cpl Pit Ground surface elev. ~ s . r d R Depth to IKriiitirig tailor / 2 b in.
Sod icsttion Rate
Horizon Depth Dominant Color Redox Desr~iption Texture Stricture Consistence Boundary Roots GP D/!P
,
in. Munsep Qu. Sz. Coat Color Gr. Sz Sh. `F~f#'I 'Effif2
2 ~ z-vl~ 1~ `--~ Sr'~J Z k m-~r- ~ - . y ,~~
`3 y l20 l U. ~ ~ S O` G ~ - - ~ ~. Z/
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®Pit Ground surface elev. R5 . ~~ ft. Depth to limiting factor ~ /D in.
Sod Rate
Horizon Depth Dominant Color Redox Description Texuun: SWdure Consistence Boundary Roots GP DIff?
in. MunseU Qu. Sz. Cont. Cobr Gr. Sz Sh. ~ 'Etf#1 +Etf#2
~ 9/ v
Y q- z a ~,
* Effluent #1 =130D_ > 30 < 220 moll and TSS >30 < 1 50 ma/L • FJlluent #2 = BOD. < 30 melt. and TSS < 30 mglL
CSTnnNa'me (Please Print) S~'inature CSTNurnber
f iGG YV~ ~ ~LCJ wtIIC-k 2r' ~,~l~L ~ ~J ~J~~I
Addmss Dafae Evaluation Conducted Telephone Number
1
t ~ ,
Property Owner ~r ~~ t
Parcel ID # ,.,:
Page z of ~_'
Boring # U Boring
3 ®Pit Ground surface elev. ~ S • too ft Deptn~ to I'rtrriting facboi" , ~ ,L_ in. Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf
in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh: 'Eff#9 'Eff#2
.__ _
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^ Boring # ^ Boring
^ Pit Groundsurfaoeelev. ft. Depth to limiting factor in. ~~ icon Rate
Horizon th
De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/i~
p
in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 *Eff#2
~~ # ^ Boring .
^ Pit Ground surface elev. _ _ft .Depth tD Limiting factor in.
Sal icatbn Rate
Horizon Depth Dominant Cob Redox Description Texture Strud~u'e Consistence Boundary Roots GP D/ff
in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#'I 'EtT#2
* Effluent #1 = BODS > 30 _< 220 mg/L and TSS >30 <_ 150 mglL * Effluent #2 =GODS < 30 mgll and, TSS _< ~ rng/l.
The Department of Commerce is an equal opportunity service provider and employer. If you creed 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 (R07Po0)
PAGE ~ OF~_
NAME (4, Y` ~/ ~- I L LOT# Z ~ LEGAL DESCRIPTIONS E '/aAl~/a Sts T24 N R !Q E (or)
~~ (~
1
~1 00
SCALE: 1 -
BM I ELEVATION /p0~ f~
BM 1 DESCRIPTION na~• l; r~ I y'• o a k
BM 2 ELEVATION IO O.O
BM 2 DESCRIPTION ~ a < ~ ~~ ^ ~ • • o ~ k
SYSTEM ELEVATION C1 1. O y
ALTERNATE ELEVATION 9 I.O y
CONTOUR ELE NATION s o v q (~
F"~1 :.Schuma4;n_r F 1 umb i nq Ff~: NUJ. 71 s3853121 SeP
sT CRa~ covlvTSt
sl~rlC TaNx ~Arrca Aa>~lv~rrr
~-NIa
OWNI:gSHIp C~RTiFICATION FORM
Ov~n4erlBuyer
Mailing Address 4 7S0 S ~~-~/ l
~Oo . s
sss~
Propmty Address 1~~iC - y
(Verification required firm Planning Dcpartme~ for tLew conatntction)
CXty/State ~Il t s ~- Parcel Identification Number ~ ~~ 4 °
I~EC~AL DESCitZII''I'IO,~ Sir ~-,~~~cY~
property Location S'~ '/.,~ul '/., Sec. a s .
L 1 g~Y/ v.c/ t~ rt~Q,
Tel N-RAW, Town of 1S'~~Sd
Let # .,~ ~.
Subdivision 5~ C Eiv ~ l /S
Certified Survey Map # _ , 'Volume _~ ,Page # _,
warranty Deed # G ~ ~ °„~ -- - .Volume .Page # _
Spec house ^ yes ~- no Lot lints identifiable ~ yes ^ no
SYST1C+ M MA~T~~~ r maintenance
Xmpraper use and maiatenariee of yottr septic system could result in its premature failure to handle waatcx. Prope
cousista of ptunputg out the septic tank every three years or sooner, if r<eeded by a licensed pumper. What you put into the system
can affect the fitactiott of 4ie septlc tank as a treatment stage in the teasto disposal system.
The property owner agrees to submit to SL Crofa Zamng Department a cxrtification form, signed by the owner and by a
masttxplumbtc.~a~Y~pl~~~ reshictcdplumberor a Ucensedpu~verifYingd~t(1) tlve on-sitewattewatordisposat syrtCm
is izt proper operatlas oondidon and/or (2) after mtpeation and ptamping Cif necessary), the septta tank is ks: than U3 ffiii of sludge.
i/we, the undersigned have read the above rcq~tnts and agree to maintain the private acwage disposal spsbem with 8be standards
set forth, herein, as set 6y the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cettificadon
xtatTmg that your scptk system has bxn maintained must be completed and returned to the St. Croiu t:,ottnty Zoning Of face within 34
da of the throe year nation date.
~ ~ g - ~~
~U
POLc s ,- --~-.--
SI ATURE OF APPLICANT DATI3
CIWNLR. CER'X`IF'ICA,TION
that alt statements oa this form are taste to the best of my (our) knowledge. I (we) am (ate) the owners} of
1(wc) octtif}+
the pro descn above, by virtue of a warranty deed recorded in Register of Reeds Office.
PATE
~ A OF APPLICANT
w««+#• Any information that is rots-t~epresented may result in the sanitary permit being revoked by the Zoning Department. «««*««
~« Include with tlds application: a stamped waixanty deed from the Register of Deeds afi"ice
a copy of the certified sarvey map if reference is trade in the vvattanty deed
Private 4nsite Wastewater Treatment System Management Plan
Septic Tank And Gravity !n-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 far 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.6l99).
Table 1: System Design Specifications
Sancta Permit Number
Number of Bedrooms
Desi n Flow -Peak ( pd} o 0
Estimated Fiow - Avera e ( pd) `L o0
Septic Tank Capacity ( al) z ~'v
Soil Absorption Component Size (ft~) r
T pe of Wastewater Domestic
Table 2: Soil Absorption Component -Limits of Reliable Operation
Se tic lank Com onset Soil Absorption Component
Desi nFlow -Peak ( pd)
Maximum influent Particle Size (in) 1!8
Maximum BOD (m L} 220
Maximum TSS (m L} 150
Table 3: Maintenance Schedule
Se tic Tank inspect and/or service once every 3 years
Outlet Filter Inspect once a year and clean at least once eve 3 ears
Soil Absorption Com onset Ins ect once eve 3 ears
Septic Tank
The septic tank shall be maintained by an individual certifred 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. Cade (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. The outlet biter shall be cleaned as necessary to ensure
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 Soll Absorption Component
filter le equipped with an alarm, the filter shall be serviced if the alarm +s activated oontinuaualy.
tntermhtent filter aiartras may indicate surge flows or an impending c;ontlnuous a{arm. The
sepftic tank shall have its contents romoved when the volume of scum and sludge In the tank
exc~-ds 1i3 the liquid vo#urns of the tank. It the cortitents of the tank aro not removed at the
t#me of an assessmen#, ma#ntenance peroonnel shall advise the owner of when the next service
Heads to be performed to maintain less than maximum scum end sludge accumuiaticn in the
tank.
Manhole risers, ea~ss risers and covers should be inspected for water t#ghtness and
soundness, Access openings used for Servlo8 and as:essmsnt shall be sealed watertight upon
the cornpletlon of seNloe. Any opening deemed unsound, defecNve~ or subJect to failure must
be replaced.. Exposed access openings groater than 8-inches In diameter shalt be secured by
an effective lock(ng device to preverti aax~dentai or unauthorizsd entry Into the tank.
No ono shed •ni+er a septic or other b~wtttrwlt or hvldlna tank l~r
arry mason without bs1nQ la full compllince with CBHAI shnd!arda !hr
etrhriny • conllned apses, The ~dnospha~a w/tlNn thr s+eptlc or other
trwrtr»ant o! holdln~ tank may conbin NthN ~~ and roscue o! a
person >~ ate Interior of the tank rlnsyba dil~oulrf or lenpossi6lf.
Tank abandonment shall be In accordance with Comm 88,33, Wis. Adm. Code when the
tank 1s no longer used as a l'OWTB component,
The soli absorption component serving this structure #s designed to accept domestic
wast4water from a rasldsntlal facility. The limits of operation of this component are shown In
Table 2,
'T'he longevity of a soil absorption oomponent depends great{y on proper and timely
maintenance, and system use with#n or below the limits of roliable operet#on. Oood water
conservation practicx~s by ail oaa~pants and the #nstsitatlon of wa#er conserving plumbing
ftxturos era key factors in extending the useful life of thfs component.
The Bali asbaorptlon component`s apsration must be assessed by inspection at least
onr~ every flues years. Ths tnspec~ton shall include recording the levels of pending, if any, in
the observ>eiton pipes, and a visual Inspectlon for any evidence of surface seepage ar discharge
from the component. On steeply sloping s#tes, areas of erosion should be Identified and
reported to the owner for repair. The surtace discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard,
Trat~c around or over the soil absorption component should be avoided partlc;utarly
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 usuai#y temporary, but Is difficult or
impassible to repair until weather rondltians Improve. M general, soi! compaction over this
aamponent will reduce diffusion of oxygen into the soli and dispersal cell, which may last! to
more Inten9e, end earlier, organic slogging of the soli.
Management Pian for a Septic Tank and 8oi# Absorption Component
F~#antin9a of deep-rooted tress end shrubs directly over ofi w#thin ten feet of the component
should be avoided since root intrusion into the component may obstruct wastewater flow.
Contingency Pian
In the event of system to#lure, a new system could De lnsta#ied in an alternate area. With the
#nataiiation ofi a diverter valve, the existing system could also be reused #lter a period of three to
four years.
it is the property owners responsibility to maintain the altemate area free from any piant#ng of
trees, shrubs, etc. In case of failure of the original system, tf~-ee altemate area will be needed. If
any trees, shrubs, etc. have been planted on the alternate area, they will have to be removed at
y ~ ~~~•
if alternate area is destroyed, there are other alternative systems that can be used, in which,
could r~s~lt in added expense to the property owner,
Any tank abandonment shell b8 done in accordance with Wisc. Coate 83.33. Arty questions
rragardtnq this Dods, pteaa contact your local Zoning Office or contact the instaiiing plumber.
.~r...oNerv~ ~ece.. l~{S~3$ to -' ~ tp$O
~c~~,v,.~-. ~.1E,,...n. 1~l vin, b - ns~ t ~ tS~ 3 ~b b' 3 ~ ~ ~
~ ~... Miller/Davis Co. ° St. Paul, MN 651-642-1,988
~ 117-M-Co radon_ Minnesota Uniform Conveyancing Blanks (1978) _ __-_____.____ .__.
-~'~Q~-_---.....__ ---~..__ __ --------. _ ..-- - -~--------
I
sTaTE of M><NNESOTa ss. Affidavit Regarding Corporation
COUNTY OF - --_-_ _ _ ___. --_ _ __ __ __ - --
and
being first duly sworn, on oath says(s) that:
• _ and the ------ ------------- ---
1. ('They are) (---- he >!s) the - - --------- __---- -- - -- ---- ---- ------ ---- --
respectively, of .- _ _-______-_ _ _ ___._-- Carriage Homes_.XXI,_Inc- _ ------ - -
a __ ___-__ -Minnesota______-_ -_ _ corporation, the corporation
named as ----------------------- _ _ _ _ --- ---~-- ------
in the document dated ___-____. -_-______ ._- -__-, and filed for record --_. --- ----
as Document No. __.______--------------------- (or•in Book --_ of -___-- _.--_-- --------
Page .-------------.--------------------- --------) in the Office of the (County Recorder) (R~E~kOt~~~
of _..--_ .__ _____ _.__._ --_..__ __ St. Croix_._ ._ _ ..--- _---_ ._ .._ County, Minnesota.
2. Said corporation's principal place of business is at . _ _-...._.- ___ _._ __ ------ --
_ _ _ _ _. _.
and said corporation's previous principal place(s) of business during the past ten years (has) (have) een at:
3. There have been no:
a. Bankruptcy or dissolution proceedings involving said corporation during the time said corporation has had
any interest in the premises described in the above document ("Premises");
b. Unsatisfied judgments of record against said corporation nor any actions pending in any courts which
affect the Premises;
c. Tax liens filed against said corporation; except as herein stated:
4. Any bankruptcy or dissolution proceedings of record against corporations with the same or similar names,
during the time period in which the above named corporation had any interest in the Premises, are not against
the above named corporation.
5. Any judgments or tax liens of record against corporations with the same or similar names are not against the
above named corporation.
6. ~ There has been no labor or materials furnished to the Premises for which payment has not been made.
7. There are no unrecorded contracts, leases, easements or other agreements or interests relating to the Premises
except as stated herein:
8. There are no persons in possession of any portion of the Premises other than pursuant to a recorded document
except as stated herein:
-- ~ 19. There are no encroachments or boundary line questions affecting the Premises for which Affiant(s)
(has) (have) knowledge.
Affiant(s) know(s) the matters herein stated are true and make(s) this Affidavit for the purpose of inducing the
'; passing of title to the Premises.
,.
Carriage.Homes,~~e/~7j -- 1i. ~'` ,
Subscribe d sworn to before me this ; ~~. _- --.-
u
day of -.', _.2001_..
_ c~~ q~,~.-~~ , c~o_._ _
I jl ~
DOCUMENT NO. wnnn,AxTY n~tfln
~;• ~I ` ~~~ ~QD ~ I BTATE OF WiBCONBIN-FORM B
.. ~.
+, THI/ fPACE REfERV[D FOR RECORDING DATA
i
__. _
I ._______:..._ __ f ~
'THIS INDENTURE, Made b RICHARD •N. - PEARSON and :JEAN M. _
PF;ARSON...husband • and v~ife - ............................................................................
. •• raptor_S ~ of . St.Croix --• ... .............................................Count-, Wisconsin,
h teb conveys and warFants- to. .CARRIAGE HOMES -XXI, INC_: r a _
M nn sota corporation,
....
..._....~_....._......_.._.........--•-• ...................................... rautee........ of ~
Washington .....~~~~
..._.._ .:....................•---__...---...-----..._.._................._.County, or the sum of .- -.. _ .
Qna_~ollar:-and,•no1100---($1:00)•.and.•other••~ood-_and•valua6le--• RETURN To
I_. .. . - _. ...
_ _ .. ..
the following tract of land in._..~5~:._.CrQlx .....................................•-__-_•---.County,
Wisconsin: .~1~._.4~..~h~..N4ii~~W~iz~..Q~ariier-_-jN~) -.and-.-~lor~h••iialf (N~) of the Southwest
Quarter (SW~) of Section Twenty-Five (25), Township Twenty-Nine (29) .North, Range
Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey
Map filed June 29, 1994, recorded in Volume 10, Page 2782, 5t. Croix County Register
of Deeds, as Document No. 518444.
Ta Witness Whereof the said grantor. S._ haVe...... hereunto set".....__their••,•••••.-• hands... and seals..._ this
- ........_. day of.._ ~aY .............•--....................._., A. D., ~~-_2QDJ.
• ....................... ............................................................(SEAL)
BICiNIDD AND AffiALED IN PRESENCE OF I
i
it - . 1
~ I ........................................................ ....................(SEAL)
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~ ..._ ................. ... ............ M.
.............................................................................................1_ (SEAL )
MinneS~ta
OWNED 9Y O~ERS
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