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HomeMy WebLinkAbout020-1342-10-170/* wj@=.w1Ogw&mvafcommeroe sdeV end euj&W Ws>on PRIVATE SEWAGE SYSTEM INSPECTION REPORT C%ENE fbkL INFORMATION (ATTACH TO PERMIT) Pwsa,er kltorrr *m you provloe may be used for secondwy pugxmm IPdvacy Low. s. 15.04 (1x Peomit s Name: 0 C ity 0 vilW Q Town 0i: Hudson TnwnsW WNFAMIN11,195 Chu Insp. BM Elev.: SM Descnptan: 1j%nm rrVrVi%m!iI swim i TYPE MANUFACTURER CAPACITY Septic 6 O Septic > 3s -7, To at 7 ton Length NA Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. ve Air 'hake ROAD Septic > 3s -7, To Is"' Length NA D Bldg. Sewer NA Aeratio . SYSTEM TO P/L BLDG WELL LAKE/STREAM ing Man u A 3 • YS Z - S' PUMP/ SIPHON INFORMATION urer BS PTDH Model Num ELEV. TD - ft friction I Loss ea BED /IrRENCO amain Length Dia. D SOIL ABSORPTION SYSTEM i --, ,/ i ELEVATION DATA STATION BS HI FS ELEV. Benchmark NO. Of Pits 1"side Dia. Liquid Depth BED /IrRENCO width Alt RM No. enches Bldg. Sewer DIME IONS S Ht Inlet SYSTEM TO P/L BLDG WELL LAKE/STREAM Ht Outlet Man u A 3 • YS Z - S' M y um rte/ ��(fwr �✓ INFORMATION et Inlet- Header /Man. p' PZ � , Dist. Pipe '44 A 11 i/9 .7th �41r 9 Bot System rz. C r e 3ror Final Grade O / .441 7-ll 9`... INISTRIRUTION SYSTEM Header / ani o Length _ 2 / Dia. L Distribution Pipe(s) r Length a,zs Dia. spacing x Hole Size x Hole S A) Vent To Air Intake /U PIT NO. Of Pits 1"side Dia. Liquid Depth BED /IrRENCO width No. enches 3 DIME IONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM G q Man u yPe > 106 , 1 >�00 M y um rte/ ��(fwr �✓ INFORMATION System: J INISTRIRUTION SYSTEM Header / ani o Length _ 2 / Dia. L Distribution Pipe(s) r Length a,zs Dia. spacing x Hole Size x Hole S A) Vent To Air Intake /U Bed /Trench Center :!L& Topsoil Q Yes Q No Q Yes ❑ No 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 Q Yes Q No Q Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspe # 1: P / Z�j O� Inspection #2: Location: 504 Carriage Lane, Hudson, WI 54016 Heights -Lot 17 1.) Alt BM Description = �+'� •� c s��`"� 2.) Bldg sewer length = 14 - amount of cover = ? /If Plan revision required? Yes ❑ No Use other side for additional information. SSD-6710 (1.8/97) V. (NW 1/4 NW 1/4 32 T29N R19W) - 322 Windsor / 3. � , Jas �ti t 1�1�G+ %►ti2�L �.11f� -4 ft. voLL tom, 4 -) lYV O`( e1gli• e.A d,, WcS cfes�y��r tise� a.55aw,et{ 6.r.;•. 3 2 / (2,_�,. - - _j LL&M pne Inspector nature Cert. No. .er✓tce fres&eKey j awl con9?�cv►f�Y l!peA py"'Y ekes P I Wn ,, 4k 9 Wo o f 44, ;k, Je_,, Al, �G Qi .' bi C40-94At & b4piE 201 W. Washington Ave. Sanitary Permit Applicati0n PO Box '7102 In accord with Comm 93.2 1, Wis, Aden. Code Madison, W1 53707 -7302 Deglartm�nt at Camma Person al information you provide may be used for socondary purposes (Submit completed form to county if not (Priv L s. 1 3,04(l ) (m)] - _ state owned.) Attach l ate lava to the coon only for thus rn on Were lass then $ x i l inches in size. � County State � Number C1 Chock if taviaiou to pnioua application State Plan I. Lp. j�ttJnber I-VI T z'Y x L u,atlOn totorrm�:tion - Pk Print all I ermation Pr wly ()%&W Name Property l,oastinrt _ lx taut Ptapertr owner's Mailixf Addrfts T lot Ntanlxr s Cil ta�� lip code _ haut Number Se1mvisitn Name err cSM Number 11 Type of Building: (ebeek one) C3 Village I or 2 (Family Dwelling — No. of Bedrooms: � W Ttnvtt of Q PubSic/Canrraerciat (describe use): ❑ State -owned Ill Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. ^New System f 2. 0 Replacement 1 3. © Replacement of 14. 13 Addition to Parcel Tax Numtw(s) S Tank Exi system V $) Permit Number Dale larlue d D A San 4q P+amit was viously issued g? IV. Type of POWT System: (Chock all that apply) , - pr 1 , D Mound 0 Sand Filter Q Corxs"ctcd Waiand Cl PrWairiacd In- ground D Holding Tank Q Single Pass O Grip Lippe 0 At -grade ❑ Aerobic Tnsotment Unit Q Recirculating D Other 3� 5. `d s i ✓� ,ode y� o r s � �'` � V l/Treatme it Area Information: 1. Design !lane (gpd} 2, i}i A !?taperer 4. Soil Application S. Percolsriaa Kate 6 System Flevation 7, Finat Gn4e Reytrirex3 l Proposal (o(.�O'•S Raw ((lalaJday /sq. R) (Mirr.hrrah} evxtiar► � d. �a VI Tank Capacity in Total 4 of Manufacutrer Prefab Site Simi Fiber. Plastic Information Gallons Gallons Tanks Con- Con glass New Existing ' crate slructed Tartfcs Tanks a D a D VII Resporisibility Statement the turderst assume r ponsibiliti, for installation of the POWTS sho the attached tans. pl y Name (per) E'itrmt�er's 4ignadtre {tie stamps): S No. Husm"s Itl Me NUMNOY l/; a ►2i S,,�i�,��p� ,�1 - -�r� ._ ..._ �79�i'� _ 7� �G- 3 �a2 Plumber's.' S{ , City, State, Zap uc3c) VIII Comaty/I " rtm►ent Use Only ed Sanitary Permit fee (Includes Grouadwster Date Issued Issuing Asen t Signature (No stamps) �.. � � AApproved 13 Owaa Given Initial Adverse Sure a Fee) iJereemination 295-- 26 2eo� nn IX. Conditions of Approval /Reasons for � pprovah S& .z x �� '� �T( �� 0�4 vwu.�� loc. �uur+- -�o s x►1_ t {eg U60 �`` O .C8,4,14W �- c1� � Its tt� �,,.�.. �1Lr�LYAVN1a•,�IL . C�-�.- � � -r s ��- -�.�t^ - K.� A �S _ r _ r - ; 6eL¢_ TV XA "U6 aagfrl ter: rte � x is `Wisconsin Dep artment of Commerce SOIL AND SITE EVALUATION Division of Safety Buildings - ,-- -._ Page and _ -- Bureau of Integrated Services in accordan with t.1LHR9, Wis. Adm. Code of Attach complete site plan on paper not less than 81/2 x 11 i in i County J include, but not limited to: vertical and horizontal reference BM), d � percent slope, scale or dimensions, north arrow, and Iota ' distance to nearest road . Parcel I.D. # D EC ; '7 `:= APPLICANT INFORMATION - Please print ti CROIX Reviewed by Date COUNTY Personal information you provide may be used for secondary pu l� ;� �� f i .p 7. • `' Property er `x' Pro on i �L Gd 1/4 6d 1 /4,S T ,N,R Y(orw Propbrty Owners Mailing Address # Block# Subd. Dame or CSM# MM I -5 t City State Zip Code Phone Number ❑ City 4illage fff Town cm.� Nea Road J3 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement H Public or commercial - Describe: Code derived daily flow er gpd Recommended design loading rate - , - d : — bed. gpd,* trench, gpd* Absorption area required gy bed, ft _ trench, ft2 Maximum design loading rate . , bed, gpd4F , "' trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent materia Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S El ® S ❑ u In - [9 S❑ U 0 S 1:1 u [:3S O U ❑ S 0 u ) SOIL DESCRIPTION RE / Remarks: Zz_ in. Reryiarks: i •s .s •S . Y . CST Name (PI se P 'nt) \ Sig ture Telephone No. ZZ Address 1 Date CST Number Dominant Color Mottlesm e ,- MM Remarks: Zz_ in. Reryiarks: i •s .s •S . Y . CST Name (PI se P 'nt) \ Sig ture Telephone No. ZZ Address 1 Date CST Number PROPERTY OWNER PARCEL I.D.# Boring # 1 „ Ground elev. 4 2 - 111 ft. Depth to limiting SOIL DESCRIPTION REPORT Page -IZ2?— of Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Consistence Boundary Roots 2 Bed , Trench J Sh. 3 t d o s Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ Bed , Trench 3 o s fa or in. Remarks: Boring # El Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) �S •S .S .S .s .S GJ 4 s -}/o/4 il � v/ 311'-3 I---- /;;,�) /-,-/ PtiAV- ,< jo i es -, 3 G i ° ✓� �kpb� td Z" - � 'j.. � /, �/, � 0 a 67 � 7 F I 4o - r le iIJO� Se e S O �a`�D cJ vo ,r 3 sf bile- � a y S N V r^ 1 i l �✓� mo as ? Fqe� 3ja.?la/ 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). Tfatiio 4 • Cvatam nesien Specifications Sanitaiy Permit Number Number of Bedrooms 3 QD Desi n Flow - Peak ( pd) Estimated Flow - Average ( pd) Septic Tank Capacity ( al) Soil Absorption Component Size (ft') Z — r ' Type of Wastewater Do estic u Table 2: Soil Absor tion Component - Limits of Reliable Operation Septic Tank Component Soil Absorption mponent Design Flow - Peak ( d) 2_ Co "a Maximum Influent Particle Size (in) 1/8 Maximum BOD (m /L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Sc Outlet and/or service once ever, once a year and clean at once every 3 Septic Tank 2. O f— Z -I once every 3 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 . c tan and outlet filter shall be assessed at least once every 3 years by inspection. outlet flte shall be cleaned as necessary to ensur proper operation. The filter cartridge should no be removed unless provisions are made to ream 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 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be installed in an alternate area. With the installation of a diverter valve, the existing system could also be reused after a period of three to four years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc. In case of failure of the original system, the alternate area will be needed. If any trees, shrubs, etc. have been planted on the alternate area, they will have to be removed at property owners expense. If alternate area is destroyed, there are other alternative systems that can be used, in which, could result in added expense to the property owner. Any tank abandonment shall be done in accordance with Wisc. Code 83.33. Any questions regarding this code, please contact your local Zoning Office or contact the installing plumber. FROM : WEST LAKE BUILDERS INC FR}X NO. : 715 3069870 Mar. 23 2001 09:57RM P1 41 %-ELUL ■ a.vv • I v� TANK mA1N'rI;NANC� AGR ' ' c' AND QVVN$R.SHIP CF,;RTIFTCATION FORM It C� owner' hsail'uig Address - Property Address _ Cf (Vetificsoon required frarn Planning Department for ro4w co nstructiosij City/State _ -_� Parcel identification Number W--- --�-�- r• Town ef 2 rWL-X1 property Gaantiort. Subdivisions 1 5 llr�`z- -__�.- Gct; tified survey htap # _ r , Volume .�_: -_-� Page # ..._.�..� --- -_• D eed #� Gy Volume Warranty U .._ $pet; house ©yes)'Iffrcto Lot liner identifiable $ yes 0 no SYS A hiA AE UNC; Improper use and rnai.^.teaaaceof y*tjr sz e '' ncs�if+aeedtd prem a eased pumpero�vh3t you put rlta aoni9sta of purtipirtg taut the sc ptit tank every tLu y ears or soo can arfect tba function of the septic rank as a tre;j=etit Stags in tlta waste disposal systctu. Z7 +e property a:trter sartcs to subbit to St. Croix Zoning Departrttaat a certlficatian form, sign d by the owecr ant by a MUM plmber, jourueymmn plumber, re st r icted phariber or a licer„ °ed Pumpervcrifyiag that(,) thr: s is less t t}ta!! 1/3 full of sla! is lit proper oporating condition ardc -'or (2.) after inspection sod Pumping (if ue..cssar)•), septi V e, the undetsigned have read the aboYe regairemcatt and agre t0 trtaLntato the BAtCaI RGSOu 9,, S Ste of WiscO t Cer tfi ztioa ;et fortis. he,reitt. as set t y the Departatent of C+s,rurtatea and the ptpartir�tmt of N statitzg that your Septic systetto has been maintained must be eorst( *eted and to tltie St. Croix County Zon gfCicc within 30 returned days of ire thrce yoar. xpiratien cute. f '�.L . L' ,' n QATR (G , A OF APPr t+ s T O'I'tYi,,, C IF�,C,�ATI _ , knowled e 1 we) a;,, {ere) tlta o" -ner(. of I (eve) Certify that att sts`en`unt t on a t bis dCCd� [C�R[� t c ST F�dSister of t pceds L�!fice, { the p operty <iestr*cd,#bove. by sz tNATt, A� rtirra,yi.���� •* +••� Any information that i3 rntis ccFtcaentsd may rasuit ill the sanitary' pernit being virvoked by the Zonisig Dipartnicrt. •'•'�' ,• (nttxitic a'tih ttrtx appticatiot = ; of the ctr survey ��nwGti i�f r ee nisde u a co;ly 4 fi t tltc wan 'anty deed Vol. 1605PAGE STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED I This Deed, made between West Lake Builders, Inc., a Wisconsin Corporation Grantor, and (*!Ft' b. Wiesemeyer and Kendra J. Wiesemeyer, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot I , W indsor Heiehts in the Town of Hudson, St. Croix County, tsconsin. Recording Area 1&41 C)21 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03 -22 -2001 9:30 AM WARRANZY DEED EXEMPT I CERT :COPY FEE: COPY FEE: TRANSFER FEE: 233.70 RECORDING FEE: 10.00 PAGES.- 1 W Name and Return Address EAGLE VALLEY BANK, N.A. 1301 Coulee Rd Unit 2 Hudson, WI 54016 020 - 1342 -10 -170 Parcel Identification Number (PM) This is not homestead property. 0$) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this / �P -11=1 day of March 2001 AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. k County ) authenticated this day of *' mac` % Personally came before me this day of 'March 2001 the above named . a4 K o F • West Lake Builders, Inc. by G" , [t's LJ T C Q Z S i rQ TITLE: MEMBER STATE BAR OF WICSII� to me known to be the person(s) who executed-the foregoing (If not, instru ent and acknowl dged the same. authorized by § 706.06, Wis.,Stats.) " r THIS INSTRUMENT WAS DRAFTED BY ' ov�c-'-"- Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 3 1 t ' a-w ) ) Fond du Lac, WI an m c company 'Names of persons signing in any capacity must be typed or printed below their signature. Information soo.6e5 STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1999 West Lake Builders, Inc. 22 1.056 ACRES I 45,989 SO. FT., ' ) 03 N 85158'5 2 6.63 —� 1 o. 1.061 ACRES '/ / Y � 5,221 SO. FT. or 3a. JK /• �� / c '� PUBLIC / 17 "E / V • Y , 34.97 = • • ,�•�,�"� 1 . \ ` n 1.195 ACRES , 60,745 SO. FT. 56 ACRES •50 SQ. FT. r.'— — — 1� A V 2 1 LZ 2 . . % (V • • • ' fir • • 1.013 ACRES r \ 44,116 SQ. FT; - � O bi >9 1.150 ACRES • 50,102 SQ. FT. `\ 1.456 v ACF 63,434 SO. I -- 613.56' - - -�\ I U 0 I I 0 I N in I O M I 1 � I (n ` � I I (Y+1 h1 1 1 133 ` I IW W1 i 1 I U i I o I ( I S 88'49' 43" W 12.50' II I tJ I----- -F- - -, I I I O O 1 I Q Lo O M O "� 1; •I \• M ►7 . rn 1 � Lo w 100' IK b I �L. a� N N w t' 33' i �. L7 ; —. " 89 W 672.89"--. -- • - -• -- :ANDS �' RECORDED I VOL PG. 200 201 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. I 1" — 1 nn' NUMBER DIRECTION DISTANCE L2 S10'36'1ON 1.076 ACRES _ 46,885 SQ. FT. I L4 N40 "F 86.33' C-4 J 85'32'06" •E_ r� — 269.45 100' I z 20 ' • 1.013 ACRES r \ 44,116 SQ. FT; - � O bi >9 1.150 ACRES • 50,102 SQ. FT. `\ 1.456 v ACF 63,434 SO. I -- 613.56' - - -�\ I U 0 I I 0 I N in I O M I 1 � I (n ` � I I (Y+1 h1 1 1 133 ` I IW W1 i 1 I U i I o I ( I S 88'49' 43" W 12.50' II I tJ I----- -F- - -, I I I O O 1 I Q Lo O M O "� 1; •I \• M ►7 . rn 1 � Lo w 100' IK b I �L. a� N N w t' 33' i �. L7 ; —. " 89 W 672.89"--. -- • - -• -- :ANDS �' RECORDED I VOL PG. 200 201 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. I 1" — 1 nn' NUMBER DIRECTION DISTANCE L2 S10'36'1ON 232.44' L3 S6257'00 "E 70.00' L4 N40 "F 86.33' I 641 rr DI1 1 i o N1 I I 1 i 1 N 8'49'43" E I -4; 4 57.7 SE1� OF THE NW1 /4 w I r ' J - -- z to � ;n ao t r _) O D N L I N I W O CC I Z ' in o i cn c C