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HomeMy WebLinkAbout020-1342-10-220Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township West Lake Builders I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: iL —a $ AA. t rl -AT10%kl r%ATA MIVr\ INr VIRIVIMI w1% TYPE MANUFACTURER CAPACITY Septic - 3X If Dosing ` [� Yes No Aeration Alt. BM Length Dia Spacing Holding 2, 7si2b I ce-10 ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > t [� Yes No Z Alt. BM Length Dia Spacing Dosing 2, 7si2b I ce-10 ' Bldg. Sewer Aeration is-so St/Ht Inlet S �Z Holding St/Ht Outlet , PUMP /SIPHON INFORMATION Number Ft >OjYABSORPTION SYSTEM W04MQL Length r DIMENSIONS ? f C Z5 County: St. Croix Sanitary Permit No: 395214 State Plan ID N Parcel Tax No: 020 - 1342 -10 -220 STATION BS HI FS ELEV. Benchmark `�• D �ay.sa [� Yes No I ri4. ay Alt. BM Length Dia Spacing 2, 7si2b I ce-10 ' Bldg. Sewer is-so St/Ht Inlet S �Z g8. Ze St/Ht Outlet , Dt Inlet Dt Bottom Header /Man. Dist. Pipe 5 Bot. System Final Grade Lib .fl St Cover S t I.A.L. VrII IVI• -IA PIT DIMENSIONS INo. Of Pits Ilnside Dia. INFORMATION CHAMBER OR v t Type Of System: � f UNIT MoqeI Numbe DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Bed/Trench Center Pipe( Topsoil [� Yes No > r— r J Length Dia Length Dia Spacing SOIL COVER v D-- Q..f c rinly vv Mnnnrl Ar Ot -nrade Svsterns Oniv 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 #1: // 0 Inspection #2: T� Location: 519 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T299NN R_19WW)) Windsor Heights arcel o: 1838 1.)AItBM Description =�� oU�� to � $•Z U S , I 2.) Bldg sewer length = 3d c 1 . z:p = - amount of cover = 2 t q �� 5- ° cc r Plan revision Required? ❑ Yes >( No c o 1 ocher side f�dditionai informa C / n ,w Date sepctors Signature Cert. No. tae. I r - - - - -- - Safety Lad Buildings Davisica+ cour.:y r 241 W. W&$Wgton Avg,, P.O. Box 71522 x �I� Madltots, A'I $3707 - 1162 ; w Address v Mont of C m raa �tq C.ar e ��� �` - u Y �,,,, t w ts * MM y P y� erMlt Applfcatio y _ /�{,.�� j� , � � ' ! W mm W can O.U. k. Ada � pM� i;� Y ��,.:'} 1v�.i t1 M�'if70Q Mn Ieshlwdl00 !elrt A11 v D. I+ ur bet po - -- -- ved O Domed Fie) �� od ) M C> otAppreue�l/Aoaeau for Diu►pye+wal 7 �� h r>~c�uwk�t dwri t+t`t w It^P evl t �w. `n^�UoLr, ►v)l�ncc�(fl Uv �o cc'spl� Zl�� . ►tint �onc,' '' ., , 1 _ '" �' rs :3AIl S08 M. 05101) j ,` !r' � � a•. Z. .183Q� .._... Proww Owaer'e MoMm AWM CPO, , i , PAY I Md it l x it •... ,,•,.••• ••••• , Clap. 8taq zip Code N ` - r � Black Nwobor WWv n aao GSM wax . Type of SWIft ( dl that aPpl') j 1 of Z PwaO DwelWS - Numtwr pf t;iedt+oome ...,. O IL Qv SS' 0 PubltotGb>saat nw - Dow be Uw So ./ {� S" Owned ZVYleK a piaoQ III. Typo of Pe ;hi (Mok W ono box an A (P=btn4U edwM for iat m). Complete 9w 8 it appllabtb) A' 1 )stow Z 13 � � S 0 ltepltcemeat et d M Addwm m et► we -Tug only D. D Ook it lbaitW PlMdt W"lowty UVJM t Numbet Wdol S 7 " 60 -- �-- ~'-• —� Issued W — . T* of rw eppi9)�wft scheme A For lnternei rx0 "*MM 4MW9W 14-* MW IID MMW el U k-W For SO o Cottatructod Vletland � 22 G' Pratttrw Ist• mmw 41 t;aMbIg Ttaie a ❑ Siasle Put n Drip Lim � 45 L7 m4rw 46 © Aetobfa Teega nt Unit 49 31eolrat1l 30 Other be (A 00 V. Rlw=no am WOMM MU Ded6rt AM Ares nnA�,,,,,�I..d� Awleedea ale an SY alevttlott ! Ittaat Grade Attr(Ot1b1l3ttyeJ (Min.11ncbl i I3le dA 1'"�"" � i � ly' X66 �aav Iaee _ �- � � g n Tads q' ?aati Number owl= d Tab i adsstuiacmter Pre C,oaereto Cetttweted Suol , Fiber ; Pltstic Qlaas i �' BZsbitWep� tlrs tta>nnm� feu' ZLWT3 thon w tise ettw5s+d '"� Iiuebtaes Pbane Number e -55 �- u G� 7 7"' 5'- 3�G- ved O Domed Fie) �� od ) M C> otAppreue�l/Aoaeau for Diu►pye+wal 7 �� h r>~c�uwk�t dwri t+t`t w It^P evl t �w. `n^�UoLr, ►v)l�ncc�(fl Uv �o cc'spl� Zl�� . ►tint �onc,' '' ., , 1 _ '" �' rs :3AIl S08 M. 05101) Gr/ti°5 ��a��u��GC ieL S .0 d 1�' l✓, , GG�,� c rrll` 1�E'i� � ,7�� z li 5ke[ pine J _ too` 7 1 a d� AT A pro S U 1 N &M r � ter" Wisconsin Department of Commerce Division of Safety and Buildings Sureau of Integrated Services in a Attach complete site plan on paper not less than 81/2 x include, but not limited to: vertical and horizontal refer percent slope, scale or dimensions, north arrow, and 14 APPLICANT INFORMATION - Please prli Personal information you provide may be used for secondary SOIL AND SITE EVALUATION o ce With s.�:ILF`>ZR 83.09, Wis. Adm. Code inches i 1z� ust'�.�'1 County i point (Bl,�flir�" idand of and distance to nearest road.. Parcel I.D. # '� nforma&AOCX R '' ewes by Page � of Y 'L f' r / f 0 of 1 1/4 1 14,S T ,N,R E (or� Property Owner's Mailing Ad ress of # Bloc Subd. ame or CSM# City Statt Zip Code Phone Number ❑ City Village ❑ Town N rest Road ® New Construction Use: © Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate • _S_ bed, gpd/ft gpdffi Absorption area required bed, ft trench, ft g g ,= g p� � � �— Maximum design lo rate - bed, trench, g p Recommended infiltration surface elevation(s) �-�`Y ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable A1 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system I ® s ❑ u ® s ❑ u ❑ S ❑ u ❑ S ❑ u ❑ S [z II I ❑ S 01 U Boring # Ground elev. 9Z2-ft. Depth to limiting factor }_Y Boring # Ground elev. 2&2-ft. Depth to limiting factor 7 ?-,/ i. SOIL DESCRIPTION REPORT Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 Bed , Trench a r Remarks: Ramnrlrc- CST Name (P as Print igna a Telephone No. Address Date CST Number PROPERTY OWNER PARCEL I.D.# Boring # El Ground elev. , �Z�ft. Depth to limiting factor �in. Boring # 1 Ground elev. !&Lft. Depth to limiting factor W4.6-in. Boring # Ground elev. n-L-ft. Depth to limiting factor �>.&�in. Boring # Ground elev. ft. SOIL DESCRIPTION REPORT �' No- . Page of 3 Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 2 Bed , Trench 1 J - AIZ s , fo Loc. � by Remarks: J =n'��� ®� Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP /ft Bed , Trench J - AIZ s , fo Loc. Depth to limiting factor ' Remarks: 8 r� q SBD- 8330,(R. 07/96) J`/uasa.� G�l,� sy��� �d �,F,�cf/ /1��n! � m � / s�,ra� adz _ � /LYld � G uanu f t 2 w cd • , Cl 1 .0 • r a • � 11 "1 �I�II I S • .5 a ro � r� 3� L � y c� �— r Z G uanu f h t 2 w cd r Cl t�l ll .0 • r i i'rJ 11 FA • � 11 "1 �I�II I S • h s 3 e r 3� X� t 2 w cd r Cl .0 x r Vi U � i� .5 a ro � r� 3� L � y c� �— r Z d � -��CD u -oz� U _ x x t x v a A o m gym: s 3 e r 3� X� w cd O C � i� .5 a ro r� 3� moo ma�g. Z d -��CD u -oz� IL x a o gym: q �[ • N 9 • �e T ¢ IICC ID � •� �• 3 go 0 S N s ra i f s„ w cd O C � i� .5 a ro W E moo ma�g. -��CD u -oz� IL • 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). L� i aoie i : system Design Specifications Sanitary Permit Number 3gsu Number of Bedrooms 150 Design Flow - k ( pd) food Estimated Flow - a e g d) Se tic Tank Capacity (gal) 21 sorption Com on Soil Absorp Size (W) y� Type of Wastewater Domestic Table 2: Soil Absorption Cmmnnnan# - I irni+a .,f Design Flow -Peak (gpd) Maximum Influent Particle Size (in) Septic Tank onent Soil Absorption Component 1/8 8 Maximum BOD (m /L) 22 Maximum TSS (m /L) 150 Tahla 3• RAtain*nnsrli.mh Qr.Me..1..1.. 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. The outlet fitter 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 Soil Absorption P rp ion 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 altemate 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 Wise. Code 83.33. Any questions regarding this code, please contact your local Zoning Office or contact the installing plumber. .Zo N► N L4 to 8 O Sck� v..r�, o..ka.R � �. v�.,;r+ b ► n+c� (l t S� 3 � b' 3 1 � t ST C ROIX COU NTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM. 0 ner/Buver _ ���� Zct K'-. as,tL tri T '. -- -- —.- -- Mailing Address _._ 7 TyIe►� N /cJ! Property Address (Verification required from Planning Department for new City /State __ 'jjg g �i Parcel Identification Number LEGAL DE SCRIPTTON Property Location ,�� ' /., . ,l/Gr� ' /., 5cc.� , 'i'� N-R—ZY Town of 4� s � , Lot # Subdivision �t� i st� K -As Certified Survey Map # Warranty Deed # Spec house ❑ yes). no Volume Page # Volume , Page # Lot lines identifiableX yes ❑ no SYSTE MAT MLENANCE 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 tluee years or sooner, if needed by a licensed pu riper. 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 attd by a rnasterpltimber, jouruey-man 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 ahldge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the sttnd3rds set forth, herein, as set by the Department of Conunerce acid the Department of Natural Resources, State of Wisconsin. Cerfification stating that your septic system has been maintained must be competed and returned to the St. Croix County Zoning Office within 30 days of (lie three year expiration date. 4cwy� SIGNATURI O A:PKICANY DATE W es + " t3 ll. -r �c O CERT If14ATIOv I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) the of the property desctibcd above, by virtue of a warranty deed rccorded in Register of Deeds Office. SIGNATURE OF APPLICANT � �llti�S DATIE • `� "* Any information that is mis represented may result in the sanitary permit being revoked by the Zoning Department. • " "} •" Include with this application: a stamped wartanty deed from. the Register of Deeds office a copy of the certified survey ntap if reference is made in the wan'anty deed STATE BAR WARRAZ*M DEED DOCUMENT 2 - 1982 j �^y DOCUMENT NO. i I,, /� I PAU 061 Mary K. Kral, a single person, conveys and warrants to est La e Hail rs, ne. a Wi Gr.nnsi n _t ==r_ ti o- IEGI::' 'irk`;. aZ MIX CO., W1 Pled fro Ream FEB 3 1997 5 fit y 10:00 A. M Reytatx of Dwtdi the fdkrwing descnbed tea', estate in St Croix County, State of Wisconsin: (See Attached Exhibit "A ") THIS SP CF AESERVED FOR R DA NAME AND RETURN ADDRESS✓` _ II L //jjj , g*4w ,r,�'i -� 020 - 1093 -10; 020- 1093 -60; i- Et EN ICA N NUMBER $ OS R This i s homestead property. (s) XMU Exception to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this __ day o(— January A.D., 19 (SEAL) YY1 kA- H R `(^ * *I (SEAL) Mary K. Kral (SEAL) AUTHENTICATION Siswute(s) authenticated this day of , 19 r TITLE: MEMBER STATE BAR OF WISCONSIN (if not, authorized by V06.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY AtrnrnpV Kr_ictina Qg:Jancl _ Hodson, WI (Signatures may be authenticated or acknowledgrd. Both are not necessary.) ACKNOWLEDGMENT ZIPAL) State of Wisconsin, ss. St. Croix Personally came before the this _( day of Ja nt]ary 19 -U_, the above named M= K. Kral, a single persQu, person who executed the foregoing ledee the same. to me known to • ivy Notary My (if not, state County, Wm ( 'Names oC 2crsons pin; in any caps city should by typed or printed below their signatures. WARRA v CY DEED STATE BAR OF WISCONSIN VtM1Y orw LOW Co, k - r — F GVM No. 2 - 1982 MM ullft, VAS. • vv, rIL I ¢ACIM EXHIBIT "A" q "`� •'� SE1 /4 of NW1 /4 EXCEPT the South 66 Feet of West 660 faet thereof and EXCEPT the East 3 -1/2 rods of .South 20 rods thereof and EXCEPT that part lying Ely of O'Neil Road; The North 66 feet of East 678 feel of NE1 /4 of SW1 1 /4; Part of SWI /4 of NEi /4 described as follows: Outlot " 1" of Certified , :;;rvey Map filed October 15, 1980, in Vol. 0 4 ", page 1001, Doc. No. 357079. All in Section 32, Township 29 North, Range 15 West, 9... Croix County, Wisconsin. Part of NE1 /4 of SW1 /4 and part of SE1 /4 of NW1 /4 of Section 32, Township 29 North, Range 19 West, St. Croix County, Wisconsin, described as follows: Commencing at the N1 /4 corner of said Section 32; thence S0 (bearings referenced to the N -91/4 Section line of said Section 32, assumed S0 "E) 2698.18 feet along said 1/4 Section line to the point of boyi__ ^_:ing; thence continuing S0 0 12'40 "E 35.40 feet along said 1/4 Section line ;' thence N89 0 57 1 50 "W 678.01 feet; thence N0 0 16 1 48 "E 132.48 feet; thence S89 0 37'30 "W 647.66 feet; thence N0 0 05'05 "W 19.24 feet; thence N89 0 09 1 26 "E 660.06 feet; thence S0 "E 66.01 feet; thence S89 0 09 1 26 "W 12.09 feet; thence S0 0 12 1 40 "E 66.00 feet,; thence N89 0 09 1 26 "E 678.04 feet to the point of beginning, TOGETHER WITH AND SUBJECT TO A non - exclusive easement for ingress and egress as described in Quit Claim Deed dated January 12,. 1987, recorded January 15, 1987, in Vol. 0 716 ", Page 200, Doc No. 421395. t w z