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HomeMy WebLinkAbout020-1374-18-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420682 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Landsted Homes Inc. I Hudson Township 020 - 1374 -18 -000 CST BM Elev: Insp. BIytE, : BM Description: Sectionrrown /Range /Map No: / 00 , 0 l (J (J v elvl -k' A Pv,-, 12.29.20.2251 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Bench rk 2 / �. / o 2.� /Ob o Dosing . W A J F Alt. BM 5� 3. ( v 3 a` Aeration =Sewer a Holding St/Ht Inlet & TANK SETBACK INFORMATION Sv O et `3 R TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic j ` I 1 (� Dt Bottom Dosing Header an. �, •� Aeration Di Pipe 2. 9to o+ Gta-rh (a• Sq I Holding Bot. System { PUMP /SIPHON INFORMATION Final Grade 3 •g q17 �g Manufacturer Demand St� GPM 3 /^ 6P Model Number TDH Lift Frl oss System Head H Ft --F Force main Length Dia. Dist. to Well T7 SOIL ABSORPTION SYSTEM BED/TRENCH Width ` Length (I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2T r q) SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man acru INFORMATION Ty p Of System: HAMBER r V UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole x HoI Spacin Vent to Air Intake ` _ t ' Pipe(s) J Length Dia Length Lot C ,5 Dia 4 Spacin SOIL COVER x Pressure Systems Only xx Mound Or Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Cent r ( Bed/Trench Edges Topsoil I El Yes No [E Yes E No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: l / CR / Inspection #2: / / Location: 233 Starrwood Hudson, WI 54016 (SE 1/4 SW 1/4 12 T�2�8N1 R20W) Starr Wood Lot 18 �. Parcel No: 12.29.20.2251 1.) Alt BM Description = �Dg Sl I t � �l{' 1OA 16%� r�P S Qe >v\ Z� �Nt�(r 6v% Sa v>ic 2.) Bldg sewer length = 5 - amount of cover =3 i Plan revision Required? L Yes No /- Use other side for additional information. L_ I '�� j _ _� %� G�/L✓✓w lf� SBD -6710 (R.3/97) Date Insepctor's Sign ure Cert. No. Safety and Buildings Division County 1 ** &4�&onsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Site Address Department of Commerce 233 STgt��,ao�p Sanitary Permit Application sanitary Permit Number zo In accord with Comm 83.21, Wis. Adm. Code, personal information you provide (0q 2— may if Revision j ma be used for secondary ses Privac Law, sl5. Y. Application Information - Please Print All Informati State Plan I.D. Number Property Owner's Name Parcel Number 7G0' 02 .0 rs 4.. 1 8 —cxXJ C. Z -() Property Owner's Mailing Address Property Location ? Si ',4; S /- T A `J N, R oc City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number TY. Type of Butt ' g (check all that apply) 4 gab - S []city 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public/Commercial - Describe Use ®Township ❑ State Owned (2 -1) Nearest Road M. Type of Permit: (Check only one boi on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 P9 New 2 ❑ Replacement System 1 3 ❑ Replacement of 6 ❑ Addition to For County use Sy stem Tank Only Existini stem B • ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) LF.4C1ZrVr Gr or�!t s J9,o„io,e�to 44 ® Non - Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedlk /-7 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 11 Recirculating 30 ❑Other V. DispersaMeatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation - / 5V fo 7� 99. VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Talcs Tanks 3;cic or Holding Tank - _ - Dosing Chamber VII. Responsibility Stati meat I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature MP/MPRS Number Business Phone Number ie Pl s Address (Street, City, State, Zip e) I !,/ s VIII. County epartment Use Onl Approved ❑ Disapp ved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner'Given Initial Adverse �► � �_ ` Dere 'on IX. Conditions of Appr val/Reasons for Disapproval l�R l — Le C UMAzD IW.W D C ,4 pet, s w� Atfskh oowp�plans (to the County only) for the system on paper not less than 81/2 x 11 inches In dze SBD -6398 (R. 05 1gl) L07° A9 4A lb R 04 /3za�vsT /.YtzvEwAY �f _ _ �{{ ZAOE� � � p /�Ro/�oSEC WELL .D ECK �I l, S/.�Pt — y n /ff 9 P°An�a �/ �� iQE1Y0EN[E S 1 , vyE�c /moo Tv Ear a8 I / �• y � /vo. 0 SPA` s.v /Y lei STAn��GA�� - rivf��r�ATai2 %lENGti+r'1 VATIO PI ' CONO d Eu r e- A DAT jo � . t -ge I* GHA 166 "f he Standa d In It tar ChaMbE w LatcnN han m N � '4 510 Vi ew _� -- ENecWo length /'� ✓OlZ7N / /'..aloft �� !»,<!L'� --_...._..—_...... �.. ...,...��......._...— �- �- -'--'� �Ic�.7 i � ls'1��� ��. :� � � � t fns,. . �lcsl�uSi 0 I�iZYEWAY Sx�F.z'� r�f� , w /•o /ova A SZOBW/JLK �6 e C k F – O.sa 7 s LvP,_' — f I b I I ,eErzorn�cE � I ` a8 � U ✓ER AfO Tv E•2C7 I +f • LJ Ii ��t�0. oc> SprAF _rev 1Y OA 7/lt. L N �Aw/�A�� .T1vF.z� r�Tvn .%lEniG•vr -f �� .�� fl-LA Pi G P _ .._... DATE IA Aar ✓E / f lvf�' i� f IIIW' _ w `� /`�� ......+.r"""'�" r t R' 1di R Jtt+rc6ss�sa *:.. 99 oc� ,.� Sr - 'The 8tonda d In It for Ch&Mbl§r nnrti n� 510 e r V rc w '� i Zfi Length Wisconsin Department of Commerce SOIL AND SITE EVALUATION l '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 include, but not limited to: vertical and horizontal reference point (BM), direction and ST (� 1 l X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Plea tint aft i Re iewed by Date Personal information you provide may be used for 7 dary purpq* (Privacy Law, s. 15.04 (1) (m)). Property Owner , - L Property Location Govt. Lot -5 1 /4-SW 1/4,S � 2 T Z ' ? ,N,R E (or) W Property Owner's Mailing Address F l # Block# Subd. Name or CSM# / 8 STA>� o �.r City State Zip Co Phone' = ❑ City Village E Town Nearest Road t ew Construction Use: ® Residential / Number of bedrooms ! Addition to existing building eplacement ❑ Public or commercial - Describe: Code derived daily flow Q gpd Recommended design loading rate D bed, gpd /fl CL trench, gpd /ft Absorption area required gW- bed, ft2 �5 D trench, ft Maximum design loading rate O. g g gy bed, gpd /fl ,� trench, gpd/ft Recommended infiltration surface elevation(s) S4A L-) gY,5TCM S ` i� a ft (as referred to site plan benchmark) Additional design/site nsiderations &V.4L.0 A T 1 o0 u"JL iQ� QT A 1 0 IoRVA L Parent material n /sit LW L I /. I - 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 �J S❑ U El SU SOIL DESCRIPTION REPORT - tO6 20a9W #�1 Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench w 1 � 'S f X62 C r C5 Z 4.4 S 3 Ground 7 _ e z� 3 -�— Depth to limiting factor y U' in. 31.2 -/ (-1 Z Remarks: Boring # c)-3 y p23 / SL. C ir CS 2 o 4 o , S 3 Z ' $► 27 4 -- 5� /� s rh t C S vti Ground A"5 1 5. L C db- ft. , C $ �" 3' . �Y� 4 3 S Yq,y n. Depth to limiting �'� f actor in. Remarks: CST Na a (Please Telephone Prin Signature on No ,4 t2VL y �p N NSd� �� � . irs A ss Date CST Number U �& a � S 6 } �° 12-00 2.ZZ� S7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 3 � of PARCEL I.D.# Borin # Horizon Depth Dominant Color Mottles Str ure 2 9 Texture Consistence Boundary Roots .......................... in. Munsell Qu. Sz. Cont. Color Gr z. Sh. Bed , Trench ......... / < 7T 0 Ground 8 '` / Q "lZ " '� �j y M: th Depth to 7' 7 s 9 4 1 -a r" t) 6 8 limiting 86or ao in. Remarks: Boring # Ground Ey ele R 5,4 ft. Depth to limiting or - 7 9 - 7 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 6 -3 IMIA 1 (0 th CS O.S 6 1 2 /d A AS m CS Q 9 -4 /b' ' S 1L M:5 n� CS 0.1 al Ground !� -�, 7 YR J ► L © A 5b k ft. 7SYR Depth to limiting t46 MaTL4 Q f- b - factor > �- in. Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) / �.�. . ^ \u\ � v n ry ��-'-----------------'--�---------_--x_-_____________ "fa J,j , POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Y FILE INFORMATION SYSTEM SPECIFICATIONS Owner - Septic Tank Capacity a l ❑ NA Permit # r p� Septic Tank Manufacturer _ ❑ NA DESIGN PARAMETERS 1O� Effluent Filter Manufacturer - ❑ NA Number of Bedrooms Q NA Effluent Filter Model _ ❑ NA Number of Public Facility Units M NA Pump Tank Capacity al ® NA Estimated flow (average) p g at /day Pump Tank Manufacturer ® NA Design flow {peak), (Estimated x 1.5) 6a O gal/da Pump Manufacturer IN NA Soil Application Rate al /da Ifts Pump Model IM NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L 0 Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Celt(s) d NA Biochemical Oxygen Demand (BOD 530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) I 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: IN NA Other: 2 NA Other: 50 NA NA *Values typical for domestic wastewater and septic tank effluent. Other: --- MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank ® eaa r(s) r(s) s) At least once every: ❑ m ) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume O NA Inspect dispersal cell(s) At least once every: ®yea�(s ?(s) (Maximum 3 years) [3 NA Clean effluent filter At least once every: ❑ month(s) ❑ NA IM ear($) ❑ month(s) 0 NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ® NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) 62 NA E3 year(s) Other: ® NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications; Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third ( Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performecity a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GM4N (4!01) Page _ of START UP AND OPERATION For riew construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process andlor damage the dispersal cell(sl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ceil(s) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. he performance and prolong the life of the wastewater stream may improve t p I' he following e Y P Reduction or a elimination of fo 9 from the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding ank may be installed as a last resort to replace the failed POWTS. g ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure df the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name - o Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER! LOCAL REGULATORY AUTHORITY Name lZ _ Name _ Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(Wl)(d) &(f) and 83.640), (2) & (3), Wisconsin Administrative Code. 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND - OWNERSHIP CERTIFICATION FORM r Owner/Bu er � Y Mailing Address �3 S EClxJ>1 5 i . duL< ,) Property Address � � lIT� (Verification required from Planning Department for new construction) City /State �y �%` �, L.� Parcel Identification Number oz n ' 13�`( -1$- °i'O • � S'I LEGAL DESCRIPTION ' Property Location ,SE %4, S %4, Sec. AZ , T o?A N -R AO W, Town of Zlycub^j - Subdivision ��2 (.JCx�� , Lot # b Certified Survey Map # , Volume , Page # Warranty Deed # 1� 9 ,P.3,9 , Volume Page # ,AS Spec houseV yes ❑ no Lot lines identifiable El 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 licensedpumper 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. Uwe, 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 has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SI ATURE 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 owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. Q SIGNATURE OF APPLICANT DATE * * * * ** Any 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 yp;..1542PAr,E 355 629539 KATHLEEN H. WALSH DOCUMENT No. WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI RECEIVED FOR RECORD 03 -13 -2000 10:15 AM This Deed made between STARRWOOD PARTNERSHIP, LLP, a Wisconsin limited liability EXERTT0 DEED partnership, and LANDSTED HOMES, INC., a Wisconsin CERT COPY FEE: corporation, Grantee, TRANSFER FEE: 1725.00 RECORDING FEE: 10.00 W itnesseth, That the said Grantor conveys to Grantee PAGES: 1 the following described real estate in St. Croix County, State of Wisconsin: Lots 17, Q8 19, 20 and 23 of the Plat of Starr Wood in the Town of Hudson, St. Croix County, Wisconsin; Tax Parcel No. 020 - 1111 -60 & 80; 020 - 1112 -30 RETURN TO: • 11-1# bb / ^ V / 7�1% This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this / day of September, 2000. STARRWOOD PARTNERSHIP, LLP (SEAL) B udith A. Green i (SEAL) AND: Ga . Zappa c �5� — '� STATE OF WISCONSIN ) SS ST. CROIX COUNTY ) Personally came before me this /4day of September, 2000, the above named Starrwood Partnership, LLP, by Judith A. Green and Gary T. Zappa„ to me known to be the persons who executed the foregoing instrument and acknowledged the same, being authorized so to do. i4't "•i! 181 ►4 41r, - .1, Not Pub tc, taWisconsin My Commission (expires): Qfte 4A 7 - Y THIS INSTRUMENT DRAFTED BY: Robert W. Mudge MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469, Hudson WI 54016 ♦ 1 1 F .....11...1.1.....1...1.1. .1111111111.11.111.11.1.1 . 1 1 lflY� yp9�9ltl r • $ uuau •a 'IV`Y0.YS.8 klYj9 01031"N15SV'Zl N011.735lOH N13 Nf1 lM9303NJf - -- aU 3H1 Ol p3�N3H3d3N 3W o o T T r •., ........ /1. . 1 ....1.11.1. 111111 .1.111111111.1...111.111.111111 1� . I P ►o,-W ...... I Npp'5p72'W 279.94' 3 \I I 125.00 ' • 1: .' 1 � � . 1 . ... I.. ......... ... 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