HomeMy WebLinkAbout020-1374-25-000 ST. CROIX COUNTY ZONING DEPART \
AS BUILT SANITARY REPORT ��,�
Owner Arr , +Y l'%it �
/
Address Dona V to
City /State sic
Legal Description: Y ; - 0 j' \
Lot &? Block ' Subdivision/CSM # 1 5s_Ite? wa,0 6
'' /, S'4E %, Ste Sec. - 2 , Te,N -R 0 W Town of go, PET
SEPTIC TANK -- DOSE CHAMBER - TANK INFORMATION:
Tank manufacturer Size ST/PC / Setback from: House �� Well I 4f ' P/L :Sr
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM:
Type of system: Tp'oc /a Width 3 Length g .'7�' Number of Trenches _e2
Setback from: House /? Well -? 'P/L 35's Vent to fresh air intake / 70 '
ELEVATIONS
Description of benchmark �7�i �� �� � .� g ��� Elevation »n °o
Description of alternate benchmark ®,-,,ep6 j �� c � Elevation
Building Sewer / 34,' - 29' ST/HT Inlet 13G • 4; I ` ST Outlet /3 3� X PC Inlet r
PC Bottom Header/Manifold T3. /a Top of ST/PC Manhole Cover 1 31 •a? '
Distribution Lines () �!'�• g� (IQj �'j�2. ( )
Bottom of System o
Final Grade (4 �G .fib ` (�') �', ° o
Date of installation A k Permit number 38 ?9 State plan number
Plumber's signature License number �_ ? ' Date 4 - / o
Inspector 4 �—v / n1
Complete plot plan ar
NOTICE: Please provide the following:
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark, if applicable.
PLAN VIEW
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INDICATE NORTH ARROW
Wisconsin bepartment of Commerce PRIVATE SEWAGE SYSTEM Count Croix
Safety and Buildings Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanita o.:
Personal information you provice may be used for secondary purposes [Privacy Law,)9.15.04 (1)(m)).
ILeg"*HeMtIwe: ❑ City ❑ V Rono wns ip State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel �.
TANK INFORMATION ELEVATION DAT
TYPE MANUFACTURER CAPACITY STATIO BS HI FS ELEV.
Septic ;' �� �ZSD Benchmark (S" IIS�) n ,p
� 's
Dosing LA 0.3 ' s — �' • ZS'
Aeration Bldg. Sewer
Holding St/Ht Inlet � Z - 37- 13 - 4 . Z9
TANK SETBACK INFORMATION St/ Ht Outlet 3 . 04 r
TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet •�--�
Air Intake
Septic "S / 20 / NA Dt Bottom �
r
Dosing NA Header / Man. -kews L
Aeration NA Dist. Pipe 7 •
Holding Bot. System q.00 S&
PUMP/ SIPHON INFORMATION�t
anufacturer --- and s Q 0.2
M el Number GP
TDH Friction System TDH Ft
L oss Forcemain Len Dia. I f Dist. To
SOIL ABSORPTION SYSTEM ((,�-)
BED/TRENCH Width r Length N . Of Trenches PIT No. Of Pits Liquid Depth
DIMENSION 9 -1S 2 ) 1 DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING M n�fagturer:
SETBACK f
INFORMATION Type O C�swn1 3 1 �� OR UN T CHAMBER Mode Number:
System:
DISTRIBUTION SYSTEM 6.9 4. S• P/L)
Header /Manifold Distribution Pipe(s) x Hole Size �Hoiep�acing Vent To Air Intake
i
Length � Dia. Lent y /�
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 InS ectio #111 Yes/ D/No In S eCtIon #21 No /
L 0MMENTS: ( Includecodediscre ancies ersons resent etc.
Location: 215 Starrwood, Hudson, WP 54016 (NE �/4 W 1/412 T29N R20W) - 122 202258 Starr Wo
Lot 25 t
1.) Alt BM Description r T� -
2.) Bldg sewer length = ,� z.o
- amount of cover = .d
3 Z -{o
�. v Z,. �s� 3`p "T- /
�g = Z z..z
Plan revision required? ❑ Yes P<No
ion.
e o her side f r additional info
�"""� 1 t I pector's Signature Cert No.
L 1
2 (S ST Sanitary Permit Application Safety & Buildings Division
t In accord with Comm 83.2 1. Wis. Adm. Code a 3 g � 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
iSCOnsin Personal information you provide may be used for secondan purposes Madison, WI 53707 -730'
Department of Commerce (Submit completed form to county if r•
[Privacy Lau, s. 15.04(1)(m)] state ovine:
Attach com lete plans (to the county cop) only) for the system. on paper not less than 8 -1/2 x I I inches in size.
County State Sanitary Pe it Number ❑ Chec ro evious application State Plan 1. D. Number
C¢o (X �'
I. Application Information - Please Print all Information Location:
Property Owner Name Progeny Location
/Y . y St 114 jn/1/4. S T ,N. (or)
Property Owner's Mailing Address n n Lot Number Block Number
-2vo o _
C -
ity, State Zip Code PhoneTlt OFrO Subdivision Name or CSM Number
II Type of Building: (check one) ❑ City
® 1 or 2 Family Dwelling — No. of Bedrooms: P ❑ Village
❑ Public /Commercial (describe use): IN Town of
❑ State -owned
III Type of Permit: (Che only one box on line A. Check box on line B if applicable) Nea Road
`
"-.a A) 1. ® New System 2. ❑ Replacement 3. ❑ Replacement of 4. El Addition to Parcel Tax Number(s)
System Tank Only Existing System O U - "
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued a?. O 2; 5 V
IV. Type of POWT System: (Check all that apply)
® Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade / ❑ Aerobic Treatme t Unit ❑ Recirculating ❑ Other:
3 K 7 -1, 7S- 4 "&Me. a
V Dis ersaVrreatment Area Information:
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
1R V. vo
✓lf>U ,S "o .rF S/% f /• 4• 2/ , ro 96,00
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
� ® ❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement
I, t-he undersigned, assume res on ibility for installation of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number
37 - d
Plumb s Address (Street, City, State, Zip Code)
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I issaing Agent Si ature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee) CO
Determination 2 14 20ti
IX. Conditions of Approv ; e n for Disapproval:��
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SBD -6398 (R. 07100)
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PLOT h CR000 OOCTION PLANS
IAPPA OROa. EXCAVAT94 INC
KUMIHNO UNIT
PROJECT
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End View
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SOIL TESPNq BY:
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Side View &VAZIOA 9 &TrO. Af <V, I TEST
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION
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 " s) CI
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. #
APPLICANT INFORMATION - Pleas a tl�infhrr�ra,' n. R v wed by Date
Personal information you provide may be used for cd�aiy purposXs (Privacy taw, §` (1) (m)). ' 2mi
Property Owner ! `- + (' Property Location
oe
`^ Govt. Lot f J 1 /4SGJ 1/4,S 1 T 2 9 ,N,R ZD E (or) W
Property Owner's Mailing Address 4 g * of # Block# Subd. Name or CSM#
Z SA R W06 iN
City State Zip C de Pho�rle Number f city Village ® Town Nearest Road
❑ Ci
. 4 ii � 35'
nI New Construction Use: ® Residential / N her of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial.- Describe:
Code derived daily flow ` -01.3 gpd Recommended design loading rate 0.. 2 bed, gpd/ft2 gpd/ft
Absorption area required ,OsV-' bed, ft &0 trench, ft2 Maximum design loading rate
g g 0, ;2 bed, gpd /ft !.� � trench, gpd/ft
Recommended infiltration surface elevation(s) 9a,dy It (as referred to site plan benchmark)
Additional design /site considerations L' YA � L) A f o y IN ONJt T PIL , /Q P f1 RO V14 L
Parent material GLAC 141, ] Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding e k
U = Unsuitable for system 0 S El U WS ❑ U S❑ U S❑ U S❑ U ❑ S U
SOIL DESCRIPTION REPORT �)t w C 4 4 1 . Z O —�
Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft
Boring Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench
L_ cc- CS
_3 'q 2 Ski 0. 0.8
Ground $ IbY 4 M S /tif _ 6:7:61
.�
Depth to
limiting f
factDr
92 -
- 7 in. 4;- Z- . 2
Remarks:
Boring #
�5l k
Sr� 4 4 10 - M3 SCE M 5
Ground
elev.'
ft.
ct8•Z�
Depth to e t _ ,
limiting I(o'`f U `
y ' in. Remarks:
CST Na a (Please Pint) i tur Telephone No.
y .�o�>u
Add Date CST Number
t-� �dk 4 U��oty S 1 -12-60 7_22 -!�7
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
v iii
/L� / —' 'SL_ cr M CS 0
o 434 3 Z M5 M I QS 1 10%
Ground 4 3
ft.
Depth to
limiting
fac1or
�j in.
Remarks:
Boring #
A 0 - 1 6Y R 3 — SL 0 t k r,,r m l a A '
7-4 16 K Z 54 MS s — 6 lS,g
S'S3 '7, 5 y %h CS 6,,Z 0 3
Ground 16 SG M S /h 6, a
-.QL,,ev.
Depth to
limiting
dUjp
in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring #
49 -7 2 4 S4 M V>7 C451 6
Ground fb — S6 MS
6
lev.
8�•S
Depth to
limiting
fto
/ Remarks:
Boring #
Lj
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
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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).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) cT0
Estimated Flow - Average (gpd) tap
Septic Tank Capacity (gal) i 22Q it
Soil Absorption Component Size (W) z _ 1 , 9 k Z "h jot4
Type of Wastewater D&nestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) IZ,S ( Z- as s�
Maximum Influent Particle Size (in) 0 1/8 U
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 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 A�filte d outlet filter shall be assessed at least
once every 3 years by inspection. Th outle 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 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 or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ( H 0 26^ M A 1-•,l
Mailing Address Zo o �2rnf � J.dr. Asa.
Property Address °Z IS 5; A
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number zUo /.7,2y -mss.
LEGAL DESCRIPTION
Property Location . %,, �GJ ' /,, Sec. _�, T_N -R ?W, Town of 14 V 17G✓0 h•l
i
Subdivision W =Q Lot #
Certified Survey Map # - , Volume , Page #
Warranty Deed # _ ",�,pSp.? — v- La-t Q , Volume Page # y7dp
Spec house ❑ yes �4 no Lot lines identifiable Xyes ❑ no
SYSTEM MAINTENANCE
Improper d c a it o handle wastes. Proper maintenance
proper us an maintenance of your septic system could result in its premature failure t h p
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, restrictedplumber 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 sludge.
I/we, 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 mawtamed must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
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
VOL 1594 ►AGE 4 ?8
639533
WARRANTY DEED REGISTER OF DEEDS
DOCUMENT NO. ST CROIX CO., WI
RECEIVED FOR RECORD
This Deed made between STARRWOOD 03 - 02 -2001 ii.00 Ah
PARTNERSHIP, LLP, a Wisconsin limited liability YARRANTY DEED
EXEMPT I
partnership, and LANDSTED HOMES, INC., a Wisconsin CERT COPY FEE
corporation, Grantee, COPT FEE:
TRANSFER FEE: 480.00
RECORDING FEE: 10.00
Witnesseth, That the said Grantor conveys to Grantee PAGES: 1
the following described real estate in St. Croix County, State
of Wisconsin: D
C7a!—
Lot 25 of the Plat of Stars Wood in the Town of Hudson, St. Croix
County, Wisconsin;
Tax Parcel No. 020 - 1374 -2
RETURN TO:
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 o
encumbrances, and will warrant and defend same.
Dated this —J -- day of February, 200E
STARRWOOD PARTNERSHIP, LLP . DS
(SEAL) 5' -1`1 Zoo I
B udith A. Green �`
..�� (SEAL)
AND: Gary . Zapp IX
STATE OF WISCONSIN )
SS
ST. CROIX COUNTY ) ,/
Personally came before me this L day of February, 2001, the above named Starrwc Partnership, LLP,
by Judith A. Green and Gary T. Zappa„ to me known to be the persons w xecuted the f uiag instrument and
acknowledged the same, being authorized so to do. .
Nota C, Stal o iscons'
My Commission ( .
THIS INSTRUMENT DRAFTED BY:
Robert W. Mudge
MUDGE, PORTER, LUNDEEN & SEGUIN, S.C.
110 Second Street, P.O. Box 469, Hudson WI 54016
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NTROL POINT #197 \ I LOT #3 I LOT # I /LOT #
IRON PIPE L # 2
• 5929.38 \
9224.66
LOT #7
LOT #1
CONTROL POINT #194
1' IRON PIPE /
E =6101.62
PARCEL IN
I N 8988.27 + '�
VOL. 794, PC. 94 i -�' - - C LOT #8
\ \ CONTROL POINT #219
� 1' IRON PIPE
L POINT #180 �. LOT #23 - ` E - 7373.89
CONTRO
fi IRON -PIRA - - - _ 1 N - 8963.36
N 8848 75 100e' LOT
*' _ -- - \� ---- - - - - -- / LOT #9
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LO T 2 5
CONTROL POINT #217
/ 1' IRON PIPE
/ E - 7378.77
\ N - 8639.38 rT
LOT #21 / - LOT #10 LJ
r #126 I CONTROL POINT #222 / ;��
I I CONTROL POINT #176 CONTROL POINT #236 2" -IRON PIPE
I 1' IRON PIPE 2 IRON PIPE
E - 5809.90 E - 6039.61 N - 8605.38 f
N = 8597 9.3 N = 8603.62
T 10
LOT #20
j - I I II
- 1 I OT #11
I ONTROL POINT #215
r I I } IRON PIPE f ,
7385.62
I L 8302.83
LOT #19 � k
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-
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� #
CONTR POINT #208
E =R07390.P3�
LOT 7 LOT # 18 I_ I N - eo76., i�:'
I ` CONTROL POINT #227
1' IRON PIPE 1
E - 635.73
N = 11.71
ST. CROIX STATION LOT #17 1 I LOT #13
LOT 3
I /
LOT #16
LOT 2 --
d
I CONTROL POINT #230
1 • IRON PIPE LOT # 15
E - 6643.30
N - 7568.17
/ LOT #14
LOT 1 / CONTROL POINT #207
/ 1' IRON PIPE
CONTROL POINT 235 E 7007.55 ,
2' IRON PI - PE # N 7318.68
E - 6648.72
N - 7318.27