HomeMy WebLinkAbout022-1083-30-110 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
404991 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:
Stoffel, John Kinnickinnic Township 022 - 1083 -30 -110
CST BM Elev: Insp. BM Elev:� BM Description:
L o o — d i'Wwti
TANK INFORMATION ELEVATION DATA I T
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic t r Benchmark 2 2 C
Dosing
tD o vti KG 1
Bldg. Sewer
Aeration g•
(2 �r
Holding t/ t Inlet
- q. q Z. ��.
q
TANK SETBACK INFORMATION St/ t Outlet 1 2 -
TANK TO P/L WELL BLDG. FVe t to Air In ke ROAD Dt Inlet
Septic / Dt rom f
Dosing F fir'
Aeration Dist. Pi / ffi K�
0 rJ' ( 2
Holding _� Bot. Syys te � W' � �r / 7
Final Grade
PUMP /SIPHON INFORMATION _ M �ivrS it �
Manufacturer and St over
GP / L
Model Nu er / 3 f 0a 0
TDH Lift tion L System Head TDH Ft 1W
Forcemain Le Dia. Dist. to Well `
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Len th , No. Of Trenches ^ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS l� Q ) �_
SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM' LEACHING Man tur r:
INFORMATION CHAMBER O Gi
Type f System: . 6 UNI Model Number: l / a r p// If
DISTRIBUTION SYSTEM W (�
Header /Manifold Distribution I x Hole Size x Hole Spacing Vent to Air I ake
l Pipe(s) • /
' ' ba
Length Dia _ Length I Dia L ' pacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over Edges xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center > 54 Bed/Trench Topsoil l / Yes No ]Yes [I No
COMMENTS: (Include code discrepencies, persons present, etc.) x Inspection #1: / J�v Inspection #2: y 5
Location: 1665B E. River Drive River Falls, WI 54022 (SW 1/4 NE 1/4 29 T N R18W) NA Lot 2 Parcel No: 29.28.18.4510 �
1.) Alt BM Description = /v(.J 4r �-c' - V_*_ u �) g/ s K^-A- 1 YIS �-13� sb( iS �� �� { }°
= / b '� " _ 0 a T
2.) Bldg sewer length �
- amount of cover = �3/ i 31 ���%�� u �� 0�
3.) Contour = A li -
'_
d /� -
(> 1 �
Plan revision Required. I Yes IV/No
Use other side for additional information. I
Date Insepctor's Signature Cert.
SBD -6710 (R.3/97)
I (, � �a-�r� � ..Eid'p''L '/ - 7•- I •� � / W . /GGT�/ G(/r" `�
Safety and Buildings Division
201 W. Washington Ave., P.O. Box 7162 e"-C X
Visconsi Madison. WI 53707 - 7162 is Address
Department of Commerce
Sanitary Permit Application s Permit Num 9
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision /
may be used for secondary purposes Privacy Law, s15. 1 m RECEIVED
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name Parcel Number
- Z3 0 �, , i 7on7 P9 - /083 - 30--/ /0
Property Owner's Mailing Address Property Location
ST. CROIX COUNTY S W -A N E -A; S R7 T o�� N. R $
City, State Zip Code Lot Number Block Number
i U e r �� S (� T ` 0 ?L 7�� 7` 2.� ;10 1 7 Subdivision Nam CSM Number
01 4 ucik �5r9 q J9
II. Type of Building (check all that apply) � S".- s `
W1 or 2 Family Dwelling - Number of Bedrooms / ❑Village
❑ Public /Commercial - Describe Use
QTownship r A ^ t c iC f hv% c
❑ State Owned Nearest Road
z t x93• E R r 0✓
M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A. 1,9 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
stem Tank Only Exist= stem
B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued r
IV. of Permit: (Check all that apply)(numbering scheme is for internal usejRXZ
44 PpNorn - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed We
22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other
V. Dispersalffreatment Area Information:
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Eievati inal Grade
Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) lY Y Y C Elevation
C,�, 5 � /�I f � / /}
L_,.
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank 7
Dosing Chamber
VII. Responsibility Statement - I, the undersigned, assume responst'bility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
VIII. t /De artment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps)
Approved ❑Disapproved Surcharge Fee)
❑ Owner Given Initial Adverse
Determination 2 2� _
lX. C� ondiAionsof Ap rovaUReason§ fgr Drtappro
i re�.e- +�4S�lS �_ S �a- � ewirt S�++�' {.e�dCM�,�•QJ�tR�iS�"K� e�. � �� �ax� S+at S. _`� J
„ t f a A 0l Att co p1 a plans (to C ror the 7 of less stn Il inches in size) , 0n
-*c 7G� g.t -CL �ti2+t�u.Wtu� �"A.t/�Q�J (:Os[fie p�.dulnl3YtCCs i t'� ll����F+�h(i+l.i3,
SBD -6398 (R. 05101)
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Z L01 2. Y` 995 ;�Po.SS4
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tvc
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3
1250 G..l
floc
rn
M �'^ A (3d
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�Ao CELL TO BE 15 NIGN CAPACITY
SkiFILTRATM CMAM 6F'RS O F .A To ?AL OF 3 30.
�3VTOM OF CH.OfgFC TO BE 1n w5 oR 30-
54 " ,DEF?:v AS PTSZ 501 FOAL M AT)O T F ; ,r,
K
rJ�y�ri.� say
�o�.� ' ST�6� OT L C t p � c�se
Z,o'3 W Lewis sa. L 2 Y*PR5 : 2PO4 , S S
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ti
1250
V f�"� W�2vb e
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4
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1
Il�,ll � Apo .O
zor �AoTG GN . C E l l TO BE 15 NIGH CAPA CI T Y
SNIclI`tRA7)0 _ CNAM t3F'RS_ o)Z,A ToTA OF 30.
6077 of CNAIKGF ,S - ro BE 1ATO w,s OR 30—
34 PEEP ,¢S RFfZ 5011 FVihAT ?0hl I
C 34 "f)
s
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County S+ ,
Attach complete site plan on paper not less than 81/2 size. Plan must
include, but not limited to: vertical and horizontal re R �� � ction and Parcel I.D.
percent slope, scale or dimensions, north arrow gieifi and nearest road.
Please print al a>' 1+ I � � `
Reviewed by Date
Personal information you provide may be used f ndary pu Law, 8. (1) (m)).
Property Owners Pro04y Location
A z �i Gaa�t' of 1/4 N FIA S 2 Q T Z N R t O E (or)(0
Property Owner's Mailing Address ;'`, COUNTY Block # Subd. Name o CSM#
iy 4Q►S� tNG OFFICE � . x a( t S2 O
City State Zip Code r City IRvllage Town Nearest Road
R��fe Fat► 4 ZZ ( �.�_.,. ►�' °� ;
[� New Construction Ilse: M Residential / Number of bedrooms _,� _ Code derived design flow rate ys 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material &Ir+ .yYt1 K Flood Plain elevation if applicable ft.
General comments 5y64v vk a j f1 ►
and recommendations: 14•x. t (tj Q G • 2 0 r4
61. No "S 60V61 -eck a+ HO" *- (p0'` 136w4s art y= 4• /f
hick
to 5:a4 -'^t 04- LS w" -K V%O S +rVC*)r•t. a. ACC no {nnd 44-e
1
❑ Boring # Boring
® pit Ground surface elev. 9z . o(p ft. Depth to limiting factor in.
Soil Applicatio n Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
i in. Munsell Qu. Sz. Cont. Color n Gr. Sz. Sh. i 'Eff#1 'Eff#2
cs VjP 4 1 • G
2 10 51U 10vir5 1U ms Os 4ir — -- 7
3f. q-z-
a Boring # F1 Boring �
® Pit Ground surface elev. 4 2 Depth to limiting factor D in Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 `Eff#2
1 0 J I ,r V ipr Ls I V y
�.6 G
_ _ - < and TSS < 30
Effluent #1 - BOD > 30 < 220 m and TSS >30 < 150 m L Effluent #2 - BOD _ 39 rrglL mgll.
CST Name (Please Print)
,8 nature CST Number
Adder Date Evaluation Conducted Telephone Number
Z/ ���
Property Owner �'P �`esj Parcel ID # Page Z of
Boring # E] Boring
=1 ® pit Ground surface elev. 7� ft. Depth to limiting factor �_ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
J W 41 - L-k- 5 ' r C 5 .4
Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfW
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring # ❑ Boring
F-1 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 2648777.
SBD -9330 (R.07roo)
/� PAGE
�OF_
NAME 9:,21 f-)/ LOT# ,Q- LEGAL DESCRIPTION,* E S.�QTZ4� N RI $ E (or V
SCALE: I "= �O
BM I ELEVATION y
L RL
BM I DESCRIPTION t' ✓1 f
BM 2 ELEVATION l00•d
BM 2 DESCRIPTION - Ad it "A ?•� � Qd
SYSTEM ELEVATION
ALTERNATE ELEVATION e •ZD
CONTOUR ELEVATION QZ pc QO OO Q.CX�
. Q; .
•
ae). 0
92�
SIGNATURE - DATE -o IJ
►' VW STOUT PURCHASING W 7152321565 umo/vv L?
System Nlauagemont
approval of these plans this systeira
marittsoment of this system is cr it i cal. As a condition of app provided with a con "~•lets
management must be reviewed with the homeowr►cr, and the homeowner must be
set of plans including this inmaigement section.
Getters!
Pro functioning of an on•site disposal S tern system`$ n t h a t v olume, The loulcr he
volatile of water which Mows into ft system and the level of contam
volunIt of water &rid the lower the level of cor:taininarita,
the better and longer the system W11 l fiuut:on c Ind
Typical system cornponerita include a septic tank or compartmcrtt to aerttle out solids and contain grra:. ts ak
oils, a filter on the outlet of the septic tank to retain smalllparticles and ontrols` and final} some type s �'!
Of compartment to allow s dose to be accumulated, p p
adsorption cell to recycle the water in a mariner to protect groan`} water quality and public health.
t.. if the septic tank is irstalled prior to sheet -rock anWor paintin. pump the septic tank before rormu'•
residential use begins to ensure adletenee to contaminant load design criteria.
2 Install watet.suving appliances whenever and wherever possible.
3. repair even small water teaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
S. Garbage disposals sue not recommended; if you must have oac, use A spaxirig'y.
6, No paper products other than tissue should go into the systern.
7. No chemicals should ga into the system.
S. Avoid surge flows of water; try to spread laundry throughout the week.
lVlsiaternnsarce
1 . The septic tank must be inspected every three years by a properly licensed person.
2. if necessary, the septic tank most be pumped to remove solids and scum; pumping is ree,uirc(�� it t't;
combined scum and solids volume equals one third of the tank volume.
3. When the septic tank is putrlped, any solids in the bottom of the pump tank must be pumped, 0::105 ::
fitter must be back-washed into the septic tank to remove accumulated material. tt ,y}
w t examine the state, of
made b the hornco ner o
a. Periodic observation pipe: inspections should be Y
situ soil adsorption tell. Quarterly inspections are recommended, and a licensed plumber should
if effluent is consistently podded in the adsorption cell.
5. if this system contains specific treatment components other them those meat oned here. mainter.;t ►, 0
requirements will accompany their specifications.
6, The pumping components for this system include an slams which must be installed snd remiin nn a
separate circuit from the pump• if the alarm is activated, minimize water use and notify a Iicevt$0 ,Planter
for $`wise sa 5004 as possible, 'M system vc allows t"er capacity to accturi}slate Some )Rte
normal service can be restored; this volume is minimal, and no more than one or two days should m,ss ;c ire
any necessary repairs cart be made.
7 Wastewater monitoring of volume and quality is not a normal requirement for residential systt,r -s, $uC.h
monitoring may become necessary if problems dvvelcp. Any necessary monitoring shall be clone in rvc �d
with the requirements of Comm 63.54 (2). pumping and hauling ofiwastewwer may be necessary 1'
analysis and repairs are implemented. Addiuonel testing, designing, and/or installation of additions.+
treatment compormts or conversion to a holding tank may be necessary.
S1 , CrD Cc Z c+n�n 3B�a 4,1�8d
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGRBEMENT
AND
OWNERSHIP CERTIFICAT ION FORM
Owner/Buyer
Mailing Address
Property Addres
(Verification required from Planning Department for new construction)
City /State e-(L) e r te• �� S (,J Parcel Identification Number o? of - l 0 8 3
LEGAL DESCRIPTION
K I y, k1 Y1 ✓� L
Property Location S W V,, IV E V,, Sec. 9 , T � w N -R (8 W, Town of R, o e Fo [ 1 S
Subdivision
"-- ,Lot #
Certified Survey Map # b / z 3 , Volume , Page # S
Warranty Deed # & & (I yl y , Volume y . Page # 5 e/ 7
Spec house ❑ yes K no Lot lines identifiable 0 -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, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pimping (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 maintained must be completed and returned to the St. Croix County Zoning Office within 30
7M year expiration date.
SI OF APPLICANT DATE
OWNER CERTIFICATION
of
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)
the bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNAT 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 1748PAsE 547
DOCUMENT NUMBER 6 6 0 4 1 C3
KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
5T. CROIX CO., WI
RECEIVED FOR RECORD
Scott A. Ripley and Mary L. Ripley, husband and rife, Grantor, conveys 1 0 - 29 - 2001 2:00 Ph
and warrants to Jahn P. Stoffel and husband and
rile as survivorship marital property, Grantee, the following described WARRANTY DEED
real estate in st. Croix County, state of Wisconsin: _APT d
CERT COPY FEE:
LOT TWO (2 OF CERTIFIED SURVEY MAP IN V QLUNF IUX W OF CERTIFIED COPY FEE:
Y MAPS, PAGE 151 , AS DOCENT U 401532, FILED IN ST. CROIX TRANSFER FEE: 165. DO
COUNTY REGISTER OF DEEDS OFFICE APRIL 2, 1 5, BEING LOCATED IN THE RECORDING FEE: 11.00
SOUTHWEST QUARTER OF THE NORTHEAST QUARTER (SW 1/4 OF NE 1/4) OF P AGES: I
SECTION TWENTY NINE (29), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE
EIGHTEEN (18) WEST, TOWN OF KINNICKINNIC. TOGETHER WITH private road
easement as shown on said Certified Survey Map. TOGETHER WITH easement
for ingress and egress as shown on Certified Survey Map in Volume 1,
page 162, as document number 328601. NAME AND RETURN ADDRESS
St. CM X VaIiP -y 'T tle, •
109 N. f"Mn Skree+
121VerFal�S W� 5'ioa� 01- 1k5srx
22- 1083 -30 -110
Parcel Identification Number
This is not homestead property.
Exception to warranties:
All easements, ✓✓ restrictions and rights -of -way of record, if any.
Dated this °S�f day of October, 2001.
(SEAL) Z (SEAL)
�'Scott A. Ripley
(SEAL) Q (SEAL)
Mary L. Riplavi
AUTHENTICATION ACKNOWLEDGMENT
CHARIENE A. UR54N
Signature (s) Nntaly Puhl STATE OF WISCONSIN )
State of Wiscons ) Sa '
My CMIS. 4yOM3 „ Zt �'�'c,� COUNTY ) nn��
authenticated this _ day of 20_ Personally came before me this .,W, day of October, 2001
the above named Scott A. Ripley and kary L. Ripley
(stun °cu=ed to me known to be the persons(s) who executed the
fore oin strument a ackn led a the same.
INGine Pclnced or Ty edl
TITLE: MEMBER STATE BAR OF WISCONSIN g �A,�/ /1/(.Q�A. istanacurel
(If not,
authorized by 5706.06, Wis. Stats.) iaeme a =anted o= Tweet
THIS INSTRUMENT WAS DRAFTED BY: Notary Public County, Wis.
Joseph D. Boles My commission is permanent. (If not, expiration date:)
Rodli, Beskar, Boles & Krueger, S.C.
P.O. Box 138
River Falls, WI 54022
f -
1 2
t
FILED
APR 2219at tw
401433 a.
wraa. �o
CERTIFIED SURVEY MAP S
PART OF THE SW 1/4 NE 1/4, SEC. 29, T28 N- R 18W
KINNICKINNIC TOWNSHIP ST.CROIX CO. W1.
OWNER: GARY a SUSAN WANG RIVER FALLS, WI.
0 200' 400'
' ' ' BEARINGS ARE ASSUMED AND
SCALE: 1 "a 200' REFERENCED TO THE EAST 1/4
LINE, SECTION 29
4�_ EXISTING MONUMENT, Rec. EXISTING MONUMENT, Rec.
NORTH 1/4 CORNER NORTHEAST CORNER
TN. RQ SEC. 29 SEC. 29 W 4
z
66' PRIVATE
ROAD ESM'T, UNPLATTED LANDS N
O
F-
NI .IV
It v - 00
?> �' . O
O, .33' 33' O' o N
0 4 ' O
Zi 40 0., S 90 ° 0 0'0 0" W 26
JI 3.o y 3 p NORTH LINE SW NE 809.32' ' 1769.62' .0 0 °
c]I h 0 9E SEE PAGE 3, SHEET 2 9° o
ul W' M 0 . U PLATTED LANDS CUL DE SAC DESCRIP
�' o -- -- - - -- TION. o W
w�
I o N O
Q I
o< I z '00 v oo J
0
G al a S 90 0 00' 00" W 875.32' G_ 60 ' ryg
809.32 68. O
al ,D R - rL— 'PRIVATE ROAD.--- --`�
33.00' N 132.32'. 215.00 215.00' 247.00' o o I N
Z N N
"' I O O a v Q I N
33' I6 - _ I 13 °. 1 I qO O7 o0 -I j NI
ESM'T. O o.. Qm O
W O 3Lrm o o LLl l
m I 2 3 4 �� " o z o 1–
ow
PROP. O o°. ocf 0 e JI z:
00 .o d:.. °o, a 0Fr w a J
01 OD a 0 165.32 215.00' 215.00' 247.00' °o =)I zi
–
M N 90 842.32'
a a
w
Q UNPLATTED LANDS
SIN 'NE EXISTING MONUMENT, Rec.
LEGEND
EAST 1/4 CORNER, SEC. 29
•
3/4"
LB./ LIN. FT. ON BARS SET A PPROVE D .
WT. 1 A OVE
-
I X 24' IRON PIPE SET N�rf lllli9 /1p!!!t
-- WT. 1.68 LB./ LIN. FT. APR 22 1985 +rs�� ,'l i c0jv s 1* ' ° �q
AREA SCHEDULE �� ° � `
ST. CROI , COUrt1Y
LOT I 1.521 ACRE (66,293 S.F.) INC. R/W COM►RfHENSIVf PAPKS FIAHNRIO MARTIN E. L'•
A1i0 IONING CON.Ml1ZEE HALVORSEN
L'
LOT 2 1.979 ACRE (86,215 S.F) INC. R/W S•1302
LOT 3 1.979 ACRE (86,215 S.F.) INC. R/W HUDSON,
LOT4 2.273 ACRE(99,047S.F) INC. R /W� WIS. T s
TQWNSHIP APPROVALS R�ilpN0 SURD
CHAIRMAN Ip1I so
CLERK /TREAS
OCT. 15, 1984
REV. NOV. 14, 1984
Vol. 6 Page 1519 OVER REV. APRIL 20,1985
Page 1