Loading...
HomeMy WebLinkAbout028-1014-70-000 r r WWwrisir; oepartmerd of Comcneroe PRIVATE SEWAGE SYSTEM cunt safety and Buikkngs Division St. G INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal informtion you provice may be used for secondary purposes [Privacy Law s. 1 5.04 (1)(m)). 384290 Permit Holder's Name: City 0 Villa Town of: State Plan ID No.: Kr ear, David Rush River Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 1 028-1014-70-000 a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P S J11'0 0 Benchmark Z - 75 in . BM 2 •Z f' 6 S'. Z Aer 'on Bldg. Sewer j I f6 �o 3- c kolding (Sly Ht inlet f /b G TANK SETBACK INFORMATION t/ Ht Outlet Tdf-" Z Z TANK TO P/ L WELL BLDG. Vent to ROAD e Airintake eptic 5 2,ou ' `!'L 9 NA in NA Header Man. O,S' TV He G 0 ra NA Dist. Pipe 0 Mol r_ !• 3 9 q 3 - 3 L ding Bot. System L S PUMP/ SIPHON INFORMATION Final Grade Mamfact Demand t over Model Number ��S(e IT SZ O TDH ft Friction TOH Ft Loss Forcemain Length Dia. Dist.Towe SOIL ABSORPTION SYSTEM BED / TRENCH width Len r No. Of Trenches FLAKE No. Of Pits Inside Dia. Liquid Depth D IMENSIONS Z I N SETBACK SYSTEM TO P / L BLDG WELL / STREA L G Manu a ure INFORMATION Type — HAM M e Num r: System: j'j [ tip r --�- DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length 11-5— Dia. { Length �d / Dia. Spacing tl 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 ❑ Yes [] No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present leariection #1: q //y / & Inspection #2: / Location: 1944 County Road N, Baldwin, WI 54002 (SE 1/4 SW 1/411 T28N R17W) - 11281776 1.) Alt BM Description = S .r` t Y,lr�d w {If w �� 0%je 2.) Bldg sewer length =2 / ��h,,�SC �eca ;,� �j•c„ -��� 54411Y - amount of cover If exc4014 /s 6 ~ CjR+�u;o� r !w..,�l�.- cam,, cw/ e /--/�/ •) 010 5� v V cV" fin. �r 4 an revision required? []Yes ®No Use other side for additional inforrr{a_tion. f n� SBO -6710 (11.3/97) Date Inspector' ignature Cert No X, a,3� - . \� ���� ������� �� °cd� � �, .r t O 3 7 CJ Safety and Buildings Division County c , 201 W. Washington Ave., P.O. Box 7162 54 . �i �'��s�� Madison, WI 53707 - 7162 Site Address v .. Department of Commerce I t f Q N Sanitary Permit Application Sanitary Perm' Number 2-90 In accord with Comm 83.21, Wis, Adm. Code, personal information you provide MX be used for secondary Priv Law, sl5. 1 m []Chock if Revision I. Application Information — Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number Z v �% z 21 o Property Owner's Mailing Address Property Location 6 CA o f s_ ii S iA J IJ T 0 G R City, State Zip Code Photo Number Lot Number BIock Number Subdivision Name CSM Number II. Type of Building (check all that apply), ❑City ar 2 Family Dwelling - Number of Bedrooms ❑Village ❑ PubliclCommercial — Describe Use bi ❑ State Owned Nearest Road 2- 3� x 5b � - k� c:2pQ� 2 �b� e 4- ri M. Type of Permit: (Check only one box on line A (numbering scheme for intern use). Complete Bne B ' applicable) A ' ew 2 ❑ Replacement stem 3 ❑ R unty �N Rep Sy Replacement of 6 ❑Addition to For Co use Sy stem I I Tank Only Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Data Issued 1:V. Type of Permit: (Chock all that apply)(numbering scheme is for internal use) 4 Non — Pressurized In- Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tanis 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At - Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculat 30 El Other V. Dbmsalffmtjnent Area Information• Desiga Plow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rase( Gals. / Days /Sq.Ft.) (Min./inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site steel I Fur Plastic Gallons Gallons of Tanks Concrete Constructed Glass New ustins Tanks Tanks Septic or Holding Tank x Dosing Chamber VII. Ptesp onsibility Statement I, the undetsigned, assume responsibility for installation of the POVM shown on the attached Plumber's Name (Pr1M) Plum t' Signantre MP/MPRS Number Business Phone Number - 5Xq — LA.A — Z - J I I I c� r, 6 W 0 o P him,be r's Address (Street, City, S , Zip ode) VIII. IDe artment Use Only Approved ❑ Disapproved Sw tarty Permit Pee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Detertnio&don ��- IX. Conditions of ApprpyaMeasons for Disapproval PLA- Attwb COOMPIM Plans (to tlw County edy) for the system on paper not less flea 81/2: u inches to stn SBD -6398 (R. 05101) LOT PLAN PROJECT David Krear ADDRESS 632 Kickory Rd. Hudson Wi 54016 SE 1/4 SW 1/4S 11 2 2 N/R 17 W TOWN Rush River COUNTY ST. CROIX 6/21/01 BEDROOM 2 MPRS Shaun Bird 226900 DATE CONVENTIONAL )00C IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 8 00 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 275 # of chambers 16 BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 93.6 Alt. BM Top of 2" Pipe @ 100.2' 380' County Road N Plans Designed Using Conventional Powts Manual Version 2.0 Pro Pole n ? Shed with 2 Bedroom Living 300 6% Quarters Slope 6°I° 30' Slope �' 10 T 1 'l`B Alt 0 65 5 ,M B- -1 Vents 30' Vents 2 -3' X 50 Cells with >3' 30' Spacing B -3 Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 34" 111- G-rade at System Elevation I LOT PLAN PROJECT David Krear ADDRESS 632 Kickory Rd. Hudson Wi 54016 SE 1/4 SW 1/4S 11 / 2 N/R 17 W TOWN Rush River COUNTY ST. CROIX 6/21/01 2 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL )00( IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 8 00 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 275 # of chambers 16 BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.6 Alt. BM Top of 2" Pipe @ 100.2' Od 380' County Road N Plans Designed Using Conventional Powts Manual Version 2.0 Fro Pole n ? Shed with 2 Bedroom Living 300 6% Quarters Slope 6% 30' Slope 10' ST 65' 10 15 *B. �M. N B- , -1 Vents 30' Vents 2-3'X 50 Cells with >3' 0 30' Spacing -- Vent > 12" Sidewinder High of Cover Capacity Leaching Chamber 6, Long 1699 34" Grade at System Elevation WWco�lsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County <—� �X Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. It a — 0 — -- M%) Please print all information Re ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) 1z Property Own Property Location e 1)Q L) ➢ k,� �� f Govt. Lot � 114S�1/4 S Ta N R / E r) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 oz c a � °- City State (7ip Code Phone Number ❑ City ❑ Village Town Nearest Road 0 i 5�6U, i (71J' ).386- LS New Construction Use: W Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement neral comments / El Pyplic or commercial - Describe: Parent material /, p.7GLi � Flood Plain elevation if applicable D✓ ; . ft. Ge and recommendations: `� / e ), / � /� � L c m ,m e . �,ta�C �( ;- I�� C r� Cad o,- �/ � 2 0 Q t r 2 Gl f G2X- Boring # Boring Pit Ground surface elev./ ft. Depth to limiting factor f 1 () in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 DO 5`t �fl Boring # ❑Boring Pit Ground surface elev�2 ft. Depth to limiting factor L L in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I 'Eff#2 —110 y' OsG , s , a- 7 ` D * Effluent #1 = BO 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluen 2 = BOD < 3 g/L and TSS < 30 mg /L CST N me 4 ge Print i ' SiggaWre CST Number 6 0( ress rafe Evatua ion Conducted Telephone Number SBD -8330 (R07 /00) i Property Owner Parcel ID # Page of Boring # 4 Boring N671� Pit Ground surface elev& 9 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 - 2 1 ❑ 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 GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz 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 mg /L and TSS < 30 mg /L 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 -264 -8777. SBD -8330 (R.07 /00) Soil Test Plot Plan Project Name David Krear Sha it Address 632 Hickory Rd. Hudson Wi 54016 M #226900 Lot ----- Subdivision ` -- ----- Date 6/20/01 SE 1/4 SW 1/4S 11 T 28 N/R 17 W Township Rush River n Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1.5" Pipe System Elevation 93.6 * H R P Same as Benchmark Alt. BM Top of 2" Pipe @ 100.2' 380' ounty Road N Pro Pole Shed with 2 Bedroom Living Z 300 6°Io Quarters Slope 6% N 3 Slope 98' * 15' B. M. B- 65' N B -1 30' 99' B -3 I ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AORELMENT AND OWNERSHIP CERTIFICATION FORM s Owner/Buyer Mailing Address iC v T' _ !' vo) Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL 12ESOUTION Progeny Location Ste' t /., Z.� 'l,, Sec. �, T2ZZN R W, Town o •/ tom Subdivision Lot # Certified Survey Map # . Volume , Page # Warranty Deed # Volume , Page # Spec house ❑ yes Lot lines identifiabl yes ❑ no SYSTEM Aj&U ENA= 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, restrictedplumberor 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 3o days of the three year expiration date. llr� WATURF OF APk9CANT 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 pro erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APP12b&F DATE Any information that is mis- representedmay result in the sanitary permit being revoked by the Zoning Department. * * * * ** "* IncIude 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 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 z - 1k , 6 6 T 6900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing ddress � 3 �� � fl kA� g ' S q0 j L , Property Address 044 C D " RJ •1 N ,' (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Prop erty Location �r14, S r /4, Sec. . T -R�w� Tower of I�rtY Subdivision Lot # . Certified Survey Map # . Volume . Page # Warren ty Deed # 0 -� , f 4 / b , Volume Page # Spec house ❑ y no Lot lines identifiable yes ❑ no SYSTEM MAINTENAN Improper use and maintenanceof 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- Th property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, j oumeyman 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 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 days of the three year expiratio date. ©6 / e go / SIGNATURE OF APP ANT 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 owners) of the roperty described abov by virtue of a warranty deed recorded in Register of Deeds Office. a�- /of /4( SIGNATURE OF ICANT DATE « * * * ** A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** «s 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 i STATE BAR OF WISCONSIN FORM 1 - 1998 Es44926.9 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number 1667 ST. CROIX CO. , WI l�Ql. , PAGE RECEIVED FOR RECORD This Deed, made between W. RONALD MOE and BONNIE J. MOE, 06-25 -2001 10:20 AM husband and wife WARRANTY DEED EXEMPT N Grantor, CERT COPY FEE: COPY FEE: and TRANSFER FEE: 270.00 RECORDING FEE: 10.00 i PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following !„ j described real estate in ST. CROIX County, State of Wisconsin (the "Property "): Recording Area A parcel of land located in the E of the NE % of the SW Name and Return Address P 4 and the E % of the SE 4 of the SW 4 of Section 11, Township 28 North, Range 17 West, Town of Rush River, St. ''1 Croix County, Wisconsin, described as follows: j Beginning at the S 4 corner of Section 11; thence �G 1 i� S89 45'50'"K 652.66 feet along 6he south line of the SW 4 , O-a of laid Section 11; thence N00 14'49 "E 2636.64 feet; thence - ' `'�t'�'� N89 32'38"E 653.8 feet to the north -south quarter section i - � _ ` 'i line; thence S00 15 "W 2639.15 feet to the point of 028 -1014 30 028 - 1014 -70 beginning. Parcel Identification Numb This 1S riot homestead property. (is) (is not) ILS 29w- i j X1. l�• Together with all appurtenant rights, title and Interests. Lto�d(y,K a I b QN b qr w 4 a o r- a a a z t ' a a0 I � b b ' W J Q O r- uv b b r• z d Qa W . W. w > .. 4 ------- - - - - -, s ' LU O p m r O O � � Cie o u �i ---- --- - -- --- J 7%a W _ 2 H J Y r Y Y O Cj J A -At A -A7