HomeMy WebLinkAbout026-1121-14-000 Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Divisiafr
INSPECTION REPORT Sanitary Permit No:
453098 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)I.
Permit Holder's Name: City Village X Township Parcel Tax No:
Halle Builders Inc. Richmond Township 026- 1121 -14 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
1(�0. C7 TQ V 12, 05.30.18.729
TANK INFORMATION ELEVATION DATA o e
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
eptic � � 0 Benchmark /b
Ing Alt. BM
Aeration Bldg. Sewer —74 7
Holding SUHt Inlet
TANK SETBACK INFORMATION - Z - Cc-ts-J �t�D U r/b SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
1
eptic Header /Man.
1--, 1 Zq 2 ! f / Dt Bottom
Dosing 7
Aeration Dist. Pipe
Holding Bot. System
D
PUMP /SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM y � YVIQ.+t h o� •� d Z .
Model Number
TDH Lift F Iction Los S t Had T
Forcemain Length Dia. Dist. yuefl
SOIL ABSORPTION SYSTEM `/ � fwd
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth
DIMENSIONS / a
SETBACK SYSTEM TO IOU P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: f
INFORMATION CHAMBER OR
Type Of System: 3 r UNIT Model Number: a1'
DISTRIBUTION SYSTEM l3Lt
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Z t </ Pipe(s)
Length Dia Length Dia Spacing
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
Trench Center C �� / Bed/Trench Edges I ( Topsoil
J ( es
B No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:a /&V / Location: 1708 107th Street New Richmond, WI 54017 (SW 1/4 SE 1/4 5 T30N R18W)' Partridge
Run Lot 14 Parcel No: 05.30.18.729
Wes"
1.) Alt BM Description = ` 'L Boy) 2.) Bldg sewer length = 2 1 )4 j
- amount of cover = &$g G6L 5� �$ 4 �
ID I
Plan revision Required? Yes f Q 's
Use other side for additional information. No D�
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No
satety area trtttr --°-
201 W. Washington e., P %IEW t
N *Isconsin Madison, WI 3707 - 7162 Sion
Department of Commerce - 10 7
Applicatio '
Sanitary Permit Z/5 t N '�
�,�r 0 9
�
In accord v►tith Comm 83.21, Wis. Adm. Cade. persomi info Y°L► P� I Pv G O r c ; � F . 0 if Revision
be „ Law s15.
I. Application hffi t'enation - Phase Print All Information Plan LD. Number
Property Owner's Name Parcel Number
�fI Me— r I lw le — r S 49 2/2 6 0 �•� 9
Propert owner's Mailing Address prop Lo cation
S T 30 N. R If B
City. Stale Zip Code Phone Number Lot block Number
/ Subdivision Name CSM Number
New �r`�h Yhc n 4' _' t�G J — ��� =, �1G G03 �(
L Type of BuDding ( &ek aU vat apply} ✓ g . ,� ,^^ .
G or 2 Famr7y Dwef ft - Number of Hedmoma
❑ Public/CommercW — Describe Use w / ?r (.�
Nearest Road
O saw owned
13L Type of Permit: (Check only one box on Line A (nwnbering scheme for internal use). Complete Hne B if applicable)
i ew 2 0 RRn t sY 3 0Replacement of 6 0 Addition to For County use
System I Tack Only I BAStift System - T
B. O awk if Salary Permit Previously Issued Permit Number Dale Issued
IV. �of Pkrudt: (Check aU that apply)(nnmberlog scheme is for internal use)
44 O'NTon - Presauized In-Ground 210 Mound 47 0 Sand Filter SO ❑ Constructed Wetland
22 0 Pressurized k4kound 41 ❑ Holding Tank 48 0 Single Pass s1 ❑ Drip Lim
45 O At -crane 46 O Aerobic Treatment Unit 49 ❑ ❑
V. Area Inf D
F
Design low (BPS Area ispirsal Area soft Application Pe+cdation Rex Elevation Pineal Grade
R%phr.d Proposed Rsse(Gata./Daysfsq.lac) (Min./tnch) Elevation
VL Tank Info Capacity in Total Number Prefab silt Stool Fiber Plastic
Gallons Gallons of Tanks w / �I A-
Concrete a GIs"
>
Tsda Taoks
Se* or Hokin Teak
VII. Statement 4 the for of the POD shown an the attached .
Plumber's Name mar) 1' 's 4GYMPRS Number Business Phone Number
Plumber's Address (street. MY, Sate, Zip Code
J? r�, '/-?, A I3 C, - Ic 4J, s
VIII. me use 0111y Date =UawgS'*mL sue)
❑ Disapproved sanitary Permit Fee ( mclades Groundwater
�A„° "ed Surcharp Fee)
❑ owner Girt Initial Adverse
al/]A for BilemprVow
U. Conditions f Appro'
SYSTEM OWN R:
1 Septic tank, effluent Alter and
dispersal cell must all be serviced / MAi0ined
as per management plan provided by plumber.
as per applicable codIFfldR 0*) for �` �° O° Paper °� lea 31/Z x u tneha r► she
SBW398 (R 05/01)
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Wiscon §in Department of Comm [ E��'� EVALUATION REPORT Page � of
Division of Safety and Buildings
cordance with Comm 85, Wis. Adm. Code
;rµ, county s`. cro
Attach complete site plan on phan 8 1�1`k`91 inches in size. Plan must
include, but not limited to: verb I reference point;(BM), direction and Parcel I.D. ! percent slope, scale or dimensrt 40i btton and distance to nearest road. Odl&
--' ! a ! - Iq
Please prm r M76i ka' /61h '' ` Rev' wed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
&q I /ie coo' Ijers Govt. Lot SW 1/4 Se 1/4 S 5 T 30 N R �$ E ( ) W
Property Owner 's Majl Address Lod Block # �u .Name or CSM#
I 1i City /r ,►1L_l! State Zip Code Phone Number ❑ City ❑ Village W Town Nearest Road
New Construction Use: 9 Residential / Number of bedrooms 3 Code derived design flow rate W GPD
Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments ► t
and recommendations: 6v S-t ` 97 $ -r REVOL V s Fa r LA cJN �5.4 G •
I T, T, 4 t 9 6.73')
S,T I : - T:2t9a.g9') art. 5'w -ire is .s . -r m..40') � P+ is �,� 4� ,
e j
T, 0 6
T � �'
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❑ Boring # [] Boring
M X Pit Ground surface elev. /6 b ft. Depth to limiting factor 90 in. Soil Application Rate
pp a e
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
Io L 8 A aS of .y A
q1 - - go SIR qjq S �- i rs8
Fd] Boring # ❑ Boring
Pit Ground surface elev. 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
1 0 -9 10 qR L /FPL J5 c s 'y .6
4 - 16 10 V$1 S L ,_ W 1r .q
q �11 - 33 '16 W 4 1 ia sL ,d d .`C
.5 33-45 7.5 yR NI SL a K 0 VJ I
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Signature CST Number
Address Date Evaluation Conducted Telephone Number 44 60 sr " 5� pry - rl'e 4j, ..6yo;b l�I -c�0 01 7 /S- 2yS-- 3. 69x'
SBD -8330 (R07 /00)
Property Owner Na 1 I1 �t+ �!• Parcel ID # Page of
Boring #
F3
[] Boring p JO Pit Ground surface elev. D 7f �
O • Sa. ft. Depth to limiting factor 7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 va io -,/ L FPt• s►, Gs aI+ .q! .6
a ia- @q I 10 W 3 14 F58K 6 5IN C W 1 F •
3 ! -5I -7,54R 'f s� 07 FMK Qlv 1VF ,9
q si -90 Sy / , F.5,6 ist-, ----- .q . b
4 z . . s .'Le-
Boring #
F
E] 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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit . - • Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
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)
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POWTS OWNER'S MANUAL & MANA(atmtN I I-LAN Page ' of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 14 0 it 2 0(e I S Septic Tank Capacity DG U g a l 0 NA
Permit # 5 0 C Septic Tank Manufacturer (,v; cSe2 ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer /b0 Z��z ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model - / ❑ NA
Number of Public Facility Units M -IAA Pump Tank Capacity a l NA
Estimated flow (average) g al/day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) (�r'U g al/day Pump Manufacturer A
Soil Application Rate al /da /ft2 Pump Model A
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Fiker
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Disp al Cell(s) 13 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) 510' c f u / 1 00 ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y. in dia. ❑ NA Other. ❑ NA
Oar. ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) '3 At least once every: 3 ❑ ear sj s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) 3 When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ yeas s1 s) (Ma)imum 3 years) O NA
Clean effluent filter At least once every: , 3 ❑ earf) ❑ NA
❑ month(s) ❑ 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: 0 yea��) ❑ NA
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 tanks) 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 cell(s) 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 %) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and dispoVed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
AD 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 performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page Z of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). 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 cell(s) in one large dose, overloading the cell(s) 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.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of 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:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• 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 tank may be installed as a last resort to replace the failed POWTS.
T
alua ' a o ing tank
e ai ' � T) A/ at iSTRdc 0�
b gI)4418 n
❑ 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 INSTA R POWTS MAINTAINER
Name Name
Phone _ ? l = C�. _ � j Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name C ( 2olJl
. Phone Phone
This document was drafted In compliance with chapter Comm 83.22(2l(bl(1l(dl &(fl and 83-54002) & (3), Wisconsin Administrative Code.
04i'0T "2004 14:25 7152467227 HALLE BUILDERS INC PAGE 01
ST CROIX COUNTY
SEP'T'IC TANK NL4TNTENANCB AGREEMENT
AND
OWNERSHIP CERTMCATIO14 FORM
OwnerlBuyer
Mailing Address N
Property Address
(Verification mquired from Planning Department for ncas+ construction)
city /state �j j F-IC [ {- titn, '^- f parcel Identification NUMber
LEGAL DES RIPT10N
property Location !"� `l�, 'l�, S ep , _, T� o N -R � W, Town of
Subdivision ( Lot # '
11 3�
Certified Survey Map # (9 b �° ? Volume . Page # 7
`GVatTanty Deed # b U � 3 — Volume � e � � 2- Page # z ' 3
Spec house 0 yes EL no Lot lines identifiable � yes ❑ nQ
NANC`E
SYSTEIVC mature failure to handle wastes. Proper' maintenance
improper use mid maintenauee of your sep tic systeun could result in its pre into rho system
tg
consists of punq out the septic tank every thrcc years or sooner. if needed by a licensed puxnpCr. What Y put
can affoct the function of the septic tank as a treatment singe in the waste dislxrsal system.
t a certifi'x ion form, signed by the owner and by a
'rte pxglxrty owner agrees to submit to St Croix Zoning Dcpartmen 1 she an -site wastcwaterdisposal system
masWplumber, jotuneyman plamber, restrietedpltmber or a licensed pun4=�that g ( )
is in pmp,r operating condition and/or (2) after inspection and purstping (if n ss 3' ), Ptte t k is less fhan 1!3 full of sludge.
ed have read the above and agree to maintain the private sewage dispmal system'wn the standuds
set forth,
Iran, ge t herein, as act by the Department of Commcxro and Natural Resources, State of Wisconsin- Ccrtfzcation
DtP� 1i of
stating that your septic system bas been maintained must be and returned to tax St. C roa County Zo ning pfFicc within 30
days of the thine y exp' tin date.
DATF,
U WR A - F AP LICAIVT
G'E C e s of
CWN R ur Imowlc c. I we) am (arc) the
I (we} certify that al! sta own r{ )
tements on this form arc true to the best of my {o ) � {
rty desert , by virtue. of of Deeds Of
a warranty deed recorded in Register Office.
4 r ! r 0 5�
Q APPLICANT DATE
*•sse* A information that is mis-tepresented may result in the sanitary Permit being revoked by
the Zoniatg Department.
*" Include with this $tpplfcation: a stamped warranty dood from the Register of Deeds officc
a dopy of the certified survey map if rofa=ca is made in, the warranty deed
04 -07 - 04 16:34 TO: FROM:7152467227 P01
1452P 6C]i9363
KATHLEEN H. WALSH
DOCUMENT NO. State Bar of Wisconsin Form 2 - 1982 REGISTER OF DEEDS
ST. CROIX CO., WI
WARRANTY DEED RECEIVED FOR RECORD
08-27 -1999 9 :15 AN
k1ARRART* DEED
EXEMPT 15
Wesley W. Ha1lend- -Linda R. Halle, husband and wife, convey CERT COY FEE:
COPY FEE:
and warrant to Halle Builders Inc., a Wisconsin corporation, the TRANSFER FEE:
following describe rea estate in St. Croix County, Wisconsin: PAGESz i
Halle Builders, Inc.
1113 Highway 64
New Richmond, WI 54017
Parcel ID No. 026- 1019 -10 -000
The Southwest Quarter of the Southeast Quarter (SW1 /4 of SE1 /4) of Section Five (5), Township Thirty
(30) North teen (18) West, EXCEPT Volume 728, page 136 as Document No. 407700, now
kno as Lots 1 — 26, P at of Partridge Run, in the Town of Richmond.
This 's not homestead property.
Exception to warranties: municipal and zoning ordinances, easements and restrictions of record.
Dated this day of August, 1999.
We ey W. le
Linda R. Halle
ACKNOWLEDGMENT
STATE OF WISCONSIN )
) ss.
ST. CROIX COUNTY )
Personally came before me this day of
THIS DOCUMENT DRAFTED BY: August, 1999, the above -named Wesley W. Halle and
da R. Halle to me known to be the persons who
Judith A. Remington cj ��ac ted the foregoing instrument and acknowledge
REMINGTON LAW OFFICES Y the s e.
P.O. Box 177? NQ ZAR
New Richmond, WI 54017 • `
(715) 246 -3422 PubliF Stat f Wisconsin
Commiss xpires:
qT F OF NN
04x'07/2004 14:25 7152467227 HALLE BUILDERS INC PAGE 02
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