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HomeMy WebLinkAbout026-1037-30-000 Ai onsln Department of Commerce PRIVATE SEWAGE SYSTEM County- ` ` Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarx Urmit No.: Personal Information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 383811 Permit Holder's Name: ❑City [I village JZJ Tjpwno State Plan ID No.: BrushX Mound Pa ershiD. Richmond Townshi CST BM Elev. - , Insp. BM Elev.: BM Description: Parcel Tax Nn / 00 4 026-1037-30-00 TANK INFORMATION IF ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Q Do ' Alt. BM • 3 0 Aerat' Bldg. Sewer A 0 ra 2 -7 Holding Ht Inlet Q -3Z 7, 3 TANK SETBACK INFORMATION Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Air Intake Septic ��Q' NA o Do ' NA Header /Man. ? Z Z ld at'Dist. Pipe TM 9� ?0 9� 3yft, to ing Bot. System PUMP/ SIPHON INFORMATION Final Grade_ acturer St cover " 0 Model Num M TD Lift Friction S stem TDH t Di Forcemain Length a. SOIL AB RPTION SYSTEM BED / REN Width Leng No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME • ZS DIMENSION LEA Manua urer. SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM - INFORMATION Type O A ER o Num Numb System • / 3 0.1 -2 � /00 r DISTRIBUTION SYSTEM Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake �' > o � Length r Dia. L. Length a � 2 Dia. /� Spacing �_ /U � 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 ❑ 7No�] COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: (P l /O/ Inspection #2: Location: , (NE 1/4 SW 1/4 12 T30N R18W) - 123018772 Water's Edge -Lot 11 1.) Alt BM Description =6o #As-. o; 2.) Bldg sewer length = f Z -� ' - amount of cover = e" / Plan revision required? ❑ Yes ([0 No Use other side for additional information. I & SBD -6710 (R.3197) Dat 7 Anspector's Sigflat une Cert. No. I o� C (3r I I 5 t Safety & Buildings Division Sanitary Permit Application 201 W. Washington Ave. In accord with Comm 83.21, Wis. Adm. Code PO Box 7302' . See reverse side for instructions for completing this application Madison, WI 53707 -7302 N* .► �! �• � Personal m you p (S p p +��� formation provide may be used for secondary purposes (Submit completed form to county if not, .. , . t]epfrrtment:ot Commerce (Privacy Law, s. 15.04(1)(m)) state owned. Atrec�r me bhe " aot less than 5 x 11 inches in size. Coun Ste Sam Permit Number 13 Check if revision to previous application State Plan 1. D. Number \ 3�3 1 Location: I. A lication Infor ation - Please Print all Information Z pCi1 1 in Property Owner Name � 3( N R W Q tr\' ( Lot Numer Block Number Property Own e's Mailing Address IS L's Subdivision Namc or CSM Number City, State Zip Code Phone Numbcr s ` b ❑ City K ype of Wilding: (check one) ❑ village I or 2 Family Dwelling - No. of Bedrooms : aTown of blic/Comm (describe use):_ 1l t aV ❑ Statc - Owned Nearest oad Parcel T _s III. T e of ermit: eck onl one box on line A. Check box online B if a licable 5 6 ❑Addition to A) 1, New 2. ❑Replacement 3. ❑ Replacement of 4. _ Y _ Q Existing System stem S stem Tank Only Date Issued Permit Number B) ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) I ❑ Sand Filter ❑ Constructed Wetland Non - pressurized In- ground g Tank ❑ Single Pass ❑ Drip Line Pressurized In- ground ;Treatment Unit ❑ Recirculatin ❑ Other: ❑ At- de V. Dis ersal/Treatme y U 1, Soil Application S. Percolation Rate 6. System Elevation 7. Final Grade 1, Dcsign Flow (mA) ^'� rate (Galslday /sq. ft.) (Min inch) V �j v fl 5 b q 47 '95 OD, �S Prefab Site Steel Fiber- Plastic �r� l _ �T Manufacturer l �— VII ')ank Con- Con- glass Information Crete structed l ❑ ❑ a T ❑ ❑ _iC n 12.50 eS ❑ ❑ ❑ ❑ ❑. VIII. Responsibility Statement 1, the undersi ed, assume res onsibili for inst tion of the POWTS sho non the att ched Tans. Business Phone Number PWmbees Name . t) Plumber's Si atu (nos mps . e — Q), 7 J Plumber's Address (Street, City, State, Zip c) U21 jjj oi ' IX. County /Department Use Only Issuing A ent Si lure (No stamps) 0 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued E g ;MApprovcd ❑ Owner Given Initial Adverse Surge F�) t z-O4- am Determination CD X. pnditions of Appro /Reasons for Disapproval• ' p —{� n _ ���� IZ Y 1 �- o�C�"nN �- 1 0✓, hv AV /h4 - r 1 7 3 Zo i _ TUC y i + I I ' eg LI YO � F- ; r ! i 1 t II I • r E { -� i i I r 1 r r r r r , f I E I y E i I 1 r r • j LI - ! r I i i i _ I , 1 y r 1 { i r ; � I ( f k r r r ( I I , i I i — : , 1 ' 1 , i 1 I I i 1 e I {. { i I : I { I � � , 1 , , I ' I i , I 1 : r : I I : , i r { • 1 , 1 i I I I r I I ! I 1 I 1 , : I i � r , I I 1 I - i i , I i , ' 1 1 : i I ' ? + ; I , ; { , , I Wisconsin Department of Industry SOIL AND SITE E V A L U AT I R T Page 1 of 3 Labor and Human Relations e�I�� Division of Safel & Buildings in accord with ILHR 83.05 19 LCvae i .� (� oUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in sizq(E�&'i m Q'�t�tl'but - t. Croix not limited to vertical and horizontal reference point (BM), direction and o 461ope ��'ale or Q A Indin EL I.D. # dimensioned, north arrow, and location and distance to nearest road. � I �Qd APPLICANT INFORMATION PLEASE PRINT ALL INFORMAT � St C`AO* C� ED BY [ 0� PROPERTY OWNER: ? PERTY N a Derrick Const. Inc. 'i' NE 1 /4,S 12 T 30 AR 18 K(or) W PROPERTY OWNER':S MAILING ADDRESS L 9L@dK NAME OR CSM # 1505 Hy. #65 CITY, STATE ZIP CODE PHONE NUMBER ❑CITY [ [MOWN NEAREST ROAD New Richmond, WI. 54017 V15) 246 -2320 Richmond 14 St. (x] New Construction Use [ Residential / Number of bedrooms 4 [ J Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 4 bed, gpd /ft •5 trench, gpd /ft Absorption area required 1500 bed, ft 1200 trench, ft Maximum design loading rate .4 bed, gpd /ft gpd /ft P �1 g Recommended infiltration surface elevation(s) 97.45 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 2.00' below grade/ rec.mound for system long vity Parent material lake terrace Flood plain elevation, if applicable na ft rU= Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK Unsuitable fors stem ®S ❑ U ® S ❑ U ] S ❑ U EIS ❑ U ❑ S ®U ❑ S ® U SOIL DESCRIPTION REPORT L o Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -16 10 r 4/3 n Sr 2 16 -75 7.5 r 4/6 none is } Ground scl 2ms elev. 1 Depth to limiting factor +84" Remarks: Boring # 1 0 -12 10 r 4/3 none 2 12 -35 7.5 r 4/6 none f Ground 3 35 -52 7.5 r 4/4 elev. . S 1 4 52 -70 7.5 r 4/6 Depth to 5 70 -80 5 r 4/4 • `� limiting factor _T +80" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Ave. New Richmond WI 54017 Signature: 1 11 Date: 6 -2 -2000 CST Number: m02298 PROPERTYOWNER nPrri k ronGt. Tnr_ SOIL DESCRIPTION REPORT P t -of 3 PARCEL I.D. # pending Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench .. _ 2 12 -58 7.5 r 4/6 none fs OSQ mvfr w if .5 .6 Ground 3 58 -80 5 r 4/4 none scl 2csbk mfi na na .4 .5 <<{ elev. 9 7.8 ft. Depth to limiting fa for ,,,f- ?� • q 5- Remarks: Boring # 1 0 -10 10 r 4/3 none sl 2msbk mfr gw 2f .5 .6 .!r 2 10 -38 7.5 r 4/6 none fs 0sq mvfr 9w if .5f .6 5 Ground 3 38 -50 7.5 r 4/4 none scl 2msbk mfr na .4 .5 .4 elev. 4 50 -60 7.5 r 4/4 none cos osg mvfr gw na .7 .8 • T- 9 5.0 ft. Depth to 5 60 -80 5 r 4/4 2 7.5 r5 8 scl m na na na no: .2 limiting factor 6� Remarks: Boring # 1 0 -14 10 r 4 3 none sl 2mcir mvfr qw 2f .5 .6 5 2 14 -62 7.5 r 4/6 none fs osg mvfr gw if .5 .6 Ground 3 62 -82 10 r 5/4 c2d7.5 r 5/8 sil m an na na np .2 elev. 9 5.0 ft. Depth to limiting factor 6 � Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) • STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NEaSWa S12- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #11- Brushy Mound Lake This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. vvi " - 40, BM top of 1" pvc pipe C el. 100.00' -Alt. BM.= top of 1" pvc pipe @ el. 94.80' /0 z3 ✓ 4 m f 6. 3 Gary L. Steel 6 -2 -2000 V � .�� . ...- ........... -�.. •.ter... ... ....... .. ... �- • O 1 - -.1 l IJOAUi C � E ems-' - �� x E_ j � •• , O s ..- in EE %u • - C U r+ r Z O 3 c U � fJ 0- O N E ro` *- �I 0 2:1 Oc ; 0 N C c0 N - v N U O� C`= � i N J� 0 0 F- •n �� - T .-t 0. 1. a) C.0 NCL . _ .n -0 N f ai O O .J O X f © rd ry IN Kol E �a�y�� • � t • H-jo-I ZZ-1 ' l i` a�na N n o o u. �• r • fig :r L�J L (5 U •. ,� �.:i I r 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 $3$ Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) t7O Septic Tank Capacity (gal) tZ SO Soil Absorption Component Size (W) L Type of Wastewater Dorrf6stic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) S z ae Maximum Influent Particle Size (in) 1/8 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 tank shall be disposed under s. 281.48, Stats. The contents of the septic of in accordance with P NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Beds, Seepage Pits Seepage Interceptors, Seepage Be e Trenches, Privies, or Portable p g 9 Restrooms). The operating condition of the septic and outlet filter shall be assessed at least once every 3 years by inspection. Th utlet felt L shall be cleaned as necessary to ensure proper operation. The filter cartridge s not be removed unless provisions are made to e aif" in so ias 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 9 access replaced. Exposed openings reater than 8- inches in diameter shall be secured by P P an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or oche r 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 gases, and rescue o fa tank may contain let , 9 Y 9 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 6 "SI - 1 /feel rat O P AAfWcrLS. /LI lc, 40L- Q S7� YcRtS Mailing Address 5 C9 � �/ �� , c 1 t � O, 6L)- ' S 40 / Property Address 7 6 /,Cif (Verification required from Planning Department for new onstruction) .SZ n C /State _ �� ��, Parcel Identification Number ltr c - - LEGAL DESCRIPTION Property Location t %,, SW 1 /4, Sec. T 33 N -R IS W, Town of � Subdivision t 0 -rc c / Lot # Certified Survey Map # . Volume . Page # Warranty Deed # 40 -7 Volume N f . Page # /(09 Spec house >yes ❑ no Lot lines identifiable )<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 a to submit to St. Croix Zoning Department a certification g ep form, sig b the owner and' b y � Y Y a master plumber, journeyman pl*ber,restricted lumber or a licensed pumper pumpe ve rifying that (1) the on - site wastewater disposal system is in m ratio condition and/or after P Pa operating 2 () 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 d=the yy ex ' date. SI GNATURE OF APPLI ANT DATE OWNER CERTIFICATION (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 ANA described above b e of a warranty deed recorded in Register of Deeds Office. E O 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 31PAG' 169 STATE BAR OF WISCONSIN FORM 2 - 1998 6042'57 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between David L. Naser, Grantor, and Brushy RECEIVED FOR RECORD Mound Partners, LLP, a Wisconsin limited liability partnership, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee 06- 03-1999 9:30 AM the following described real estate in St. Croix County, State of Wisconsin (The WARRANTY DEED "Property "): EXEMPT # CERT COPY FEE: See attached Exhibit "A" COPY FEE: TRANSFER FEE: 1047.60 RECORDING FEE: 12.00 PAGES: 2 Recording Area Name and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 New Richmond, WI 54017 Pan af 026- 1037 -30- 000:026 - 1037 -95 -000 and 026 -1038- 10-000 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 28th day of May 1999. *David L. Naser * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) David L. Naser STATE OF WISCONSIN. ) ) ss. County ) i authenticat d this2$ hday of May , 1999 Personally came before me this day of I, (� , 19_ the above named to me known to be the person(s) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) * THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin Hendrik W. Van Dyk My Commission is permanent, VAN DYK, O'BOYLE & SILER, S.C. (If not, state expiration date: Post Office Box 127 New Richmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) — — — — Walking Trail F V y d I 1 �ci ti AREA TO SHORE: 09 "r1r d 84,974± SO. FT. j 378 .85! 1.95± ACRES 04 AREA TO MEANDER LINE: u I W 1 73,106 SO. FT. 1.68 ACRES 1- N N I S82'18'31 " E 355.00' TOTAL- ARE cJ 0 ` ` 96,187 SQ. FT. M 2.21 ACRES • I co 3 LOT f N AREA TO SHORE: 88,869± SO. FT. 2.04± ACRES i AREA TO MEANDEI 1 1 69,949 SO. FT. • ® • A 1.61 ACRES ° N LOT 4 7 ss sys? TOTAL AREA: / c� 9 F ®• ` 93,779 SQ. FT. / / / ► 386 \ 2.15 ACRES / �6• Q .W.E. 9 8.0 N''r ss ? , LOT 10 AREA TO SHORE: H.W(.L 86,296± SQ. FT. 1.98± ACRES �'S ''�1 �'F AREA TO MEANDE 68,821 SO. FT. \ \ S89'22 56 "W �® / / ys�so\ F� O `�� '` 1.58 ACRES 109.52 _ � - �;y . r ' �, F.F.E. 1002.0 \ \ \ s89.22'56 "W 33'�� \, � ZIP 10 52 �y — 52.98' 56.54' �o Z-+. ` �� B0. ��,�e; `��� ��•' LOT 11 AREA TO SHORE: O s 88,156± SO. FT. --4 `��. 2.02± ACRES . • • • a. AREA TO MEANDER LINE o ff' 66,327 SO. FT. / No 1.52 ACRES ,� • // L O T 12 F.F.E. 1002.0 • . 9 9ti� AREA TO SHORE: $ / �' °' 95,230± SQ. FT. L 0 T 13 �" 2.19± ACRES 3 TOTAL AREA: 4. AREA TO MEANDER LINE: • , ' ,,�h r 103,571 SQ. FT. rn 79,354 SQ. FT. y g� Co -4 1.82 ACRES 1 JS 2.38 ACRES SOUTH UN£ OF THE NE 114 OF THE SW 114 �FQ(tc P • I \ 348.84' 50-44' l 525.25' — — — N89*37'24 "W X 1306.68'— — — 1 t e TED LANDS A OVA