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HomeMy WebLinkAbout026-1126-23-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and f y teing;l vision ` INSPECTION REPORT Sanitary Permit No: 420583 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: Brushy Mound Partnershi Richmond Township 026- 1126- 23-000 CST BM Elev: Insp. BM Elev: BM Description: (��o /ob �jrrll 12.30• l�•7�s� TAN INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / � Benchmark BSI. AV �(t AV v Dosing Alt. A' oh s, 2.2(, /02- Aeration V Bldg. Sewer Y Hol ' St/Ht Inlet ry TANK SETBACK INFORMATION St/Ht Outlet G 2 3 TANK TO ' ` P/L WELL qB V t-to Air Intake ROAD Dt Inlet �- Septic 7 I > Dt Bottom Dosing Sy� Header /Man. '7 f Aeration Dist. Pipe Holding - Bot. System 3 Final Grade PUMP /SIPHON INFORMATION �' �T�• Manufacturer Demand St Cover — GPM 3• �� OV l Model Number TDH Lift Fricti Loss System Head TDH F Forcemain_.- Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM B ENSION Width f + Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manu t(: INFORMATION Type O_ f System � � � , � � � � CH R �" / � `," � , �- , V�� „ ' 1. � UNIT Model Number: D IBUTION SYSTEM A1 Hed anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Gl�6L T �t ► /t Pipe(s) ' /rx�!_' W i /4- /� n q L a e ngth Q Dia Length 0 Di Spacing �/v SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only - mod on Depth Over Depth Over xx Depth of xx Seeded /Sodded Bed/Trench Center cL Bed/Trench Edges Topsoil Yes DM No [] Yes [j No --� > I Al - T COMMENTS: (Incl a code discrepencies, persons present, etc.) Inspection #1:__7/2 � Inspection #2: VU Location: 1666 Waters l Edge - Drive New Richmond, WI 54017 (SE 114 NW 1/4 12 T30N R18W) Water's Edge Lot 23 Parcel No: 12.30.18.784 1.) Alt BM Description NJ Lj - 2.) Bldg sewer length =Z•('0 - amount of cover �� P f _I Plan revision Required? [l 1Tes No Use other side for additional information. _ -- Wres SBD - 6 710 (R.3/97) Date Insenature Cart. No. ���• aa.a va.dy rAi 110 JStf 4065 ST CRX CO ZONING z001 r , Stately trail HriUin�c Divisioa Gewrp 201 wit. Wuh4ltott Aw , P.O. Boot 7M via VV�1�� 53709 - 7062 s a, �,.,, Nombw (�i fSd in by Ca Do Merit of Commerce (&M 26 1 .6346 Sanitary Permit Ap a : +- SIM . «�b Cwa• » i. Mb. wefm ceee , - ad Y " put tasy be tared for saxwAuy PMOGM Privacy PMjM A*1,m (itdilfweat W, addeaq) t L AppNn*m t�rrsotier - pleoae 1•riest An ``ii t Y hroei f Lm .c Adder <ai7 Type etstt (eireck sd dw •ppb') er 2 PamBy D - ? t wha of 8* eeryo - >�er. Name CSM Ntsa►ar laDlidCornarsrdN - D.na'be !ba ^-- 0 sat.at�.ea- Orea�ef or IIL 'Typs o(?eratN» arty Deere Lon w hre A. C S itapp� bit} A. �,�,,,, synat O Aapbteeme�t syrem 0 '�1�oaasonMbNlis= Ttwk R�ar.�nteacony 0 aba . m t�titaia sy�twa •. pQ A°" of � Towfit ie How Ug P+sviow ? 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Wisconsin Department of Industry SOIL AND SITE E V A L U AT 1 T Page 1 of 3 Labompd Human Relations Division of Safety '& Buildings in accord with ILHR 83.05 i6� e(.?, � OUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz . ~ n m but St. Croix Po ( ) P CELLD. # lZlo — J �Z(o ' - Z3 not limited to vertical and horizontal reference point (BI VI), direction and / slo e, ale or o o -E� dimensioned, north arrow, and location and distance to nearest road. ;Hj 1 oe APPLICANT INFORMATION- PLEASE PRINT ALL INFORMAT j )��� GPp� ED DATE J Nti PROPERTY OWNER: , P PERTY OWN Derrick Const. Inc. GC>dG IQ SE 1K */ 12 T N,R (or} W 11 PROPERTY OWNERS MAILING ADDRESS L -4_4 d 4 dLDdK* WD. NAME OR CSM # 1505 H y. #65 2 Br d Lake C LUS ITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD New Richmond WI. 54017 (7j 246-2320 1 Ricbmontj 140th St. [�] New Construction Use b I Residential I Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /ft gpd/ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate —_ bed, gpd /ft - 8_ trench, gpd /ft Recommended infiltration surface elevation(s) 95.95 ft (as referred to site plan benchmark) Additional design / site considerations trenches spaced to code 4 00' below grade Parent material outwash Flood plain elevation, if applicable nit ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ® S El ® S El ® S El [R S ❑ U [0 S ❑ U ❑ S J7 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed JTW& .....1...____ 1 0 -9 10 r 3/3 none 1 2msbk mfr cs if .5 .6 2 19-19 7.5 r 4/4 none scl 2msbk mfr qW if .4 .5 Ground 3 19 -90 7.5 r 4/4 none ms osg ml na na .7 .8 elev. 99 ft. Depth to limiting factor +90 Remarks: S Boring # 1 0 -11 10yr 3/3 none 1 2msbk mfr cs if .5 .6 2 11 - 20 7.5yr 4/4 none scl 2msbk mfr if .4 .5 3 /20 7.5 r 4/4 none ms osq ml na III Ground elev. 9 9.8 ft. Depth to limiting r f � . 2 <` L factor +90" Remarks: 0 S CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. Aw., New Richmond-,-)WI 54017 Signature: Date: 6 -17 -2000 CST Number: m02298 PROPERTYOWNER Derrick Const, Inc. SOIL DESCRIPTION REPORT Page —of PARCEL I.D. # ! �, Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 3 1 0 -9 10 r 2/2 none 1 2cpl mfr gw if .5 .6 2 9 -16 10 r 4/4 none sicl 2msbk mfr gw if .4 .5 Ground 3 16 -25 7.5 yr 4/4 none sl 2msbk mfr gw na .5 .6 elev. 9 9.3 ft. 4 25 -90 7.5 r 4/4 none ms osg ml na na .7 .8 Depth to limiting factor +90 Remarks: GZ-- Boring # 1 0 -14 10 r 2/2 none 1 fill materials cs na np np 2 14 -24 10 r 3/3 none 1 2c 1 mfr cs if np .2 3 24 - 38 10yr 4/4 none sicl 2msbk mfr gw if .4 .5 Ground elev. 4 38 -84 7.5 r 4/4 none ms osg mvfr na na .7 .8 9 8.8 ft. Depth to limiting factor + Remarks: Boring # 1 0 -9 10yr2 /2 none 1 2cpl mfr cs na np .2 <' 5 2 9 -16 10yr4 /4 none sicl 2msbk mfr gw if .4 .5 3 16-34 7.5yr4/4 none sl 2msbk mfr gw if .5 .6 Ground elev. 4 34-84 7.5yr4/4 none ms Osg ml na na .7 .8 98 ft. Depth to limiting factor +84' Remarks: Boring # Ground elev. ft. Depth to limiting factor Lid Remarks: SBD- 8330(8.05/92) r STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 WIWI S12- T30N - R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #23- 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. N 1 =40' BM.= top of 1 pvc pipe @ el. 100.00 Alt. BM.= topof culvert C el. 94.90 1W 3D k�rrt� � G, Gary L. Steel 6 -17 -2000 A Bett Y Loz a3 � 1 0- WIF x 76 w ♦ "bado�► Lo ^41 ♦ ` ♦ r and etc �t ♦ Imp�cr The v of nnas� n' P�v�fd� eve_ nP�mum amount 3blective is l 'ninasJced to provide an leachin o surfac is design 8pillary a side wall to allow pen bottom and SPEC =hieved effluent to fl by on in al l d irections. oh' via )ttom with a ng t h e This has been O'VkW At": tra dition a l fluent ode then of louvers a . open L ...........�6" ;' Low p� Unh the Ab e' flows the sides. 34" i 9th . ... 7 along designed t len of each s t°unc, °mpacted H urt.... ...14• i Wes...... ...34" _o mpa � ed allow effluent to The l ouvers ................ 9" Height ...........11 ra 8 into backfill while Pass into th Bi°piflfu n a e In 6.5 chamber Prevgnting it from and WOO �, when }� of 12 o 1 7. wed .10 Ver lectors ST CROIX COUNTY SEPTIi, TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM Owner/Buyer 8 01 Nt3z.S 1 Mt( - 144e�_ 14C Mailing Address r x �,�# M ©,?� Si/01'7 Property Address A6 0 0 Co Arms. 4r=76 V r Q✓LI �' (Verification required from Planning Department for new construction) C v City /State AL & o Parcel Identification Number �a LEGAL DESCRIPTION Property Location 5; 'Z %., /V W y., Sec. l L . T J ?O N -R !V W, Town of Subdivision WA- 7 - - S E-6 L' Lot # Certified Survey Map # Volume . Page # Warranty Deed # (10 O L/ 7-4 Volume I L / . Page # 9 Spec house 0(yes ❑ no Lot lines identifiable Xes ❑ 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 masterplumber, joumeymanplimber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 th ee ear on SI ATURE OF APPLICANT 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 the e descri d a ove a of a warranty deed recorded in Register of Deeds Office. N TURE OF APPLICA 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 POWTS OWNER'S MANUAL & MANAGEMBff PLAN Pt" I of K h .E OAYAT�111 SVSTM $146GIRCATIOW Ow Permit i ins sever Manufacturer Tank Capacity 050 E3 Nn Septic TanManufacturer i PSG 0 NA Oft PARAINRETEf;S Effluent F or Manufacturer � ❑ NA (dumber of Bedrooms 01" Effluent Rhter Model � 0 NA Number of Public Facility Units D NA Pump Tank Capacity 0 NA gal Estimated flow leverage) 0 O Pump Tank Manufacturer 0 NA Design flow (peak). (Estimae.51 c) g al/d ay Pub Manufacturer 0 NA Soil Application Rate F / _ gwaayml Rte' Model 0 NA Standard Influent/Effluent Quakty Monthly average' Pratreatrhnuwnt Unit 0 NA Fats, Olt 6 Grease (FOG) 530 mg& 0 Sander Rker 0 Peat F*or Nocharic Oxygen Demand 190Cy 5220 mglL 0 NA 0 Mechanical Aeration 0 WeNand Tots( Suspended Solids (TSSI 5150 mg/L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal CON(s) ❑ NA Biochemical Oxygen Demand IBOD 530 mg/L P(h Ground lWavity) 0 In -Ground 1p xized) Total Suspended Solids ITSS► 530 mg/L 0 NA 0 At -Grade O Mound Fecal CONIC"" (geometric mean) 510 cfu/100ml 0 Drip-Line 0 Other: Maximum Effluent Particle Size 4 in dia. 0 NA Other. 0 NA Other: Other, [3 NA 0 Na 'Yakms typical for domestic west0w6tw and septic teak effk nt. Other: DNA MANIfTENANCE SCH DIKE Service Event Service FOmponc Inspect condition of tank(s) At least once every: 1 (hiNeorimwn 3 years) 0 NA le I s) Pub out contents of tankist When combined sludge and scurn equals one -third iKI of tank volume 0 NA Inspect dispersal ced(s) At bast once every: 0 nnonth(a) 3 yam) 0 NA yeertx) Clews effluent filter At bast once every: 0 rnsonth(s► 0 NA yearfs) Inspect l>'ymp, pump controls 3 alarm At bast once every: 0 monthhls► 0 NA Roam laterals and pressure test At least once ovary: 0 month(*) 0 NA Other a yeso At least one 0 months) every: D ~$) O NA Other: 0 PIA MANITENANCE WSTAUCTiONS lksspections of tanks and dispersal casts shall be made by an individual carrying one of the following icenses or certifications: Master Plumber; Maxtor Pturruberr Restricted Sower; POWTS kapector; POVVTS Mantauher; Septage Servicing Operator. Tank 9=13ections must inckude a visual inspection of the tank(s) to xkmtdv any mi o*v 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 drsPemal ceft) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent an the ground surf ace. The ponding of 9"km nt 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 IY or more of the task volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing 8t 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. GMW (4101) FART UP AND OPERATION ' of For new cow. Prior to two of the POWTS check treatment tankfsl for the presence of painting products or offer chemical of the that may impede the VOOM prwt process and/or damage the dispersal H higfn concentrations are detected have the con tankts) removed by a servicing operas r prior to use. System start up shall not occur when soil conditi are frozen at the infiltrative surface. Duunng power outages pump tanks whey fig above normal watttr d to the dispersal coWel in one large dose. la40b- When pourer is restored the excess wastewater win b+ effkmt. To avoid tho situation have the contents of Puad the cen(s) and may result in the backup, or surface discharge o Power to the effluent p tank removed by of compact a Pkurnlnar or POINTS S a Septage Servicing Opera" prior to westork f More normal levels within n the ho pump tank. Maintainer to assist in m nuaMy operating the Pump controls tr Do riot drive or park ape mound or at within 15 feet Clown � Or Park over. or otherwise disturb or comtpact, the am -grade soil Reduction or elimination of tour f POWTS: �• oNowmg front the wastewater stream may improve the Perfonnence and pig the We of the �y wipes; cigarette bums; condoms; cotton swabs, degreasws dental fioss; diapers; dizmMectants; tat; foundation drain ( ) water, fruit and vegetable peelings; game; grsase; herbicides; meat scraps; medications; oil; painting Products. ; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fads and/or is permanently takers our of service the properly and safely abandoned W e w ith c following in sshall ra ve C to insure that the s ys t em is chapter Comm 83.33. Wisconsin I►tbtnir utiure Code: • An piping to taroks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of an tanks and pits shall be removed and property 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 s tit son, gravel or another inert solid material. pace led with 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 bow evaluated and may be utilized for the location of a replacement soil system. The replacement a be protected from disturbance and compaction and should not be infringed rea stouW required setbacks from existing and proposed structure, lot roes and waNs. Failure to protract the replacement area will result in the need for a new sad and site evaluation to establish a suitable replacement area. em . Replacem s comply with the rides in effect at that tiros. ystems must ❑ A suitable replacement area is not available due to setback and/or son limitations. technology a holding tarok may be installed as a fast resort to replace the fared POINTS Barring advances in POINTS . ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be perforated to locate a suitable replacewnent area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade sal absorption systems may be reconstructed in place follow infultrative surface. Reconstructions of such ing removal to t t of the biomat at the systems mast comply with the miles in effect at that time. < <WAFWM> > SEP TIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL BASSES AND/OA INSUPFICIENT OXYQEIII. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY STANCES. PERSON DEATH MAY RESULT. RESCUE OF A FROM THE OF A TANK MAY E D�IKT OR IMP E. ADDlTIONAL CON MENTS POWTS INSTALLER POW= MAiIM7AWER Name ` O w L;-m Phone to - St S@" WAGE SERVitSINti OPERATOR fPtIMPBtI LOCAL REBUI.A'iQBi/ AUTHOMiy mairte Z� "ems Phone Phone This docurr+ent wan drafted in eomiAe nce witt► chapter Crtmin 83.22fZWI I lf"(11 and 83.54111). M & (3), Wit oonairn Admt *wative Code. .(.1431PAG�169 STATE BAR OF WISCONSIN FORM 2 -1998 6O'42�J7 KATHLEEN H. WALSH WARRANTY T.)IZFD. 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 "Propdrty'): EXEMPT N CERT COPY FEE: See attached Exhibit "A" COPY FEE= TRANSFER FEE: 107.60 RECORDING FEE: 12.00 PAGES: Recordin Area Name-and Return Address Hendrick W. Van Dyk VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 Now Richmond, WI 54017 Pmt of 026. 037.30.000: 026-1037-95-000 and 026. 1018 - 10.000 Parcel Identification Number (PIN) This n_t homestead property. i Exceptions to warranties: Subject to all casements, restrictions and covenants of record. Dated this 28th day of May , 1999. i *David L. Naser AUTHENTICATION ACKNOWLEDGMENT Signatures) David L. Naser STATB OP WISCONSIN• ) ss. 1 County ) autheati this day of Mn ' 1999 , Personally came before me this _ day of , 19_ the ab ove named W. ' to me known to be the person(s) who executed the foregoing * Hendrik W. Van Dyk instrument and acknowledge the same. j TITLE: MEMBER STATE BAR OP 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 & SITYR, S.C. (If not, state expiration date: Post Office Box 127 ---) New Rirhmnnd_ WT 54017 r Im 1 1 rA 0 y s° o o v 'u oo o tTi o T1 '� O O L � CS ' C� % N ¢ ° v �0 + p 9 a) o (L) v o o v '� bA '� ., � v y O v �n G •..yy O -- U p fsa v ++ m Q) c� 3 � o v N ' O v p -W S1 to 'l� O m O, �O EA U 4 4 9 * , 0 0 p., v as i - • �s u