HomeMy WebLinkAbout026-1153-36-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453146 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:
Barr, Jesse I Richmond Township 026- 1153 -36 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
1 100-6 1 TO c_ iPos 1 l 19.30.18.1174
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / Benchmark
W O D C7 � ►YI I � r �J-� /O� 33 lob - v
Dosing Alt. BM
P� -Z_ s .7 9.52
Aeration Bldg. Sewer
.0 -2q 95,
Holding St/Ht Inlet
' 70i' q q.3Z
TANK SETBACK INFORMATION �t �1 t/� 10c7 SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 2 it v10f'O I Dt Bottom
16 5 Dosing Header /Man. lrT it 7 ,7g
Aeration Dist. Pipe Gue /0,3 q p ,9q O I
°Ptta�' 3S ri
Holding Bot. System 30
Final Grade
PUMP /SIPHON INFORMATION 7, �D
Manufacturer � GPMand St Cover
/ �� 3A
Model Number
TDH Lift Friction Loss System Head TDH / Ft
Forcemai Length Dia. / I Dist.toWell
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches QG PIT DIMENSI S No. Of Pits Inside D/ Liquid Depth /
r
DIMENSIONS 3 / 75 75 a ,/
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR a
Type Of System: ytQA.<> / � CM
V GulaJe . �] . UNIT Model Number: J
G T
3 5 �
DISTRIBUTION SYSTEM >5�
Header /Manifold Distribution --Tx-Hole Size x Hole Spacing Vent to Air Intake
it
!/ Pipe(s)
Length 7 1 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 I x Mulched
Bed /Trench Center 6 Bed/Trench Edges 3111 Topsoil / es No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ &/ 1 / 0 # /
Location: 907 148th Ave Unknown (Unknown 19 T30N R18W) Glen View Lot 36 / Parcel No: 19.30.18.1174
1.) Alt BM Description = 5�i_�C CV\,kev a ' Sit v.-� )yLY (�) ..k/11
2.) Bldg sewer length = 2-3 r /
- amount of cover = 30 � pzti � 1, (o, l
C 3� eV4 j 04IA4 0ln(, U , 0— A_170�
Plan revision Required? Yes No
h_ 0 4 / 005
Use other side for additional information.' _ } _ 49
SBD -6710 (R.3/97) Date nsepctor's Signature Cert. No.
4 Ass Safety and Buildings Division County
201 W. Washing ton Ave., P.O. Box 7162
visconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce
(608) 266 -3 t51 3 14L
Sanitary Permit Application State Plan LD. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Information c -
� f Tb f}116 .
Property Owner's Na me Parcel N Lot # Block #
s s� 13ARK 5 3
Property Owner's M ailing Address APR 9, - Property Location
U ( 1 r , 2 ' , , �, T,f I — AI 1 1 (�
City, State Zip Code r 'A, v w '� > Section 7
zo ��
(circl
S e ne)
II. Type of Building (check all that apply) T 3 0 N; RE or
3 �' � `
,un or 2 Family Dwelling - Number of Bedrooms s Subdivision Name CSM Number
❑ Public /Commercial - Describe Use p t
El Owned - Describe Use = K 6 t7 • S ❑City_ ❑Village ownship of Kl arho N t )
III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) D2 ( - f 5 3 - 31� Q�{j
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
t
! uNon - Pressurized In- Ground El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil 11 At-Grade El Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter W Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation y $ I
qS0
1
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber P stir
Gallons Gallons of Uni W 1 9&6Q A, - /� oncrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank - O V
I 1 I W�� J
Aerobic Treatment Unit
Dosing Chamber
I
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si ture MP /MPRS Number Business Phone Number
�1 m �plk ln4�j god
Plumber's Addre ss (Street, City, State, Zip C )
] Pw �s N 440S0> �)SC G1
VIII. County Departmeni Use Onl
Sanitary Permit Fee (includes Groundwater Da Issued ssuin Agent Signa (No Stamps)
Approved El Disapproved Surcharge Fee) 0 .
❑ Owner Given Reason for Denial sz) �
][X. Conditions of Approval /Reasons for Disapproval 3� TC
SYSTEM OWNER:
1 Septic tank, effluent filter and �� <
dispersal cell must all be serviced !maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances
SBD -6398 R. 0
Attach complete plans (to the County only) for the sys on per not less than 81/2 x 11 inches in size ,
1/03 (/V 6�
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 1/2 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. ri A D
Please print all information. Re ewed by Oatg li
Personal information you provide may "used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
t2l/e; 7j--& S Govt. Lot ap L/1 /4 S T30 N R id E (o W
Property Owner s Mailing Address Lo #( Block # Su Name / or M#
' J C J10 CV L G �,�(�
City fate Zip Code P one,Number El city ❑ Village To Nearest Road
� �.<1 0 1 ()
New Construction User Residential / Number of bedrooms � Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe: ___--- ______ -- -- - - - - -- -- - - --
Parent material ��/G4s'�CG /rX )!./ Flood Plain elevation if applicable 0 6 e !�1 6 ft.
General comments �� rt✓ t� f✓%��, y ✓
and recommendations:
5s, U �
. 268 q
04 �a a,
M [) �ng # Boring J° rb
pit Ground surface elev. ' ft. Depth to limiting factor in. '
Soil App lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff #1 'Eff#2
Z L y o l �� , - z . z
Bodng # Boring /�
Pit Ground surface elev - -
ft. Depth to limiting factor a , 9 -n. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f `
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
L �--- L a M 1 ts 1 7 • 1;'
D �,. a a , z
3 _ S / �-
Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 1 Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) ture CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 � / / Ca 715- 246 -4516
i
3L
Property Owner Parcel ID # Page of
FT [] B Boring #
oring
1 4 Pit Ground surface elev.Dft. Depth to limiting factor _- !1-� in. Soil liration 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 'Etf#2
L .,
q 1-no
F-1 Boring # Boring
Ground surface elev. ft. Depth to limiting factor in. E] Pit Soil lication 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
i
F-1 Boring # ❑Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPQM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mg& ' Effluent #2 = BOD _< 30 mg& 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 -264 -8777.
Sa (a.6=)
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun Bird
Address P.O. Box 10598
White Bear Lake Mn 55110 CSTM #f/
Lot 3 Subdivision Glen View Date 7/1 8/03
1/4 N W 1/4S 1 9 T 3 0 N /13 W Township Richmond
Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 88. 6/87.5 *HRPSame as Benchmark
Alt. BM Top of Survey Iron @ 96.5 Scale is 1" = 40'
unless otherwise
noted
Please note: survey was not
completed at time of testing,
setbacks from lot lines may Please Note: Tested area
change. Installer must verify may not be suitable for
all lot lines and setbacks desired building area.
before installation. Check system location
before excavating.
a�
a 90'
a 92' 12%
o Slo
94' B -2 35' B -3
70'
5'
IL— B.M.
211' Property Line n _ 1
L�B .M. 562' Property Line
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 (RV99).
Table 1: System Design Specifications
Sanitary Permit Number 453
Number of Bedrooms
Design Flow - Peak (gpd) 5 V
Estimated Flow - Average (gpd) 3 u
Septic Tank Capacity (gal) 1000
Soil Absorption Component Size (ft?) 84
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) 4SO $
Maximum Influent Particle Size (in) g 1/8
Maximum BOD (m /L) 220
Maximum TSS (mg /L) 130 150
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
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se ti k and outlet filter shall be assessed at least
once every 3 yeas by inspection. a outlet fil shall be cleaned as necessary to ens ure
proper o pera ' The filter cartridge s ou not be removed unless provisions are made to
re ain solids in the tank that may slough off the filter when removed from its enclosure. If the
• Management Plan fora 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 replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other 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 may contain lethal gases, and rescue of a
Y
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 P
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 slo in sites, areas of erosion should be identified and
P P
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
ed trees n shrubs direct) .
Plantings of dee -root e s a d y over or within ten feet of the
9 P
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester & Sons Excavating 386 -9020
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address mp �
(Verification required from Planning Department for new construction)
City/State 'AyS U N W Parcel Identification Number
LEGAL DESCRIPTION
Property Location _ 1 /4, N r /4, Sec. . T O N -RJL Town of ►f\c) o e
'Subdivision l-4 U V t l t L) , Lot # J y
Certified Survey Map # - -- : Volume Page #
Warranty Deed # zfj � ti . Volume A Page # z.2 0
Spec house O yes IR no Lot lines identifiable 5 yes 0 no
SYSTEM MAINTENANCE -
Impr4per 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, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
L in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 lull 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 30
days of the three year expiration date.
Sj6 ATURE OF APPLICANT DATE
. : •OWNER CERTIFICATION
ti V 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 proPi ty,.described above, by virtue of a warranty deed recorded in Register of Deeds Office.
/ /D Ll
;M ATURE OF APPLICANT DATE
'••••• Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department.
•• Include with this ap 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
U 2497P 206 -7s`54-!:- i
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
This Deed, made between Hillvale Development Limited Liability RECEIVED FOR RECORD
Partnership Grantor, 01/23/2004 10 : 30Al1
and Jesse G. Barr, WARRANTY DEED
Grantee. EXDPT #
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11.00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 145.50
(if space is needed, please attach addendum): COPY FEE:
of 36 lest of GlenView in the Town of Richmond, St. Croix County, CC FEE:
Isconsin.
PAGES: 1
Recording Area
Name and Return Address
026 - 1153 -36 -000
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this D day of January , 2004
* * H illvale Developm Li mited L iability Partnership
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF
ss.
County )
authenticated this day of r
Personally came before me this _16 '_'day of
January 2004 the above n g a
Hillvale Development Limited Liability Partne by
uj Z
Richard Nelson Z 5 0
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _ — — to me known to be the person(s) who executed the foregoi _ °
authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
Attorne Kristine Band
Y -- -- - -. _ _— ._.ems__ —_._.. �.
Hudson, WI 54 01 6 Notary Public, State of /Y� /�
My Commission is permanent. (If not, state expiration date
(Signatures may be authenticated or acknowledged. Both are not necessary.) r4 N J�9 /� , ; j — , tZ 0 O.y •)
* Names of persons signing in any capacity must be typed or printed below their signature. Inrormation Professionals Co., Fond du Lac, WI
STATE BAR OF WISCONSIN 800 - 655.2021
WARRANTY DEED FORM No. 2 - 1444
an.ax
N88'49' "E 701.53'
508.95' 137 : 41 ' e7.4r
. ""'' • / 123.12'
/ 192.58'
z 38 r
90.908 S.F.' j DRAINAGE
(2.09 ACRES). ki EASEMENT
Cn L.B.O. EL •• 929pp H.W.L 9 7.
to
4 -W i lt
39
I 8 7241 S.F.
/ (2.00 ACRES) n
L8.0. EL. - 929.50
1
37
N 99,005 .o
S.F.
• (2.27 ACRES) /
1 �\ DRAINAGE
i `` / -kA \MENT
.� � /
ENT
15y�W r Sd2'M'2e'W /97.
36
3,570 t;
(5.8 ES
�a. L.B.O. EL 1, 927.00
DRAINAGE
H•W L + 924.85
Z 1 N89'54'11 "W 21 'bt I i
U O .� 29.50 AO• q�
v c31 t� �rt.ky
WEST QUARTER CORNER H
SEC. 19, T30N, R18W
4
FOUND 3/4" O.D. IRON PipE
..ATION SKETCH 4,q ss,88.
0
AVENUE S
Soil Test Plot Plan
Project Name Lakes and Hill Development Shaun Bird
Address
P.O. Box 10598
White Bear Lake Mn 55110 CSTM #& 6900
Lot 36 Subdivision Glen View Date 7/18/03
'1 /4 N W 1 /4S 1 9 T 30 N/13 W
Township Richmond
E] Boring Q Well PL Property Line County ST. CROIX
IL BM or VRp Assume Elevation 100 ft. Top of Steel Fence Post
System Elevation 88.6/87.5 *HRpSame as Benchmark
Alt. BM Top of Survey Iron @ 96.5 Scale is 1" = 40'
unless otherwise
noted
Please note: survey was not
completed at time of testing,
setbacks from lot lines may please Note: Tested area
• may not be suitable for
change. Installer must verify
desired building area.
'all lot lines and setbacks
before installation. Check system location
before excavating.
a�
90'
o . 92' 12°.''0
Slo
94 B -2 35' B -3
70'
4
5'
B.M.
211' Property Line -1
562' Property • P Y Line