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HomeMy WebLinkAbout026-1144-30-000 Wisconsin epartmtlit of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420667 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: Murray, Daniel L I Richmond Town 026- 1144 -30 -000 CST BM Elev Insp. BM Elev: t BM Description: Section/Town /Range /Map No: 10011f )D(. C & $S 20.30.18.1054 TANK (NFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � // r- Benchmar Dosing W � � �I Alt. B Aeration Bldg. Sewer Holding St/Ht Inlet t l.0 91 5% T11 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 Dt Bottom 1Y ID 9 /.'30 1 Dosing w 7^� k Header /Man. Aeration v Dist. Pipe Holding Bot. System to 98./0 PUM HON INFORMATION Final Grade aE- pj.q0' Manufactu r Demand St Cover rr�— / GPM r/r Model Number Pad L TDH Lift Friction Loss System He TDH Ft Forcemain Length a. , &d Dist. to Well 1 -50 SOIL ABSORPTION SYSTEM( BED/TRENCH Width Length7 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 t 9 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Mac oufato INFORMATION CHAMBER OR �` Type Of System: ' D /� / > UNIT Model Number: 1 2- 14 t pvw DISTRIBUTIO Y TEM Header /Ma *fgl Distribution x Hole Size x Hole Spacing Vent to Air Intake r Pipe( Length Len Dia pacing 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 COMMEN (I lude code di re eRichmon n 'es, persons present, etc.) Inspection #1 T . : Aq Inspection #2: -4- ' ' 2- Location: 1073 1 th e New WI 54017 (NE 1/4 SW 1/4 20 T30N R18W) Waldroff Meadows Lot 13 Parcel No: 20.30.18.1054 1.) Alt BM Description = 2.) Bldg sewer length = Z 1 �l ii - amount of cover ` �.... Plan revision Requir Y No Use other side for ad itiona r SBD -6710 (R.3/97) ✓ _ 4�1q,P Insepctor's Sig�atyre • J "� z.) P,,,,� tars - s�e�+ � • °° -- 1 { Safety and Buildings Division County 201 W. Washington Ave., P.Q. Box 7162 � , I Madison. WI 53707 - 7162 Site Address De ar.tmertt of Commerce / -�9 - 73 Sanitary Permit Application s�ta'y Permit Number In accord with Comm 83.21, Ms. Adm. Code, personal information you provide ` non be used for a Privacy Law, s1?. 1 rn ❑ Check if Revision I. Application Information - Please Print All State Plan LD. Number iz�0 ONINOZ /v Property Owner's Name Parcel Number I�cl�a £OOZ t 9 NVf 0 30 - ,6©c- Property Owner's Mailing Address Property Location 1A tW4• S Tad N R l� City, State Z Loot Number 3 Block Number Subdivision Name CSM Number ./l/ II, Type of Building (check all that apply) /G2 w ❑City 1 or 2 Family Dwelling - Number of Bedrooms J� 9 ` _3 3 ❑Village D Public/Commercial - Describe Use (township D State Owned � tN r (Nearest Road M. Type of Permit: bteck only one box on line A (numbering scheme for internal use). Complete line B if applicable) 1 XNew 2 ❑ Replacement System 3 C Replacement of 6 1 C) Addition to For County use System I I i Tank Onl Existw S stem B. ❑ Check if Sanitary Permit Previously Issued Penult Number Date Issued k M Type of Permit: (Check all that apply) (numbering scheme is for internal use) . • wit 44 9 Non - Pressurized in- Ground 2111 Mound 47 ❑ Sand Filter 50 G Constructed Wetland Or 816d f' -lr_ i 22 CJ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At - Grade 46 ❑ Aerobic Treatment Unit 49 D Recirculating 30 ❑ Othe ! V. Dis ersal/Treatment Area Information: a 2 _TT'Z*•v &_ v,4 Fhb - v r/ Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required 3 Proposed � Rate(Gals./Days /Sq.Ft.) (Min.(Inch) y ol�,PT' Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks / � �� I Concrete Constructed Glass New Existing ! Tanks Tanks / ! Septic or Holding Tank Dosing Clamber VII. Responsibility Statemertt- I, the undersigned, assume respo nsibility for installatio of the POMS shown on the attached plans. Plumber's Name (Print ,i P Signature li, RS Number Business Phone Number ? /s- Plunbees Address (Street, City, State, Zip Code) VIII o /De artwent Use Onl Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued eat Signature o tamps) ' Surcharge Fee) ( L C3 Owner Given Initial Adverse. .� 'ls 3/ D ��i,.' ��,t Determination o Y IX. Conditions of Ap roval/Ressons for Disapp oval A /D2. /', �J rn � hof s / � q v ° j-!Qd d �► , -� .Pill. �a c�- cr+1 8 / 6 a�-d do�rs� -�cr� .71 sT k . s y as 8 7 - 3 "#e plans ( to the Earuq ws1,j) for We sfstew ea pa�� M x� taelra in size SBD -6398 (R. 05101) WtV yr t 3 • �'3— I , ��'� 'ut �cGon � �6/2r �► c / � Te �iQe tia r zo i i �I !�� �aa ��.tibars BTU 1G0 f an � I r � TAOa as r 1'oo ° I ! f I I f I j i v � t � I J 3 R 4A,* m bens O ?,r .a � PAGE_OF NAME Wa (CI fnX � LOT# I", LEGAL DESCRIPTION H. ' /,NE' /. S2aT o N R ►R E (orbs SCALE: F'= BM 1 ELEVATION , BM I DESCRIPTIO p 1 R e ba _ r ? BM 2 ELEVATION /w. 0 ii BM 2 DESCRIPTION -6e O -Q 91 �u t � SYSTEM ELEVATION _ )c ALTERNATE ELEVATION C) CONTOUR ELEVATION JO 3 (O (. 3C) , L�o4 ' Shape. � o� � n M w .- aZ a� oZ yS P, �" r L � /C1.36 r S ► �7.ys' 304, -3 VK SIGNA URE G DATE Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Divisioh of Safe)y and Buildings in accordance with Comm 85, Wis. Adm. Code , County 57 , Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must o include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 2�" percent slope, scale or dimensions, north arrow, and location and distance to nearest road. // y 3 0 - —GYD Please print all information. R y Date Personal information ou provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 63 Property Owner MUG6 Property Locatio r vLa Govt. Lot V U✓ 114 S E 1/4 S Z(3 N R E o T �d � ( ) Property Owner's Mailing Address Lot # Block # Subd. Name or CSMII yer 3 l .�' .9 Read I Cck�. d r� City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road eH I WI 5Uotco 06 6449-4doW tC11{'m &-td [g New Construction Use: I Residential / Number of bedrooms Code derived design flow rate S �_ GPD ❑ Replacement ❑ Public or commercial - Describe: Pr- Parent material e C) Q SG Flood Plain elevation if applicable r ft. General comments S5 r>1 2 % f J 1 q� 30 �32 �� and recommendations: L ST CR07X F �i ❑ Boring 1 Boring # ®, pit Ground surface elev. /6/- 20 �/'� ft. Depth to limiting factor •�— in. .. � Soft Apoliqa "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 D-!c 1 S . 2 n4� G S • 2 1 /0 -7 4 I 3T Boring # ❑ Boring a [ pit Ground surface elev. AD Z. / a t. Depth to limiting factor 1 In. Soil Application 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 I *Eff#2 o 2mab n-fi 3- 15 1 41y s.) 2 * 121 ko 33 4 ms ml 0 7C , ' 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) ignature CST Number H - �- -� - - - - - -- 5 G Address Date Evaluation Conducted Telephone Number 2 Property Owner GJa 1 d rd , TV Parcel ID # p> z Of F-31 ring # E] 6L ®. pit Ground surface elev. /O✓• ft. Depth to limiting factor ►9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 5 Z 'rLk rrA C- io ro S m Z Boring # Borin ❑ 9 Pit Ground surface elev. / Z . 3s Depth to limiting factor Z in. Soil Application 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 1 a--H 5< C- l v� 2 14-31 S� t — $ 3 .► qu lye_ _o'— 39 6, N s ! f� s a Boring # E] Boring Ground surface elev. / D 1 • a "�O ft. Depth to limiting facto in. ® Pit Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 S I k rnPr v� 5 2 jZ Pr qS -3 3 - 7. d- i3.2'' " Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 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- 2648777. SBD -8330 (R07/00) l PAGE_OF NAME like (CI if n •+ LOT# 13 LEGAL DESCRIPTION" J ' /+NE-' /< S2a T Zn,N R 1R E (or(% SCALE: 1 "= qc) BM 1 ELEVATION BM 1 DESCRIPTION �0 D� �u R e ba c BM 2 ELEVATION BM 2 DESCRIPTION O-Q � qq u 2 K 2 {' SYSTEM ELEVATION y 1 J 1C ALTERNATE ELEVATION 1 CONTOUR ELEVATION /02 . 2�O 3 Io • 3C� 1 G32 a� a Z U B3 ql m r S e-me(C SIGNATURE tG - -- - — DATE FR Schumaker Plumbir FAX M0. : 7153863121 Sep. 05 2002 05:44PM P3 ST CROIX COUN'r'1' S +ZP11C TANK MAINI'BNANCE AGRESMBNT I AND OWNWHIP CERTIFICA114N FORM 0wraftyor n f 1 Mdit M&M X3`1 "' � 73 d o 1 � (Veri�ieNiea e�iad Goa r4rde� Depr�art hoe ter q�yJ$owe ' Pwxl IdeadBoodoa Number pot & �/ `� �— 3U — 0 d propotgr L40d= . V4 yM aea, , , T '. ,rl�.,W� Town of r tot II �✓ owal map 0 .. • Ydlma0 A W 8pov yre� d ae Let gm volw6x yo P ado • . �propewrdo[��loq�tetdaidmw�Isi�� i�al�l•�.�pe�� eeaoLto et ar* ttr welfeltrdcpwptbDOe y.os at rraeK It�tl�orwd ya vd h* do qVion aa�el d�ae�. 600doaoR4wOtlapmic� .a���r�IerMRowl . '�Ga p�gpe�growaodrryo�r�o �'ti 6t, Coets !'�6yc � ti �a � � ' a . � die bawe o�,tre t� wde�ow to md�ba tba w� d q�'°� *416° +btu iot >tali.�set4grdr>dapwlMaoati!ll Betas, oosaaddree� l�Sl�aoeaaow;llolead'� 0 - d�tPemr�lo�5. iai�. d�ama�t�eoomPloOedadw�dmd�s s�tl�bc.Comq►O��' tba� yowr sx�t;es d>�. CE+" t *d IR OWN WO on dde &M aye tM et *a bW o[ WY f 00 faar WIL I {we) an (US) �e o*►�{ ) fi� off► � ' Yy rigae et a.�r deed wau�ded is #+ad�eae ei ooelb oeea. =NAT= DATE 0*66M by *o LODW DOUW=t • o' bndude wfth mk appttasdoa: a vWmwA %w aWy dad iem do W of ba b sloe ,► a" d dl it ddsd d Mey Wo If dntit+eow k Mich Ia dw wormy dead II 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 ya (o Number of Bedrooms 3 Design Flow - Peak ( pd) Estimated Flow - Average ( pd) 36 Septic Tank Capacity (al) 1'ao n Soli Absorption Component Size ) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak pd) Maximum Influent Particle Size (in) 1/8 Maximum BOD ( m /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every aylars Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once eve years ---- SetAlc 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 septic tank and outlet filter shall be assessed at least once every 3 years by inspection, The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Pian for a Septic Tani, arc Soy: Arisorption COmpanent filter Is equipped with an alarm, the filter shall be serviced if the alarm is activated contlnuous!y. Intermlttsnt flltir slums may Indicate surge flows or an Impending oontlnuous alarm, Tire esptie tank shall hsve its contents removed when the volume of soum and sludge In the tank Moods 4/3 the liquid volume of the tank. if the contents of the tank are not removed at the time of an mosaunent, maintenance personnel shall 26160 the owner of when the next service nods to be performed to msintaln leas then maximum scum and sludge accurnulatictn If' the tank. Manhole risers, acoess risers and covers should be inspected for water tiphtness and Soundness. Access openlMe used for service and assessment $hail be $eati►d Watertight upon ft tom p letiol'1 of service. Any opening deemed unsound, detective, or subject to NUM must to replaced. , Exposed access openings greater than 84nohos In dlawlOW? sheaf} be secured by an iefiteative looking duke to pmvent amlerttal or umautharized +entry Into the tank. S one should enbl a sop* cw other trwbnent Or hotdfna funk for any »wean wlthorg balm in ha scarp jemoe wNh a" olafnd&48 for ut ho a ONO" epm. ate �tLn�phen► WNW th 4111p* of otfnr ftwo f Of ho:l bark may amen l PM Ithd IM US of e peirM f?lrloatt is kmdor of I" Ow ybe W~ of tatpalf si" r Tank abandonment shall be in goocrdance with Comm 83.33, Wts. Adm. Code when the tank Is no tongar used as a AOWT3 component. fail 609000 Gan" The soil absorption component serving this structure is designed to accept domestic wastewater tram a residential 140ty. The limits of operation of this ocmperWAt ore shown in Table 3, The longevity of a soli absorption component depends greatly on props' and timely maintenance, and system use within or below rho limits of reliable operation, Good water consery rim prodoes by ad cicupants and the Instellatlor: of water Canserving plumbing fixtures are key faders In exte riding the useful life of this component The sell absorption component`s operation must be assessed by inspection at least once every flues years, The inspection shalt include recording the levels of pondinp, if ery, in the observadw pipes, and a visuai inspection for any e vidence of surface seepage or discharge f rom this component. On steeply sloping sit". gross of eralon should be Identified and reported to ft owner for repair. The suftoe discharge of domestic wastewater or sewage from the vystaem is prohibited and considered a human heglth hazard TMMO around or over the soil absorption component should be avoided particularly dur►ng winter months, The compaction or removal of gnaw cover over th Component may lead to hydraulic fadiure b freezing. This type of fa il ure is usually tsmiporery, but is difficult or Impossible to repair until weather oonduns improve, in general, sal rompection over this cwr"riant will reduce ditfuelon of Mgan into the soil and dispersal call, which may lead to more Intense, and sariler, orpanlo clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption COmpement Pianthp of deep-rooted treat and shrubs directly over of within tan feat of this component should be avoided eltws root Inausion Into the cOmpanent may obstruct w+utsv►*W flaw. Contlnwcy Plan in the event of system failure, a new system could be ln stailed in an iiltarnata area. With the IrW00 nian of a divarter valve, the existing system could oleo be reused after a perlod Of three to fever yams. It is the property wws responsibility to maintain the aitern" area feat frm any planting of trees, shrubs, alc. in sus of failure of the original system, the altema" area wili be needed. if any treas, shrubs, etc. haw bean planted an the sit MW area, lhsy will have to be rarrioved et property ft ars evenew if alternate area is destroyed, there are other alternative systems that can be used, in Which, could result in added expow to tare prop** a w. Any tank abandonment shall be done in a000rdance wish `NWG. Code $3.33. Any quastions rrwding this code, please contact your legal Zorning Office or cvtaot f» matt RV plumber. �c�,�ak...�. �1.wew+b►n► (Z IS'� 3`b V vo ,18?9 PAfE 72 ' STATE BAR OF WISCONSIN FORM 2.1999 6 701 O 1 WARRANTY DEED �c ATHLEEN H. WALSH DocumenlNumber REGISTER OF DEEDS 31. CROIX CO., WI This Deed, made between Da J. Wal and J ulie A. . RECEIVED FOR RECORD Waldroff, h usband and wife, — ' 024'1 -2002 9:40 AM WARRANTY DEED Grantor, and Daniel L. Murray EXEMPT It - CRT COPY FEE: E:OPY FEE: TRANSFER FEE: 192.00 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area jC-.un lat of Waldroff Meadows in the Town of Richmond, St. Croix Name and Return Address Wisconsi n. �tilB - f f�tofsol� 026- 1061 -50 Parcel Identification Number (PIN) This- is n ot homestead property. Q§) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this 1 ,51- day of January 2002 la�k - + id J. Waldroff • • J e A. Waldroff AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) _ ) ss. County ) authenticated this day of it'QE.S I, �pfi � ly came before me this 3 1 day of _ h an -69 ° _ 2002 the above named x and Julie A. Waldroff, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If not, foregoing ( am to be the person (s) who executed the fore g S a y a4 authorized by 706.06, Wis. Stats.) an acknow c ged Ooe THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Co mi sr r is permanent. (If not, state e t (Signatures may be authenticated or acknowledged. Both are not necessary.) _ ) + Names of persons signing in any capacity must be typed or printed below their signature. infomation v,wes.iwais c�pany, Fond du tae, Wt STATE BAR OF WISCONSIN 500-65-5-2021 WARRANTY DEED FORM No. 2.1999 t� W 487.83' ROAD CENTER OF CUL-DE-SAC 487.83' STORMWATER ,� •' PONDINQ AREA 1 H.W.L. = 940.0 . � • � • 0I 1 O 1 N I 1 42 9 �i I MIN FFE = . o S� 9 O F a � Q, ! co a LOT 13 U. 4.021 ACRES ^ ;! ca I (175,134 SO. FT.) Q LOT 12 TOTAL � 3.951 ACRES 3.145 ACRES (172,127 SO. FT.) $ L O n ' (137,016 SO. FT.) TO MEANDER LIN • __ _ TOTAL v _ � r o1 3.115 ACRES MIN FFE = 941.4 (135,705 SO. FT.) TO MEANDER LINE Q 1 � Z I I I I �I I EASEME 7 3 Number Bec Ll NBE L3 WE L4 NY 87 306.4& L5 SOC (fit) ----- - - - - -- L6 N8 114 OF THE SE1 /4 OF SECTION 20 I°�'Okk L7 N8 BENCH MARK: TOP I L8 N7t OF 1 IRON PIPE, L9 N5Z ELEVATION 958.8 I L10 S8s I Lll Soo I L12 Soo I L13 SBS I L14 N00 I L15 NBC I L16 NBS L17 N3E 1