HomeMy WebLinkAbout030-1004-90-000 Department County: ent of Commewe PRIVATE SEWAGE SYSTEM St. Croix
nd Building Division
INSPECTION REPORT Sanitary Permit No:
479469 0
,ENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
lersonal 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:
Beer, Richard I St. Joseph, Town of 1 030- 1004 -90 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
p 6 - 0 - 0/ i 02.29.19.24A
TANK INFORMATION U ItLtVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic p� Benchmark 2
'F Zo 5
Dosing It. BM
Aeration 1 Idg. Sewer r I
Holding St/Ht Inlet S SS
_ I0
� $ �
TANK SETBACK INFORMATION SUHt Outlet C r(' •W
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 / T Bottom — - --
L
Dosing Header /Man. -- - - - -.
Aeration Dist. Pipe (� , 9 D r
I
Holding Bot. System
Final Grade - 1
PUMP /SIP ON INFORMATION �ija trk l
Manufacturer Demand St Cov r � Z •G5� (� -CD r
GPM S�
Model Number
TDH Lift iction Loss System Head DH Ft
I
Forcemain Length to well
SOIL ORPTION SYSTEM
4Wd%(� RENgO Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME ONS ,7 7c�
SETBACK SYSTEM TO T � P/L BLDG WELL LAKE /STREAM LEACHING Man rure
INFORMATION CHAMBER OR r OI SR1
Type Of System: V • ZZ UNIT Model Number 6�
DISTRIBUTION SYSTEM
Header /Manifold IDistribution I x Hole Spacing Vent to Air Intake
Pipes) _.. 2 ,
1 Ldmgth "— Dia Length Dia Z + 7
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of 1 77 dded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil 1� Yes ] No ij Yes [ No
COMMENTS: (Include code discrepencies persci s pre en etc.) Inspection #1: T T_JS t T Inspection #2:
Loca 1150 County Road A Hudson, WI 5 016 (SE 1/4 NW 1/4 2 T29N R19W) NA Lot Parcel No: 02.29.19.24A
1.) Alt BM Description = (Ml A
2.) Bldg sewer length= 1.0
- amount of cover = I S rt+
Plan revision Required? `- Yes XNo
Use other side for additional information. � J _- - - - - -- /
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
�� J7
AV '� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
lsconsin ( - 44cl qO
Department of Commerce r D
fate Plan � .. Number
s • A. Sanitary Permit Applic do "7
In accord with Comm 83.21, Wis. Adm. Code, personal in ation ju rovid� i roj Address (if different than mailing address)
may be used for secondary purposes Privacy Law,
I. Application Information— Please Print All Information t: ; S1 . CROIXCUUN1'Y
Property Owner's Name o2 _1C1,4 - qp - �• �/4
/Cl r 2�C Property Location
Property Owner's Mailing Address // Z
&)I., Section
Phone Number
Zip Code J cirri one
City, State , tI g9 E W
j G' —f--9 ..� t ! �
11. Type of Building (check all that apply) - 3'A+ QuL n
❑ 1 or 2 Family Dwelling - Number of Bedrooms I T C �Q�Vt
public/Commercial - Describe Use L j ❑City ❑Village ownship o
❑s Awned - Describe Use
a/
III. Type of Permit: (Check only one box on line A. Complete lin B if applicable)
e ❑ Other Modification to Existing System
❑ Replacement System ❑ T Tank Replacement Only
°' ew System List Previous Permit Number and Date Issued
Permit Renewal ❑p Revision
❑ Change of E] permit Transfer to New
g. ❑ plumber Owner
Before Expiration
IV. T e ofPOWTS S stem: Check all that a 1 I 3 K
❑Mound < 24 in. of suitable soil ❑ At -Grade
on - Pressurized In- Ground ❑Mound ? 24 in. of suitable soil Si Pass Sand Filter
In- Ground [I Holding Tank E] Peat Filter ❑ Aerobic Treatment Unit ❑ R and Filter C1 / ting
pressurized
Constructed Wetland ❑ pn am ❑ ❑ Other (explain) /+ j
' hing chamber Drip Lie Gravel-less Pipe
Recirculating Synthetic Media Filter System Elevation
Dis ers Area Required (sf)
Design Flow (gpd) Desi Dispersal Area proposed (sf)
V, pis ersaVTreatment Area nformation:
Design oil Application Rate(gpdsfl sp rs
� prefab Site Steel Fiber Plastic
VI. ank Info Capacity in
Total Number Manufacturer Concrete Constructed Glass
Gallons Gallons of Units ?,44 'A _ estt
New ExisdnB�" .
Tanks Tanks '
Septic or Holding Tank 2
Aerobic Treatment Unit
Dosing Chamber
Assume r esponsibility instAllation of the YOW rS shown on the S B us i nes s Phone Number
V1I. Responsibility Statement I+ MP/MPRS Number �/ V /
l
Plumb er's Name (Print) .! rJ�� 7 t!/
4ZW "I � Plumb ignature Code Cam/ [,v
Plumber's Address (Street City, State,
(>� 2 / - - ent Signature (N Stamps)
Sanitary Permit Fee ncludes Groundwater Date Issued Issuin Ag
VIII. Coun /Department Use Onl
P Appl-Ved ❑ Disapproved Surcharge Fee) J t 17- van on enial �pg� ,,
Pprov RY f . tl'c�n nrnval �v' _ (C1$^q^ 1 dZ?(� ��
LX. Conditions o l / n
SYSTEM NER: � �p_.✓vti 4��s . � o �� v ��
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.
to the Coun onl for the system on paper not Tess than SIlL x 11 inches in s ize
Attach complete plans ( tY y)
SBD -6398 (R. 01/03)
i
PLOT PLAN
nchard Beers ADDRESS 1150 Ctv Rd A Hudson Wi 54016
'1/4 NW 1 /4s 2 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
8/29/05 GPD 77
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 283 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 217 # of chambers 7
BENCHMARK V.R.P. Bottom of Shed Siding ASSUME ELEVATION 100' Filter Zabel A -1800
❑ BOREHOLE O WELL IH.R.P. Same as Benchmark
Cty Rd A SYSTEM ELEVATION 94.5' 4.5' below grade
Z O " Scale = 1 /4 11 = 1 O'
Calcs:
2 employees @ 13 gpd/employee = 26
1 floor drain = 25 gpd
Total gpd. = 51, X 1.5 for peak flow
= 77 gpd
150' 77 gpd/.7gpd /ft ^2 =110 ft ^2/31. lft ^2 /chamber
�"' = 3.6 chambers, going to use 7 chambers
�o because I have the room.
Tank size 77gpd X 2.088 =161 gallons, going
to use a Huffcutt 283 gallon tank
Soo
Accessory Building to serve 2 Q a w
employees and 1 floor drain, e W m u'
Sq � p � 0
absolutely no living quarters ~�O O
are to be present, S;' o a
O'tt W
w ir
this area is to serve 2 farm q; a
New well is to meet B.N}1ands only! d ° o
all setbacks found o w
in Comm. 83 U
H uffcutt 283 ST
6 -1
p B -2
1320' PropertyLine
Tank is to be properly bedded and
provided with lockdown covers with
B-3 approved warning labels
0% Slope
r�
' Safety and Buildings
commerce.wi. OV 4003 N KINNEY COULEE RD
g LACROSSE WI 54601 -1831
TDD #: (608) 264 -8777
isconsin www.w isco n sin.go /
Department of Commerce isconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
September 07, 2005
CUST ID No. 226900 ATTN: POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING, INC ST CROIX COUNTY SPIA
1008 192 ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/07/2007 Identification Numbers
Transaction ID No. 1192097
SITE: Site ID No. 704164
Richard Beers Please refer to both identification numbers,
1150 Cty a above, in all correspondence with the agency.
Town of Saint Joseph
St Croix County
SETA, NW1 /4, S2, T29N, R19W
FOR:
Description: Employee's Break Room
Object Type: POWTS Component Manual Regulated Object ID No.: 1038317
Maintenance required; 126 in Soil minimum depth to limiting factor from original grade; System(s): In- ground
POWTS Component Manual, SBD- 10705 -P (N.01 /01); Zabel A -1800 Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- A
ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" .� C
SBD- 10705 -P (N.01 /01). Q
A N
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to r�
inspection by authorized representatives of the Department, which may include local inspectors. All permits v
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
I
w
SHAUN R BIRD Page 2 9/7/2005
Sincerely, Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Dennis orenson
Wastewater Specialist, Integrated Services WiSMART code: 7633
(608)785-9336,
dsorenson@commerce.state.wi.us
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017 RECEIVED
715- 246 -4516 AUG 3 1 2005
SAFETY & BUiLUINUS
Date: 8/28/05
Owner: Richard Beer 2
Location: SE1 /4 NW1 /4 S2 T29 N,R19W 1150 Cty Rd A St. Joseph
System type: In- ground absorbtion system(conventional)
Manuals Used: In- ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. System Plot Plan
3.Chamber Cross Secti
5 - 6. maintance and con ncy plan
7 -9. Soil Test
Signature
License numb J26900 itia�
Oi l
O '01S 010 O�NG�G
5E
PLOT PLAN
PROJECT Richard Beers ADDRESS 1150 Ctv Rd A Hudson Wi 54016
SE 1 /4 NW 1/ 2 /T 29 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 8/29/05 GPD 77
CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 283 LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 217 # of chambers 7
BENCHMARK V.R.P. Bottom of Shed Siding ASSUME ELEVATION 100' Filter Zabel A -1800
❑ BOREHOLE O WELL *H.R.P Same as Benchmark
Cty Rd A SYSTEM ELEVATION 94.5' 4.5' below qrade
�z
Scale= 1/4" = 10'
Calcs:
2 employees @ 13 gpd/employee = 26
1 floor drain = 25 gpd
Total gpd = 51, X 1.5 for peak flow
= 77 gpd
150' 77 gpd /.7gpd /ft ^2 =110 ft^2 /31.1ft ^2 /chamber
= 3.6 chambers, going to use 7 chambers
because I have the room.
Tank size 77gpd X 2.088 =161 gallons, going
to use a Huffcutt 283 gallon tank
500'
Accessory Building to serve 2 a
employees and 1 floor drain, �� W a ° 2
tj >a ' o
absolutely no living quarters F4 It 0 o
are to be present, „�,� Q-
L
ct
L W
this area is to serve 2 farm y
Cj
New well is to meet this
only! 4 a o
all setbacks found V a 1, a
in Comm. 83 °' v
Huffcutt 283 ST
B -1 ❑ B -2
1320' PropertyLine
Tank is to be properly bedded and
provided with lockdown covers with
B-3 approved warning labels
0% Slope
Cross Section of Standard Blodlffuser Leaching Chamber
Typical cross section for 1 of 1 cells
To be >1' above grade Standard Biodiffuser
Leaching Chamber Finish grade elevation
with 31.1 ft2 of Area
Typical Installation
L Grade
/34
From Septic Tank
L
6' 34
Grade at System Elevation
1 -3' X 45' Cell
Same on other end Observation tubeNent
° 3.25'
a A
7 chambers per cell
System elevations:
A__94.5
• �' MENT PLAN
AGE
MA NUAL & MaN CA'1ON
poV ,,� -�-s ov�tNER S � SYSTEM St;E� 3 a� E3 NA
Septic Tank Cana ❑ WA
u f�ts r
tt� INFORMATION �, -apticTartk [fin ❑ NA
owner Effluent Finer "Manufacturer / 1170 ♦s NA
Fffl u ent Filter Model N p ►
1Gl"t PA�►M P mp.Tank
Capacity
)ES m anufa ctu rer
t+ium units aflda pump lank M
erCW Number pump Mangy
flow � Model
Esau flow x 1 -5) -..: Pum
flout (peak }• (tea aUdB pretreau —nent Unit r p Peat Filter
POWSW So P o n hate ,,new Svera9e p epe n Q � nd 3 Mechanical
{ifuent Quality, Demand (BOS & Grease (FO 00 gfL Manufactu O Disinfection
rtti� OxY9E S 5150 m n- .. i(s) tn�round (prsur+¢ed)
Biodh Total Suspended Solids Cr tl(onthly average D 1n�JCOUnd (gm'my 11 Mound
p aced i fuent QuardY ; Erl '30 mgn- C] At -grade fl Other.
en
D (BODs 530 m9n- 0 Dri ine non- co�'�"d''�Wasu"'ter&'o
Biochemical Oxyg rtded Solids (TS , cfu /j Qorni for domestic Total Total SusPe eotnetnc m ean) . sepr Kl uent
F� oOtiform (9 y inch lam sett ror �� wa stewater -
rode Size ..• Values tYp�
M�mum'E�uertt Pa Freque Service Freq Maximum 3 yrs -)
I,IANCE SC HFOULE p month at(s)
t+1TB vent every �cd (Y,) nk volume
MAi
Service - E At least once an Scum equals ane-third M of ta aximum 3 yrs.)
f tanks) V rn n combined Sludge a Q month aKs)
tnsped o ond'�tion o every � r(s)
c o ntents of tank(s) At least once a month
out co p NA
tnsped
Pump dispersal ceii(s) At least once every t1 months ars) ear(s) G NA
�
Clean affluent fitter At least once every l7 months
a ye
Pump controls alarm At least once every fl year (s) DNA
inspect Pump' P Q months C1 NA
ross
rats and p ure test least once event o months g year(s1
Rash
Other every At
,er At least
ng one of the foitowin►9 r or
Other t
Mainatnen: SeP�e
a indt Ad� r tnsPect°r � ' may any ML or brQ UP
INSTFtuc�oNS t cells be made sha try Sewe
MgmirE of tanks and dispe Masten Plumber Restricts i i ns pection of the tanke and and to check s} to for any els
ins May Plumber: M ust include a visua ed sludg to cheer the effluent the
S eryi
certifiCat Tank MsPecd°ns M uro ti 1e volume of oombtn vis Insp of effluent on
yor. mess sfia1J be The ponding
drt9 Operator,
any cracks or leaks. The disPer l t its) fion� loca
of ills ► reg $utttority
are round sur�*e- of effluent on the ground sunk utatary e, t h e
• nding
or pot ►dit79 of etffuent s a o check for any 9 d wires the immediate noti trd [� °r more of the tanK �i� � NR
in the obsecv in
atian pip Conditton an uals onean d disposed of in accordance
ground �� � indicate a faiGn$ a and scam in any rank � stator. an
rrtulatian of stud) Septage Servicing F and any
What the combined a be rem ov ed ed by a ment Oon►POne
ntents of the tank shall compo
R+ov a �fied POVV TS Maintainer -
entire t;o e. S nents. P
113, Wiscansln Admin'sbawe 2nical or pressurized POV'i ' shall be P Ce event
�mpng of effluent filters, 12 months or less 10 days Of �mpiet<on °f any sem
The at inter ls authority
other maintenance o monto ded to the local regulato ry within
roducts or Other
shall be p the p �senCe of painting P
A � fepoct ns �
P AN the pO�S aleck treatment tank(s) oell(s)_ if high cono� "a°
STAR the d
Y A ND OPEM,10 'or to use at s andlar damage �po e � o dor to use -
For new Cone , o a the treatment Pry b a $ eptage servicing P
chertlicals t tth Im of the tank(s) Cen'oved Y
detected
" e surface.
! conditions are frozen at the infiltrative n i5 restored the excess
system start up s halt not occur when y
� alt above normal highwater levels. wn� power
e dose. overloading the ceH(s) and may result in the
s tages Pump tanks cetlts� in one larg k removed by a
During poxe -f be discharVed to the dispel ci a Plurr3bet or POVVTS Maintainer to
Y�er die t To avoid this
Du situation have the ca antes theup�
ra p
or surface tQ the effluent pu mp
t>a F operato pfror.to 1, sooty to restore normal levels within the pump
S � ppetating ilia ¢gyp tent s rk OVer, Or offie[1NI.Se disturb Of compact
'SW Ev
over � s and dispersal cells_ Do not drive Or pa
Do not drive or park vetlides anY mound or at -grade sort absorption area. and pmtong the Gfe
the area within 4S feet down slope w astewater stream may im rove the perfprmant:e
of the fopasnnng from the w P deQ�sem, apeN
Reduction or dental floss: dlt -eiimina dyatte butts: condoms; cation swabs; herbiades; meat water fruit and vegetable peetirigs: gasoline; grease:
of the POWTS- 8ntibtotitix: drain { SUM Pump} , napkins; tampons: and water sow brine.
� � ns; cdi: painting prpdrrds: p e sticides; san'rfary P -
scraps. shall tae taken to Insure ttrat the
ABANDONWENT falls andtor is �y gken otlt of service the following steps
r► the POWTS e d in compliance with ch- Gomm 83.33, V Isc Onsin Administrative Code
Vvhe
system is properly ands abandoned pipe openings se
disconnected and the abandoned P aled.
d its shad! be _ d � po � of by a Septa9e Servicing Operator.
All piping to tanks an P its shall be removed and properly and the v oid space
of an tanks and
The contents p
a ll tanks and Pits shall be excavated and removed or tfieir covers re moved
After p umping , .
fitted with loll, gravel or another inert solid material
CO�MNGENCY PLAN a foSitmrin9 measures have been, or must be taken, to Provide a code
if the POWTS faits and cannot be reP� location of a replacement soil
con t re��nent system n evaluated and may be utit - ized for the ian and should not
unable re pl a cement has been
ant area should be protected from disturbance an corn cx to
n m. The repiacern sed structure' lot Fees and wells. Failure
suitable a
absa aired se tbacks from existing and propo
a
r'eR will result in the need for a new soil and site eval
be infringed upon by that time -
protect the replacement area ent systems must comply with the rules t l effect in POWTS
re placement area- Replaaem lace the failed POINTS - due to setbacK
unable replacement area is not available
as a last resort o per sett limitations_ Barnn9e POVYiS a sod.artd
D A s tank may be lisp n failure of fh
tec a holding a suitable replacement area- UPo replacement area is available a
site has
e n a suitable rep
ri ot been evaluated to identify
ormed to locate lacement area- if no rep is
site evaluation must be pert a last resort to replace the fatted POVplac removal of the biomat at
hotting tank may be installed as in
face following
in e
de SO[T absorption systems may be reconstructed with th roles effect at that time_
p Mound and at. a ctions of such systems must cornpty
the infiltrative surface, Reconstructions
<<WARNiNGX> TR rMIKS MENT TANK UNDER MAY CONTAIN LETHAL GAS C1R SSIBLE.
C MSTA�NCESF DEATH MAYGEAt.
SEPTIC AND OTHER
, PUMP R 00 NOT ENTER A SEPTIC, PUMP Fp OTHER TREAT
00 RESCUE
OF A PERSON >rROltift THE INTERIOR O� A TANK MAYBE DIFFICULT OR IMPO
ADOTRONAL COMMENTS
P4WTS I NTAINER
Powrs INSTALLER / Name U��u �✓l5i
Name Phone
AERATOR PUMPF.�- LOCAL_ REGULATORY AUTHORITY
SEPTAGE SERVICING O Agency i�
Name �i�c- �- Phone
Phone `7 ) ���a v and SanitabW agt:�_ Th1S eocnment m�
of the Goren La ke. rvrarquetfe and Waushara County Zo ning Cade. Use of this document does not
Iris aocns►ertwas di t ed by the staff 1 area 83.54(1). (7) $ (3). vY�scan5in Ad+n 1e CMyy (7101)
the minimwn requuere of Ch_ Comm 83- 7.2(711( ?Cd1 Cfl
guarantee the =aace of the POWTS.
Wisconsin Department of Commerce0IL` LUATION REPORT Page of
Division of Safety and Buildings �' _
in accordance wFh ����''"" de Attach complete site plan on paper not less than 8 1/2 x 1 fsiian must County include, but not limited to: vertical and horizontal referenc
M), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and loco ca3o jej FQad. Please print all informa Re�riewed by Date
Personal information you provide may be used for secondary pur �ctAR'010( 0"� m)). (Z r �GrI
Property Owner Z
i cY. /' Govt. Lot .SC 1 /4�jd /4 S T Y N R E (or
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
City oState Zip Code Phone Number ❑ City ❑ Village Town Near pt Road
New Construction Use: esidential / Number of bedrooms Code derived design flow rate �� GPD
❑ Replacement //❑ Public or commercial - Describe:
Parent material atf ,e �rc.Q.l� / Flood Plain elevation if applicable ft.
General comments `
and recommendations:
13e1�',c1���
-30 l Cr.a A-- 4V
Boring # Boiling
pit Ground surface elev. ft. Depth to limiting factor _I li !o in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
® Boring # ❑ Boring
9pit Ground surface elev. Oft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
L2
• Ef fluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 ��_�� 715 -246 -4516
t
Property Owner _ Parcel ID # Page of
Boring # ❑ Boring 1�
a Pit Ground surface elev. �-0 1 /ft. Depth to limiting factor 1 � �!J in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIIf?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. n 'Eff #1 'Eff#2
!1 r 7 Z> "- a w
z. V -1 26 - -- ---- -- C � m 4
2 -V
a Boring # ❑ 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2
F-1 Boring # ❑ 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/fft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L 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.
SBD -8070 (RAW)
Soil Test Plot Plan
Project Name Richard Beers Shau r
Address 1150 Cty Rd A
Hudson Wi 54016 CS #226900
Lot ------ Subdivision 2nd House on Farm Date E 4/05
SE 1/4 NW 1 /4S 2 T 29 N /R W Township St. Joseph
[ Boring 0 Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Bottom of Shed Siding
System Elevation 94.5' *HRpSame as Benchmark
Cty Rd A
Scale is 1" = 40'
150' unless otherwise
noted
500'
Existing Storage shed to
have 1 bedroom living
84' quarters
* >200' to existing main farm
B M. 10 hou and well and sep
2'
25'
50' B -2�
B -�
20' 0% Slope
25'
B -3 /
1320 P.L.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer
Mailing Address
property Address
(Verification required from Planning Department for new construction)
City/State Parcel Identification Number
00 - — 0 — 4 - 9 �
LEGAL DESCRIPTION
T N_ , Town of
�
n 5 '/. /4, 1 ,4 L W
Property Locado Sec. - — Lot # r
Subdivision � °'��
Page #
Certified Survey Map #
Volume
Warranty Deed #
__, Volume _______— Page #
Lot lines identifiable ❑ yeso
Spec house ❑ y`�"
Sk M MAINTENANCE remature failure to handle wastes. Proper maintenance
Improper use and maintenanceof your septic system could result in its P if needed by a licensed pumper. What you put into the system
consists of pumping out the septic tank every three years or sooner,
can affect the function of the septic tank as a treatment stage in the waste disposal syswnL o s by the owner and by a
owner agrees that (1) th
to submit to St. Croix Zoning Department a cereficatron f rm, signed
The property lumber or a licensedpumper verrfytng e on-site wastewater disposal system
mastCrplumber, journeyman plumber, restrictedp in necessarY)� the septic tank is less than 1/3 full of sludge.
condition and/or (2) after inspection and pumping (
is in proper operating read the above requir with the standards
ements and agree to maintain the private sewage disposal system Certification hi30
Set forth, herein, as set by
Ifwe, the undersigned have the Department went of Natural Resources, State of Wisconsin
ent of Commerce and the Department ed to the St. Croix County Zones Office witn
stating that your septic system has been maintained must be comp return
leted and
days of the three year expiration date.
DATE
SIGNATURE OF APPLICANT
O"Ei R CERT our knowledge. I (we) am (are) the Owner(s) of
are I (we) certify that all statements on this form deed tr z corded in Register of Deeds Office
the property described above, by virtue of a warranty
DATE
SIB AA OF APPLICANT
An information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department-
«« Include with this application: a stamped warranty decd from the if re is mad in the warranty deed
a copy of the certified. survey map
Safety and 1.
County iIn`gt ox
� 7162 �4 ' ' 1 x—
� 0 I 53707 - 71 62 Sanitary Permit Number (to be filled in by Co.)
onsin P C ; 08) 266 -3151 Q
Department of Commerce
� fate Plan I.D. Number
Sanitary Permit Applic non xcouN�
In accord with Comm 83.21, Wis. Adm. Code, personal info ationl(du s OFFIGI 7 �A)s ' 1 a
may be used for secondary purposes Privacy Law, sl .04(l)(A �Nl Project Address (if different than mailing add
I. Application Information - Please Print All Information
J
Property Owner's N e Parcel # Lot # Block #
e> a,
Property Owner's Mailing Property Location
dress
✓l� /4, Section
City, State / ZZiip Codef� f Phone Number
T 2 )� c E c r W e)
It. Type of Building (check all th apply) `
Sub rsio me CSM Number
r 2 Family Dwelling - Number of B rooms
❑ Public/Commercial - Describe Use
❑ State Owned - Describe Use ❑City_❑ ship of
� b
III. Type of Permit: (Check only one box line A. Complete line B if applicable)
4' fi System ❑ Replacement Sys ❑ Treatment/Holding Tank Replacem Only ❑ od' on to Existing AI-u
❑ Permit Renewal [I Permit Revision ❑ Change of C1 Permit sfer to New
List Previ ermit Number and
Before Exp
B. iration n Plumber Owner
IV. Tvoe of POWTS System: Check all that a 1
on - Pressurized In- Ground ❑ Mound > 24 in. of suitab oil ❑ Mou 24 i of s ble r C1 At -Grade ❑ Si P s Sand Filte
Constructed Wetland ❑ Pressurized In -Gr and ❑ Holding T ❑ P Filter ob ent Unit ul g Sand Fill
Recirculating Synthetic Media Filter aching Chamber ❑ D L' ❑ Gravel -] e ip Other (explain)
it
V. Dispersal/Treatment Area I ormation:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis rea Required (so ispersal Area Proposefl(s
21 "? �
VI. Tank Info Capacity in Total Nu r Manufacturer fa l Fi Plastic
Gallons Gallons of its C c e C s s
New Existing
Tanks Tanks
Septic or Holding Tank'
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1 , the un igned me responsibility for installation o e POWTS shown on the attached plans.
Plum Nameint) Pl ber' lure MPlMPRS Num Business Phone Number
Plumber's Address (Street, City, State, de) e
VIII. Coun epartmentUsejDnly
Sanitary Permit Fee (includes Groundwater Date Is Issuing Agent Signature (No Stamps)
❑ Approved ❑ Disapprov Surcharge Fee)
❑ Owne even Reason for Denial
1X. Conditions of ' oval/Reasons for Disapproval
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size
SBD -6398 (R. 01/03)
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St. Croix County Map Output Page Page 1 of 1
St. Croix Count Ma in
jk, MLr�ICIPaI Bolfld orbs
St. Croix County Planning Department adl vlslcvtis
1101 Carmichael Road Cerzyed oLrvey Maps
Hudson, WI 54016 0 PC Of " MIs
Phone: (715) 386 -4674 Fl om'
IDrai 1'lage
DISCLAIMER: The information contained on this map is advisory. Map Streams
accuracy is limited by the quality of the public records from which it was Darn
prepared. It is not intended as a substitute for an accurate field survey. rerr real oven n
hrerrnl 1knl
AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist " Y°r
presently in the County may not be present in the photos.
http: //72.21. 230.178/ servlet /com.esri. esrimap . Esrimap?ServiceName= StCroixOV &Client... 9/12/2005
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