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HomeMy WebLinkAbout020-1439-51-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Pnvacy Law, s 15 04 (1)1 Permit Holder's Name City Village Township Gregory & Gina Somerville TOWN OF HUDSON CST BM Elev Insp Nev IBM Description TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing 1 S r Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing i Aeration Holding PUMP/SIPHON INFORMATION I. ,'M STATION BS HI FS Benchmark 10 �ELLEV< Alt BM Bldg. Sewer SUHt Inlet St/Ht Outlet Of Inlet Dt Bottom Header/Man Dist Pipe Bot System Final Grade St Cover Ualrli I)iu- t� r 1f.86 9 '/ / 37 BED/TRENCH DIMENSIONS Wdlh Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK SYSTEM TO /L I BL G WELL LAKE/STREAM LEACHING Manufactu INFORMATION CHAMBER OR UNIT r Type Of System Model r UIJ I KItlU I li JY, I tM Hea``Maoifolq a1`x JJVATT�_ V� L ngth Dia Disinbution Pipes) Length Dia Spacing xHole Size xHole Spacing ant to Airintake t.�. 4 OYv1 E!� bi I:VVhK x Pressure Svstems Only xx Mound Or At -Grades Svsfems Only Depth Over Bed/Trench Center v CC ` ri Depth Over Bed/Trench Edg xx Depth of xx Seeded/Sodded xx Mulched COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1- Inspection #2 Location: 879 HIGHLANDER TRL 1) Alt BM Description = it Pa 1\r {"ex(�r 2 ) Bldg sewer length = �qvc - amount of cover = J Plan revision Required? _] Yes No Use other side for additional information SBD-6710 (R 3197) Date Insep is Signature Cert No i W _ ou ty Sanitary Permit App foal on' ST. CROIX COUNTY WISCONSIN eol� In laccortl th Chapart12St. CroixCounty Sanitary Ordinance P al inform lion you provide may be used for secondary PLANNING 6 ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT purposes CENTER S` [PnvacyLaw. S. 15.04(1)(m)] 1101 Carmichael Road Hudson, WI 54016-7710 cool" 0t (715)386-4680 Fax (715)386-4686 St Cev coin ate plans for the system on paper not less than 8-1/2 x 11 inches in size. con'n, nty Sanitary Permit # ❑ Check if revision to previous application —2AZ —0S� 1. Application Information • Please Print all Information Lo ation: .27}} Property Owner Name �7 (f1lC O W/A/pa.erd/ //G va vfE va, see fpNE T N, R E or )40 Property Owners Mailing Address 879 i/,.Tdfl ��,�f Lot Number Block Number / City, Stale f�a.�sonl ,�2 Zip Code o/L SY Phone Numer Subdivision Name or CSM Number /s' 09-a7(-/1dlo Rns t.h .o 11 Type of Building: (check one) Mity, ❑Village 5i{own of W' 1 or 2 Family Oweling - No. of Bedrooms. ❑ Public/Commercial (describe use): ❑ State-owned Nearest Road If. Type of Permit: (Check only one box on line A. Check box on line e it applicable) Parcel Tax Number(s) A) 1. Repair 2.0 Reconnection 3.❑Non-plumbing 4 ❑Rejuvenation 020 ^/7s9^S/-000 ATX Sanitation B tv JA(Jt— Permit Number Date Issued $'State Sanitary Permit was previously issued q 9 U 312,310 IV. Type of POWT System: (Check all that apply) $' Non -pressurized In -gm nd 0 Mound a 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound Ar0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Other Cl At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) `�� 2. Dispers I Area Required c558 3. Dispersal Area HIasFwff� repvsed 4. Soil Application Rate (Gals./day/sq.ft.) 5. Percolation Rate (Min /inch 6. System Elevation 7. Final Grade Elevation AP' 7I.6 0.7 95-,24 94.s6. VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic Gallons Tanks Concrete structed glass New I Existing Tanks Tanks etiks f1Ga ( w« � ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenctionlrejuvenaaoNinstallation of non -plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non -plum ing sanitation system. Plumbers Name (print) Plumber's ature o to ). MP/MPRS No. Business Phone Number ^C4ee t .JeW rsu 3/38y - t/ts-GZ.r Plumbers Aress (Street, City, State, Zip Code) p (ZD SS /cfde't f�/k r,./s Svc,aZ_ Vill. County Use Only Approved ❑ Disapproved tier nitial Adverse Sanitaryrmi-fifes �% Ste— Date Issued '3� Issuin Agent Signature (_ No stamps ` '(QAJV,voY,'p-`) Date anon o'• 3 Z IX. Conditions o prove Raaaagefar9lsappFaral: YSTEM OWNER ) Mr-ua� ei, vNgr �L . Septic tank. effluentfilter and dispersal celllmust be serviced /maintained as per management plan provided by plumber. `( )TV j 'u_*1 n" �'� All setback requirements must be maintained as per applicatca code/ordinances.tN P lLL�tt bar - Yen#- i f , F4___J 11 jLicopy Z --* a ti nz� N Rx j F� Nip r u PAyt 5°F 7 ST CROIX COUNTY REPAIR DRAIN FIELD HEADER PIPE REPAIR FOR A FOUR BEDROOM RESIDENCE Owner's Name Gregory & Gina Somerville 879 Highlander Trail Hudson, WI 54016 Located in the NW & SW '/, of the NE '/4 of Section 25, T29N, R19W. TOWN OF HUDSON ST CROIX COUNTY WI Parcel # 020-1439-51-000 Lot #51 09-071 Indigo Ponds Lots 1/57 020-03 INDEX Page 1 Index & Title Page 2 County Permit application Page 3 Project Summery Page 4 Assumed and Proposed Piping Page 5 Site Plan Page 6-7 Manual and Management Plan Attachments: Ownership Address, Cert for Reuse of Existing Septic tank, Deed, Plat, 2007 Permit & inspection, Soil test, Permit file info. Prepared By Signatu Michael Rodewald 285 County Road SS River Falls WI, 54022 715-821-6229 MPRS 931384 285 counrry RIVER FALLS BM428-3723 715-425-8866 3/11/2021 Re: 879 Highlander Trail Town of Hudson Project Summery The system was installed 5/l/2007. A recent inspection on 3/8/2021 found the lower elevation trench ponding and the upper elevation trench dry. We are assuming the effluent is flowing past the connection for the upper trench and the lower trench is accepting all of the effluent. Repair plan is to excavate the header system and install a NDS diverter valve at the outlet of the septic tank and run an individual distribution pipe to each trench to provide equal distribution. Page 3 of 7 SS aMt 6 �,prn� Cn�r*Oc GS CAD45 7�(j l-, V<<<<.i (/ p I ✓ .t R.Y k' i� 1.✓r, i.(ncl, FsM e so vo ) X 2 .We,,,v,iie tiC)f s i � ,,�(/ r.�r, 9 tf f ra. 71 VL ) X 2 .We,,,v,iie tiC)f s i � ,,�(/ r.�r, 9 tf f ra. 71 VL -------- ---- �t5 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION Owner rNfi SOrNt/'Vl Me 71 Permit rr - - OESION PARAMETERS Number of Bedrooms ❑ ryq Number of Public Facility Units ❑ NA Estimated flow (average) al/de Design flow (peak), (Estimated x 1.5) 0 gallday Soil Application Rate al/de /ftr Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD,) 5220 mg1L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand iBOD,I 530 mg/L Total Suspended Solids (TSS) 530 mg/L ❑ NA Fecal Coliform Igeornstrio mean) 51 D' cfu/100ml Maximum Effluent Particle Size Ys in die. ❑ NA Other: ❑ NA "values typical for domestic wastewater and eaptic tank affluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 2 6 d al ❑ NA Septic Tank Manufacturer CA.,j Cz_Le (.r! ❑ NA Effluent Filter Manufacturer Z, L ❑ NA Effluent Filter Model Q tj ❑ NA Pump Tank Capacity ei ❑ NA Pump Tank Manufacturer ❑ NA Pump Manufacturer ❑ NA Pump Model ❑ NA Pretreatment Unit ❑ NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cells) ❑ NA plln-Ground (gravity) ❑ In -Ground (pressurized) ❑ At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service frequency Inspect condition of tank(s) At least once every: J 7 ® meonarls)th a (Maximum 3 y earsi ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Yr) of tank volume ❑ NA Inspect dispersal cells) At bast once ovary' 3 ❑a earls) moniVaI (Maximum years) ears) ❑ NA Clean effluent filter At least once every: ❑ nwn $I tS earls) ❑ NA Inspect pump, pump controls & alarm At least once every: .._— ❑ monthls) ❑ ear(sl ❑ NA Flush laterals and pressure test At least once every: ❑ monthlsl ❑ ea,(8) ❑ NA Other: At least once every: ❑ monthlo) ❑ earls) ❑ dNAOther: ❑ MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must Include a visual Inspection of the tank(s) to identify any missing 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 Dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent 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 (Y,) or more of the tank 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 unite, and any servicing at 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. OMW 14101) -7�7- ~START OF AND OPERATION Page _ For new construction, prior to use of the POWTS check treatment tankis) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankisl removed by a septage Servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal callisl In one large dose, overloading the cellls) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within IS feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code; • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly 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 apace filled with soil, gravel or another Inert solid materiel. CONTINGENCY PLAN If the POWTS falls 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 been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement 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 soil absorption systems may be reconstructed In place following removal of the blomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER — -- ---- POWTS MAINTAINER Name peHeJvd— 'cXCrfvs-A4 Neme Phone 7f r—(��2,f' G r N � Phone SEPTAGE SERVICING OPERATOR (PUMPERI LOCAL REGULATORY AUTHORITY Name Name Phone, Phone 3 `E6 fin This document was drafted In compliance with chapter Comm 83,2212)lbl(t I(d)adf) and 83.840). (2) 6 13), Wisconsin Administrative Code. DIVERTER AND BACKWATER VALVES Diverter Valve Here's the simplest, strongest and most economical diverter valve ever invented for septic tank leach fields It is made of tough molded plastic that will not shatter, bend, rust or corrode. It is lighter in weight, easier to handle and less expensive to ship. Functional The dlverter valve stem flow may be controlled to individual or multiple fields (up to three) in any combination. With a three-way valve stem, flow may be diverted to any two outlets. To allow flow through all outlets, the valve stem may be removed from the assembly. Easy to Install Connect 4" plastic sewer and drain pipe to inlets and outlets on the four-way distnbution box. (Unwanted outlets may be sealed by installing caps.) The deserter shield which houses the diverter stem may be cut to desired length. 6u -im pvc 575P Am. 575 'IAPMO Listed. 30.5" 4125" ID 1APM0 Listed 1" 6" Gravity Backwater Valve 4" PVC Diverter Valve Witte 4 9.50 35PV 4" ABS Dlveder Valve Black 4 7.50 35AB uossu 1 2 3 TANK TANK TANK 4 10 \0) 00 6 1 x] ORURN TO x4 TANK TANK irr� slim LI TANK The NDS gravity Flow Backwater Valve is designed to protect low areas or basements from the backflow of waste from street sewers. It is available in 2", 3', 4" and 6" sizes, PVC material It is a cost-effective and a chemically resistant alternative to cast iron valves. Backwater Valve The quick action flapper allows unrestricted uni-directional flow. Elastomenc gasket in the flapper ensures a watertight seal. Flapper can be easily removed and replaced if required. Threaded access cap is designed for hand tightening. Access cap neoprene gasket provides a positive seal. Valve hub outlets fit 2", 3", 4" or 6' DWV pipe and may be adapted to 2', 3", 4' or 6' sewer and drain pipe with NDS DWV to Sewer & Drain Adapters. Lightweight, easy to install. Horizontal installation required, with arrows on top of the valve hub pointing in the direction of the flow of water. Access riser with cover offers a simple, economical access to the valve for inspection and maintenance. The riser may be cut to the desired length. 275P, 275 2.18" 5.03" 3S3" 16" 4" A 275P8 2AB" 5.03" 3.53" 16" 4"\ C 375P, 375 3.51" 7.58" 6.10" 16" W. 375P8,3758 351" 7.56" 6,10" 16" 6" 475P, 475 4A7" 11.18" 7.16" 16" 8" B 475Pa,475B 4AT' 11.18" 7.18" 16" a" Approvals applicable to valve only mu.iaui ST. CRo iNTY SANITARY SYSTEM File #: lU_o Office Use Only OWNERSHIP/ADDRESS FORM Creoted 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer 1hrelbry # 6slrrUA 5drmery/Ilfe Mailing Address SZCF wft'gta ber>' 7T,** / City/State/Zip _ f%. J10)J wz 6No / 6 Phone Number (required)_ G /2 - '?/z - /ol'o Email Address (required) Q46d re", Ile 0 141dzil (YS Parcel Identification Number l920 -/93q -57/-00 (found on the property tax bill) S4J j NF NEW SYSTEM: LEGAL DESCRIPTION Property Location 11W 114 , 1A , Sec. e 'S- T AN Rj_tW, Town of %y 4 Pseo Subdivision Plat: (J9-O7/- /Nui6U (?0ND5 4oh 07 090 -03 Lot# 51. Certified Survey Map # Volume Page # Warranty Deed # /40 9 /y,S (before 2006)Volume Page # Number of bedrooms __q _ Spec house 0 yes P15c) Lot lines identifiable kyes O no OFFICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@5ccwi aov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi oov ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 91 /i q � (/w�d.� t—,,4 located at: '/a, -JE- '/4, Section 2,!r—, Town 2c1 N, Range__/±__W, Town of /%u4&4w , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 2120�iozo Did flow back occur from absorption system? Yes NOX (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /?.6 o Construction: Prefab Concrete k Steel Other Manufacturer (if known): �,l tekr Age of Tank (if known): S/ /07 Permit number (if nown) `l99g9a XA'Ens6d Plumber Signature) (Print Name) (Title) 3/// /2o 2 / (Date) 9 (License Number) MP PRS Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145,06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 INDIGO PONDS N YdinFNM OnN/FFM hIR•M4M N.rIFlwNM O✓i,XFLI.uI Yfn/F Lirl hY,M•NYxw/a.F /M "ahi OwL,i Y1MF llh bMA ArynIIKMXM WXww GYINIYPd OsY,YMYMy pN/MIYNI W,hMLM/OW /FIYMM 1rF �n pp Y SNW asF / N IFbI MR i n LRn i 1R! NA NT N M 4n / NIR 8 Pi 4YF /vnX �•nlCi 0 Ylp ¢TIIA t! '1/ via al wRtlai a rl ue �^ Vr V. / / I � Ri1wR RRIII � w�•_w / �,/ w/• I 4yl1rtw�rRNm o ^ ♦♦ �, Ir11�W Rirlvr /'—�cVY 1V�t�w1 L 4maROIv14l OM, mom tiW, Yq�V aoW wWa�f6Ra®Y 1 a C — 0.vp wrI. Iam•rw �,�• {5 swill MM 50 ,e u. mfJ rIY. ,IdR I lIIYI Rf ,TI, 'Y � w0•m � � � �f Ina v r®.Im I 1nw Nt '\ I I i I I p,2 / Y 1 FYfRRT1•\ iV I Ot I• InwRam / t ,y,� I ' MMW ,I,u1 i r°mwlm a mvMMW a io a IFaI ii ke VON N!et\nRfl/ L I i ounor 3 Mm MY r ma ur q ^Ie,RYRa, �,f arn,laWKI / 37 My 32 a� W. / I I ,µ rY% aaa IIl psq S, nPo. 3, tlr wl IF' �, w�n 6,u wav f!i sass wo NRa! y /Y.. [ F3 ♦ � � RNWN 3 Raaw s�a�i�ola� YLJI011I�(_Vyl�li Ir,IIaX1.111 " 4w�I,a�IMYe JAA1�8 �F�t,FFK �rrlal TED Rw� ON.. /�/ t N83'2526 315 _ �t11GHLANDER / �47 / '�` �. 5 3 3851 n Y f57194 S.F + w (3.609 AC.) /' 4 ` u 2 N EXTERIOR N(Z220 AC) y 12•W 5 5 u �'ENRVG BELOW 164,9-2N2.05 �+ ELEVA170W 966.7' m .A92�56% E t ('� E►�M p`L� N 1 ORp1N��1k� NK CN1_ r EOP STEELPrPE v'C T10N-965.36' n ' 235.11' / 362.80' \ 92.28' i 505.63 N80'47'40'E 597.91' OENCHMAR NS 957 j :_PROPOSEO r TRAIL ta rr TRAIL V 120748o S. F (2.772 AC.) No I Ex"IOR NG /OPENING BELOW ELEVAT)ON 948.2' i T `.' ncl P r ELIPE �TIO"'933.09' r� 104449s.v t (2398 Ar-) 140 DWELLING 8 L�� T'ENWC 94&2, ELEYA71p1 TOP SOC TEEL M RK ELEMTlON_ PfPE- 968.3f 9187E (2109 Inspection #2:_1_1_ Parcel No: 25.29.19 2777 or Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM courrry St. CTOIX Safety and building Division INSPECTION REPORT Sanitary Permit No 499290 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan IDNo Personal information you provide may be used `or secondary purposes IPrrvacy Law, s 15 04 (1)(ri Permit Holder's Name City Village X Township Parcel Tax No Rin erg, Bob & Karen Hudson, Town of 020-1439-51.000 CST BM Elev Insp BM Elev BM Description /� Secbon/7own/Range/Map No C1 NAA .l t GS ( 25.29.19,2777 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER tn9- JJ CAPACITY Septic 1q• 5 boil / c ri Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic 7 ft AIA— Z4 `-7 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Li Friction Loss Syste ead TDH t Forcemai Length Dist to Well SOIL ABSORPTION SYSTEM STATION BS HI I FS ELEV. Benchmark G, b /Og / M Alt. Blv / `' /col to Bldg Sewer y •' ,I 5 lot,, it SVHt Inlet IG 3 II�.y / St/Ht Outlet Dt Inlet Dt Bottom ` Header/Man. /e . 371 98. /Y Dist. Pipe t!r !2 •4 !If. 3 9(-. '1 Z(- Bot. System vt+pu.. �\ I ..3 IS•3 `jS Ztr 3. L(c Final Grade 7.6 /0/. Sh St Cover �'le-^l.,t-' 'I•a4 /69•G BED/TRENCH Width / Length x No Ot Trenches PIT DIMENSIONS No Of Pits Inside Dia Liqwd Depth DIMENSIONS 3 15 r /ia 2 I I \ �- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR UNIT Type OF System Model Number DISTRIBUTION SYSTEM Lie ---- Z 1 L cl Headenlyandold 7 Length ,I Distnbution Posts) Length Do � Spacing x Hole Size x Hole Spacing \ Vent to Art Ilak 3 (' C'. SOIL COVER x proeeura Rvetnme Only xx MmmH Or At.Orade Svstems Only Depth Over / Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil \ xx Seaded/S tle0 xx Mulctled / _ • 2 V J \ Yes No \Yes .g No COMMENTS: (include code discrepancies, persons present, etc.) Inspection #1 I_/_ Location: 879 Highlander Trail Hudson, Al 54016 (NW 1/4 NE 1/4 25 T29N R19W) Indigo Ponds Lot 51 1.) Alt BM Description= Gif,— EZ L-1 t 2,1 Bldg sewer length = J - amount of cover Plan revision Required? +i Yes >(N o 1 Use other side for additional Information. C� Date Insepcio Signal SB"710 (R 3197) rq Al Commere:e.wi.gov a a iseonsin Safety and Buildings Division 201 W. Washington Ave. P. Ma 150p' E(! ED County Sanitary Permit Number (to be filled in by Co.) Department of commerce y" Sanitary Permit Appli atipppa,R 2 3 2007 Sete Transaction Number In accordance with s Comm. 83 21(2), Wts. Adm Code, submission oC thi Corm to the appropriate governmenta Prn3mt Address Of differewthanmadmgaddress) Ill i /C�A��n is^r /T unit is required prior to obtaining a sanitary permit Note Applaaiio form ffarLs� s,�l�q)7sjfS it submitted to the Department of Commerce. Personal information you rove may a used for secondary purposes in accordance with the litivacy Law, s 15041 m , Stats 1. Application Information - Please Print All Information Property wnn's Name Parcel # Property"Owner's Mailing Address pV Property Location `a 277-7 Govt. Lot A I IJ y, Section �'S ude one) T��N, R_ Eorl� City, State /� /m t M Ztp Code Phone S D Number - -�R11. Type of Building (check all that apply) %lor2Fam0y Dwelling-Numbcof Bedrootnts4/ tspjl #'A ///'/5L p��.a•�_ ✓ Block# ❑ PubhCComm,,cod- Describe Use of a s/ Subdivision Name Q Q Q /�405 ❑ Crry of ❑Slate Owned-Dcscr,k Use CSM z D;s+'Gel zzFzI C ❑Village of ®-Town of �{i S0 Number �' III. Type of Permit. (Chick only one box on line A. Complete line B if applicable) A. ew System stem qw y ( ❑ Replacement System :1 Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. I❑Permit Renewal ExpirationOwner ill.Permil Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued qqZBefore ,/ 9 o Z ��'v —0 -7 TV. T e of POWTS S item/Component/Device: Check all that apply) ❑ Non-limssunzed n-Ground ❑ Pressunud In -Ground ❑ AtLrade ❑ Mound>_ 24 m of.isabtt soil ❑ Mound a 24 in of suitable sod ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Devine (explain) V. Dis ersalfrreatment Area Information: '%4Ae 6. 9 17 . De ign Flaw (gpd) Design Sod Applrcatbn Rac(g t) 6 Disposal Area Required (at) Dispersal Area Proposed (s stem Elevation �f3 ui� 4 (�9f�s VI. Tank Info Capacity in Gallons Total Gallons a of Units Manufacturer D / L G✓ / D I O 4 F• v c e. U , `'� y N un 4. 0 _2 ca. New Tanks Existing Tanks Septic or Holding Tank — •/ I� Doan, Chamber VIL Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWT S shown on the attached plans. Plumber's Name (Pi in[) D / tea Plumber's Signature MP/ Number Z 26 9? Business Phone Number 17 273 i�S� Plumber's Add, ess(Street. City. State.Zrp Codc) Vlll. County/Department Use Only k✓. pproved 1^l^ ❑ ❑ sapp caner � en R or Denial Permit Fee Ihte $ p o0 0 �' Iss 3 23 fo7 Issuing A Signattue IX. Conditiong4f Ap rp, oval_/Rcations for Disapproval I 1. SeptMlo tank, ,effluent finer anti dispersal can must all bs etervkea / millmil d A- as per management plan provided by plumil U u 1 V z All semaok requirements must be malnWned L obi f Par Yale nl and fubml0 ro the CoanN ofily on pvper not lest Ill In Ill che, In aloe SBD.6398(R 01107) Valid torn 01/09 F G�-U-r v L,+-� I QOA 4.1-4lCVIrJ k1.995-jI3'5R9 �t S POE U� � w �{3 mu,az I J "tI pufr zof 5-1 .A NT Wisconsin Department of Commerce Division of Safely and Buildings SOIL EVALUATION REPORT Page 1 of 3 m auwn aanw mui c.unmi oo, rna rum. �.kwe Attach complete sae plan on paper not lase Than 8 1/2z 11 inches in size. Plan must include, but rat limited to: vertical and horizontal reference point (BM), direction and percent elope, scale or dimensions, north arrow, and location and di nca to nearest road. Please print all Inrormatlon. Personal informeton you provide may ae used coumy ST. CROIX Parcel I.D. 020 - 1439 - 51 - 000 Re ' by Dat s3 Z 3 0 Property Owner LEE SIGNATURE OMES Loration ^ e . Lct --- 1Iq NE 1/4 25 7 29 N R 19 E:1 El Property Owner's Mailing Address 201 Packer Drive, ite G L # 51 Block # -- Subd. Namef or CSW Indigo Ponds City State zip Code W[ 1 54023 Village L!jTown Nearest Road bludde. I Hi blander Trail Q New Construction tlseQ Readenaal / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commenial - Describe: Parent material outwash Flood Plain elevation a applicable R AA General lcommentsand recommentsConventional In -ground trenches -- 0.7 loading rate — to be designed by Roger Nelson and rec Frost encountered 3-4 ft. - trenches to be located in the 0.7 sand below frost depth. 101 miat'LAA)zlegr�iar+..�i :S � 1 -vilsu - -_ -- 50 , l LL Boxing be Y__ f4�0 �� # Q Pit Ground surface elev 101.00 0. Depth to limiting factor 130 in. Sod Application Rate Honzon Depth in. Dominant Color Munsetl Redox Description Go. Sz Cod. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'EB#1 'Eff#2 1 0-12 10YR2/2 - -_ _. __ cs 2 12-36 10YR3/3 " -- -- as -- -- -- 3 36-57 10YR4/4 -- sil 2fsbk MIT as Ivf-tn 0.6 0.8 4 57-130 10YR5/4 ms Osg mil 0.7 1.6 Horizon 4 has some cm & 1.5% gr. n J 2 )0 a Bodm # ❑ Boring 100.00 120 '❑ Pit Ground surface elev. ft. Depth to lirmbng factor in SOM Apipficatiori Rate Honzon Depth in. Dominant Color Munsell Redox Description Ou Sz Cont Color Texture Structwe Gr Sz. Sh. Consistence Boundary Roots GPDRf 'Efl#1 'Ef1#2 1 0-10 10YR2/2 - __ __ __ cs 2 10-30 IOYR3/3 cs 3 3040 7.5YR4/4 - sl Ifsbk mvfr cw lvf-m 0.4 0.7 q 40-120 IOYR5/4 -- ms Osg ml -- -- 0.7 1.6 Horizon 4 has some cos & 1-5%gr w Efnuaa #1 - BUD, > 30 < no rrVL and TSS >30 <�M5/50r mg6rL�i� // ' Effluent #2C= BOD < 30 mg& and TSS < 30 mWL CST Name (Please erira) / r I �iLiLX� J CST Nknb2 Mary Jo Hollister (Hollister•s Soil Testing & Design) 224832 Address Data Evaluation Concluded Telephone Number W9875 690th Avenue, River Falls, WI 54022 02 - 15 - 07 (715) 426 - 1775 Property Owner Lee Signature Homes (LOT 51) Parcel ID # 020 - 1439 - 51 - 000 Pa0e of 2 — 3 U Who El Pit Ground surface elev. 93.00 ft. Depth to limiting factor 110 n Shc Application Rare Horizon Depth in. Dominant Color I Munleell Redox Description Qu. Sz. Cont. Color Texhae Structure Gr. Sz Sh. Consistence Boundary Rods GP1NR •Ee#1 'ER#2 1 0-16 10YR2/2 -- -- -- __ cb 2 16-26 IOYR313 -- cs -- 3 26-44 7.5YR4/4 _- Is -- -- aw __ -- 4 44-110 10YR5/4 Ins Osg ml 0.7 1.6 Horizon 4 has some cos & 1-5% gr. ■Boring ii, Boring Pit Ground surface elev ft Depth to limiting factor in_ ©®� • ®_�_®_®_©S7WaaL71vG1� Boring E-1 #ng BoriS r-- Pit end surface elev R Depth to IiniGrg factor m Srti AnI Nvsfw. Rob l . Effluent #1 = SOD, > 30 < 220 rrg/L and TSS >30 < 150 mgiL • Elauera 92 - BODE < 30 mg/L and TSS < 30 rrgrL 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. W"3Mrm (A 07M) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner L&P skeNA-tiAym +IoMr-s 1 " Legal Description except where noted) N W'/4 of 'WE ,vE /g, sec. Z.s, TAU. R14W, -Mwj g = Backhoe pit —9�/ s ST, C Rp\x �u.U'Cyy WISCON 5i f�} . ��.. 4rth /� I IOU 'TO SCI\V-E) <Y, �p � .1N La GWi' 100.00 Site Location: 1 November 25, 2003 James Rusch James R Hill, Inc 2500 W County Road 42, Suite 120 Burnsville, MN 55337 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Caffnichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 RE: Shoreland Zoning District / Indigo Ponds Subdivision Dear Mr. Rusch: Certain lots of Indigo Ponds may require a County Special Exception Permit for filling and grading due to their location in the ShoLWapd Zoning District. The lots include: 36, 37, 38, 39, 40, 41, 45, 46, 47, 49, 50,111] 52 and 53. Lot 53 is currently under review for further subdividing. If the building site is located within 300' of the Ordinary High Water Mark (OHWM), has direct surface water drainage to the ponds and exceeds the grading limit that is allowed by ordinance in the Shoreland area, a Special Exception permit will be required prior to commencement of construction. Affected lots whose building site is beyond 300' from the OHWM of the ponds will not be required to obtain a Special Exception permit. Please note that on these lots an erosion control plan must be reviewed and approved by the Zoning Office before the issuance of a sanitary permit for the particular lot. It is preferred that the erosion control plan and the sanitary application be submitted to the Zoning Office at the same time to better coordinate our review. If you have questions or concerns, please feel free to contact this office. Sir rely, Rod Eslinger Zoning Specialist RE/jh CC: Town of Hudson, Brian Wert file Y1 ❑ ❑ ❑ Q O z 0 O M W ¢ F- z z j ZQ ui D a z N > w L . Z a m C m = C o m m O m L m > ° m m m R 0= C m N a = O m 5 o o m m E E L c N D m N m o� .o d 3 m� m❑ m C N m m N T _ d Q O) �❑ J m m n -- m c m c m N 0 E 3 a m fJ N m ° m x E E O 3 m m m m (n ° m° L m L m L m wo E3 F E.: W 0 W co 2i J 0.. Y 0 J 0 0 Q 0 vJ m CO 400 N fA N W Q Q K W U LL LL O z U) w N E O 2 F Q W Q �W LL 0 W W m W W z W U) U) W J Z CO W x W W I— W Z a Cn 0 0 J W P= 0 z 0 Z U 0 LLQ� ❑U) Q z Oo cr- U W U, 2 I— O:D 0-1❑ W W J