Loading...
HomeMy WebLinkAbout020-1365-18-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. (ATTACH TO PERMIT) 633369 GENERAL INFORMATION Sale Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)I Permit Holder's Name' City Village Township Parcel Tax No Adam & Tamara Kowles I TOWN OF HUDSON 020-1365-18-000 CST BM Elev Insp. BM Elev IBM Desc;lpipron Section/rownlRangelidap No 7 �. q g I /-XiS44ry1' m4n)?,l (6L-tf 1 15.29.19.2178 TANK INFORMATION / ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Fh i s�% 'tut lao c� n gr F 1 ZR 21 1 41A Aeration Holding TANK SETBACK INFORMATION cnGLC 4-- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 1 I Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer IDemand PM Model Nu er TDH L Fred In Los System ead TDH Ft Force in Length Dia. Ditto ell SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV Benchmark / "D 7 97. Y!/ Q AIL BM Bldg Sewer SUHt Inlet i 1 Jr SUHt Outlet '! Y �i /1 Dt Inlet Dt Bottom r Header/Man 8� y ff DI _PI(�.t.(7t Y' ly //� /5 �77. .f 49a. in 9 Bot. System ,/J � {xj 9.8 pp Q /� Final Grade . � �D�L' St Cover f` X fro BEDITRENCH DIMENSIONS Width r 3 Lent / 1 No Of Trenche1s_' PIT DIMENSIONS No Of (O 2, c w SETBACK SYSTEM TO JPILedo BLDG WELL LAKEISTREAM I LEACHING Manufacturer //��. INFORMATION CHAMBER OR UNIT �h,fY/- Type Of S tam �N�n tea ( / / `7 >`O r Model Number. 1p ✓ JtL� DISTRIBUTION SYSTEM Header/M nifold G(j r / I lr Length ! Dia '7 Dismbubon P,pe(s) Length Dia Spacng x Hole Size x Hole Spacing VejNuo it I a GX1 p SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only IN Depth Over / t Bedrrrench Center _ ✓ . Depth Over Bed/Trench Edges % ! 1 r xx Depth of Topsoil xx Seeded/Sodded xx Mulched No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 981 MARCYS CT r i.) All BM Description = rd O4 Fo V" p ;l 2.) Bldg sewer length = 1 t -amount of cover= kf$I /YIn Plan revision Required? E] Yes No Ili % rb z Use other side for additional mformanon. _. D Date SB0. 6710 (R.3197) Inspection#1 Inspection tl2: 'Vhro�. kA+- /Oln Insepctor's Signature Cart. No �flN-anal— (y� MAY 11 2021 Industry Scrim Division 1400EWaswngmnAw Cc" 51 Gkti1X Smvtary 1'amit Number (to be filled nC) (' P.O. Box 7162 `IP l Madiaat wI'3707-n62 is Sanitary Permit Applicatio "per ,� In acco"la c with SPS 383.21(2) Wis. Ado, Cade, wGmation ofthu forma tttlrggal tacit is roaWral Prior to oblaYmlB a sanitary, e' permit NoAPplirffiien fon.te far water-ma.rd POWTs aro ... . to i\iA prnnjeea A.W.ma (.fd:Bve.r dr. o�.ling add.m) the Depnveart of Safely and Pwies ia+ml Seriices Penn al information you provI& may be toed for Secondary in accorda.x%,M the Privacy law, a 15,04(i)(mil Stets- 1. Applications Lfiareadme - Plum Priat All lali mdem Property Owner's Name, Parcel N b Tr��W}�A DWLF� E XCyG 13b5�1$—ULG Property Owar' Mail ng Addreeas Property Imam Sj1 A!Aa `-s' CeIIKT Oars Ia mow: %, /'t;t %., section IS city, state Zip Code RtmeNumber ai U DSCN J (I I 7-(O �fe . (✓) ZCi de o es/ t . f 2y N. R 19 R Type efBaBding (clawk W due apply) Iota Subdivmw Nava p RIVE)CPAKK N� C4'bc Ior2 Family Daelfefg- Number ofBedraoms Z Block ❑ Pubiw&ommercial - Demh the — ❑ City of El Stem owned-Dmcnbc Lho ❑ Village of 'Iona "'�•,J�'!V CSM Nr®bat --. of / lIL Type sf Permit: (Cbak oily man box on, Jim A. ComplNe Bee B tf appBuble) A ❑ New System Replacemem System ❑ Trcannowtioiding Tart Reyhcamat Only ❑ odic modification to EvstGtg System (explain) B. ❑ Permit Reawal ❑ Permit Revisiw. ❑ Change of Pltmber ❑ PermitTraaf x to New fist Preirmis Permit Number ad Date Ivatod Betbre Expiration owns 374 {/ 2-n- ll - 2Ct() 1V, Type of POWTS S Cheek an that tioo-Pea.mad 1rr Oravd ❑ Pres%imd en -Ground ❑ AI -Grade Q Motad > 24 m, of edible soil ❑ Mo.ad <24 m. ofstmable roil Bolding Tank ❑Other Dispersal C®Po (oRlam) ❑ pretreatment Dena (explan V. reatmeat Area laforeaatba: G Design Flow (gPd) Design Soil Application RANAtalso `•.' Dmpcsal Am RaWrod (st) Dispersal Area (st) Syst®F2evattat r 0,7 64Z.fcsZ G53.L Ri, gf.bs VL Task Ifs Capacity in Cellars Taal Cullom N of Units �A S N.esker des rota -` -' a4 I—• S Urs A W A! rJ S scpec<a++aLraek Dwaaiw a VIL Rimpowillift Sfahmeat- 1. the randa>aQad, reptrar�iay ter iasta0atiu dtle POW2'S aaowa as the aturied plus Plumber's Nam (Print) Stpahee 1111AMM Nra ter Bras Pherte Number Tk>hL��-) 1 Plumber's Adder it Vabo , I icy, Zip Code) 10-i�A'72- 71( "` \ti�u(- F'tvE-K 14 ttit `:JJC"e VI11. rtmeal flu Ulft A � Permit Fee t S1 s� lad AgrntSwuavo ❑ 2 r Rip rat Denial 1 ixtICtantle STEM OWNED Approy ( 11 t 2 e 3) D1r� f Septic tank effluent filter and Q ppa,� pa d CMS Qb - idispersal cell must be serviced I maintained I o las per management plan provided by plumber. r• requirements must be maintained �' rtty r j $ yVtCl.l�etrt'eall-xC2- as per applicable code/offl MttwjT r SMIDWbaInd f-" ^^"l`u (1 21 �&Ort- { SBD-6398 (R. 08/14) Plot Plan Page Z of 4/ PROPERTY OWNER:-AL�i T,� F-A I NOWLSs Legal Description: LhT 1; VNCV_PARX MFkt7Dwsf NL4 DIThE M)� Sc. Is -szg,,� fil9+r) iow>J c� k4+,�soN� �.c��x CouNzv_ scDNs tti) . Ozo— 13 bs_i�_ p�1 711 /vAPr s Cmpr VP*4 vC Sitp loc"on: .�/ NCJdtt pIL v �£aRoaM (ND SIAP£� ®ti i41�. KT�gtia C%hWFlE�� 1" _= 40 FT.,, (except where noted) == backhoe pit tJ 6M °F PMMb"( J`: gP.40 PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manual Design ReAvences: Version 2.0, SeD-10705-P {N.01(01, R. 10/12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section & Plan View Pg 4 of 4 Management Plan Attachments:Enclosures: MVtQAIL TEST POVYTS Application for Review " wo, Pl-oN Soil Evaluation Report & Site Ma T' pumc: 'K&Rizr I >ePTiC 7AvK .k ctW7 Ded�, Project Name i Description ownerName(s): AuA, h\,€ -T AAAr,i Yj,utk:s Phone: W2- - 0. - 6iz0 Owner Address:i ,b1.cys ccurTr Null;cu i Zip: Project Address: _ t e-A M E) GovL Lot: NW 1/4 of NE 1/4, Section /5- , T 2q N-RIq EQor W Township: 44 n; County 57 c hclX Project Parcel to # Designer Information Designer Name: /'�1AKV 1c -Hael'trzr Phone: DesignerAddress: Kw& ArTHUR'S C+ 1 u ,KZ. tW= E-mail. _ G (t sft'r�es�n �{� or�+JCOK _ c+owt Tiv! License Number. I b,5w - co 7 Remarks: Zip:-'4&�90 0 Signature: [ �a Date: 00py, �? stamp p 21, � f�ilP;^wRT FPWJVFA 1�fl FAt.t,s, �A"'�"•yux.uapNYr D�-z� Z.c21 Plot Plan Page Z of,'/ PROPERTY OWNER: GjOw� )' Legal Description:) iff IVht40' =%t�K /�Ei"1^�.= ;P•" - 2��T"'� `! TOW J ; _ _ r �� x . � , ra``` , Y• _ r44 V t F yE WAY Site location: l (roo swpa 1" _= 40 FT.,, (except where noted) 3 a Y oF n•��F3�+,'t'�l l . x 10,6 r _= backhoe pit 2.oho 4�9F-5 North JA Y� I )�.40 IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Quick4 Standard-W Chambers 3-ft Trench (down -sizing credit) �IL8'JI • • _ -i'L KOWLES ;fib-i�v� Septic Taws) -hZ7a: M IL�t•UESiE:"Z'U Sepsc Taq(s)Ynarn(a): J. IJ 9a 9d -9W -am E1Lv� F Na•6u•ar. L Ef*, Eger M.W16 74100 +r � TYPICAL TRENCH I - CROSS SECTION VIEW ff L (No Scale) • •• q1.� Pm We minimum3ft System Eleratbn =_ ft separatlon between 9encmes. (typ ]) Qvkk4 Slaneem.w .1 End en (Show location of Inlet f outlet poe oweedon on plan Wow,) �nr »0 e= n (typk.o ��,INSTALL PER TRENCH. h,Olack4 SI6W @ 20 ft EISPJdsmbw= 3 /�� ft' + I Pales of end caps Q 6 }I' EISMpee. 1c' ft' _ IA=306 1 I3Fao TYPICAL TRENCH PLAN VIEW (No Sole) `Quacks Stanmro-w cnerneer (trpicaq (..0 by Ms sy •,n) wvw..s�i a mw=raYar. MuNna. m Prapoaaa e=13A parlmllch 3210 R' Requlr Inml.efbn Ar = 4,4Z.Sb ft' Distribution Method: D m w O n A x Z trenches = Proposed T04W EtSA = 1-52— ft. NW (F(Y-D �LJZ. Situ -4 y; 704 Z Ersfl/ t+>u(T = 3L.143 L1K �t LnNCTs i 3a maw >Y `� :� 12+ IZ.b = raEN�'+r�s lc`1 Z 1 Etiu C�tPs PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT: The caner of this "nourw gravity system shall be responsible for its perpetual operation and „ub tenance pursuant to requirements of SPS 382-W. Wisc. Amin. Code. Pursuant to SPS 383.52 (2), Wim Admin. Code, this system shad be considered a human health hazard if not mmitained in accordance with this approved rma agermant plan. Futhemrore, all inspection and maitenahce ate shall be perfomied by a registered POWTS dlaft"ner in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating LYnits: Design Flow = %% gpd; SM S 220 mgL'; TSS S 160 mgL; FOGS 30 mW wtspecfiorr Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i_e. odors, user compla inK etc-) o ma al malfunction (i.e., pumps, valves, switches, floaft, etc) o material fatigue (i e., leeks, breaks, corrosion, etc.) o solids volume in anaerobic treatrnert tanks) and any dear appute wnoe(s) (i.e., distribution / drop banes) o magiiid or improper use (i.e., exceeding demon capacities, prO bd®d aclkrr6es� alo•) o edert of pxxding in distribution cell prior to dosing o doming ixregutarities - if applicable (i.e., pump re-cyderg, float switch settings, etc.) o electrical components - if applicable (i.e., wlfig, connections, switches, controls. timers, alarms, etc.) o disthbution lateral or lateral oriice plugging (measure lei distal pressure — compare to dew specfiicahom) o surface discharge of effluent or sewage back-up into structure served MfalrMenance Ciwcid MIAWAIN EVERY 3 YEARS (or when necessary) o Septic and done tsptdsi strap be pumped by a cerlifred septage servicing operator licensed under s. 281.48 Wxa. Stats. wirer No volume of solids In the tank(s) exceeds one-tifd (113) the liquid vokarre of the tamps) or as required by local ordnance. Disposal of contents shall be Wusuarm to NR 113. Wsc. Admin. Code. o Effluent filledsi shell be inspected every 3 years and shall be cleared when necessary to ramove any accumulated solids according to man ufacturves specifications. A servicing period will always be greater bran 12 moms. System maintenance reports shall be submitted to the proper local government unit in accoadance with SPS 383 56 Wfsc, Admin. Code. Repoli any component failure or maMunction to: j_ fYathe d ihdividuef or oanpany: 'I () M_ i �? P„'% ,�-y,`_'rl •✓� "'(Air-� Phone: Z.S-q2-5F Localgevammentunit STGioxt CownuufYY_ 4VtrxDPM>N-f Phone: 7f�=35t-�1�80 Local goverment unit address '•, `OA; fait 27P: 540' 1 Any defptfive part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement or failed or malfunctioning components shall comply with SPS 383, Wfsc. Admin. Coate. No product for chemical or physical restoration of the POWfS may be used unless approved by the department in accordersce, with SPS 384, Wisc. Admin. Code. Con*man w Play In the evert Net ay failed treatment component of this POWTS cannot be repaired, it shah be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed m-ground dispersal component may be abandoned and replaced by a code -co mplywV dspenal compomaM in a pre-detsrmined area of suitable sods. ff use of this POWTS is discoorifirtued. it shall be abandoned in accordance with SPS 383.33, Wise. Admin. Code. 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 (Street address) qSl ;1,law located at: ti ICI '/4, - E '/4, Section ' /5 , Town,7._N, Range I q W, Town of 44 Unsi7t� , 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. J / Most recent date of inspection or service !zpV Did flow back occur from absorption system? Yes k No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: I Ot,O Construction: Prefab Concrete 'X Steel Other Manufacturer (if known): WiUwEs'i-E//ss8J1 Age of Tank (if known): ';-?Q}n Permit�iumber (if known) 37 Zf �t I� T�kM,as -A, Wnw= (Licensed Plumber Sign ure) (Print Name) *FLwbt 6 cy� (Title) /1 (Date) ZZ7g46i (License Number) MP/MPRS 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 File #: Sr CRO utv-1-Y SANITARY SYSTEM office use only ,10 OWNERSHIP/ADDRESS FORM Created z120?' 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 A -DAM ��t1M:1RS KUWLE Mailing Address qSl MAt`ezV COURT City/State/Zip AUDy)k�f lwt.T SyCllo Phone Number (required) Email Address (required) Q iOlAe5c !Uai t Parcel Identification Number pzC'- I S-lrS-Cif) (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location A; lj t/s , Nt 1/4 , Sec is T �` N R lI_W, Town of +4 QZ -00 Subdivision Plat: Overt Pmr, All=?o ow s Lot # 18 Certified Survey Map # Volume - Page # - Warranty Deed # "IG 534�- (before 2006)Volume )-Syt,. Page # to Number of bedrooms 3 Spec house O yes#no Lot lines identifiablyyes Ct no OFFICE USE ONLY New Property Address Nenfication of ew address required from Community Development Deparbnent 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 1101 Carmichael Road, Hudson, WI 54016 A. �9 E i5�� -`6$' LOT 20 - `. Q, 056 h \ 2.22 ACRES 96, 840 S0. FT.' -DRAINAGE i f` lxh s Q -J. "/5 m HIGH WATER- - `: I 4 ,fie �J6 A,t' Z < EA, - ELEVATION 920. 0' , EASEAENT No < I 09. M, .. 392. 29 � e0 rp o 14 ® LOT 19 n :RES v, �\ ® 2.04 ACRES 100 3 w 89, 027 50. FT, °j t, a dTVY IN, ' 7p co ' a 02>'AB ®11 33' 33' 4® 503o04' 150E �O m 8� N03004' (50W i 52.94'I- 52.94' 01 I Z Q ------------ Lu 25'W .317..30' , 93 ACRES do 641 SO FT, In , , LOT 18 $ CI z. s TrP. 2.09 ACRES y 1 i - - 9 7. 795 50. FT. CA a ® A co o 9T (6 27 ACRES 589 SO. FT. "' LOT 17 s. , 3 2.10 ACRES f 9t,461 SOFT. 7 w b Q NS IN TELEPHONE O VOL, 450, PG" 65 _________ _____. EDICATED TO THE PUBLIC t? n n n 13 12. 21 ' ROAD INE OF THE NW 114 OF THL NE le4, SECTION 15 . WbDMUM DWWVMtnt SOIL AND SITE EVALUATION end DPwvw�a 3 Ni m a safety and &eesu of kowsted seMces 1n accordance With Comm 83.D9, Wis. Adm. Code Aflwh co pWo she pMn on piper not ass drmi 8 irz x I I raceme in sin. Pten must WoUde, b'A na'nmed to: venim cold t0d20rdm rerermne Poky (BM). direction end w0w+Swope. ew'e a am.rnm, corm aww. and bearer raid mstaws to rremest mad. APPLICANT INFORMATION - Pleats print al/ bdmm ijon. Pam[♦I � rav Vo,+dn vet be fined lur» cr�mue (pdreY,aw, s /5Dr ll) (m}F —75 State 0 l�r-� w NE .NA /9 E EA Now Corraur:'dn Use: 1 Nurnbw a bsdn= m _„ - 9 Addbm re mdMft Wkkng ❑ papim yont LJ Pub'o m camnewisl - D« code oadvee mar bore (olb ppd aeoonerwxaed deco foearg raft - bea'vW • Z batch. AWOMWn mee egLdrW _gS]—bet, tt2_22.� _barrn, n2 Mairm ,, deso reta,p,als . l bad Wd*_j—aerren. Wd&l fiemrm molded ffOMm vestme eta abm" r/ Z • (9 O n (as weaned to sib pare berw1wrom Additlo" des tirusae oo a Waborm CI Z • (a O Parem macanar d )+ t \ la Flom pram eleva&n. If app'cebie R5A rt S = S ng* br syeam CmrrmilmW Mound kwAwnd Prenwe AT6rade Sym m n Fi Haft g Tani u. urmtetaae for sraeem �s ❑ u 0 S❑ u ®s ❑ u ®s ❑ u ❑ s O u IDS p u award ebv. �pi_•Y9t Dopm to W-bry bcbf Li b_ 6oretep s fy 2 Ground elev. glt-Dt Depth re Wrav tm 114 in snx nFcromwim twonar ©® ® ==0� © noMb 0 , �*T� Nome (riaaea r" sfyrmm Tmepborm No. / t'j�jr" 5chLLma -715-Z'17-1iOOX wareem ' Deep oaT nu,rw qog G'=eleer.S{. +-`f SaYlel3ef, oil 5416Z5 /1-8-99 z533Ug vBOPEMOWWR (701(00CG, SOIL DESCRIPTION REPORT pap PARCEL I.D.. �11--A--_ _ Boring # �3 diev. 9L• (to fc Dyhb *ftw 4 factor Iz4 in. ®S ® ®©® MIm�©®ffff nl�mla . MMIM Remarks Boring # y Ground ,FafL Depth to fire" ©fl�l0® ©=�1 INO EM®aMM �M� EMMINMEMMIMM MM���MM --- tactor Ilk n Remarks: BoringdMINUM# Ul Ground 4ott. Depth b lb. Tie9 MORRIS MIMMEM MIMMEM MIMMEM lector _ Remarks: Boring # Ground elev. DepM a Ing:rrtlrrttq factor M. Remarks: SRM330 (R.9198) PAGE 3 ,OF Stole- 4 `if COUNTY NO& 633369 STATE SANITARY PERMIT PREVIOUS NO. WIN. PLUMBE p WANG LIC.# Z 49 TOWN OF CAM SEC14,T-23_N, R j AND/OR LOT BLOCK &WfW'?P qL4 ',DOtMS SUBDIVISION "Oor all. CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of [he private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (e) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (t) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. _ Z O ED ISSUING OFFICER - DATE PERMIT EXPIRES Z UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI 1/20)