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HomeMy WebLinkAbout020-1101-70-000 (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 [Privacy Law, s 15.04 (1)(m)] TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic J. "C5eT fl LAV vc>U I-i ble 5'z5 Aeration Holding TANK SETBACK INFORMATION TANK TO l� WELL BLDG Septic > PUMP/SIPHON INFORMATION 0 Manufacturer Demand GPM Model N mber TDH it Friction Loss ystem JaZ DH Ft Forcembili Length Di Dist to ell SOIL ABSORPTION SYSTEM County. St. Croix Sanitary Permit No 633854 State Plan ID No Parcel Tax No: 020-1101-70-000 Seclion/Town/Range/Map No 34.29.19.404A STATION BS HI FS ELEV Benchmark E;;�t 5 .8 77,l Bldg. Sewer S, 97 SUHt Inlet , p! r , ��3 (G(� St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Bot. 9ySGtem �3 to, y y5 a Final Grade , 5 0. v 7. St Cover , / r (o. / / ��. zi�5— / ?- 7 1-- -7 BEDrrRENCH DIMENSIONS Width >, Length x // No Of Trenches 2- PIT DIMENSIONS No. O1 Pds Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO PI BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Nf( TyppeOf — System: J Y7I ZGO' Model NumbeF7, r/�J OISTRI9UTION SYSTEM !v Header/Mauifold 7� Leng[h� Dia Distribution Pipes)L x Hole Size x Hole Spacing Vent to Air Intake / Length Dia Spacng SUIL COVER x Pressure Svstems Only xx Mound Or At.C.rade Svstnms Only Depth Over , t d/T Berench Center / (../ l Depth Over \\/1 Bed/Trench Edges / f % tt ` xx Depth of Topsoil xx Seeded/Sodded zx Mulched L] Yes No Ves u No COMMENTS: (Include code discrepancies, persons present, etc.) Location: 669 CTY RE) N 1 . 1.) Alt BM Description = COE"16 7'e S'p� vhl:�t✓ �o�i(� 2.) Bldg sewer length = -amount of cover = Plan revision Required? _-1 Yes No Use other side for additional informal n SBD-6710 (R.3/97) ye 14-t-f-S Inspection #1: Inspection #2. —1Mc, )1 S�w\ed — VY vl Date Insepctors Signature Cart No County � crolx induatn Ser]1co:. Di, isior 1400 E W:ahthgtur. As c O SQmAnn N- aoa! _ 5`' I Property Chmerb Mal ling Addrras Proprm Loewim llCf( �:p("t Gn]Ilot --i_ I rhww Nmrlw� ,; SL Ne . sesuon Gh Slam 7,p CW, G 1p t. vdc u f / ♦, It 1, l 11, 1'ype of BuiWim g (check all that apply) 2 tAt ur2 Famdy Dwdhrt_4-]umLser nl Bedrooms_____-____, Cufdn'sion Same N ACI ❑ PubhaiCommernul-Ikxnbe tie -- 1 LJ Cav of ❑State Owned-Dcscnbc lase_ CShi Number'!!1;33(i ❑VJlage of f XTown.f �2 — 111. Type of Pennit: (Check only one bot on line A. Complete line B if applicably A New System ❑Ruplacrment S]stem Q Irratmenckioldme ;ank Repl.uement thti\ ❑Otter Modnicanon to EXtsung Sysem (eepla:n) ff• I ❑ Permit Rencual ❑ Permit Re]ulon ❑ Change of Plumher ❑ P2nnli Iran]tirm Nl'\] list Pic] mug Pe mn Number and Date I�uN ' Refine Expluoon O'Nna-' IV. T of PO"-I'S System/Com nent/Device: Check all that a Iv Non-Press.d In -Grow ❑ Pressunxed In -Ground ❑ At outs - in o:'swuble smi ❑ MourN < 24 in of suneble soli Holding -I aide ;& Other Dispersal Component xp • I 'L LCl< S =' 1':eneamcat Desk¢ (cVlauiri V. DJaIpenalirTrestment Area Information: Y'e✓l.C. lkslgn Flo.. (gpd) I Design Solt Application Ralc(_ t) Dispersal Area Required (s:0 Ulspersal Arca Proposed ist) 5) stem Elevation 7ti0 co yl. Tank Info Capacm m T,L 1 ,; %Manufacturer Gallons Gallon] limo I Po !Yl du S zs _--. -rEualnc Y? I i New full: laN. _ � j `y n 8etnreCb� VI/. Responsibility Staterai 1, she uadenigned, assoase rnpomibilin for installation of the POUTS sbown on the •narhed plax Plumber's Name (Pent) Plumber s Signaturr .1 WANtR6 Number lsucmess Phone Nomt+cr I' �_ � r 2a R � I/i � d-U 7/5 IE�.--ZSSC Number's Address (Street. Cm. Sr:ne Zip ('<de) I%- 7i�,cn; k)- t�4 0/4? Fill. Counts_ /Demirlment Ise Onlye .Apprmcd I Dlsappros Sd I i��j. eD 1 Z / I Lssumg Agent: urc ❑ Owntr Gnrerl Reason lu: tkmal I I r la. Conditions of ApprovaVReasonatorbisapptas al3 M �X Z ss ct {�pr �3� (1t S /,y 1-1 SVSTEIA OWNER 1✓ /'� 1. Sept;( lank, effluent filter and �/8 .1 , dlmersa! cell Itnnt be servketllmaintainM .1 ✓ 1 as per mam"meat plA.t provided by p!umbee da..cj Dw_.. �.�. /t 11 A. 4.A,, retoxi: requirements must Do malrltalnan j •-'^/CI .-`•"—t . r ry r v`C. JI/J !•e-• •-�Y .•rrrl�-.-� p4a p1.m mrth..w .w nu r4 C n vvh paytr vq Mas nun 8 11 a (I I —inch, in Aa ! 5> ce,p IkKWcn/ Rre iL L6 � or-eSer� SBD-(,398 tR. Ufl+I S> / ! 1 Plot Plan Page /_ of '' PROPERTY OWNER: �rf M �,� 2S')r) , vs Legal Description: SW �!� Site loca ion: IN�n «fTc 4 I —I 1" _= 40 FT. {except where noted) G == backhoe pit North c COp� 10 '�tEcn r.'9Fn . o> +. �0ro e -AUPA) TA NK so v7� FIITEft �;�5'J J/ 44 e,. -_L�2 �'sR0U11D ,,%- /fit✓ CD STAK I of, 5 PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manua! Design Reikrences: Version 2.0, SBD-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: POWTS Application for Review Soil Evaluation Report & Site Ma SFr 1C TA-� K 4,.hE'FtiteA Project Name / Description ownerName(s): JEAN /V1. PC-69,xN D(c. I RVYi Phone: (ail _ ::I- 137 Owner Address: I I U1 l t.f 5fy t zW CY� vEj I ulY z N , Zip: Project Address: CS•H. >\; Govt Lot: — �_Q� _1 /4 of _pG 1 /4, Section 31 . T 2H N-R 0 E ❑ or W lei Township: Oubt-a\1 County: 5T- c' RrIX Project Parcel ID *. Designer Information Designer Name; .% lA&v _l flaer'r:p�rr Phone: DoiignWAddress: ZSLf9'I K06,4KtHu23 Ct.� E-mail: [t01Gsferde5tqn r cu41coK.,4o" This License Number. I Bali - co'/ Remarks: zap: 5q 8�p sp2cl.rracntd6igy�idY81 stamp Signature: Date: brl�inr testesonApEywobnow copy. Plot Plan Page of - PROPERTY OWNER: rl /t Legal Description:CI r - 1" _= 40 FT. (except where noted) _= backhoe pit North I' Op. D n 50:-f+i'� C ter-n, _ K1 N Site location: r J ` IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) I GeotexlYa SOIL COVER Cover 12- mm. trench depth (typical) SystemElevatbn= 'j7,LC ft (typical) min. 12' (Ypcal) Septic Tanks) Manufacturer. wte `W- Septic Tank(s) Volume(s). gal gal gal gal Effluent Filter Manufacturer r�`t.ycOlK Effluent Filter Model TYPICAL TRENCH CROSS SECTION VIEW (No Scale) + Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet I Dutlet pipe connection on plan view.) PLAN VIEW OBSERVATION PIPE DETAIL (No sank) Ship Go Arose ♦ ;i I rag Grade (rnckYetl aseuded) 4.0 PVC Po _...r TOP of Dope b Mmr:ab al or above finished grado (al 1/4'-1I� '%6"Skis � Sp apen Anchmrig Dove 4" 0 omerv~ pipe Shan be mtaalwl (No Scale) perforated Lateral =" Ob°dwo°°"°J"" jo fi servabon Pipe (bPtcal) (typical) (typical) ---------- 70i,------———————— ---- ------_10Z - --------- B=17iZft I A=3.0 ft j (typical) (typical) Lia'C` = 0.7'-K> b4 2.`sL-4.\ XoE u IIWc' INSTALL PER TRENCH: '7 10-ft bundles @ 50 fF EISA/unit = '�'2 ft- + 5-ft bundles Q 25 f(' EISAlunit = ft' = Proposed EISA per trench = ft` <ft2.Yu#}2Ets+){U�WT,= lLS.t`wEZ1203HBundle (typical) CR IS AotNr.wk "s � (mfd by Infiltrator Systems, Inc) 14 un1iT 5 - z = 7 Install pursuant to manufacturers Instructions. ' 7 X Jt 7,0 , IZ) .3' X 70 TK6AL:tfrs ::.t--- r cpaal corer (m. 1 Irol) nNO.Wn Sudan® Required Infiltration Area 04Z. E ft' Distribution Method: x —2- trenches = Proposed Total EISA = X0 ft` N*JtF0L-P In -ground Gravity Management Plan IMPORTANT: PAGE 4 OF 4 The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human heatth hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operatina Limits: Design Flow = 450 gpd. 8OD5 <— 220 mgL"'; TSS 5150 mgI_"; FOGS 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution I drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tankls) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent fliterls) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturers specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordant with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit GARY ZAPPA/ZAPPA BROTHERS Pion: ST. CROIX COMMUNITY DEVELOPMENT phi: Local government unit address: HUDSON, WI 715-386-2850 715-386-4680 ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuard to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to tho appropriate agency for roviow and approval. A failod in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ST. C! LINTY SANITARY SYSTEM OWNERSHIPIADDRESS FORM File #: Office Use Only creoaed 2izu21 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 PropertyFiles Scanned weblink. OWNER/BUYER INFORMATION Owner Buyer Mailing Address I Ic9 C RAT v Igw t7R City/State/Zip 4luirc-v lti'i 5401(0 Phone Number (required) Email Address (required) r n � in peitr^st' n Parcel Identification Number ( PoF4DI:tk- (found on the property tax bill) ass Ti�u'S1� � I�i4 NEW SYSTEM: LEGAL DESCRIPTION Property Location t/a , t/. , Sec. T 2-q N RAW, Town of HUD-52�ti1 Subdivision Plat: NA Lot # _ Certified Survey Map # �,C? �9 %y . Volume Ir/ Page # gj � Warranty Deed # `� 7 1 Z Z,_efore 2006)Volume f- . Page #VIC-. Number of bedrooms '7; Spec house O yes;ld no Lot lines identifiableA yes O no New Property Address U / (Staff Initials) 69aS C% (verification of new address 71 z9Z Zt (Date) OFFICE USE ONLY from Community Development Department for new construction.) 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 �uj 6' n 41 wr IN IN ar f1 w A f1 M 11 n n n f1 n n N o if 11 n 0 1It V I/ 1$ N 13 11 11 1 1 1 r 1!! 1 1 1 a l l l l l l l l twlslm alc, w p 111111 IOwal I /all If— r o ---------'------------------ T � Iw! `r 14 ImInwur Z Him In'rlweAl LU W' I ♦• l I} H �} I. .- � IOIf Itlll M1il ww. lU. \ar trtar anarcNnrcl� +c o rw lst ltla 11.1 11 41 W n w 21 IN n IN A IN 11 n o n rI IN o It o 11 U IN 11 11 1! 11 1/ 11 13 11 It la 1 1 a 1 1 4 f 1 1 a • 01M I1.-�+�•. {M • p�r jF. I • t1 :77 •� E I 1FR11I'Ia4M11wa1MIA[1 0MWrw1 { i I � � I.. _ - � i l - � ; l .. m••.tr a1! v e tr 11w wm1 ®.[ .1laro rwl tns _. ._. . wnu wn wlwtulln• wt • -� - 0 1K w¢wwa lr __ ,. _ __ _ _ .. . - -_ : _. 1 '.-_._: .. r _. _. ! i vp•w!•a.•au owt ■awl 690CIAL 1111■ wwr me w1am Mn. WILT IA®B wv`lilwww¢weswww ."'. ltwxw alram.11•w __. ._.. ___... ,/, p 2ml INAAINGTON lin -w�wllwlww wuw oawwwlrw wo.lwtwllmtwl MASTER PLAN tum, wwwlr was !!WWI" '—._... Of rwn am w wr wl41a rw 1c tw l wo mrt ra 1Ni•! IMN 1NF•t111 N7�i0-/PTRIOi tlA17ON am WOUtILDIIq O�wwLwwiRwwwww rrl wIw wcwl �w �. 1w w 1a11stkI.. "Impommat M a•u li - ANT IIi1W2020 I21IIiam 1-A Nor Wisconsin Department of -Safety and Professional Services Division of fndustrx3firiixs �� , I SOIL E T 2iin a�rdancle with SPS 383, NRs, Adm. Code County Attach complete site plan on paper not loss tharF8,112 11 inches in size. Plan must include, but not Iim ed to: vertical and h rence point (BM), direction and parcel I.D. percentslops,sca orllunpns{g�is.-1raF1 artow, andbcat1on and distance to nearest road. Please print all Intormadon. Re^viewed byPersonal iMorm = you PrO MG may C used far secondary purposes (Pnvacy Law, s 15 04 (1) (m)) / L — L CST-aOa► - o b Page I of 4 ST. CROIX 020 - 1 101 - 70 - 000 -(Z-6 l . I- _ �,vpclq l_w.ewu JEAN M. PEARSON EXEMPT BYPASS TRUST Govt Lot --- SW 114 NE 1/4 S 34 T 29 N R 19 E(r� Properly Owners Mailing Address Lot Block # 1 S�ubCd. Name or CSMS/ � 1 r� 1109 CREST VEIW DRIVE. � _ 65M -31 _ lD fS City State Zip Code Phone Number ity v4ww L!jTovrt Nearest Road HUDSON, WI 1 54016 ( 651) 329 - 1375 C.T.H. N '.� New Cons6ucbon UWE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material SANDY OUTWASH Flood Plain elevation if applicable ft. NA and s 1;0 VENTIONAL FN Cii�OUND TR��rCEfES - 0.7 LOADIN RATE MAX 1Z Ce)ow jtM0 See Kedrx ,Y. P'+�3. 82r 04 ko ferre - bill !364ro4er )uvt U �: u Boring Spit Ground surface elev. 97.80 ft. Depth to limiting factor 110 in Soil Application Rate Horizon Depth in. Dominant Cokx Munsell Redox Description Do. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe •EfM •Eff#2 1 0-14 7.5YR2.5i I sil 2f-msbk mfr cs 2vf-m 0.6 0.8 2 14-20 7.5YR3/3 — sil 2fabk rnfr as lvf-f 0.6 0.8 3 20-42 7.5YR4/4 grly cos Osg d1 cs Ivf-f 0.7 1.6 4 42-110 7.5YR4/6 cos Ogg dl _ 0.7 1.6 few cobs. 1y 33' C wing XBorin101.28 100 Pit Ground surfaceelev. ft. Depth to Im iting factor in, Horizon Depth in. Dominant Color Murrell Redox Description Co. Sz Cont. Color Texture Structure Cr. Sz Sh Consistence Boundary Roots uwn nale GPD/fF -Ef 1 -•Eff#2 1 0-24 IOYR2/2 -- sil 2f-msbk mfr cs Ivf--m 0.6 0.8 2 24-08 7.5YR3/4 - is Osg nil as Ivf-f 0.7 1.6 3 48-100 7.5YR4/6 S Osg ml - 0.7 1.6 Horizon 3 has some lase„ of 7.5YR3i4 Is and cos. cut 3 fl on back side of pit. CST Nance (Please Print) — SN GIIUCIIIM TT — aria I Al c Jll mg CST Number 28497 King Arthur's Court, Danbury, WI 54830 04 - 21, 2021 715-426-1775 Property Owner PEARSON, Jean Trust Parcel ID # 020 - 1101 - 70 - 000 Page of 3 U Boring Bong # ❑ Pit Ground surface elev. 99' lO It Depth to limding factor 48 in FgoiApplicabon Rate Horizon Depth Dominant Color sell Redox Description Qu Sz Cont. Color Texture Structure Gr Sz Sh. Consistence Boundary Roots GPDM -Eff#1 I -Eff#2 0-3 cut I 7.5YR3i4 -- S Os= rut CS lvf-f 0.7 1.6 2 2148 7.5YR4/6 — S Osg rut ai — 0.7 1_6 3 48 58 7.5YR4/4 inId 7.5YR3/4 Om Intl— 0.0 0.0 J +cl u JJ rr ❑ Boring # U Boring Pit Ground surface elev R Depth to Ixnding factor inSoil Application Rate Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr Sz Sh. Consistence Boundary Roots GPDAf 'Eff#1 I 'Eff#2 Boring Boring # Ground surface elev It Depth to landing factor inPit Shc Aoobcabon Rate Honzon Depth in Dorranant Color Munsell Redox DescMbon Ou Sz Cont Color Texture Structure Gr, Sz Sh Consistence Boundary Roots GPDMF 'EfF#1 I -Eff#2 Effluent #1 = BOD, > 30 < 220 ng/L and TSS >30 < 150 mg/L Effluent #2 = BOD, < 30 mglL and TSS < 30 nglL '.D`11n TROT I Plot Plan Page 3 of '4 T PROPERTY OWNER: Legal Description: 5'iJ/L1 nr- --c 0750 Site location: Ste` ,c` 4 H t.i f r,gz 1" _= 40 FT. (except where noted) M _= backhoe pit North ,i k �?r7tal,'rta n` i t DTsz S �+rYE gi _` 1AK— Ze /oi. S' ;a i t � � 3 • t COUNTY NO. 633854 STATE SANITA y PERMIT f2 M uTg��X�� OWNER FiGhM7 PLUMBER LIC.# 222 TOWN OF ,Soh SEC3&j ,T ZA N, R� AND/OR LOT / BLOCK M THIS PERMIT •T SUBDIVISION ENE CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the 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. (c) The sanitary permit is valid and may be renewed for a specified period. to) 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. (f) 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. ISSUING OFFICER - DATE UNLESS RENEWED FQAE THAT DATE AIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499(RI 1/20)