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Home My WebLink About020-1325-60-000 (3)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)] Permit Holder's Name City Village Township William M. Moua I TOWN OF HUDSON CST BM Elev linsD BM Elev IBM Descrmtion TANK INFORMATION TYPE MANUFACTURER CAPACITY r Septic y. n v Dosing Aeralloff" `fin 7� J�� Holding TANK SETBACK INFORMATION TANK TO PJL WELL BLDG Vent to Air Intake ROAD Septic 7 n Dosing Aeration Holding PUMP/SIPHON INFORMATION Ft SOIL ABSORPTION SYSTEM BEOrrRENCH Width ,i Length, No Of chas DIMENSIONS 'r a N -/ ELEVATION DATA STATION BS HI FS ELEV. Benchmark o6 cp Lin „/ AIL BM ^ ✓! l 1 � --,to7. C 3 BI(W. Sewer }. SUHt Inlet SLIM Outlet Z t Inlet B onn Header/Man. i3rw / 6 i Dist Pipe Yh 'I-4 $ O Cj Bot. System n qO Final Grade 3.5 0 St Cover �5 a INruN6mAnuN -'I CHAMBER OR :} (- V Ty Of System ) UNIT -I I IN u r I tCJ _ I l o DISTRIBUTION SYSTEM HeaderlManifI Dislnbulion x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SUIL GOVER x Pressure Svstems Only xx-Mound Or At.Grade Svstems Only Depth Over i Bed[Trench Center . > Depth Over -7 Bed/Trench Edges xx Depth of Topsoil SeededlSodded a Mulched = —' ) F] Yes j No l'es Na COMMENTS: (Include code discrepancies, persons present, etc.) Location: 837 MOON BEAM W 1.) AIt BM Descnption = lbw 'p rl-vti 2.) Bldg sewer length = �- ' , - amount of cover = Inspection #1: Inspection #2 itr n� podv Plan revision Required? Yes )Q No � (?7� ny�1 ' 111 I)c�� Use other side for additional information V I 0 _//�t _ _ _ _ _ I Date sepc rs Signature Can No. SBD-6710 (R.3l97) SYS 1. Se dos as 2 All TE U UIndustry Services Division D S _ 1400 County StC'ov. SgN-a +a - E Wbshington Ave r-1 Sanitary Perron Number be filled P.O. BOX % (to m by Co I Madison, WI 53 1 Coon[Y n 6 3 �q CJ 5� ve A e�)t t]pplj(;'$t]QY] m_ late Trurtsactlon N'umher In accordance with (2). N is Adm Code. suhmissum of dus fomr to [he appropriate go,emme '--� is required prior to obtammg a samar, pent Note Application forms for sateowned POWTS are submitted to proiec[ Address (ddlf%rent then malting address) the Department o1 Satecy and Professional Sers Ices Personal Information Nov provde may Doc used (or sewndary ses m accordance w nh the Pnvacv Law, s 15 04 1 Im I, .Stars 837 Moonbeam N I. A lication Information -Please Print All Information Property Owner's Name WIIIIemM Moua Parcel a �� 020-1325-60-000 Proper} Owner's Mailing Address 837 Moonbeam W Property Location Gast Lot Gty State Hudson, WI /Ipfide Phone Number SL S.. NN ';,, Section 12 54016 ucle ones 'f 29 N' IL Type of Building (check all that apply) Lot n RI9Lnr� ® I or2 Fanuly Dwelling Numhcruf Bcdnwms� 59 Sulxlrvisunt Name ❑ Public/Commercial Describe Use I annoy Ridge Special Addition 2- Addition - _ _— Rlac{, b ❑ City of ❑ State Owned - Describe Ux ❑ Village of C'SM Number ® Town of Iludson 111. Ty a of Permit: Check on one box on line A. Complete line B if a licable A ❑ New System Replacement System ❑ l reatmenulloldm Tank Re lacement Only g p ❑ Other Modification m Pwsting Sysem (explain) B. ❑Perrot Renewal ❑ Permit Revision ❑ l'hangc oI' ❑ Permit 1 ransfer 6o New List Previous Permit Number and Date Issued l3elorc Expiration Plumber (honer 324637, 10/26l1998 IV. Type of POWTS S ystent%Corr onenUDev ice: Check all that apply) Nun-Prc.suriicd In4, m ❑ Preccurired In -Grind ❑ At -Grade ❑ Mound > 24 m of curable soil ❑ Mound , 24 m of suitable sod Holding Tank Olhtt Dispersal C'orrpom:nt (explain) ❑ Preueatment Device (explan) / / V. Dis ersalrFreatment Area Information: t Design Flow Igpol Design Sod Apphcauo Dispersed! Arc Required (90 Dispersal Area Proposed (sit) System Llevalwn 600 Rnle(gpds8 1200 1200 90 7' 0.5 VI. Tank Info Capacity m Uallon> 'folal X of Manufacturer Gallons New Tanks L.Isnng Tanks r Units ,m �+ v L 2 - a S rn r Septic or IlcWmg fank 320 1000 1320 1 As ieser Concrete Dosing C'hamher VII. Responsibility Statement- I, the undrmigned, assume re+pnnsihility for'astallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ' gn ure { MP/MPRS Number Business Phone Number John Schmitt j L j[� 223760 i 15-760-1W86 Plumber's Address [Street, City State, Zip Code) 586 Valley View Trod. SomerxcL WI 54025 Vlll. Coon /De artment Use Onl ,Approved ❑ D Permit Fee Date Date Issued I son Ae`n Sign to " 3 S�7 ❑ sell Reason [or Denial 2�' j,02- D(. Conditions o ro / I �1 �/y�� LA- t t'te. pp Rease e.a 3) B ill r uArx v / pt p OWNER: tank, effluent filter and lQ P-k.o& rsal cell must be serviced_/_maintamed. i p 5 r management plan provided by plumber. /s, �1 P_p.l>1n6v -+n ('t2 - -L,•g_ � �aN� p n coma plans Air the sysRmIdd subm' la Ill (bitba+prr rat thin li a 11 us'Q/TVIt in r lir�.aa• as per applicable code/ordinancecs. SBD-6398 (R03/1a) 5) i7v� �,�� M �� +► i-o ter-. SYSTEM PLOT PLAN Moua 4 Bedroom Replacement Septic System Project Address: 837 Moon Beam W BM1 Symbol: AL BM Elevation: 96.20' BM Description: Top of sepdc tank cover BM2 Symbol: Q BM Elevation: 92.55' BM Description: Septic tank outle8 Slope Gradient of Tested Area: (2%) Well Symbol (if applicable) Notes: See CSM for complete lot rfc]COPY Design Flow: 600 GPD Attach design flow calculations for commercial plans: Pipe Materials I ASTM Standard Tables 384.30-3 8 384.30-5 4" SCH 40 PVC pipe ASTM- D28e5 4" 3034 PVC pipe ASTM-D3034 Moon Beam W R/W f Proposed W320-MR Septic Tank W/ Polylok 1 525 \ Valve \ \ � I Scale: 1" = 59 0 50 75 100 112.6' VA Existing Wieser exlsbng 1000 gal Septic Well Tank Driveway Existing BiUI - 4 Bedroom House Pole Garage Shed e i i i i 7 7 / / T1 r T2 T1- 3'x 75' Infiltrator High Capacity trench EI.= 88.75' T2- Tx 75' Infiltrator High Capacity trench EI = 88.70' J T3- 3'x80' EZ Flow Trench El = 90.70' e T4- 3'x80' EZ Flow Trench EI.= 90.70' rp11LR.WA T5- 3'x80' EZ Flow Trench El= 90.70'> . e CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Moua 4 Bedroom Septic System Owners Name: William Moua Owner's Address 837 Moon Beam W Hudson, WI 54016 Legal Description: SE1/4, NWl/4, S12, T29N, R19W Township Hudson County: St. Croix Subdivision Name: Tanney Ridge Special Addition 2nd Addition Lot Number: 59 Block Number Parcel I.D. Number 020-1325-60-000 Plan Transaction No. Page 1 index and title Page 2 Plot Plan Page 3 Existing Septic Tank Specifications Page 4 Existing Tank Certification Page 5 Proposed Septic Tank Specifications Page 6 Effluent Filter Information Page 7 System Sizing & Cross Section Page 8 EZ Flow Information Page 9 Management and contingency plan Page 10 Sanitary System Ownership/Address Form Page 11 Warranty Deed Page 12 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/28/2021 Phone Number: 715-760-0486 Signature: JLc' In Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 SYSTEM PLOT PLAN Moua 4 Bedroom Replacement Septic System Project Address. 837 Moon Beam W BM1 Symbol A BM Elevation 0620' SM Description Top of Septic tank cover BM2 Symbol* Q BM Elevation 92 55' BM Descnplion. Septic tank outlell Slope Gradient of Tested Area (2%) Well Symbol (if eppllcabW Notes See CSM for complete lot Design Flow 600 GPD Attach design flow calculations for commercial plans: Pipe Materials 1 ASTM Standard Tables 384 30-3 B 384 30-5 4" SCH 40 PVC pipe ASTM- D2665 4'3034 PVC pipe ASTM-D3034 Moon Beam W RM! mN 1 r 50 75 100 - % 4 MPH Proposed W320-NIR Septic Tanx W1 Polylok 1 525 Existing Wieser Ezisbng v \ 1000 gal Septic Well Tank 4Valver�OnvewayExisting BU1_- 4Bedroom HouserS'hed I Garage 95' / B f T1 T57a T3 T2 ■ 2% 81 94' / T1- 3'x 75' Infiltrator High Capacity trench El .= 88.75' T2- 3'x 75' Infiltrator High Capacity trench El = 88 70' T3- 3'x8O' EZ Flow Trench El = 90 70' ee T4- 3'x80' EZ Flow Trench El = 90 70'� rp .g1:01 T5- 3'xB9' EZ Flow Trench El.= 9070' 4' FAST-A-SFAI_ 7 nJ ao a NI ET a � y --1 2} - TANKS ARE WLP1000-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1 /2" <' CAST -A SEAL BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1 /4" LENGTH: 8'—B" WIDTH: 7'-2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: 6,790 LBS. INLET AND OUTLET 4" CAST —A —SEAL BOOT OR EQUAL GASKET INIFT AND OUTLET BAFFLE AND FILTER: WSCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY 27.83 GALAN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'-0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) vo — -- -- TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: ---- y OUTLET FOR CUSTOM TANKS CONTACT WESER CONCRETE I -N I - REVIEWED BY ;.� '-PUMP PAU REVIEW DATE DRAWINGS SUBMITTED SIDE VIEW FOR APPROVAL APPROVED BY: APPROVAL DATE: AEET OR EXCEED ASTM C-1227 REQUIREMENTS PRODUCTS NEEDED BY: - i OF m d L6 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)837 Moon Beam W located at: SE !4, rJW %4, Section 12 Town 29 N, Range 19 W, Town of Hudson 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 ? --i 7 - 2 ( Did flow back occur from absorption system'? Yes (if no, skip next line.) Approximate volume or length of time: Tank Capacity: 1000 Construction: Prefab Concrete x Steel Manufacturer (if known): Wieser Concrete Nox gallons minutes Other Age of Tank (if known): 1012611998 Permit nu ber (if known) 324637 John Schmitt (Li/01 sed Plumber Signature) (Print Name) MPRS (Title) ( Date) 223760 (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 Page 4 y 4" CAST-A-SFPL 1�1 FILLER OR BAFFLE IBli�ilx� �a INLET �Q 3' (TANKS ARE MANUFACTURED TO MEET OR EXCEED 4" CAST A SEAL eta REQUIREMENTS W320— M R TANK SPECIFICATIONS DIMENSIONS: WALL: 3" n BOTTOM: 3" COVER: 4' MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 58' `? LENGTH: 4'-2' WIDTH: 4'-2' 2 BELOW INLET: 46 1/2' } LIQUID LEVEL: 43" o WEIGHT: 3,880 LBS. a INLET AND OUTLET: s' 4" CAST -A -SEAL BOOT OR EQUAL GASKET ` INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) < z ' 3 4/ LIQUID CAPACITY: 8.00 GAL/IN H W " C ; LOADING DESIGN: 8'-0' UNSATURATED SOIL TANK CAN BE USED AS- u� CO p co SEPTIC / HOLDING / PUMP OR SIPHON v w I s COVER: MIX DESIGN ,j8 (NO FIBER) cj TANK: MIX DESIGN #10 (STRUCTURAL FIBER) WI :o CUSTOMIZED TANKS: i FOR CUSTOM TANKS CONTACT WIESER CONCRETE i J a z C I O Mi REVIEWED BY REVIEW DATE 3 a w N DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET NO i APPROVAL DATE: PRODUCTS NEEDED BY. _ of � r<<,, 1't_- —,S I !Slttcitf Vikel Pf -;_'; 1 llit't The PL-525 Filter is rated for 10,009 GPD (gallons per day) making It one of the largest filters In Its class It has 525 linear feet of 1/ 16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the hall will float up and temporarily shut off the system so the effluent won't leave the tank. I r.nn •_� Rated for 10,000 GPD (gallons per day). • 525linear feet of I/16" filtration. Accepts 4" and 6" SCI-M 40 pipe. • Built in gas deflector. • Automatic shut -oft ball when filter Is removed. • Alarm accessibility • Accepts PVC extension handle I'L-;2� In'taiLdnu; Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1 Locate the outlet of the septic tank 2. Remove the tank cover and pump tank If nccessan'. 3 Glue the filter housing to the 4" or 6" outlet pipe If the filter is not centered under the access opening use a Polylok Extend & Lnk or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover PI-;?; NLnNonan, The PL-525 Effluent Filters will operate efficiently for several years under not mal conditions before requiring cleaning It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing Servicing should be done bti a certified septic tank pumper or Installer. 1 Locate the outlet of the septic tank. 2. Remove tank corer and pump tank if necessary. 3 Do not use plumbing when filter Is removed 4. Pull PL-525 cartridge out of the housing 5 Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6 Insert the filter cartridge back into the housing making sure the filter is properly ahgnuxi and completely inscrtcd 7. Replace and secure septic tank cover ill h" 1 ilitatir•n `+f,aa Alarm tch 10,000 GPD I'l (Optional) Accept r, ry n Sen a11 0 pipe C Accepts l" P%'C tendon Handle Rated tnr 1 u.nlKi GPD 525 Linear Ft of 1/16 Filtration SioL i Gertl ied to I NSF: ANSI Standard 46 i i li Poh Ink, Zabel & Best hlten accept the smartF,lbertW .wi trh and alarm ca. nefletm, AntOfna nl Shut -Off Ball Each v�HaCc loin rai Hang !arks Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT fIM92 Toll Free: 877.765.9565 Fax. 203.284.8_ 14 �.polylok.com Page 6 oli IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) ceooe tlw I l Cover —� 91 SOIL COVER 1P mintrench depth L (Ivpiull) System Elevation'- 90.7 R. (typical) min 12" Lypl» l) Septic Tanks) Manufacturer Wieser Septic Tank(s) Vo4ume(s)- 1000 gal 320 94 gel gal Effluent Filter Manufacturer Polvlok Effluent Filter Model # 525 TYPICAL TRENCH CROSS SECTION VIEW J.' .. (No Scale) � e Provide minimum 3 ft Separation between trenchp_S. TYPICAL TRENCH (Show location of inlet 1 outlet pipe connection on plan view.) PLAN VIEW Q OMane Lun pipe simll be lmul— (No Scale) Perforated Lateral a1' ,Obsery tion.ntre Observation Rrz -, (typical) (typical) r-------------��------------ __ ---------------?f--------- B= 80------ (typical) INSTALL PER TRENCH: 8 10-ft bundles @ 50 if EISA/unit = 400 + 0 5-ft bundles @ 25 ft EISA/unil = 0 = Proposed EISA per trench = 400 x3 OBSERVATION PIPE DETAIL (No Gc Ie) s,,. -Type or StpCap f 7 4`P PVC fApw t op of pipe to W¢ nale al oraoove fi snad grade 111 ' l4g $.$' bb'-1h 6" S ^elvn Ar tnonrg 1) 1, .. 10 ft (typical) A = 3.0 ft (typical) - EZ1203H Bundle (typical) ft (mfd by Infiltrator Systems, Inc ) Install pursuant to manufacturer's instructions ftr Fin,O.J Grntle (muLbeJ 3 aviMev I TLp�J Cover (inn 14ra1 m W O 7l ft` Required Infiltration Area = 1200 nt Distribution Method: trenches = Proposed Total EISA = 1200 ft- branched manifold El RESET Installation Instructions for EZflow Systems in Wisconsin Wisconsin Department of Commerce, Safety and Buildings Division, has reviewed the specifications and/or plans for this Product and determined it to be in compliancy witn chaofres Comm 82 through 84. Wisconsir Admin. Code, and Chapters 145 and 160. Wisconsin Statutes. All sites must meet the Site & Soil Conditions & Locations & Isolation distances as noted in local regulations The approves products are 1203H (3-12" bundles with pipe in centei bundle in 5 or 10' lenytns) and 1203HP (3-12" cundlea with pipe in each bundle in 5 or 10' lengths A sngle pipe bindle contains a fnur inch perfnrated pipe sur- rounded by EPS aggregate and �s held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyetl-ylene netting, Materials and Equipment Needed • EZtlov✓ Bundles • EZflow Gectedule Fabnc • EZflow Internal Pipe Coune,s • Pipe for Header and Inlet • Backhoe/Excavator Installation Instructions The instructions for installation of EZflow products are given below This product must be installed in assonance with state rules defined in chapters Comm 82 through 84. W�nccu,,n Ad- ministrative Code, and Cnapters 145 and 160. Wsconsin Stat- utes, as well as the local heal'.'- department's cu'renf desio_n manial 1. After the local real:h department has determneo soinc, configuration, and layout for the EZflow systems, stake or mark with paint the location of trenches and lines Be careful to set correct tank, invert pipe, header one or dis- tribution oox and trench bottom elevations befure urstal- la:ion of pipe oundles. 2. Remove rla=_tic EZ`iow shipping bags pno, to pla_,ng bundles in the trend l es)- Remove an/ plastic bags in the trench be`cre sys-ern is covered, 3. This product must have geotexhle fabric that meets re- quirements of s. Comm 84.30 (5) (g), Ws Adm. Code, installed directly on +.op of the product and extending down along the sides of the product to a point at least six inches from the bottom of product. 4, When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- tion, cut also crevices better load -beano rapacity af:er hackfi ling s ccmplete- #%EZflow- by INFILTRATOR 5, The Absorption area (SF) necessary for a given site shall no sized based on maximum daily sewage flow (GPD) and the Permeability for the site. If certain criteria is met, the EISA sizing can be used in Wisconsin, resulting in a 400ro smalier d,ainfeld. 6, D.ace EZ'Iow bundle(s, n the EZflow configu:a`,on ap- provec by systen- design permit specfiecl for the particu- ar site. The top cr -erter-most brindles ,.ontairany p:)p are joined end to end with an riternal pipe coupler Any adcitional aggregate only hundles that may be required should be butted agaaist the other aggregate -only bin- dles and do not require any type of connection. 7. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent so I intrusion -he installer shall rrake sure the the GEC s nogituoned upward and u in contact ,much the fabric cwnta bed it the adjacent ^;En- der before bac0ling 8. The EZflow Drainflelo Systems should he installed in a level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground s.irface elevation (uniform depth), with all continuous adjoining 10-foot cylindrical bundles placed end to end, with central bundle distribution pipe interconnected, without any dams, stepdcwr:s or ether water stops, The t-en_h top shall to arsded such tnat water will rod For„ Backpi should no seeded or scodec immediately after conni::r ion to ieeuce eros o, 10. EZflow EPS 'bundles are flexible and can fit in curved trenches as may be necessary to avoid trees, boulders, or other obsiacl-s. 1 LEPS aggregate is tighter than water, therefore, d might be expected that natural buoyancy forces would le�o to caese EZflow as;embhes to Toat o„ t of ground when pcncing cc-ur,, Field e*perience has shown, however, that th s e not a problem when systems have a minimum of 6" of sod cover as recommended by manufacturer. 1203H-GEO Geote.1ile r Material Page 8 In -ground Gravity Management Plan IMPORTANT: PAGE 4OF4 The owner of this in -ground gravity system shall be responsible for rs 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 health 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 Operating Limits: Design Flow = .11 gpd; BODs 5 220 nrl TSS 5 150 ni FOG 5 30 nrl Inspection Checklist INSPECT EVERY 3 YEARS type of use c age of system 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.) solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / 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.) distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) c Septic and dose tank(s) 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. a Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company Schmitt $ Sons Excavating, Inc. Phone: 715-760-0486 Local government unit: St. Croix County Community Developement Phone 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson zip. 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant 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 the appropriate agency for review and approval. A failed 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. Page 9 "QtIN'l-Y SANITARY SYSTEM File#: nly OWNERSHIP/ADDRESS FORM Gwed ce 120 1 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 ProSerty Files Scannec weblink. OWNER/BUYER INFORMATION Owner/Buyer William MOua Mailing Address 837 Moonbeam W City/State/Zip Hudson, WI 54016 Phone Number veouired)651-216-4438 Email Address (required) mrmoua@gmail.com Parcel Identification Number 020-1325-60-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE ,/4 NW 14, Sec. 12 T 29 N R 19 W, Town of Hudson Subdivision Plat- Tanney Ridge Special Addition 2nd Addition Lot* 59 . Certified Survey Map # Plat Warranty Deed # 984662 Number of bedrooms 4 New Property Address (Staff Initials) Page # (before 2006)Volume Page # —'— Spec house 0 yes ■ no Lot lines identifiable ■ yes O no OFFICE USE ONLY Nenficaaon of rxaddress required from Community Development Department for new construct icn ) (Date; This form must be submitted with all Private Onslte Water Treatment System (POINTS) applications. New System: tnctude 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 cd-vd scwi uo+; 1101 Carmichael Road, Hudson, WI 54016 715-245-42S0 Fax VAIVA'�('^Wl (1vv Page 10 N 4�y�JUN 2 ? i��99 � ;T�cwyx BENCHMARK: To P o F ` !c ! Y'l r 1 t4,9 4�- ALTERNATE BM: rL q j <n t I (C)C L r U v lily 1 0 (- ") SEPTIC TANK PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: l,uF Liquid Capacity: /060 Setback from: Well House 7 ' other o27 TO Nkj etAFKr'' Pump: Manufacturer Model# Size Float seperation - Gallons/cycle: — Alarm Location SOIL ABSORPTION SYSTEM i Width: Length % Number of trenches Z Distance & Direction to nearest prop, line: %O fo TfisT /O Setback from: well: I f S House Other — l ELEVATIONS Building Sewer—/, 2 - I ST Inlet: 7•�S (+ ST outlet: OS L PC inlet— PC bottom r Pump Off Header/Manifold f 0,o S Bottom of system_ Existing Grade 3 0 Final grade 5.3 O - >,I� DATE OF INSTALLATION: PLUMBER ON JOB: %jar✓r l{l•✓ptti LICENSE NUMBER: 1- Z ^, O 3 INSPECTOR: (' ,L _ �"is!k" 3 / 9 3 : j t r i ETC - 104 AS BUILT SANITARY SYSTEM REPORT / OWNER_ $AN\ (i1ILLf� �Y �C V1 ADDRESS 7 / ooAt /1/rI fit• F T 14uQsoN cal( ya/6 SUBDIVISION / CSM# Tt(N(�rE Y R I p ig LOT SCJ SECTION / Z T '�/ N-R Iq n, Town of /-IUDSCj/ ST. CROIX COUNTY, WISCONSIN SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM �moaN6-/ow-_wE W�<t war z s" Eb✓ r. --� Vc Z, rtro► z 3 erg i J 1 J w ig f r t f r t 7+ <I, �Cjf,CNATf /{OCEA INDICATE NORTH Provide setback and el tion information on!reverse of this Provide 2 dimensions to enter of septic ank manhole co, " T �rFF '$,m.l Co r W sconeln Department of Corrsrnerce Safety and Bullcings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) ranronei Irnorsrsaaon you prince may De used for secondary purposes (privacy , 3.15,04 (1)(m)) MIrLLER, sSNama: age Towno AMM M Elpy_ Insp M E ev Ary Oesvipuon: W7 r r rmm mIrummAI wIV TYPE MANUFACTURER CAPACITY Septic Wet Dosing Aeration Holding TANK SETBACK INFORMATION _ L WIN P/ SiPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction S stem TDH Ft Forcemain Length Dia Dist To well SOILABSORPTION SYSTEM ELEVATION DATA ountbT. CROIX annar1 ire.arrt.lJo State Plan IDNo: Parcel 172 bgi 13 2 5 - 6 0 - 0 0 0 A9800526 TION BS HI FS ELEV. nchmark n 3. �v Bldg Sewer _ 6/Ht Inlet P,L IZ.p Ht Outlet O z_s� et Dt om Header/Man. //,52 170./3 Dist. Pipe T Z a 9_?5 Bot. System 7z /2- 0 Final Grade I 17 r / _L_. ./ BED REN Width f Len S / No Qf Trenches PIT DIMENSIONS No Of Pas I Inside Die Liquid Depth SETBACK SYSTEM TO P/L BLDGL WELL LAKE/STREAM LE Manua/tur r. }; f INFORMATION B ype *. / $S 1 � - / My e N m er r System J DISTRIBUTION SYSTEM Headerl Mani o * � Distribution Pipe(s) �y A x Ho a Slze x Hole Spaung Ven To Au Intake x I Length Die Length 3 Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/Sodded xx Mulched Bed /Trench Center Bed iiren<h Edges Topsoil ❑Yes 0 No ❑ Yes O No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUDSON 12. 29.19 , SE, NW 837 MOON C"U) RD-TANNEY RIDGE LOT 59 f J z5' 6f alb. 5e,"c✓ Plan revision required? Q Yes Q No z2 Use other side for additional information 8B04710 (R.3r97) Data mpecto'+L eture Can No 3 `C�sw�f Safety and Buildings Divulon Wnsln SANITARY PERMIT APPLICATION 201 W. Washington Avenue in accord with ILHR 63 05, W,s Adm Code P 0 Box 7302 Department of Commerce Madison, WI 53707-7302 a Attach p ek ,.i.,. - o�� e p,o,, tsu are urunty copy only) Tor the system, on paper not less County than 8 la all inches in size. 5111"• ' • See reverse side for instructions for completing this application state5•karyP r�miit Number Personal Informds Information you Provide may be used for seconpu as - 3� " �1 B3 7 n QeQr>7 W St �, r to peVn ru• .pp ratan lPrivacy Law, s 15 04 (i) (m)) State Plann D Nu 1 Number A N- PLE AS E PRINT ALL INFI N Pro Wrner,NTnr C� ropeny Location /'-� �M I fng '5 1 r4 14, S (2 T Z , N, R Q E (oM,&) Z011(Pr rty Owper� (ling Address Lot Number Block Number City, State iF ••r L Code Phone Number Subd,vss,on Name or CSM Number o0S0N Wr � 1 (387.z7� TA E lbeojE IL TYPE OF Ell : (check one) [I State Owned 0 "age Nearest Road Public 1 or 2 FamilyDwelling- No of bedrooms3 TOwn DF ON /M60M 43E)9jo III. BUILDING USE: (If budding type is public. check all that apply) Parcel Tax Number(s) A OLo-l3zS-�o ❑ pertinent/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility / Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A Check box on line B, if applicable) A) 1. VNew 2. ❑ Replacement 3. ❑ Replacement of 4 ❑ Reconnection of S. ❑ Repair of an --_System _System ___ __Tank Only ExisUnQSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 1 , Seepage Bed 21 [1 Mound 30 [1 Specify Type 41 []Holding Tank 12 Seepage Trench St DF_ 1111 NV IEk 22 ❑ In -Ground Pressure / 42 [1Pit Privy 13 Seepage Pit /A1 F4TRRTO Z Zk 3-'7S- 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. AbsorP Area 3 Absorp. Area 4 Loading Rate 5 Perc. Rate 6. System Elev. 7. final Grade y Si7 Required (sq, ft.) Pro osed (sq ft.) (Gals/day/sq. ft.) (Min./inch) $,br g Elevation on/ %SO 2F:.3 •!� -� f Feet 9'4,40 Feet VII ANK Ca FORMATION in gallons Total f of Manufacturer's Name Prefab. �o� Fiber- plastic Fxce` New Exist n Gallons Tanks Concrete rtructed steel glass App n T Septic Tank or HoldingTank ow FI ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /5i hon Chamber ❑ 1 ❑ ❑ I El 11 ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumbers Signature No Sta s) MPM1P0.5W No.: Business Phone Number; - ` N EL4_ to - 35�� - P umber's Address (Street, City, State, 411) Code): to o ukTc-g_ X(04,lE A HoU M wf S%c11` IX. COUNTY/DEPARTMENT USE ONLY El Disapproved Sanitary Permit Fee P^"10ecrwro.uw a e ssue Issuing Agent Signature (No Ste mps) OApproved «n. e• reel - ❑Owner Given Initial O �g Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SB0. 6398 (R.111e7) asrnaussoa odgi l• cawuv o••'" re s•r"r a w.u.,t, dw„«, Hw,h.t SB0. 6398 (R.111e7) asrnaussoa odgi l• cawuv o••'" re s•r"r a w.u.,t, dw„«, Hw,h.t St4ri� �t ILL�l� T�QNKEi RI D6E �r� sy 83 7 MacNf3e�4w\ LoL- l 7NX#ozc-/325-�o sysTem Fl,= ag,g" �cA�l/v"-/o� .n �o Wbll LOT- \ L oT S d Z .10 FiG 301/4 CIO�0� 4 i �.,Sp11T R BAR AGF �— 1 5 AjoTF cuT To BE MALE TO \ 35 I�Q / MAiuTRIN MAT Dreth �EQuiRMFu71 4, 2 T�26NcHES- 12 INFIRIUROi1/Cll q I B=z } s•l - TOTAL. i IV. YY �IoPF ~ ig Q'S r�i I w u 4 h z I uo,�Y to�� 1=' (} n, 202` Sa tdaEce with n VA L�U ATIION REPORT f P fessionad'61t!rvic CST-aoai — tP31 #2123 Page 1 of 4 Schmitt Sod Testing, Inc on pwwr( OI'1 4 enc ��' inches m E4e Attach complete sitkd Plan must County S1 Cf01% include bin not Nm er a reference point (BM) direction and - _ percent Elope scalnorth arrow and location and distance to nearest road Parcel 10 Please print all rnfrm oatlon 020-1325-60-000. Perspial mfpmalgr you povde meY be u9ed for seulMery quposes IPnvai} Law 5 15 a t. i i Imll By D Z�/ Property Owner Property Location Moua, William M Govt Lot SE1/4, NW1/4, S12 T29N, R19W Property owners MaLng Address Lot # Bock # Subd Name or CSM# 837 Moon Beam - W 59 Tanney Ridge Special Addn, 2Nd Addn Cdy_ State ZIP Code Phone Nuber m Cdy Village Town Nearest Road -. Hudson WI W16 651-216-4438 Hudson Moonbeam Rd W New Construction Use Residential l Number 0 beurvulms - 4 Code denved design flow vale 600 GPD Replacement Public or comma l - Describe Parent material Ouhvash (Sattre Sift Loam) Flood plan elevation if applicable NA it General comments Area is suitable fix a �rxlvenlonal system w1h a 0.5 gp&scM rate Possible system elevatifxi fix r acemeril area Is 90 7(Y. Slope and reconmeridations of area is two fljil ❑ Boning # Boring Pit Ground 94.45 surface elev it Depth to umding factor 110+ m 1Sod Appbcalan Rate) Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD7k in blunsea Ou Sz Corti Color Gr Sz Sh •Eros -EW2 1 0-10 10yr3/3 none sl 2mgr mfr as 2f,2vf 0.6 10 2 10-25 10yr4/4 hone grscl 2msbk mfr qw lvf 0.4 0.6 3 25-32 10yr4/6 none sl 2msbk mfr gw lvf 06 1 0 4 32-42 10yr5/6 none Is - -- Osg nil cs ------ 0.7 1.6 5 42-110 10yr6/4 none grfs 059 ml ---- ------ 0.5 10 IT Boring # Bofing Ground 95.60 'Sal Pn surface elev h Depth to limning factor 110+ in Appbcatron Rate' Horzon Depm Dominant Color Rector Description Texture Structure 'Consistence Boundary Roos GPD/M in Munsell ou Sz Cont Color Gr Sz Sh •ERaI •Ee#2 1 0-13 10yr3/3 none sI 2mgr mfr as 2vf 0.6 1.0 2 13-32 10yr4/4 none grsct 2msbk mfr gw 2vf 0.4 0.6 3 32-44 10yr4/6 none sl 2msbk mfr qw 2vf 0.6 1.0 4 44-48 10yr5/6 none is 059 ml cs 2vf 0.7 1.6 5 48-I10 10yr6/4 none grs 0sq ml --- 0.7 1.6 a Effluent 01 = 800,1 30 < 220 nKyL and TSS �30 . 150 myL 'Effluent #2 = 600s< 30 mg& and T SS < 30 mg/L — CST Name (Phase Print) Signature / CST Number Thomas J Schmitt -�.,.,/��ei'E�---- 227429 Address Schmitt Sal Testurg, Inc Date Evaluation Conducted T#hphorms Number 1595 72nd St New Richmond WI 54017 6/16/2021 715-760-1978 I'll, R:t. D-4-4 Property Owner Moua, William M. Parcel ID # 020-1325-60-000 __ Page _-2 of 4 Boring # Bonng Pit Ground surface elev 96.15 if Depth to binning factor 110+ in -. _ Sod Application Rate Hommn Depth Dominunseant Color Redox Description Texture Structure Consistence.. Boundary Roots GPD/fl' In Mll Ou Sz Cont color Gr Sz Sh •Eff,It •ER#2 1 0-19 1r3/3 none sl 2 gr mfr as 2vf 0.6 I 1.0 -I 2 19-33 1 r4 4 none sd sbk mfr w g j lvf 0.4 0.6 3 33-42 7.5yr4/6 none grsl I 2msbk mfr gW lvf 06 1.0 4 42-52 10yr5/6 none Ifs I Osg ( ml a 0.5 1.0 --- I—— --� _ . -- � -- 5 52-110 30yr6/4 none grs 05g ml --- --- 0.7 1.6 ❑Boring Boring # Pit Go rid surface elev -- --- fl Depth to limiting factor in Soil App6cahon Rate Horizon Depth Dominant Color Redox Description Texture i Structure IConslslenns�Boundary' Roots GPD/It' in Munsell Ou Sz Cent Color Gr. Sz Sh. •Erfst •Effs2 i i i I Boring # Boring Pit Ground surface elev ff Depth to limning factor ,❑ -- -- - -- Sod Applicatron Rate Horizon Depth Dominant Color Redox Description Texture Structure ,Consistence. Boundary Roots GPD/fP in Munsell Ou Sz- Cont Color Gr Sz Sh •Efhtt •Eea2 , i Effluent #1 = BODs> 30 < 220 mgll- and TSS >30 <-150 mgA- • Effluent #2 = SODS c 30 mg1L and TSS <-30 mg/L The Department of Commerce Is an equal oppurtuml) eon ice pram ider and employer. Ify Liu need assistance to acre, services (Or matcnal an On all rrnatr 1iomral. please amtaa the department at 608-266-3151 or I`I Y 608-264-R777. Snnenn 1x o]vol Schmrti So,I Twin,, W v 0 m � I Existing weu Wieser 1000 gal O = 60' \ •\ Septic \ B3 BM 2 BM \ House _ voeo.ee GnRnGE -xis E Fbw ixnticc / �• B2 •\ � I I POLE SHED Existing 3x 75' 3, B Infiltrator trenches 2% SLOPE �• \ i �. Usua�r 96.20, Top of septic tank manhole cover BM 2 92.55' Septic Tank outlet Conducted for: William M. Moua 837 Moonbeam Rd W Huson, WI 54016 PlU 020-1325-60-000 Lot 59 Tanney Ridge SE1/4 NW1/4 S12 T29N Town of Hudson I I Conducted By: Thomas J. Schmitt CST 227'429 6-16-2021 St Croix County, WI Legend FLvCB ]n`l Sl,carrb ntaLdWs US Hgnwa Stale 1N9M1w.,�S Gr�nry H1yl�wnys 19 W1 Rimy RVapc Roafs R.vmn R.. Rxi w Way Ha,ln,a]s Cnn.eyaxe ;hve,..� 0 20 40 60it UISCLAIKEH Tlnv rt,aP,c nM g,gr�l�M la ov^ .YXUTAIu Cyrrel] �SInH�I NtMry ea aA Wn� IIIARn� Q�JFNI JIP IV8 f&9(UnylMlll� t{ IM^. V4el. «., St Croix County, WI In I., • i' .., . �t ,�i.,;., Legend O Wlow lav Pd� i , tlx��5�lp�� tiv'Innt N F . `I r �, ' ♦ 1 "'�I ,y '� 11 i" 1p�41' nm a..ars IM Y� Hners �Strcam> I , S IMn ATIes 5{ f il` HgMnys i CYLL •.Y I�I �.V Slile N�hwaas ll. illi e m4� y CJu,ry hNp,ways �#I m�n v.� ,a jw yr I 4 aoa, aynlaWay kt, Al Id f IY�efiq �71 141 w 1 �,A t 2&0 300N /I WF ;I A' IM6 , . STATE SANITARY PERMIT OWNER W 4jw% PLUMBERAa TOWN OF� SEC IT. ,T_ AND/OR LOT 'E WALPREVIOU NO.%3' jg-x�&A)rrx) CHAPTER 145.135 (2) WISGASIN STATUTES tAOU (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. w I �{ ' IC.# 221140 (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 maybe 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. N, R E/W LOCK`-� Hi The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 IF 41AL *M�AJ SUBDIVISION Note: If you wish to renew the permit, or transfer ownership of the permit, pleas- n& A[he county authority. ORIZ D ISSUING OFFICER - DATE I fZ/ PERMIT EXPIRES $JNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)