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Home My WebLink About020-1341-14-000 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM I County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 642293 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)l. Permit Holders Name: City Village Township Parcel Tax No: Anthony A. & Lori L. Jurek TOWN OF HUDSON 020-1341-14-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 24.29.19.1814 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing WW t-SeK 3 20 Holdin TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION Manufacturer Model Number U:--Pyw• TDH Lif `'30 Friction Loss System Head TI�2 •4IFt Forcemain Length Dia. M 1 Dist. to Well N 00 w.79 SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SVHt Inlet St/Ht Outlet 00, Header/MAR' Dist. Pipe Bat. System al Grade St Cover( ST Z 80 f rr_ Nm.a ST/Of r,nw�.e "' i3•S0 gb•5�'r BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETS INFORM TION SYSTEM TO P/L BLD E LAKE/STREAM CHING CHAMBER OR UNIT Manufacturer. Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 BedfTrench Center Bed/Trench Edges Topsoil 0 Yes No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) / lInspection #1: Inspection #2: Location: 884 YOUNG RD �� v S �' 1 pT `' two 5 ` 1.) Alt BM Description = CL �Plw•+b vfg�rQ r S I 8 2.) Bldg sewer length = RD r e- �u- Ill��y..�,,,,, �� Nt p1N , (.� 5 5 �✓ I)My S" ) 3 -amount of cover "a tST �s ^ �-'o G( 'wn ��-&&%9 TY`a��/C.��+► i 4.0 oF� e.. ra*..+ c.�ati t Is P'�. TOt�%iZ C.{{ Plan revision Required? 0 Yes No LILJ a other side for additional /information. SEl1Q.(i� JQ Ot" R4� S�.f.VEi C�(S to % 8 Vn,SeQajp.�s Si 1� raT1.l u D �re Can. /No. C DalT2 LPG-G�fQr �Cf' par ? 6"6w Shy 9 ),J , 11�D pot d --g-- 15pj -Z-ozz q ¢ MAR yMf1 A p f� 202 Industry Services Division 4822 Madison Yards Way County n / z (I Sanitary Permit Number (to be filled in by Co.) /f -7i lQ 2. (� Y 2 V t �'OL'L i=:r]!v cj-I Madison, WI 53705 P.O. Box 7162 Madison, WI53707-7162 Sanitary Permit Application State Transaction Number Ili accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application fors for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. Project Address (if different than mailing address) 1. Applicatlon'.ljiformatton � Please:Print All Information . Property Owner's IN Parcel # 07 o- Property Owner's Mailing Address r4s Property Location Govt. Lot n,5� T C- N R or W City,State Zip Code Phone Number 11 Type of Building (cheek all thatopply) , 1 or 2 Family Dwelling -Number of Bedrooms 6 Lot # Subdivision Na s,� / nPublic/Commercial- DescribeU e!5 State Owned -Describe Use '� l'r Block # ❑C of Elvillageof CSMNumber 0 own of 111%, ype of POWTS Permit: (Check .either 'New" or: "Replacement" and other applicable oo line A. Cheek one baz `on line B.,Comple,te Une'C It a lieable...: . A. [Diew System e as lher edification to Existing System (explain) Additional Pretreatment Unit (explain) B' ❑Bolding Tank []In -Ground [:]AAt-Gmde Mound Individual Site Design Other Type (explain) (conventional) C. Renewal Before ❑Revision OChange of Plumber Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV.`:DispeirsaVT.reatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/so Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Tank Information apacity in Gallons Total Gellona # of Units Manufacturer o P. New Tanks Existing Tanks Septic or Holding Tank OO �'{,Sq•,.(" Dosing Chamber / Rao �e7 V.-RespilAsibilityStatement-1,theundersigned, assame!; ponsibtlity-for installation of The POWTSrshownon the attached.plans Plumber's Name (Print «� r Plum ' rature MP/MPRS Nuumber Z Business Phone Num r Plumber's Address (Street, City, State, Zip Ca �e /p 5/01 VL Coun /De artment-Use Only Approved ❑ Disapproved ❑ Owner Given Reason for Denial Permit Fee $ �� • 00 Date sued2 Issuing Age l ature 3 % v Conditions of A roval/Reason for Dasappt'oval= �.,.p,, SYSTEMOINN>�: %i yVl i 6S �°/ bVl v`� s /S4-Cy► % �kuRo rt 1. Septic tank, effluent filter and Ov 'aspersal cell must by managementpurvlcoided yplud as per management plan provided plumbers: 2 All setback requiremanrt must be mainto'rrted as per applicable code/ordlnencef. Z2, Attach to complete plans for the system and submit to the County only on paper not less than rn x s r mcoes in size �—J SBD-6398 (R. 03/21) � '� }te1" � // r 0 FA kvta nt,` 113 D D Sir► d�aa - o� 9 BARmow ounty itary Pe mit A plication ST. CROIX COUNTY WISCONSIN 1 GpV 7,^ Ina or with .Sanhapert 12 St. Croix County Sanitary Ordinance \��)Gd?b t niormation may be used for secondary PLANNING & ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 0 you provide purposes d D [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road S C_o mm , Hudson, WI 54016-7710 (715)386-4680 Fax(715)386-4686 Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ❑ Check if revision to previous application 1. Application INPrmation - Please Print all Information Location: Property Owner Na e � 2 ,) V fo1/4 1/4, Sec T'2,_9 N, q R E ( ) W Property Owner's Mailing dress I Number Block Num er > W k /q -- CMAA_11� Zip Code Phone Num r Subdivis�io(n/ni4ame or CSM Number L// r Z I,l Ile of Building: (check one) Mity ❑ Vill ge own t 1 or 2 Family Dwelling - No. of Be oms: ❑ Public/Commercial (describe use): NearQ t Road (/ r ❑ State-owned ck box on line B if applicable) It. Type of Permit: (Check only one box on lin\1[S Par el Ta (s) A) 1.❑ Repair 12A Reconnectionn-plumbing 4. ❑ Rejuvenation ation B) Permit Number Date Issued State Sanitary Permit was previously issued b -30 3 l !J IV. Type of POINT System: (Check all that apply) on -pressurized In -ground ❑ Moun z 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constru d Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In -ground ❑ Holding Ta ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Trea a nit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area oil lication Rate 5. Percolation Rate 6. System Elevation 7. Final Grade 7SO Required Proposed (Gals./da ft.) (Min./inch) ( �x' "� K Elev Lion r e I f r IV VI. Tank Information apaicly in Gallons Total # of Manufa rer Prefab Site Con- Steel Fiber- Plast' Gallo Tanks Concrete structed glass New Existing Tanks Tanks ❑ ❑ ❑ ❑ Jy_VII. ❑ El El esponslbilltyStatement I, the undersigned, assume responsibi' for a aidreconnenction/rejuvenation/installation of non-pl bing for the POWTS shown on the attached plans. A license is not required for terralift re it or in Ilation of non -plumbing sanitation system. Plumber's Name (print) s Signalure (no stamps): MNMPRS No. Business Phone Nu ber Plumber's Address (Sire Cit te, Zip Cod ) 3Z v S - , l Vill. County Use I Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ElAp oved Owner Given Initial Adverse I li Determination I IX. Conditions of Approval/Reasons for Disapproval: y PROJECT Anthonv Jurek SE 114 NE 1/4s 24 /T 28 SYSTEM ELEVATION Existinq CONVENTIONAL AT -GRADE System PLOT PLAN ADDRESS 884 Youno Road Hudson Wi 54016 N/R 19 W TOWN Hudson COUNTY ST. CROIX DATE3/6/22 BEDROOM 5 CONVENTIONAL LIFT %00( HOLDING TANK MOUND SEPTIC TANK SIZE 1500 LIFT TANK SIZE900/30 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1071 # of Chambers37 BENCHMARK V.R.P. Top of highest foundation wall ASSUME ELEVATION 103.93' Filter,ifetime ❑ BOREHOLE O WELL *H.R.P. same as benchmark PROJECT Anthonv Jurek SE 1/4 NE 1/4S 24 /T 28 System PLOT PLAN _ ADDRESS 884 Youna Road Hudson Wi 54016 N/R 19 W TOWN Hudson COUNTY ST. CROIX SYSTEM ELEVATION Existing DATE 3/6/22 BEDROOM 5 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1500 LIFT TANK SIZE900/30 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1071 # of Chambers37 k', BENCHMARK V.R.P. Top of highest foundation wall ASSUME ELEVATION 103.93' Filter Lifetime ❑ BOREHOLE O WELL sH.R.P. same as benchmark Septic System and Well Inspection Report Bird Plumbing Inc 1432 120th St. New Richmond Wi 54017 715-246-4516 sbird@frontiernet.net I Shaun Bird, certify that on 3/6/22 1 Inspected the Septic System (POWTS) Inspected the Well XXX Obtained a drinking water sample Property Owner/Buyer Anthony Jurek As a result of my inspecton, I certify that: Site Address 884 Young Road Hudson Wi XXX In my opinion, the septic system was, on the date of my inspection, in working order and in compliance with the standards set forth by the Department of Safety and Proffesional Services. Any exceptions or needed repairs will be listed below. Date of last pumping 10/5/2021 System appears to be sized for 5_ Bedrooms In my opinion, the well at the date of my inspection, is in good condition and complies with all WDNR standards. Water sample sent to Quality Water Testing Lab Somerset Wisconsin. See attached Property Transfer Wells form. Any exceptions or needed repairs will be listed below. In my opinion, the septic system or the well is not working or not in compliance with the Departmet of Safety and Public Services or WDNR. See attached Property Transfer Wells Inspection form. 6" of snow at time of inspection. Septic System maintance information: Pump tank every 3 years and clean effluent filter if installed once a year. For further information, contact your local zoning office. Disclosure: This test is not a guarantee of future perfo a e but a proffesional opinion. Usage can change from different owners. This is not a warranty of this syste for any loss caused by reliance on this cerfication. Past problems with this system,( if an d to be disclosed by the seller. Shaun Bird MPRS/CSTM #226900 DNR# MA(Y Date 3/6/22 Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Tank Model Number 3 p Total Tank Capacity U Max. Bury Depth — Pump Manufacturer k 1 6 r Pump Model Number L Alarm Manufacturer Alarm Model Number Switch Type 4% � . Inlet Vent Min. 12" Above Grade With Cap — — — — - Finished Grade Switch Settings and Reserve Capacity Tank Volume = GPI Dimension Inches Volume Gal. (reserve) A `z c.( 5- J (alarm) B 2 p (dose) C CY (dead) D Total t-1 1.. Minimum Pump Performance Required GPM I @ tTDH Total Dynamic Head (TDH) - Feet Elevation Head Distal Head --- Network Head Loss ' Force Main Head Loss ( 7 Filter Head Loss Total Weather-proof Junction Box Manhole Min. 4" Above Grade With Locking Device of 1` Disconnect Means AT Off Elev. C Ft Bottom of Tank Elev. 7 S•Z Ft D GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical servicecomplies with NEC 300 and Comm 16.28. ,,'A 59 Weep Hole 10/071gj Page of Pump Specifications _ LE50 Series 1/2 HP Submersible Sewage Pump