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HomeMy WebLinkAbout030-2070-20-200 (2)County Industry Services Division st. Croix 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) S p P.O. Box 7162 S Madison, WI 53707-7162 State Transaction Number Sanitary Permit Application r1naccordance with SPS 383.21(2). Wis. Adm. Code. submission of this form to the appropriate governmental unit red prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary 1301 Birch Park Road purposes in accordance with the Privacy Law, s. 15.04 1 (m), Stats. I. Application Information — Please Print All Information Parcel # Property Owners Name 030-2070-20-200 Nick & Wendy Franta Property Location Property Owner's Mailing Address 130) Birch Park Road Govt. Lot Zip Code Phone Number NW ''1A, NE '''A, Section 36 City, State le one) Hudson, WI 54016 T 30 N R 20 E Acuc 11. Type of Building (check all that apply) , [ Lot # '7 3 FN/A ivision Name ® :: I or 2 Family Dwelling — Number of Bedrooms Block#Public/Commercial — Describe Use City of ❑ State Owned —Describe Use CSM Number El Village of ® Town of St. Joseph IlL T pe of Permit: Check only one box on line A. Complete line B if applicable) E] other Modification to Existing System (explain) A. ❑ New System ® Replacement System [:1 Treatment/Hol ding Tank Replacement Only ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B ❑ Permit Renewal ❑Permit Revision Plumber Owner 487908, 9/29/2005 Before Expiration IV. Type of POWTS S stem/Com onent/Device: Check all that appi ® Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ Holding Tank ❑Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Elevation Design Flow (gpd) Design Soil Application Dispersal Area Required (sfl Dispersal Area Proposed (sf) 900 93 Oe 91.60' 600 Rate(gpdsf) 900 0.7 Capacity in 0 VI. Tank Info 5 Gallons Total # of U h Manufacturer w o �,, Gallons Units y U i75 y New Tanks Existing Tanks 1200 1200 1 Wieser Concrete ❑ ❑ ❑ C Septic or Holding Tank ® ❑ ❑ ❑ Dosing Chamber 800 800 1 Wieser Concrete VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTSshown o the attached plaher ns. Phone Number /MPRS Plumber's Name (Print) Plu r' Si tore 223760 715-760-0486 ZAO" John Schmitt Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 V1II. Count /De artment Use On{ ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ Ili. Conditions of Approval/Reasons for Disapproval than 8 rrz x 11 inches in size Attach —to complete plans for the system and submit to the County only on paper aot less SBD-6398 (R03/14) CONVENTIONAL COMPONENT DESIGN Residential Apphc�3tion INDEX AND TITLE PAGE Project Name: Franta 4 Bedroom Replacement Septic Sydtem Owners Name: Nick & Wendy Franta Owner's Address 1301 Birch Park Road Hudson, WI 54016 Legal Description: Township County: Subdivision Name: Lot Number: Parcel I.D. Number Plan Transaction No. NW 1/4, NE 1/4, S36, T30N, R20W St. Joseph St. Croix N/A 3 Block Number 030-2070-20-200 Page 1 Index and title Page 2 Plot Plan Page 3 Septic & Dose Tank Specifications Page 4 Existing Tank Certification Page 5 Effluent Filter Information Page 6 Dose Tank Cross Section Page 7 Pump Curve Page 8 System Sizing & Cross Section Page 9 EZ Flow Information Page 10 Management and contingency plan Page 11 Sanitary System Ownership/Address Form Page 12 Warranty Deed Page 13 CSM or Plat Attachment 1 Soil Evaluation Report Designer: John Schmitt Date: 10/1/2023 Signature: L 4_� In -Ground Soil Absorption Component Manual Version 2.1 May 2022 Licnese Number: MPRS 223760 Phone Number: 715-760-0486 Page 1 SYSTEM PLOT PLAN Franta 4 Bedroom Septic System 'roject Address: 1301 Birch Parl Road 3M1 Symbol: A BM Elevation: 97.45' 3M Description: Top of Inlet Cover 3M2 Symbol: Q BM Elevation: BM Description: Slope Gradient of Tested Area: (18%) Well Symbol (if applicable) Notes: See CSM for Complete Lot To Birch Park Road o- Design Flow: 600 GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe ASTM- D2665 4" SCH 3034 PVC pipe ASTM-133034 N Scale: 1" = 60' 0 60 90 120 152 T1-Existing 3'x100' infiltrator Quick 4 Trench El.=96.01' T2-Existing Tx80' Infiltrator Quick 4 Trench El.=94.41' T3- Proposed 3'x90' EZ Flow trench EI.=93.00' T4- Proposed 3'x90' EZ Flow trench EI.=91.60' 94' 96' \ 100' \ "T4 \ �\ T\ T3 B\\ \Bi \ \\ Existing 1200/800 BM1 Septic/Dose tank w/ Zabel A-100 Existing Effluent filter Weil o Existing 4 Bedroom House Property Line Driveway Garage C a d- d- C� L L O IQ O U 001, �U O LL J O n N U7 iw-009-OOZIdIM :311d 99-b9—SZ�-009 00/00/00 :31V0 O9Lb9 IM ')4308 N301" '01. 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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)1301 Birch Park Road located at: NW 1/a, NE '/a, Section 36 , Town 30 N, Range 20 W, Town of St. Joseph , 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 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons Tank Capacity: 1200/800 Construction: Prefab Concrete X Steel Manufacturer (if known): Wieser concrete Age of Tank (if known): 1 2/6/2005 Permit number (if known) 487908 (Licensed Plumber Signature) MPRS (Title) (Date) John Schmitt Other (Print Name) minutes 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 PAGE 2of2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter0 alarm, you will be notified by an alarm when the filter needs servicing. F Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. Step 2: Firmly pull the filter handle and slide the cartridge out of the case. 0 Residential Applications Certified to ANSUNSF Standard 46 Copyright 2014, Polylok, Inc. All rights reserved Product(s) covered by one or more U.S. and/or International patents. other U.S. and international patents may be pending. 1-877-765-9565 / www.polylok.com Page 5 PAGE 5OF6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 22.24 gal/in a. Depth (in) Volume (gal) q 18 400.32 B 2.0 41.2 [C] 5 E244E.64 p 11 *Pump Tank Liquid Level = 36 in Force Main Diameter = 2 in Force Main Length = 40 ft Force Main Void Volume = 6.52 gal Electrical must comply with SPS 316 and NEC 300 Extend manhole riser as necessary. Weatherproof Junction Box Approved Locking Manhole Tr with Warning Label Attached (typical) �--Conduit / 4" Min. or 2.0 ft above Established Flood Elevation (typical) ,/—Airiighl Seal ' _ Quick Disconnect 18" Min. . � (typical) * T Weep Hole � Approved Joints with Approved Pipe 3 ft onto Solid Ground A (typical) _Alarm —On -B UTII�� PUMP -OFF Pump �,_Off . ELEVATION = 86.81 ft D INSIDE BOTTOM ` Concrete Block ELEVATION 85,89 = ft 3" Approved Bedding Material Beneath Tank [C] Total Dose Volume TDV = 117.72 gal/dose (5X total lateral void volume <_ TDV <_ 0.2X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 20 9Pm PUMP TANK: Volume = 800 gal Wieser Concrete Manufacturer: Pump Manufacturer: Gould Pump Model: PE 41 (See attached pump curve.) Controls/Alarm Manufacturer: Tank Alert Controls/Alarm Model: 101 Float switches containing mercury are prohibited. Vertical Head = 6•19 ft + Min. Supply Head = 0 ft + FM Friction Loss = .37 ft + Fitting Loss* = 0 ft (min. supply head x 0.3) = TOTAL DYNAMIC HEAD = 6.56 ft SEPTIC TANK(S): Total Volume = 1200 gal Manufacturer(s): _ Wieser Concrete Install approved effluent filter at the septic tank outlet Immediately u,l2stream of the Homo tan_ Filter Manufacturer: Zabel Filter Model: _ A-100 Wastewater METERS FEET 40 PE51 35 10 30 PE41 o = 25 v z 20 0 J 15 O 1 10 1 5 MODELS: PE31, PE41, PE51 HP: .33,.40,.50 0 0 10 20 30 40 50 60 70 GPM 80 5 10 15 m3/h 0 CAPACITY PERFORMANCE RATINGS PF31 I no PE41 tofwater) %16 25 PE51 Page 7 PAGE 3 L.L. Q � J � M W ON N L W � = .N �(nV U � c: 0 � U �w F-- c: V / L p o �. � ce) Zw D 0-0 IL Q Q Z a) (n �m >0 0 C� L o f VJ L J Q c ii E $ c W M + W �. °a'i a .,� c Zc ; C > O w v Co LU mg a _ =_ rn N � O d CL U) m a m U d Eta U 2ME Fn in O c_a d x ''pCCAA� v m 17 o o r W d; = w U> M Z �- Z - w N a m U Q w O U_ Z U �- � 0 L 3 U a O c o _ c a • U I y � Q O c O � U r � 0 3 0 c a) L p sT O o 215, a CCO °' U w > 0 11 Z w LIJ > 0 ; LU (n U�Z 9 E �a c� PAGE 3 OF 5 M nI C6 0 U c ; c � E L C m m U w CO >>,, m N v b E � c w a co EU) .� C Q �a I I II II a a � [n W LU CD N a`ni a`ni O Lo W. ccy)) II a II U) w 0 o ' o D � m � a 0- d II U) v N (c v 4— � N 11 X s U N a Q LLJ a) cn 0 CI- 0 m Page 8 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 compliance with chapters Comm 82 through 84, Wisconsin 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 approved products are 1203H (3-12" bundles with pipe in center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles with pipe in each bundle in 5' or 10' lengths. A single pipe bundle contains a four inch perforated pipe sur- rounded by EPS aggregate and is held together with poly- ehtylene netting. A single aggregate bundle contains aggregate only and is held together with polyethylene netting. Materials and Equipment Needed • EZflow Bundles • EZflow Geotextile Fabric • EZflow Internal Pipe Couplers • 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 accordance with state rules defined in chapters Comm 82 through 84, Wisconsin Ad- ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design manual. After the local health department has determined sizing, 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 line or dis- tribution box and trench bottom elevations before instal- lation of pipe bundles. 2. Remove plastic EZflow shipping bags prior to placing bundles in the trench(es). Remove any plastic bags in the trench before system is covered. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top 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, but also provides better load -bearing capacity after backfilling is complete. 1EZ ow - by INFILTRATOR 5. The Absorption area (SF) necessary for a given site shall be 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 40% smaller drainfield. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- lar site. The top or center -most bundles containing pipe are joined end to end with an internal pipe coupler. Any additional aggregate only bundles that may be required, should be butted against the other aggregate -only bun- dles and do not require any type of connection. The top of each GEO cylinder contains a filter fabric pre - manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer shall make sure the the GEO is positioned upward and is in contact with the fabric contained in the adjacent cylin- der before backfilling. 8. The EZflow Drainfield Systems should be installed in a level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground surface elevation (uniform depth), with all continuous adjoining 10-foot cylindrical bundles placed end to end, with central bundle distribution pipe interconnected, without any dams, stepdowns or other water stops. 9. The trench top shall be graded such that water will not pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 10. EZflow EPS bundles are flexible and can fit in curved trenches as may be necessary to avoid trees, boulders, or other obstacles. 11.EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to cause EZflow assemblies to float out of ground when ponding occurs. Field experience has shown, however, that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 1203H-GEO ^^+�xtile r Material ........................................ . ................ .............................. Page 9 PAGE 4 OF 4 In -ground Dosed -Gravity Management Plan IMPORTANT: The owner of this in -ground dosed -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 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 = 600 gpd; BOD5 <— 220 mgL"'; TSS 5150 mgL"; 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 / 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 tanks) 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 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: Local government unit: John Schmitt St. Croix Coun Local government unit address: Phone: 715-760-0486 Community Development Phone: 1101 Carmichael Road, Hudson, WI 715-386-4680 ZIP: 54025 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 10 SANITARY SYSTEM File $T. C R O 1- U N T Y Office Use Only �" OWNERSHIP/ADDRESS FORM created212027 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 fnlirh P. 1/VPnriv Franta Owner/Buyer Mailing Address 1301 Birch Park Road City/State/Zip ui iricnn VUI -r;4ni R Phone Number (requ 612-221-4513 Email Address (required) nicholasfrankfranta@gmaii.com Parcel Identification Number 030-2070-20-200 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW , /4 , NE 1/4 , sec. 36 . T 30 N R20 W, Town of St. Joseph Lot # 3 Subdivision Plat: NA 721641 Volume Page # certified Survey Map # Warranty Deed # 2819 797182 (before 2006)Volume , Page #406 pec house 13 yes ■ no Lot lines identifiable ■ yes E3 no Number of bedrooms 3 S 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 cdd@—scc\A(i.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www sccwi.gov Page 11 U, 2918P 296 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between Edward P. O'Kane, Trustee of the Edward P. O'Kane Living Trust dated August 2, 2004 ("Grantor," whether one or more), and Nicholas Frants and Wendy Franta ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Located in the NW 1/4 of the NE 1/4 of Section 36, Township 30 North, Range 20 West, Town of St. Joseph, St. Croix County, Wisconsin; being Lot 3 of the Certified Survey Map recorded on May 15, 2003 in Volume 17, Page 4519, as Document No. 721641 8i10r=3,7GD KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX GO., V1 RECEIVED FOR RECORD 10/31/2005 10:00AN WARRANTY DEED EXEMPT t) 17 REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address p te��lmk 12_4�kQl',1,lke�:SA-A� 3B8}-eavkrRoad a SO i 16 A&_ d , L0r stta, Tam Schnmmer 5 4 0) to 030-2070-20-200 Subject to Road Easement as shown on Certified Survey Map and recorded in Volume Parcel Identification Number (PIN) 2213, pages 439440. This homestead property. This deed is given in satisfaction of the Land Contract recorded on June 9, 2005 in Volume (is) (is not) 2819, page 406 as Document No. 797182 with the St. Croix County Register of Deeds Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: easements, covenants and conditions of record, if any. (SEAL) L) AUTHENTICATION Signatures) Edward P. O'Kane, Trustee of the Edward P. O'Kane Living Trust dated August 2, 2004 authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06 ) THIS INSTRUMENT DRAFTED BY: + Edward P.O' ne, Trustee of the Edward P. O'Kane 1v ng rus a e ugus (SEAL) - -- - ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX ) ss. COUNTY) Personally came before me on the above -named Edward P. O'Kane, Trustee of the Edward P. O'Kane Living Trust dated August 2, 2004 to me known to be the person(s) who executed the foregoing instrument and acknowledged the s ne. Heywood, Cari & Anderson, S.C., 816 Dominion Drive, Notary Public, State of WISCONSIN Suite 100, P.O. Boz 125, Hudson, WI 54016 My commission (is permanent) (expires: (Slgeatares may be aatbeatiested or acknowledged. Both are not aecearary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDI WARRANTY DEED STATE BAR OF WISCONSIN *Type name below signatures. O State Bar of VYhoonain 2003 INF04kt0*' L"W Famw Page 12 qumtry,� NO. I" e „ , ' N I'm nu i ttt N0% O „y N 0 ai Q 4Q Q O O O zoOE W �N�, .L+ QtC I L p O C C ce- 0 Q ZCOu w BMOC av� O C O Z DU 11 N10.; W y V) v �o U �Mt�—. c 6.2 4) U J N �0 ISM 0611d W 10A u v c w � c EMIK I U I / � C O U 1 SM.G arN I O tyyi 7 I Z (n Q 0 I I / Z s 1 11 1 I V1 �MI I t n O1 01 ONi CVO NN.. 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LL•6_v.moos , 2 cn�nni .09'66Z (L9'66ti 3..£(,£0.00N) (�uawnuom wnu/wnIV) OZ-Of-9f 'oas 1awOO JaPon0 YPON Punoj SaNd-1 C 311b'�dNn c M O O • -0 U � N O x � 01.0 co > E O U u = N ' 0 ` N o.. �..�Zo y O V m 3 S-v'c O O m O v 00 w(Lw U)I O Z QI m 00 �I urn `a W H I-.- QI 01, C J wo » ,O— ZI _ of � D M f0 0)O�\ (7 f401) OD Z Z -A �.\O!\ aT `O = a c 7 c � H O J -a aN °' L r ui C t� +. v Z ? 0 (3 1 u T +i9 T ZL Page 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERA!. INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(m)[ Pen nit Holder's Name. City Village X Township Franta, Nick & Wendy St. Joseph, Town of CST PM Elev: Insp. BM Elev: BM Description: rOf,4i► TANK IMPI1'1RMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic {,,J ti Pfs2.t•.� 7, 's C4- � 7iGb Dosing (( o v+�CJ KJJ ,Ar"t� /�- 1 Holding TAAIK CFTRArK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic$,-U/ Dosing 7 25 � �JA-- 'Z5 U ' Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand a GPM 35 Model Numb TDH Lift Friction Loss T System ad TDH , Ft ,cab , b Forcemain ,/ Dist, to well A/ Z STATION BS HI FS ELEV. Benchmark 41�- dev'% Alt. BM To� a Go I Z• Z-7 161 Bldg. Sewer IZ 9D Y o7C2 St/Ht inlet SUHt Outlet Dt inlet Dt Bottom Yl • Sy �S .gq Header/Man. > 77, 1 tt, Dist. Pipe fp , ZS 'f.`% , r 9S,53 Bet. System Final Grade l opt v` CF.n d St Cover �\ f✓�t-- CoJ I SOIL ABSORPTION 5Y5I 11=m PIT DIMENSIONS No. Of Pits BEDrrRENCH Width Length , No. Of Trenches j DIMENSIONS 3 ��f f- /�j 2_ _ SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM CH MBER OR INFORMATION Type Of Syste�} nn 72 ,f / /L UNIT 15 DISTRIBUTION SYSTEM x Hole s Header/Manifold Distribution x Hole Size Pipes) Length Dia Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems On17 Depth Over xx Depth of xx Seeded/5odde Depth Over t Topsoil \ Bed(Trench Center q Bed/Trench Edges \ COMMENTS, (include code discrepencies, persons present, etc.) Inspection Location: 1304 27th Stre_6t Hudson, W l 5401 (NW 114 NE 1 /4 36 T30N R20W) NA Lot 3 aFay EZ Cd�e rs 1.) Alt BM Description = 0�0 r ( l' d„� 2.) Bldg sewer length = an - amount of cover = r Plan revision Required? Yes NNo Use other side for additional information: --- J Date SBD-6710 (R.3/97) Inside Dia.=Depth Manufacturer: /� •I �� Model Number 0 J *2 S .Jar 06 icing Vent to Air Intake >< S xx Mulched Yes No Yes �m_I No Inspection Parcel No: 36,30.20.611H --- — Cert. No. Safety and Buildings Division Box 7162 County , C Q©( 201 W. Washington Ave., P.O. Sanitary Permit Number (o be filled in by Co.) visconsin N(608)266-3151 Madison, Wl 53707 - 7162 7 $ g 720 Department of Commerce Sanitary Permit Applieati State Tlan I D Number in accord with Comm 83.21, W is. Adm. Code, nal nna yo may be used for secondary purposes „ ltt'roject ddress (if different than m rng tr / I{ (1 I. Application Information - Please Print All Information Property Owner's Name ST. +- ;. -„==1 a Lot M Block N p 2070 .� N 1cr, rt � wE ve A,)na- -Z,0V (4 property Owner's Mailing Address Property Location n / WE —A, section City, State Zip Code Phone Number .�1 j E IJ f AJ Iq I3'I As C9 % D �J V- - /�O - II arcle e) T -3O N, RAE oc Ill. Type of Building (check all that apply) Ok a j - 'Sc)iO h. /a`^ Subdivision Name ,-� CSM Number (� l or 2 Family Dwelling - Number oCBedrooms />�es�- r I -7 2- t (oc,f ( / �/ © 5 v ? i V ❑ Public/Commercial - Describe Use �� i `_� ❑City_E]Village �ownshipofST3OfC`124 2 D+ r _, , i ❑ State Owned - Describe Use , III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New ❑ Replacement System L) Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List PreviousPermitNumber and Date Issued B. ERenewal O Perm❑ Permit Revision Permit Transfer to New ❑ Change of PCO) Before E Plumber wner W. Type of POWTS System. Check all that apply) V T Non -Pressurized in -Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ HoWing Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter U Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVfreatment Area Information: Deli n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Areaa Requtrede Dispel Area se)j (sf) System Elevation m y, / v tog�0 ✓ 7J� 44 VI. Tank Info Capacity in Total Number Manufacturer Gallons Gallons of Units Prefab Site Steel Fiber Plastic Concrete Constructed Glass n New Existing Ni Z4& A 7-arks Tanks Septic or Bolding Tm+k ,/ Y` Aerobic Treatn><nt Unit � u Dosing Chamber �/ VII. Responsibility Statement- I, the undersigned, sssotne respons' ffity for installation of the POWTS shown on the attached plans. Business Phone Number Plumb Si ature MP/MPR9`Number Plumber's Name (Print) gn Z 7 a A_ /V6L S 01J/l Z Plumber's Address (Street, City, State, Zip Coor G G(_ Vill. Count Department Use Only Sanitary Permit Fee (includes Groundwater Date Issue lssuin ent ignat re Stamps) Approved EEl D'pproved Surcharge Fee) � � b5O f ven Reason for Denial IX. Conditions of Approval/Reasons for Disapproval DOW Wiseman" ---A— .. /N jpplgljb 00b 10 .>............ �� wn�r not Ins than 8112 s I1 inches in sae nrr CumPn Pw..., - _........� v, SBD-6398 (R. 01/03) 1149 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 81/2 x 11 inches in size.County Plan must St. Croix: include, but not limited to: vertical and horizontal reference point (BM), direction and - -- -- percent dope, scale or dirnernsions, north arrow, and location and distance to nearest road. Parcel I.D. 030-2070-20- Please print all info Reviewed By Date Personal information you provide m be used7�r�s�r d�C� n-Y , s. 15.04 (1) (m)). Property Owner l Property Location O'Kane, Edward _ 7 2��2 GM. Lot NW 1A NE 1/4 S 36 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Sut a- Name or CSM# 1300 27th St. r�OtX (OUNI f 3 j Proposed CSM City State Zip Corfu City Village ✓ Town Nearest Road Hudson WI ; 161 715-549-5587 St.Joseph I 27Th St ✓ New Construction Use: ✓ Residential / Number of bedrooms _ 3 _ Code derived design flow rate _ 450 `—GPD Replacement Public or commercial - Describe: Parent material Outwash Plain _ _ Flood plain elevation, if applicable na _ General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area I is (Upper) 96.6�r) 94.70'. Slope is 18%. I '1 I Boring # Boring ✓ Ph Ground Surface elev. 99.70 ft. Deoth to timitina factor ? 1 O in. I Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPD/ft' 'Effi#2 "Eff#1 1 0-11 1oyr3/2 none I 2mgr mfr gw 2m,21f .5 .8 2 11-19 7.5yr5/4 none sl 2fsbk mfr gw 2f .5 .9 3 19 52 7.5yr5/6 none s Osg ml gw --- .7 1.2 4 52-72 1'0yr5/4 none grs Osg ml gw - — 7 i.2 5 72-110 10yr5/6 none s Osg mt — 7 1.2 2 Boring # Boring ✓ an r;mtind Surface elev. 99.70 R. Denth to limdina factor —___ 03 _in. FSot Application Rafe Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots PD 'Eff#1 'Eft#2 1 0 5 1 t0yr313 none sl l 2mgr — mfr gw 2m,2f 5 9 - 2 3 4 5 _ 5-12 12-32 32-54 54-103 1Oyr4/4 7.5yr5/6 1 10yr5/4 1Oyr5/6 -- -- none none none none — - - sl s grs s i _ 2msbk Osg Osg 0sg _ --- _ mfr ml ml ml gw cw evlr --- i 2f -- ------ .5 7 7 7 .9 1.2 --- 1.2 1.2 Effluent #1 = BOD? 30 <_ 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOO 130 mglL ana I s,j <su mg1L CST Name (Please Print) Signature: - CST Number Thomas J. Schmitt -_ -�-- 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond. WI 54017 12/15/02 715-247-2941 Property owner O Pne, Edward Parcel ID # 030-2070-20-000 Page 2 of 3 E Boring # Boring — ✓ Pit Ground Surface elev. 94.40 ft. Depth to limiting factor >ZQi in. so' pppin Rate Horizon Depth in. Oorninanl Color Muntsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots _ SPDM `Eff#1 Eff#2 1 0-13 1Oyr3/2 none sl 2mgr mfr gw 2m,2f .5 .9 2 13-23 10yr4/4 none sl 2fsbk mfr _ gw 2f .5 .9 3 23-35 7.5yr5/4 none S Osg MI Cw -- 7 1.2 4 35-71 10yr5/4 none grs Osg ( ml Cw .7 1.2 5 71-101 10yr5/6 none S Osg ml — .7 1.2 F-I Boring # Boring -- -- -- Pit Ground Surface elev. __ ft. Depth to limiting factor in. Sod Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color i Texture Structure Gr. Sz. Sh. Consistence Bound" Roots GPDAE `Eff#1 `EfW2 Boring # Boring oit (:rn�in,d Siufanp PIPv ft. Depth to limiting factor _ in. $pit gppl Rate Horizon Depth in. Dominant Color Mun sell Redox Description Texture Qu. Sz. Corn. Color Structure Gr. Sz. Sh. Consistence Boundary Roots -Eff#1 `Eff#2 i " Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L -llte Department of Commerce is an equal opportunity service provider and emplover. 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