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HomeMy WebLinkAbout020-1109-60-000% b commerceml.gov isconsin Department of Commerce April 17,2007 OUST ID No. 222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES.- 04/17/2009 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #- (608) 264--8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary A YTAI: PO WTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMI CHAEL RD HUDSON WI 54016 e J. IQa t on Ndihb e-'rS:'- . ... .... .. _ Transaction ID No. 1386134 Q. , Y" N 1711 A K11) 11 L1; Va SITE: .. ... .... refer to o �i Ont c on numbers'' Pease fe :b­th,:_;'d" -7ifl-'ati Cottonwood Ridge South a�-O.Ve�, in"-d''Itcorresp6i Leila. County Road N Town of Hudson, 54016 St Croix County SEI/4, SWI/4, S36,729N., R19W Lot: 6-7-8-9, Subdivision: Cottonwood Ridge South FOR: Description: Pressurized In -Ground / Commercial (4 houses)1 ATU Object Type: POWTS Component Manual Regulated Object ID No.: 1108003 Revision; Maintenance required; .2,400 GPD Flow rate; 110 in Soil minimum depth. to limiting factor from original grade; System: In -ground POWTS Component Manual, SBD-10705-P (N.01101), Pressure Distribution Component Manual -Version 2.0, SBD- 10706-P (N-0 1/0 1); Aerobic Treatment Unit, Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 10 1 .0 1 (10), Wisconsin Statutes is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, Stats. coyl The following conditions shall be met during construction or installation and prior to occupancy or use: 1P fig Reminders • This system is to be constricted and located in accordance with the enclosed approved plans and with the component manuals listed above. 6 F. • The Biomicrobics, FAST 0.75 units (one installed at each house) must be installed in accordance with the manufacture's'printed instruction and system sizing criteria found in Comm 83, Wis. Adm. Code. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • A maintenance and monitoring contract for the Biomicrobics, FAST 0.75 unit is required for as long as the units are in service. • The observation pipes must be. located at a junction point between two EZ-Flow products so as not to create separation of the bundles within a product. HENRY F GROTE Page 2 4/17/2007 0 The wells must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c 0 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of See. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat Comm 83.22 7 A copy of the approved planss pecif ications and this letter shall be on -site dtu­ingcon_str�ictzon and open to inspection -by authorized representatives of the Department, which may include local ilisDectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The ovaier of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83-54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Corrun 83.54(4) shall be considered a hurnan health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the components) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. hi granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state. scats 10 1 .12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bratz POWTS Reviewer II, Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 WiSMART code.7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. County commeme,wi,gov tidings Division �_�_��201 W, WDShingtoa Ave, P,O. Box 7162 Madison, W1 53707-71621 ........ SQUnsin San�r, PeI Number (tri be filled in by Lib-,) S State 7yansaction Nuinber anitary Permit Application n -jecardance w"01 �. ('wiirn. 83, 21', (2). Wk Fub11ri1S5lur, Ot'di Is form to the apiropr iate gavern riemal 13e & 13 Y- ullit ;S requiied pi-101, to ciblatninu a sanitary perniji. Note- ,%pplicutlon fc)ny4 Ter state -Owned POWYS are Proj Oc A dd re. ss (i r d i ffe ren t than mailing address) subinjoed io rlic. Pers,--.nal you p),ovidc may bt used for second.-iry purposc.." In act"ordancc with Lhe LaFvlva Slats, w. Is. I. AVIA cati011 111foril7ation — Please Print Ali Informanoll Proper:rN y Ov/rjev'�. Nan)c Parcfl nux-EUE-E-1 v r. Lj Property Owner's Mai ling Addregs •----- --- � ...�,,y... 1 .�._ PToptrzy Locnatio A P R 4� �� kjovt. Lot WT TY t C I tv, S ta C Z ie one) T N; R E or( I I. Type of Building (check all that apply, I Lot# vr 2 Fanifly Dwelfi79u��vislon Name ng 8 lock Doicrltse Use r-- %72 DQ,�cribv L; st 0000�(SM Numl Village Ur ,Pdo w n o f .000 Tv Pe of Perinit: (Check only one box Oa line A. COMP to R#4e' ikf applicable) A. sysf,�,nl D Replacement Syst-M, C1 'Treat h v1io Id i r. g Tank Re p I ac -n-ic r 0 rt ly Ottit'r Mod' i teltion to Exi-sling syicrm texpltlll) B. List Previous Permit Numberind Pate Isitted 1) Pemik Renewal . ul nit p-cv iiion L1 ChanSe ot'Plumbtv C3 PwTnit 'rn4risfer to New Lictlot-e Explyaut;t) IV. Type ol'POWTSLVWI� trt xonit/ e: (Check idl ffint APP meU111- <I 1, 0 Jon. -Pressurized hi-61,01jild Ai.--Giade Mowid > 24 in chi e 4611 -, r, I - e ?,OjkJ 177-1 C:� /V Ot, ��t 0 Huldin,j'Farik E 01ho, Dispem..M COMPOnerif ^P1,vrr;tltmerI Dcvice (explain) 5 - %- Dispersal/Ti,calment Area Information., "I VIU De5lgn Soil AplAication Rate(gpdst) rall Ave;ak,� q u i vei (s If Dispersal Arra Proposed -i 1, F111 p7r; .117 Systei Elevatit:;r. �2 41 V1. Tank ii-tfo C4paviiy in IF Galions GWr.'s 1s0 N,wTanks Exis6ig Tanks p Septic or Koldtllt'j"k Res onsibilit), Staiement- I tht underssli tied, assuriw r4�xpori6lbfflty for Install tit. of the POW' B �Kopn on the uttached plan Flumber"s Signature PRS Nuniber Bu�ImIIgs Phont-Numbei- '"-Iluniber's Name 'Pro -it) i7f, 5)1 i% J � r � gat �`•' � � ��" -mac? y^ ,,��-�.-""`",.."�'_____ _-- - - `'� : � �' � � �� _�, — `�' *``�` `------`7�f !�-- f T i I PlvviNr's Address (Street. City, SlaW, Zip Code) ZM Departrikelit Use 011!j— Dis-Ived Y�^� �. _... -«•_. Perm it F�e Date klut-� suing Agent I Signal re t }loner Given Rt;&on for Denial VI kpiditions of Al-)prtkvaVRessonx f(W Di'"pl)roval -art to 0 Plot plans ru, the SYSO, m ;I Ild sub mlt to me Cc 14 nq only wi );3per do loi than 8 1/2 x j I In CIAO 14 j S D-639F ('P,. W/07) Val id 'L hR1 0 1 /0 fD - 6 3 9 'E /(R." 01 0 TZI Cottonwood Ridge South -- Common In -ground System Revision to Transaction 4 1343361, Site ID 4 720623 Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's s ' peel f ications. Construction methods must comply with the following Component Manuals: In -Ground, SBD-10705-P (01 /01 } Pressure Distribution, SBD-10706-P (01 /01) 16 a, 1,6 Location: Lots 6, 7, 8, Cottonwood Ridge South Sly 1/4) S W 1/4, Sec, 36,T29N,R 19W Town: Hudson County: St. Croix Date: April 20, 2007 Owner: Kernon Bast Address: 948 Labarge Road Hudson, W1 54016 EN F. of Designer: HENRY 00 Henry Gr e GROTE SSW 1 699 ENCOMONIE: .� Signature : V� *4 Wis. 0 License: W1 D - 1 9-007 11114SS I G� It I I 11%1%** Attachments: SBD-10577 - Plan Approval Application SBD-8330 Affidavit of maintenance (copy) Prior approval letter (copy) �110 V LD Page 1: cover OF COMMERCE AMU M"NGS 2. overview 9: general system management 3: design criteria & calculations 10: system specific management ,ESPONDENCE 4: absorption area plot plan I I : general lot plot plan 5: system cross section 12: duplex dose pump check valve Betai 6: plan view, lateral detail 7: dose tank exit detail 8: dose pump curve page 1 of 12 Cottonwood Ridge South - Overview The revised plans differ from the original, approved plans in that the aerobic treatment Units are decentralized onto each lot and incorporated into combination septic-ATU tanks. '"rhe in -ground trench system is shifted to the southern portion of the tested area due to changes in the subdivision final grading plan which will improve overall site surface drainage. Approximately three feet of landscape fill is proposed over the existing grade in the trench system area bringing final, filled grade to about 103 with about seven feet of backfill above the system synthetic aggregate. Final settled slope should be a nominal 2 percent to the southwest. In general the Cottonwood Ridge South Subdivision lots will have individual, on -lot septic systems. Four lots, lots, 6, 7, 8, and 9, have soils which are poorly suited for on -lot systems. Each of these four lots will have on -lot, combination, septic-ATU tanks to produce highly treated effluent. Four bedroom homes are anticipated and designs will be limited to four bedrooms "rhich will require the installation of Wieser 975/1425 SEPTIC/BIO tanks. Septic compartment outlets will b� equipped with filters and filter alarms to ensure timely filter servicing. ATU units are Biomicrobics, FAST 0.75, Highly treated effluent will either flow by gravity or be transferred by small pumps to the system effluent collection line located in a thirty foot wide le sanitary easement. Solids free effluent will flow downhill in the common effluent col ction line to a pump tank located on lots 12 and 13. 1'; The common effluent collection line must be constructed with schedule 40 PVC and installed in accord with Comm 82.30(11)(e). In particular the trench bottom must be over -excavated a minimum of three inches and the elevation of the pipe established at the pipe invert with at least three inches of clean sand. Pipe backfill shall be in accord with Comm 82.30(11)(e)2.a for the initial twelve inches. Cleanouts with frost sleeves will be constructed at each lot line. The 1000 gallon dose tank is equipped with duplex pumps controlled by duplex controls. The duplex control alternates pumps to periodically send effluent to the in -ground trench system. At full designed flow of 2400 gallons the in -ground system will be dosed three hundred gallons eight times a day, approximately every three hours, The "conventional" 'in -ground trench system consists of six 3' x 105' trenches constructed with E-Z Flow synthetic aggregate, Equal distribution is assured by pressurized laterals with 1 /8 inch diameter holes in the centers of each trench,' In -situ soils loading is a maximum of 1.6 gallons per day per square f6ot requiring at least 1600 square feet of adsorption area. System design is conservative at 1890 square feet giving an in - situ loading rate at fall design flow of 1.27 gallons per day per square foot. System elevation is set to ensure system elevation about 2.0 feet below the sand horizon interface with heavier soil textures in the upper 24-34 inches of reported soil profiles. Page 2 of 12 1 Note that friction loss calculations include the first two segments of the center fed manifold due to significant friction losses in the 1.5 inch manifold; terminal segment manifold losses are covered by the 30% system loss calculation. Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BOD5< 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 15 ' Omg/L. Fecal Coliform. > 10,000 cfuJI 00 mL Treated Residential Wastewater Contaminant Load: 30 mg/L < BOD5 Septic tank + "highly -treated" effluent 30 mg/L < TSS Fecal Coliforrn < 10,0.00 cfu/100 mL Bedrooms x 100 gal/bedroom/day x'1.5 gallons/day hydraulic load Design Calculations In situ designed loading rate �+ gallons/sq. ft. per day Depth to estimated high ground water 4-4 - in. Depth to bedrock in. Cross slope at system % System surge/dose tank ose tank filter gallons r- 41, C. L-1 AT 77 Force main length ft. of in. Manifold/header length 0 ft. of 1 V-L in. Drain -back r13 gallons Lateral length ft. of in. Lateral elevation ft. @ bottom of lateral Lateral hole size in. @ 10 in, ( ft.) Spacing � &_: 1, 1 holes/lateral holes%total Lateral volume 1��9, Coto gallons Total lateral discharge rate T 6, gallons/minute @ ft. head Network pressure compensation losses (—k L Plev2tinn difference 4" n ft Force main friction loss '2, � C:p 1� Manifold, first segment friction loss k'-LI Manifold, second segment friction loss Fib Total dynamic head 14- Dose pumps gpm Manufacturer C.'ar 0 L -S e � Dose volume Measurement pump on and off He��ht alarm from tank bottom ft. @ gallons/minute( 11, - 6Z'/ r ` ft. @ gallons/minute (x2k�,3 q'/1 ft. @ gallons/minute (x2} ft. of head, duplex pumps and controls Model# 1-4-AS k 11 �4 0 6�1 gallons I ku 0 in, Ar 0 in. Septic/ATU tanks (4) W -k QA" cO-�Jt4-z,�; Scp*r\jwtko gallons, on each lot Septic tank effluent filters (4) (D t with filter alarms ATU 1 a N­k L_ C_ a 0 tj 71 4- -"V_Q specs.calcs Page of � C- r rc- p, 7 j o Sb co\) 0 1 - OL-0 i - 63* -4 b " �a ^/",& r '�w -ft -wt) )yyr) qL <�� a � o •S)o p� 01. %-% I\i '� 4e- 6%A, W iaUC � -•- ..�,' ti� •�`�-o� °l�! l 14 c- eA- Aa-�, � � 1 [�f � p� � O vti � w� Q�/ W� �,�„ww � L i 1ti � � � Qk rr. i �h 4LI � Q+U G.+�' � �, � ►�L � �r � w �+► t-.6, 'e� � -A� (-,D u "A" � ( -S. - 04 "-� "�a-v, L o 14ck 4Q. o( j-Z. Page of min. 2' verr, Pipe MCH cap P.UMP.CHAMBER CROSS SECTION 10, from door, Winclow. 2 or frc5h air Intake Ve r cap Weather Proof jurctior, 5<7x N cover wl wv rn i riq La be 120 MII Final Eley, Grade 49 MIN 181, MIN —w Onto tes Wee, -0 On L \& A AlrtLcght 5eal Alarm 4 ero C, Pump on ELE V, ft ELEV. ft 0 Concrcte (31ock ElOv. AA TV VT 0 1� T- N- TV L oi a... -& I 40- - - _U 3* approveJ becWlrig maTzrisl urtcler-'tank liquid level gallons/in. SPECIFICATIONS Note: Pump and alarm are on separate Number of Doses: (PerDay circuits as per Wis. Adm. Code Gallons Per Day /# of Doses: Gallons Volume of Backflow: Gallons Tank Manufacturer: Total Dose Volume: -,S Gallons Tank Size: Gallons Alarm Manufacturer: Capacities: A inches orb 1 Gallons Model Number-, 6 inches or Gallons C \\,o inches Or Gallons Pump Manufacturers C,90- D inches or Gallons Model Number, -WCgv- \0�\ Total ........ inches or\ Gallons Minimum Discharge Rate: GPM Vertical Difference Between Pump Off and Distribution Pipe: ,069094 votes a Minimum Required Supply Pressure: ....... o vooto, s000 vote@ too tote fee so, 0 + Ft, < Ft. of Force Main x �"J,6z Friction Factore/1 00 Ft. Of**#'& -Ott ....... + Lo Ft. - C7 �Ljt- iot I Dynamic Head L. ln(ernal Pump Tank Dimensions: Length q Width Depth to inlet 9 For Homes * Farms * Trailer courts 0 Motels 0 Schools 9 Hospitals 9 Industry 9 Effluent Systems anywhere effluent or drainage must be disposed of quickly, quietly and efficiently, Heavy -Duty Solids Handling Dependable Capability to 1/4 1/3) 1/2 H.P. 60 Hz Single Phase 115, 230 Volt, 1/2, 3/4 , 1, 11/2 H.P. 60 Hz Single Phase 230 Volt, Three Phase 208-230, 460 Volt. 90 80 70 LU U_ 60 Uj -1 50 40 Z 30 10 0 ��y F V F.o L A ONE ME EMEEMME EMMMMMN1 ME Emil L WEN MODEL RPM 3885 1750/3450 I- 10 V A- a MENNEN M 117 WED7H ON QRN 0 No" Bulletin CL2.1A July 8, 1983 GOULDS Model 3885 (Supersedes Model 3870, Submersible Effluent Pumps Pump Specifications Solids Haildhily Cipa0iWy lo Discharge Size 2­ N111 Semi -Open Impeller 3 vant", desitji,. ,". L, S L I S U I ( I I IL), K! C'l baCk-oll Pwllt) CL11 � 611)OS Of) C);3CNS.JC lot Casing vohjlk' lyl)°� 10, Stainless S(eei Fasteners 3`6 Df COI,' r es i s i a n c e Mechanical Seal splf'ifh Maximum Temperature *.60-F Capable of Running Dry Witt`1001 oan)�-'tg& to coi­,poot�nts Motor Specifications Motor Fully Sut)aierqed 11) nign g,.­,oc iLaL)int? u.. ticn X)c Bearings H e 3 V y - J.; I i t):3 Stainless Steel Snart re') S1;WL:L' S",%P, Single Phase Units Aii 1­1111�jik.- o i n 1) f CIt i: i i -N i:,, Three Phast• units Power CL)rd �;klll t��`Ir• tL, ' ,�l..�lv i ' � .,, ,)f rye _ .. .... Single PtlIZIL' Ufll(� SPECCli F I CAT ION S A % E Bi E Clt VV;THC),J' NOTICE 0 10 20 30 40 so 60 70 80 90 100 110 120 GOULDS PUMPS, INC. GALLONS PER MINUTE I)Et,*CA 44-r-­ .. _-L -Z System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided. with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on -site disposal system., "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health,. 1. If the septic tanks are installed prior to sheet -rock and/or painting, pump the septic tanks before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water -saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the System. 7. No chemicals_should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Aerobic tank effluent must be less than or equal to the design criteria specified in page 3 of these plans. 10. If septic, treatment or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather -proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tanks must be inspected every three years by a properly licensed person. 2. If necessary, the septic tanks must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tanks are pumped, any solids in the bottom of the dose tanks and aerobic treatment tank must be pumped, and the filters must be back -washed into the septic tanks to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the septic compartment filters should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. This system has an aerobic treatment tank which must be inspected every six months according to specifications and contract, b. The aerobic treatment system has a blower which runs continuously; if blower operation has stopped a licensed plumber should be notified for service as soon as possible. 7. The pumping components for this system include alarms which must be installed and remain on separate circuits from the pumps. If alarms are activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs.can be made. 8. Avoid compaction such as vehicle traffic above or within 15' of the adsorption system. 9. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 10. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 1 1. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 12. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components may be necessary. Page 9 of 12 CLT _aJ 1rr D .......s. CYO � � � � fl �� � '' � � .�� `ate+.' '• � ,,, ©; � 7 � � ��'] - 'ZIT - ,w00z - r vl� - -j -� 0 - ---, / z i-�--"1-39 �. + �+•� it 4c�� j f � a, p k Cit h ` (A '%j �� JL � .ter D cu 66 RnC2 21-f 41 ' F �162 D rr A }�y R 11 i V PIA 1 _sr-, ►% _ t yt SLA S hiB 2 7 1 WhB 7 44 2B - D _ C3 1 4 t, 1 3 4 Le 1 CJ4 F J pis. r t a y t n fj - �T — �Y -.. �v+�t 14 1 .3 _,tin - F ._ -1 A fi4 : /'R. � �� ' ram_ _ ��f��jJ [L� [�r_ljy U Sf4 'r'LIL to i J d2 _ s or �7 24_�-4 36 IRpg SE 2 � �� 3s -11 4 J 17 1 z r + 38►. f:� r 303? Y-' 3Cr 3-+ 3 =1; ., a 3 �' E 3t_+ JeB I sacz \ 1 Sad I SE FWAlP ON EAS EMEN T 8(.A.1 ?:4 i D #E) 1-6 Fm ,+ 4 FoB Cottonwood South Legend Block Number Dimensions Document Easement Forty I D CSM Lot PIN Text Parcel 10 Rural Parcel ID City and Village Plat Name Parcels Towns Sections LJ St Croix Co -- Other Counties Lakes and Rivers Rivers and Streams .� Interstates US Highways State Highways County Highways Local Roads Ramps Road Right of Way Railroads Soils Lot Lines Subdivisi s. i 0 200 400 600ft DISCLAIMER: This map is not guaranteed to be accurate, correct, current, or complete and conclusions drawn are the responsibility of the I Iccr P. Quirr Date Printed. 0916l12 10.39 AM Dcrces 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)j. Permit Holder's Name: Bast, Kernon J. city Village X Township Hudson, Town of CST BM Elev- Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION A Manufacturer Demand GPM Model Number TDH I Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County'. St. Croix Sanitary Permit No: 0 _7 _- � State Ploe'3) No: Parcel Tax 020-1479-10-000 Section/Town/Range/Map No: 36.29.19.3031 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer t/Ht Inlet t/ t Outlet Dt t DVt to m Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. ©f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I I SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR UNIT 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 Svsterns Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges I Topsoil I Yes No Yes ' Y7. 1! No L-L I LL -_ COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:-/-/ Inspection #2: Location: 853 Yost Drive Hudson, WI 54016 (SW 1/4 SE 1/4 36 T29N R1 9W) 'Cottonwood South '07 Lot 10 Parcel No: 36.29.19.3031 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan revision Required? F Yes [E No Use other side for additional information. Date SBD-6710 (R.3/97) Insepctor's Signature Cert. No.