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HomeMy WebLinkAbout020-1407-11-000Wisconsin 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 X Township Bast, Kernon Hudson Townshi CST BM Elev: ~~Q~ ~ Insp. BM Elev: /~-O BM Description: ,ill ~~ TANK INFORMATION TYPE MANUFACTURER .CAPACITY Septic ~J~ ( ~_ ~,/~' Lev' osing I '/ VV era ion `~(S- Holding ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , I , ~ / ~~ / ~ c ~ + _ J Dosing 7S > /0~, Q/ Aeration Holding PUMP/SI'PHON INFORMATION {~Ul~t,~J Manufacturer Demand GPM Model Number ~0 TDH Lift O q FrictiRn Loss L System Hga ~ N TDH ~ Ft Forcemain Length Dia.2 a Dist j We~~ t county: St. Croix Sanitary Permit No: ~ ~ 453493 QJ-51D State Plan ID No: Parcel Tax No: 020-1407-11-000 Section/Town/Range/Map No: 10.29.19.2558 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer s ~~ 9~. ~ ~• 30 9/, 2 Z SdHt Inlet ~ ~-~S ~. 7 ~ SUHt Outlet ~ p ~~ C ~O` j--~ Dt Inlet ~.0 ~9~10~ Dt Bottom Header/ an. 2 ~i~ C, ~~ T / • ~~5 ~. Dist. Pipe st~ 0 -~vr ~' 1 ~ ~ ~7 3s Bot. System~%~~I ~ J 9~- 3 ~ Final Grade ~ ~ ~'Z(~_ s ~.o~ ~"~` z.8z ~ s ~ t ' S. ~„~j ~ p 1'~'/ ` '~ D'S ~ ~ • f SOIL ABSORPTION SYSTEM ZZ ~ Z1~ ~,~ BED/TRENCH DIMENSIONS Width t Length ~~ o. Of Tre~ s PIT DIMENSIONS ~ No. Of Pits Inside Dia. Liquid Depth ~ /, SETBACK SYSTEM TO P/L BLDG . WELL LAKE/STREA LEACHING Manufa rer. INFORMATION CHAMBER I ~~ Typel~f System: l'~„Vl _ . ~ - _ n ~ ~~' >~ ~, ~''/ D Model Number. ~ ~`C DI,S~I~IBUTION SYSTEM %t/rJ_ ~~,,,, (d-~~-'•- ?S ' lic-- ead anifold i /1 Distribution ~ n 7 Pipe(s) L x Hole Size x Hole Spacing ~. ~ Vent to Air Intake i _ Length D a_ Length Dia Spacing SOIL COVER x Pressure Systems Only xz Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ (~ ~`LW Bed/Trench Edges Topsoil (~ Yes o !~-] Yes ~] No ~E~ ~-~' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: p~• Iz ~~ inspection #2: ~D /// /~~ Location: 696 Zephyer Lane Hudson, WI 54016 (SE 1/4 SE 1/4 10 T29N R19W) Shepard Par Lot ~ 1s Parcel No: 10.29.19.2558 1.) Alt BM Description = ~ ,,,/ 2.) Bldg sewer length = ,, ,~'.~ C°~~/S/zoo2,, [ per, ^ ,~,, - apmo(un~t -of c~r = ~r,~' ..t~. c~~"` ~ ~ ~ Q~~ *` (`#'~ ~~ PT ~3. ~•M~ t Plan reJlsion Required? L; Yes ~ ': No ~ /~ ~ / D~-i --_ _ -- ~~ ~ 6 it Use other side for additional information. , ! / ~ _ Cum ~ ___~ SBD-6710 (R.3l97) ~~ Date Insepctor's ignature Cert. No. ~Z Z~~ >~. S uildm~ Division C~tY 2 7162 ~ ~' _ G i~~nsi ~ M~~, ~~ ~~' Pumit Number (to be filled in by Co.) i Department of Commerce ~ r 608 266-31 ~ ~ 5 3 T Sanitary Permit Applica on ~ F~ ~- ~a ~ ~; ~~~+~ s P~aLD. Nnmber to accord with Comm 83.21, Wis. Adm. Coda personal inf 'on you provide --- may be used for secondary purposes Privacy Law, s15 1Xul9T. CROIX COUNTI~ Y ect Address (if different firm[ mailing address) s - I. Application Information -Please Print All Information ~ ~ z .c/l! Property Owner's Name ~ # L.ot # Block # /J~ /S/9'S' / ®2B -/ y - - ~/ Property Owner's Mailing Address ProP~Y I,ocadon • S~ y. SF v. section /Q City, State Zip Code Phone Number , , S ®/~ ~ - ~ ~ - 7~ E ~ ~ T L ~ N_ R~ Type of Bui isg (check ail that apply) II ~ _ . aD ~y~„ s„b,~,~l ~c n,eJ K~ Subdivision Nmne CSM Number r[~'1 or 2 Family Dwelling -Number of Bedrooms 7 ~ a ,tiS ^ PublidCommercial - Describe Use ~ '~ ^ State Owned -Describe Use ^City ^Viibrge ownship o ~ /V III. T ype of Permit: (Check only one box on line A. Complete line B ifapplicable) '4' ~ New Systertt ^ Replacement System ^ Tteatmerrt/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal 'Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Ltisrted Before Expiration -""- Plumbs Owner `/S3 N. T of POWTS S stem: Check all that a melon -Pressurrzed In-Ground ^ Mound > 24 in. of suitable soil ^ Mound <24 m. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Auobic Tn~trrrerrt Unit ^ Recirculating Sand Filter ^ Recirculating S~mthehic Media Fiit~ Drip Other explain) tlt t~Z V. D' ersaVlreatment Area Infornntiion: ~ r • ~ Design Flow (gpd) Design Soil Application Ra Dispersal Area Proposed (sf) System Elevation 5 Bel / ~ '7• /~ '~ ' ~`f'.v / . ~ i z y,, ~ , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tacks Existing Tacks Z Septic or Holding Tank .--- 1J~U Aerobic Treatrnent Unit Dosing Chamber ~~~~ ~ VII. Responsibility Statement- I, the andersiped, aaame rYSpoasibi ' Ratios of the POWTS shown oa the stlaehtd plans. Plumber's Name (Print) Plum s Signatue ~IvlP/MPRS Number Business Phone Number Plumber's Address (Streex, City, S Zip VIII. Cons /De artment Use On proved ^ D' Sanitary Permit Fee (includes Groundwater Date Issued Lgsning t Signature o S ~ Surcharge Fee) ~ ~~ ~ . °° e~ ZZ,I ds for ial ^ a IX. Conditions of ApprovaURessons for Disapproval \ , 3 Qe~~ J,p+~ - IJe~J S a . ~ ~ ~ a C's~_ Y T~A G MI~t M : i i ~. +~. «lwill 11~f Mel ~.,, ~ d-n ('~~ an ~-~reS ~ ., ~ ~o~a.airrw l~r J mwl~l A-c r ~ ~tl n ~ Q ~ p t:.~ . t w jr ~ , M -~..S~.c ~. M M~olc a,u6w~1s ewM M taMnrMNd f // 5 f a Z S~ ~ ~ r ~f ~~lt t;sll/t / OI~IINWN. ~ a 3 ~ ~ ~ ; - ~. ~. r~e~ SAS ~ Attach eomprese pans lro me wunry onryt mr me oo papevwa .w ...~.. o„~ ~ ., .......~. ..`.. ~ fc~.~ Sy6'~E~ el2.Jc.~'ioJ~ lrlp~ 3. SBD-6398 (R. 01/03) ~ 1 rr~- `~J2 ~~ be~dv.~ l~h ~1of i 1.a~- . ~.. Fogerty Plumbing ~22iiso 2x283 l:lcKeozie Rd. s~~~er, wi saso~t (7I~} G35-~09 ~~ ~yYd' • /~lr ~ ~j~/t ~°~"° I -3 h ~ K ltil9~~ = ~~,~ ~1°~ e~' ~/~ Svc ~ sT/F~D ~fG ,. , .\~ ~ Ali = ~kT d ~ ~ T+~ ®f f.T. ls~~R ~ !5'• 7 ~- ~~ ~~~ ~~ 41r r .~---) ~~~ q ~ \~ x s !e ''``JJ,, c1/ t ~3~. p = 5.,. w Fru~iZ ~ , s x a= ~- a•~K 97 3 ' ra 96-s ` Acp~/E ars' ` ~ f /' ~ ~~ y~& ~ ~` ,~ ~k"~,~,r i S~ p_ D ~%~,~ ~ Q~ ,,. ads ~s .~~ ~~ ., f /' N - ~ ~ I ~~ ~~~ Fogerty Ptumbin$ - X221180 2f32E3 McKenzie Rd. Spe~ner. WI 54801 _ ~ (7is) X35-9509 ~,~ ~fY~ ~.~1~ ~~ /~~t laT ~~r 1" =y~' frMG~ ,r1~! = ~~, ~P ®f ~y Svc ~ sr~~ ~FG~~.~ ~Lsr/~ ~~tJ[!~ LsJVIa. ~6i0.O ~ X = g~,v,G s =/~tiK~b LeT ~AKnI~~ s.j. w,~'G~'iZ sit b.r~cK ,. sT ~~'~ i y' ` ~~y l.. ~~~ ~ ~ ~ ~`. ~~ . s ,~ ~ ~~a /03. o x ~; -d ~ ~ 'i r F7•S ~ L•=~~PfT J7, 3 ~ i ~ 96s ` Def~Tff .~ ~ ,f ~/ ~~ r^ ~ x ~~ /', ~~ ~r ~~r ~----> .I ~ a ~f -~ ~~ er ~oa~ ~ ®aoo £o c~~~ d~Y~c~ v '~ # S` ~ n ~ ~ w . Q~ ° ~ ' N N N O ~~ o v~ Ha o •~ O U N m O U O V ~ ~ e ~. m m Q+ a s ~_ O u ~ ~ t m w ri M - ~ 11 ~ ~ ~ '~ O V ~ ~ O ~ ~ W - -_--- - . ~ . . p ~ °d 0 v ti~ ~;~ ` i ~ 1 ~ ~ ~ ~ ~ ~ ~ ~. i~ . J~ ~ ~ ~! - ~C o ~ ~ F il ~ ~ aka ~ ~~ ~ L'? ~ _ 0 11 { F`'_ . ~ ~ ' ~~ i s- _ ~~ 9r- :f ~ ~ ~ ~ =~ -_ -:~ t ~~ ~- - v _ _ - ~~ ___ _ __ - - 1. •' •, - -~ ~ • Y i •.f -• _ i ~ ~ ~ - -~- ! ~ ° i _ ~.. ~.: ,.. U _ ' _ 't sue' ~ - - : ~ ~ _ ~-: - ~ ~ - `: irk= - +:~ o a' ~ _: =--~-J= - ~'~ ~_ _ _________.__.-s ~ n ~ ~ m ~~ ~ ~ ~ '~f -fl a o ~_ w t U o 'ou p o o >, ~ H ~~ Fogerty Plumbing X221180 2f~2F?`3 fi.7cKenz~e Rcl. ~i:,. _: ~^.r, WI 54801 ` (7 ~; X35-9609 . Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and L Device / 4" Mm. Above Final Grade 4" Sch. 40 Vent > or = to 12'• Above Final Grade Inlet Appr°ved E$luent Filter <or=to U8" Baffie~ particle Size A Weather Proof Junction Box IIectric per NEC 300 & COMM. 1628 WAC Al~te Outlet Location W/Approved 4" Sleeve _ Force MainDiann. = z ', " Hole air Anti Sipes Device B Pmmp Off Elev. C Tank Mfr. a.,rrt-= ~ D Dose Tank Elev. Vertical Difference Between Pump Offand DistrtbutionPipe = /~. G f (- °~ . ............... Minimum y Pre&s~ue ................... •--- _ - o - . Friction Factor/100FT.. - 3 3 2. ~~ 3 FT. of Farce Main x ~ .. - / Total Dynamic Head .................... _ !y. 4 ,/ ~ S. 3.~ N• v ~_ ~a~S ° ~ r SYVF 5'~w -R 4 ~9• S :-- ~~- ? ' ~~.3 ~~~ ~ Number of Doses ... _ ~_ Pei Day Gal. perDay/ #Of Doses = ~ p O ~- Volume of gack8ow .................................................................... - si, ~ Gai. Thal Dose voluune ......................................... ....................... =1.$.L,~ Gal. pomp Tank Capacity 7s~ Gallons Dimensions Inches Gallons Pomp Tank Vohme ~ Gal/Inch A 2 3 ~riD. ~~ Y2'' $ 2 35.72 pump Mfr. ~'eN`D C ~.~. . ~ s,. P~ pump Model ,~'fl e y / D ~, r . ~1=-~ q Minimum Discharge Rate ---- 3 a GPM / Alarm Mfr. s . ~ _ ,~'~ ~ ~r~ ~ Total= Y Z ~ ~o Alarm Model to ~- o r K ~s 7 ': ~ 7. 3 ` Bed Tank per COMM. 83.450 Anchor Tank as necessar3- to negate buoyant forces per COMM. 83.43(8}(g}. i ` •~ ~~ `I `''hHP .Up~to 40 GPM _ Discharge size 1'/: NPT : ' Solids: ~~ maximum Motor Single phase:115V Materials of Co~istruction Brass/thermopt~stic Features and Benefits •Top suction eliminates impeller clogging. • Corrosion resistant construction. • Float actuated switch. METENS FEET ~ MODEL DVP03 c 6 20 = 5 v 15 ~4 ~ 3 10 0 2 5 r 1 0 00 5 10 15 ZO 25 30 35 40 U.S.GPM o` i a s e Iom~nO CAPACITY METEfl3 FEET to a 6 i 6 v 5 a z 4, 0 3 C 2 0 °0 10 20 0 2 4 6 6 10 12 m1Ar caraclTY Pump Specifications /,o and'/2 HP Up to 60 GPM Maximum head to 32' Discharge size 1'/2" NPT Solids:'/+" maximum Motor All motors feature ball bearing construction. Single phase:115V Materials of Construction Cast iron Thermoplastic Stainless steel MODEL: 3871 ~o z5 20 - 15 EP05 10 EP04 5 ~ o w fi o uxvw. Features and Benefits • EP04 impeller- semi-open design with pump out vanes to protect mechanical seal. • EP05 impeller -enclosed design for improved performance. • Rugged,glass-filled thermoplastic casing and base design provides ;superior strength and corrosion resistance. • Cast iron motor housing for efficient heat transfer, strength, and durability. • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. - • CSA listed models available. A!1 Models are designed for continuous operation and feature stainless steel hardware. urt.o~~a+~ w, wu. rwa~. auuc COY AtlaC1t Odnptete Sde Plan °~ paP~ 1 ~ SQe. Plata must ~ ~ _ Nt~lde. but trot 6rnited itC oer6r~ and t1 and Parcel iD_ _ P~ettt . SCanIB O[ d"qn. rfOflh a ~ ~ toad. ~~ " ~ ~~ --- Please pint all ' ~ s5 5 tww~mree~aror t~tiph~s~ac ~. ~~. flik tpcasaR _ Pr~riY Unmet '~~n/ ~''UUi +'~.,~..,~ v' Govt. s 1/4 S~ 1M 'S T -Z. _ N R +r E (~/ .E T r .. tot # g Subd. blame ar t~IWt Propmiy {)wners i41ai~ Address - ~ ~ ,_ _ ~/ - z ~y z sra~ ~ ~ ~ ~e rw~ p ~r ~ ~ ~ ao~a Code aemrea tloMt rate !~U GPt New ConshrxGon tlse: ~ ~ Wurtbet d bedroans ~-- ~ Replacement ~ Public a convrnerc~t - Dpscn~e' /1///~ ~ Patent tttaterial ~/UT~,~~" - Flood Plain ete+r~+ if GenecalrAnxt+ert~ CoN/ycwYte'!~#L- ~'-~ - aru! ' ~ey,~ ~.LL T~c,~'it/c6t~S fdR r-~,E ...Helms •¢J+.~/~ .~ ~~• 3 C~rotstd sur<aoe elev. /IO• ~ R t?epth 1o i~trtl6r~ larlor ~ to Z a~ S~ Rpp~on ~' ~9 ~ ^ ~~ ® ~ C.ar so,~,daty Roots GP1)ftt' tidimn Depits Uornitnattt Rsdox Desaipt+on Textwe Sttueeue ~ '~~. 'Effd2 irt_ lYttatseM (]a. Sz Cont. Color Gt_ Sz Sh. __---- .._._ o ~Ia - .7 _ _ ~G _ _ OTl S . - ~ L ,~ r /~fi z ~J -- 9 i. ~ #3 s ~ ~~. ` s~,Er r =i t3otit-g ~ ~ eors~ eltw ~. pep>tn to ~ "` Sots " Rate ©~ ~ ~~- Texarre Sttut~ Ccr~attoe ~ottdaw l~ ~aminartt Cater l~edorr o~+Pl~+ -~, _ in, fi~tnsell tlu. sz Cant. Cotar Gr sz. Sb. ,~ isr ,z. . ~ .6 / i- =-z -- S .o ,s L f1lt Z ~ -20 _ _ _ G _ - /• 7 0- Z _ . 7 ~ ~. 6 i_ ~ 3 s ~, G _ ~ ~3 rats s ~ xh/F T ~ 3 ~ > < 15U~mg11.. *2 = t~ODs < 30 mglL and TS5 ~ 30 anyll: - EiRuernt iFt = 8~S > ~ ~ 220 ~ and TSS 30 _ CST Number ~sr pie t~ {..., '~---~ ~ z d ~ Daf3e Evattra7lon Candut3ed Telephotm Atpitess Fogerty Plumbing & Perk T 'tfg --= ~ `7~ ~9~~ - - - -- - - -- - - - 9/a~S' L~tL .. ~ / Page ~~ ~ - ~GTf~- Parr~el ID # i92© /~ 7-- / / ~/ Property O B wner orm9 # urface elev ~ d H ~ ~ 1~9 Soi I s ~ Grotu- ' Cam 8or/~y Rods Redorr Descrip#on Texlue S~ e ~ `EtF~'1 ~~ Ftorizorr Depth Dom M9 Gh3. Sz Cont. Cdor Gr. Sz Sh. t 7 ~, _ / 5 JH d / e-S t _ L s 7 Z -/a / _ ~ S S~ ` ~ .3 2- _ s ~ L A L L .- _ ~ .,_ ~ o 7.3 ~ ~^°9 Depth to 9 tam ---'-' ~- Sod icaliar- R~ Bon<-9 # ~ Pit Gro~d surface elev. _____--- H. y ~ GPDIff Dominamt Redox DesanP~ Tex4re •Etf#1 'Eft#2 Gr. Sz Sh. tionzon Depth Qu. Sz Cont. Cobr in. Munsel fador _---- ~. Boring # ~ ~9 Ground surface elev. _--- 8. Depth tD Grrritrr9 Sot ,LJ Pit T~ Carrs~enoe ROOD •Eft#1 Horiz~ ~~ Dom Redox DesaiPdm ~. Sz Sh. in. Mur-se9 Ou. Sz Cunt- Color • • Eflluerrt #2 =HODS < 30 mgA-and TSS _< 30 mgl~ 'Effluent #1 = GODS > 30 <_ 220 mgA- and TSS >30 <_ 150 mglL ortunit service provider and employer. If you need assistance to access services or 3131 or`f~'Y 608-264-8777. The Department of Commerce is an equal opp Y need material in an alternate format, please contact the depaRment at 608 SDD•8330 (R.6100) • rogerty rromding X221180 2t32~3 ~1cKenzie Rd. Spccner, WI 54801 (715) 635-9609 ~/~ ~fY~ ~.~1~ ~~ /~f s laT ~i~ q~N/~ ~~uc~' Lsx/~ igp•p ~ ,~,gs = .AST: d w, ~ 7a~ ®f f•~ !s-~s~ , !s• 7 X = 3©~~ s =•/~uWD LoT ~sK+J~ ~ F co E lL ~' b~+scK ~` i ST ~~~. ~~a~ ~~ ,~ ., _~ ~ ,y,o' ro3• n \~ .-3 o~.~ ` ioi ~o' \~ .~ .~ f s~`~r^ ~~~~ x ~9, ~~ ~c~ l~~tr .~-~ ,~\ - .\ a? ut~ iQ,~l /so ~~ Safety and Buildings Division ~tY 201 W. WashinSton Ave., P.O. Box T162 .s , ' j~~~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number m be fiAed in by Co.) Department of Commerce (~ 26ti`3151 S3 Sanitary Permit Application state Plan LD. Number persotnl information you provide Wis Adm Code Zi accord with Comm ffi I . , . , . n may be used for seco~ary purposes Privacy Law, s15.04(lxm) Project A (if different than mailing address) I. Applit~tion Information - Please Print All Information . ._ Z Property Awtter's Na me - _t B _ Lot tg ( Block g ~ '~~' 020- (~0~- (/- ~~ ZS$$ ,a B Property Owner's M ailing Address - Property Location - S',~ 54, Ss= Si,Set~on ~ City, State Zip Code Phone NumiSibr _ O / ~' ® _ ~ 7 ., (circle o~) R~E q~ T ~ N ( all that a ly) e of Buildin II T . - ' g pp . yp ~ bivssion Nam ~Nntt+be'r ~ ., ~ e~, IId'I or 2 Family Dwelling - of Bedrooms ^ PubliGCommercial -Describe ~ ~" ^ State Owned -Describe Use -- - ~~ ~~ ^City ^ViIlage fJl OWnSF1~ of III. Type of Permit: (Check only erne x on lme A. Complete line B ' applicable) '4' ~ New System ^ Repltcement S ^ Trtxtmetn/Hold' atilt Replacement Only ^ Otlcer Modification ro Existing System B . ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer ro New List Previatts Permit Number aid Date Issued Before Expiration umber Owner IV. of POVYTS S (Check all that ) (~'I'Yon -Pressurizal In-Ground ^ Mound > 24 in. of su' it ^ Mouttd < 24 in. of suitable soil ^ At~rade ^ Single Pass Sand Fitter ^ Constntcted Wet1aM ^ Pressurized Itt-Groutd ^ Holding ^ Peaz F'ilta ^ Aerobic Treatment Unit ^ Fih~er~~~D C~~~" ' ` "-' " U ^ Recirculating Symlietic Media Filter ^ Leaching Chamber 'p Line ^ Gra less Pipe ^ Other (explain) V. Dis reatment Area Informatio .? EGt ~ te~~ Design Flow (gpd) Design Soil Application Rat (st) Area Proposed (sf) S Elevation VI. Tank Info Capacity in Total N M rarer Prefab Site Steel Fiber Plastic Gallons Galbns of Conti Constnttxod Gla4s Tanks Tanks •~"" ~Mw~ Aerobic Treaama Unit Dosing ('lumber •--- VII. Responsibility Statement- I, the.... assume .for insta0ation of the PO on lice attached plans. Plumyer's Na me (Print) Plum i gtnwre ~~f ' ~A~IMPRS Number Business Phoce Number _ Fogerty P[nmben~ I ax ~ Tii - .mss- 9~0 Pium~~`li~ ~~.~' ~ -et:3S = s .2 Ito F•'fX Spooner, WI 5801, 6si ot- ad ~ VIII. se O 7 L ~iApproved ^ Disapproved Sanitary Permit Fee tndttdes GratndwaDer Dace Issued Issuing c Signer m (No Stamps) ^ Owner Given for Denial Surcharge Fee) ~~ ~ - QZ ~ 1[X. Conditions of ApprovaUR for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must ail be servleed /maintained ~as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) roc the system on paper not less than Stn x 11 inches in size Fogerty Plumbing - #221180 28288 McKenzie Rd. Spooner, WI 54801 . ~~`~ y; (715) 635-9 ~~ ,~i-w tor'' i~ tc1jL~ / `~ SO ~ ~~~nON ,d~/ B~ ~~y r~~/ ~~ Boa ~ (~~ ~T _-~ ~- ,~cT. ,a ,~ .• ,~ ., 9Y~ x ~ ~~_.~~ _-._ r ~ /~• ' s~ B~'4r ~_ v ~, 5. N i ~, _ I ~ - t x ~i ~~ ~'' z - 3 ~ji i O _ ~/ ;1 1 ~jeira. ,~~E .~ L LoT ~ // S4tL~' / r ~ SD ~ ,d~'!' per, I'® ~/Y r~K/ J~~', A°~°~• X = `lo,t r ~ ; f~~adb ~o ,c~D s Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, Wl 54801 (715) 635-9 ~~ ~~~ U/ /~ - J' W ~ lt.~ CG 7 Sri • / .~' yfit7~ J~ jL~S ~+~" ' ?~k / 1. ~r~r : C-/ a c-2- 87~ ~,~ =mar' ~ ~ ~~• ' r~ ~s~4r .~ ~ , ~-- ~ ~~_ , 1 ~~'~ ,` ~. •- , ~~ ~ , ~-, ~ 3y9 L N ~' ~ 3a , ~ $-i ~ ~~z x~ a-s /Z~ , Wi§consirt department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Divtsion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ~~- . C o', Attach complete site plan on paper not less than 8 1/2 x 11 ' sin size. Plan must indude, tw# not limited to: vertical and horizontal reference 'nt (~ Parcel l.D. percent slope, scale or dimensions, north arrow, and I and ~. p -) p} - / - oop ~. ?S~~ Please print all informaifi Re 'ewed by Date Personal information you provide may be used fa secondary (Pr~3~ aa5.~a m)). ~ ~ I Property Owner Property Locati ST. CROI C~p tYs t 1/4~E 1l4 S~ 0 T Z~ N R I E (or) ~- S~- ZONIN Properly Owner's Mailing Address o # Subd. Name or CSM# qy~ ~ r~ .S~ r~ City State Zip Code Phon tuber ^ City ^ Vllage (~ Town Nearest Road ~~ 5y01(~ (~ 15) ~ ~~?5 ~uc~s~i~ Sc~ New Constn~ction Use: [.~ Residential / Number of bedrooms ~~ Code derived design flow rate ~ ~'C~ - ~ O © GPD ^ Replacement 11 ^ PubGc or cornmercial -Describe: Parent material O U T (..~ 0.~ Flood Plain elevation ff applicable N ~ fL General comments S~s~e~ e(ev, yQ: ~Q' and recommendations: #-~fa ~I~Ua q~-~d Boring # ~ Boring v.~ min inn ,~J ~ Plt v~uw~u aunaa.c c~cv. L~. u. a~cNu~ w ~u~um~y ~aa.aw - n~. Soil Apptiption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I b- ~~ 10 ~IZ •~~ I rr~r c. I v~ . 5 . ~' z i -3> I(~ y ~ S ; ~ k ,mfr ~ ~ - . J ~- 9o$oi ~3.t ~1•Z Boring # ^ Boring =_J b61 Pit vwunu sw iacc c~cv. ! ~ u. vcNu ~ w iu ~ ww ~y ~aa.aan I ! i_ i u ~. Sa'I Applipfion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ a-IZ ~~ ,r3 z -- s. ~ 2t~~~bk ~ s I ~ . 5 . Z ~2-yG Ib ~y~~ S~ ~ 'L m-~~ ~ s - . FS° ~~-j~~~ io '-~ - t s c~ - . ~ ~. z . ~.~ $~. ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L CST Name (Please Print) ~ ~C~~''~~ Address Zit3 £so t~ Sf- ~awle~sel~ l..) t S~io2~ ' Effluent #2 =GODS < 30 mg/L and TSS _< 30 mg/L CST Number u--©z 2x33©~ Evaluation Conducted Telephone Number `l+s' au> yooFS Property Owner ~~ Parcel ID # Page ~ of a Boring ~ ^ Boring ~. Pit Ground surface elev. 9 ~ ~ U ft. Depth to limiting factor =.~_ in. Soil application Rate dox Des(xiption R Texture Structure Consistence Boundary Roots GPD/ftz Horizon I Depth in. 6-~ Z Dominant Color Munsefl iO 3 Z e Qu. Sz. Cont Color -5 +~ Gr. Sz. Sh. 2 Y,r~cb ~~ ~ C S l v~ 'Etf#1 . J 'Effi#2 2 (~ ! ~1~ - 5• I Z -~r-,~ c- c 3 -- . 5 - 1}. y ~ . Bonng # ~ Bonng ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption Rate dox Description R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell e (~. Sz. Cont. Color Gr. Sz. Sh. •Eff#'1 'Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor m. Soil appflption Rate dox Description R Texture Structrue Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = RODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mgtL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/OD) PAGE 3 OF 3 ~T ME Qc.s..~ TOT# I I LEGAL DESCRIPTION SL-~ ~ SC% ,S /d T Z 9' N R. 1~ E(or~ SCALE: 1"= ~'(~ ~ BM 1 ELEVATION ldU - O BM 1 DESCRIPTION . -~.~ ~!<{~r ~~ ~„~1 BM 2 ELEVATION 9~/~ ~U BM 2 DESCRIPTION ~-o Q~ d -(- .}'y ~~ S~--e ~ ~ ~6 c~ SYSTEM ELEVATION ~G • FS ~ ALTERNATE ELEVATION ~O- ~ ~ CONTOUR ELEVATION 4 S,c~o ~ ~`1- a ~ N T3~ ~- Bin z s ~S o 0 ~y.~ 5-~~ / d _. `}- ~' J 7~ ~r SIGNATURE ~~~ ~ --- -> DATE / ~`~ ~ ~~ v ~~ ao 'Q •-+ l c morn ~ m~ o. Eo ~~nrn 0. a ,--. ~ ~ cn II ~~ ~N~ N~ ~ ~ ' c#N an ~ Ei II II ~ N ~ ~ } .b N •~ ? ~, o ~ ~ ., a ~ .a Gx~ ~ U ,,., !t .~ o II fs, ., ~ ,~ . . • .I ~i ( ~ ~ ~~ ~n ~~ ~ a _ _ _=. ~ ~ A •~ .•.. O - ~ - - --. - -.' Q ~ ~+~. •••-~ y~! ~ ~~ ~ _- f• ' ` }• * • - `~ ~! ~ 0 ~: v• a O - V b p,, II it it w 3 ~ e U, tz. ~ ! .~ ~ ~ ~ ~ ~ ~~~ W ~! ,~ .~ ~ ~ •~ ~ rr O ai .~~ U ~. 0 m 3 b N cd b 0 N .~ 0 a~ .~ 0 a~i 0 s- 31 e-wer~ wTtA~~ YVW 1.7 UVVIVCt[ .7 IVINIVVNL Oc +YIF1rVM\7L.~r~~-~~' ' ''^'~ YLC nrrvnmr~ ~ ^v.. owner ~~,~ /S~.s% - ' - Permit ff ~s3 ~ q3 +JW~171~ revv~ur.c.uw Number of Bedrooms ^ NA Number of Public Facii-rtY Unrts _ ~NA Estimated flow {average) gaUday pesign flow (peak), {Estimated x 1.5) ~~ gal/day Soil Application Rate __ al/day/ftz Standard Influent/Effinent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) <_220 mg/L ^ NA _ Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent QualRy Monthly average Biochemical Oxygen Demand (RODS! 530 m9d- Total Suspended Solids {TSS) 530 mg/L ^ NA -Fecal Colifomn {geometric mean) _<i 0` cfu/100m1 MaUi:imum Effluent Particle Size Y8 in dia. ^ NA ether: ^ NA '~Vah~s typical for domestic wastewater and septic tanK ernuem. MAINTENANCE SCHEDULE Service Evert Inspect condition of tankls) Pump out contents of tankls) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls & alarm Flush- laterals and pressure test , Othas:- At least once every: rays ~ vi~ SYSTEM N++~~ Septic Tank Capacity/ _ 1 )" v al ^ NA Septic Tank Manufacturer - . ~ ^ NA Effluent Fdter Manufacturer a,~L ^ NA Effluent Filter Model _ .. / s ^ NA Pump Tank Capacity ~ ~l NA pump Tank M~ufacturer ~ NA Pump M~ufacturer (`j NA Pump Model ~] NA Pretreatment Unit Q NA ^ Sand/Gravel Fitter ^ Peat Fitter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ~ Dispersal CeNis! ^ NA In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other. ^ NA Service Frequency {Maximum 3 years) C] NA When combined sludge and scum equals one-third (Y3! of tank volume ^ NA ^ month(s) {Maximum 3 years) ^ NA At least once every: ~j year(s) ^ month{s! ^ NA At least once every: ~, I year(s) ^ month{s) At least once every: ^ year(s) ' ^ month(s) At least once every: ^ year{s! ^ monthts) At least once every: ^ year(s) q,NA j~ NA EI~A ~ MAINTENANCE INSTRUCTIONS one of the following licenses or certifications: Inspections of tanks and dispersal cells shall be made by an andividual carrying O erator. Tank Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector pOWTS Maintainer, Septage Servicing P inspections must include a visual inspection of the tank(s) to identify ~Y missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent On the ground surface. The dispersal cell(s) sha{{ be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the graund surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/I~er Mailing Address _Qy~ ~ /~..~_~i~Q C~~~ Property Address ~ 9'~0 ~-j~"~~lv r~ v~~ (Verification required from Planning Department for new City/State ~~~,n ~ eL,~ parcel Identification Number LEGAL DESCRIPTION a2°-~`~0~-t/- °~`r°~' 2$~'~') Property Location ~i~ ~/., s,~ y,, Sec. !o , TAN-Rl~~~l~, Town of __ ~~s~. Subdivision ~~~"~,~-,c~~ /..~ir~K _ _ _ Lot # ~~ Certified Survey Map # Volume _ ,Page # Warranty Deed # 3 7 s'~ y Volume / 7-2 ~~ .Page # LI9 Spec house ^ yes ~o Lot lines identifiable Ltd-yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da s of the three yea expiration date. SIGN TUBE OF APPLICANT ~ ~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 'e~ / / SIG TURF OF PLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****s ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r ` STATE BAR OF WISCONSIN FORM 1 - 1998 WARRssA~~NTY D~+EE//D'~~ This Deed, made between Weldon E . Richert and Lee Anne Rio_•hert husband and wife Grantor, and Kernon J. Bast and Donalda J_ Speer-Bast Grantor, for a valuable consideration, conveys to Grantee the following described real estate iu St . Croix County. State of Wi: t the "Property" ): See attached Exhibit A , [~~-7524 !:fii i !-iLttN H. WALSH it i ~~: 's...i.i~i'ER iJf' D~EUS S:. CN.tJiX CG_, WI ay-~-pool 12:30 GMI aAR1iANTY DEED EXEtM=` i N r'E~`T r~RY FEE: CGGY l~t:E: i3:tN5FEl~ =EE: 1224.00 REiDRDI!`~r fEE: 13.00 rca Vnmu and Return Address ~-8~yi Seatt~2bed- • •-:~es~ , r~r~ _ ~ ^ ~ ~ Edina Rt3atlty Title #~~.-~~ 40Q S. 2nd St., #115 oft W! 54016 I•s,rrcl Idcnliticetion Numbn[ (t'1\) This t g if~o ~' homestead property. (isl (is uo[) Together will all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good. indefeasable in simple tcc and free and clear of encumbrances except Dated this ~d ~ y of Sep~.ernber 2001 / J- (SEAL) (SEAL) Weldon E. Richert ee Anne R -her (SEAL) (SEAL) AUTHENTICATION Siguature(s ) ACKNOWLEbGEMENT State Of W" ew~~ ss. -- ~.A _ county. authcuticatcd this day of Persotntlly crmc before me this ~~ ~J day of Sept ember , 2 0 O 1 ,the above named - Weldon E. Richert and Lee Anne Richert, 1',usband and wife TITLE: MEMBER STATE BAR OF WISCONSIN (If uot, authorized by `706.06, Wis. Slats. ) THIS INSTRUMENT WAS DRAFTED I3Y Coldwell Banker Burnet 01-2535'7 1301 Coulee Road Hudson. WI 54016 ( Sigltatures may be authcnticaeed or acknowledged. Both arc not etecessary.) c:m,es ur persons sienine In AnV l'1lDHC1tY must fie IVUCd ur nnntcd Tx:low thci WAttRANTV DEED me known to be the person .S who executed the foregoing iustratucut and acknowl ge the same. • Notary Public. State ~ Ar FV6uC -.•.UpN-507w My conuuissiott is pe ~~ti9~C~btree?cRu~tfNbsd e: .) 1+C)[t141 No. 1 - 19911 Mt7wuukce, Wis. _ YOL 1 ~~a`~iAGf bl~U EXHIBIT "A" Legal Description mart of 5Ts 34 o'fNE 34 +md Past ofNH i4 o€SE °ifi of Sdxiaa 10.~9~-19 desaribc+d as SoIIows: Ca~noma~cu~g at tlae NW coaoaer o4' NB 34 of SE ~, SectSc~ 10.?9-19, ~e 13Z teoc S,. "cbwce 8 130 ieec ro gala, throAe N m ~ paa~E of iaoberseoaoa ve~th C aardNW RR t of ~Y. ~co S4V a1lo~o,>t aatbd >d~ ~ ~ to Sae pooa~ of vad~eaeetion wYth the canter o! Soots brad. tt~ S to the ~aiat of bed Zbte rtaloe a e~estied m is son smta plpe Ss~ 3s ~oaw m ~SOe,'LO be set m txaoa>aL Thane irs also a~ lroin pdpe atalra aoa the S boamdet9 otthe a'bv+~e 1~d sad tllaa E bormdmgr oi~ SeoSL RR~ed. T}sase s>blu.+s sTe oft aver fumia,+e eocaaya. 11ad, Paaet oftbe138'l. vf~e SR 54 osSoaioa 14,29-19, as foBa.vs: 4B ~ a art ~7 stmlas be<nl~ad a alae 1~ aoane~ ed the S'>E 36 of sod Sedfeaa- 30; '~uwoe S 132 feet so a oemeobF><i in Sa>aa atsToe" i4 t3~e+ PU1Nr OF S~C~'NQ tlsasod W~ 1.28'7 ~'. ~iAOD dC 1txs, to a aamle~sed is eted stooa; ~ ooa~aae 33 fleet W;'~uaoee S I98 feet. zdOUR of IeSt; thCaoe 833 met to a eul~esttod i~ a~ etalm tha>roa eoimt~iagF.b-1?87 8xS mocc ae' Iess, t+o a eat~oaoted is steet. ataloe; tlaeuee N 198 firrt, sact+e or 1eea, so the Poises a~ BeS_ ~o ~.L£~.OOS~ ~~ (' \\ \\ ~'f~. ~ \ \ ado X~ 1 ~ \ \ \ ~, ~ ~ ~ ~ \ ~ I ~ \ ~ ~ ~ ' ~~ a ~ \ ~ `~ :~ ~ r \ ~ o;\ \ ~\ :~ \ ~\ p 11\\IU ~ \ \• \ \ , ~`~\ .y d \ o ~` ~~ ~ \ ~ ~~~ 9 ~~ o ~~ ~ o -- °z~~ Q ~a ~W Q~ ~; a~^ ~ ~ o~~~~ W ~ ~ -- Z z ~~~Ln i 2 §~~$ ~~ ~~ ~, 9; ~; ; ~~ ~~ ~~ ~; ~; ~; ~' nn1 .I, 1 ~I~~~~~~~~~~~~~ ~~ ~~ a~ z W ~. ~~ ~~tt~ M.L~,LZ.OOS ~a ,9S'LOZI M.L ~Lti"6EE ~ 3. L o 0 0~ O ~ W u: J O • l11 Q _ / ' ~'•'•'• .~~ ~ ...-.;~-----__---N~ ~ ~ -~ ` : ~ - ... o `. ~ . \ ,~ '\ ~' ., `:\ ,~ ~ o~: Ay \ ~ ~N l \, p,~ ~ ~ ~ \ I a`~ ; ; : \~ \1 ~. ~; '~ ~ .,, \f ~ o. \ \ \ \i ~`. ., \ ~\ ., \ ~` \ ~ ~ .. ST ~ ~~ ~Y PLANNING 6t ZONING ~~ FAx MEN[o _ DATE: Na v . I S ~ Z~ -. To: .D~ ~~ ~G ~cz-~; CodeAdministradon FAX NUMBER: 715-386-4680 ~(~ ~ ~ S , s~p Land Information ~~? Planning FROM: ~ //U 715-386-4674.w FAX NUMBER: 715-386-4686 Real PrCijierty PHONE NUMBER: ~ ~~p 715;86-4677 Recycling ?1,5-386-4675 NUMBER OF PAGES, INCLUDING COVER SHEET. 2 . ;h. 'S" T., RE: ,{ ~.~ E , ~..i~ W (L ~ F~ ~"(S ~ D S E~tI ~ {. "(~ ~- .4- C ~ P i . ,y'' l ,..# ::.< 1 .F,'• ST. CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HUDSON, W/ 54016 PZ@CO.SAINT-GROIX. WLUS 715-386,4686 FAX WWW.CO.SAINT-CROIX. WI.US ST cRo~cOuNTY PLANNING & ZONING MEMO -~ ..~* ,_ dh;~ r ~~4~~ , ' ;,; , Y;:, ~:, Code Administratip 715-386-4680 Land Information & Planning 715-38G-4674 ' ~ Real Ptop 715-33 - 677 , ~ . P Reo~~cJing 715-386-4675 _.^r .~,: ;t 'S' ~. ~s DATE: NOVEMBER 1 5, 2005 To: File FROM: Kevin Grabau , RE: Shepherd Park lot #11 I received a phone call from plumber Keith Knutson on September 12, 2005. Keith was installing the POWTS system for lot #11. He set the tank and was ready to instal! the absorption system. As he was excavating down into the soils, he noticed what appeared to be redoximorphic features in the soil down to and into area of system elevation. Mr. Knutson called me and asked if I would come out and check the soils. There were several pits open for me to evaluate when I arrived on site. I checked several pits in the area of Adam Schumaker's soil tested site. I found redox features in all pits. There were tongues and whole horizons that displayed both low and high chroma redox features down to a depth of over 8.0 below grade. We searched the entire soil tested area of Schumaker's site and could not find an area adequately sized for an absorption system that was absent of redox. We then explored an area to the south of Schumaker's site, but could not find three pits that would be acceptable for installation of the absorption system. Absorption fields cannot be installed within areas of redoximorphic features! They can be installed below an area of redox features if certain code criteria are maintained, or can be installed above an area of redox features if the system elevation is at least 36 inches above the highest redox features found in the soils. Neither of these conditions could be met, and the conventional system could not be installed in the Schumaker site. In the northeast area of this lot, soils were found to be code compliant for a conventional type absorption system. David Fogerty evaluated the soils and submitted a soil test report. The system area could not be reached by gravity flow and a dose tank was required to pump the effluent up to the soil-tested site. A sanitary permit revision was received by Fogerty on September 21, 2005. Cc: David Fogerty, MPRS, CST PZ@ C O. SAI NT-C R O I X. W L U S ST. CRO/X COUNTY GOVERNMENT CENTER 1 1 O 1 CARM/CHAFE ROAD, HUDSON, Wi 54016 71x386,4686 FAx WWW.CO.SAINT-CROIX.WI.US