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HomeMy WebLinkAbout020-1445-07-000WisconsinDepartmentofCom rce P IVATE SEWAGE SYSTEM Safety d Building Division- ~ ~ ~~~~ ~' SPECTION REPORT a GENERAL INFORMATION ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (P cy Law, s.15.04 (1)(m)). Permit Holder's Name: City ~ Village X Township Bast, Kernon Hudson Townshi CST BM Elev: oy-~e Insp. BM Elev: ~.~ BM Descripf ,1 T~7~ TANK INFORMATION TYPE ~ 1 MANUFACTURER ~ c~•e w CAPACITY Septic W ~ C J ~ Z Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ( ~Ul) ~ r _ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numb TDH Lift 'on Loss System Head DH Ft Forcemain ength Dia. ELEVATION DATA County: St. CrOiX sanitary Permit No: 453392 0 State Plan ID No: Parcel Tax No: Sectionlrown/Range/Map No: 11.29.19. STATION BS HI FS EL V. ~ ,/D Benchmark Z , go o~~~ f~-, /~ Alt. BM~%~~'~4 ut~ °`-'c L. 7 1 ~ 3 Bldg. Sewer S ., d ~ • yS' SUHt Inlet 'Z ~~ •7~ SUHt Outlet ~~~ dl. S7 Dt Inlet Dt Bottom Header/Man. ~ (o ~ ~ /oi: y Dist. Pipe 2 h r,_. Bot. System l'~~0~ q~ ~~ ~ ,~O ,/b Final Gra ~ ~/l 5 , 7 ~•~ /O2•~ St Cover 3' rl' ~-r? ~ Z ~ Zb U S'• ~. SOIL ABSORPTION SYSTEM~Zj ~ a ~ ~3 ~,`rlr~n~~s.p/b BED/TRENCH Width t Length ~ No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ l ~ Z\ ' - SETBACK SYS TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ INFORMATION CHA uNET OR Type Of_ System: ~ ~~/ ~ ~ I ~ Model N mber:`~ / I ~ DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No 0 Yes ~ No COM111~ T ( elude c de Iscrepencies, persons present, etc.) Inspection #1:~~ / tin 2: / / Location: ending -Wild Turkey Trail Hudson, WI 5401 (NW 1l4 SE 1/4 1 9N R19W) upset Hi1{s Lot 7 Pa :11.29.19. 1.) Alt BM Description = ~~ rP _.. ~ ~ 2.) Bldg sewer length = Z~ ~ ~-~_~ ~ ~,r-, p 1~,.~ ( ~ P l6 ~ -amount of cover = I~ n+ ,~'1'"" ~ •" ~ ~G^^ m ~ (gib` Plan revision Required? ~ Yes ~o ~ 2 ~ `~ i ~ Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature ~ ~ -- -~--P~° Nd ~~a y ~ ~~n~ z~~ laso w~-~- ~ ~ alr / /d 5 c~-~ ~~ f ~~ T~ o ~ S w~u~~ ~ ~-~. rr,~-,r. s.. ~ ~ 201 W. Waslti on ~7L.` ~sconsin M~~ gW2t15 ~ ~ Fc Oe artment of Commerce Sanitary Permit Appli do z 4 2004 In accord with Comm 83.21, Wis. Adm. Code, personal ~ ,,ppr~ovide may be usod for secondary purposes Pri IS. ~1~0/X CpU~T 1. Application Information -Please Print All Iafotmati ~ property Owner's Name ~ A County 1 ~ t,"f'"T"R/C' /D.Sol LG--~~'~--/~ .i a Lot K \ Block N IA111116' 11YY^CnIJ .... ~ ~y., y~Sb, Section 1~ Zip Code Phone Number `mil // ~ ~-j ~rcle one) ~.~ . ~~~~ J ! d6 l~ T ~(1`I; R ~ E or W [L Type of Building (check all that apply) ~ Subdivision Name CS ~~ or 2 Family Dwelling - Number of Bedrooms _T b1ic/~Comtnercial-Describe Use ^City ^Vil c ~(' wnship of ^ State Owned -Describe Use III. Type of Permit: (Check only one box oa line A. Complete line B ifapplicable) -- a~ A' New System ^ Replacernertt System ^ Treatmatt/Holding Tank Replaoanatt Only ^ Other Modifiation to Existing System List Previous Permit Number and Date Issued B. ^ Pamir Renewal ^ Permit Revision Change of ^ Permit Transfer to New Before Expiration PI mba Owne IV.1 Ot PV W LJ .~ cm: •,accra au ~uaa ^1 ^ Non -Prcssuriaod_In-Ground ^ Mound >_ 24 is of suitable wil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Singlc Pass Sand Filar Constructed Wetland ^ Pressurized tn~'iround ^ Holding Tank ^ Peat Filter ^ Aerobic Treaattent Unit ^ Recirculating Sand Filter ^ lain) Recirculadng Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less $ pe ( V. Dis tsal/I'reatmentAreer Information: 2 _ ~ Area pro I ertyElevati ~, ~ Desi Flow (gpd) Design Soil Application Rate(gpdsf) rsPa~ ~~ ~ ls~ ~~, / e Q DD ~ 5vK Prefab Site Stcel Fiber I YI. Tank Info Capacity in Total Numbs Manufacture Gallons Gallons of Units oncrete Constnrcted Glass ~'-100 1 up11c err nowmE ^ a11w 1 /JC"'/1) ----- 1 /.7L /l l / 1 liC. VII. Responsibility Statement- i, the aadersigned, assume / / ~ Plamba's gnaturc Yltl. Count ~/De artment Use Onl Sanitary Pemit Fee Approved ^ Di _ Surcharge Fce) , ^ O a~u~r~iGen Reason ial ' IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be servigpc~~~ i~, tail fined as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach I:eAlpkte plam (to the CAanty Derry) fa SBD-6398 (R. 01/03) fort tion of We POWT'S shown oa the attached plans MP RS Number Business Phone Numbe as a 3~~ ~~ - a ~~~ _ < T~ 3) lei ~ s c ~ -~ G~*-'~~ °F' P~l~.~.e~ ~~ S~,t.,.t,1,~ B te.,e ~~ St...-40~ / S ry:tem oa~p~ of tas= tl loeha 1 ize -f,~-s~ area . . ~~ _. .,,. ,: .. N-~~ N6 Asa y Faso w-~-~- ~ ~ 1/~~ ~V S - ~~ 1 = ~.~ ~~ ~~y,i~T a ~ ~~ s ~~-~- ~~ „~~` Ez D~- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of Z FILE INFO~iM ION Owner Permit # 3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~ at/day Design flow (peak-, (Estimated x 1.5) al/day Soil Application Rate gal/da /ft2 Standard Influent/Effluent Quality Mont ly average * Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~-`~~ ^ NA Pump Tank Capacity al A Pump Tank Manufacturer A Pump Manufacturer A Pump Model ~ A Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Cell(s) ~.In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ~ ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ yea~ls~(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) third IY31 of tank volume When combined sludge and scum equals one- ^ NA Inspect dispersal cell(s) At least once every: ~ ^ yea~~C~1s) (Maximum 3 years) l ^ NA Clean effluent filter At least once every: ^monthls) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: monthls) ^ yearlsl ^ NA Flush laterals and pressure test At least once every: ^ earl 1(s1 Y ^ NA other: At least once every: ^monthls) ^ yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any 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) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fatling 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 (Y3) 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 512 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. Page 2 of, START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls? for the presence of painting products or otheP chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls? removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T . (~ alua ' a o Ing ank r/ be ' e al a '~R01-11'8 TC~ ~~2 !~/~1~/ ~NS77z(JC~'l DnJ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ~nr)ITIANAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone ~ ~' ~ Phone SEPTAGE SERVICI G OPERA OR (PUMPER) Name _ o l ~.. ~ Phone LOCAL REGULATORY AUTHORITY Name s-r, ~' l d U ~I ZD/l~l ~tJ Phone ~/S- 3g(o_ (O (7 This document as drafted in compliance with chapter Comm 83.22(2)Ib1111(d1&lf) and 83.54111, 121 & (3-, Wisconsin Administrative Code. Wisconsin D arttinent of Commerce PRIVATE SEWAGE SYSTEM Safety and BLilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO WERMIT7 Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Bast, Kernon City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL DG. Vent to Air Intake ROAD Septic Dosing Aeration Holding ~' PUMP/SIPHON INFORMATION Manufacturer errand PM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to ell SOIL ABSORPTION SYSTEM / ELEVATION DATA county: St. Croix Sanitary Permit No: 453392 0 State Plan ID No: Parcel Tax No: Section/TownlRange/Map No: 11.29.19. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. E3ist. Pipe .'~ Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches P DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/ REAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: ~ UNIT Model Number. DISTRIBUTION SYSTEM '\ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER ~ x Pressure Systems Only xx Mound Or At-Grade Svsterrts Only Depth Over Depth Over xx Depth of xx Seeded/S ded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No -,i ~] Yes ,,~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / \Inspection #2: / / Location: Pending Unknown (NW 1/4 SE 1/4 11 T29N R19W) Sunset Hills Lot 7 Parcel No: 11.29.19. 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ~-, Yes [] No r~ j I~ ~ ~ ~~ Use other side for additional information. ~ j i __ _ ~ ~_ _. _._. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. c N p n to p g v n ~ f o d f G °; .. ~ ~ ~ ~ w ~ 3 ~ ~: ~ ~ 3 3 ~ ,~ ~ ~ Z Z m O A ~ (A T. T. N O O A W ~ 1 ,= _ ~ N O O a a lA CS m ~ W ~ N ~ ~ S~ ~ o < < a ~ C m ~ W N =' p_ o N O co N (D 7 N fD o . ~ C ~ ~ ,n ~ ~' ~ ~ (D A CT vi = N D, cfz N N cn j~ j' fD n j I ° ~ C? O G ~ N 01 G C CD n j ~ 7 N v OD p a a o 7 d! ~ ~~ J ~ a J H ~ C°71 ~ 0 O .N. N c A N H m ~ A ~~. r p m r m ~~ D N a N CD r d N z Co ~ m ~ _ `c ° W ~ I . o ~ °w I ~ ~ ~ ~ ~ v '~~ o ~ ~~ a ' it ~r a a n m ~ " m ~ ~ o. n o ~ .. ~ m ~ ~ ~ "D ~ ~ ~ ~ ~ C ~_ ~ ~ ~ ~ E I v (n n G /i f y N A ~ ~° °' ~ ~ f A N N ° G N ~ vq N ~ d 'O O W ~ d '6 = 7 ~ ~ N N a y N N 3 ° ' ~ N 3 °1 7 ~ a ~ M Z .. Z ~' ao o ° _; D -'_n o O ' ~ ~ w r. N m ~ N N ~- ~ N ~ N N y ~ CD y. fD ~ N ~ ~ ~ ~ s ~ ~ ~ co ~ N TJ G m _ C N' 3 ~ ~ ~ ~ ~ a z o~Drn a = ~ ~ ~ ~ ~_ A ~ ~ Z y D o p .ao u, 3~ T a i ~ y o ~' m a ~ , z o m ~ ~ N ~ p o > ~~ j ~ ~ N ~ N ~ ~ ~ z ! ~ -I m ~' a ~ 3 ~ n c .m ~ a ~ 3 ~ a Z 0 ~ 0 ~ N m ~ N Z ~ ~ ', fD A F 7 a ~ A N A O n~ Cn D ~ 7 W S f7 N 7 N C ~ 0 f.+ ~ N d O' ~~a O. ~ n 0 W ~ a.av,c ~~ d r, C7 ~ ~ ~ N y ~~ . m ~ ~ N a ~ O ~ fD ' p ~ ~ G i 'J C ~ 'S Q O j (D 7 v ~ T tQ G fD v CD ~ Z a I m ~ ~N ~ m o a G 7 m O ~ ~ •T -I O. fp (p ~ m cno-o a f m ~_ Q f ~ w D ao m cmi .~. 3 N c ~ ' i fD fD .0~. S ~ 7 fD ~. O O 'D ~ ~ f!~ N O N O N a ~ m m ~ w 3. ~ ~ v o ,~ am ~ v o ~. O- A ~ S S Q.'~O m fD ~O ~ O N ~ ~ N ~ N Q CD fD D . O " A N < ~ 0 7 .~. ~ ~ O j O 3 7 !A O • ro m ~ O v> O o ~ o g o ~- °o ~- Parcel #: 020-1445-07-000 os/2~/200 08:33 AM PAGE 1 OF 1 Alt. Parcel #: 11.29.19.2828 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/15/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -HARTINGER, DANNY G & CYNTHIA L DANNY G & CYNTHIA L HARTINGER 1054 LABARGE RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description " 1054 LABARGE RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.540 Plat: 10/15-SUNSET HILLS 020/04 LOTS 1/10 SEC 11 T29N R19W PT NW SE SUNSET HILLS Block/Condo Bldg: LOT 07 ' 04 LOT 7 (2.54AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 11-29N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 06/16/2006 827604 WD 11 /08/2004 779188 2691 / 11 EZ-U 09/22/2004 774960 2660/417 EZ-I 07/15/2004 768925 10/15 PLAT ~nn7 ci innMeRV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class RESIDENTIAL G1 Acres 2.540 Last Changed: 05/30/2006 Land Improve Total State Reason 77,200 222,600 299,800 NO Totals for 2007: General Property 2.540 77,200 222,600 299,800 Woodland 0.000 0 0 Totals for 2006: General Property 2.540 77,200 222,600 299,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 ~• ~~~ - Safety and Buildings Division County ~ ~~ 201 W. Washington Ave., P.n. Box 7162 , I S~O~SIII Madison, WI 53707 - 7 Sanitazy Permit Number (to be filled in by Co.) (608) 266-3151 t~S3 3 `j Z De artment of Commerce Sanitary Permit Application S~~ Plan I.D. Ntunber rovide l i f ti d W C on you p n orma e, persona o In accord with Comm 83.21, u. Adm Project Address (f di an mailing address) maybe used for sor~ttdary Purposes Privacy Law~s13.A4(i)~m)w, .,,:_... ,:......,..~.. ~ ' ~ _.. ... __ . L Application Information -Please Print All Information r Property Owner's Name u ..._ a, ;~~ ' ~J p1 # Lot #t Block # v J Property Owner's ' ing Address /~ ~ ~ v ,; r , i ,~y_ ` Ali ' n 56.~JJr 44, S~tion ~_ City, State T`.tp Gode l f ,, Phone Number T ~ N: RL_LE r W W li "° "` at app II. Type of Building ( all y) ,) °'d ~ ~ `- Subdivision Name CSM Number ~ xl or 2 Family Dwelling - of Bedrooms ~' PublidCommusial -Describe 3 K _~ City_ Yulage waship of star ovv,red - ~~ Use ,o III. T ype of Permit: (Check ody one online A. Complete line B if applicab A' ~(ew System Replaceatent Trrauaent/Holdttg Tack R t Only M n ao Existutg System Lut ~ 't Number and B. Permit Renewal Permit Revision Change of 't 7'cansf to Before Expiration umber IV S m: (Check all that a 1 ressurized Tn-Ground Mound _> 24 in. of suitable so M < Z4 is of sui 14 Single Filter Constructed Wedand Pressurized Lt-Ground Holding Tank Floer A re T t t ecirwlating doer / IZ Synthetic Media Fil Chamber Dri Gravel-less Pi ~-) L Y. Di tment Area Info d) Design Soii Application Rate(gpdsf) Area (af) Dispersal Area Proposed (sf) S ~ Des Flow ( `` ~~ ~~V ~ ~ Taiok jp fo Capacity in Total Nu Mano Gallons Gallons of U ~,,-'~a,Q~,~ ~ _~ ~ Pr+~b Si S Fber Concrete Glass New P.usdog Tanks Taoks Sep6ra Holdog Tank ~ Z Aerobic Tnxtment Unit Dosing GaunTber YII. Res Onalblli Statement I, the and a tssibillty for lastallatton of the 1'O shown oa the attach u B s ~Plu~` s Naate (Print) Plu MP/MPRS Nu ~ tneas u /) // tate.?ip Plumber's A (S~. ~ty, S ' ` ~ ` ~ , f J ` J T 7 l./ / g ~ ( ~ t Use O rtmen VIII. Coun /De Sanitary Permit Fee ('utclndes Groundwater Date Issued Signature (No tamps) Approved Disapproved Surcharge Fee) ~ ~ ~_ ~ P Owner Given Reason for Denial I7C. Conditions of Approval/Reasoasfcr Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. dfA t~''1 .r ~- Attach complete pleas (to the County only) [or the system on paper not less than 8111 x 11 Inches is size PLOT PLAN PROJECT Kernon Bast ~ DDRESS 948 Labarge Rd. Hudson Wi 54016 NW i/a SE i/as 11 /T 29 v/ w TowN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 7,9/04 BEDROOM 4 CONVENTIONAL XXX IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # chambers 28 ,BENCHMARK V.R.P. Top of survey iron ~ g~,~ ~ ASSUME ELEVATION 100' Filter Z 1 A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 98.6/98.0 5'below qr e setbacks required by Plans Designed Using WDNR Conventional Powts Manual Version 2.0 Alterna Benchmark Top of 1/2" iron pipe @ 104.1' ------ ' B.M. 20' Surve Iron found 0' B-1 ,}. 512' Prouerty Line 9% Slope ~ Alt. B.M. 20' 1' >6" of Cover 20, O1' 0' 10' _3 10 Drainage easement ~On~ B ar4oom Scale is 1" House unless otherwise noted Vent dard Biodiffuser hing Chamber 31.1 ft2 of Area Wild Tur14~y Trail ~erS 6' Long 11 " Grade at System Elevation -~- Wisconsin Department of Commerce SOIL EVALIJATI01~ REPORT Page of Division ofSafety and Buildings f .~ ~ 1fl m accoraance wan ~,omm a~, vvis. ~r~ea ~ -- County ~ J Pla Attach com lete site lan on er not less than 8 1/2 x 11 inches in size a , p . p p p indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all inform fo~n ~rM ~~~~ s {r~~ F ~ ~ ~ ~' ~ ~ '' Re 'wed by Date h . ~ Personal irHorrnation you provide may be used for secondary urposes (Pnvacy Law, s. 15.04 (1) (m)) ~ ~J ~ 9 1.C1 u Property Owner ~f J ~J L 1 Pr//o'fll ()~ Loca 'on ~/ E W ~~ Q /. y~~ T N R (o GtSvt. lot 1 /4J 1 /4 S Property is Maili ddr ~, ~~ if.. tif~t #y ~ Bi # ~' ' Subd. Name or CSM# ~ ~ ~' ~i~~~l ai,~ ,r- ;i ~l ~, City State Zi ode Phone N '°"" City Vill a Town Neare Road / // New Construction Us esidential I Number of bedrooms Code derived design flow rate GPD i~ ^ Replacement ~J, ^ Public or merdal -Describe: ________ ___ __- Parent material /~~~~ .ll ~ Flood Plain elevation if applicable ~ l~ ft. General comments ,- ~ ~ ~ Q ~ J (] Q /'~ and recommendation~~i/ ~~j,~ ~L~i~~4if/~' `~ ~U ~ (/ l U ~ V Boring # ^ Boring ` Pit Ground surface elev.~_ ft. pepth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texlure Structure Consistence Boundary Roots GP D/Ftz in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 ~ D"Z s z ~-" ~ ~ - J ~ _3 ~~ /~ ig - -7 / Pit Ground surface elev ~ Depth to limiting factor/~in. ~~ # ~~n~ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I - 3~z s ,'^ ~ - ~ 2 t - ~ s- ~ i ~ , ~ I l~ wt 9~ ~ Go ~~ • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 1 ` Emuent #2 = BUU < su nlg/L an0 i ~ < 3U mg/L CST Nartte {Please Print) to CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conduc ed Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ ://~-~ U 715-246-4516 Property Owner _ ~ Parcel ID # Page of a Boring # ^ Boring ``~~ it Ground surface elev. I " ` ft. Depth to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 _G~ ~ ~ 'y q .rte Go ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cdor Redox Desciption. Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BODE > 30 < 220 mgll. and TSS >30 < 150 mgll. 'Effluent #2 = BODS < 30 mglL and TSS < 30 mglL 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. sao-eaw ee.~oot t ~ ~~ ~ Soil Test Plot Pla Project Name Kernon Bast ~ Sh n B'rd Address 948 Labarge Rd. Hudson Wi 54016 M #226900 Lot ~ Subdivision Sunset Hills Date 7/11 /04 N W 1/4 SE 1/4S 11 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 98.6/98.0 *HRpSameasBenchmark Alternate Benchmark Top of 1/2" iron pipe @ 104.1' 200' B.M. 512' Pr 20' ~Surve ron found B-2 60' 0' B-1 9% Slope It ~ 20' 101' B.M. 10' 10' B_3 103' Drainage easement Scale is 1" = 40' 1 ~ unless otherwise ~perty ie noted Line Wild Turkey Trail Maintenance and Contingency Plan for a Septic System Maintenance Plan d once eve 3 ears. 1. Septic T~~nk is to be pumps rY Y 2. Effluent fitter is to be cleaned once a year. Please note: a larger filter is being installed in order to extE~nd the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner ac,rees to limit greases, garbage, and water conditioner discharge into the system. 5. The ownf~r agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. WatershE3d is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 tinge cy Plan Option #1 If system #ails, determine cause of failure, use alternate area and install new in tested replacement area.. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. PJo adequate area, is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace ,any other failing components as needed. Plumber: :~haun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper T~~m Mondor 715-246-5148 N Shaun Bircl #226900 ST CROIX COUN'T'Y . ~ ~ SEPTIC T~-NK ~INTENANCE AGREEMENT" " ,p,ND• " p~Jg~SHIP CERTIFICATION FORM ~ ,-, (e~~,~ rrs i ,` OwnerBuYef ~ J ~ ~ ~T ~ L Z ~a- /DSO c._ f3~i. `~' ~ . Mailing Address _ ~~ Property Address artment for new construction) ~~ ~~---- (Verification required from Planning Dep parcel Identification Number City/State LEGAL DESCRIPTION ~ % / Properly Location f~ Subdivision _ ~_ ~~ Town of ~''f ,Lot # ~ r Certified Survey Map # ~- -' `./ Volume ~ . "Page # Volume _. Page # Warranty Deed # Spec hous~eS ~ no Lot lines identifiabl s ^ no SY57'EM MAINTENANCE remature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system could result in its p ou ut into the system ears or sooner, if needed by a licensed pumper. What Y P consists of pumping out the septic tank every ~~ Y osal s stem. can affect the function of the septic tank as a treatment stage in the waste disp Y ~ by the owner and by a owner agrees to submit to St. Croix Zoning Department a certification forrn, sign The property erverifying that (1) the on-site wastewaterdisposal system masterplumber, journeymanPlumber, restrictedplumber or a licensedpumP the septic tank is less than 1/3 full of sludge. ction and pumping (~ necessary), is in proper operating condition and/or (2) after inspe ee to maintain the Private sewage disposal system with the standards Uwe, the undersigned have read the above requirements and agr t of Commerce and the Department of Natural Resources, State of Zoning Office wi Rhin 30 set forth, herein, as set by the Deparmmen leted and returned to the St. Croix County stating that your septic system has been maintained must be comp days of the three ear expiration date. S ~~ ~ ~ ~/ _ DATE SiGNA =- OF APPLICANT OWNER CERTIFICATION our' laiowledge. I (we) am (are) the owner(s) of I (we) certify that all statements oa this form are true to the best of my ( ~ described above, by virtue of a yrarranty deed recorded in Register of Deeds Office. the property S ~ ~~ DAT SIGNATURE OF APPLICANT ****„* An information that is mis-rtpresented may result in the sanitary permit being revoked by the Zoning Department. #***** y ** Include with this application: a stamped warranty deed from the Regeferencelis madeffm the warranty deed a copy of the certified survey map w RIECEIV DE ~~ I..~Se< ~ `~ s6'~e • `~~ lam. ~ ~ 3 JAN 0-9 ZO~bI~ ~ALUATION REPORT ~ Division of sand Brr ~_ ~..~ ..~. s. ~ - ST GiPo~ ~ Attac~r c~npete site pan «~ flot ier~ elre size. Plan rr i~,de. bcR not rimed to: vr;ttigi tai reference aoir-t {et4t). din~tion aril . Peroent slope. scale orrS~rrfautiorts. nartlt grow, grid ior~tion and to n~rest road. p~ ip, 0 2 0 • io/3.70 • e~aa Phase print all information. Reviewed by Dose PsROipi kao~etloa you provide n+ey e . us e~ torsa~oa~d~ry vur1~ t~~Y ta~v. s. tso~t 4~) E~~ / G //~'N ,~A"L~`/~/ !1/ - ~ Caa+R. Lot 1i4 s~ 114 S` /, T Z~ N R j~ 'E{orj W Y ~ $ /Wd-ess G~ • T~`I'~ivE dot # Bfodc # Subd. Name a CSk~ SvNSG-T' ff-~!S /' f UD.Sa ~ ~ ~' c«!e Phone Number /u/. 5 yo/G 7/S 38h • 9~S O ~y ~ .Town Nearest aosd ~a,v T,~,~,Ey ,~,v . ~~ con~uc4on use: ~ R / Number of bedrooms - code derived design now rate ~' "' t?a coo D Reptaoerrre~rx Q Public or ooninrerci~ - Desalbe: l -S~D~L~T/~14.~ ~. f=lood Plain elarati~on if app>icabie /V ~. Gerrerat oomitrents and ' ~IPE~- T~'sT~a sv.•T%9~/3GE ,Foie •tv /~v y/c'OV.~o ,~ C3 o. a- y l - . pd C~nund surfao9 fir. ~ ~ _ tt. Dept, to Tag factor ~ ~a ir,, sw Rye Horizon Oeplh Oa~rrrisrarrt Redorc Description Texture Stnx~ra Corrsistenoe 8ounday Roots lrr. Qu. SL Cant. Color Qr. Sz. Sh. 'iJf1E1 'E!T#2 ~ o - r, /D yie 3~ ----- G 2 f ,~ ~~ti 3 • ,~ • S z ~ • ~ s - S/L fs c2 / ~ • z • 3 •3 7•s s vt / ~ S D~ a2~ cs -- . 7 t• Z /D 7 S O / ~~ ~ ~ Z ,~ .-,~ .~...~~a...~.,a~.. .~ ~„~.~.~~.~.~ ,~. sai Race Horizon DeP~ tlorrlir{eflt Redox Damon Texture 31rrrC1llrE Gorasoe Boundary Rods GP DH! ~ Qu. Sz. Cont. Cdor Gr: Sz. Sh. '@~tt 'EiTp2 3 Z ~o ~ s o . .~ ~ ~. ~ [1Ruerk ~'! = 80D > 30 < 220 moll and T5S >30 < 1 50 rml[_ • E>iVssnt !r2 a R[]t) c ~ .ned! 9rhi'iS:S t Aff •.rs11 . ter ~ ~ 7~1-13~t'i GGaT' ( Z. ~. c3sr~s ~ naiB Evafira6on Corxitro~d Telephone Number oa.._~_ ~ Associates • •~.a~C Jewage Consultants 2812 10th Ave. SP~+ng Valley, WI 54767 Measurements noted on CST's plot plan may not be accurate, as some --. t. ~~~fiN l~'R1~-e~ ~~ $vvS~ ~ Milli M oao-l6~3. 70 • ts~ ~ ~ ~ • ~~ ~•o t ~ 7 ~ 2- ~ 3 ~ ' J ~ $ ~ " GD >/ ~ ~. ~ c~,. sZ c~c. c ~ s~. sn. -~ -~ ! ° '/~ /D ~ L /~s,b,~ .~,. fib 3 f • ~' ~Z / /D ~--- S/L / f s U 3 d•S /0 ~ ~ ez~ moors ~lcL /fS~,~~ :~1n c -- . z :3 s y~ ~G C~,~ ~~ (^-~ .~ LI p1~ f'ts IQt~ StB~ ~@Y. ~. (2 ~6 Cpl' ~f7. Soft Race Etorixon t7e~tle ©ort tiedox Uesatp~oc~ Textt~e Sba~e Cooe ~Y im, #~lta~ t1u. S`~ t.~Oat. Catrx csx. Sz Sh. i t,~ Cua~cxxta~f~etav. #1. t3epfiEo €aotor ht. ~ ~ ' ~lortmn t7e~t ~ Rzdaoc Don_ Tie ~ ~ q+.. fi~uweR clu. Sz Oont. Coto . S`t. Sh. "t~f 't3~2 ~9 _ ~ ~ t~rocaK! slaYace elegy ~ t+ ~a !ate Sod Rate F~ottaoa flepth Llo[+Y Redaoc - Text~tne ire ~ 9oemd~y Rock t~[tAF i its. t+kunse~ EItL 52. Coat. Gt ~. ~+. '~i i i • Ettit~st #t = t3t7Ba > 30 < 7Z0 ax~L. atu# tuS >30 < i50 mgtt_ #2 = t3t3D6 <_ 3t1 tnglt, aid T5S < ~ mgt. L~~ I\ For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 2812 10th Ave. Spring Valley, WI 54767 715-772-3442 ~i ' . = ~.rc~~,,e ~°~'rs ~, = Gr~.v ~nv/~ 5 :----- od~l i ~-- d _- ,6, ~~ sir: T°~ o~ / ~~ s~~,c. /°i~,~t 98- Ya- ___----- ~~5 LD~ ~~~~ T~ ~ ~ ,~ ~M~~~o~Y /5f~~~~ ~~ o ~-- /o ~~ r - 9 y, o d r q~ ~-~ yo' ~ , .`vi.~0 ~ , . q g,~ _----- nor -~-~ s Zoo I, `a~ t~ ` ~ . PLO LAN PROJECT Kernon Bast' RESS 948 LaBarae Rd Hudson Wi 54016 NW 1/4 SE 1/4S 11 /T 29 N/ 9 W WN Hudson COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE5/10/04 BEDROOM 4 CONVENTIONAL XX)C IN-GROUND P SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28 ,BENCHMARK V.R.P. Top Of Steel Pipe ASSUME ELEVATION 100' Filter Za A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION y4.Fi/y4.U 5' belOW ~ Pro 4 Bedroom House 25' T 10' 30' 5% Slo Vent >6„ Standard Biodiffuser of Cover I-eaching Chamber with 31.1 ft2 of Ar 6' Long 111 " at B-3 ~- 2-3' X 88' Spacing '~ 58' Vents .M. #2 B-2 16'_ Top of 1/2" Steel Pioe @ >3' ~~ 1 Plans gned U Conventional Powt Manual Version 2.0 14' ! 1 ` ' Coltory f . Safery and Buildings Division ~-. ~ tt'~ i ZO 1 W. W asbingtO° Ave., P.O. Box 7082 Sanitary Pemit Numbs (~ be 5llad is by Co.) ~~~~ Madison, WI 53747 - 7082 ~S~O (608) 261.b546 State plea LD. Number Department of Commerce li~$tjO11 Sanitary Permit App on ou provide ~f different than 'ling addrssa) °al iafota~ Y Project Address (• to accord with Comm 83.21, ~Yis. Ad:tt- C ~ ~ i,aw, al S.OdU Km) ~~ ~'D n,,,y ~ used for ~condaty p~ ~ ~ Black ~ t. Appuudoa Iaformatioa -Please Print All Information _. y __ parcel # ,...~. PropeRy Owttar s K me ~ i Pro • Location pro Oda s ailing ~~ -1~.- i.~ ~., Suction Pte' C~ Zip C e ~ ONiNG OFFICE ("r` OD Ci State ` O E t Vv' J M Numbs $ubdlySiOD IImE / / / /~ II. Ype otBulltiln8 Ct:heelc all stn spp1Y) ~ ! ~~ ~ tor2FamityDwellinL-NusaberofH ~Vi13a ownsbipof ~Cily ^ publidCatnmercisl- Describe Usc D state Awned - Desa+~ Use p Uesble) - Cheek Daly ones boz oa llne Complete line B if a p ~ O tIL Type of Permit: ( ent thiY the Modification to Existing SYatent T' tmentlHoldiag 7aalc Replacem -"~-'l~. A• New Sys[am ~ RaPliGemeOT System t previous P uasbe sad THte Issti [] pewit Traasfu to New' ^ Change o Owner ~ H. Q pest ~~ Q permit Rev.sion plumber ustioa ~ ~ Sefoee Exp' a Pass Sand Filter ~~e V Sind ^ Iy, a Of PQ S stem: Check all that ~ i table soi] ^ Mound < 2 ~ . ofsuitable so' ,xu~ og sand Filter 14 in. Of sui Aerobic peat Uait utiud in-Ground ^ Mound _ Non-Press ~ zouad CJ Holdia8 T~ ^ p°at Filter ~pther (explain . Conseruetad Waiand ^ prefisuri2ed [] Dri Line ^ Crravel-less .~ Chamber ~ (sf) Elevaa Raciratlstia S etic Media Filte ~pusal Area 9~~ (ft1 is ~~ I(/p0 V. DL trsal/Trsatme~nt ~ Soi1 PPh~aa ~~~~ ~~~ ~ Fiber PL D~ ow (SPd) Ca Glass ~~Q ~ ~ Number Man to ~ Capacity is Total VL Taak Info Gallons Gallons of Units a -----~"^- the unaers ... -__- y~, Rsapomtbill Statement- I, pitunb SisSa+cure Plumb¢'s t'~amc (Print) s Addrss (Stree4 Ciry• State. Zlp c) Plumber' r~~ /~h n--Y~ ~~-/D s.Rmeat YJse Onl ~,~! sang ^ Approved Q DimPPro``~ Sutt Q Qwncr Given Reason for Dettialp royal IX. Coalitions of ApprovaURes<s°ns for visa p tastallatloa of the PO ` , ess Pho~ ,,,ry ~ A~ lrumbec ~ ~ ~ ,~ (/~ ~` J w ;1 plans (te tYc Fee) tot kff than i1R :I1 lsctut to fist syftem es p+tPe i.~n_~Z4R (R. 0$1021