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HomeMy WebLinkAbout020-1378-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 567245 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Porter, Tim & Deb Hudson, Town of 020-1378-13-000 CST BM Elev: Insp. BM Elev: BM De riptiop: Section/Town/Range/Map No: Z w b Z.^ 12.29.19.2352 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z,LJ Dosing ! b Y%) Alt. BM Aeration 1• Bldg. Sewer Holding St/Ht Inlet / -J St/Ht Outlet G~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD artniet ~ tnv Septic Dt-B'bttom of ~ • 0 Dosing der/ a an. S,93 Aeration Dist. Pipe V cli cv~ ';t "7~ (p Holding Bot. System > 1 " V1 Final Grade PUMP/SIPHON INFORMATION COO V 14---,~~~~L -,.S-~e-mS~~ c~D Manufacturer Demand St Cover GPM ~ ✓15rC vs Model Number TDH Lift Friction Loss System H TFt Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM et,) ' c 'd i - 73 c, ' v '1t~e~vt,i BEDITRENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM (LEACHING Manufae Y r INFORMATION MB T ,pg Of System: I ; L-)f > ts '71> UNIT Model Number: t ~y f 'Y~ cc DISTRk,BUTION SYSTEM / A O~.,ti- eader anifold stri ution / x Hole Size x Hole Spacing Vent Air Intake I Pipe(s) ~j (4 i+1A _ S Length Dia L Length v Dia Spacing SOIL COVER / t t~ f yt~ Pressure Systems Only xx Mound Or At-Grade Systems Only L,7 10 .0 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Depth Over Bed/Trench Center 1 / t v, Bed/Trench Edges Topsoil Yes No Yes 0 No COMMENTS: (Include c de discrepencies, persons present, etc.) Inspection #1: 1 Inspection #2: / / Location: 1053 Moonbeam Road Hudson, WI 54016 (NW 1/4 SE 1/4 12 T29N R1 9W) Moonbeamh Ridge Lot 13 Parcel No: 12.29.19.2352 1.) Alt BM Description 2.) Bldg Sewer length = /V/~ -F"^/ ✓ J - amount of cover = Plan revision Required? Yes No qg~~e Use other side for additional information. Date Insepctors SCert. No. SBD-6710 (R.3/97) ~ Soil eda/c~i~'on /oi E 3 /z , /6 ® CXiSZ~%nc~ ~ yu cue C k6,L 5 Cale. / Ste, ~w'~13-/ 4~ be 6 14"'46"- 1063 /110"1 Beall "00/- L-)( Son, , SS/O/6 L.a t /3, P/~o,~jrteon -e 0 ,Q; c5 C, /J GVl' Sys; 5 eC' /1 bozo - /378 -/3 --ccG (Ze-//. -l rlC (Z) 6-7 ok--a e~ .ms s 5 /o/~e f~ r aw l S ys-~ti» area, elev! ~ 6e = 9i! .~O' a2 ~-cnr~t a ~ ~,'t- 93.7s'w/ 2.i+ ~YEra-zip "C ~;ytl dG~ so. ce cle✓= 9s! /0/7/' Z\ r%l ri!'ayC: aev< ~Ca 05cd QS'~(Z~ t,f'i3ti' uiU~=f'JiU» ~uc • at e/ ~~✓~t aFo~.tletP, .a0 - . ~P/ BO't~CiM O Sid: . f~ssarxe..~l elegy/,' ~cwe-d ~a~.ar1 ; 24 1')GVn 6(2a n ~'Q(ICA,.~ c~ ra Sses RO a~ ~M DIY ~y~ar County Safety and Buildings Division St. Croix $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) pa; Madison, WI 53707-7162 Permit Application State Transaction Number In accordance S .21 is. Adm. Code, submission of this fonn to the appropriate governmental unit Na is required pn tain' sanitary permit. Note: Application forms for state-owned POWTS are s 'tted to Project Address (if different than mailing address) the DeparUnent afc and Professional Services. Personal information you provide may be used for , purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. Ab~e 1. Application Information - Please Print All Information , Property Owner's Name Paz # Tim & Deb Porter 411 ' 020-1378-13-000 Property Owner's Mailing Address ,CC7(~j~T Properly Location ( Z 1053 Moonbeam Road Govt. Lot ` City, state Zip Code Phone Number NW SE Section 12 (circle one) Hu n, W1 54016 715 386-3487 T 29 N; R 19 E or W II. ype of Building (check all that apply) Lot # 79 1 or 2 Family Dwelling - Number of Bedrooms 4 13 Subdivision Name Block # Plat of Moonbeam Ridge ❑ Public/Commercial -Describe Use Na ❑ City of Q State Owned - Describe Use CSM Number ❑ 7oagef of Na3 n o-Hudson III. Type of Permit: (Check o yon , o A. Complete line B if applicable) A. ❑ New System Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ' Issu B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Be re Expiration Owner 3 . ZQO IV. T of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component en ice (explain)__ V. Dispersal/Treatment Area Information 601nfiltrator "Q-4 Plus" Standard chambers & 6 endea s, Existing Zabel 100A effluent filter Design Flow (gpd) Design Soil Application 600 Gpd 0.5 Gpd/Sq. Ft. 1,200.00 sq. ft. 1,230.60 Sq. Ft. 94.50' VI. Tank Info Capacity in Total # of Manufacturer „ Gallons Gallons Units U° y New Tanks Existing Tanks V in v vi w G7 0. Septic or Holding Tank 1,200 1,200 1 Wieser Concrete X Dosing Chamber VII. Responsibility Statement- I, the anders ed, ass a responsibility for installs of the POWTS shown on the attached plans. Plumber's Name (Print) lumber's ignature MP/MPRS Number Business Phone Number James K. Thom son MPRS 30021 715 248-776? Plumber's Address (Street, City, State, Zip Cod 340 Paulson Lake Lane, Osceola, WI 54020 VII oun epartment Use Only Permit Fee a0 Date Issued !suing; Agent ign Approved oo, ❑ Disapproved d ❑ Owner Given Reason for Denial $ 19/2 A u~+ IX• Conditions of Approval/Reasons for Disapproval r l4-C, r 441 • Cn V _ h.,J SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be_ser_iced /-maintained Z~ as per management plan provided by plumber. Flo! 4~210 2. All setback requirements must be maintained l- a r i b f tins for the system and submit to the County only on paper not less than 81/1 x 11 inches is size . SBD-6398 (R 11/11) Conventional F©WTS Index & Tilte Sheet Project Name: Porter 4 bedroom Replacement Conventional POWTS Owners Name: Tim & Deb Porter Owner's adress: 1053 Moonbeam Rd., Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 13, Plat of Moonbeam Ridge Legal Description: NW1/4 SE1/4, Sec. 12, T.29N., R. 19W., Tn. of Hudson, St. Croix Co., Wl. Parcel ID 020-1378-13-000 Page I Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Certification for Utilization of existing septic tank Page 7 Parcel map Page 8 Waranty Deed Attachments: Soil Evaluaiton Report Mater Pl ber Resttpcted Service: James K. Thompson, DSPS Credential #30021 I Signature: `r - Date:CC4-►~~~~~3 Page 1 Of 8 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.0Il01) ■ Soi/ e~a/lic~l~n poi S ~i/e• / s4~. 1063 r~?cv~ beam ,Pa/. 0 /_i~5'C, /Ic(vf/~i~5~ .5 CC. 5e. &o;,r ('o., LO I. 1, ~o-zo - i.378 -13 -oco iE no w/'ee,a.6/e . E~~e~. ~'~~'/fia~i✓e 5 ~~~'ae~, S/ape tJ.roc,~~~ ar e~i. glee bz = kS! so' 32 5Y5 Al, z c"c "SideWirtcL~/ e%wo 3~ Fn r /try b ~~so-. ce ele✓ = 95! ioi 7s1' N ~ar-QyL d~~ ~ 4sP/.4Cf Pr~po7~d afr~u~way ~•o ~Ci~;~ ~a e- KEsia/~xCE • ar o io% yrr E,YiS fi~ Ey; s E;u.',-e~ er ~,cr~x zoo Sr..P, 5/d, 7. fissu~,ced e ~e~! `w ~qwn ~~cvr?bea"n 4"il oc~~aSSeS ~oad l~a.zof'8 PORTER DISPERSAL CELL SIZING CALCULATIONS 1. (4 bedroomsx 100 gallons estimated flowx 1.5 design factor) = 600.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.5gvgYm. ft. 3. Absorption area required: 1204;00 M, ft_ 4. Absorption area as proposed: 1.230.60 sq. ft. (60chambers total) Infiltrator "Quick 4 Plus'= 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft. EISA 1,200.00 sq. ft. - (6 endcapsx5.10) =1,169.40 sq. ft. 1,169.40 sq. ft./20.00 = 58.47 chambers required Number of trenches: 3 @ 20 chambers per trench Trench width: 2,83' Trench length: 82.00' Trench spacing: 9.00' on center Total system area w/ 9' center spacing: 21.00'x 83.00' Pg. 3 of 8 Soil Absorption System Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 95.5 ft f Leaching Chamber 9~ft System Elevation ft ft ft Soil Absorption System Plan View 83 ft 2, 8 ft (P ft Leaching Trench 1 Chambers [Ell Mimi 111111111111111111111111111111111111111111111111111111111111 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model 7nj,~/ EISA Rating -2d.0 sq ft per chamber Soil Application Rate o. S gpd/sq ft 6 gpd Design Flow - O, 5- Soil Application Rate 2-0.y EISA = 59 Chambers 3 rows of ,ZO chambers each. Page of Operation and Maintenance of Conventional Septic Systems Septic systems have two primary functions - to clean domestic wastewater and to dispose of it. A properly designed and installed system should provide many years of use, but like anything, septic systems have limitations. Even the best system will fail over time and will fail prematurely if used improperly. Septic systems are biological systems that depend on beneficial bacteria to breakdown and digest waste materials while removing harmful bacteria and viruses. Only bio-degradable wastes should enter the system - it is not designed not intended to be a dumping station for the things that you do not know what else to do with! Do not put synthetic materials into the system! As soap, grease, oil, food waste, fecal matter and other solid wastes are flushed down the drain, they enter the septic tank and are retained there. The liquid effluent passes through to the pump chamber and is then pumped (dosed) into a drainfield where it is purified as it filters through the underlying soil. Over time, solids that are carried through the tank, dead bacteria and slime-mold clog the soil under the drainfield and limit its permeability. Eventually this clogging becomes so thick that the system will no longer drain properly, resulting in a discharge of sewage effluent to the ground surface or a backup into the house. Careful use and periodic maintenance can help insure a longer system life. To help nroloye the systems life, keep these thinss in mind System Use ■ Minimize the amount of wastewater that enters the system. Practice water conservation - i.e. turn off the faucet while brushing your teeth. Repair or replace leaking fixtures with water conserving fixtures, reduce shower times, wash dishes only when there is a full load, etc. Do not allow water softener, air conditioner, dehumidifier or high efficiency furnace discharges to enter the system. • Spread out water use. Do a few loads of laundry a day rather than doing many loads in one day. Use a front-loading washing machine or one with a suds-saver feature. Use liquid laundry soaps. ■ Limit the amount of household cleaners, degreasers, disinfectants, etc. that enter the system. Do not use automatic toilet bowl cleaners or drain cleaners. ■ Do not allow paints, solvents, thinners, pesticides, poisons, acids, etc. to enter the system. ■ Do not put synthetic materials into the system, i.e. paper toweling, feminine hygiene products, disposable baby wipes, diapers, cigarette butts, condoms, etc. • Do not use a garbage disposal. Do not put food waste, coffee grounds, grease or oil down the drain. ■ Biological or chemical septic tank additives should not be used - they can actually harm the system. ■ Trees or shrubs should not be planted directly on the drainfield. ■ Traffic over the system (other than mowing) from automobiles, motorcycles, snowmobiles, etc. should be avoided. Soil compaction above the system will hinder aeration within the system and limit evaporation out of it. Traffic areas also increase frost penetration and can lead to freeze-ups. System Maintenance • The operating condition of the septic tank and pump tank should be assessed every two years (code requires a 3 year maximum maintenance cycle) by a certified sanitary waste hauler. The contents of the septic tank and pump chamber should be pumped out and disposed of at that time. ■ Septic and pump tank openings should be inspected for water tightness and soundness. Any opening deemed unsound, defective, or subject to failure should be replaced. Exposed openings need to be secured by a locking device to prevent accidental or unauthorized entry into the tanks. No one should ever enter a septic tank or pump tank without proper breathing apparatus, as dangerous gases may be present that can cause death, ■ The filter at the outlet of the septic tank should be cleaned yearly or as necessary to ensure proper operation. • All switches, alarms, and pumps should be tested to verify proper operation. • Observation pipes within the drainfield should be checked for effluent ponding. Ponding levels above 6 inches indicate an impending hydraulic failure and require more frequent monitoring. If the septic tank, pump tank, or any of their components become defective they should be repaired or replaced. Defective pumps, pump controls, alarms or related wiring should be immediately repaired or replaced with a component of equal performance. If the system fails to accept wastewater or begins to discharge wastewater to the surface, the drainfield should be replaced. Questions on the installation, operation or maintenance of the septic system should be directed to A.C.E. Soil & Site Evaluations (System installer) at (7I5) 248-7767. S°,(6 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address 1053 Moonbeam Road, Hudson, Wl 54016 located at: NW '/a, SE V4, Section 12 , Town 28 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service October 3, 2013 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,200 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete ge o ank (if known): 12 years, installed 7/17/01 Permit umber if known 384286 James K. Thompson tensed Plumber Si ature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS October 26, 2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 q ~ 0~8 V I I i Qom"" 0 d - @119M i Z9, Lee tz keg attk~ Ii 1 ......a 7G T ~ N • cri Q , X ol _,,.,..-«.._...._~G„ 000, SAW co SOUL N ~ S I 1 a NS JAI NO A .70'~d VO'L 1668P1 281 Ile" + STATE BAR OF WISCMafN FORM 2. mess 649391 OocsatcstNamhsr WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS S . CROIX CO., YI Tbb Deed. made between P. C. Collovs RDRders, Iue , a I~IYEO FM RECW Minnesota Corporation, 06-Y6-2001 $ 00 AN - - Grantor, and Titaolhy G Porter and Deborttb J Porter, ► p Ta DEf9 wife COPY Ems. FEE: TA MM FEE: 179.70 K WINS FEE: 10.0 Grantee. Granter, for a valuable consideration, conveys to Grantee dw following described real estate in St. Croix State of Wisconsin (if more space b needed, piesse attach addendum); Lot 13, plat of Moonbeam Ridge in the Town of Hudson. St Croix County, RcMrfmg Aces Wisconsin. New and Return Address 020.1013-70 Poled Idmtiticstion Nwnher (MN) This is not ►ntowad property Exception to warranties: Easements, reatrictions and rights-of--way ofrvoord, if any. Ob lis moll Dated this lay of June apt P. jogovs ra a ~ Cogsw, Psoadeat AUTHENTICATION ACKNOWLEDGMENT Signat"s) R C. Calbra t3ldidsrs, Inw a Allanasota STATE OF WISCONSIN ) Co~poratlea, by P. C~CoNova, PraHe+t ) ~ authenticated t - County ) y of June 20011 Personally came before me this - day of _ the above named + _Kritties O&ed _ TITLE: MEMBER STATE BAR OF WISCONSIN t If not, to me known to be the person(a) who executed the foretong authorized by 706.06. W is. Slats.)-' insuurnent and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY - Attorney KrisW81 laad re T Notary Public, State of Wisconsin My Commission is permanent. junob state expiration date; (Signeaaw may be wateationed or wjwwledged. Both set ant nW"My.) ) Neater of petsmn sgnisg in say c p dq mat be typed or prhtkd bebw the'a signMarc. a+amr Fn►ma+aanr. eewswv. Fans eu tae w sceasbtot+ WARRANTY DECD STATE MAR Of WISCONSIN FORM Nw 2 -19x9 p~,g0r ~J - II ' 2, _351r Wisconsin Department of Commerce SOIL EVALUATION REPORT e~~~.~;Q_.. Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code O A.C.E. Soil & Site Evaluations Attach complete site an on County pl paper not ~ than 8%: x 11 inches in size. Plan must St. Croix include, but not linked to: vertical and horizontal reference point (BM), direction and percent slope, scale or d'anerreions, north arrow, and location and distance to nearest road. Parcel I.D. 78-13-000 Please print alt information. Rev' B Dalte Personal in>omhation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / ( 3 12 Property Owner Property Location Tim & Deborah Porter Govt. Lot NW 1/4 SE 19 S 12 T 29 N R 19 W Property Owner's Mailing Address Lot # Stock # Subd. Name or CSM# 1053 Moonbeam Road 13 na Moonbeam Ridge City State Zip Code Phone Number City J Village sol Town Nearest Road Hudson WI 54016 (715) 386-3487 Hudson Moonbeam Road New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe: Parent material Glacial Gutwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventi S dispersal cell with 0.5 gal./sq.ft./day loading rate. Recommended infiltrative surface ele . = 94.50'. dispersal cell elev. = 94.80'. Boring # J Boring sm Pit Ground Surface elev. 101.35 ft. Depth to limiting factor >127" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD!(P In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 "Eff#2 1 0-11 10yr3/2 none sit 2fgr mvfr cs 2vf,f 0.6 0.8- 2 11-35 1Oyr4/4 none sit 2fsbk ds Cw 1vf,f 0.4 0.8 3 35-46 1Oyr4/4 none sl 2msbk dsh Cw - 0.5 1.0 4 4 7.5yr4l6 none Is Osg dl 9w - 0.7 1.6 5 80 10yr5/4 none / Osg dl aw - 0.5 1. <-S J %1 %7 aT4W ~,8042 7 10yr5/4 none s & grr sg dl - 0.5 1.0 6 Worizons & contain many stra ' layers of Ke, , Is, s gr. too numerous to differentialte. Ho es refle stnctW soil F texture and reduced permiability of horizons associated with s tifcation. L Boring # Boring J j] Pit Ground Surface elev. 101.69 ft. Depth to limiting factor >132" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsoll Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 "Eff#2 1 0-9 1 Oyr3/2 none sit 2fgr dsh cs 2f,1 m 0.6 0.8 2 9-18 1Oyr4/4 none gr scl 2fsbk dh Cw lvf,fm 0.4 0.6 3 18-31 10yr5/4 none sit 2fsbk dsh Cw 1vf,f 0.6 0.8 4 31- 7.5yr4/6 none gr sl 2msbk dh cw - 011.0 5 51-98 7.5yr4/6 none Cos & gr Osg di cw 6 98-132 1Oyr5/6 none s Osg di aw, - 0.5 1.0 1-106 contains 1/2" - " irregular, discontinuou s 0yr4/4 Ifs. Loading rate reduced to reflect reduced permiability also ' h banding. ' Effluent #1= BOD? 30 <220 mg/L and S$ >30 < 1 mg/L ffluent #2 = BOD <_30 mg/L and TSS 30 mg/L CST Name (Please Print) \ftnatu~pl . CST Number James K. Thompson % 3602 1-e Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W154020 10/22/2013 715-248-7767 ■ Soi/ edu/lia~ton ~Oi ~ "k49' be6 PorE~ /D1-3 rrlcor,bea11 Pal. p //u dSon, "Y 55/0/6 5C. d-roix 60 mob - /.378 -/3 n o Qw"ee-,-" e S y5~~ ai'c.~. a2 EY~'s ~ a~PS~c r5 a.~ CCC Ti<.ao C~~ Ert+~c 1. Y.t a 3,'t 9.3 ?5"'W/ =,IYEratvr k,~-~ ckarc~~ "Side~vT.rclsy c%G.,r,b~/s.~ eC eye-! ~arafe QsP~Cf dp;ueway. ~ a . 0 ~o.P. .7-4V w : ,cg m o -F Assu,.ce.d e1e~ ewe Iawn /rtcun 6(2a n ssas Pa.z°~~ n N O 3 m n d r~ M CD `D- c 0 v1D m~ 0 C N N °C • j n N O tNA O 0 00 w -0 O O = C N~ y to Q NI y m 00 (D CO O p. trtD O U) CD p 7 O v N , ; \ 1 j O O p O a 7 C7 N p N A O O N - W O W O N ro O ~p O = Np O (~I 3 O N W!, 1 0 O O a \a C 0 w U) co O D N N CD c Ln :3 f 3 N N N CL 3 O 0 0 O (2 00 00 O \ N p O V A N N G1 0 0 o a n o c c ! co) 7 a 3 Z O O O 3 NcnNa W°o Q a 0 0 O_ _ CD N y a W CD 3 CL 3 d ~ <D - a rr CD A o o z= z O ° D O D N m ? m !V• 0 7 O C O O W (D C a 1 = I Oro 3 O m n a d N -I N = O N C K - I N Co (D I w m ~ Z I CD A A II a I O N C z a O N I fi ti I I' I ~ I 0 ti ~ o h CD A o CO ti +0+0 G 'y O L ti y Department vicommerce and Division County: PRIVATE SEWAGE SYSTEM INSPECTION REPORT t. Croix GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermRNo.: Personal kdormalfon you provice may be used for seoondary purposes (Privacy Law,. s.15.04 (1)(1111N. 84286 Permit Holder's Name: ❑ City ❑ Vi Nge Town o : State Plan ID No.: Pori Ar, Tim I Hudson Township EST BM Elev.; Insp. SM E ev.: BM Description: I Parcel Tax No.: o l• I~ o S Wp.,~ 4-- 3 tQO 20-1378-13-000 TANK INFORMATION ELEVATION DATA 1~2 aq lq_ ~3Sa TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic P Zl~ Benchmark art 4f 3 Dosing It BM LD A- 5F-) Aeration Bldg. Sewer -7 90 O' Holding St/ Ht Inlet p~- q(o • 3 TANK SETBACK INFORMATION St/ Ht Outlet g, 10 uo< -(of TANKTO P/L WELL BLDG. Aai~take ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. 11 Aeration NA Dist. Pipe 8' loo % . Z Holding Bot. System 10, cow 9rf- / PUMP/ SIPHON INFORMA Final Grade 3. (ate o Manu durer Dema over a D2 • S;f Mode( N er GPM - $3, (01 b I o ~ , I TDH lift Idlon System TDH Ft e-I,& Forcemain Length Dia. Fi Dist. To Well SOIL ABSORPTION SYSTEM ~s e✓S,~ BED /TRENCH Width I Length ( N O Trenches PIT No. Of Pits Inside Dia. Liquid Dept -DIMENSIONS 3 ~Sea ~t [DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man ca. ure : SETBACK INFORMATION Type O CHAMBER Model Number k System: >Sb ^ 2S OR UNIT 6 DISTRIBUTION SYSTEM Header / Mani pld ~ Distribut n Pipe(s) ~oleSize ~x"Holessppacinng Vent To Air Intak 9 Length Dia. ` Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons presenjljgb~ction #1: o}/ 1"+/ e I Inspection #2: / Location: 1053 Moonbeam Road, Hudson, WI 54016 (NW 1/4 SE 1/4 12 T29N R19W) -1229192352 Moonbeam Ridge -Lot 13 1.) Alt BM Description = 2.) Bldg sewer length= -amount of comer = 3) Phan revision required? Y ❑ No Use other side for additio ormation. SBD-6710 (R.3(97) 1 S, to ` ~G Inspector's Signature Cart N< Safety and Buildings Division County R 201 W. Washington Ave., P.O. Box 7162 7, Visconsin Madison, WI 53707 - 7162 Site Address rl Department of Commerce tary Permit Number Sani pplicat cm Sanitary Permit Application-.- personal ir0i'matidn you provide In accord with Comm 83.21, Wis. Adm. Code, ❑ Check if Revision y 1.41~' 1 may be used for secondary purposes Privac sl I. Application Information - Please Print All Informatio State Plan I.D. Number Property Owner's Nam ; t Parcel Number Q Zb - 3 8' (3 - o a o Property Owner's Mailing Address :t k N-r( _ Property Location yy td X(GOFF~Gti 5I=1A' S T G / N, R E Y,47-5Q J 14 City, State Zip Code Numb~s.~ Lot r Block Number Subdivision Name CSM Number 40-~ II. Type of Building (check all that apply) j ❑ory or 2 Family Dwelling - Number of Bedrooms C~ ❑Village ❑ Public/Commercial - Describe Use wnship ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to system Tank Only Exis ' S stem Permit Number Date Issued B. ❑ Check if Sanitary Permit Previously Issued 1V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44A Non -Pressurized In-Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In"-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other ,)111 5- V. Dispe tsal/'IYeatment Area Information: C) j~~442,r 17-11 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevatio inal Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) ~I Lr( Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tion of the POWTS shown on the attached plans. P rs N (Print) Plum Si RS Number Business Phone Number Plumber's Address (Street, CYity, State, Zip Code) VIII. Count /De artment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse U / Determination 2 IX. Conditions of App/Iroval/Reasons for Disappr/oval/ SyS~tn. ~lCv4T~oy. CtJaS lOWrrcd 7r~ 1MQ•v~Y.tr`r. Ati4Jc~ori{7 0~ 106,vC✓ f,,- v~tTC. z~ A~. as-bu l~ 6k-11 be love'v 4ed e~~ "rac~ iv~SPeetio~, 3,iS sys~Cw• c5 cfes~~k(G~ ~or a `ldelrw~ (nocMe~ ~or<S"~rue~~v~ p 3~ ~a~rw~ Wor~~a~ YG~a~r< Q 111~ 1. A AV We O O Attach complete plans (to the County only) for the system on papa not less than 81/2 x 11 inches in size ~)ti5S~►N.e 4e ned-r origrvw lyladel 44reLIh6L9e Staal ~e diUCr-tecl fv,n- 5y51,an SBD-6398 (R. 05101) t ~ ~ as ~e J ~y~~Lk X x ` 53: ~ Wisconsin Department of Commerce SOIL AND SITE EVALUATION I 3 Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 94- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # APPLICANT INFORMATION - Please print all information. d b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner , Property Location CollO Govt. Lot VJ 1/4'S F 1/4,S (Z T, C( N,R q E (or)Q Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# -I r) (I " i'3 icl R..) City State Zip Code ( hone Number ❑ City ❑ Ma~m e® Town Nearest oad oc, n b•c C,, M t? CA New Construction Use: Residential/ Number of bedrooms 3_ y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow C gpd Recommended design loading rate 1 bed, gpd/fi2~trench, gpd/ft2 Absorption area required KS7 _bed, ft27S0 trench, ft2 Maximum design loading rate 1 bed, gpd/fi2__!R_trench, gpd/ft2 Recommended infiltration surface elevation(s) ctr. 3 S ft (as referred to site plan benchmark) Additional design/site considerations V+/_ C/ Parent material e}V , Wad Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system WS El U S ❑ U S❑ U S0 U ❑ S (U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GqDr/ft2 in. Munsell ou. Sz. Cont. Color Gr. Sz. Sh. Bed Ground cl_~ elev. Depth to , limiting q.5- 3 ar 2 f~l r in. Remarks: Boring # ~ t Z ' ( Z. ~ I'Yl~f C l ll~ , MOWM (,P him, _57 Ground elev. Depth to limiting f@ic;or -LIWin. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number e 5 -cad 330 SOIL DESCRIPTION REPORT PROPERTY OWNER Page Z of PARCEL I.D.# he Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 L in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 3 -2 3 S' 2. CS (v~ - . ifv/r Z y - Si ( IL m~' c Ground Le Nsc" I C S U /el n Depth to limiting qs 3~ l¢'~ factor J-W-in. 43 t~ ; Remarks: Boring # 2-./3 5Z S; ( Z i bK c 3, -4)3 (C) L O m1 c s - ? Ground elev. ft. Depth to limiting factor Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Boring # c_i 312 - S~ 5 Z 2rrb bk rr,' e s - s' 3 - _ m-S .Srn1 c S C~ Ground elev. ~ Srft• ' d4 00 Depth to limiting of y , factor 11b in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) y a PAGE 3 OF NAME r -o I t6 a w. LOT# 13 LEGAL DESCRIPTIONg w '/,sE'/<,S IZ TZq,N,R (c( E (or)W SCALE: F'= /00 BM 1 ELEVATION /00 • C) BM 1 DESCRIPTION J p c4 J' ??s BM 2 ELEVATION-? 7- V0 ('Z BM 2 DESCRIPTION 4pa4 I? pvc p:,OS /a,~ti w/F,(a~ SYSTEM ELEVATION 15-, 3 ' ALTERNATE ELEVATION QS 3 S CONTOUR ELEVATION I ~oSla~Pt' of wit. 6 (JFSIGNATURE DATE cad ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer , Mailing Address E , /ylrl~//~ !~1 /3 /e Property Address (Verification required from Planning Department for new construction) 4 k Parcel Identification Numb / City/State 02 0 '13~-tom -moo LEGAL DESCRIPTION Property Location_ t %s, ~ See. T2N-R~W, Town of Subdivision Lot # /c3 Certified Survey Map # Volume ..Page # 07 Warranty Deed # Volume Page # Spec house ❑ yes J~r no Lot lines identifiable ❑ yes Xno 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 in 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 mastCt Plumber, journeyman plumber, restricted plumber or a licensed pumper venfyung that (1) 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 fortb, 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 days of the three year expiration date. SIGNATURE 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE permit being revoked by the Zoning Department.****** . Any information that is mis-represented may result in the sanitary 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 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) 5_0 Estimated Flow - Average (gpd) Septic Tank Capacity (gal) D Soil Absorption Component Size (W) ! Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption components operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 I Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. A s GW~ LLA~ 15) 0?6 3 vo _ 1668 PAv 281 ' STATE BAR OF WISCONSIN FORM 2.1999 649391 Document Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between P. C, C011ova Builders, In-c.,-a- RECEIVED FOR RECORD Minnesota Corporation, _ 06-26-2001 8:00 AN WARRANTY DEED Grantor, and -Timothy G. Porter and Deborah J. Porter, husband and CERT C tl EXEMPT wife ERT COPY FEE: COPY FEE: TRANSFER FEE: 179.70 RECORDING FEE: 10.00 Grantee. - - - RAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in - St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 13, Plat of Moonbeam Ridge in the Town of Hudson, St. Croix County, Name and Return Address Wisconsin. r-r 020-1015.70 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. 0C ('snot) Dated this 2i ay of June _ 2001 P. . Collova B '1 rs nc. AUTHENTICATION ACKNOWLEDGMENT Signature(s) P. C. Collova Builders, Inc., a Minnesota STATE OF WISCONSIN ) Corporation, by P. C. Collova, President ) ss. County ) authenticated t y of June _ 2001 Personally came before me this _ day of the above named . Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY . Attorney Kristina Ogland Notary Wisconsin Hudson, WI 54016 Public, Stater Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged- Both are not necessary.) ) « Names of persons signing in any capacity must be typed or printed below their signature. ird m-Ii , Wor-In conic y. 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