HomeMy WebLinkAbout020-1411-04-000 p ppv-
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
+ INSPECTION REPORT Sanitary Permit No:
430324 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:
Luedtke, Brent I Hudson Township 020 - 1411 -04 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/03 `� `S N I F . 4 CS I' C3. /V'-.- ' 13.29.19.2574
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / �, Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht outlet 7 Z� 99 ;�5'
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic I °��= r �r Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe iA 1
c _ S. s�.
Holding Bot. System -fl'
u . - 7 T 17. 76
PUMP /SIPHON INFORMATION Final Grade
`t to l . 7
Ma ufacturer Demand St Cover
Model N miler
TDH Li friction Loss System Head - 7 DH Ft
Forcemain Length bha,.. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengthk Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 }�„ G' __._._
7
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufact
INFORMATION CHAMBER OR 'J • v cC• 1 " ✓•j jZ
Type Of System: r T/ UNIT
-1 Model Number: �(y
DISTRIBUTION SYSTEM YL _ 9 - /t7 iC2
HeadgdManifold Distribution ) x Hole Size x Hole Spacing Vent to Air In take
_ r Pipe(s) 7 /
Length � -ilia L4 , Length - -` Dia 'Spacing
901L COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 3 L ^_ct y —e"I j
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center j ` -, -- if C d/Trench Edges _..._ Topsoil L' Yes No Yes No
Li CJ ✓r S -
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: It / / 4 3 Inspection #2: ! /
,l3
Location: 838 Hillside Trail Hudson, WI 54016 (NE 114 SW 1/i�4 f29N R1 9W) Alexander Meadows Lot 4 Parcel No: 13.29.19.2574
1.) Alt BM Description = S. c 6 r
2.) Bldg sewer length = 14
- amount of cover =
Plan revision Required? Yes ' Nlo -
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No.
Safety & Buildings Division
lVi sconsin Saditar Permit A lication 201 W. Washington Ave
Y PP PO sox 7302
In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302
Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)) state owned.
Attach com lete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
County State SanatikEy Permi Nu b r O C 99k4Ffa;isiow4Qo ion State Plan 1. D. Number
I. Application Information - Please Print all Location: / L /
P Owner Name Property Location
LP,4jkl,
(� T�)
1/4 1/4, S/ T N R E cr
Property Owner's Mailing Address i Lot Number Block Numb
City, State Zip Code Phone Number Subdivision Name or CSM Nu ber
New �� � �' D doujs
I Type o[ uitding: (check one) .Q1L 0 City
I or 2 Family Dwelling - No. of Bedro ms! O village
dd Public/Commercial (describe use)3 f (� �1GG�'�� ��'
O State -owned d sQAj
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road )( A
A) 1. k(New System 1 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s) l,T
System Tank Only Existing System 0_ 1 11 _0W
$) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
1�( Non- tressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
d Pressurized In- ground ❑ Bolding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area I formation: / 3/ fkx
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Syste eat' 7. Final Grade
Required Proposed Rate (Gals. /day /sq. RJ (Min. /inch) N / Elevation 10 a- N
.115 0 9 d da — rh 1 8.19 lo).tSL
L `1•to 61.
VI Tank Capacity in Total # of • Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks ( n Con- Con- glass
New Existing !� :Z `f Crete structed
Tanks Tanks r
❑ ❑ ❑ ❑ ❑
VII Responsibility Statement.
I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na rat) Plumber's Signs W :(no stamps): MP/MPRS No. Business Phone Number
P reet, City, State, Zip CodejZj
/ 070 o/6
VIII Cquntyffiepartnlint Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date ssue Issuing Age t Sign lure (N )
Approved ❑ Owner Given Initial Adverse Su Se 0 g O 3
Determination '�
IX. Conditions of Approval asons for Disapproval:
STEM OWNER:
Tx� 1
1 i an c, effluent filter a d 0 ,� �(p _ `�� /�/
dispersal cell must all be serviced I maintained /� � 2jZ
as per management plan provided by plumber.
2. All setback requirements must be maintained
Sv Sm / T /a-�\r L lPE V2sC7_) z_47�jS so / Z_1ee - _ e - --
1
5 1042
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 a 3
Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code Steel Sal Service
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D.
Please print all information. D Z U - V / —
R Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). fAll,� 3 Z L D
Property Owner G rL, ';; rope Location
LaCasse Development, Inc. Govt_ L(f NE 1/4 SW 19 S 13 T 29 N R 19 W
Property Owner's Mailing Address A UG Lot # Block # Subd. Name or CSM#
573 Cty Rd " A" - Q 4 na Alexander Meadows
City State Zip C Phr�pe COON Y itY Village Town Nearest Road
Hudson WI 5401 7a6A381G E Hudson Alexander Rd.
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Drift Flood plain elevation, if applicable na
General comments
and recommendations: s ystem elevation 98.65 ft t renches spaced and depth to code 3.50 ft below grade
Boring # Boring
Pit Ground Surface elev. 102.85 ft. Depth to limiting factor 96 in. Sod Appl -gMw Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft'
*Eff#1 *Eff#2
1 0 -9 10yr312 none sit 2msbk mfr cs if .5 .8
2 9 -19 10yr4/4 none sicl 2msbk mfr gw 1vf .4 .6
3 19 -25 1Cyr4/4 none set 2msbk mfr gw na .4 .6
4 25 -96 7.5yr4/4 none sills 2msbk mfr na na 05 .9
(
1 -7 _ Horizon stratifred layers
Boring # Boring
it, Pit Ground Surface elev. 102.15 ft. Depth to limiting factor 96 in• Sorl Applr-ation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 I *Eff#2
1 0 -10 1Oyr3/2 none sit 2msbk mfr cs 1f .5 .8
2 10 -26 1Oyr4/4 none scl 2msbk mfr cs 1vf .4 .6
3 26 -5 7.5yr4/4 none sl 2msbk mfr gw na -05 .9
4 52-96 7.5yr4/6 none sUis 2msbk mfr na na -15 9
Horizon # 4 has stratified layers
* Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = SOD < 30 mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel 248956
Address Steel Sal Service `� Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 7/31/2002 175 - 246 -5085
Property Owner L.aCasse Development, Inc: Parcel ID # pending Page 2 of 3
a Boring # Boring J6 Pit Ground Surface elev. 100.55 ft. Depth to limiting factor 96 in. Sal Applicaton Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
*Eff#1 *Eff#2
1 0 -9 10yr3/2 none sil 2msbk mfr gw 1 of .5 .8
2 9 -24 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 4-7 7.5yr4/4 none sl 2msbk mfr gw na 0 .9
4 72 -96 7.5yr4/6 none slAs 2msbk mfr na na .5 .9
�2 ti
Horizon # 4 has stratified layers
4] Boring # Boring
Pit Ground Surface elev. 100.55 ft. Depth to limiting factor 96 in. ApplrAw Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft
*Eff#1 *Eff#2
1 0 -9 10yr3/2 none sit 2msbk mfr gw 1 of .5 .8
2 9 -25 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 25 -39 7.5yr4/4 none sl 2msbk mfr cs na .5 .9
4 39-9 7.5yr4/6 none OstAs 2msbk mfr na na .9
F Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft
*Eff#1 *Eff#2
' Effluent #1 = BOD ? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg/L and TSS <-30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
r
c
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST- POWTSM LaCasse Dev., Inc. New Richmond, WI 54017
Lic. # 248956 NEI /4,SW1 /4,S13,T29,R19W (715) 246 -6200
Town of Hudson, St. Croix Co. (715) 246 -5085
Alexander Meadows, Lot 4 N
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for
your use. The location of the test ma y or m not be as shown as p ermanent lot lines were not
Y
established at the time the test was conducted.
-RM
0p pe A/L "+ torntr
= A0 5tx�-hP* k £/.
7op 1 Pv pipe-
p = 3orrn is
130 f i'n y
5� �
2 p�
3
33'
£ 4
,
7 3� -oz
. 6 / l - 70 t- / «/k/ _5 ,' d e- uJl nil e. r.s.
LLM
N.IML'
' � � SUS' - - •
- - - -- O T AMP
Cl - Boa) N C� �" �SPi`' G h /AAA .
T o �{ S�Pt f PI
P
NE hkRNA(Z
All 6m
� l�v= I o3.9S
T�
r aPC
f o dam �
a�
�, CQ
Q
a
.r
0
u
he S 3X
3XS �.aS
JU
A
l 1 � Jo •� T
I
ii6 m K Wi
W M _ :'m... .
n= ate) N� I►= &NC- ►�p�k .
/oo.O
NE. 1(1
fl -pv= I o3l!
T -p C4 lb" PVC
n
tw o? '
�v
Q
Q
t l ��e s 3 x
6a a -�NN x S�a
i ``` /�•
J�
r• � O
_ _ w
10C ( HIR I
F
v •
4
Y'
A
MOPAFITOPIMENWI/4
1
x
x
949
- -- -- o _--- ---- --
43+
'A
960.7 958.8
x
N.M1A. NSA
X
950.8
AC, 966.9
.: ` AC.), x
x ! �" a x
• 854.3. •� , � 964.6
8
TO AC. n
(4.70 AC.)
x
968.9
•�, x
N 975. .2
,\ \ x• N
� J9Q 9 73.2
x
�� '�� �. �•� ��� • • - ......
96
-X.
9654 _ _ • TWU
lo" . t SOT
a k. • •x
ti •�f 985'3
���' t� '•, . � ,.. �65.i ,. 963.2
}, Vi e►,' 5 .. - x
5T CROIX COUNTY
SEP rIC 'TANK. MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
fVwfficavon requited from planning Dcparbtnent for new coinstructio � w
. W Parcel Identification Number
r14, See. l3 , T �1 - _. W, Town
..�..
A xtK 'O'kn�—T—?Q1- G ws Lot 4 a...w.
Volume , Page #
Volume �. , Page . °�
R VOI 1 Lot lines identifixbleA yes 0 no
a
aad maiutenanceof your septic system could result in its premature failure to handle wastes.
s 3 , s' ft age septic umk every three years or sooner, if needed by a licensed pumper. What you puff ilea 111;
f1wu -fiao o f the septic task as a treatment stage in the waste disposal system.
<; •' p c ; ; owner agrees to submit to St. Croix Zoning Department a certification form, signed the o ar m i f d in -'
�, ,ti.'.'z(!,Yfrkaupluniber, restrictedphu nber or a licensedpumper verifylag that (1) the on -site wastewatt ';I� t
qmdifion and/or ( 2) Y) 2 � tion and in if trace ),the septic tank is less 1, 3
v
avz ad tae aboveq riquirements and agree to maintain the private sewage disposal systoo
t `S '
',is pkt by tl of and the Depattnient of Natural Resources, State of iscotw a, 41
"m has been maintained mist be coinpleted and returned to
the 3t. Croix CoarnV Zonin&OA A
" �;A "xpi tiod date.
0 -3
k1; AS LICANT DATE
rat all eta a is on this form are true to the best of my (our) knowledge. i (eve) am (arc) d.s o .:l ,_
„ " irtue a �+ deed recorded in Register of Office.
'I WPLJCANT j j� DATE
t -16 rrais- rapr+. y t in the sanitary permit being revoked by the Uning p xsa 6.
A4,Jt aW& plAlcatlorae a stanAped w aif deed from the Register of Dead office
s cM of the cartified survey map if reference is road in the wManty dead
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 p
Number of Bedrooms
Design Flow Peak (gpd)
Estimated Flow - Average (gpd) 425fa 3 o b
Septic Tank Capacity (gal) bb ll
Soil Absorption Component Size (ft 4
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) Y V
Maximum Influent Particle Size (in) P B 1/8
Maximum BOD (m /L) a b 220
Maximum TSS (mg /L) G 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter t I
Inspect once a year and clean a east 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 eeast
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
c 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 P erformed 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 component's 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
it Improve. In general, soil compaction impossible to repair until weather conditions impro g action over this P
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
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.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester & Sons Excavating 386 -9020
I
1 2226 P 202 719616
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 2 - 1999 REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between LaCasse Development, Inc., a 05/01/2003 08:30AN
Wisconsin Corporation
WARRANTY DEED
EXEMPT #
Grantor, and Brent Luedtke, REC FEE: 11.00
TRANS FEE: 209.70
COPY FEE:
CC FEE:
PAGES: 1
Grantee.
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
Name and Return Address
Lot 4, lat of Alexander Meadows in the Town of Hudson, St. Croix
Cou Wisconsin.
' LA - t - and
020- 1017 - 50,020 -1017- 70,020 - 1018 -20
Parcel Identification Number (PIN)
This is not homestead property.
QK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this &Lay of April 2003
LaCasse Development, Inc.
s s .
Richard W LaCasse
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATZ OF WISCONSIN )
<� ) ss.
County )
authenticated this day of , U�
Personally came before me this ���'�ay of
April , 2003 the above named
LaCasse Development, Inc., a Wisconsin Corporation
' bv Richard W. LaCasse, it'
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, ^ (ii o n t b pe son(s who executed the foregoing
authorized by § 706.06, Wis. Stats.) n t t o c n I ged s
THIS INSTRUMENT WAS DRAFTED BY
Attorn Kristina O gland _ Notary Pub c, State of Wisconsin
Hudson, WI 54016 My Commission is (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. iro ar v fess
WARRANTY DEED
ionals company, Fond du Lac, WI
STATE BAR OF WISCONSIN Notary �u°+c X55 ZOZi
FORM No. 2 - 1999 State of Wisconsin
C OUNTY PLAT ORAL
gE, GtdX C LOCATED IN PART OF THE NW1 /4 OF THE L
OF THE SE1 /4 OF SECTION 13 , T29N, RM
°3724"E 5338.33'
�(�pdQ_�_t_GD dQG]D�3
71 .29' EAST -WEST 1/4 UNE 119.07
310.75
--- 34 Z 3 N ---- -- - - - - -- i Block Dist. = 1887.80'
\� STORM WATER 1
RETENTION AREA H.W.E. = 952.0 I
LOT 5 --- LOT 4
2.191 ACRES
�v (95,439 SO. FT.) Iv 2.521 ACRES
L.B.O. = 954.0 (109,821 SO. FT.) $
3G Jri WNAGE
........ �E4SEMENT LOT 3
• . . . I 2.696 ACRES
TRAIL — c8
\_
. . . . . • .�>_ N
S "o .SOB
EASEMW ; 1 _ C7
B STORM
LOT 17 WATER RETENTION c , a
�n"nnce . AREA