HomeMy WebLinkAbout020-1479-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
572876
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: 7 City Village X Township Parcel Tax No:
Bast Kernon J. & Don Id J. Seer- Hudson, Town of 020-1479-21-000
CST BM Elev: Insp.BM Elev: BM Description: �'' 1 r Section/Town/Range/Map No:
b d d r'e tiT� c� 36.29.19.3042
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,k CAPACITY STATION BS HI FS ELEV.
Septic v �l •3; � Benchmark
Dosing n Alt.BM�`
l!J f • .�a.ti_
Aeration Bldg.Sewer
9,3 90 ,7
Holding St/Ht Inlet �• �� q
p v
TANK SETBACK INFORMATION St/Ht Outlet Cr,,c�d• O
TANK TO P/ WELL BLDG. Vent to Air ntake ROAD DtInlet \
Septic JA _ � Q5 / Dt Bottom
Dosing � Header/Man. �D• 3 JAA
Aeration Dist. Pipe /6-11 8 Z
Holding Bot.System N.4r 9$. 3
dy
Final Grade Tq %. �
PUMP/SIPHON INFORMATION •S
Manufacturer Demand St Cover��t - , 7.
GPM J
Model Number
TDH Friction Loss System H T Ft
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches PIT DIME SIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS IW4 3 ,IQ ( A � ��
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer, ( T
INFORMATION CHAMBER OR y�r �
S��dL cy
Type f System: �` _ /_Q r //� UNIT Model um ,
N/� Nn r
DISTRIBUTION SYSTEM L564 k c.
Header/Manifold �( Distribution x Hole Size x Hole Spacing Ve�o Air I ke
Length 7 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 � QYes No Yes 0 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 836 Settlement Drive Hudson,WI 54016(SE 1/4 SW 1/4 36 19
T29 W) Cottonwood South'07 Lot 21 Parcel No: 36.29.19.3042
1.)Alt BM Description
2.)Bldg sewer length= b
-amount of cover=
Plan revision Required? ❑ Yes No 1-7
Use other side for additional information. I I
SBD-6710(R.3/97) Date I f Signatust Cert.No.
l'.61:-!{' '1 I� 1.fount}:=G 4 . n `'
r 1 Safety and Buildings Divikion i �J l' 0 ]�-
< 201 W_Washington Ave.,P.O.Box 7162 1 Sanitary Permit Number(to be filled in by Co.) Ij
,iqp ;' 115 � Madison,VV153707-7162 i
1 �
S rrrz',.,t.;;yOUNTY I j 5 7 2- --7
`-''
:'..0,' tir i t c t �z v.c.`e- 1 I State Transaction Number
fO .i itary Permit Application 1
In accordance with SI'S 383.21(2),Wis.Adm.Code;submission of this form to the appropriate governmental unit ,
is required prior to obtaining a sanitary pernut Note:Application forms for state-owned POWTS are submitted to i Project.Address Of different than mailing address)
the Department of Safety and Professional Series. Personal information you provide may be used for secondary 14t......_ / �t f'
purposes in accordance with the Privacy Laws .15.04(1)(m),Stilts. I 3l� �e ,m e,-,41
v N+ t f t,
1. Application Information—Please Print All In ormptn ✓✓
Property Owner's Name W Parcel ii
dliI J ' 1 Property Location
Property Owner's Mailing Address ( 3 ")[�
_-� `� 2)
� 1 Govt.Lot
City,State (Ai,' Zip Code ; Phone Number 1-SE l/4,51,0 Y., Section/� /Y� 0 6 ' R/ circle n
T� N; R E W •Il.Type of Building(check all that apply) Lot
1 .,:rar Subdivision Name / C 2 Family Dwelling Number of Bedrooms _
d 1. � I c- 1—t." ck d �(0 IL. l LtL..
❑Public/Commercial-Describe Use __�J_T_ j — ! ❑City of
�a,)-�.e� rat"„�
CSM Number I ❑Village of i
❑State Owned-Describe Use �,t 11 I
�/ \5�-. Ce�S
L Lv CIA&L r5 itZ_cu••� wn of fir . ..
IIt:Type of Permit: (Check only o box on line A. Complete line B if applicable) ZO O K
w System I ❑Replacement System 1 ❑Treatment/Holding Tank Replacement Only ; Other Modification to Existing System(explain)
List Previous Perma Number and Date Issued
B. { ❑Permit Renewal ermit Revision 1 ❑Change of Plumber ❑Permit Transfer to New 1 f /�
■Before Expiration I Owner r,,� _,tir (�e* �i 4,,,cie-
IV.Type of POWTS System/Component/Device: (Check all that apply) �'�' , _ •g- r AllJ 'cf�
4211-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil U Mound<24 m.of suitable soil
❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(expllaain) �
V.Dispersal/Treatment Area Information: ..51-)30.-&-./�`/�`� rim e ( ' Z-
Design Flow(gpd) I Design Soil Application R efgpdsl) Dispersal Area Required(sr) 1 Dispersal Area Propose (sf) I System Pier on Y788.. /
VI.Tank Info I Capacity in Total t of. j Manufacturer
l _
Gallons 1 Gallons Units I s
New Tanks Existing Tanks I d o d ' .' I m °
1 ( 1 6.7C inVcn - v Via.
C ,
Septic or Holding Tank //025-1- / j /Le. I I I I
Dosing Chamber I -/ _� 1 i 1 l 1
i
VII.Responsibility Statement- I,the undersigned,assu/ ponsibility for installation of the PORTS shown on the attached plans.
Plumb 's Name(Print) Plumber'. , ..attire I MP/MPRS Number I Business Phone Number
�s ; ( ? /� 1tZ6/ 1 (/) 2
Plumber's Address(Street,City,State,`Lip -ode) i is
i �,
VIII ounty/Department Use Only i ---
' Permit Fee I Date Issued I Issuing, Aent Signature
Approved S �5 ,bo 1 3 I7 /5
aerfflven Reason for Dental I
"?', "'t.1' 'asons for Disapproval (�
M.Cond1 �i''t r.d 1 . v\e...
1.• Septic tank,effluent finer and pp \ c�C✓t�o
dispersal cell must all be services I maintained P ,,A,, vtna..;A.. o-c.-nc... : •
, as per management plan provided by plumber. k1Ve 0.,-.L...,o‘,,,,),,,,...Z....---- I s
2. Ataelback reyuitements must be maintained /�
I as per applicable code/ordinances. �� d` 6 .c_ Jb i-'• U`k C e.� AJ f�- i Z
I
Attach to complete plans for the system and submit to the County on paper not less 7 5 1/2 a'II inchm,in size
S( 4- S . 1
SBD-6398(C 11;11) Area V1u 7 — L fre6e_ite .Ai--
6) Pco cccvv..e.
>� # 6/0-z2 3/°,�,Q
Soil Test and Sys m OT PLAN #zZ O
PROJECT Kernon Bast ADDRESS 948 LaBarae Rd. Hudson Wi 54016
SE 1/4 SW 1/4S 36 IT 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 88.9/88.8/88.7 5.5' below grade 3/16/15 4
BEDROOM
DATE
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1216 # of chamb s 60
BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
A
Property Line Scale = 1 4 = 1 0'
All piping shall be SDR 30/34,within 10'
of tank,piping shall be Schedule 40.
95.5'
—,B-3
�� K 0, S ' 20,
Pro 4 Bedroom
50' 95.0' House
5' jB.M.*
B-1
30'
94.5'
5 B-2 Vents 3-3' X 82' cells with>3' spacing
150'
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long
Grade at System Elevation
34"
Settlement Drive
Property Owner Parcel ID# Page of
Boring# ❑ Boring p
._(2) U�Pit Ground surface elev.?S. 1-ft. Depth to limiting factor / 0 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2
- y,3/v . y , 01,x,. f (I - ..- [. 1,b
3 0---/3) /4 -eA,
, \ .5 ,_
( st?_. ,i, / /1/, mw , _.) / 0 _
c \\ _ -1
gt , - ,66 ...........---.1 +\
0, \\I
..., 1, \ ,■-of
-1_ 1, „.,4
Boring# ❑ Boring I
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
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 Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2
•Effluent#1 =BOD,>30<220 mg/L.and TSS>30<150 mg/1_ •Effluent#2=BO;<30 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
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(8.6/00)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85,Wis. Adm. Code
Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must County 4` l f 01
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I ►.
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. j ad-• J / 2, - s 1i)E
Please print all information. Rev/ by Br Date
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 4..1.4110 3 / / / 5
Propei1y Own r, Property Location
kK t r ct Govt.Lot Sri 1/4 5'/A)1/4 S,3 G 7 N 13/7 E(0
Propertyis Mailing Address_ () Lot# Block# Subd. Name ,. CSM# ,y
`T`-f` Y ( . IScf/ //C_ Z/ — (o u�ne� S lluc. ^�
�'' State Zip Codtt Phone Number ❑City ❑Villag Town Nearest Road
New Construction Us Residential/Number of bedrooms `i Code derived design flow rate 6 6 G GPD
❑Replacement ❑ Public r commercial-Describe: _—_—___- /� ----_------Parent material �� Floodd Plain elevation if applicable A✓1/�T ft.
General comments 5i S r.('(I1t/ qy-Ct,i s- z
and recommendations:
System Type L1ih/ 4 (�/J System Elevation g-.. i/eit, ej� ' 7
l
1 Boring# Boring
Pit Ground surface elev. Oft. Depth to limiting factor /30 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2
/z
/ 0-t g Mi 3 .s/ /.ny9.- / • t( /, 0
3 yI-/k/iP- // fir os r77/ ,/11 Ai,!' - / 0
4
1 LcA
...4 ■-i,
--y5 _ . ,-1 .1 '
Boring# n 0 Boring
Pit Ground surface elev. ft. Depth to limiting factor��'�— in' Soil Application Rate
61
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
1 # L a /fir 31�- --- —�/ , r-- C r - , 6 / 0,
L -s' /o r yr( c/ .7, ,�,k ,n y 14- V / 6
2 .97-a",,// i , _,C-- osi___-,- mi ividi Ai).* , - /5
44(:>c ,I, ctt k\
. .„‘ \v y ..„...--7-CV■ A .
•Effluent#1 =BOD.>30<220 mg/L and TSS>30<150 mg/L •Ef fluent#2=BOD,<30 mg/L and TSS<30 mg/L
CST Name(Please Print) Sign CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 /‘` '— 715-246-4516
•
Property Owner Parcel ID# Page of
Boring# ❑ Boring
f`pit Ground surface elev.?-5-•
lit. Depth to limiting factor / 3 Sin.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff?
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2
Z et'''.1(1. 164,,-,3/t , 4-.)-61- !7) 774,7 / r ,
3 0--I3il ;ei 5 �� ,� / ,�, P,' , .- / a 1 4
���\ 't\ l`
. 6iC :fr' \\// ' 1 k \ \\t)C .
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 GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
Baring# 0 Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
I Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eif#1 'Eff#2
'Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 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
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(8.6/00)
•
Safety and Buildings Division
201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by CO)
S - ' Madison,WI 5370 16
i� S 72- `6
Stan:Trartsactrnn Number
ogo it Application
In accordance ' 3 f2 Vdis,Adm.Code,submission of this form to the appropriate governmental unit
is required ��g a sanitary permit. Note:Application forms for state-owned POVJTS are submitted to Pmiect Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
Durposes in accordance with the Privacy Law.s.15.04(1)(m),Stats.
L A lication Information-Please Print All Informa Parcel 4
Property Owner's Name 3
�✓ ae
Property'Owners Mailing Address Property Location
/77� � Gwt.Lot
City,Slate. 1 Zip Code Phone Number I `?;�sLy Y., Section -3 I
I circle� I
� TZ�N; R E W
II.Type of Building(check all that apply Lot#
f�' s bu drvisionName Lp-C'C-i
or 2 Family Dweilin,-Number of Bedr m
❑Pubiic/Cotnmercial-Describe Use � Gh _ � ❑City of
_ �{
CSM Number ( ❑Viktage of
El State Owned--Describe Use
b-,-0y
2 �\`� (i✓ :S
III.Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. System ❑Replacement System I Ll Treazment/Holding Tank:Replacement Only Other Modification to Existing System(explain)
_ ; List Previous Permit Number and Date]sued
B. ❑ Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New
Before Expiration
Owner
�I,VV.T e of POWTS SYstem/Con onent/Deviee: Check all that apply)
Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound< in.o suitable soil
Bolding Tank ❑other Dispersal Component(explain)
E]Pretreatment Device(explain) _
i
V.Dis ersal/Trea ent Area Information:
D . F1 w(gpd) Design Soil Application Rate(gpds { Dispersal Area Required(sf) Dispersal Area Proposed(sij System El ation /
(/
VI.Tank Info Capacity in I Total ii of Manufacturer s
Gallons Gallons 1 Units 1? ° ' v
m U
J d
New Tanks I Existing Tans e :: m m
Septic or Holding Tank.
Dosing Chamber �
VII.Responsibility Statement- I,the undersigned,assume r sihility for installation of the POWTS shown on the attached plans.
Plumber's?game(Print) I Plumber's Si e MP/MPKS Number Business Phone Number
E '
I ZZ�llb 17
Plumber's Addre ss(Street uy,State,Zip Code,i
D 5
VIII. untv/De artment Use Only
Permit Fee Date sued / Issuing t.Signature
Approved ( Disapproved $ 75 ( J—/L7
/ j
! ❑O ea Reason fnr Denial
IX.Conditift`t$ �tt1Al�l hsons for Disapproval
1. Septic tank,effluent filter and
dispersal cell must all be services!maintains
as per management plan provided by plumber. W
2. All sedl WK requiremertta must bs iilaintak*d t r p
ce er an*41ble•code/ordinance:. �►,,. 7
1 e not less than rr_z.Il.inches in sac
Attach to complete plans for the system and submit w the Comfy aty on paper
SBD-6398(R. 11/11)
PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBarge Rd.
Hudson Wi 54016
SE 1/4 SW 1/4S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 94.0/93.8 5' below grade DATE 2/25/15 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
1255 gallons LIFT TANK SIZE DOSE TANK SIZE
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 1212 # of chambers 60
BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Property Line
All piping shall be SDR 30/34,within 10' ��I� _ 1 /4'� _ .� ��
of tank,piping shall be Schedule 40.
25' 99' B-2 126'
ST
20' 2-3' X 122' cells 18
with>3' spacing
Pro 4 B.M.*
Bedroom
House 98' Vents
B-15' 2'
81'
3% Slope
B-3
Vent 174'
>6„ Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
5.6ft^2/pair of end caps
4' Long 12"
Grade at System Elevation
3491
Settlement Drive
i
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 2/25/15
Owner: Kernon Bast
Location: SW 1/4 SE 1/4 S9 T28N,R19 826 Settlement Drive Hudson
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specificatio S eet
Signature
License n er#226900
PLOT PLAN
PROJECT Kernon Bast ADDRESS 948 LaBarge Rd. Hudson Wi 54016
SE 1/4 SW 1/4S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
SYSTEM ELEVATION 94.0/93.8 5' below grade DATE 2/25/15 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 60
IL BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
All piping shall be SDR 30/34, within 10' Property Line
of tank,piping shall be Schedule 40. Scale — 1 /4' 1 0'
25' 99' B-2 126'od ST
20' 2-3' X 122' cells 18
Pro 4 with>3' spacing
Bedroom B.M.
House 98,
Vents
B-15' 2,
3% Slope
B-3 81'
Vent
174'
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12 , 5.6ft^2/pair of end caps
34" Grade at System Elevation
Settlement Drive
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
5.6ft^2 pair of end plates
Finish grade elevation
Typical Installation 99.0'
Vent Grade Vent
3, 4„
A31 x/30/34 Septic Tank
5' Long 1 5' ong 1
Grade at System Elevation
3619 Grade at System Elevation
Spacing 5'
2-3' X 122' ' Cells
Same on other end Observation tubeNent
At end of cell
A
B
30 chambers per cell
System elevations:
A-94.0'
B 93.8'
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner /-j/4 j Pa nk Manufacturer: /rte C�,tivl. ❑ NA
Permit# Septic [3 Dose ❑Holding Volume:/o?SS— (gal)
DESIGN PARAMETERS
nk Manufacturer: ANA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: ANA Vertical Distance Tank Bottom(s)to Service Pad: 4L/ (ft)
Estimated(average)flow: y0 p (gal/day) Horizontal Distance Tank(s)to Service Pad: (ft)
Specific servicing mechanics must be provided I vertical is>15 feet or
Design(peak)Flow=(estimated x 1.5): (jG (gallday) If horizontal is>150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: 0,,�—(galidaylft=) Effluent Filter Manufacturer: �j��� ❑ NA
Standard(Domestic)influent/Effluent Monthly average Effluent Filter Model:
Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (BOOS) s220 mg/L ❑ NA Pump Model:
Total Suspended Solids(TSS) s150 rngfL
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L - Manufacturer. A
(BODO >220 mg/L ❑ NA ❑Mechanical Aeration ❑Peat Filter
(TSS) >150 mg/L ❑Disinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BOOS) s30 mg/L Soil Absorption System
(TSS) 530 mg/L ❑ NA Ground(gravity) ❑In Ground(pressure) ❑ NA
Fecal Conform(geometric mean) s10 ❑At-Grade ❑Mound
Maximum Effluent Particle Size in dia. ❑ NA ❑Drip-Line ❑Other:
Other: ❑ NA Other. C1 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) hen combined sludge and scum equals one-third('h)of tank volume
❑ hen the high water alarm is activated
p month(s) Maximum 3 years) ❑NA
Inspect condition of tank(s) At least once every: �1year(s)
,� ❑month(s) Maximum 3 years) NA
Inspect dispersal cell(s) At least once every: � �year(s) (Maximum
/ / onth(s) ❑ NA
Clean effluent fitter At least once every: ear(s)
Inspect pump,pump controls&alarm At}east once every: ❑month(s) ❑ NA❑year(s)
❑month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑year(s)
Other: At least once every: ❑month(s) ❑ NA
❑year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume,the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code:
Ali 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 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system, if high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be--discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when sal conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment
tanks and sal absorption system: acids, antibiotics, baby wipes,-cigarefte`butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps,medications,oils,painting products, pesticides,sani4ry napkins,solvents,tampons, and water softener brine discharge.
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 s. Comm 83.33,Wisconsin Administrative Code:
• All piping to tanks,pits and other soil absorption systems 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(pumper).
• 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 the time of their permit issuance.
A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
• The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
• 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE
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ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER.
Name r Name'
Phone ���–_ J~ Phone 6-
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name / L
P
9"
hone a �S� Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(20)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
FI LTER CARTRIDGE INSTRUCTIONS
Installation
STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STEP 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four.
STEP 3 For installations utilizing the optional supplemental side support:
solvent weld the 3/4-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 901.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and filter.
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent.
4. Once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up on the filter handle to dislodge the
cartridge from the case. "
5. Slide the cartridge up and out of the case for cleaning. r
6, If a VRS switch connected to an alarm is present, the switch 4
should be removed by turning counterclockwise 901 and cleaned ,
with water only. `
7. While holding the cartridge on its side (large flat surface facing �' s
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material is rinsed back into the tank.
a
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 901. r ' `
9. Insert the filter cartridge back into the case, pressing down untilQ, 'S
the filter locks into the bottom of the case.
10.Replace and secure the access opening on the tank.
BEAR ONSETS7'FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY
BEAR ONSITE—Fitter Case-Lifetime Limited warranty _.....
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Visconsin SOIL EVALUATION REPORT #2007
Department of Commerce in accordance with Comm 85,Wis.Adm.Code Page 1 of 3
Division of Safety and Buildings Steel's Soil 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(BM14irection and
percent slope,scale or dimensions,north arrow,and locatio ce to nearest road. Parcel I.D. �Z d—/ ��Please print all informatio Da e
Personal information you provide may be used for secno c s(Privacy aw, 15.04(1)(m)). Z� 0�
Property Owner ❑ Prope Location
Bast, Kernon 6 vt.L na SE1/4,4W44, S36,T29N, R19W
Property Owner's Mailing Address GOB Lot# Block# Subd.Name or CSM#
948 Labarge Rd. 21 na Cottonwood Ridge South
City State Zip Code PhoBle umb E] City [].Village ❑ Town Nearest Road
Hudson WI 54016 71 6-7775 Hudson I Cty Rd N
❑New Construction Use: ❑ Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD
❑Replacement ❑ Public or commercial-Describe: na
Parent material outwash plains and stream terraces Flood plain elevation,if applicable na ft.
General comments Conventional system , sytstem elevation 94.64ft.Trenches spaced and depth to code 4.41 ft below grade.
and recommendations:
FT]Boring#
Z Ground surface elev. 99.05 ft. Depth to limiting factor 110 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-12 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 12-31 10yr4/4 none sicl 2msbk mfr cs na .4 .6
3 31-44 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0
4 44-52 7.5yr4/6 none grcos osg mvfr cs na .7 1.6
5 52-110 7.5yr4/6 none ms osg ml na na .7 1.6
Boring# El
Ground surface elev. 99.05 ft. Depth to limiting factor 110 in. Soil Applicati&Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-11 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 11-25 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 25-53 7.5yr4/4 none gr cos osg mvfr gw na .7 1.6
4 53-110 7.5yr4/6 none ms osg ml na na .7 1.6
pe
1
c�N
�3 ,f
52
*Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOW s<30 mg/L and TSS<30 mg/L—
CST Name(Please Print) Signature: CST Number
David J. Steel 248956
Address Steel's Soil Service Date Evaluation Conducted Telephone Number
994 200th St.Baldwin,WI 54002 10/21/2006 715-760-0347
SBD-8330(207/00)
Property Owner Bast, Kernon Parcel ID# Pending Page 2 of 3
Fil Boring#
El
surface elev. 98.15 ft. ` Depth to limiting 110 in.
� factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 -Eff#2
1 0-15 10yr3/1 none sil 2msbk mfr CS 1vf .6 .8
2 15-38 10yr4/4 none Sid 2msbk mfr gw na .4 .6
3 38-60 7.5yr4/4 none gr cos osg mvfr gw na .7 1.6
4 110 7.5yr4/6 none ms osg ml na na .7 1.6
1
II
L
F-1 Boring# E Ground surface elev. ft. Depth to limiting factor in.
❑ Soil Application 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
F-1 Boring# C Ground surface elev. ft. Depth to limiting factor in.
� Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 *Eff#2
I
I
Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 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
need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330(R.07/00)
Steel's Soil Service
STEEL'S SOIL SERVICE 3 of 3
David J. Steel Kennon Bast 994 200" St.
CST-POWTSM SWl/4,SE1/4,S36,T29N,R19W Baldwin, WI 54002
Lic. #248956 Town of Hudson, St Croix Co. Direct 715-760-0347
Cottonwood Ridge South, Lot 21 Fax 715-684-3449
This soil evaluation was conducted to satisfy a zoning requirement,it may or may not be suitable for your use.
The location of this test may or may not be as shown,as permanent lot lines were not established at the
time the soil test was conducted.
Legend N
1"=40'
=Benchmark Ele. 100.00 ft
Top of 3/4"pvc pipe
• =Alt Benchmark Ele. 100.00 ft
Top of 3/4"pvc pipe
❑ =Borings
�✓ Boring Elevations
BI = 99.05 ft
B2= 99.05 ft
B3 = 98.15 ft
�Z , r B4= 0.00 ft
3�
8 �
3 ��'
53 \
x
x
X
046.3 x
1 10 8. RAIN B! •
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l
87313 N x
3.46 Acres a C.B.A. = 8 1060.7
150786 sq. , �_°�oit_°_a:
.A.3.4 0
LBO 1040. X '4 0
2`O
CO 2.84
0
�2.BAcr ft C . . =Q.8 AC. 2.64 ores
"1C�0-1 0 14792 ft
13 C.B.A. = 1.7 AC. C.B. =2.6 C. .20 Ac
- LBO=1042.00 9 sq.ft
`p X • v C.B.A. 2.2 AC.
1039.0
, \ SA's �sst
NG PIT DEPTH 15'
.T POND
1.39' 1040.
---- 10386--- ------------ ----
----- — -- -- --- ---- ------ -- - -- ---- ---- -
ST@ CROIX COUNTY
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November 19, 2009
Y'
3:.
Kernon Bast
c/o Edina Realty, Inc.
Yt�Y Vii:
400 South 2"d Street
` Hudson, WI 54016
Code Administrat„ RE: Compliance deposit refunds for Cottonwood South '07 lots
715-386-4680 Section 36, Town of Hudson
w
Land Information Dear Mr. Bast:
Planning
r:
715-386-4674
I recently reviewed the Board of Adjustment Decision for the above subdivision while
processing a sanitary permit application and noted that you have compliance deposits that
Real Prope'y may be eligible for refund. According to Condition #5:
715-3 677
Re cling "The plan shall be accompanied by a $100 nonrefundable staff review fee and a cash
-386-4675 compliance deposit for the lot. The compliance deposit for the six lots under construction
shall be $1,100 each, and the compliance deposit for the remaining lots in the subdivision
shall be $300 each. The cash compliance deposit will be held by the Zoning Administrator
until construction is complete, permanent vegetation has been established, and the project
is found to be in compliance with the conditions of this approval, at which time the deposit
will be refunded in full. Upon completing construction on each lot, the applicant shall submit
to the Zoning Administrator photos of the completed construction and certification from the
P hf
project engineer that the construction has been completed as approved to serve as proof of
compliance."
Our sanitary database records show eight(8) permits were issued whose POWTS have
been installed and inspected. However, there are some non-compliance issues that must
4
be resolved before lots 2 and lot 24 will be considered "complete". We need to obtain
` elevations and documentation of the building sewer and tanks that were installed on lot 24
without county inspecto and the mound on lot 2 does not meet the required setback from
wr the north lot line.
y
When we have received photos that document completion of construction on each lot, your
deposit refunds will be processed.
r
Sincerely,'
Pam Quinn
Zoning Specialist
Cc: Brian & Molly Hayes, lot 24 property owners
Andre Buechner, lot 2 property owner
ST.CRO1X COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715386-4686 FAX
PZPCO.SAINT-CROIX.W1.US W W W.C O.SAI NT-C ROIX.W I.US
Standard ErControl Plan
for I- & 2-Family Difivelling Construction Sees
According to Chapters ILHR 20 &- 21 of the Wisconsin Uniform Dwelling Code, soil erosion
control information needs to be included on the plot plan which is submitted and approved prior
to the issuance of building permits for I= & 2-family dwelling units in those Jurisdictions where
the soil erosion control provisions of the Uniform Dwelling Code are enforced.This Standard
Erosion Control Plan is provided to assist in meeting this requirement.
Instructions:
1. Complete this plan by pilling in requested information, completing the site diagram and marking
appropriate boxes on the inside of this form.
2. in completing the site diagram,give consideration to potential erosion that may occur before, during, and
after grading. Water runoff patterns can change significantly as a site is reshaped.
3. Submit this plan at the time of building permit application.
PROJECT LOCATION 417lP %itCf111&&l'f &1&— W95y1^wL Please indicate north
BUILDER OWNER k&*1 f.9W by completing the arrow.
WORKSHEET COMPLETED BY Q Z DATE &,11015 1'
SITE DIAGRAM Scale:7 inch 'Meet �
EROSION
I 0 # ! CONTROL FLAN
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PROPERTY
LINE
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EXISTING
; #Al ! ' # t # ( I I I DRAINAGE
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DIVERSION
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STOCKPILED
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SCALE:,50 S I/4•C UD
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