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Home My WebLink About020-1395-05-000 County: St. Croix ,consin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: INSPECTION REPORT 579045 0 ~fety and Building Division (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: Personal information you provide may be used for secondary purposes City Village X Township 020-1395-05-000 Permit Holders Name: Hudson, Town of Cochrane, Dale J. Sectionrrown/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: 25.29.19.2399 625 lib BS HI FS ELEV. TANK INFORMATION ELEVATION DATA CAPACITY STATION TYPE MANUFACTURER Septic Benchmark 1 5• lift i e~1~+5 Alt. BMA~ / , to `T • 1 Gil' ~-v` Bldg. Sewer n Aeration St/Ht Inlet Holding St/Ht Outlet TANK SETBACK INFORMATION WELL BLDG. e o Air Intake ROAD Dt Inlet TANK TO A/'' 2 A Dt Bottom Septic z 6 L Header/Man. Dosing Dist. Piper 4 $,k Aeration g~• `J Bot. System 7-Q0 Z 9 a , Z Holding Final Gra 1• g PUMPISIPHON INFORMATION Demand St Coer cf ? $ - Manufacturer GPM MO umber a,~~J-~~ 5•~~" s ~3 t1 Z • J cS TD Lift Friction Loss System Hea TDH Ft /-r .••sL Dia. Dist. to Well Forcemain Length Inside Dias` SOIL ABSORPTION SYSTEM Liquid Depth Length No. Of Trenches PIT DIMENSIONS No.OfPits RENCH Width DIME SETBACK NSIONS IONS 3 SYSTEM TO Z ) ~ee+LEACHING Manufactur p/L BLDG WELL I LAXE/STREAM If CHAMBER OR J ` I If S~, J yst* INFORMATION 66.0 ' 1 /t UNIT Model umber em ~ V7 ~J~ ~V I'r Type Of S e,: .a n~J[~ 0 ~ 1!114- a'~ ~3a DISTRIBUTION SYSTEM x Hole S' X Hole Sp Gna 9 Ver W>erl~1D Ai take e HeaderlManifoy Distribution \ Pipe(s) Spacing 5 Dia_ Length Dia Length SOIL COVER ) x Pressure Systems Only xx Mound Or At-Grade Systems Only ,a Mulched xx Depth of Depth Over Depth Over xx Seeded/Sodded Topsoil es No Yes No Bed(rrench Center BedlTrench Edges / Inspection COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Parcel No: 25.29.19.2399 Location: 826 Prairie Meadows Dr Hudson, WI 54016 (NW 1/4 NW 1/4 25 T29N R1 9W) Scenic Hills Lot 5 ~a 1.) Alt BM Description = t 2.) Bldg sewer length = ~~~•~~i `J~ r ` - amount of cover = _ l ~ Plan revision Required. ❑ Yes No Cert. No. Use other side for additional informa . n. Date Insepctor s Si nature SBD-6710 (R.3/97) County F Safety and Buildings Division St. Croix 201 W. Washington Av .0. x 7 2 unitary Permit Nr (to be filled in by Co.) p JUL 3 1 NIS Madison, WI 53 - 7 9 6 4 8 ~ State Transaction Number Sanitaryermit Application A- In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary uses in accordance with the Priv Law, s. 15.0 1 m , Stats. 826 Prairie Meadow Dr. 1. A lication Information - Please Print A nformation parcel # property owner's Name 020-1395-05-000 Dale and Tammy Cochrane property Location / 23 G- property Owner's Mailing Address 11-9 1 826 Prairie Meadow Dr. Govt. Lot City, State Zip Code Phone Number NW INW 1/4, Section 25 circle one) Hudson Wi. T29 N; R 14 EorW II. Type of Building (check all that apply) Lot 3 5 Subdivision Name ( Ior2FamilyDwelling -Number of Bedroom 1~_, Scenic Hills Block # ❑ Public/Commercial - Describe Use & ❑ City of CSM Number El Village of ❑StateOwned-Describe Use ZQ si- ell tJ (]Twof Hudson ~ M. Type of Permit: (Check on one x on line A. Complete line B if applicable) 2&^0- A- ❑ New System EkReplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner 405023 4-19-2002 IV. T of POWTS System/Component/Device: Check all that apply) EkNon-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 (explain) ❑ Pretreatment Device (explain) n V. Dis ersal f reatment Area Information: n~ S v&tn Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required (sf) Di ..Are* Proposed (sf) System 1 Elevation 91 .0~ r 91.81 450 ✓ .7 643 4 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units Zabel A-100 yy ~CQ U U N N N R New Tanks Existing Tanks filter 0. U N 03 w 5 a~ septic or Holding Tank 1000 Weeks x Dosing Chamber VII. Responsibility Statement- I, the undersigned, assn a res sibui tanatio f the POWTS shown on the attached plans. Plumber's Name (Print) Flu Sign Mp/MPRS Number Business Phone Number Keith Knudtson 48443 651-470-1737 Plumber's Address (Street, City, State, Zip Code 927 150th St. Roberts Wi. 54023 VIII. oun /De artment Use On Permit Fee Date 11s"sued~y Issuing t Signature pproved P pro $ ( 1o I ✓ ❑ lven Reason fo 4 75 IX. ConditSWI EldlQlPd 1511fteasons for Disapproval 1: , Septic tank, effluent filter and •v`"~'"~- ~ 6~ dispersal cell must all be services / maintained 6 1 5 ®ul e U k r -as per management plan provided by plumber. , ~/e r i*d must be~malrrtie as pifr 1 Attach to complete plans for the system ands it mto the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) `el a° e*l 3 ~M r Ott 5 id- s Ada ws ~ l ~ ~a u5e GY h ~R e•7 ~t,4 ~L D 1 "gar {C CONTpACTINGB LC Q a I r 927 i 50TH ST: 64,g447MPRS / I ROBERT S, 51-47 1`738526 CELL 617 CO o~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Cochrane sewer Owner's Name: Dale or Tammy Cochrane Owner's Address: 826 Praire Medow Dr. Hudson Wi. Legal Description: NW 1/4 NW 1/4 S 25 T 29 N R 19 W Township: Hudson County: St Croix Subdivision Name: Scenic Hills Lot Number. 5 Parcel ID Number: 020-1395-05-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page S Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson License Number. 648443 Date: 07/29/2015 Phone Number (651) 470-1737 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 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) 826 Praire Medow °r. located at: NW 1/4, NW 1/4, Section 25 , Town 29 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 7-22-15 Did flow back occur from absorption system? Yes No x (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Weeks Age of Tpnk (if known): 13 yrs. Pe t um er f 4050 3 Keith Knudtson ( icensed ber Signature) (Print Name) 648443 (Title) (License Number) MP/MPRS 07-28-2015 (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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page o - FILE INFORMATION! SYSTEM SPECIFICA"nomS Owner Septic Tank Capacity al ❑ NA Permit Septic Tank Manufacturer- ❑ NA DESIGN PARAMETERS = Effluent Filter Manufacturer - ❑ NA Number of Bedrooms ❑ NA Effluent Fitter Model a aZ9 ❑ NA Number of Public Facility Units Pump Tank Capacity gal kA Estimated flow (average) al/day Pump Tank Manufacturer X;AA Design flow (peak), (Estimated x 1.5) gaUda Pump Manufacturer Soil Apprication Rate al/days Pump Model Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ti 11tA Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter ❑ Peat Fitter Biochemical Oxygen Demand (BODS) <1' 20 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average D' Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg/L ound (gravity) ❑ in-Ground (pressurized) Total Suspended solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Conform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size ~Ys in dia ❑ NA other E3 NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ gionth(s) (Maximum 3 Yeats) ❑ NA JR"Year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ NA Inspect dispersal cell(s) At (east once every: 3 ❑ yearn(dsh~(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: Ppionthis) ❑ NA I r year(s) Inspect pump, pump controls & alarm At least once every: 0 y~ s'1 s) Flush laterals and pressure test At least once every: ear(s) NA Y Other. At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shalt be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fairing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. AD other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 7 eel; e- 3 10 ~c hoase F-GLI A ~RT,s.~ C~a ~L l dad. oo ~ 50 J a2 y KNUDTSONCTINGBLLC & COO~ 648447M I j O r0~ r 927150TH ST. 8526 BOB S, W1 54023- E 526 V CLL 6 51.47 1737 $oit AbsRM t4_ n Satsm_ Cross Section ft F al rade 4' Schedule 40 PVC Vent Pipe Wdh Vent Cap ~ ft Leaching Chamber ~ft em Elevation _3 _ft c5-- ft Soil Abegmtlon_SysIM, Plan View ft ft Ifliflill Leading Trench 1 ---~-;-ft Vent Or Observation Pipe Chambem 4' Dia. Trench 2 Header Leachina Chamber Specifications Manufacturer And Model EISA Rating_ sq ft per chamber Soil Application Rate 4 ' gpd/sq ft gpd Design Flow + Soil Application Rate EISA = Chambers 2 rows of _-Z40- chambers each. i Page of i 1131 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of safety and Budleings cgs in accordance vaith Comm 85, Wis. Adm. Code Tom SchmRt Ated► carnpiele slle plan on paper not less than 8%x 11 inches in size. Plan mud County ixitrde. tNrt ntd frrited loc vptlcai and hori¢athtl oaferal point ( lrl , d vscl on and St. Croix percent slaps, soda a dtrwnslore north Snow, and location and dielertoe fo neatest med. Parcel I.D. pid w aN NHbnradorr 020-1395-05-000 Personnel bdornreN, you poWde may beuml s 15. I) ML - By Date (Z Prop" Owner P Location Grande Designs ` % Q GowLtot NW 114 NW 114 S 25 T 29 NR 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 781 Crestview Drive So. ply. COUNT Scenic Hills City State zip City Vdlage ✓ Town Nearest Road Saint Paul MN 5511 Hudson Prairie Meadow Drive ✓ New Construction Ilse: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventiwtal system with a 0.7 9Pd1sgB rating. Possible system elevation for Area 1 is (high trench) 92.8; (low, trench) 91 Ar. Slope is 13%. Boring # Boring v Pit Ground surface elev. 97.27 ft. Depth to limiting factor >105 in. Sol App edon hate Horizon Depth Dotrinett Color Reft Deactiplion Texture Skuc4re Cansielenca tloutdary Rods in. Aft" Qu. Sz. Cont. Color ti►. Sz. Sh. •Eff#t 1 0-8 10yr3/2 none 1 2m9r mfr Cs 2f .5 .8 2 8-22 10yr4/4 none sd 2fsbk mfr gW 2f .4 .6 3 2240 7.5yr4/4 none ad 2msbk mfr 9W if .4 .8 4 40-149 10yr4/3 m2d 1 6 at 2msbk: mfr 9v+ 5 9 5 49-58~ 10yr514 none Cos Osg mi CW .7 1.6 6 56-105 10w" rwne rns Osg ml - .7 1.2 d& 42, V ` 1 L I Boring 0 Boring L_~1 ✓ Pit Ground surface elev. 97.47 R Derry to wing factor >106 in. Sol App Rd& Horizon 0eph Dominant Color Redorr Deem"m Texture Structre Consiolence Boundary Rods In. Murew Qu. Sz. Cant Color Oc SL Sh. *EtW1 *01112 1 0-8 10yr312 none 1 2mgr mfr ce 2f .5 .8 2 8-19 10yr4/4 none ad 2msbk mfr 9w If .4 .8 3 19-35 10yr4/4 none sl 2msbk mfr 9W .5 .9 4 35-42 7.5yr4/4 51 /6 W 2msbk mfr gW .5 9 5 42456 10yr5l4 none Col; 089 mi Cw - .7 1.6 6 56-106 10yr516 none ms 089 ml .7 ' 061Z • Eftiuant #1 - BODe 30 < 220 mgA. and TSS X30 < 150 mglL ` Effluent 02 - 800 S30 mgfL and TSS t.30 mglL CST Name (Please Print) Sigotrrre: I CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Data Evalustiar Conducted Telephone Number loo, 585 Valley View Trail, Somerset, M 64025 685102 715.549-8551 f~t~U1S''IQh/ _ _ _ _ - • = _ _ _ _ _ , _ _ - _ - - R~IOK ////OAS. _ t/,E~M' o~ /XSP i qyoa rea. - - N-0- I ' ~rFSt.~r~s - IA -5or - - - AfT 40- Pre - M) _440- arm D1? So - - 5 6 ~lAccF y_r ~ crr_ ~.@y o2rt ET 40 . Al Pfope~ owner Grande Designs Panoei to * 020-1395-05-000 page 2_of-3_ Bon F3 Boring ✓ Pit Ground Surface elev. 93.57 fL Depth to ! factor >102 in. Sol Application Rate =107-0 MW" Reddx D 4tion To*" Stnctrae Cams t3oindwY Raote Qu SL Cant Color r Sz Sh. `Ef1f111 'Effi2 1 0-9 10yr313 none I 2mgr mfr rx 2f 5 8 2 9-17 10yr4/4 none Is 2msbk mfr 9w If 7 1.2 3 1 40yr514 none Cos 099 m1 9w .7 1.6 4 4 102 10yr5/6 none ms 099 rrd .7 1.2 2l. L'd .Z`{ r J4 ,i 67 / ❑ Boring # Boring 3 Pit Ground Surface elev. fL Depth t limiting factor in. Sol Application Rafe Do* DomYw* Color Reaex Detaiplfon Texprte Stnchae t)ourdory Roctc irL Mused Qu. Sz. Coot Color rr Sz. a -Efm -Ef*2 Boring # PiBoring ❑ t Ground Surface elev. ft Depth to limiting factor in. Sol Application Rate Flatmn Depth 1 Dw*=tC W RomDsoo"on Ted" Stru tole Carriefenoe trL Mused Qu. Sz. Coat Odor Gr. Sz. Sh. Sort y Root 'EfR" '1211102 i i I I Effluent 01 BOD,> 30 a 220 mglL and TSS >30 < 150 mglL • Effluent #2 BOD < 30 nV& and TSS <30 The Department of Commence is an s 5. mgti equal opportunity service provider and employer. If you aced assistance to access services, m.1 motwe:ol in an oNer..atn fn.+nst nl.wcp nnntort th. .renoam..~t of I.AR_744-21 It 1 nr 7'rv !.l1R_7l.A _R^/77 r - - pie 30-x' y -bip tit) (S I%A r. g3;p jt2 r F G 3r ~V14 p,ky Port,rp StN? 7N.~5 s'fl 6 (f~ lle (71 S) Pr pjlr 1. M&aA--J NO ~ nt S2s'7.~9r~t ~t4v ~ _ Sw 5'c~-c ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Dale or Tammy Cochrane Mailing Address Property Address 826 Praire Medow Dr. (Verification required from Planning & Zoning Department for new construction.) City/State Hudson Wi. 020-1395-05-000 Parcel Identification Number LEGAL DESCRIPTION Property Location NW 1/4 , NW 1/4 , Sec. 25 , T 29 N R 19 W, Town of H u d so n subdivision Plat. Scenic Hills Lot # 5 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 13yes ho Lot lines identifiable ❑yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department withi 0 days of the three year expiration date. I/we certify that all statements on his 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 arranty deed recorded in Register of Deeds Office. Nu er of bedro s 3 -7- S A F APPLICANT(S) ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) a -76 - 3 / Kos 2y.zs q!5 zl~ 53 ~ ~ 72- SS g52.3c~ ~Ird3 q~l ~sl lack 1 r Z.o.aS ~3Z. 3 ~ 1.3 q3 I PC, ~ k- x &)6 D.~S t \ f ~ z .tsSHS 88s ~ P 1 1 l;b` sit 7i tz i i f! $ f ~ all s . i . OM011 MNN~I lnL9N L \ ` Y Y M Y ~ , ~ ~IIP9 ®6br1~B11 J Y Y Y i E E E Y ~►~aaoosw9aae®wnesvsR ~u,cum~eiseuarra ~ ~ E y D Y ~ ,