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HomeMy WebLinkAbout020-1485-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 592119 GENERAL INFORMATION 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 Township Parcel Tax No: V;zb 666 Kernon Bast TOWN OF HUDSON 02171_1054_60_= CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: aY►'11 '6_r 00 6P ~j 21.29.19.29 & TANK INFORMATION ELEVATI N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ,A,Septic -X^ Benchmark W; cse.r I Z50 X17 I61• 166 e Alt. BM S 146-37 1'1 ,J,u 10L 6Z Aeration Bldg. Sewer Holding St/Ht Inlet 38 l'y. 7 9 TANK SETBACK INFORMATION St/Ht Outlet 75 `14: 4/? TANK TO P* WELL BLDG. ent Air Intake ROAD Dt Inlet Q~^ M ~ Dt Bottom \ Septic / Z~ A/ I IA- 16 Z'Q Dosing I Header/Man. 93-79 Aeration Dist. Pipe 7A P c13. 67 Holding Bot. System 46AO U-57 Final Grade PUMP/SIPHON INFORMATION 2 -X0 F Manufacturer Demand St Covqi- ` • /QQ v GPM J Model Number TDH Lift riction Loss System Head TDH Ft Forcemain ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length JNo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f _ A SETBACK SYSTEM TO P/L BLDG WELL U LAKE/STREAM LEACHING Manufacturer: / INFORMATION CHAMBER OR rr ?ryT-cet ~ Type Of System 36 1 *9 I~ UNIT Mq yl u er:4 ~.o n Jc o N (~f A~A DISTRIBUTION SYSTEM ZZ jI ' s Header/Manifold -I Distribution Ix Hole Size Ix Hole Spacing Vento Air ake Pipe(s) Length -"7 Dia Length Dia ft-_ 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 V• 4__r Bed/Trench Edges Topsoil es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: No Address Available 1 O^ 1.) Alt BM Description 2.) Bldg sewer length = JG - amount of cover = Ol 0 O~ Plan revision Required? ❑ Yes No LIZ- r I 60 7 Use other side for additional information / ~J J L4~ - SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No. 1 UVED County Safety and Buildings Division rL6 j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison WI 53707-7162 ti gZH 30MMt NII Y DEVESMf Permit Application. State Transaction tuber In accordance with SPS 383 21(2), Wis. Adm. Code, submission of this form to the appropm, /04 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS 4 ProjectAddress (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used t, purposes in accordance with the Privacy Law, s. 15.04(1 (m), Stats./'~ j J L Application Information - Please Pr' t ormation ( ( ~q p~ v' p Property Owners Name Parcel # -i- ~N~~i pJ v-;4' ~ I(i)y `~b-, Property O er s Mailing Address Property Location V A - e 1) 11 GovL Lot Gi State Zip Code Phon Number ~-7 Section Ulu 5 a i~1 ;Q b (circle one) T ~ N, R F or W 11. Type of Building (check all that apply) L Q I or 2 Family Dwelling - Number of Bedrooms Subdivision Name V I Ok. ad s oe 0 k t Public/Commercial - Describe Use n' G ❑ City of ❑ State Owned - Describe Use r CSM Number ❑ Village of i 6✓ 2 Z T ~i C.. ❑ Town of _ril f C j - D 11:1. Type of Permit: (Ch''eck only o box on line A. Complete line B if applicable) rt'' Ej*jew System j ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 6• El Permit Renewal \ etmit Revision CI Change of Plumber 11 Permit Transfer to New List Previous Permit um er an Daze Issued Before )expiration ~ Owner f 1 1V. a of POWTS System/Component/Device: Check all that apply) 1?4-on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ Al-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable! soil r ❑ Holding Tank ❑ O r Dispersal Component (explain)- _ ❑ Pretreatment Device (explain) .hll A~L~.r V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application (gpdf Dispersal Area Re uired Dis ersal Area Pro osed I Q 9 p p ~1 System Elevation Gtr -~s 'C1'C 9~s~b 1-b- 7 VL Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units o o New Tanks Existing Tanks U ~ i W A P. ~ rn u, rn ti. C7 0, Septic or Holding Tan, Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P er's Sign re MP/MPRS Number Horsiness Phone Nu bee A ~ i ~:..a a )!,yU:U Plumber's Address (Street, City. State. Zip Code) w VIII. oun IDepartment Use nl Approved I Permit Fee Dale sued Issuin ent Signa Approved Reason Denial S 9d ' Z9 IX:. Conti 11401,11111. 1 I Ik tint a °n Disapproval . dish KJ ai cell must all a sp , n~3~ ~%A t~s, r. ne , . % 1 as,per Irtaralgement plan ptcriicied by plumber, lr'oouez t--~tA A.%-, /moo 2. A~ 'neigtliret uitlts must be mWntr. ifitd _ n p as per Mitt code 1 o linanoes. I~ f `n~e►~'~ ~e'Y~.. Attach to complete plans for the system and submit to the County only on paper not less than 8 ln_ z I 1 inches in sin SBD-6398 (R_ I Ill]) --~ttttttttttttttt~ &L A A&M- e j3tjjj~ Lc y! i ~ t/- A y f,}nu~t ln.~ . ,r i jml MAP h Q c► f'i1t4~1 xaJ(1 killv i ? 1 i ~ tv I t i r) PC) A" Srt1^ci~rt~ .gip ~ ~ f't ( ~ PVC Vant Pipe Gra(le Nth Cap Leac.fling Ci7?arYltl~+i ~ r L-CliAlbsor ~Joln 'Slust 'Al 3-f-, I Tranch r - 4" Dion Vent '-~)e ()bsa; VQVon Pip,, ~ Tranc i 2 ~ t-It?~Ct~a - ~TrenCh Manuf~-P-gwes Anci AfiociFi F: fSA ~ Rating Per cttarrlber Soil Application Rate Pc!/sq 9Pd Design -7 Rate EISA Chambom Page Wisconsin DMECEIVE`L'•~ofessional Services Page 1 of 3 Division of Industry Services OCT 06 zolb SOIL EVAI. CSNNW9FNP4NZP In accordance with SPS 385, Wis. Adm. Code County ST. CROIX COUNTY St. Croix Attach cor(~rj~cDr~n 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical an horizont nce point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 020-1054-6 10 Ref#2452 Please print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04(1)(m)). Property Owner Property Location Kernon & Donna Speer Bast Govt. Lot SW % NW % S 21 T 9 N R E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name r CSM# 948 LaBarge Rd. it. to Na Plat of Cedar Valley City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson WI 54016 (715) 222-4405 Hudson Site Add: 567 Wildberry Dr. ® New Construction Use: ❑ Residential/ Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Glacial Outwash Flood Plan elevation if applicable na ft. General comments and recommendations: Site suitable for In-ground POWTS with 0.7 gpd/sq/ft. design loading rate. Sil inclusion observed in SW corner of B3 at 40" - 78" - do not include soils of this type as infiltrative area during dispersal cell installation. Recommended infiltrative surface = 93.50'. Boring # ❑ Boring ® Pit Ground surface elev. 98.75 ft. Depth to limiting factor >120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-22 10yr6/4 none cl fill Om mvfr aw - 0.0 0.0 2 22-29 10yr3/4 none sl 1 msbk mfr cw 1 vf,f 0.4 0.7 3 29-35 7.5yr4/4 none Is Osg ml gw 1 vf,f 0.7 1.6 4 35-55 10yr5/4 none s w/ Ifs Osg ml cw - 0.5 1.0 bands 5 55-71 10yr5/4 none cos Osg dl cw 0.7 1.6 6 71-120 10yr6/4 none s Osg dl 0.7 1.6 F22 Boring # ❑ Boring 1 ® Pit Ground surface elev. 98.98 ft. Depth to limiting factor >118" in. W~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-20 10yr211 none I 2fgr mvfr cw 1vf,fm 0.6 0.8 2 20-45 10yr3/6 none fsl 1 msbk mvfr ow 1 vf,fm 0.4 0.7 3 45-53 10yr4/4 none Is Osg ml cw 1 fm 0.7 1.6 4 53-81 10yr4/6 none s Osg ml cw 1 fm 0.7 1.6 5 81-118 10yr5/4 none st8r`af Osg dl - 0.7 1.6 * Effluent #1 = BOD, > 30 220 mg/ and TSS > 30:5 150 m /L fl nt #2 = BOD, > 30 _ m /L and TSS > 30<_ 150 mg/L CST Name (Please Print) Signat e CST Number James K. Thompson S-~ - 30021 Address Date Evaluation Conducted Telephone Number X40 Paulson Lake Lane, Osceola 711C 0- 113 ~ Septembz 01. 2 6 , 24~ r767 SBD-8330 (R04/15) Parcel 020-1054-60-010 Valid as of 10/03/2016 07:29 PM Alt. Parcel #:21.29.19.200A TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Owner and Mailing Address: Co-Owner(s): KERNON J & DONALDA SPEER BAST 948 LABARGE RD Physical Property HUDSON WI 54016 Address(es): Information Not Available Districts: Dist# Description Parcel History: 2611 SCH DIST OF HUDSON Date Doc# Vol/Page Type 1700 WITC 11 09/12/2016 1035451 :11/59 PLAT 10/25/2013 988059 / WD Legal Description: Acres: 0.000 07/03/2013 981663 26/5936 CSM SEC 21 T29N R19W PT NW NE LYING S OF RR & 02/14/2011 932155 / QC SW NE EXC CSM 26-5936 more... Plat Tract (S-T-R 401/4 1601/4 GL) Block/Condo Bldg N/A-NOT AVAILABLE 21-29N-19W SW NE 2016 Valuations: Values Last Changed on 06/29/2016 Class and Description Acres Land Improvement Total G4-AGRICULTURAL 32.906 5,200.00 0.00 5,200.00 G5-UNDEVELOPED 8.300 16,600.00 0.00 16,600.00 Totals for 2016 General Property 41.206 21,800.00 0.00 21,800.00 Woodland 0.000 _ 0.00. 0.00: 0.00 Totals for 2015 General Property 41.206 22,200.00 0.00 22,200.00 Woodland 0.000 0.00 0.00 0.00 2016 Taxes Taxes have not yet been calculated. Key Primary Boring # El Boring ® Pit Ground surface elev. 99.33 ft. Depth to limiting factor >121" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2' 1 0-22 10yr2/1 none I 2fgr mvfr aw 2vf,f1 0.6 0.8 rn 2 22-52 10yr4/4 none sicl 1 msbk mfr cw 1 vf,fm 0.2 0.3 3 52-56 10yr4/4 none Is Osg ml cw - 0.7 1.6 4 56-88 10yr5/4 none strat. s Osg ml cs - 0.7 1.6 5 88-121 10ry6/4 none s Osg dl 0.7 1.6 Boring # ❑ Boring / la b ❑ 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/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. - I *Eff#1 *Eff#2 i- 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/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. - *Eff#1 *Eff#2 i I-- t Effluent #1 = BOD, > 30s 220 nag: L and TSS > 30 < 150 m,g l.. Effluent #2 _ BOD = 30 - 220 mg; L and TSS > 30 150 mg-iL • ®EX~Sf~Ilr4c~C ~(ev` I . ~ ca.~-Ye,~~. .s ca /e moo' i /Crtrnon llonnQ .Jt2I s 6 - - 9re LoE//%a~oFC~i►~alley T rr f; 5cc.2.1, TZf"r A0194011 ~1 rar O FC-/ "1 azo-i~s5r-~o-oio Swr_dr-5a~ c : To oF~a c.-c~c, v-, ~f bu,"l d, Scwc//oca~r~. /~-s.suc-nc{,~e%✓-/oJ.ct~. fraP~se.~! Bu:/d,~ 5.(wti = 9S.S0`~ G~d.4.f. Q~ ~ 91cYJ; drr✓ewal' -Porgy art~` i ~ca.agL ; - - ~ J oslo(xm~ I ~ropast.cl _ - Con~w ra.cd~oo rn ~ - a3 i ~ County ~F--! - ECIV► Safety and Buildings Division S o l K, 201 W. Washington Ave., P.O. Box 7162 7~\ Iwi Madison, Wt 53707-7162 Sanitary Permit Number (to be fmlled in by Co. ) SEP 14 20N c+stoan~ ' S~ 2 f ST. I r o2pN16NI -1-MMM "~l$ .t pp1PG State'I'ransaction Number In accordance wl SPS 383.21(2)_ Wis. Adm. Code, submission of this foi... QF14 /CZ,V I _ is required prior to obtaining a sanitary permit. Note: Application forms for stat own e cr 9 D~C e it the Department of Safely and Professional Servies. Personal information you eprovide may be used for , T` to Pro'ect Address (if different than mailing address) I purposes in accordance with the Privacy Law, s. 15.040 )(m) State ~ i. Application Information - Please Print All In mati ~I r Property Owner `s :Name 3 Parcel ~ -A uz-Not,~ lit~,St 01~ Property i)wner's Mailing Add. Fes 1 Property Location t C,ty ate _ (JOVt. LOT 1 'Lip Code i I Phone dumber 6( 1 Section -AL _1 r f 1 (circle one) fl. Type of Building (check all that apply') _ I L.,crt N; R ` F_ or w I or 2 Family Dwelling - Number of Bedro [us Subdivision Name K. BI ern gl~e ❑ Public/Commercial -Describe Use o _ t _ --_v-"".+~+- - ❑ city of _ ❑ State Owned - Describe Use _ CSM Numb ❑ village of A2- ~~b~ l~S 4-2. 7- G er!'S Town of_~ III. Type of Permit: (Check only o e box on line A. fete line B if appl' a le) New System i Replacement System Trea ment/Holding Tank Re ement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ! ❑ Permit Revision Ch List Previous Permit Number and Daze Issued Before Expiration Permit Transfer to New I r f Y Owner ~JV~tK~ N. 'T'ype of POWTS System/Component/Device: C • all that appfyL_ i j NNon-Pressurized In-Ground ❑ yj--:02 Pressurized In-Ground J At-Grade 0 mound r 24 in. of suitable soil ❑ Mound < 24 in- of suitable soil G J Ifolding Tank ❑ Other Dispersal Component (explain)_` ❑ Pretreatment. Device (explain)_ Y Dis ersaUlCreatm nt Area Information: - i Design i-y, { d) Design Soil Application Rat gpdsf) Dispersal C, Re wired - (~p \ jV~ 9 Dispersal Area Proposed System Elevation VI-Tank info Capacity in 1 T Total I, of Gallons Manufacturer - L (?allons Units Nesv Tanks I W~ o Existing Tanks I ~ CID Septic or Holding Tank 4 r~ w c7 p, /Ole -,5z-5 Dosing Chamber - VII. Responsibility Statement- T, the undersigned •sume responsibility for installation of the POW'Y'S shown on the attached plans. 1 j Plumber's Name (Print) Yht ber' ignatu MP/MPRS Number Business Vhone Number L a 'l15 --76 Q 1 I'l, err s Address (Street, City, State, ip Code:) - VIII. ount /Department Llse f)nl • Approved I Pernut Fee Date ssue Issuing t Signahire er eason for Denr I $ IA&e -0 Oa LX. Condig B~'~ MOs BNIbReasons for Disapproval 1. Septic tank, cell nY l be swe( 3 J • Off t~ ,h /1Gi,~ Owl-di.J dispersal cell must all fie„ eseas Ltnainta' as per maragement plan provided i W t~ tt/1 r ~t . 2 AN to~ik by plumber. `Must lae meiriteirNd t„ Per ePPkMe code / orillinvx w. Ate,, ~a Attach to complete plans for the system and subrnii to a Gn my only ppaper not less than 8 In_ i i 1 Ct1e5 m SSY' 5~ s ~ SBD-6398 (R_ 11/11) A)6 lq-4~ Ll A 4 U ~Toa ~A 0- 71- G ~r Mao f~~ 1~1~1L►~,w rSa sfi r x L-1. s g CONVEN TlONA(._ COMPON ENT DESIGN Residential Appli(,*qfion iNjDEX AND TITLE PAGE f~ - rrajer_,t Name: 1~1v~ N c"'Vner's Nam(" iZ1vo1, p Ovan(3r's Address: I_ectal Cta`gc;,'i,tinn: township Gotn'~?v ~ ~~'l Lc,% Numbers 1 ?arce:l jr) mumber: ~y I ► I 2 Plot Plan Pago 3 - 31/St t1~ ir:!:'' , Cross-c Cfi n Flage 5 Mainten n-cr i; fora 1ic~ C i St. C,pix C,:v S_sntic Tank NAi 9intnnailn . Fort, Pape 8 or Att~rYri~p'r~ i! `l"ejt & f f~i;r.~F C'Ian; "D b_01 1 siana(lre nFd ~~ursuant to thn In-i_,round 5 , - Abs rp,ron C.'.cvr,paront M r u, 1 fr~r ~~~1VT':i V~rsinn ?.U SFID. I07r5-n Pop, I I SO S 4" OSV I f'VC 3fFrtf Pr~r_ Final ~3ra~ir~ ion 19.00 L Veoi for C3[35rw~V If}fl Pip, Q ~fk~i~1^~1 2 i j !•'t OL!'ek' ~~`._.,fj_I.1.4.~1;_f.11~~.~.11_E~; I~. ~37 it Spec ffig Mall And RDA EISA -Cpl t3 ~s P Ghc~'ti Sod. 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"3r>aw~r r' &I ohm tart;'c(o9 'w imnlnlf,; sny ms!n; or ~rakgn hay"Glor~~rz~z !dsriti~,j dry rrrr mRn sr Isere, Frea"wra m!tIr rer n•P crombim3H S!W, Ta 'Ind anrd to nf or * 'fr.,r An' hank; z?la ar proms lm af 'n", %art On -*6 ormind swrf'sce, Tho d',spsr1;,q; rro?t.{s) rhos l hos v7"Vu.A71y ;n. ar;;sr it ('),mk wha Ripluen1l: ievma s iro the .aar r~x i ~o Vfpgo ~YIN to r hmlxl 1, ,r Ary pnmdin3 ,31 ~f~'rz-': ran okra grm%ltt m4lmaa, ?"ha pn e7q;V~ tf !,r Vzylt nr ,lyr groom ? ar,rrPploo may ln~lnte~ s' Ming omdItion ,sna engmlras the i~ti~rrnadl'a s rrr;~iJNR''Inn 0~ rha 1~~~.1 r'~~rtlsr~r~~ p.w~~lnri9;lt. 1Alhon th4 mlar 7rr"u.11atf n`1 Vii' 'Owlge ant Qew7i "n PiI`% zrs ggw,519 t'nll ',f'1i'rta { ) or lllno a 0 thig nk uolom,a, the ?Smjra a,jrrznn;s war ~)n tank MRfr hm, ra Ott%el bV u °,wq4 srtJriri; Cyrnrr'"r.!~r And Osprrr,'O?l a", ,fir 'Yre'r t e 1411* af"4 tlC r N,1~ 111, W;rno n;ain Aelmin1nrrmvrvp C nfln, All Cff18f' Cyr'6/P A, r4,iw1 lei W. not i mIt'R o 1a '",hp mvialrip C3 sfflijam 111rmm, 1Tir7t1'PvpC ~l t rls~iRduif7a"{ Y'Af'7~1pP"9l1~~+r ~1r+lfY~~Y$rRJt3r1fi waits, and sm: l gtIvIMIl g ar t ; a ~ mrn~°} Thal! hA pprflprrnaci her F. lml.Mand ~ ~~~~:i<!1~•inYePry~r, A aprvlrn rrapcr,: sha;! .*N, prmvrr ad T:e fiha Inane r~ ,,"tat:ary + hrir2~ti+ tnri~.hirr 'i K1 d'Ayn rsl trmrUVon of Ov W0y 8'emn' ' ©,Antnz mjol