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HomeMy WebLinkAbout020-1393-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592184 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: Matthew & Suzanne Kari TOWN OF HUDSON 020-1393-16-000 CST BM Elev: Insp. BM Elev. BM Description: Section/Town/Range/Map No: Lo4- 12.29.19.2389 em WA av 1 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 1A i~ AI a"S* Dosing 611 Y~• Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INF A 0 St/ et Q 97- .'7 TANK TO P/L WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing ad an. z1v be 92 Aeration Dist. Pipe / . Holding Bot. t T I/.3 0.35" 9.3J 9 PUMP/SIPHON INFORMATION Final Grade 9.2 Pi•2 -7 9/J 92. Manufact Zemand / / Mo Number GPM T H Lift Friction Loss stem Head TDH Ft Fo emain Len Dia. Dist. to Well _T I I I r . - SOIL ABSORPTION SYSTEM BED/TRENCH Width ( Length /7 No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. Liqui5,DBpth DIMENSIONS (q/~ :7 1-11 _2 Z /11 SETBACK SYSTEM TO P/L BLDG WELL LAKE/S EAM LEACHING Manufacture . INFORMATION CHAMBER OR Ty e Of System: ` UNIT Model be~ L D UTION SYSTEM oV'J drf ~/V 0 L eade anifoll r Distribution x Hale Size Ix Hole Spacing Ve syf Aa _W Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es Topsoil g D Yes E No Yes [1 No COMMENTS: (Include coded e I present, etc.) Inspection #1: Inspection #2: rad.~ Location: 859 CH RLIE N RD I fi1'UaIlS w 1.) Alt BM Descripti n - / = V"~ T Q 1 V'~`^" 2.) Bldg sewer length Lit ed. ~ Co-kxt~ 11v - amount of c = , e /Is 9 Plan revision Required? es No Use other side for additional informati Date ISignature Cert. No. SBD-6710 (R.3/97) cAK) RE- lo1L /7~ 11 400 E W tees lion County t I t Av S'T CRDI)C asiling N O V i l " Maoris n, KP Y2 74A 9 C emit Number (to be filled in by Co.) WG6W JrrI Z `g~ 30MMUN 't Application StaboTrartsactionNumb., In accordance with SPS 38321(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 statc-owii d POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professiatal Services. Personal information you provide may be used for secondary i purposes accordance with the Privacy Law, s. 15. 1 m Slats- Q i L tion Information -Phase Print All Information v s ~I Q v I 1~ 4 r Property Owner's Name y r Parcel # >4 I-t~1t~ SiL N€ 1~ 1. ~f~i21 pZf) - 1393 -/(o_ coo Property Owner's Mailing Address Property 1"ation )9. R city, state Govt. Lot Zip Code Phone Number 5 LO , S~ Section tZ E--{-voscAj wa 7~ (circle IL Type of Building (check all that apply) Lot # T Z N; R t`+ E 1)9 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use ~4eA Block # N~ ~ti PJ } /i/t I J 57 ❑ City of ❑ State Owned - Describe Use _ p CSM Number ❑ Village of 0: (f 16 l Town of ~U DS 0/L HL Type of Permit. (Check only hoer on line` A. Complete lime B if applicable) A. d w.L~ ❑ New System Replacement System ❑ TreatmentlHoldin Tank 8 Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and DntL Ism Before Expiration Owner ZO l' $ ' D 0 IV. T of POW1 S S om neaLSevice; Check all that a on" zed In-Ground ❑ Pressurmed In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. o~ a soil _ n ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Sf V. Dis al/Trtea Area Information= 0 Design Flow (glx Design Soil Applip 'on Rate( Dispersal Area Required ( Dispersal Area sf) System Elevation Prqx7 VL Tack Info Capacity in Total # of Manufacturer Gallons Gallons Units S c a New Tacks Eiii Talcs U Septic or tiokhng Tank a U n m W w C7 O. VII. Responsibility Statement- k the undersigned, assame respeasiNlity for' tiun of the sho" on the attached pllam. Plum I Pteu1ber's Namey{~.p~/~// umber BBuu/sinesss Phase Number Plumber's Address S ZL/03 / T J Greet, City, State, zip ode) c~o~1 sv'yzLI -y3 VIII. oua rtmemt Use t3h0 Approved ❑ t Fee Date Issuing t Signature ❑ b en Reasm for Denial IR. Condit&W6&EA4*A44 ooa for Disapproval 1 - soptic tank, effluent lifter zind 3) 611-6 mdb4- /16 tiisper ai cell must all be sr-rAicjsr nm!!i reL as per moment plan pto'aided by plumber. 1 'art #11 Op is must be maintz. Ved /I •a ~4~T't . as per illpFNrablo code / crdinancea.. Attack to easopiete plan for the system and sabait to the Co®ry ody ors papv nor Ins ttlu a Vl s 11 inch" in sin SBD-6398 (R 08/14) PAGE 1 OF 4 In-Ground Gravity Plan Index & Cover Sheet Component Wwat DesWn References: Version 2.0, SBD-10705-P (N.01/01, R. 10(12) Pg 1 of 4 Index & Cover Sheet Pg 2 of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross-Section & Plan View Pg 4 of 4 Management Plan Attachments: Enclosures: T N r t L,T~_--TC K POWTS Application for Review Soil Evaluation Report & Site Map Project Name / Description Owner Name(s): A Aftg6IJ G. - vz, ,x x.t K,+,o--,l Phone: &:~51 - z~ Owner Address: 6"A F Lte K'Wy tN Rtj, •tA Lt p_-6A) Zip: ,3100-7 Project Address: Govt Lot: s~L 1 /4 of _e~E 1/4, Section t z- , T L-i N-R i `i E Q or V1,~ Township: _ 'H U 0 s 6ij County: S+ • c Fze i>C Project Parcel ID C,zt.- i ~5q coO Designer Information Designer Name: _&/W ,.Y Je +4 L tPjoe~g I Phone: 7)5 - 14 yt' Designer Address: Zg Wf-7 k(./\X, AK_T- tq,,2_S C+ A% a u12Y Zip: 69 & *50 E-mail: d-Ic It 4-er_ eSfG/I OLZ-N d< t-oty This s ~s°e« p~ec~,} stamp. License Number: •'•.4 Remarks: ~~tAFIY J ~A h v gT 7,r,~ 7Z+ P -AIUD ,D MUPMAT s. titan Fi~LLS,,: R a kikq, Signature: (camJ~ DaW j t mac, l6, required on copy. PlotPlon Page Zof q Property Owner 59ZAAN M. jam. K~a-rc i 1 » = 4(1 f~ ~`"'~s ~ t/lon 1AT (awept Wkere natellg c W '/y aF -rte t(y see. I z TZy~ Kt,~Ii re • 1 erl' _ ~QeMioe Pik` --~~St]~l~ ~~c Cn~~rtY WtSrn i<E~I Z~S0~4A~G~5 aZO- I3- North &'Sa CHOARc tE Rww RMJ- , v o ~ ~ aced ~ a y'1 nq o U WELL >--O'FOWq AV a ~RoPos~o M i Site Location: P iW.v 5~~ A (;rt K, PAGE 4 OF 4 In-ground Gravity Management Plan IMPORTANT: The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = 450 gpd; BODS 220 mgL"'; TSS :5 150 mgL"; FOG 30 mgU1 Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing c dosing irregularities - if applicable (i.e_, pump re-cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank(s) shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Advanced Septic Systems Phone: 715- 703 - 8337 Local government unit: St. Croix Community Development Phone: 715-386-4680 Local government unit address: Hudson, WI ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in-ground dispersal component may be abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. sa. ` ~`~`~ra~+~~dad~~ x,,<, :i'n ..•,R:,, ~ m ,!:.N.. s •.-:w, xis •.E Quick4, CHAMBER SYSIfM, I I The Quick4® Plug HNFIL water technologies TRaTOR® Standard Chamber PlUSTM k4 Series 9L[C~ / The Quick4 Plus Standard Chamber offers maximum strength through its two center structural columns. I This chamber can be installed in k.. a 36-inch-wide trench. Like the 4 original line of Quick4 chambers, ? t.. it offers advanced contouring capability with its Contour Swivel ConnectionTM which permits turns up to 15-degrees, right or left. It is f also available in four-foot lengths to I provide optimal installation flexibility. i The Quick4 Plus All-in-One 12 Quick4 Plus Standard Chamber Benefits: Endcap, and the Quick4 Periscope Two center structural columns offer increased stability and superior strength are available with this chamber, Advanced contouring connections providing increased flexibility in system configurations. • Latching mechanism allows for quick installation Four-foot chamber lengths are easy to handle and install Supports wheel loads of 16,000 Ibs/axle with 12" of cover i Maxillnuin Strength " t 1 Standard Specifications Size Quick4 Plus All-in-One 12 Endcap Quick4 Plus All-in-One Periscope 34"W x 53"L x 12"H Benefits: Benefits: (864 mm x 1346 mm x 305 mm) May be used at the end of chamber Allows for raised invert installations Effective Length row for an inlet/outlet or can be 180° directional inletting 48" (1219 mm) installed mid-trench Mid-trench connection feature allows • 12" raised invert is ideal for serial applications Louver Height construction of chamber rows with 8" (203 mm) center feed, as an alternative to inletting at the ends of chamber rows Storage Capacity Center-feed connection allows for 47 gal (178 Q easy installation of serial distribution systems Invert Height Certified by the International 0.6" (15 mm), 5.3" 135 mm), Pipe connection options include ( Association of Plumbing 8.0" (203 mm), 12.7" (323 mm) sides, ends or top and Mechanical Officials (IAPMO) APPROVED in - Quick4 Plus Standard Chamber VA 12' 34' 48" EFFECTIVE LENGTH Quick4 Plus All-in-One 12 Endcap PRESSURIZED PIPE DRILL POINTS LOCATIONS (2 PLACES) O Q 13' 8* INVERT 33' 11 FRONT VIEW SIDE VIEW Quick4 Plus All-in-One Periscope INFILTRATOR WATER TECHNOLOGIES, LLC (`INFILTRATOR") Infiltrator Water Technologies, LLC STANDARD LIMITED Drainfield WARRANTY (a) The structural integrity of each chamber, endcap, EZflow expanded polystyrene and/or other accessory manufactured by Infiltrator ("Units"), when installed and operated in a leachfield of an QUICK4 PLUS onsite septic system in accordance with Infiltrator's instructions, is warranted to the original pur- ALL-IN-ONE PERISCOPE chaser ("Holder") against defective materials and workmanship for one year from the date that the / (360° SWIVEL) septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installa- tion of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/ 1 I INVERT or installation of the Units. (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to 6 the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the instal- lation instructions; failure to maintain the minimum ground covers set forth in the installation instruc- t 5 , 9 , tions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No A 4 Business Park Road P.O. Box 768 warranty applies to any party other than the original Holder. The above represents the Standard Old Saybrook, CT 06475 Limited Warranty offered by Infiltrator. A limited number of states and counties have different war- 810-571-7000 • F. 860-577-7001 ranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in 1.800-221-4436 Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and www.infiltratorwater.com should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4, and SideWinder are registered trademarks of Infiltrator Water Technologies. Infiltrator is a registered trademark in France. Infiltrator Water Technologies is a registered trademark in Mexico. Contour, Micro Leaching, Poly-ruff, ChamberSpacer, MultiPort, Posil-ock, QuickCut, QuickPlay, SnapLock and StraightLock are trademarks of Infiltrator Water Technologies. PolyLok is a trademark of PolyLok, Inc. TUF-TITE is a registered trademark of TUF-TITE, INC. Ultra-Rib is a trademark of IPEX Inc. ® 2016 Infiltrator Water Technologies, LLC. All rights reserved. Printed in U.S.A. PLUS05 0816 • • o • • • • TWO :111 V 1 9 6 8 P 9 8 0 STATE BAR OF WiSCONSIN FORM 2 - 1999 6 8 9 3 4 -7 WARRANTY DEED KATHLEEN H- WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between P. C. Collova Builders, Inc, _a RECEIVED FOR RECORD - - Minnesota Corporation; Daniel R. Beer and Kimberly A. Beer, husband 09-05-2002 9:30 AM and wife, WpRRA14TY DEED Grantor, and Matthew G. Kari and Suzanne M. Kari, husband and EXEMPT it wife, REC FEE t 11.00 - - - - - - TRANS FEE: 185.70 - - - COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in _St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 16, Moonbeam Ridge First Addition in the Town of Hudson, St. Croix Recording Area County, Wisconsin. Name and Return Address Estreen & Qgland 304 Locust Street Of c4. , Hudson, WI 54016 Part ot020-1378-09-000 parcel Identification Number (PIN) Tlhis is not homestead property. CK) (is not) Exceptions to jwarranties: Easements, restrictions and rights-of-way of record, if any. Dated this day of August 2002 P. C. va Builders, inc. * Da el R. Beer * C Collova, resident - - - - Wimberly A. Beer + AUTHENTICATION ACKNOWLEDGMENT Signature(s) P. C. Collova Builders, Inc., a Minnesota STATE OF WISCONSIN } Corporation, by P. C. Collova, President, Daniel R. Beer and ) ss. - - - ~~•y~/t County authenticated this✓_ay of August 2002 - - - - Personally came before me this day of the above named l` TITLE: MFi11B1 11IKATM-BAR OF WISCONSIN .11 Z7 to me known to be the person(s) who executed the foregoing (Srs6t, V- - - t instrument and acknowledged the same. aut~ipbi~e~~by ~ 11j.6»66, Wis. Stats.) T (~INS~ (iIvIENT WAS DRAFTED BY Attorney Kristilili --land * _ Notary Public, State: of Wisconsin Hudson, WI 54016 _ My Commission is permanent. (It' not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity, must he typed or printed below their signature. irnorR,ar~o.~ Profes ,-Is comp-Y ror,d d. lac, wi WARRANTY DEED STATE BAR OF WISCONSIN e0c-e55-2021 FORM No. 2 - 1999 1 ^,ROIX COUI'?'', ( ~f h ST. CROIX COUNTY ZONING OFFICE jov coo 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 followin residence: (Street address) S - i e- ~-V'q lid located at:c5 tiV '/a,5E '/a, Section Town, ` , N, Range W, Town of 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 _ f " ,r` Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /6()& _ Construction: Prefab Concrete Steel Other Manufacturer (if known): met rll s Age of Tank (if known): C_:U Permit number (if known) Q-_ (Licensed Plumber Sig`"nature) (Print Name) (Title) (License Number) MP/MPRS (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 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Perrot No: 420418 0 GENERAL INFORMATION, (ATTACH TO PERMIT) State Plan ID No. Personal information you prodide may be used for secondary purposes (Privacy Law, s.15.04 It Xm)]. Permit Holder's Name: City Village Township Parcel Tax No: Karl, Matt Hudson Township 020-1378 -000 CST BM Elev: I Insp. BM Ele% BM Description: to. O 00.0 CST gwi I ( Qw% Est OL TANK INFORMATION ELEVATION DATA 8 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. -3,09 ^ OS 1a0 t a Septic Benchma 01Sp -r ,,,k.-- 1 ulv,a Dosing Alt. BM r-- Aeration Bldg. Sewer s', p Or I Holding St/Ht Inlet SID 95: W TANK SETBACK INFORMATION St/Ht Outlet Q5:0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic l Dt Bottom Dosing Header/Man. Aeration Dist. Pipe 0 "Jo 9 • ie ~ Holding Bot. System 1 42 Final Grade 3.90 n /s PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM TO O(. SS Model N ber TDH Lift Fricti oss System Head DH Ft Forcemain Le Dia. Dist. I SOIL ,MSQRPTION SYSTEM RENCH ldth t Length No. Of Tre dies PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DINWXS#M 3 i8 iSr C2- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf w INFORMATION CHAMBER OR Type Of System: - UNIT Model Num r 12- of DISTRIBU O SYSTEM -6 L---Q M~rDi-A tt Distribution x Hole Sae x Hole Spacing Vent to Air Intake Pi (s) ILD Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 1xx Seeded/Sodded Mulched Bed/Trench Center Bedlfrench Edges Topsoil ®Yes © No Yes 7LS~No CO M N S: (Include cod cxep ncies, persons present, etc.) Inspection #1:Md!•/ 04 1 -200 z Inspection #2: 'JILPO 1.) AXBM Descriptiorlie Rya Road Hudson W (1,(I 4 SE 11412 T29N[R77 Moonbeam id Lot C -As. Parcel N"'. 1 K 2.) Bldg sewer length = 7J`f~ amount of cover Plan revision Required? -Y~s O Z othe de for d 'bonal Information. Z. No. - -6710 . 7 ~o ; t s Insepctor s Signature cart Safety and Bmildiivision Coimrys_ / , 11VIsconsin 201 W. wabingboa Ave., P.O. Box 7162 Madison. WI SM;7141 Ad&= Department of Commerce fee IV s- J / p Z.- SS`s cp*rki Sanitary Permit Application sookuy PCs - N ~ T In accord with Comm 83.21. wit. Adm. Code. petsomi idonmdow you provide i, twa be thsed for Revision L". s15. 1 pnvx I. Application Wocmtdion - please Prim An Intwasatka Sane Phu LD. Nw*w !3 Propetty Owner's Pared Ntuttaer NA-fu OZO C. Wt Ptopeaty Owncei Maalmg Address Property Location city. &OW Zip Code Phone Nnmher BTU Munber O "S-5a Name CSIA Number II. Type of Btsitdbq (chuck all amt apply) Oats T 2 F.Wy D.Mog - Number of Bedroowas 7~> OVdbte 0 - Describe use 0 sere Owned Ntaatu IIt. ofj%nuib (Check only me boat an Bns A (sambaing scam me for heavel me). Camplete Use B 9 applicable) A. 'I- tjow Por County an "IT 2 0 Ropiaoes mt Sysmn 3 0 RepLcsmeor ot 6 0 Addition. 0 snit E• x,Cihe*it SsshmPawkPtevioa*Issued .r,9 /*AL IV, Type of Paa ft (Cbe* all that ikpptyXmmbwlng ~scchonee its for iotertal me) 44 1n-Gromad 210 Mound 410 sand Fiber 50 0 Coawuctod Wedw d 0 Ptessucimd IrGramd 410 Holding rant 43 0 byte Pas 510 Drip Line 45 0 At (bade +6 0 AcroW tmnmear th* 49 0 Rsdtc~ 30 0 other LGfrlki V. Aria Info rmDesirgn Flew WQ Dk cnd Area Dis xnd Area SA Appticadou Ptawihdoa Ram system Mewhow Regd¢ad Ptaposed Ram(Grds. ft%1Sq.FL) adb Iimcto Elevation 0/~311 '~~nelo -7 - /'Ov -v--- VL Tank Into Cspa dw in ToW Number Manwhcaver heft Site Steel Fiber Plastic (ialioas Gallows Of Tanta Concrete Coasrrrc W abus New Wift sate Swtica sTaa/ Doi" c himber VII- ge~ay - 1, the rapossDAity ror kutWhO w or the POWs shown as the atted" plat.. `Pbmyer",s Name MPsll~4 Ntmshyr Busioea Phone 7~/ 11 '1~7~ I : M*M (sweet. CSy sate. ) use ved sanitary Permit Pee (mcW n Owmndws.er Date Apo Shmakm (No Stomps) Surcinar F- ;Nen Itbiti.l Adverse) =Dvft~Mh*A: w .7t/ f UL C.omditions dAppsanva for Disapproval t1{ . - 1 4~~ ANN* a-Phie >bus do Cawdy e.b9 fw dw s)msa ea pate met ter dan IM s 11 Whas h do SBD-6398 (R. 05101) PLOT PLAN PROJECT Matt Kari DDRESs 7052 49th St, N. Oakdale Mn 55128 SW 114 SE 1/4S- 12 /T 29 19 w TOWN Hudson couNTY ST. CROIX MPRS Shaun Bird 226900, DATE 11/2102 BEDROOM 3 CONVENTIONAL X00C IN•GR U PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Base of Walkout Door ASSUME ELEVATIO 100' Filter Zabel A-100 ❑ BOREHOLE (DWELL .H,g,p. Same as Benchmark SYSTEM ELEVATION 92.5/92.4 Charlie Ryan Road ternate benchmark is of Basemen o .9 30 101' B-2100' 99' Vents 2-3' x 69' Cells with >3' spacing 35 35 0' B3. ST 30' Garage 0, B-1 Pro 3 5 5 Alt. B.M. Bedroom od House B.M. Vent >6 Standard Infiltrator° of Cover Leaching Chamber with 31.1 ft2 of Area N 12" Plans Designed Using 6' Long Conventional Powts Grade at System Elevation Manual Version 2.0 34 Property Line ~r Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT Page I of 2 in accordance with SPS 383, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. 0 - 1393 - 16 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie by V/404 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15 04 (1) (m)). Property Owner Property Location MATTHEW G. & SUZANNE M. KARL Govt. Lot SW 1/4 SE 114 S 12 29 N R 19 E (or)W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 859 Charlie Ryan Road 16 Moonbeam Ridge 1st City State Zip Code Phone Number ity Village jwlTown Nearest Road Hudson, WI 54016 ( 651) 329 - 6676 Charlie Ryan Road New Construction LlseE] Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement EIPublic or commercial - Describe: Parent material sandy loam till Flood Plain elevation if applicable NA ft. General comments Conventional In-ground trenches 0.4 loading rate and recommendations: Pit conducted to verify soil conditions and extend area suitable for replacement trenches. 1❑ Boring # ❑ Boring a Pit Ground surface elev. 91.20 ft. Depth to limiting factor 63 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 1 0-9 10YR2/2 1 2f-msbk mvfr as 2vf-m 0.6 0.8 2 9-24 10YR3/6 sl I f-mabk mfr es 1 of-m 0.4 0.7 3 24-63 7.5YR3/4 sl l mabk mvfr cw l of-f 0.4 0.7 4 63-67 7.5YR3/4 f1f 7.5YR4/4 sl Om mvfr 0.2 0.7 Horizon 2 is a heavy ,t. rl ❑ 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 ` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L, Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si te CST Number MARY JO HUPPERT Hollister's Soil Testin &Design L 224832 Address ate Eval Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 715-426-1775 SBD-83 30 (RO 13) Plot Plan Page z ofz. Property Owner /VI rr tnt S uz~~N~ M v 1"= cTlptlofl kAiz i 40ft Legal Des 117 /b. M~DA RFAnn R►r St,_ (except where noted) s~ ply, s~e+ IZ TL9~1~ X19 TO WAi 07-- '=1 = Backhoe pit Dst)n1_ sT eRaIA)-tV WtSrmskm Z. SD f{&<&5 zzb- , 393- North P5q G+IARe._tE XYM R6A, N v w a pt »1 FRL;ti1 t~ T~DpQ ~ bK~WF/~'4p / 8I iA v 31 Site Location: f m 64 . Plot Plan Page Zof Prope7v Owner M~-r-r- ,ter su N~ MQ KA-P 1» = 40ft allotion LA7 ik_ nnl)nN QGVA Ric-as (awept wkere noteo `4y aF se'/y ssw. ►z Ti~IN MA IA W err- 1J` = BQC I)e pit id.DSt~► vT crz6:Y fin,, aJtY w1ne NSIM Z~SO 5 ma- Norlk ?51 CHARLtE XYM Rb D a O M 3 lea IV) ' v L ~p qa b Site Locadon: e~ v 4~`4 qr ~ f5 4 'Ad k F r w 4~ 7F 3 f 16 C4 P-41 w