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HomeMy WebLinkAbout020-1485-15-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592145 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: Kernon Bast TOWN OF HUDSON 020-1485-15-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 21.29.19.3090 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer I Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head r DH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size X Hole Spacing Vent to Air Intake 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 Edges Topsoil E] Yes F] No n Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 551 WILDBERRY DR 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = I Plan revision Required? ❑ Yes [ No - - - - - - Use other side for additional information. 1 J J SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. I' vY `v Zak Count Safety and Buildings Division j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be fi ed in by Co.) ~7o a Nov 2 9 ~l t: Madison, Wl 5376 162 ST. CROIX COUN1 Y 1 11~ 111.11 11 1, 111, 1111 rill, I 30MMU A- 10 d4nit Application rate Trdnsaedon Number In accordance with SPS 38321(?). Wis. Adm. Code, submission of this form to the appropriate go. All is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are sut,.., roject Address (if different than mailing; address) the Department of Safety and Professional Series- Personal information you provide may be used for secorl purposes in accordance with the Privacy Law, s. 15.040)(m), Stats. 1 1. Application Information - Please Print A! or on i pq IQ J( V R Property Owner's Name 2 Parcel # Property Owner's 9 L Mailing Address Property Location I j Govt. Lot City, State Zip Code f j Phone~Nlumber N i1i y, &y - y, Section - Y) S hl 1iv 7 y V _ i V T 9k 1 N, R 19 (sirs E orek) IL Type of Building (check all that apply) 1 Subdivision n _ ❑ I or 2 Family Dwelling - Number of Bedrooms f ubdivision Name ok 4>D Bloc Pit ~J ❑ Public/Commercial - Describe Use A ❑ City of ❑ State Owned - Describe Use CSM Number ❑ village of _ 2 ; t~ ~Zk ❑ Town of S t t C~ 111. Type of Permit: (Check only o boa on line A. Complete line B if applicable) j k. 1 Npew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) l S. I' List Previous Permit N ber d D Issued El Permit Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner S~ , Tlu' t I IV. Type of POWTS S stem/Com onent/Device: Check all that a ! •/c 1 -2* Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soils t ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) •~I~ V. Dis rsal/T -ea nt Area Information: , j Desi n Row (gpd) Design Soil Application Rate(g Dispersal Area Required (s Dispersal Are ,Pfoposed (51) Syste Elevation VI. Tank Info Capacity in Total 71 of Manufacturer Gallons Gallons Units 15 Neu- Tanks a-isting Tanks h CID 2Z I Septic or Holding Tang f Dosing Chamber ) V t VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI C s .C ature MP/MPRS Number Business Phone Number Plumber's Address (Street, City. State, Zip Code) 01 V oun /De artm nt Use Only pproved cr Permmiit Fee ` Date I ueedd issuing tr t Signature Liven Reason r Denial Z / LX. Condi,40, Q "easW for Disapproval 3 Q 1 b`111 tank, a flusrlf tend IJIJ~ q6 f/I dlsperr-c i cell rlutt 4 be tics ! i-r- in 1- as per mar,agemaiii an p uiideh Uy plumber. 7. 'All iseti regWg49nts must W riamtdt d j as per apFlicablo w& / rdilianill Attach to complete plans for the system and submit to the County only on paper not less than 8 u3 x I I inches in sin SBD-6398 (R_ 11/11) i ` f\i Y~I i, b i C S! f ~ ~ ~~rm`~jf)t C, o ❑ LIU f i E i i , 44- c - - j 451, A4 poi Tl'h Cot 7 7. ~r - - C b a3 ~ !~U as ~~,b►n„~h 5 3x$`~ 00 p PI I ~ -a p i F-D PVC ifert Pic Final GrAot, With Veit Leaching t'ii~mber _ ~ ~ in rSy tr 1 Ele-vation ti. AL, so 51'R~°'i49E4 f Il J) < Trench I Ct' M ~l M."RIM IRWITUIERM-ON 4" Dig. T eom,t; ►-idu Ve-n, '-)F ob5La vatinn Pipfl f MR _ L 4- - _ Man And Model 7CT - D h + , j F1A Ratinq = t Sq ff PeT chamber I Soil- Application Rate G3 _ '7 ~ bpd/sa, Moo' Design ~Ic?vnr - Soil Appticetjor+ :,,ate 9 C j? EISA tfih tatJ ®rotnrs QA - chambers (a,,,jClj. Page - of RECEIVED Wisconsin Department of Safety and Professional Services Page 1 of 3 Division of Industry Services / / +,a~ ~ SOIL 1Q I" A W a1 q 4 ®~d 2 3 Z016 REPORT ST CFTOIX COUNTY In accordance with SPS 385, Wis. Adm. Cod WAY' DEVELO ENT Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St. Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 020-1 -15-000 Ref#2458 Please print all information. Revi d by 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 % NE % S 21 T 29 R 19 ) W Property Owner's Mailing Address Lot # Block # Subd. N me or CSM# 948 LaBarge Rd. 15 Na Plat of Cedar Valley City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson WI 54016 (715) 222-4405 Hudson Site Addxxx 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. Recommended infiltrative surface = 92.75' 1❑ Boring # ❑ Boring ® Pit Ground surface elev. 97.52 ft. Depth to limiting factor >11 1" in. Soil Application Rate Horizon Depth ;Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 2/1 none sil 2fgr mvfr cw 2vf,f 0.6 0.8 2 15-38 1 Oyr4/4 none sicl 1 msbk mfr cw 1 vf,f 0.4 0.7 3 38-44 1 Oyr4/6 none Is Osg ml gw 1 vf,f 0.7 1.6 4 44-89 1Oyr4/6 none s Osg ml gw 0.7 1.6 5 89-111 10yr5/4 none s Osg dl 0.7 1.6 1 ( ❑ oring 121 Boring # Pit Ground surface elev. 97.68 ft. Depth to limiting factor >115" 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 0-19 10yr2/1 none sil 2fgr mvfr cw 1 fmc 0.6 0.8 2 19-38 10yr4/4 none sil 2msbk mvfr cw 2fmc 0.6 0.8 3 38-45 1Oyr4/6 none Is Osg ml cw 2vf,fm 0.7 1.6 4 45-85 1Oyr4/6 none s Osg ml cw 1fm 0.7 1.6 5 85-115 1Oyr5/4 none s Osg dl - 0.7 1.6 * Effluent #1 = BOD, > 30<- 220 m / and TSS > 30 150 m /L * Effluent #2 = BOD, > 30s 220 m /L and TSS > 30 150 m /L CST Name (Please Print) Signature CST Number James K. Thompson 'i 30021 Address Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020-5413 September 30, 2016 (715) 248-7767 SBD-8330 (R04/15) Boring # ❑ Boring ® Pit Ground surface elev. 97.08 ft. Depth to limiting factor >109" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10yr2/1 none sil 2fgr mvfr aw 2vf,f 0.6 0.8 2 14-30 10yr4/4 none sil 2fsbk mfr cw 1vf,f 0.6 0.8 3 30-37 7.5yr4/6 none sl 1 msbk mvfr cw 1 vf,f 0.4 0.6 4 37-43 7.5yr4/6 none Is Osg ml cs 1 of 0.7 1.6 5 43-83 10ry4/6 none s Osg dl gs 0.7 1.6 6 83-109 10yr5/4 none s Osg dl 0.7 1.6 q-L ~ I ❑ Boring # ❑ Boring ❑ Pit Ground urface rI . 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 ❑ Boring # F-1 Boring ❑ Pit Ground Surface elev. ft. Depth to limiting factor Soil Application mate 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 Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 5 150 mg/L Effluent #2 = BOD, > 30 220 mg/L and TSS > 30s 150 mg/L • ~;~60~ by ~4d Y//s~s ~i~ Ewr'i nc, ~y / it om~0 sm ro~~'~Ie 46 I (~e~n on if Lin n~( Sµ~ef /S--CcG 6c iyp acres w; /rfbcr~ ct1 Y ~}ssu-me o/ a te'. led. ~/ev` 4 fPo~' SEwbb bu:Id,~ scwa~- = 9s C6' ~ ,pa s. Wince q duX g4!'t9t z I~ 3 e-lel - 97 6J.' ley. 3 sn r~1= ECEIVED County 7J,/ Safety and Buildings Division R x 1 ! 4 ` K 2O1 W. Washington Ave., P.O. Box 7162 Santt--Pe-m-"t N='u!m-bet (t !1 s o be filled in b Co mow/ OCT 4 20 i) Madison, k37 -71 by > OIX COUNTY OMMUNI 1JF51VTDW7RYA State•riansactionN 1 r ` ary eimit A.pplicatiol., In as ortlance with SPS 383.21(2), Wis. Adm. Code, submission of this fomt io the appropriate ;overnmental unit _ Ls required prior to obtaining a sanitary permit. Mote: Application forms for state-owned POWTS are submitted to Project Address (if different than mailin , address) the Department of Safely and Professional Servies. Personal information you provide may be used for secondarvil u oses in accordance with the Privacy Law, s. 1.04(1 (m), Stats. Z Application Information -Please Print All Informs on Property Owner's Name Parcel # Property Owners Mailing Address Property Location City State Govt. Lot I Zip Code Phone Number t --r 1 K- Section L -1lil I Sit 9(circleone) R. 'T'ype of Building (check all that apply) ~ Lott ! R __~L_-For W N Or 2 Family Dwelling - Number of Bedrooms h drivision Name ❑ Public/Commercial -Describe Use aK Ob ~ Block V,4 I i_~ ❑ City of ❑ State Owned - Describe Use CSM Number El Village of L, ZZ CSC Town of M. Type o Permit: (Check only one ox on line A. Complete lin f applicable) f New System I Replacement System ❑ Tmatment/Hold, Ta Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision ❑ ange yf PI I Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner (1~+ IV. "I~ype of POWTS System/Component/Device: a lye on-Pressurized In-Ground ❑ Pressurized In-Ground Gradc ❑ Mound % 24 in. of suitable soil ❑ Mound 2R i f suitable ❑ Holding an. Other Dispersal Component (explain}_ ❑ Pretreatment Device (explain)_ _ I V. Dispersal/Treat ent Area Information: - f Des Flow Design St«l~lplication Rate( ds } I DispersalAr(R~equired (s1 Dispersal Ar(ea Proposed (si) System Flevatio VI. 'l'ank Info Capacity in ( Total I of Manufacturer --T - 7- Gallons Gallons Units 2 New Tanks a ~ Existing Tanks it: v8 t' (G O kj a` n cx C7 a. Septic or Holding Tani; - - i__ , as o ► J-_ e se r - j Dosing Chamber VIi. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (Print) Pin is Signs MP/MPRS Number ~ Business Phone Number '1160- Oill? Plumber's Address (Street, City, State, Zip Code) " VIII. unt /De artmen ise On_tY P-- emiit Fee- ( pprot+ed Disapp I Date I sued Issuing nt Signature - f even Reason o $ $ to, IX. Condit lKeasous for Disapproval ! stank, effluent Iiltend J Rtd4,1 (b J Y1G~a. O.1a.ew fNspen^al cxtl must all etv t n~ int me 00 Perm ragement plan provided by plumber. h/► MA rum.. 2. A#,-XeftW* dquft+eM9ft must be mainte,ir;ed as per aPlicable cods; / c4nanres. Attach to cnmplefc plans For tLe system and submit to the Cnun ty only nn paper not less than R ~n_ a ] I ihC6es in size SBD-6398 (R_ 11/I1) r1mv ~ r Derv c 7S' E L r t w ~ G ff~ F 4: i i L _ y lulcop i f GrONVE# J T'1O.. ;'N,f"'"11.._ L,r~: ~I~V".9~t„~'I\tl~i~,{~'~.f^d Il?+' 1 Dvann _..._Y.._.......;....-.:.,........ r.n._..vn.._.......;._~n.....___ r. 1 t71ni11:~i~Ip b 0*5 P!, 1 T Rage 5 I pa~ Y air~1~£tit.,rr. ~)i, 4}ner.; ).xr-gu~ni In ~r gyn." nii /~br;~,rp~tson t,'.om~~onnnt Al1aNnlnl err "4~IN?",3 Vr'r,inn ~ a13D f0'"11.1r.~a';N.(i'1/~'I i i r JI PVC ve 'Pipe Final Graf-, ti1>rQ{~ I~ar1~ r~P E~. i.J_, i_esching Chamber 7,Q r.~ 1(t,~ 1 n +30.AGRie~r i_ 1' G CT!' G l~Fiad S/ A F xk 17 I _W1 4" Dio. r Vent OF OhsaTvatir)n Pipe 3 rer~cR~ 2 ~ Header d Trench O AallUfaCtuceF And A40&,E sr5 char her Sniff Application Rate 9Pd/GG ft Soil Ap631'icatioej .2,jte S i_6 3_ ciiarntm, of PILF. lMr-ORMATlO: l YtST t e a l , {Z IU ~ r' p l Stpptta Tank waPsr~~y ~ dal ~ ~A Owner errvit septio Tank Manuftamrar it w M NA 098112N ,,ARAN h°I~rr^k 1 1 Ar Manw•f~rattarar o M NIA NuMbar vl Nr!mo =-4 Efflumnt Filter WOE r-p MA ► _ Rlurt' der Of F`>t lfe FQni3iky Units Q NA Pump i pnk Capsolty NA f1" Pump enk iWI>ant~fa t liar NA 1 Rsttrrta~ed fiow (gtvarae} ~ _ d r b xirtteirld x i Pure Manufaa"er t NA de.ign'10ct( 109ak), {Ea.t } ailr~u 3 Pump Model MA 1 Sall Appfl" AIM RaGa s aYlU1a~~~ I~ St<andartl Int'Its~al~tlpffluant ~.~tailty Mtsttitt~r taueratta~' Pr~t.•ra>~~rmen; ~fnit all- Pats, oil & laro (iXt~~}} :990 MOIL L:i ~e17t1/RbrAVBi Pllkar ~ Pam Pi}tar nd k @1oCharmirapl Oxvgan Demand (3l< 0al X220 rr w NA Q IVlac~tr~t7tr~i Aeration i carat Strip 3rded Solids (T $S! 9" V Tq ,r 0 NA I hlivnthPY averegs rrls~~arpal el!(s} pratrarsd ~ffltciant CWe}}ty 1=t in~C rnund tpravfay} CI In-Craund tprawwrlsad) 1 Blochornical OxVgan }~t;Mnd (HQGtaf ~ G r3tg/!, f NA A14rade i~ t~>awztd Q G har: Toi"aI ~uaperadad 8r<sl►ds iT~S} d i~ prip~t»iiaa Fetal Cv trM (VaSme rM Mew) S NA t7tr€ar: Y ;n rya, Q NA M Nk Mactmisrn Effluent Particle Siva ¢ - nxhart 0 NA 1 - ~.rthar: °~\Pal4td9'nlPir.B! §ar dc,m©etia wnscswatar and a8pfita "ank ei luorr4• s~r~rt Sara c ; ~ t tad §r~t years) M NA 37 year eg As [barn l NA inspec# *0ndltf~+n of tan'k(e} ct tank V041ms tMhen rorrtWned shtdri ate scorn : >♦eta ars~4tthil'GI iYs1 _ tri Ptttrtp Dolt c~nta§rt8 of tierric(a} , t xn} lM i tr1> tsars} OK A., 1410"t ante saatya Rrtapeat dis~p~rsssi rap{e} ~ .M,..,~p~Yit~} At fa&81: tt ISM&tA Gal .8r'b} G Chan affiuGnt filter NA a ccantrdls eiarm At lr+ast rn+a~ revery. ~ ~ - ~ MA R ~~gpCi {5LS1Y1LYx phi . - i4 iti h i~f Ai; lajjat oncse o mery; lush lassos is and larasauro teat - - -Y- i. ,7.,i; ` MA '1 ~'l'Cr~-1t~S; 1 /•~G. isag, ta{'i'a8 fllr2ry> i;,i 'yrreb~'.si 1NA p, C1Ct19~.~ i N1A6tti1 C" r}h9t >k 4 "C ° CJ11t one of th¢ foliz%virl tieena dr as lPti~l 4Drt~; ~i f1 inspartzons of tYka and dtapar l one s s1i np. sTarda )ay an operatar. Tank indiwiduai ,PUNTS MOINM OUP teatasr i ntzer lyh;tmbar: MM ar Plumber R atrlotae 81ewpxt POW M inspaat ol, rrac~ksA or rnls~ istspeati na moat rariud~? 3ngpse-tian Mrr~unrt ding wd2e an e scam and t%r Aheak.. fraraatnv ha * UP ar pvri> 7g of 'iteaal fl' 80 tual tfGa on htxl"41o!~ ar any P rnaaaura the va!11rt'ca of srDMIn~F lh© dl9pare8i aG11ls} 3'17rsti ~1a UtLllty "tll6pgG8~t~ in fha ak~sariratlan atsrged, er7of 6tlofStr1§it nk thf nn the Eiflllt3 i* grcrut~L! ievsia q srfat a gray 9nrliveta a satltn r~rad'.tCitan arcd requires the of sfi'luant,. an tote ground Wrfacs, The irnmodlat+s nvti te+attecn of tha bars! MIrlawMy authority. y, e the ft aGsiwnre, the ant4re - Of liOsn the Qamhined annum ul3 ton of Sludge and sourrl ;11 ni7y tantt equ ie nri i'trd f~ 4 or ttl s tank shati ba rprnaved by a Semtnga Se lr ing operntor and disposed al In ar-M-dlarins with oftai wr NR 112, ~rsntents of S.~ kMirremai t A.dt~atnlarrar,'~crr, Cade, m fio fibiP a cai ad fti~t4UT ftn a?:arR~ttWi nab : pratre~rtl'sfl't AN ot`lsreritiaae, irt>iuctinl hwfi, rtailYi% m an servicing of aff1werit rari4l~, anti any eervloirrS at! i;,'CSrVai~ t V ~ 8 •s??~*t't» gt~+tnr ta)ttta ,R 4c:r~ttra ramsarl: sh8l; toe taravidad to 2ha tor-al rsgwts'kQrSi eatY!rrtir with-111 'I a tlY~ a rtif crs39111t'A~4i~i1 e, M."