Loading...
HomeMy WebLinkAbout020-1452-11-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 597420 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: Kyle & Angie Hewitt TOWN OF HUDSON 020-1452-11-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 13.29.19.2899 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY B STATION y6 HI FS ELEV. 1 Septic k. 766) Benchmark q. i tst• 00-oe) Dosing Alt. BM Aeration I . Sewed lr 00 Holdin 9t/Ht Inlet §t/Ht Ou e TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f Dt Bottom Sol Dosing '1~' Header/Man. Aeration l OU`G Dist. Pipe 65 Ho~di Bot. System r q PUMP/SIPHON INFORMATION / Final Grade „T tpa-~ Manufacturer Demand St Cover GPM Model Number RAJ d' r .~c3 4. s. r q ~ qq.~ TDH Lift Friction Joss System TDle _ Ft r O ' O n Forcemain Length Dia. Dist. to Well j ~i o~ SOIL ABSORPTION SYSTEM AN. Ckt-4 i- b, a , BED/TRENCH Width Length No. Of Trenche PIT QIMEENSIONS No. Of Pits I ide Dia. Liq 'd Dut epth DIMENSIONS SETBACK SYSTEM TO iL U_/ / BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~c INFORMATION Typ Of CHAMBER OR C. System: A / UNIT Model Number: + DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacir~ Vent to Air Intake / ~ Pipe(s) 5C Length C9 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 Edg~ Topsoil Yes ❑ ~ZYes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 813 DOVE CT / ' - y - W~ C' ►r~ b 1/~3~6~ d 1.) Alt BM Description = 2.) Bldg sewer length = i~ kl '1 - amount of cover = Jam-/ Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Lp 'L L'AYu' ,11 L l5/ SBD-6710 (R.3/97) Date Insepctor's Signa ure Cert. No. r ✓"rlr~: all i r RECEIYE- Safety and Buildings Division County 1 - -A x 201 W. Washington Ave., P.O. Box 7162 S Cr Jul Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) 7 7 z/Z0 r XZPZWJP8y0 State Trans actionNumber In accordance with SPS 383.21 (2), Wis. Adm. Code; stabmissiot , um appropriate governmental unit 'a' 17' is required prior to obtaining a sanitarypermit. Note: Application forms for state-owned POWTS are submitted to Project Add ss (if diff erent th mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 3 0dif. u oses in accordance with the Privacy Law, s. 15.04 1 m Stats. ~~i~VVVV 1. Application Information - Please Print All Information (14ac~ Property Owner's Name Parcel # a~-s Property Owner' Mailing Address / Property Location ac) c) y 013 4Dc)v (111VI / 13. Govt. Lot City, State Zip Code Phone Number V. " Section (circle one 11. Type of Building (check all that aPP1Y) Lot # T _N; R _ E o I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ~V Cb i f) /V U L~ ❑ Public/Commercial -Describe Use Bloc ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z Lj 4-W 6" me CS - Town of IVO &r~zq III. Type of Permit: (Check only one bo on line A. Complete line B if applicable) m A. ❑ New System .Replacement System ❑ Treatment/Holding Tank 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-Date Issued Before Expiration Owner 3i IV. Type of POWTS System/Component/Device: Check all that apply) Non-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)1 7 11 V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate( gp s0 Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation _~q7 ~ 06 I yrtl) ~17, - - K.?- 6?- ?r,~ , VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U U New Tanks Existing Tanks ~w Septic or HQL Q&Z :k 0 e o`~ y Dosing Chamber X" 1V ~ ~ser x VII. jtqsponsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu er' Name (Print Plumber's Signature 44P/MPRS Number Business Phone Number ` X1-,"01/1 Vii, to, Plumber's Address ( trees, City, State, Zip Code) 7 :,1 f , A/ackscl,7 0 /Z" VIII oun /De artment Use Only Approved El Dis ve Permit Fee Date Issued Issuin ent Signature 4~ $ o0 17 ❑ n Reason enial 0Z7 ' 2~ IX. Condig j YWReeeasons for Disapproval 1. 'Senf;<'tark', etfltxsrtt tikeT t~ i <iispe► .tei cell must all be s,?_ips! rn=fita°rec as pef "nagemen! plan p!o liaeh by plumber.. 2. 'JIUI'tlcthegt;lw~ctsrn9 rrtttct-.we 1~tdirti ir:e=i as W npplilaftis c4d* / ,:rdinanow. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x it inches in size SBD-6398 (R. 11/11) Private On-Site Wastewater Treatment System (POWTS) Pg of PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner ccc~/y/C/ lcx/Q T ' ( Q / / ~si( i/a, 1fIZZ) '/d Section T~N, RZ~7__E or W PIN # OCi OVilla e ty, 'Town of ©l X a4 N W E g~ S 3G~1(D ewe!( ~xrs IDaO uJ ,Qd~e, Crxar~ 5 ~y'al~f C ee~s~ gM 1 4- 8 jj()2~ t P_a du1 a Tre ,~I - o V 9g1/eLv, Q ~~3t~ - - - _ - ' -1w 4c 04 erg„ k4 C f Pg of Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: k) y ' ttIn q e le- #F(z) Project Name and System Type: &U./r Location: 13 0c) oe ~L1~7i Street Address Siflr S tic R N GCS Legal Description ownship/County Contents: Page 1:" L ~ ex qe Page 2: P14)PI& J~ Page 3: Ci-sss SP C, 0'! 111A? Page 4: _~jia T~~7 E~~IC~Z Page 5: X_bl P io n7e,71 _rr T~ Page 6: ( alp jE~X TK. le Page 7:,V Cm Gf v;l dphu (ae k f i h I rfi eia~' s )5ca? Page 8: ~CG~1K Cri' S'0 Page 9: -PU M0 ~J Ct~ Attachments:J& 1; )grryiq~ Plumber/Designer: Signed: Date: Number: c~f~~~ Pg of Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner I/a, 4~ 1/4 , Section . V ' T__S~LN, R/~ E or W PIN # OCity, OVillage, Wown of 1 0 l',v o S13 0 d 'J.~.~ J! t~fl+71d~~ o „ /I Qu> rJ~'(~ 1 J 00 0 sf S 7,1 4 lc/e4 i Z rifovt v / SO or~r~,*)cA Pg of Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner Alf x112 ltJl~ '/a , Section cf T~N, RZ~'__E or W PIN # OCitY, Ovillage0 gown of 0010 _4~ c_ //-00 ~v~.~ N Wf' S~ S wett 26y) 0 ~ ~xtS~rh Sf ,9,V, Cr.0r~ 9;000,5411 ,J aru~e ~a~se ~'0 7~~15p1 p~fip CG,~fi~~' j ~U 6 t '1 P~cl out a ~G Tre x 4 I- o 0 Q3 V 41/ c~ cJ 1- or 2- Family Dwelling In-ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ 9 # of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate (DLR) or Soil Application Rate = _a 6- gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF gal/day = DLR a ~3 gpd/ft? _ ft2 # Chambers = Required Distribution cell area ft2 - ft2/ unit EISA = Chambers Chamber Manufacturer and Model: Z2 9- /d► l./o Juac Cs Actual Distribution cell area = Required cell area -R&I W, f ft2/ unit EISA End Cap Pair= ft2 Cross-Section In-ground Soil Absorption System (2-cell): 4" Schedule 40 PVC -vent pipe with vent cap 12 inches minimum 12 inches minimum J -.110.5 inches Soil Cover Trench Sys- I tem Elevation inch Chamber Height 7 7{ rt _i - t e-YjT ','rcnch /System Elevation ~ ft ~-ft Trench Separation Leaching Chamber Width 44 ft to limiting factor O~ . r++"7: r.'r `.-.:•~'•ti r•.: ~ ;,r., . = r•` r r- : F•"r•.':-::`: ~:';'r •'r -:•i:' Plan View In-ground Soil Absorption System (2-Cell): Trench 1 Modify _ft header/ design as yy~~ ft Leaching Chambers needed. i ~ Trench 2 4 inch Header Sch. ~ft with end camps Draw O for a Vent and for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. Page_ of -l-rL f'a9.- of OWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE.INFO'RMATION SYSTEM SPECIFICATIONS Owner ` Sp.tic Tank Capacity ~Q al ❑ NA 14 gn Permit Septic- Tank Manufacturer 0 NA weeks Effluent Filter Manufacturer , ESIGNP~1f{~k11lIETlEFf`S :7 ~ ❑ NA D Ova) Number of Bedrooms - '0 NA Effluent Filter Model' ❑ NA Number of Corr~merclal units NA Pump Tank` Capacity gal 0 NA Estimated flow (average)gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gat/day Pump Manufacturer 2 ❑ NA Soil Application Rate g.al/day/ft2 Pump Model C7 `NA Influent/EffluentQuality Nlonthly average'' Pretreatment Unit NA Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter: Q Peatfilter tland Biochemical Oxygen Demand (OQ'D5) <220 mg/L 0 Mechanical :Ae.ration Ca We ❑ Disinfection Other: Total Suspended Solids (TSS) <150 mg/L Manufacturer Pretreated Effluent Quality XNA Monthly average** Dispersal Cell(s) Biochemical Oxygen Demand (BODB) <30 mg/L X in-ground (gravity) CI In-ground '(pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ At-grade Mound Fecal Coliform (geometric mean) 5104..cfu/1OQml ❑ Drip-line O'Othe.r: IVlaximum Effluent Particle Size Y8 inch diameter Values typical for. domestic;lnon-Commercial)-Wastewetef aril septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Ins" ect condition cif tank(s) At least once every O months Q! year(s) (IViaxiirrum 3 yrs.) Pump out contents of tank(s) When combined sludge-and scum equals one-third ,(Y3) of tank.; volume Inspect dispersal cell(s) At least once every 0 months 0 year(s) (Maximum 3 yrsJ Clean effluent filter At least once every ` ©'>months 14 year(s).: Inspect pump•,,;pump controls & alarm At least once every ❑ months 0 year(s)❑ NA Flush laterals and pressure test At least once every ❑ months: 00 year(s) ❑ NA Other. At least once every ❑ months ❑ year(s): O NA Other: At least once: every ❑ months ❑ year(s) kI NA MAINTENANCE:-iN$TlillOTIONS:.lnspections of tanks and dispersal cells shaft be made by an individual carrying one;of the following licenses or certifications: Master Plumber;"Master Plumber Restricted:Sewe,r POWTS-1nspector; POWTS Maintainer; Septage Servicing Operator. 'Tank inspections must include a :vi'sual lnspect4on 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 s0eface. The dispersal' cell (s) shall be visuallyJas,p.ected to checkthe effluent levels.i.n 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 tank equals one=third or more of the tank volume-, the entire contents of the tank shall be removed by a Septage Servicing Operator•and.dispo:sed of in accordance with ch..NR 113, Wisconsin Administrative Code, The servicing•of effluent filters, mechanical or pressurized. . POWTS components, `pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report`shall ie'provided to the local regulatory authority within 10 days of completion of any service event. STARTUP AND OPERATION: For new construction, prior to use of: the POWT:S check treatment tank(s) for the presence of painti6g.Products-orother, chemicals that may impede the treatment process and/or damage the dispersal cell(s)'. If high conoentrations;are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not. occur when soil conditions are frozen at the infiltrative surface. of Page Duririg power.outages_pump tanks rihayr fill above normal Mghwater levels When power is restored the excess wastewater will be discharged to the dispersal ceKs)>in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation-have the -contents of the pump, tank removed by a:-Septage Servicing. Operator prior to restoring power to the effluent-pump or contact a Plumber`or POWTS Maintainer to assist in manually operating.the pump controls to restore normal levels within the pump tank. Do not<drive. or.park vehicles over tanks and dispersal ci lls 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 performaodd and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain '(sump pump):Water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; ,painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT., When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system "rs properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits 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. • 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. CONTIN - NCY'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: 'f sorpton femay be rn utilize or the location A suitable replacement area-habeen evaluated and and compactonfandesho Id not be'li b ngedt upon ~ system: The replace l~,erst -aFrea `sho,uld be protected structUre wells .;,lot lines area t Rthe eplacement systems replacement by required setbacks from -existing and p s° a evaluation to establish ansui able replFailuacreetomenprotec will result in the need for anew sort and must comply with the rules in effect at that time. GI A .suitable replacement area is not available due to set a replace of sil he faatio POWTS Barring advances in POINTS technology a holding tank may.-;be installed as a last res .ort Uponf-ailure of the and p The site has not been evaluated to identify a suitable ac Ime ment area self no replacement area is a`vai able aiIho ding~tank evaluation must tie performed~to locate a suitable repl may be installed as a last resort.to-replace the failed POWTS. p . and at-grade soil absorption systems maybe. reconstructed in place fol in effect atlthof the at time. Mound a.n g of such systems must comply with.t e rules infiltrative surface. Reconstructions omat at the < < WARNING.> > SEPTIC, PUMP AND. TREATMENT TANKS MaY,CONTAIN. LETHAL LASS RCUMSTANC~S FDEA1'H 1VIAYGEN. TANK UNDER A DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT NY SULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR`IMPOSS1 LE, RE , ADDITIONAL COMMENTS: POINTS MAINTAINER POWTS INSTALLER Name Name Phone.. Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERV CING OPERATO"R:.IPUMPER) Agency en 2 Name (shone / W Phone ~♦~ffc r,f.the Green Lake, Marquette and Waushara County ZoniA g and ~~~ttft~ctfl~geUse of this document tdoestnot Page of wring power nutagespump tanks rriay fill ibover ormal ht.hwater levels When power is restored the excess wastewater will e discharged to. the dispersal •cell(s)=in:.pne-large dose, overloading the cell(s) and may result in the backup or surface discharge f`.effluent. To avoid-thissituation-have the-contents of.the pump-tank removed by a Septage<.Servicing.Operator prior to estoring power to the.:effluerft lod" or contact a Plumber`or POWTS Maintainer to assist in manually operating;the pump ontrols to restore normal levels within the pump ;fank. )o not-drive or.park vehicles over tanks. and dispersal cells Do,not drive 6r park over; or- otherwise' disturb or compact, the area vithin 15 feet down slope bf:any mound or at-grade soil absorption area. ieduction:or .elimine,tion .af thir.foI o.vving ':from the wastewater stream may improve the performance and prolong the life- >f the POWTS: antibiotics; baby wipes; cigarette butts; pandoe; cotton swabs; degreasers; dental floss; diapers; iisinfectants; fat; foundation drain (sump pump):.water; fruit and vegetable peelings; gasoline; grease, herbicides; meat --craps; medications; oil; painting products; pesticides; -sanitary napkins; tampons; and water softener brine. 1BANDONEMENT: When the POWTS `fails and/-or is permanently taken out of service the following steps shall be taken to nsure that the system is-properly and safely abandoned in compliance with ch. Comm 83.33;. Wisconsin Administrative All piping to tanks and pits 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. • After pumping, all tanks and pits shall be excavated and removed or theircovers removed and the void space filled with soil, gravel or another inert solid -material. ONTING-ENCY`OLAN:'rf the POWTS fails and cannot be repaired.the following measures have been, or must be taken, ro provide a. code cpmpliant rePlacement system: A suitable replacement-area has;-been>evaluated and may. be utilized 'for the location of a 'replacement so![--absorption and not-be system. The replac-Urttertt area-sho;uid be protect truure , Jot lines and paction Failure to protect the replacem. ee d arpea structure, by required setbac-ks fr4m existing and proposed vtt.ill:result-•in the need for anew soil and site evaluation to establish .a suitable replacement area. Replacement systems must':.comply with the rules in effect at that time. 0 A suitable replacement:area is not available due to setback and/althe faatio s, Ba Sng advances in POWTS Itechnolag.y a holding tank may..-be. installed as a last resortto replace 0 _ The site has not been evaluated to.=identify a suitable rep lam area. area no replacement the is aWT able all and ng eank mat at the evaluation must tie performed to locate a suitable may be installed es a last resort to-replace the failed POWTS. bf the p Mound and at-grade soil absorption systems maybe rEC.onstructed win ce iPhheoulles in effect atlthat time. infiltrative surface. Reconstructions of such systems must-comply < < WARNING > > P AN©.OTNER.TREATMENT TANKS MAY,CONTAIN.LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. TANcES DO NOT ENTER.A S;EPTIG PUMP OR-OTHER TREATMENT T T~~K MAY BE DIFFICU4TSOR MpOSS1I'3L~ H MAY SEPTIC:, PUM RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A . , ADDITIONAL GOM119MENTS: POWTS. MAINTAINER POWTS INSTALLER . Name Name Rhone.. / Phone SEPTAGE MV1CING:,OPERATa11;(PUMPER) LOCAL RE. ULATORY AUTHORITY S - - f l _ ency 35L Cr'oo if 7 p aa Name Ag P one es. 'Phone documen .it.rhe Green Lake, Marquette and 1Naushata County Zon~ngdY~~Sanitation BgeUse of this.docu enttdoestnot ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/ er Mailing Address 0 ~ a1 CW r t Property Address ,,SGL~ ejV = %3 _o? t?. (Ve 'fication require from Planning & "Zoning Departent for new construction.) City/state Cut' Parcel Identification Number L)Q O /z,5 - Qod LEGAL DESCRIPTION Property Locations '/4'/4 , Sec. T _A_,Q N R W, Town of . Subdivision Plat: Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes ❑ no 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. Uwe, 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 within 30 days of the three year expiration date. Uwe certify that all statements on th' form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a war anty deed recorded in Register of Deeds Office. Number of bedrooms 1/ f /1~7 SIG ATURE OF APPLICANT(S) DATE ***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) 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) located at:,5 t _ 1/4, ,W '/4, Section Town--,,4,~N, Ranged _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 Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service lzy&kl ~l InIV 30-04 & Did flow back occur from absorption system? Yes No X r? (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: )(200 Construction: Prefab Concrete X Steel Other Manufacturer (if known): (,/s Age of Tank (if known): P it number (if known) ~ Vii) t'w 61-a46 - "De iar/l s (Licensed Plumber Signature) (Print Name) 5 J V (Title) (License Number) W/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 Page 1 of 1 W u- PUMP PERFORMANCE CURVE MODEL 98 25 20 : 10 OO 2 5 0 10 20 30 40 50 60 70 80 GALLONS LITERS g0 160 240 FLO N PER hull C~IUTE OC097, https://fdn.gIeapahead.com/rtp/tools/125026-63.gif 7/25/2017 Page 6 of 8 cc w w \-1EAD CAPACITY CURVE "53-55" SERIES 25 TOTAL DYNAMIC I11' D/ FLOW Pf:n MIN f: I:rrt.IICNr Atli) 111' Al I,111N1: APACITY HEAD NIPS/MIN _ 2 6 20 FEET M S "GAL LTRS u 5 ~2 0'- 11 63 10 .05 34 120 1s 4.57 19 72 15 19 s 5.07 0 0 z 4 OELLE/ ZA9- z ~ d' I-•. 2 5 - 0 S 10 20 30 4 50 GALLONS LITERS. 0 80 FLOW PER MINUTE Table 6 FPJCTION LOSS (FOOT/100 FEET) IN PLASTIC PIPE` Flow in Nominal Pi Size G?M 314 1 1.1/4 1.1/ 2 3 4 6 I 2 3 3.24 4 5.32 5 8.34 velocities hl this aru 6 11.68 2.18 aloe below 2 feet per snood 7 15.53 3.83 2 19.29 4.91 9 24.73 6.10 10 30.05 7.41 2.50 11 3544 8.24 2.99 12 42.10 10.39 3.51 13 48.22 12.04 4.07 14 56.00 13.11 4.66 1.92 13 63.62 15.69 5.30 2.11 16 71.69 17.62 5.97 2.46 6.62 2 17 1030 19.72 7A2 3.06 I f 21.99 19 2430 2.21 3 32 20 26.72 9.02 3.72 25 40.38 13.63 5.62 1.39 N 30 56.57 19.10 7.97 1.94 35 25.41 10.46 2.54 40 32.13 13.40 330 45 40.45 16.66 4.11 50 49.15 20.24 4.9.9 12.36 7.00 0.97 60 37.72 9.31 1.29 70 11.91 1.66 to 14.11 2.06 90 velocities in this am 0.62 excw 10 feet per second. which is 18.00 2.30 100 too 8M f" 27.20. 3.71 0.93 125 vviow now rates and 5.30 1.31 ISO pipe diameter 7.05 1.74 175 9,02 2.23 200 13.64 3.36 0.47 150 4.71 0.66 300 6.27 0.87 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer L~ -e%ler- Tank Model Number ) ) Pump Model Number Total Tank Capacity Alarm Manufacturer Max. Bury Depth % Alarm Model Number Switch Type Filter Manufacturer ; Total Dynamic Head (TDH) - Feet Filter Model Number - Elevation Head Distal Pressure - Network Loss - Minimum Pump Performance Required Force Main Loss GPM @ Ft TDH Total yy Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box Finished Grade - Depth of l p Vent Min. Cover Disconnect Ft ~ Above Grade e Means With Vent Cap t t 'S _ Outlet Outlet Filter tY t'i 'S Inlet s---- Inlet Baffle Y - YS> <}< A Switch Settings and Reserve Capacity s>~ 1/4" Tank Volume = GPI Weep <y< B y< Hole Dimension Inches Volume Gal. << t (reserve) A ! <>< , > > (alarm) B 2 Off Elevation L (dose) C M Ft -A - - Bottom t> (dead) D 1_-_- t;{ D 't Elevation > - Total Ft Y t > s I Y Y > > Y ) > Y > > > Y Y I Y I / > ) > > Y ) > ) 1 > "-s s -s-ST-i TZ- 11 < < { < [ S { < i i S t < 'I' < [ [ < S [ [ [ S < t < t < < i t i i t [ [ t t i t'f t < < i C i i S t>i s s > ) > s > > > ) s > s > >[Y<> > I > > > > > s ) s > ) > > s > > Y > > s > J > s > > > s s > > GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of C' C/ Septic-Dose Tank Cross Section And,~ump Performance Specification's Tank Manufacturer e y Pump Manufacturer Tank Model Number Pump Model Number Total Tank Capacity Alarm Manufacturer ~ t- 'Ile i Max. Bury Depth ~ Alarm Model Number Switch Type Filter Manufacturer - Total Dynamic Head (TDH) - Feet Filter Model Number - ffY Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM @ Ft TDH Total _ Z1_!_ Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade „ < 6 Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof 1 Junction Box Finished Cover Grade - Depth of l y Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap > ' Outlet Outlet Filter Inlet Inlet Baffle - - A Switch Settings and Reserve Capacity '/4" Tank Volume = GPI <i< Weep Hole >z~ Dimension r1nches Volume Gal. <>r B (reserve) A i (alarm) B 2 Off Elevation C t (dose) C Ft , Bottom (dead) D D Elevation Total Ft GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of Wisconsin Department r C_ J ► -c~U 1 7 - 7 ry and Professional Services DitFt610ttovvy: R 'EPC3RT cage of > 3 Y9A3B6EA477V0 Jul. ` 1 in accorr _ rte. rcam_ Code County ST. GRC}L~ A ttach com not less than 3 112 x 11 inches in size. Plans must incl~' M nd t3artzontal reference paint (°iN), direction and Parcei f- 1452 - I I - 000 ^Mow imensions, north arrow, and location and distance to nearest road. Please priest all srtfcsrmati¢ Revi by Gate Personal information you provide may be used for secondary purposes {Privacy Lang, s. 15-D4 (1) (m)). Property owner Property Location 1 KYLE I. & CiEEA M. ITT Govt_ Lot Sir 1/4 I`• ' 1/4 13 T ?q N R 19 F (or) NV Property Owner's Wiling Address Lot # Block # ' Subd. Na r CSW 833 move Court 13 Bluebird Meadows City State Z Code Phone Number ity [7Village ■ T own Nearest Road Hudson, wI 54016 ( ) Dove C'om-t New Construction ! ise Residential I Number or bedrooms ~ Code derived design flow rate 450 GPI Replacement Public or commercial - Describe: Parent material sandv ouhvash Flood Plain elevation if applicable - , TMdA ft. General comments Conventional In-firound Trenches - 0.7 loadin rat and recommendations: - g e add pump tank and install trenches at approx. 30" Additional borings required per Ryan Farrington, Zoning Specialist to vary soil conditions for replacement area. Boring # D Boring Pit Ground surface elev. I03.20 ft. Depth to limiting factor cation" Ral'e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfI` in. ldlunsell Qu. Sz- Cont. Color Gr- Sz. Sh- -Efif#1 "Eff#2 1 0-12 10YR72 - s l 2f-msbk ds cs 2vf-co 0-6 0.8 12-24 10YR3/4 - cI rrsfi 2fabk cs I vf=m 4.2 0.3 3 24-56 7.5YR314 - cos Qs dl cs Ivf-rrt 0.7 1.6 4 56-88 7.5YR4/6 s qs tnl 0.7 1.6 one band of 7 54'R3:_, sl that doss not affect water movement somegr. 2 ) Boring # L Boring 103.20 82 F Pit Ground surface elev. - Depth to Grniting facto; in- Soil.plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Cansis nc9 Boundary Boats GPDifI? in- Munseli Qu- Sz. Cont. Color Gr- 5z Sh. *Eff##1 ' Eff#2 -12 10 ` R?l2 A 2f-msbk- ds cs l of-co 0.6 0.8 2 12-26 I{}1'R3i4 - Cl 2fabk mf cs Ivf-tn 0 2 0.3 3 26 -36 7.5314 s&gr (3sg ml as Ivf-m €7 1.6 4 36-38 7.5YR 414 - Cos 4lsg F ~ as Ivf-m 0.7 r 1.5 5 38-53 7.5YR414 - s f)sg n'1 cs Ivf-f 0.7 3.6 6 53-82 7SYR4/6 - s 0-,g dl - 0.7 3.6 ' Effluent #1 = BOO > 30 < 220 mg/1- and TSS > 0 c 150 mg/L ' Effluent #2 = BODS K 30 mglL and TSS 30 mg1L CST Name (Please Print) Si CST Number P~tt~z~Y 3C1 YUPPERT `Holfister`s Sail Testirig&,Desigfti Awn_ ~ 224832 } Address Date Ev It' Lion Conducted Telephone Number 28497 Icing Arthurs Court, Danbury, NA71 54830 R 07- 19 - 2017 725-426-1775 SBD-8330(R07/13) t Property Owner FsLW F TT, I~vie ~~A ngv1a F~araei 0 # 020 - I452 - li - 000 Page of 3 uJiiCltJ,° Bering # Ground surfaceelekt_ Depth to i miffing factor In. Soli ,'ya~~lC?i!On Rate Horizon epti # ~ar~inant Ucrfo, Redox Description T erturs ; Structure Consisten e Boundary , Roots G?Dlt d s ;f_ (43unse4i Cu. Sz. Cont. Color or- Sz. Sh. `E2 rP sii [ 2€'-€nsbk~ rds cs M } 0.8 I G-12 1 . ' ' 2 -'6 t t "I 4 ci I -fable l rnf: cs 1vf-rn E 02 0-, 0-7 j 26-30 IcOs MI t 2'«C 2T%f'Fi2 30-90' 7.5YP3i4 E s Osg nal - IA,f--f 0.7 t 1.6 _i i E Boring (I wring Ground surface elev. €L Depth to limiting g factor in. I Pit SDil Application Rate i 6orizcn Depth j Dorn Enant Color Redox Description Texture ~ Stricture Consisten:.e faourtdary Foots Gr D,ff a on. f i+hursell ~ Qu. Sz cont. Color Gr. Sz. Sig. `"Effi i j 'Ef€#-2 t 4 s ~ l i i s E t Sortng So 9rr g - q Ground surface. elev. ft. Depth to tier€tinrg factor in. Pit Soil Ap 0cation Fate E Horizon Depth j Dominant Caior Fedox Des Tipbon j Te <<ure Structure Consistence Boundary Roots ~ GpDrff f in_ i Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff-t I -Efr#2 t i 1 ~ E ; t 6 ~ E { F 3 ~ 1 l l i t r I ~ I ~ l r ~ EAuen #1 = BOD, > 30 < 220 mgL and TSS >30 < 150 mgrL " Effii.jen #2 = BOD,, < 35 mcVL and TSS < 30 rng/L SBt,- 3:;n(Wfl3 ertp DtivrreF ' I?t'ITT, KVI,. &-~.n~el zs~e 1D # 020 - j452 - 1 000 op Page 3 of 3 37 So ing I r scring # 10 i 210 110 _J r° it Ground surface e ev_ IEL Depth to finking fact; if2. t JDIi A F1iiC?.,i!O!1 ttSic i l"9anZ6r Deptf't %Jam(nan: ~(3iar Red,-R DrSCrtpitL#ri ~ t t'Y,ttlFe ~ Strii.;2u3S f wIIr"SSiSt8r3:^ ~ Boundary Roots G;-D/fIr i ftriunseti Cu. Sz Can'. Go3or ~ u Sz Sig. ~ I { Eff--i ~ 'Eti~2 f P 1 I 0-21-12C 1C, 1.2Z 2 -msbk ds cs 10 0.6 0.8 r cs ` It i-m U_? ~~..J 26-30 0-7 y t 7i !_=ryp.314 - C Ilt l - i A If t. ' 1. Bonng fj 3;:zring # ~ Pft Ground surface elev. _ Horizon Depth Dominant Coin: Fze3ox Desciption Textare j Stricture {E :.onsisterfze{ Eoundar"' i roots GFD,t€ E Munsev Ch.. S cac-rt_ cotor { C,F. ,Sz. 5 t. I ~I i _ffiPi Ef #2 [ f 1 I i E r ` I s t i i t I I ? + l ~ ~ E ` t f Borim- t E ~j &arinc II EE' ~ ~nif Ground surflacWKiev. €t Depth to tirsifing fay r in, Sail r' DPi"Catmn cafe Horan Depth Dorm ant Coin k ax Des=rpf6on i TexiliFe Structure C.ransisten_~ BosndarCF Roots GPDfff f in. Munsell i Qu. Sz. ;;ant_ Color ( Gr. a"'z. Sh. E`i~-` ? Efi,- i I t i f I I Effluerr',I = BOD. > 30 < 220 mWt and TSS >3G < ISO rngCE_ Effiiuert #2 = BOD, <.30 ;ngr~ art- TSS < W Fngf- Plot Plan Page 50f Pr°operty Owner f Legal DeSCr iP lOn Le-4 t; ,l u r rn( (t'JICCept where noted) IHf :,iA y) t i t iF tar ~~t.} -s C - 1-'., 21?AJ Backhoepit p !t (A 05.; z A)~~*.'?... t, 4^ ~ X 1';F+f ~ i 1.) k 4: .1 A, rya r i ,~,,+ta?~-j-,f a North C~ot~oh? ~c~•,~ cvr ~da~ Si~~~ C " a exi, kkoo ssr4e vt ~S/v S Ina e-s Q3 ~ c /0%Q CD ~ v Site .Location ~z~;" ~ ~ JbUT~'"1 rys , 1491 4sconsin bepartment of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8'% x 11 icy in size. Plan must County St. Croix Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimernsions, north arrow, and location and distance to clearest road. Parcel I.D. Pending PleasepfintsHinformation. iewed g ` Date Personal information you prov" may be used for secondary pGrpos¢s (Privacy taw, s.15.04 (1) (m)). b Property Owner Property Location LaCasse Development, Incl. Govt. Lot na SW 1 /4 NW 19 S 13 T 29 N R 19 W 1 Property Owner's Mailing Addre s Lot # Block # Subd. Name or CSM# - 573 Cty Rd "A" 11 na City t ' cLr e.Number -J City _f Village y_J Town Nearest Road A Hudson WI 54016 715-381-5405 Hudson 6 G 0 New Construction Use: 116 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement I Public or commercial - Describe:--- Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 95.30ft. Trenches spaced and depth to code 5.00ft below grade, a Boring # I Boring 16 Pit Ground Surface elev. 100.30_-ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-14 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 14-28 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 28-120 7.5yr4/4 none ms osg ml na na .7 1.6 zr- q` 40 7 3 ~c Fil Boring # I Boring 1/ Pit Ground Surface elev. 100.30 ft. Depth to limiting factor 120 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-16 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 16-26 10yr4/4 none f sicl 2msbk mfr cs na .4 .6 3 6-120 7.5yr4/4 none ms osg ml na na .7 1.6 Q 7~ J Hp A. -~-ti ~I ~S _ i Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <_30 mg/L and T S < 30 /L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 8/20/2004 715-6845680 • Property Owner LaCasse Development, Inc. Parcel ID # Pending - Page 2_of 3 Boring # J Boring j Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 120 in. Soil AOication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots ,Etf#1 rPDM 'Eff#2 In. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 1 0-32 10yt3/1 none Sil 2msbk mfr CS 1f .6 .8 2 3248 10yr4/4 none Sicl 2msbk mfr cs na .4 .6 3 48-120 7.5yr4/4 none SI 2msbk mfr na na .6 1.0 lD ~ Boring # Boring 11 ^-11 J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots `Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. icatiorr Rate Horizon Depth Dominant Odor Redox Description Texture Structure Consistence Boundary Roots in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#i Eff#2 " Effluent #1 = BOD? 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. • Property Owner LaCasse Development , Inc. Parcel ID # Pending Page 2 of 3 Boring # ~j Boring ! Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 120 in. Soil Application Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQffie 'Eif#1 `Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-32 10yr3/1 none sil 2msbk mfr Cs 1f .6 .8 2 3248 10yr4/4 none sicl 2msbk mfr CS na .4 .6 3 48-120 7.5yr4/4 none sl 2msbk mfr na na 6 1.0 ❑ Boring # :.j Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture shwure Consistence Boundary Roots in. -Munsell Qu. Sz. Cont Color QPDr Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # J Boring F-1 Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Application Rate J QPD/ff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Gr. Sz. Sh. 'Eff#1 'Eft#2 in. Munsell Qu. Sz. Cont. Color Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 S-30 mg/L and TSS 30 mgA 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. o ~ ~ y y ~1:5 Y~z °4